Personnel Action Form
Print Employee Name:
Personnel Number (P#):
Rig/Dept./Location:
Address Change
Position:
1st 5 #S of SSN
Date:
New Phone No.
New Address:
City:
Promotion/Demotion
State:
Date:
Zip:
From (Position):
To (Position):
New Pay Rate (if applicable):
Transfer Information
Date:
From Rig/Location:
To Rig/Location:
From (Position):
To (Position):
New Pay Rate (if applicable):
Disciplinary Action
Date:
Type of Warning:
Verbal
Written
Reason:
Suspension
From Date:
To Date:
More than 30 days requires SVP Approval _______
Reason:
Authorization to Return from Suspension
Termination
Return Date:
Position:
Term Date:
Rig/Dept.:
Method (verbal,phone,etc):
Termed By (Print Name):
Eligible for Rehire? YES
Title:
NO
Date:
Lay-off. Reason for Layoff:
Voluntary quit. Date of Notice:
Reason (refer to back for guidance):
Discharged. Specify Reason & Detail Required (refer to back for guidance):
Workers' Comp. Injury
Date of Occurrence:
Estimated Absence:
Less than 1 week
First Full Day Away from Work:
Less than 1 month
First Full Day Returning to Work:
More than 1 month
(Submit all required paperwork to WC)
Leave of Absence
Start Date:
Anticipated Length of Leave (# of Days):
Medical Leave (Non-work related - personal or family):
Military Leave
Personal Leave
(Type of Military Leave)
Reason:
Requests for 30 days or more of PERSONAL LEAVE requires SVP Approval
Authorization to Return from Leave
Return Date:
Rig/Dept.: __________
Verified employee has completed Fit for Duty
(Submit all required paperwork to Benefits)
Print Supervisor/Manager Name:
Title:
Supervisor/Manager Signature:
Date:
Print Employee Name:
Employee Signature:
Date:
Office Signature:
Date:
Email completed forms to HRUSD@ensignenergy.com
1/17/2014
REASONS FOR SUSPENSION/TERMINATION
THIS LIST DOES NOT INCLUDE ALL MISCONDUCT THAT COULD RESULT IN
SUSPENSION OR TERMINATION.
BE SPECIFIC ON THE FRONT OF THIS FORM
Violation of DO NOT LIST
First offense: Suspension or termination depending on circumstances
Second Offense: Termination no rehire
Consequences apply to:
Anyone who breaks any of the rules or anyone who approves anyone breaking the
rules, or Supervisor who witnesses a rule being broken and does not take action.
1. Operation Safety:
a) Refer to the Do Not List for specific violation and specify on front of this form under
Suspension or Termination section, as applicable.
2. Falsifying Records
a) Show people on payroll sheet who were not working or let anyone sign-off for another person.
b) Enter any false information on drilling report books such as surveys, BOP pressure tests, Social Security
numbers, payroll time, etc.
3. Workers Compensation
a) Fail to report and record all injuries immediately or upon first learning of the injury (or potential for an injury
being Workers Comp. related).
Violation of other Company Policies
First Offense: Termination
Second Offense: Termination No Rehire
4. Contraband
a) Allow or be in possession of intoxicating beverages, illegal drugs, or firearms at any rig location, yard or shop,
or in any camp.
b) Work under the influence of intoxicating beverages or illegal drugs, or work under prescription medication that
could impair the ability to perform work safely.
st
c) Failure to pass a Drug Test (1 failure can reapply after 365 days).
Supervisor Discretion: Suspension or Termination
5. Other reasons be specific on the Personnel Action Form
a) Other violations of Company directives, policies, or procedures of a seriousness that warrants suspension or
termination. (EXPLAIN ON FRONT)
b) Performance. (EXPLAIN ON FRONT)
c) Management decision based on circumstances. (EXPLAIN ON FRONT)
Notes:
Contact Benefits at BenefitsUSD@ensignenergy.com for all Leave of Absence Requests and Return
from Leave Requests.
Once an individual has been put on the Do Not Rehire list, the Senior Vice President, Operations must
approve any removal from that list.
Any deviation from the above actions requires approval of the Senior Vice President, Operations.
VOLUNTARY QUIT
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
Resigned, other position
Resignation
Return to School
Quit-no notice
No show
Walk off
Retired
Military Service (This may be LOA check with benefits)
Unsatisfactory performance (Detail must be provided)
Deceased
Failed drug test
Other DETAILED EXPLINATION ON FRONT IS REQUIRED
