Injury And Illness Case Management

Question 1

Occupational injury?

Answer 1

Any injury, such as cut, fracture, sprain, amputation, etc. which results form occupational incident or exposure involving a single causative event in work environment

Question 2

Occupational illness?

Answer 2

Any abnormal condition or disorder, caused by exposure to environmental factors associated with employment

Question 3

Record only injury or illness

Answer 3

Non disabling injury or illness which does not require first aid or medical treatment

Question 4

First aid injury or illness?

Answer 4

Minor non disabling injury or illness which involves one time medical treatment

Question 5

Non disabling injury or illness?

Answer 5

Injury or illness which requires more than first aid, may require more than 1 time medical care, and employee able to return to work filling date of injury

Question 6

Commanders SHALL maintain a CHP ___ including employees who are assigned to limited duty or are off duty as result of occupational injury or illness

Answer 6

121D

Question 7

Commanders SHALL submit a monthly CHP 121D to respective Division by the ___ of each month

Answer 7

10th

Question 8

Divisions SHALL send CHP 121D to appropriate assistant commissioner no later than the ___ of each month

Answer 8

15th

Question 9

Within 24 hours of reporting a recurrence of an injury or illness employee SHALL prepare a CHP ___

Answer 9

51

Question 10

Injuries and illness SHALL be recorded on the CAL OSHA LOG within ___ workdays following knowledge of injury or illness

Answer 10

6

Question 11

The following injuries and illnesses SHALL be recorded:

Answer 11

• all occupational injuries
• all occupational deaths
• all occupational injuries other than record only or first aid

Question 12

If the status of an injury changes within ___ years of original occurrence, the log in which injury or illness is recorded must be updated

Answer 12

5

Question 13

When an injury or illness claim is denied by SCIF, you must _____ the entire entry and make appropriate notation in the log and CHP 121

Answer 13

Line out

Question 14

When an injury or illness recorded on the log later results in ___, line out columns H-L on log and mark G, add date of ___ in column D, and make appropriate notation on CHP 121

Answer 14

Death and death

Question 15

Areas, communications centers, enforcement facilities, and headquarters SHALL total their previous years logs and forward signed copies to respective field and headquarters division by ____ 15th

Answer 15

January

Question 16

Headquarters divisions SHALL forward their totaled and signed composite logs for previous year to OSU by ______ 15 each year

Answer 16

February

Question 17

Commands must save OSHA 300 log and annual summary for ___ years following end of calendar year

Answer 17

5

Question 18

CHP 121s SHALL be maintained for ___ years for each injury or illness recorded on the log

Answer 18

5

Question 19

CHP 121 SHALL be completed by employees supervisor within ___ hours of notification of alleged occupational injury or illness and ___ be typed

Answer 19

24 hours and SHALL

Question 20

Commander or designee SHALL review and sign CHP 121 within ___ days of notification of an injury or illness

Answer 20

3

Question 21

Commander or designee SHALL ensure CHP 121 (unless record only or first aid w/o medical expenses incurred) is field with appropriate SCIF office within ___ days of notification of an injury or illness

Answer 21

5

Question 22

Within __ days of initial notification of, or any status change of, an employee injury, illness, or hazardous exposure, supervisor SHALL record or update incident on CHP 422

Answer 22

3

Question 23

Within 24 hours of notification of an injury or illness, supervisor SHALL provide employee with a copy of CHP ___ and CHP ___

Answer 23

600 and 601

Question 24

SCIF 3301 SHALL be initiated by supervisor and provided to employee within ___ hours of notification of an alleged injury or illness other than record only or first aid

Answer 24

24

Question 25

Completed SCIF 3301s SHALL be forwarded to SCIF within ___ days of command receipt of forms

Answer 25

5

Question 26

Upon request an employee SHALL be provided with a copy of the CHP ___,CHP ___, CHP ___, CHP ____

Answer 26

121, 121A, 121B, and 121C

Question 27

If an employee requests reasonable accommodation for a disability, a determination ____ be made whether an accommodation is feasible in order to allow the employee to perform the assigned duties

Answer 27

SHALL

Question 28

When department ordered FDD examination is scheduled, employee SHALL be provided a CHP 121C, medical information release authorization to sign and identify medical care providers who have treated employee for related conditions within the past ___ years

Answer 28

10

Question 29

Commanders SHALL ensure that disabled employees return to work in a ____ duty capacity as soon as medically appropriate

Answer 29

Limited

Question 30

Uniformed employees SHALL only participate in ___ - enforcement activities while assigned to limited duty

Answer 30

Non

Question 31

Commanders may authorize limited duty assignments of less than ___ year

Answer 31

1

Question 32

Permissive reinstatement request is made when an individual wishes to return to the dept after a ____ resignation

Answer 32

Voluntary

Question 33

All permissive reinstatement request must be made within ___ years of date of separation

Answer 33

3

Question 34

No time restriction for Mandatory reinstatement requests by individuals wishing to return from industrial disability retirement, but must be capable of performing 14 critical task and under maximum age of __

Answer 34

60

Question 35

Employee attending workers compensation appeals board (WCAB) hearing or trial, or attends on behalf of claimant, ___ eligible for use of state time

Answer 35

Is not

Question 36

Any documents Submitted to WCAB may become ____ record

Answer 36

Public