:---------------------------------------SAMPLE------------------------------------------------
Gender Transition Plan and Agreement
The employee formerly known as _____________________ (current name) has notified the_______________________ (company name) that he/she intends to or has started transition from their birth gender to that of their gender identity and use the name of ________________
(new gender appropriate name). This plan and agreement outlines the actions to be taken to ensure that this transition is successful and non-disruptive to the working environment.
1.
Timeline: _____________________ (current Name) has notified the company that he/she will start living in their new gender role on or about_________________. This plan begins on______________and will be in effect for____________ months ending on__________ unless the transitioning employee completes their transition sooner. Completion is considered when the employees' gender marker is changed with the Social Security Administration.
Timeline: _____________________ (current Name) has notified the company that he/she will start living in their new gender role on or about_________________. This plan begins on______________and will be in effect for____________ months ending on__________ unless the transitioning employee completes their transition sooner. Completion is considered when the employees' gender marker is changed with the Social Security Administration.2.Dress Code: It is expected that____________________ (new name) will adhere to the dress code that is appropriate for their new gender and to the company dress code that is appropriate for the conduct of company business.
Dress Code: It is expected that____________________ (new name) will adhere to the dress code that is appropriate for their new gender and to the company dress code that is appropriate for the conduct of company business.3.Medical Protocols: It is expected that________________(new name) will follow the
Medical Protocols: It is expected that________________(new name) will follow thePrescribed medical protocols for gender transition and will follow company processes in regards to medical leaves of absence, etc. All matters related to medical care and processes shall follow ________________(company name) policy and protocols, including privacy, disclosure of information, leaves of absence, etc. Other than the fact of gender transition, the signatories to this plan will not discuss medical condition or medical procedures with co-workers, customers, or suppliers.
4.Company Records: ______________________(current name) employment records will be adjusted to reflect the new name of______________________ on or about___________ with the exception of Social Security Number related records unless the transitioning employee has proceeded and obtained a revised SSN card reflecting their new gender name. All company identification such as identity badges, e-mail, computer accounts, etc will be adjusted on or by ___________. (Check current IRS and SSN regulations)
Company Records: ______________________(current name) employment records will be adjusted to reflect the new name of______________________ on or about___________ with the exception of Social Security Number related records unless the transitioning employee has proceeded and obtained a revised SSN card reflecting their new gender name. All company identification such as identity badges, e-mail, computer accounts, etc will be adjusted on or by ___________. (Check current IRS and SSN regulations)5.Facilities Use: It is agreed that___________________ (new name) will begin using the __________(male/female) restrooms on__________. _________________(new name) agrees to use these facilities only when dressed in a way that is appropriate to their transitioning gender.
Facilities Use: It is agreed that___________________ (new name) will begin using the __________(male/female) restrooms on__________. _________________(new name) agrees to use these facilities only when dressed in a way that is appropriate to their transitioning gender.6.Interpersonal Relationships and Conduct Of Company business:
Interpersonal Relationships and Conduct Of Company business:It is agreed that_________________(current name) is now known by________________ (new name). Proper personal pronouns (he, she, her and him) shall be used in addressing ______________. It is assumed that there may be unintentional mistakes in proper pronoun use by co-workers from time to time. Such mistakes in pronoun use should become less frequent over time. It is agreed that such mistakes will addressed with courtesy and diplomacy. If after a reasonable time period or such mistakes appear intentional __________________ shall notify the Transition Focal, HR or their supervisor who will then work to investigate the matter and take appropriate action.
7.Informing Those in Frequent Workplace Contact: It is agreed that an informational session will be scheduled for all co-workers that_________________ interacts with on a daily basis and all others within the general work area. The purpose of this meeting or these sessions is to inform those employees of the expected norms of conduct per company anti-discrimination policy and to allow for questions and concerns to be addressed. Except for the fact of transition, medical privacy will be maintained.
Informing Those in Frequent Workplace Contact: It is agreed that an informational session will be scheduled for all co-workers that_________________ interacts with on a daily basis and all others within the general work area. The purpose of this meeting or these sessions is to inform those employees of the expected norms of conduct per company anti-discrimination policy and to allow for questions and concerns to be addressed. Except for the fact of transition, medical privacy will be maintained.8.Complaint Process: Any concerns or complaints from any source regardng this transition shall be referred to the Transition Focal or HR and not to________________. (Transitioning individual)
Complaint Process: Any concerns or complaints from any source regardng this transition shall be referred to the Transition Focal or HR and not to________________. (Transitioning individual)9.Amendment Process: If_____________________ or the company signatories feel that this plan needs amendment or change, a request to do so may be made in writing, stating the specific changes to be requested and the reason for them, by any party. Submittal shall be made to the Transition Focal who facilitate the process of amending this plan if the requested changes are valid. A typical required change would be such as a legal name change documentation from the old name to the new gender specific name.
Amendment Process: If_____________________ or the company signatories feel that this plan needs amendment or change, a request to do so may be made in writing, stating the specific changes to be requested and the reason for them, by any party. Submittal shall be made to the Transition Focal who facilitate the process of amending this plan if the requested changes are valid. A typical required change would be such as a legal name change documentation from the old name to the new gender specific name._______________________________________________________
___________________Transitioning EmployeeDate
Date____________________________________________________Note: The Transition Focal may be the HR representive or
________________Note: The Transition Focal may be the HR representive orFocal Date another designated indivdual if decided to use this option.
Date another designated indivdual if decided to use this option. ________________________________________________________
____________________Human Resources Representative Date
Date________________________________________________________
____________________Supervisory Manager Date
Date----------------------------------------SAMPLE-----------------------------------------------
