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This form is for use only by County employees. Please fill out the
online form then print and send with supporting materials via
interoffice mail to the Human Resources Department, 400 S. Fort
Harrison Ave., Clearwater, Attn: Employee Communications.
EMPLOYEE SUGGESTION AWARDS PROGRAM
Suggestion Form
(For HR use only)
Name: _______________________________________________ Title: ________________________________________
Department: _____________________________________________________ Work phone: ______________________
I have read the program guidelines (next page). The Non-Eligibility Rules do not pertain to my suggestion. I hereby
understand, and agree, that the acceptance by me of any monetary award from Pinellas County for this suggestion shall
be deemed payment in full for myself, my heirs, or my assignees. I hereby waive claim or claims against the County which
may arise as a consequence of the County adopting this suggestion.
Signature: ____________________________________________ Date: _____________________
If this is a group suggestion, all other joint suggesters must sign and print their names below:
Signatures
Print names
Before describing your suggestion in detail, please answer the following.
1. Does your suggestion apply to your own department/office? Yes No
If it applies to your work site only, list the site:
If it is applicable also to other work departments/offices/work sites, please list them below:
2. Will your suggestion result in dollar savings to the County? Yes No
If yes, what is your estimate of net savings? $____________________
The savings should pertain to only the first year and deduct all start-up costs such as materials, new purchases
required, etc. You must also provide detailed documentation of how you arrived at your estimate.
3. Has your suggestion already been implemented? Yes No If yes, when? ___________________________
4. Give a brief, non-technical description of your suggestion:
Now, on separate sheets of paper, describe your suggestion in full. Clearly identify the problem prompting your
suggestion, and show in detail how your suggestion will solve the problem. Include sketches, samples, layouts or other
supporting information which will be helpful in understanding your suggestion.
www.pinellascounty.org/hr/suggestion
