5013 - Reporting On The Job Injury Or Illness Flashcards
Who shall be responsible for ensuring a safe and health work environment for all TFD personnel.
The Fire Chief or his/her designee.
Who shall be responsible for:
- Coordinating with the City’s Risk Management personnel on all worker’s compensation issues related to TFD employees injured on the job
- Managing all transitional assignment and return to work issues for TFD employees
The Deputy Chief of Support Services
Who shall be responsible for:
- Investigating reported injuries and illnesses as required
- Reviewing and tracking all injuries
- Monitoring injury and illness trends and reporting on them to the Fire Chief
- Reviewing injuries and illnesses on a case by case basis with the TFD Safety Committee
- Maintaining this document
The Administrative Battalion Chief for Safety
Who shall be responsible for:
- Making LEOFF 2 OJI packets, LEOFF I OJI forms and exposure packets available in his/her station
- Ordering additional forms and packets as necessary
- Ensuring that OSHA Form 300A is posted as required
Station Captains
Who shall be responsible for receiving and processing employee paperwork related to reports of on-the-job injury and/or illness.
The Financial Assistant for Payroll at Fire Headquarters
When were LEOFF II Personnel hired?.
on or after October 1, 1977
TFD personnel shall report the following by when to his/her supervisor
a. An occupational accident that causes injury or illness
b. An illness apparently caused by an occupational exposure
before the end of his/her duty period, but no later than twenty-four (24) hours after the incident:
- If symptoms are not apparent at the time of the incident, the employee shall report the symptoms within how long?
forty-eight (48) hours after becoming aware of the injury or illness
The Financial Assistant for Payroll shall maintain records of all reported on- the-job injuries and illnesses, including
a. Every occupational death
b. Each injury that involves one of the following–
i. Unconsciousness
ii. Inability to perform all phases of regular duty-related assignment
iii. Inability to work full-time on duty
iv. Transitional assignment v. Medical treatment beyond first-aid
The TFD Safety Office shall post an annual summary of occupational injuries and illnesses on the safety bulletin board at each TFD station and facility.
The summary shall include:
a. The totals from OSHA Form 300A b. Calendar year covered c. Company and establishment name d. Certification signature, title and date
When shall The summary shall be completed and posted?
no later than February 1 each calendar year and shall remain in place until March 1 of the same calendar year.
LEOFF 1, LEOFF 2 and Civilian Employees OJIBWA reporting procedure:
- Notify your supervisor.
- Refer to other TFD policies that may contain additional reporting requirements related the circumstance of your injury or illness.
a. If the OJI involves an exposure to bloodborne pathogens follow the procedures set forth in TFD Policy 3505 - Fill out HRE 002 with your supervisor.
- Route the completed HRE 002 to the Financial Assistant for Payroll at Fire Headquarters.
Supervisor responsibilities for OJI:
- Refer to other TFD policies that may contain additional reporting requirements related to the circumstances of the employee’s reported OJI.
a. If the OJI involves an exposure to bloodborne pathogens follow the procedures set forth in TFD Policy 3505 - Note the time and circumstances of the employee’s OJI in the company’s daybook.
- Fill out HRE 002 with the employee.
- Route the completed HRE 002 is routed to the Payroll Clerk at Fire Headquarters.
- If the OJI was sustained during an emergency incident, enter the appropriate information into the Incident Reporting System.
- If the OJI generated a medical incident, ensure that an EMIR is completed.
LEOFF 2 and Civilian Employees procedures for time off and medical treatment for OJI:
- If you take time off from work as a result of the injury or illness: a. Operations personnel call the sick line recorder (591-KISS) b. Non-operations personnel call your supervisor
- Obtain an OJI packet containing the required forms and detailed instructions.
- Make arrangements to be seen by your Health Care Provider (HCP) as soon as possible.
- When you see your HCP for your injury or illness inform your HCP that your employer is self-insured.
- Ask your HCP to:
a. Complete “Physician’s Initial Report”
b. Send all medical bills to the Workers Compensation Third Party Administrator as identified on the report - If applicable, ask your HCP to also:
a. Fill out the Medical Fitness Report
b. Submit it to the Financial Assistant for Payroll at TFD Headquarters - Complete SIF-2 and route it to the Financial Assistant for Payroll at TFD Headquarters.
- Keep the Deputy Chief of Support Services informed on the current status of your OJI and return to work status.
LEOFF 1 Personnel procedures for time off and medical treatment from OJI:
- If you are assigned to Operations, leave a message on the sick leave recorder (591-KISS).
- If you are not assigned to Operations, call your supervisor.
- Complete PER 879.
a. Note the date of the OJI in the “reasons” section
b. If you will be off work for an extended period, leave the “days/hours” section and the “ending date” blank.
c. Do not wait until you return to work to submit this form - Route the PER 879 the Financial Assistant for Payroll at TFD Headquarters.
- Complete FIR 139
a. Fill out the employee’s part of the “Verification of On-the-Job Injury” section
b. Have your doctor (M.D. or D.O. only) complete and sign the physician’s part of the “Verification of On-the-Job Injury” section - Route the completed FIR 139 to the Financial Assistant for Payroll at TFD Headquarters.
