916 – Workers’ Compensation

Question 1

Members who are disabled in any way due to an occupational injury/disease and, due to the impairment, are unable to perform any assigned duty will notify a supervisor of such occurrence as early as practical.

1. Notification shall be made by the affected member, in writing, by ____________ and shall contain time and date of occurrence, location, type of injury/disease, and witness (es).
2. In the event the affected member is incapable of the required notification, the ________________ shall be responsible for submitting documentation of the incident.

Answer 1

incident report with assignment number
/
supervisor in charge at the time of the injury

Question 2

A supervisor, upon receiving notification of a member’s complaint of occupational injury/disease, regardless of the severity of the complaint, shall complete the required form(s) in compliance with Workers’ Compensation mandates.

1. The affected member’s immediate supervisor, if on-duty, shall complete the necessary documentation.
2. In the event the affected member’s immediate supervisor is off-duty (i.e., relief day, vacation, sick, etc.), ________ assigned to ________ completes the necessary documentation.

Answer 2

any supervisor
/
the same unit

Question 3

Before a member is carried injured on-duty,
he is required to have a physician complete SAPD Form #172, Physician Authorization for On-Duty Injury Status, ____ the State Form #DWC073, Texas Workers’ Compensation Work Status Report. The completed form is submitted to the supervisor

Answer 3

or

Question 4

The completed SAPD Form #172 or State Form #DWC073 is submitted to the member’s supervisor and the supervisor is responsible for forwarding the documentation to the ____________ no later than the ____________.

Answer 4

Accounting and Personnel Office
/
following business day

Question 5

For purposes of reporting an occupational injury/disease, a supervisor must complete the ________________________ Form, and forward the completed form to the Accounting and Personnel Office within ________ of the occurrence through email SAPDAccountingInjuredOfficer@sanantonio.gov.

Answer 5

Supervisor Report of Injury or Illness
/
forty-eight (48) hours

Question 6

State Form #DWC-6, Employer’s Supplemental Report of Injury, is required to be completed by a supervisor in the following instances

1. Within forty-eight (48) hours of the time the injured member ____________ due to an
   occupational injury/disease, the form must be received in the Accounting and Personnel Office.
2. If the initial State Form #DWC01 submitted for the injured member did not note loss of time from duty and ________ due to the same occurrence,
3. Within forty-eight (48) hours of a member’s ________ from an occupational injury/disease, whether
   returning to ________ assignment,

Answer 6

started losing time from work
/
time was subsequently lost
/
return to work
/
limited duty or regular

Question 7

Supervisors are required to e-mail or fax documentation related to the member’s claim of occupational injury/disease. The supervisor collects the copies, ________ them, and places them in the member’s unit level field file.

Answer 7

time-stamps

Question 8

Supervisors are responsible for ensuring submission of documentation, except for ________, is delivered to the Accounting and Personnel Office within the specified time-frame.

For purposes of this section, the documents are considered “delivered to Accounting and Personnel Office” when they have been received by the Accounting and Personnel Office within ________.

Answer 8

the incident report
/
specified time-frame