Documents & Forms
Employee Forms
Form Name
Fitness Reimbursement
Description
The City will reimburse an employee 50% of your monthly gym membership fee (max reimbursement $25 per month) with proof of membership and proof of 8 gym visits per month.
Link
Name, address, and phone number change
Fill out this form for changing name, address, and phone number.
(Note: documentation of name change will be required)
Vacation pay request
Noncontract employees may request up to 80 hours in vacation pay out each year, as long as they have 40 hours remaining.
2025 Dr. Visit Form
Employees and their spouses on our healthcare plan may receive a $50 gift card, each, if they go to their doctor for a wellness visit. Due by 11/30/25
LabCorp Form
Employees and their spouses on our healthcare plan may receive a $50 gift card each, if they complete biometric screening. This may be done at the doctor, when we offer it onsite, or at a LabCorp location. Due by 11/30/25
Claim Forms
Form Name
Description
Link
Medical Claim Form
This form must be downloaded and mailed to Allied Benefit Systems.
Dental Claim Form
This form must be downloaded and mailed to Allied Benefit Systems.
Vision Claim Form
This form must be downloaded and mailed to Allied Benefit Systems.
Life Change Forms
Changes can only be completed outside of open enrollment when there is a qualifying life event. This includes marriage, divorce, birth or adoption, or spouse’s change in insurance. Notice of a qualifying life event is due within 30 days.
All Life Changes will be made on Employee Navigator.
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Visit the BS&A Self-Service to view and request changes to personal data and to view historical payroll and W-2 information, leave balances, and direct deposits. The guide below will help you get logged in and walk you through the self-service.
Download BS&A Cloud - Employee Self-Service Guide​​
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*if you still have trouble logging in, reach out to HR.
BWC Forms & Damaged Vehicle Form
Form Name
Description
Link
Injury Reporting Packet
These forms are required BWC forms to be filled out by injured employee and the attending physician.
Personal Injury Report
This form is to be filled out by the employee and supervisor and sent to HR.
Witness Statement Form
This form is to be filled out by the witness(es) of the incident, if applicable.
C-55 Salary Continuation
Fill out this form if requested.
BWC Forms & Damaged Vehicle Form
Form Name
Description
Link
Injury Reporting Packet
These forms are required BWC forms to be filled out by injured employee and the attending physician.
Personal Injury Report
This form is to be filled out by the employee and supervisor and sent to HR.
Witness Statement Form
This form is to be filled out by the witness(es) of the incident, if applicable.
C-55 Salary Continuation
Fill out this form if requested.
Damaged Vehicle
Fill out this form for damaged/missing equipment or City Vehicle Accident Report
​Union Contracts
The City of Oxford has four public employee unions.