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PERSONNEL PROCEDURES FOR UC IRVINE STAFF MEMBERS


SEPARATION ACTIONS
Procedure 66: Medical Separation


Responsible Office:
Human Resources
Issued: November 2002

A. References


B. Authority and Responsibility

The department head is responsible for taking and/or approving any Medical Separation action. Consultation with Human Resources (Human Resources Consultant and Disability and Rehabilitation Consultant) is required prior to taking any action.


C. Guidelines


D. Procedure


E. Applicability

All staff members, except employees who are in a bargaining unit that has an exclusive representative (union) and are covered by the applicable provisions of the collective bargaining agreement.


Procedure 66: EXHIBIT A

Sample Written Notice of Intent to Medically Separate

Date

Name
Title

RE: Written Notice of Intent to Medically Separate

In accordance with Personnel Policies for UC Staff Members, Policy 66, Medical Separation, this is to inform you that effective (at least 18 calendar days from date of issuance), I intend to Medically Separate you from your position of (state position title), in the Department of (state department name).

This action is being taken as a result of (state the reason(s) for the medical separation).

You have the right to respond to me orally or in writing on or before 8 calendar days with reasons why this action should not be taken. You have the right to representation in presenting your response.

Supervisor

c: Department Head
Human Resources Consultant
Disability and Rehabilitation Consultant

Attachments:
Medical Separation Review Request
(Documentation as appropriate)
Proof of Service dated _______________


Procedure 66: EXHIBIT B

Sample Written Notice of Medical Separation

Date

Name
Title

RE: Written Notice of Medical Separation

After careful review of the information you provided me on (date), in your response to the Notice of Intent to Medically Separate, I find no basis to rescind the intended action. Therefore, effective (date), you will be medically separated from your position with (Department).

Please contact_______________, Benefits Representative, at 824-____ to discuss the important options available to you regarding your benefits.

You have the right to request a review of this action under Personnel Policies for UC Staff Members, Policy 70, Complaint Resolution.

Supervisor

c: Department Head
Human Resources Consultant
Benefits Representative
Disability and Rehabilitation Consultant

Attachment: Proof of Service dated _______________


Procedure 66: EXHIBIT C

Sample Proof of Service: Personal Delivery

PROOF OF SERVICE

Personal Delivery

I declare that I am over the age of eighteen years and am not a party to the action described in the attached notice. My work address is University of California, Irvine, Department/Unit Name, Room Number + Building Name + Zot Code, Irvine, California, 92697-Zot Code. On date, I personally delivered the attached (Written Notice of Intent to __________ or Written Notice of __________) to:

(Name of Recipient)
(Location)

I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on (date) at Irvine, California.

Signature
Name Typed Here


Procedure 66: EXHIBIT D

Sample Proof of Service: Delivery by U.S. Mail

PROOF OF SERVICE

Delivery by U. S. Mail

I declare that I am over the age of eighteen years and am not a party to the action described in the attached notice. My work address is University of California, Irvine, Department/Unit Name, Room Number + Building Name + Zot Code, Irvine, California, 92697-Zot Code. On (date), I served the attached (Written Notice of Intent to __________ or Written Notice of __________) by placing a true copy enclosed in a sealed envelope with postage fully paid in the United States mail, addressed as follows:

(Name of Recipient)
(Street Address)
(City, State, Zip Code)

I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on (date) at Irvine, California.

Signature
Name Typed Here



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