HPM 10.7 Injury & Illness

Question 1

Shall the supervisor be present when an employee is being examined by the medical care provider? (2-8)

Answer 1

In no event shall supervisors be present when employees are examined by medical care providers.

Question 2

If an Applicant reports an injury during the application process, what forms are used? (3-4)

Answer 2

Reporting and routing shall be initiated bt the supervisor managing the app process. CHP-121 shall indicate salary as, “none” and the occupation as, “Job Applicant”.

Question 3

An employee reports the Recurrence of an injury or illness, what forms are filled out and who should fill them out if the employee is incapacitated? (3-5)

Answer 3

Within 24 hours of reporting the recurrence, the employee shall prepare a memo detailing circumstances surrounding the recurrence and a description of the injury/illness. A supervisor shall, if the employee cannot.

Question 4

In addition to a 121, all injury and illnesses are recorded on what form and must be recorded within what time frame? (4-4)

Answer 4

They are reported on OSHA 300 LOG form within 6 work days following knowledge of injury/ill

Question 5

Who shall document an injury or illness of an employee while temporarily assigned to another command? (4-5)

Answer 5

The temporary command unless the result of a civil disturbance

Question 6

If the status of an injury or illness changes within ______________ years of the original occurrence, the log on which the injury or illness is recorded must be updated. (4-6)

Answer 6

5 years

Question 7

If an Injury or Illness is denied by SCIF, what happens to the OSHA #300 log entry? (4-6)

Answer 7

The entire entry is lined out, an appropriate notation is made on the log and the CHP121 is kept in the #300 file

Question 8

The commander or designee shall review the CHP 121 within what time frame? And how soon shall it be filed with SCIF? (5-1)

Answer 8

Reviewed w/in 3 days

Filed w/ SCIF w/in 5 days

Question 9

In the event of a hazardous exposure claim, what forms does the Supervisor fill out and complete? (5-2)

Answer 9

121A within 24 hrs, 121 is only occupational injury or illness only

Question 10

Supervisor shall provide the medical care provider with what form to assist in determining if the employee may perform full or limited duty? (5-5)

Answer 10

CHP 225, CHP Patrol Officer Task Statements, When? ASAP

Question 11

What is the form the Supervisor provides to the medical care provider after notification of a non-disabling injury or illness which requires assignment of limited duty? (5-5)

Answer 11

CHP 443 Approval of limited duty assignment, When? ASAP

Question 12

When must the supervisor give the injured/ill employee the CHP 600 (rights of privacy) and CHP 601(coping with your injury) forms? (5-6)

Answer 12

Within 24 hrs

Question 13

The supervisor is responsible for initiating a SCIF form and providing a ____________ form for all injuries including first aid? (5-6)

Answer 13

SCIF 3301 Employees Claim for Workers Comp Benefits

• to Officer within 24 hrs
• to SCIF within 5 days from command receipt of the forms

Question 14

The California Labor Code, Section 5401(a) defines first aid as what?

Answer 14

any one-time treatment, and any follow-up visit for the purpose of observation even though it may be provided by a physician or registered professional

Question 15

What are the Supervisor’s duties within 24 hours of an injury or illness to an employee?

Answer 15

To provide the employee with a CHP 600, CHP 601, complete and have employee sign CHP 121, and CHP121A, Initiate SCIF 3301 and provide copy to employee, prepare status change Comm-Net Message to DRU

Question 16

If the potential exists that an employee may be impaired in the performance of his/her duties due to a physical or psychological condition, the Department may obtain a medical examination to determine the extent of such impairment. Depending upon the circumstances associated with the employee’s impairment, the medical examination may be obtained using what two methods?

Answer 16

A Department-ordered fitness-for-duty (FFD) examination or a State Compensation Insurance Fund (SCIF)-initiated medical examination.

Question 17

What are the restrictions for employees on limited duty?

Answer 17

Uniformed employees shall only participate in non-enforcement activities while assigned to limited duty. While on limited duty, employees shall not wear a uniform, display a badge, or operate an enforcement vehicle.

Question 18

Proposed limited duty assignments shall be documented in detail on the following?

Answer 18

CHP 443 approval of limited duty assignments

Question 19

Who approves limited duty assignments of less than one year?

Answer 19

Commander (Assistant Commissioner does more than)

Question 20

Must uniformed employees who are absent from full duty less than one year be retrained and recertified at the academy?

Answer 20

No, at Area

Question 21

What agency is responsible for the adjudication of disputed claims?

Answer 21

Workers’ Compensation Appeals Board WCAB

Question 22

Can an employee or their attorney request a WCAB hearing and/or trial to resolve benefit disputes between the employee and SCIF?

Answer 22

Yes

Question 23

Is an employee who is attending their own WCAB hearing or trial eligible for the use of state time?

Answer 23

No unless they are off duty on 4800 time on the day of

Question 24

Annual Fitess Challenge includes___#_____ events and is __________.

Answer 24

5, Voluntary

Question 25

Who and how often should should contact State Fund? (2-6)

Answer 25

Commanders or their designees shall contact State Fund at least monthly to review the status of those cases in which employees have been placed off
duty or on limited duty.

Question 26

How long do you keep in contact with State Fund?

2-6

Answer 26

Commanders or their designees shall maintain ongoing communication with State Fund to discuss cases that appear on the open claims report.

Question 27

What is done with recordings of injury incidents? (2-8)?

Answer 27

If the supervisor becomes aware of a video or audio recording of the incident, a copy of the recording(s) shall be made. Information relevant to the extent of the injury shall be documented.

Question 28

Does policy apply to nonindustrial cases? (1-3)

Answer 28

Policy and procedures outlined in this manual are primarily applied to occupational injuries and illnesses, but may be applied to nonindustrial injuries and illness as deemed appropriate.

Question 29

What is a Record-Only injury? (1-4)

Answer 29

Nondisabling injury or illness which does not
require first aid or medical treatment. Record-only incidents shall be documented on a CHP 121E, Supervisor’s Incident Report-Record Only