Injury/Exposure Flashcards
PROCEDURES FOR INJURED PERSONNEL
- Immediately seek proper emergency medical care.
- Place your unit “Out Of Service” as soon as practical and contact your Battalion Chief.
- Call Workers’ Compensation 866-803-5100 to initiate a 1st Notice of Injury
a. Make note of contact person and claim number.
b. If no answer, document time called and message left. - Personnel should make a determination, in collaboration with their Battalion Chief, and the Workers Comp Triage Nurse on the treatment needed.
a. In the event the contact phone is not answered, personnel should consult with their immediate supervisor and ED staff to determine treatment needed.
b. Personnel should note Workers’ Comp will only pay for authorized treatment and time off. Leaving duty or seeking treatment without prior authorization may not be covered. - Personnel must obtain a work status from the treating physician; this may be in the form of a “work excuse note” or the official Workers Compensation form DWC-25. The work status must be forwarded to the Battalion Chief and faxed to the Assistant Chief of Administrative Operations (941) 861-5119 prior to going home, off duty or returning to work.
- Personnel shall complete Part A and B of the SCFD Injury/Exposure Investigation Report (Form 128) as directed below. Form 128 should then be turned over to their Battalion Chief.
Injuries and exposures that occur while on-duty have identified procedures required by Sarasota County Government to verify that _______ occur.
proper treatment, follow-up, and documentation
PROCEDURES FOR PERSONNEL WHO HAVE HAD A BIO-HAZARD EXPOSURE
- Immediately utilize SCFD approved decontamination measures.
- Place your unit Out Of Service as soon as practical and contact your Battalion Chief and EMS Operations Captain.
- Call Workers’ Compensation 866-803-5100 to initiate a 1st Notice of Injury.
a. Make note of contact person and claim number.
b. If no answer, document time called and message left. - Personnel should make a determination, in collaboration with their Battalion Chief, EMS Operations Captain, and the Workers Comp Triage Nurse on the need for treatment and/or testing.
a. In the event the contact phone is not answered, personnel should consult with their immediate supervisor, EMS Operations Captain, and ED staff to determine treatment and/or testing needed.
b. Personnel should note Workers’ Comp will only pay for authorized treatment and time off. Leaving duty or seeking treatment without prior authorization may not be covered. - Personnel must obtain a work status from the treating physician; this may be in the form of a “work excuse note” or the official Workers Compensation form DWC-25. The work status must be forwarded to the Battalion Chief and faxed to the Assistant Chief of Administrative Operations (941) 861-5119 prior to going home, off duty or returning to work.
- Personnel shall complete Part A and B of the SCFD Injury/Exposure Investigation Report (Form 128) as directed below. Form 128 should then be turned over to their Battalion Chief.
SCFD INJURY/EXPOSURE INVESTIGATION REPORT (FORM 128) (MUST ________
typed
Part A - Employee and General Information : This section is for general information such as ______-
injured/exposed personnel’s name/position, supervisor, work location, and contact phone number
It is important for personnel to document an off-duty contact phone number, do not use_______
station phone numbers.
Personnel must obtain a work status from the treating physician; this may be in the form of a _______
“work excuse note” or the official Workers Compensation form DWC-25.
The work status must be forwarded to the ______
Battalion Chief and faxed to the Assistant Chief of Administrative Operations (941) 861-5119 prior to going home, off duty or returning to work.
Call Workers’ Compensation _______ to initiate a 1st Notice of Injury.
866-803-5100
a. Make note of contact person and claim number.
b. If no answer, document time called and message left.
Part B - Description of Accident
Describe in as much detail as possible where and how the incident happened. This section is for facts, not opinion. Statements from witnesses should be detailed here. Additional pages can be attached as needed. Include related incident number. Include what was done post-exposure/injury in the way of medical care or decontamination.
Describe in detail (where and how the incident happened)
Include facts, not opinion.
Statements from witnesses
Additional pages can be attached as needed.
Include incident number.
Include what was done for medical care or decontamination.
PROCEDURE FOR SUPERVISORY STAFF TO FOLLOW FOR INJURIES
- Verify that employee has treated the injury
- place the employee’s unit out of service
- Verify employee has called Workers’ Comp Claim (866-803-5100).
- If Workers’ Comp has not been contacted, call.
- If unable to stay with employee until ED follow up completed:
a. Advise employee to contact you prior to leaving ED.
b. Advise employee to stay out of service.
c. Advise employee to follow recommendations from ED physician.
d. If employee declines any treatment and/or recommendations from ED physician, document what was declined and employee’s reasons. - When ED follow up completed:
a. Request copies of any work status (Work excuse or DWC-25).
b. Attach copy to Form 128.
c. Determine whether employee is okay to go back on duty. - Assist employee to thoroughly complete Form 128.
- If the injury required medical treatment send email to:
a. ffinjury@scgov.net
b. The Subject Line is to be “Injury to SCFD Employee”.
c. Include in the email:
i. Date and time of occurrence
ii. Name of each employee involved - If an injury involves a hospital admittance:
a. Fill the injured firefighter’s vacancy.
b. Call the Assistant Chief – Administrative Operations. - Make a copy of all paperwork and give to employee for their records.
- Fax or hand deliver the Work Status to the Assistant Chief – Administrative Operations (941) 861-5119.
____% of injuries occur because of behaviors whether it’s on the part of the employee injured, a co-worker or management.
95%
On DWC-25, if box 21 is checked, _____
If box 23 is checked, employee has work restrictions, send home, they will be scheduled for a light duty assignment.
employee is released to full duty.
If box 22 is checked _______
employee is not approved to be at work, send home.
If box 23 is checked _________
employee has work restrictions, send home, they will be scheduled for a light duty assignment.
