HTML Preview Employee Suggestion Submission Form page number 1.
(Provide details. Attach additional pages, sketches, or samples to clarify. Include steps for implementation of suggestion.)
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EMPLOYEE SUGGESTION PROGRAM SUBMISSION FORM
SUGGESTION NUMBER
TO GIVE YOUR SUGGESTION EVERY CONSIDERATION, PLEASE REVIEW THE INSTRUCTIONS ON THE BACK SIDE OF THIS FORM. PLEASE COMPLETE THE ENTIRE FORM.
MAKE A COPY OF YOUR COMPLETED FORM FOR YOUR RECORDS AND SEND THE ORIGINAL TO THE HUMAN RESOURCES DEPARTMENT – HR CENTER, 135 N. 2ND AVENUE.
A SUGGESTION NUMBER WILL BE ASSIGNED UPON RECEIPT AND SENT TO YOU. IF YOU HAVE ANY QUESTIONS, PLEASE CALL 602-262-6608.
(Please Print or Type)
________________________________________________________ ________________________________ __________________
NAME JOB TITLE EMPLOYEE ID NUMBER
___________________________________ ___________________________________ ____________________________________
DEPARTMENT DIVISION / SECTION OFFICE PHONE NUMBER
____________________________________ _________________________________________________________________________
HOME PHONE NUMBER TITLE OF SUGGESTION
_______________________________________________________________________________________________________________
WHICH DEPARTMENT(S) IS AFFECTED BY YOUR SUGGESTION?
________________________________________________________ ____________________________________________________
SIGNATURE (Suggestion not accepted if unsigned) DATE SUBMITTED
Check this box if two or more employees have collaborated on this suggestion and attach all names, job titles, employee ID
numbers, and signatures.
How did you hear about the Employee Suggestion Program?
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Intranet
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City Employee
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Department Presentation
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Other _________________________________________________
DESCRIBE THE PROBLEM, CURRENT METHOD, OR PROCEDURE
YOUR PROPOSED SOLUTION
SAVINGS INFORMATION
Check the box that describes your suggestion’s savings, if any. For tangible savings, attach documentation to clarify/support
the first year’s annual savings/cost avoidance figures.
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TANGIBLE: A definite dollar value can be determined. Please provide
annual cost of suggested method which should include labor,
materials, implementation costs, operation, maintenance, etc. Attach
additional pages documenting your first year’s annual savings
and/or cost avoidance figures.
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INTANGIBLE: This suggestion involves improvements in working conditions,
changes in procedures, revisions of forms, or employee health, or safety.
Measurable cost savings or cost avoidance cannot be precisely determined.
First Year’s Annual
Savings / Cost Avoidance / Revenue Generated
Cost of current method ____________
Less cost of proposed method – ____________
Annual Savings/Cost Avoidance/ ____________
Revenue Generated
150-27D Rev. 4/12
PERSONAL INFORMATION
A.
B.
C.
D.
HUMAN RESOURCES DEPARTMENT
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