Sarpy County

If your position is covered by a Union, please review your Collective Bargaining Agreement for specifics.

Insurance & Safety Forms

Employee Insurance: Change Request Form

     C.D.L. Notification of Traffic Violation   

CDL Operator's Guide (NIRMA)    

Incident/Accident Investigation Checklist

Workers' Compensation: Employee Acknowledgement 

Workers' Compensation: First Report of Alleged Occupational Injury/Illness Report - (Contact Human Resources for filing instructions and Provider Forms)

Significant Exposure Report

Employee Statement / Supervisor's Report

Supervisor's Report

Personal Vehicle Use Waiver Form

Liability Form: contact your department for specifics

Leave Forms

Absence from Office Request Form -- updated (Revised December 2016) 
HIPAA Release Form   
Funeral/Bereavement Leave   (Revised September 2018)
Catastrophic Illness Donation Request  (Revised  February 2018)
Military Leave Request Form

Education Forms ~ Miscellaneous Forms

Educational Reimbursement Application Form  - Classified Employee
Educational Reimbursement Application Form - Unclassified Employee (Attorney ~ Emergency Mgt ~ Department Head/Principal Assistant ~ Elected Official/Chief ~ Sworn Officer ~ Bailiff)
F.O.P. Sworn - Advanced Educational Incentive Request Form

General Employee Complaint Form -- contact HR
Key Card Request Form -- contact HR
Whistleblower Form -- contact HR