HPM 10.7, Injury, Illnesss Case Management Flashcards
If an employee is currently the subject of an internal investigation and files a CHP 121, what shall the CHP 121 be marked?
Questionable.
1-5
What is a DWC-7, Notice to Employees-Injuries Caused by Work?
A notice required by 3550 LC to be posted in a conspicuous place with the name of the current compensation carrier or adjusting agent responsible for occ. injury and illness claims.
1-7
What is a Cal-OSHA 300A and when is it to be posted?
Cal-OSHA 300A is th annual summary of work related injuries or illnesses and shall be posted from Feb 1 through April 30.
1-7
What is the CHP 121E?
Supervisor’s Incident Report-Record Only.
Annex A
Who determines whether an injury or illness was preventable?
Commanders
2-3
If an injury is determined to be preventable, what shall the commander or designee do?
Personally meet with the employee and review the reasons the injury, illness, or hazard exposure was deemed preventable.
2-3
A medical bill received by the command shall be expeditiously forwarded where?
To Fiscal Management Section.
2-4
What shall a commander provide to an employee in the event of an occ. injury or illness?
Commanders shall prepare a personalized memorandum expressing desire to assist employee with injury case management prepare attachments that outline the Departments policy regarding occ injury/illness case management and the employees rights/responsibilities.
2-4
What is the CHP 225?
CHP Officer 14 Critical Physical Activities.
2-4 and Annex P
What shall commanders do if an employee is not making a good faith effort toward prescribed medical rehabilitation?
Notify Division and provide recommendations for potential departmental actions.
2-5
What will commanders require related to the employees secondary employment while injured?
Written authorization from the employee’s medical care provider indicating the secondary employment will not affect their ability to recover.
2-5
If an employee’s secondary employment was suspended, but an employee provides written authorization that secondary employment will not impede recover, what shall a commander do?
Shall reinstate suspended secondary employment.
2-6
At a minimum, how frequently shall commanders (or designee) contact State Fund?
At least monthly.
2-6
How frequently shall commanders report their case management activity to Division?
Quarterly.
2-7
What is the CHP 121 D for?
Injury/Illness Status Report, of employees assigned to limited duty or off duty due to occupational injury or illness. The CHP 121D is to provide accessible means of identifying employees and providing status updates.
2-7
How often shall the CHP 121 D be submitted to Division?
Monthly, by the 10th of each month.
2-7
What shall the 121 D contain?
it shall contain Information on employees assigned to limited duty or are off duty for 30 calendar days or more as a result of an occupational injury or illness. Negative reports are required.
2-7
What shall a commander send immediately (on the first day) when an employee is off-duty as a result of an injury or illness?
Send a Comm-net to the appropriate AC, Division commander, DRU, and HR with the following:
- Contact name and number
- Employee name and ID
- Type of injury
- Date of Injury
- Prior duty status/new duty status
- Effective date
- Estimated period of duty status
- Dr. Name and #
- Additional info
2-8
What are notification requirements for a death or serious injury?
Division and appropriate AC shall be phoned immediately. If AC not available then (in order until someone is contacted):
Exec. Assistant to AC
Deputy Commissioner
Commissioner
If none of the above are reached, then call ENTAC.
3-3