» Independence – New PC/Employee Setup Request

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About
Services
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Independence Admin Portal

Independence - New PC/Employee Setup Request

This form is intended for administrators to request either a new PC setup or a new employee setup.

Step 1 of 4

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Please select the reason for using this form:*
- Request a new PC for an existing employee
- Request new PC and work accounts for a new employee
- Request work accounts (email, PCC, etc.) for a new employee (No new PC)
Existing Employee's Name*
First Last
Please specify:*
New Employee Name:*
First Last
Job Title:*
Start Date for New Employee:*
Is the employee going to be head of a specific department?*
- Yes
- No
What department?*
If the employee is a department head, they will use the email address specifically created for their position (i.e. BOM@stphealth.com).
- Administrator@
- Admissions@
- AP@
- BOM@
- DON@
- DSD@
- Maintenance@
The employee will need access to:*
- Email
- PCC
Will the employee need access to PCC?*
PCC role will be configured on the next page.
- Yes
- No
The employee's email will have the following format:
Jane Doe
jdoe@stphealth.com
PCC role will be configured on the next page.
Is the new employee replacing a current/previous employee?*
- Yes
- No
If Yes, who is the employee being replaced?*
First Last
On what date should the previous employee's email be disabled?
Should the previous employee's email be forwarded to the new user?*
- Yes
- No
Should the previous employee's email history be imported to the new user?*
- Yes
- No
Should the previous employee's email have an auto-reply message enabled?*
- Yes
- No
Does the previous employee know they are being replaced?*
- Yes
- No

Access & Software
Do their user documents need to be backed up from their old PC?*
- Yes
- No
Does the new employee require access to the remote desktop server?
Remote desktop server gives users centralized, secured access to files and resources such as automatic backups of their files and MS Office.
- Yes
- No
- N/A
What is the employee's PCC role?*
We will create the PCC account and assign their specified roles based on their position.
What is their PCC role?*
Programs needed:*
- Adobe Acrobat Reader
- 7-Zip
- Other
- N/A
If other software is needed, please list them below:*
What kind of PC does the employee need?*
- Laptop
- Desktop
Are there any specific system requirements for the PC?*
- Yes
- No
What are the requirements? Please be as detailed as possible.*
(i.e. Hard-drive capacity, RAM capacity, make/model, dual monitors, processor, etc.)
Additional Info:

Printer Setup & Email Signature
Which printer(s) does the employee need?*
- Santa Paula Main Printer
- Personal Office Printer
- Other
- N/A
If other printers are needed, please list their names, model numbers and IP addresses below:*
Example:
Name: Nursing Station 2
Model: Ricoh c3003
IP Address: 192.168.93.127
Personal Office Printer: What is the make and model? Is it connected through USB or through the network? If it's through the network, what is the IP Address?*
Would you like an email signature created for this employee?*
- Yes
- No (User will create their own email signature)
How should their email signature appear?*
(Title? Direct phone line? Fax number? Any special lines/designations? Etc.)
Example:
John Smith
DON
jsmith@stphealth.com
P: 602-433-6300
F: 602-433-6414

Form Completed By:
Your Full Name:*
First Last
Your Email:*
Enter Email Confirm Email
Your Job Title:*
What's the best way to contact you?*
Choose any you prefer.
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #*
Office Phone #*
How should we contact you?*
Name
This field is for validation purposes and should be left unchanged.

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The Vineyards - Access for Existing Employee

This form is intended for administrators requesting access for an existing employee.

Employee's Name:*
First Last
What access is needed for this employee?*
- Email
- PCC
- Other
Does this employee have an existing PCC account?*
- Yes
- No
Would you like a PCC account created for this employee?*
- Yes
- No
If yes, please select their position:*
We will create the PCC account and assign their specified roles based on their position.
Please name their title/position:*
If yes, what changes are needed to their account?*
- Need to add assigned roles for employee
- Need to grant employee access to another facility
A PCC account will not be created for this employee.
Whose PCC roles should we mirror for this employee?*
Please name another employee who already has the right PCC roles so we can copy those roles to the account.
First Last
Which facility is needed for this employee?*
Please tell us what access the employee needs:*
Which printer(s) does the employee need? (if any)
- Dietary Printer - RICOH MP c3003
- Main Office Copy Room
- Personal Office Printer
- WorkCentre 5755
- Xerox 7855
- Xerox 7556
- Other
If other printers are needed, please list their model numbers and their corresponding IP addresses below:*
Personal Office Printer: What is the make and model? Is it connected through USB or through the network? If it's through the network, what is the IP Address?*
Additional Info:
Your Name:*
First Last
What's the best way to contact you?*
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #:*
Office Phone #:*
How should we contact you?*
Phone
This field is for validation purposes and should be left unchanged.

The Vineyards User Separation Request

This form is intended for administrators to notify us of an employee termination.

Terminated Employee's Name:*
First Last
What date will the employee be terminated?*
Should we archive/back up their data?*
- Email
- User Documents
- Other
Additional Info:
Your Name:*
First Last
What's the best way to contact you?
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #:*
Office Phone #:*
How should we contact you?*
Comments
This field is for validation purposes and should be left unchanged.

The Vineyards - Printer Access Request

This form is intended for employees to request printers to be added to their PCs.

What printer(s) do you need to be added to your PC?*
- Dietary Printer - Ricoh MP c3003
- Main Office Copy Room
- Personal Office Printer
- WorkCentre 5755
- Xerox 7855
- Other
If other printers are needed, please list their model numbers and IP addresses below:*
Personal Office Printer: What is the make and model? Is it connected through USB or through the network? If it's through the network, what is the IP Address?*
Your Name*
First Last
What's the best way to contact you?*
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #:*
Office Phone #:*
How should we contact you?*
Phone
This field is for validation purposes and should be left unchanged.

The Vineyards - Submit Ticket

Your Name:*
First Last
Your Email:*
Enter Email Confirm Email
What is your expected response time for this issue?*
- Standard SLA (3 business days or fewer)
- Tomorrow (within next business day)
- Immediately
Our standard Service Level Agreement (SLA) for tickets is 3 days.*
To help us understand and escalate the importance of the issue you're experiencing, please describe the business impact that the issue is causing.
Selecting this option means that you believe this issue out-prioritizes all other known issues and must be addressed immediately.*
Upon submission of this form, a technician will be contacting you soon. For expedited service, please call us at 661-636-0290 after the form is submitted.
Cell Phone #:*
What do you need help with?*
- Email
- Forgot/reset password for Email, PCC, etc.
- Hardware
- Internet/WiFi
- PCC
- Printer/Fax
- Software
- Terminal Server
- Other
Please list the software/application: (ex. Microsoft Word, Dynamics, Google Chrome, etc.)*
What password do you need to be reset?*
- Email
- Local PC
- PCC
- Terminal Server (Great Plains)
Employee ID/Badge # (if known):
Username:*
Email Password Reset*
Enter Email Confirm Email
Please specify the issue:*
- Can't send/receive emails
- Outlook Setup
- Report suspicious email
Please specify the issue:*
- Slow/unstable connection
- No connection
Please specify the issue:*
- Need access/role
What specific role(s) do they need?*
Please describe the role. If possible, please list an employee that already has the desired role so we can copy it over.
Please specify the issue:*
- Printer is not connected to PC
- Documents printing in improper format
- Can't send/receive faxes
Please describe the issue:*
Additional Information:
Upload Attachments (if any):
Attach screenshots/images so we can better understand your request.
Drop files here or

Accepted file types: jpg, png.
Upon submission, this request will be sent to your Executive Director/Administrator for approval.
What's the best way to contact you?*
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #:*
Office Phone #:*
How should we contact you?*
Name
This field is for validation purposes and should be left unchanged.

The Vineyards - New Employee setup

Is this person coming from another facility?*
- Yes
- No
Please use the "Moving Facilities" request form found on The Vineyards Admin Portal
What is the new employees name?*
First Last
What will this person's position/job title be?*
When is their first day?*
What access do they need?*
- Email
- Domain/Computer Login
- PCC
- Other not listed
Please specify:*
PCC Facility Access
Which Facilities?*
- Select All
- Vineyards
- Amberwood Gardens
- Avondale Villa
- Clearwater Stockton
- Corporate
- Lodi Creek Post Acute
- Milan Villa
- Redwoods Post Acute
- RiverPointe
- Stratford VIlla
- The Orchards Post-Acute
- The Ridge Post-Acute
- Tuscany Villa
- Westgate Villa
Username or Name of user to copy roles from:*
Do they need remote access?*
- Yes
- No
Form Completed By:
Your Full Name:*
First Last
Section Break for "Your email"
Your Email
Section Break for Contact
What's the best way to contact you?*
- Cell Phone #
- Office Phone #
- Email
- Other
Section Break for Cell phone
Cell Phone #*
Section Break for Office phone
Office Phone #*
Section Break for Other
How should we contact you?*
Replacing Existing Employee?
Is the new employee replacing a current employee?*
- Yes
- No
Section Break for replacing a current employee = "yes"
You have indicated that an employee is being replaced, to avoid ongoing charges for email we recommend completing the "Employee Separation Form". Click "Yes" below to be taken to the "Employee Separation Form" once you have completed this request.
Would you like to be automatically taken to the "Employee Separation Form" upon completing this request?*
- Yes
- No
Phone
This field is for validation purposes and should be left unchanged.

The Vineyards - Employee Moving Facilities

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- First Choice
- Second Choice
- Third Choice
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The Vineyards - User Separation Request

This form is intended for administrators to notify us of an employee termination.

You have been automatically directed to the Employee Separation form per your request.
Terminated Employee's Name:*
First Last
Terminated Employee's Email:*
Enter Email Confirm Email
What date will the employee be terminated?*
Should we archive/back up their data?*
- Email
- User Documents
- Other
Additional Info:
Your Name:*
First Last
Your Email:*
Enter Email Confirm Email
What's the best way to contact you?
- Cell Phone #
- Office Phone #
- Email
- Other
Cell Phone #:*
Office Phone #:*
How should we contact you?*
Email
This field is for validation purposes and should be left unchanged.