Directive 12.14 IOD or Disability,

Question 1

According to Directive 12.14 IOD or Disability, A supervisor notified of an injury or exposure( No matter how minor) is responsible to ensure that the employee prepares a ?

Answer 1

Employee Injury Report (83-s-58) and a heart and lung Claim Form (75-628). This must be done even if the employee dose not wish to seek immediate medical evaluation or treatment.

Question 2

According to Directive 12.14 IOD or Disability, Who will investigate and make the initial determination as to the service connection of an injury or exposure of an employee, whether incurred on duty or off duty.

Answer 2

The Commanding officer.

Question 3

According to Directive 12.14 IOD or Disability, True or False, The employee will be presented with two copies of the Encounter form on each visit to city Network Provider.

Answer 3

True

Question 4

According to Directive 12.14 IOD or Disability, The Preparation and submission of the injury report and heart and lung Claim form(75-628) is mandatory to ensure the department meets the requirements of___________ ?

Answer 4

Workmen’s Compensation Act and the PA Heart and Lung Act

Question 5

According to Directive 12.14 IOD or Disability, All injuries or exposure on duty will be reported on this form within___________? working days after occurrence by the injured employee

Answer 5

Two days 48 hours
Employee Injury Report (82-S-58)
Five (5) copies

Question 6

According to Directive 12.14 IOD or Disability, Employees involved in a off-duty police action and who are injured will be carried as ___________?

Answer 6

Sick……… on the DARS until a determination is made concerning the injury incurred.

Question 7

According to Directive 12.14 IOD or Disability, All employee who incur service- connected injuries or exposure will be

Answer 7

Treated at an approved city network provider or the nearest Emergency room for emergency.

NOTE : if the officer is treated by a personal physician or hospital, That doctor will NOT be reimbursed by the city.

Question 8

According to Directive 12.14 IOD or Disability The time limit for reporting to the city Claims Administrator is

Answer 8

48 hours
Employees will report to a city Network Provider for treatment within 48 hours after incurring a service connected injury or exposure.

Question 9

The PA Heart and Lung Act covers only

Answer 9

sworn personnel, who incur injuries in the
performance of duty and only those injuries of a temporary nature. Determination of
whether a service connected injury is covered under the Heart and Lung Act will be
made by the City Claims Administrator in consultation with Risk Management and the
Police Department Safety Office.

Question 10

Personnel complaining of dizziness, chest pains, light-headedness, etc., will be taken to________?

Answer 10

The nearest hospital. Referrals will not be prepared for these types of complaints. When there is a question as to whether the illness is a duty related action, the Safety Office will be contacted prior to issuing referrals.

Question 11

Personnel complaining of an exposure due to contact with, or close proximity to, a potentially hazardous chemical will ensure this information, including the type of chemical, is documented on

Answer 11

The City of Philadelphia Accident, Injury, and Illness
(COPAII) Report (82-S-58). The O.R.S. will contact the Fire Department, if necessary, to ascertain the type of chemical involved for inclusion on the injury report. Obtain the control number from the Fire Department for this incident at this time.

Question 12

When a need arises for a Philadelphia Police Officer to store their privately owned
and/or service weapon(s) while seeking treatment at any medical site within City
Network Providers for an on-duty injury, the following procedures are to be followed:

Answer 12

1. Upon reporting to the site, whether for initial treatment or for follow-up treatment, the officer will request a lock box and a key to accommodate their weapon from a staff member of the City Network Provider.
2. Place their weapon(s) within the lock box.
3. Maintain the key while at the site.
4. Upon completion of treatment, retrieve the weapon from the lock box.
5. Return the key to a staff member of the City Network Provider.

Question 13

Personnel sustaining a human bite in the line of duty must inform the examining physician that the injury was the result of a human bite. Failure to do so may result in

Answer 13

serious disability and loss of benefits on the part of the employee.

Question 14

All orders and instructions concerning treatment procedures given by doctors at the City Network Provider will be

Answer 14

obeyed.

Question 15

If the employee is to be transferred to another hospital, who will be notified ?

Answer 15

the Radio Room Supervisor will be notified prior to removal, if possible.

Question 16

A memorandum will be prepared by the employee’s Commanding Officer and submitted through the chain of command to the Safety Office whenever any personnel

Answer 16

Are admitted to a hospital. A copy of this memo will be faxed immediately to the safety Office at 215-686-3384.

Question 17

Referral to City Network Provider (82-S-30) – Original and three (3) copies.

Answer 17

1) Original and copy – Taken by injured employee to treating facility.
2) Copy – Sent to Safety Office with completed Employee Injury Report.
3) Copy – Retained at permanent District/Unit headquarters.

Question 18

The employee’s Commanding Officer will ensure the form is distributed as indicated below, within 48 hours of the injury:

Answer 18

1) Original and two (2) copies - Safety Office
2) Copy - Injured employee
3) Copy - District/Unit file.

Question 19

Determination as to whether or not a disability is service connected will be made on the
basis of:

Answer 19

1. All facts in the service history of the case.
2. The findings of doctors at the City Network Provider.
3. Evidence which the employee may possess (private medical records) concerning
   their claim of a service-connected injury/illness. These records will be submitted at the employee’s own expense.
4. Any other relevant evidence pertaining to the employee’s claim of service- connected injury/illness.