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Employee Assistance Plan Template

Employee Assistance Plan Template

The Employee Assistance Plan is a fillable form used to document employee access to wellness and support services, including counseling, mental health assistance, stress management resources and crisis support. It includes sections for service requests, confidentiality acknowledgment and follow-up actions.

Originally published by luminpdf.com

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Employee Assistance Plan form with sections for support services, reasons for request, confidentiality acknowledgment and signatures

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Employee Assistance Plan form with sections for support services, reasons for request, confidentiality acknowledgment and signatures page 0

Employee Assistance Plan form with sections for support services, reasons for request, confidentiality acknowledgment and signatures page 1

Employee Assistance Plan form with sections for support services, reasons for request, confidentiality acknowledgment and signatures page 2

Used 137 times

Frequently asked questions

The Employee Assistance Plan is a form used to request and document access to support services such as counseling, mental health assistance and crisis response. It includes fields for identifying the type of support needed, recording action plans and capturing employee consent regarding confidentiality. The completed form helps employers coordinate wellness resources while maintaining appropriate documentation for follow-up and support.
The employee and the designated HR or EAP representative complete the form together during a support request.
Submit the form to HR or the assigned EAP coordinator for confidential handling and documentation.

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