EAP Referral | Positive Innovations

Type of referral to EAP:

Informal- The employee is encouraged to contact EAP for advice in identifying strategies in resolving the stated job performance concerns.

Formal-The employee is requested to contact the EAP by (select date below) and comply with the recommendations. The employee is expected to satisfy the on the job improvements that have been identified and their involvement with EAP does not protect the employee from disciplinary action. The employer will receive feedback on appointment and compliance status.

Mandatory-The employee is required to contact the EAP by (select date below) and comply with the recommendations or face further discipline. The employee is expected to satisfy the on the job improvements that have been identified and their involvement with EAP does not protect the employee from disciplinary action. The employer will receive feedback on appointment and compliance status.

I understand that my signature on this form and Disclosure of Health Information is necessary for Positive Innovations to share the following information. The Authorization for Disclosure of Health Information is usually completed during the first meeting with the counselor. In the absence of the forms completed, Positive Innovations cannot share whether you made/ kept an appointment at EAP. The following information can be shared once you sign the release: 1. Date that the employee contacted the EAP. 2. Participation or non-participation in the recommended plan of action. 3. Continuation or discontinuation in recommended plan of action.

Contact Us: 915-301-0174 (Texas)

478-305-7139 (Georgia)

EAP Supervisor Referral