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Sgt Exam 2025 - JT/RC/SH > HPM 10.7 Injury and Illness Case Management > Flashcards

HPM 10.7 Injury and Illness Case Management Flashcards

1
Q

Define Case Management

A

Active and effective participation in entire process

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2
Q

Define Occupational Injury

A

Any injury, exposure, etc in work environment from single causative event

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3
Q

Define Occupational Illness

A

Any abnormal condition, disorder, caused by exposure to environmental factors associated with employment. Includes chronic illness and diseases which may be caused by inhalation, absorption, ingestion, cumulative trauma, stress, or direct contact

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4
Q

Define Record Only Injury/Illness

A

Does not require first aid or medical treament. CHP 121E

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5
Q

Define First Aid Injury or Illness

A

Minor and nondisabling which involves one time medical treatment. (burn, scratch, cut… etc)

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6
Q

Define Nondisabling Injury or Illness

A

Requires more than first aid. Employee returns to work following the date of illness/injury. May require more than one time treatment.
1. Injured during shift and completes shift
2. injured during shift and unable to complete shift, however, returns to work the next scheduled work shift
3. Job related injury during non-work hours and returns for next scheduled shift

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7
Q

Define Disabling injury or illness

A

Unable to return to work following the date:
1. Injured during shift and incapable or reporting to work for THE NEXT SCHEDULED WORK SHFIT or any subsequent shift.
2. Same applies to a job related injury occurring during non-work hours.

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8
Q

Define serious Injury or Illness

A

Disabling requiring overnight hospital care other than for observation, a lengthy disability status or disability retirement.

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9
Q

Define hazardous exposure

A

exposed to chemical, biological, or physical agent not resulting in injur yor illness

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10
Q

Define Injury/Illness Designation

A

Reported severity of Injury/Illness (record only, first aid, nondisabling, disabling)

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11
Q

Define Recurrence of Injury or Illness

A

Recurrence does not have a new, clearly defined incident to cause injury or illness. It is a spontaneous reappearance of a prior condition

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12
Q

Define Aggravation of Injury or Illness

A

has an IDENTIFIABLE NEW INCIDENT OF INJURY OR ILLNESS. Shall be processed as a new injury/illness

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13
Q

Define Questionable Injury or Illness

A

Substantial evidence questions whether the injury or illness is work related. Should not be deemed questionable because not witnessed or result of cumulative trauma. NOTE: Employees under internal investigation shall have claim marked as “questionable,” but specifics of the investigation shall not be noted on the CHP 121
- Reasons for questioning the claim shall be documented on the CHP 121

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14
Q

Who provides the Determination of Preventability?

A
  1. Commander’s Determination: shall determine preventability and shall implement corrective measures
  2. Employee Notification when deemed preventable: Commander or designee shall personally meet with employee to review reason
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15
Q

When would an officer be restricted on Use of Peace Officer Powers?

A

Commander shall direct uniformed employee off duty as a result of industrial/non-industrial injury/illness where physician diagnoses employee incapable of performing 14 critical tasks (CHP 225), to avoid activities regarding use of peace officer powers

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16
Q

When would an officer have Peace Officer Powers removed?

A

Commander shall revoke uniformed member’s peace officer powers and secure state-issued firearms when off duty due to psychological reasons including stress

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17
Q

Commanders or their designees MAY/SHOULD/SHALL contact State Fund monthly to review cases of employees placed off duty

A

SHALL

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18
Q

When SHALL commanders submit MONTHLY CHP 121D to Division?

A

By the 10th of each month

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19
Q

The supervisor MAY/SHOULD/SHALL be personally and actively involved in case management

A

SHALL

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20
Q

The supervisor MAY/SHOULD/SHALL insure compliance to injury, illness and hazardous exposure reporting and routing procedures

A

SHALL

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21
Q

The supervisor MAY/SHOULD/SHALL conduct a comprehensive review of the facts surrounding the incident. If video or audio recorded of incident is available, a copy of the recording(s) shall be made.

A

SHALL

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22
Q

TRUE/FALSE: The supervisor should assist employee w/ receiving prompt and proper medical care if believed necessary by managmeent or employee

A

FALSE: The supervisor SHALL assist employee with receiving prompt and proper medical care if believed necessary by management or employee

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23
Q

Supervisor responsibility: If practical, MAY/SHOULD/SHALL accompany employees initial medical appointment and discuss work capability with the employee’s physician.

A

SHALL

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24
Q

Supervisor responsibility: True/False:
Supervisor shall not attempt to be present when employee is being examined by the doctor

A

True

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25
Q

What is the Supervisor responsibility when it comes to medical appointments? (6)

A
  1. If practical, shall accompany employees to initial medical appointment and discuss work capability with the employee’s physician
  2. SHALL NOT ATTEMPT TO BE PRESENT WHEN EMPLOYEE IS BEING EXAMINED BY THE DOCTOR
  3. Review limited duty with doctor when appropriate
  4. Obtain an estimated date of return
  5. Document discussion on CHP 121
  6. If appt. Out of area, attempt to make arrangements with local area supervisor or manager
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26
Q

What is the Supervisor responsibility when there is a lack of rehab efforts by an employee?

A

Shall notify commander if employee is not making good faith effort towards prescribed medical rehabilitation

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27
Q

It is the employee’s responsibility for ensuring submission of an STD 634 (Absence Request) when?

A

NO LATER THAN THE FIRST WORKING DAY FOLLOWING THE END OF EACH PAY PERIOD

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28
Q

What occurs to job applicants if injuries sustained during the application process?

A

Supervisor managing the application shall initiate a CHP 121

NOTE: shall NOT be included in departments occupational safety statistics

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29
Q

Are volunteers entitled to workers compensation benefits?

A

No - excluded as employees and not entitled to workers compensation benefits ( per California Labor Code, Section 2235(i) and State Administrative manual, Section 2580.3)

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30
Q

What if there is a recurrence of an injury or illness?

A

Within 24 hours, employee prepares memorandum (CHP51) detailing circumstances and description of injury

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31
Q

CHP 121, Employer’s Report of occupational injury or illness (14 items)

A
  1. Completion. By a supervisor within 24 hours of notification
  2. CHP 121 SHALL be typed
  3. Employee’s Signature, Sign within 24 hours of reporting injury
  4. Employee’s Inability to sign (within 24 hours) Supervisor shall document circumstances in “Comments,” and submit. Employee shall sign ASAP.
  5. Employee’s refusal to sign supervisor shall type/print “refused to sign” in employee’s signature block and document in comments section
  6. Commander’s Signature. within THREE (3) DAYS of notification of injury/illness
  7. Filing with State Fund. Commander/designee files CHP 121 within FIVE (5) DAYS (does not include Record Only or first aid without medical expense)
  8. Delay in Filing with State Fund. Shall not be delayed for any reason. Minimum shall submit partially completed CHP 121 State Fund will accept a FAX pending sending of original)
  9. Temporary Assignment. Temp Command completes CHP 121, copy forwarded to permanent Command who will be responsible for subsequent case management.
  10. Travel Status. Permanent Command is responsible for CHP 121. etc.
  11. Assignment outside the Department. Appropriate Assistance Commissioner completes CHP 121, forwards copy to permanent Command who is responsible for subsequent case management.
  12. Cadets - Academy responsible until graduation when file is forwarded to new command for all further case management
  13. Training at Other Sites - permanent assignment command is responsible
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32
Q

CHP 121, will be completed by who and in what time frame?

A

Supervisor within 24 hours of notification

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33
Q

CHP 121 MAY/SHOULD/SHALL be typed

A

SHALL

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34
Q

What occurs if an employee is unable to sign a CHP 121 within 24 hours?

A

Supervisor shall document circumstances in “Comments,” and submit. Employee shall sign ASAP

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35
Q

What occurs if an employee refuses to sign a CHP 121?

A

Supervisor shall type/print “refused to sign” in employee’s signature block and document in comments section

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36
Q

What is the time frame to acquire the Commander’s signature for a CHP 121?

A

within THREE (3) DAYS of notification of injury/illness

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37
Q

What is the time frame for the Commander to file a CHP 121 with State Fund?

A

within FIVE (5) DAYS (does not include Record Only or first aid without medical expense)

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38
Q

How long can a CHP 121 be delayed for filing with State Fund?

A

SHALL NOT be delayed for any reason. Minimum shall submit partially completed CHP 121 State Fund will accept a FAX pending sending of original

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39
Q

Who complete a CHP 121 when officer is on a temporary assignment?

A

Temp command completes CHP 121, copy forwarded to permanent Command who will be responsible for subsequent case management

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40
Q

Who is responsible for a CHP 121 when officer is on a temp assignment due to civil disturbance?

A

Permanent command is responsible for 121 and case managment

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41
Q

Who is responsible for CHP 121 when officer is on Travel status?

A

Permanent command is responsible for CHP 121. etc.

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42
Q

Who is responsible for CHP 121 when assignment is outside of the Department?

A

Appropriate Assistance Commissioner completes CHP 121, forwards copy to permanent Command who is responsible for subsequent case management

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43
Q

Who is responsible for CHP 121 for cadets?

A

Academy responsible until graduation when file is forwarded to new command for all further case management

44
Q

Who is responsible for CHP 121 when training at other sites?

A

Permanent assignment command is responsible

45
Q

CHP 121A, Supervisory review of Occupational Injury, illness, or exposure (13 Items)

A
  1. Completed w/in 24 hrs. of notification. (Annex P-3 and P-4)
  2. Shall be typed or printed neatly in INK.
  3. Employee shall review and sign file copy (121A) w/in 24 hrs. of an injury.
  4. If the employee is incapable of signing the CHP 121A within 24 hours of incident, the supervisor shall document the circumstances with prevented the signing of the form within the “Comments” section. The employee shall sign form ASAP.
  5. Employee Refusal to Sign. Supervisor shall type/print “Refused to Sign.” in signature block and document the refusal in the comments section.
  6. Commander’s Signature. CHP 121A shall be signed by the Commander within 3 days of notification of injury/illness.
  7. Routing. Routing procedures for the CHP 121A shall not be delayed for any reason. Partially complete at least include statement that additional info will be forwarded ASAP.
  8. Temp Assignment – Temp Command completes CHP 121A, copy forwarded to permanent Command who will be responsible for subsequent case management.
  9. Temp Assignment due to Civil Disturbance - Permanent command is responsible for 121A
  10. Travel Status. Permanent Command is responsible for CHP 121A. etc.
  11. Assignment outside the Department. Appropriate Assistant Commissioner completes CHP 121A, forwards copy to permanent Command who is responsible for subsequent case management.
  12. Cadets - Academy responsible until graduation when file is forwarded to new command.
  13. Training at Other Sites – permanent assignment command is responsible
46
Q

What is the time frame to complete a CHP 121A?

A

Within 24 hours of notification

47
Q

Can the CHP 121A be filled out by hand?

A

Yes, SHALL be typed or printed neatly in INK

48
Q

When will an employee review and sign a copy of the CHP 121A?

A

within 24hours of injury

49
Q

If the employe is incapable of signing the CHP 121A within 24 hours of the incident, the supervisor MAY/SHOULD/SHALL document what prevented the signing of the form within the “comments” section.

A

SHALL - and the employee shall sign form ASAP

50
Q

What occurs when an employee refuses to sign a CHP 121A

A

Supervisor shall type/print “Refused to Sign.” in the signature block and document the refusal in the comments section

51
Q

What is the time frame to obtain the Commander’s signature on a CHP 121A?

A

Shall be signed within 3 days of notification of injury/illness

52
Q

Can the routing procedure for a CHP 121A be delayed?

A

Routing shall not be delayed for any reason. Partially complete at least include statement, then additional info will be forwarded asap

53
Q

Who completes the CHP 121A when on a temp assignment?

A

Temp Command completes, copy forwarded to permanent command who will be responsible for subsequent case management

54
Q

Who completes the CHP 121A when on a temp assignment due to a civil disturbance?

A

Permanent command is responsible

55
Q

Who is responsible for a CHP 121A when on travel status?

A

Permanent command

56
Q

Who is responsible for a CHP 121A when on an assignment outside the department?

A

Appropriate assistant Commissioner completes and forwards copy to permanent command who is responsible for subsequent case maangement

57
Q

Who is responsible for a CHP 121A for cadets?

A

Academy is responsible until graduation when file is forwarded to new command\

58
Q

Who is responsible for a CHP 121A when training at other sites?

A

Permanent command

59
Q

What is a CHP 121B?

A

Employee report of injury (same as 121)

60
Q

When shall a CHP 121B be completed by the employee?

A

within 24 hours of reporting injury or illness

61
Q

What occurs if the employe is incapable to signing the CHP 121B within 24 hours?

A

Supervisor shall document circumstances with prevented the signing of the form within the “Comments” section of CHP 121A. The employee shall then sign the 121B ASAP

62
Q

What occurs if an employee refuses to sign a CHP 121B?

A

Supervisor types/prints “Refused to Sign.” in the signature block of the 121B and document the refusal in comments section of the 121A

63
Q

What is a CHP 121C?

A

Medical Information Release Authorization

64
Q

When shall a CHP 121C be signed by the employee?

A

Within 24 hours

65
Q

What occurs if the employe is incapable to signing the CHP 121C within 24 hours?

A

Supervisor shall document circumstances with prevented the signing of the form within the “Comments” section of CHP 121A. The employee shall then sign ASAP

66
Q

What occurs if an employee refuses to sign a CHP 121C?

A

Advise the employee, per SCIF, delay or denial of benefits may result.
If refusal continues, supervisor types/prints “Refused to Sign.” in the signature block of the 121C and document the refusal in comments section of the 121A

67
Q

What is a CHPC 121 D?

A

Industrial Injury/Illness status report

68
Q

Who maintains a CHP 121D for employees off duty or assigned limited duty for an occupational injury/illness

A

Comander

69
Q

Should a CHP 121D be posted for general view?

A

SHALL NOT be posted for general view

70
Q

What is a CHP 225?

A

California Highway Patrol Officer Task Statements

71
Q

A supervisor, as soon as possible, MAY/SHOULD/SHALL provide medical care provider with a CHP 225 (full/light duty slip)?

A

SHALL

72
Q

What occurs if injury, illness, or hazardous exposure occurred during, or is related to, activities documented on previously authorized fitness plan?

A

CHP 270, Page 7, Fitness plan - copies are to be routed with CHP 121

73
Q

What is a CHP 442?

A

Individual Accident, injury and safety recognition

74
Q

How often shall a supervisor prepare/update a CHP 442?

A

Within 3 Days (Annex P-9 and P-22)

75
Q

What is a CHP 443?

A

Approval of Limited Duty Assignment

76
Q

When shall a supervisor provide a CHP 443 to the medical care provider?

A

As soon as possible after notification of nondisabling injury or illness

77
Q

What is CHP 600?

A

Right to Privacy Instructions (same as 121)

78
Q

When shall a supervisor provide a CHP 600 to the employee?

A

Within 24 hours of notification of injury/illness

79
Q

What is CHP 601?

A

Coping with your Injury (same as 121)

80
Q

When does a supervisor provide a CHP 601 to the employee?

A

within 24 hours to employee (Annex P-13)

81
Q

What is State Fund 3301?

A

Employee’s claim for workers’ compensation benefits (same as 121)

82
Q

For routing, when are complete 3301s forwarded to State Fund?

A

Within 5 days of command receipt of forms

83
Q

Who initiates a State Fund 3301?

A

Supervisor and provides to employee within 24 hours of notification, unless Record Only or First Aid (Annex P-14)

84
Q

What is a receipt of a SCIF 3301 and/or Doctor’s First Report of Injury Form considered?

A

equivalent to employee notification. All applicable reporting shall be implemented

85
Q

When shall a commander or designee review the commander’s memorandum and attachment with the employee?

A

Within 24 hours (Annexes P-15 to P-19)

86
Q

Is an employee signature mandatory on a Commander’s Memorandum and attachment?

A

Not mandatory. Without signature commander or designee shall document date and time attachment was reviewed with the employee and reason for no signature

87
Q

Commanders MAY/SHOULD/SHALL prepare a memo advising employees authorized medical care providers and/or facilities (Annex P-20)

A

SHALL

88
Q

When shall a COMM-NET be transmitted to DRU?

A

Within 24 hours of notification of nondisabling or disabling injury (see GO 100.80)

89
Q

Status Change COMM-NET message (see GO 100.80) - What occurs when a record only or first-aid injury or illness changes to nondisabling or disabling?

A

Status Change TO Nondisabling or disabling

90
Q

Status Change COMM-NET message (see GO 100.80) - What occurs when the status of a nondisabling (other than record only or first aid) or disabling injury or illness changes?

A

Stats Change OF Nondisabling or disabling

91
Q

When shall an employee provide his supervisor with a Medical Care Provider’s Statement directing employee off duty?

A

ASAP - included is the reason(s) placed off duty and estimated date of return to full or limited duty

92
Q

When shall an employee be provided with a copy of 121, 121A, 121B and 121C?

A

Upon request

93
Q

The employee’s right to choose medical provider - what is the preferred physician be documented on?

A

CHP 242

94
Q

What 2 things must a physician do to be the preferred physician by the employee?

A
  1. must sign and agree to act as designated physician on CHP 242
  2. must have previously provided medical treatment to the employee and currently retain the employees permanent medical file
95
Q

Policy: employee shall be physically and psychologically capable of performing what?

A

Essential duties of classifcation

96
Q

If potential impairment exists, the department MAY/SHOULD/SHALL obtain a medical exam?

A

MAY

97
Q

Commanders shall obtain authorization for Department ordered Finess-for-duty examination or state fund ordered medical exam from who?

A

Assistant Commissioner prior to

98
Q

What requires employees to report any known physical or psychological condition that may adversely affect job performance?

A

Statement of Inconsistent or Incompatible Activities

99
Q

Supervisor shall notify who if an employee is suffering from any condition which affects essential duties?

A

Commander

100
Q

When shall commanders ensure employees return to work?

A

As soon as medically appropriate

101
Q

What occurs if an employee is not making good faith effort toward prescribed medical rehabiltiation?

A

The supervisor shall notify the commander

102
Q

A supervisor MAY/SHOULD/SHALL notify the commander of any significant change in status of an employee’s injury/illness

A

SHALL

103
Q

How long can an employee me on limited duty?

A

Case by Case basis not to exceed 2 years

104
Q

How long can a commander authorize limited duty?

A

Less than one year

105
Q

Who’s approval is required beyond ONE YEAR and EVERY 3 MONTHS THEREAFTER (except within an Executive Office)?

A

Assistant Commissioner

106
Q

What occurs if an employee refuses limited duty (medically approved limited duty)?

A

Commander requests to appropriate assistant commissioner for the Dept. to expeditiously render a decision to ORDER employe to perform limited duty.

107
Q

Commanders shall ensure employees are promptly provided an Options Letter (Annex A) when?

A

when the employee is medically determined permanently precluded from returning to his/her regular job duties

Sgt Exam 2025 - JT/RC/SH (23 decks)

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