16- What form do I fill out Flashcards
According to the Brampton What Form Do I Complete document, What form should an employee complete when injured or suspected to be injured at work?
a. Functional Abilities Form (FAF)
b. Workplace Injury/Illness Report (WIIR)
c. Physical Demands Profile (PDP)
d. Medical Assessment Form (MAF)
B
Workplace Injury/Illness Report (WIIR):
Completed by employee when injured and/or suspected to be injured at work
Direct Supervisor is to be listed as such in report
Direct Supervisor to action report once received
If injury is sustained during a response, at an incident or while returning from an
incident, the Office of the Fire Marshall Incident and Casualty Reporting Manual
requires a CASUALTY REPORT to be completed in addition to the WIIR, this form
is directly completed in CAD
According to the Brampton What Form Do I Complete document, Who is responsible for completing the Workplace Injury/Illness Report (WIIR)?
a. Human Resources
b. Employee
c. Medical Professional
d. Direct Supervisor
B
Workplace Injury/Illness Report (WIIR):
Completed by employee when injured and/or suspected to be injured at work
Direct Supervisor is to be listed as such in report
Direct Supervisor to action report once received
If injury is sustained during a response, at an incident or while returning from an
incident, the Office of the Fire Marshall Incident and Casualty Reporting Manual
requires a CASUALTY REPORT to be completed in addition to the WIIR, this form
is directly completed in CAD
According to the Brampton What Form Do I Complete document, When is a Casualty Report required in addition to the Workplace Injury/Illness Report (WIIR)?
a. For all workplace injuries
b. Only for incidents involving fire
c. When returning to work in a modified capacity
d. If injury occurs during a response, incident, or while returning from an incident
D
Workplace Injury/Illness Report (WIIR):
Completed by employee when injured and/or suspected to be injured at work
Direct Supervisor is to be listed as such in report
Direct Supervisor to action report once received
If injury is sustained during a response, at an incident or while returning from an
incident, the Office of the Fire Marshall Incident and Casualty Reporting Manual
requires a CASUALTY REPORT to be completed in addition to the WIIR, this form
is directly completed in CAD
According to the Brampton What Form Do I Complete document, What is the purpose of the Functional Abilities Form (FAF)?
a. To report property damage
b. To request educational opportunities
c. To detail restrictions after a workplace injury
d. To request modified duties after an off-the-job injury
C
Functional Abilities Form (FAF) (Occupational Injury) (Form 8):
A FAF is to be completed by a medical professional for every Workplace
Injury/Illness Report resulting in lost time and/or medical care
If an employee is requesting to return to work in a modified capacity a FAF is
required from a medical professional detailing the restrictions of the employee
If an employee is not returning to work after a workplace injury, a FAF is required
from a medical professional with a re-assessment date
Should an employee be off for a longer duration from a workplace injury a FAF is
required monthly (every thirty days) after their first medical assessment
If an employee is returning to work in a regular capacity after a workplace injury,
a FAF with no restrictions is required
All FAFs are to be sent to the employee’s PC/DVC
According to the Brampton What Form Do I Complete document, When is the Medical Assessment Form (MAF) required for non-occupational injuries?
a. Every day off from work
b. When absent for three consecutive days or more
c. Only for motor vehicle collisions
d. When returning to work with no restrictions
D
Medical Assessment Form (MAF) (Non-Occupational Injury):
* An employee is to have a MAF completed by a medical professional under the
following criteria;
o Absent from work for three (3) consecutive days or more (Staff Divisions)
and returning to work with no restrictions
o Absent from work for thirty-six (36) consecutive hours or more
(Suppression) and returning to work with no restrictions
o When requesting modified duties after an off the job injury/illness with
restrictions listed
o When returning to full duties after an off the job injury with no restrictions
o When returning to full duties after being on modified duties due to off the
job injury with no restrictions
o When returning to full duties after suffering from chest pains
* Should an employee be off for a longer duration a MAF is required monthly (every
thirty days) after their first medical assessment
* Should an employee be on modified duties for a longer duration a MAF is required
monthly (every thirty days) after their first medical assessment
According to the Brampton What Form Do I Complete document, What is the purpose of the Physical Demands Profile (PDP) document?
a. To report communicable diseases
b. To assist in completing the FAF/MAF
c. To request educational courses
d. To assess property damage
B
Physical Demands Profile (PDP) Document:
Employees should consider bringing this form to their medical professional to assist the medical professional in completing a
FAF/MAF
According to the Brampton What Form Do I Complete document, How often is a MAF required if an employee is off for a longer duration due to a non-occupational injury?
a. Monthly (every 30 days)
b. Quarterly (every 90 days)
c. Annually (every 365 days)
d. Only after the first medical assessment
A
Medical Assessment Form (MAF) (Non-Occupational Injury):
* An employee is to have a MAF completed by a medical professional under the
following criteria;
o Absent from work for three (3) consecutive days or more (Staff Divisions)
and returning to work with no restrictions
o Absent from work for thirty-six (36) consecutive hours or more
(Suppression) and returning to work with no restrictions
According to the Brampton What Form Do I Complete document, Who completes the Designated Officer (DO) forms when an employee reports a potential exposure to a communicable disease?
a. Medical Professional
b. Investigating DO
c. Administrative staff
d. Direct Supervisor
B
Designated Officer (DO) Forms
Completed by the investigating DO when an employee reports a potential exposure
to a communicable disease
The investigating DO shall consult the reporting matrix
The investigating DO is to forward any and all related reports of the communicable
disease report to Administrative staff
According to the Brampton What Form Do I Complete document, What is consulted by the investigating DO when completing the Designated Officer (DO) forms?
a. Educational opportunities
b. Communicable disease report matrix
c. Incident and Casualty Reporting Manual
d. Physical Demands Profile (PDP)
B
Designated Officer (DO) Forms
Completed by the investigating DO when an employee reports a potential exposure
to a communicable disease
The investigating DO shall consult the reporting matrix
The investigating DO is to forward any and all related reports of the communicable
disease report to Administrative staff
According to the Brampton What Form Do I Complete document, When should an employee complete the Development and Educational Courses Approval Form?
a. After completing the educational opportunity
b. Before the educational opportunity
c. Only if the course is related to firefighting
d. Once approved by the Administrative staff
B
Development and Educational Courses Approval Form
An employee is to complete this form prior to the educational opportunity and
forward to their PC/DVC for approval when requesting to participate in an
educational opportunity under Policy 8.04
According to the Brampton What Form Do I Complete document, What form should be completed if an employee is seeking approval for an Ontario Fire College Educational Request?
a. Educational Courses Approval Form
b. Development and Educational Courses Approval Form
c. Continuing Education Form
d. Ontario Fire College Request Form
D
Ontario Fire College Educational Request
Employees are to seek prior approval from their PC/DVC prior to completing this
form
If approved, the employee is to complete the form and forward to the Admin Ast.
of Training
Note: Currently applications for Regional Training Centres (RTC) require approval from
the Deputy of the employees Division.
According to the Brampton What Form Do I Complete document, Who completes the City Property Damage Insurance Incident Report for damaged Corporation property?
a. Apparatus/vehicle driver
b. Administrative staff
c. Investigating DO
d. Supervisor (Captain/Coordinator/Ast DVC)
D
Insurance Incident Report
Completed by the Supervisor (Captain/Coordinator/Ast DVC) for damaged
Corporation property and forwarded to the PC/DVC
Completed by the apparatus/vehicle driver for motor vehicle collisions and
forward to the PC/DVC
According to the Brampton What Form Do I Complete document, What form is completed for motor vehicle collisions by the investigative Non-Union Supervisor?
a. Accident Investigation Report
b. Performance Appraisal
c. Boot Authorization Form
d. Continuing Education Form
A
Accident Investigation Report
Completed for motor vehicle collisions by the investigative Non-Union Supervisor
and forwarded to Administration
According to the Brampton What Form Do I Complete document, What form should an employee complete to request boots?
a. Boot Cleaning Form
b. Boot Authorization Form
c. Boot Reimbursement Form
d. Boot Approval Form
B
Boot Requests:
Employee requests a Boot Authorization Form from the Admin Ast. of A&M
Once received the employee is responsible for completing the form and
forwarding to their PC/DVC for approval
Once approved the employee is permitted to visit the vendor for approved
footwear
Vendor will submit the form to accounts payable at the time of purchase
According to the Brampton What Form Do I Complete document, How often is the Medical and Station Supplies (D11) form completed and submitted?
a. Daily
b. Weekly
c. Monthly
d. On demand
B
Medical and Station Supplies (D11):
Completed and submitted on Wednesdays or as supplies are required
Completed form is emailed to emailgrp_FireSEO@brampton.ca
