Opportunity and Innovation Form

EAC/AVI

O pportunity and Innovation Form

Contact Information
Full Name:	     					     					     
Last						First					M.I.
Division:	     										     
Work Address:	     										Employee #
Street Address
Work Phone:	(   )      			Alternate Phone:					(   )      
E-mail Address:		     
Have you discussed this opportunity and innovation with your supervisor and/or manager? □ Yes □ No
Type of Opportunity and Innovation
□ Process/Opportunity for Improvement □ Ideas and Innovations □ Question or concern □ Other
Describe the issue, activity, process, or service: Suggest actions needed to improve: List the benefits of the actions:
To be filled in by Opportunity and Innovation Form Panel
Date Received:	     		Submitted by:		□ EAC/UMS Rep □ Email □ Suggestion Box □ Web
Forward form to: □ UMS Rep to assess opportunities for continual improvement including preventative and corrective actions □ Employee Advisory Council □ Human Resources □ Unknown (send to Director)
Assigned to:	     		Target Date:					     
Action Taken:	     
Results of Action Taken:	     
Approved by:	     		Date Resolved:				     
Record #:	     		Was the employee contacted with response?							□ Yes □ No

If this is a personnel issue please contact your AVI Human Resources Generalist

Document Number:AVI-FRM-EAC1 Eff. Date: 06/16/11 Revision Number: 1

Approved by: EAC Desc. Of Change: Initial Release