10.7 Injury and Illness Case Management

Question 1

An Occupational Injury is any injury, exposure etc in work environment from…

Answer 1

a single causative event.

Question 2

An occupational illness is any abnormal condition or disorder caused by exposure to environmental factors associated with _____________.

Answer 2

Employment

Question 3

A Record Only injury/illness is nondisabling and does not require ___________.

Answer 3

First aid or medical treatment

Question 4

First-Aid Injury or Illness. Minor nondisabling injury or illness (splinter,
scratch, cut, burn, etc.) which involves ________ medical treatment.

Answer 4

One-time

Question 5

Nondisabling Injury or Illness. Injury or illness which requires more than ______, may require more than one-time medical care, and the employee is able to
return to work (full or limited duty) following the date of the injury or illness.

Answer 5

First Aid
Example: Employee sustains an injury or illness during working hours and is
incapable of completing the work shift due to the injury or illness; however,
employee reports to work (full or limited duty) for his/her next scheduled work
shift.

Question 6

Injury or illness which results in an employee being unable to return to work following the date of the injury or illness is called a _______________________.

Answer 6

Disabling injury/illness

Note: Employee sustains an injury or illness during working hours and is
incapable of reporting to work for his/her next scheduled work shift or a
subsequent work shift due to the injury or illness.

Question 7

True or False - Serious Injury or Illness. Disabling injury or illness which requires overnight hospital care other than for observation, a lengthy disability status, or disability retirement.

Answer 7

True

Question 8

Recurrence of Injury or Illness. A recurrence of an injury or illness does not
have a ___________incident to cause injury or illness. It is a spontaneous
reappearance of a prior condition.

Answer 8

new, clearly defined

Question 9

An aggravation of an injury or illness has an identifiable new incident of injury or illness and shall be processed as a ______________.

Answer 9

new injury or illness

Question 10

An injury or illness claim for which there is reason to _______ whether the injury or illness is work related. Injury and illness
claims should not be deemed ______ simply because they are not witnessed
or are a result of cumulative trauma.

Answer 10

question questionable

Question 11

_________ shall determine preventability
of injuries, illnesses, and hazardous exposures and shall implement
appropriate corrective measures.

Answer 11

Commanders
Note: Commanders or their designees shall personally meet with employees to review the reasons their injuries, illnesses, or hazardous exposures were deemed preventable.

Question 12

An employee may appeal an injury determined to be preventable to the _______ __________.

Answer 12

Occupational safety committee

Note: can only make suggestions to commander and not overturn.

Question 13

Commanders shall revoke a uniformed member’s peace officer powers and secure all state-issued firearms whenever the
uniformed employee is off duty as a result of a_________________________.

Answer 13

psychological reason, to include stress

Question 14

Commanders may temporarily ________employee’s secondary-employment requests if the employee’s medical care providers’ written responses indicate the secondary employment may impede the employee’s ability to recover.

Answer 14

Suspend
Note: Commanders shall reinstate suspended secondary-employment requests upon receipt of written authorization from employee’s medical care providers indicating the secondary employment will not impede the employee’s ability to recover.

Question 15

Commanders shall provide notification, via Comm-Net message, to the appropriate Assistant Commissioner, Division commander, DRU, and Human Resources Section (Transactions Unit) of any employee who is off duty as a result of an occupational injury or illness for 10/30/45 calendar days or more.

Answer 15

30

Question 16

True or False - Supervisors shall attempt to be present when employees are being examined by medical care providers.

Answer 16

False - In no event shall supervisors attempt to be present when employees are being examined by medical care providers.

Question 17

Uniformed employees who are off
duty as a result of an industrial or non-industrial injury or illness where a physician
has diagnosed that the employee is not capable of performing the 14 California
Highway Patrol Officer Tasks should/shall not engage in any activity requiring the use of peace officer powers.

Answer 17

Shall

Question 18

Within ___ hours of reporting a
recurrence of an injury or illness, the employee shall prepare a memorandum detailing the circumstances surrounding the recurrence and a description of the injury or illness.

Answer 18

24
Note: If unable, shall prepare ASAP. Employee supervisor may prepare in the interim

Question 19

True or False - Occupational Safety Logs. Injuries and illnesses shall be recorded on the
Log within six workdays following knowledge of an injury or illness. The Log shall be updated when a status change of an injury or illness occurs.

Answer 19

True
Note: If the status of an injury or illness changes within five years of the original occurrence, the Log on which the injury or illness is recorded must be updated

Question 20

CHP 121 shall be completed by the employee’s supervisor within __ hours of notification of an alleged occupational injury or illness

Answer 20

24
Note: The employee shall review and sign the field injury file copy of the CHP 121 within 24 hours of reporting an injury or illness. Unless unable.

Question 21

True or False - The commander or designee shall review and sign the CHP 121 within three days of notification of an injury or illness.

Answer 21

True

Question 22

An employee is injured while doing a temp. assignment with another command. Which command does the CHP 121?

Answer 22

Temp command, unless during a civil disturbance.

Question 23

CHP 121A, SUPERVISORY REVIEW OF OCCUPATIONAL INJURY, ILLNESS OR EXPOSURE shall be completed by the employee’s supervisor within __ hours of notification of an alleged occupational injury, illness, or hazardous exposure

Answer 23

24
Note: Signatures are all within 24 hours

Question 24

CHP 121B, EMPLOYEE REPORT OF INJURY shall be completed and signed by the employee within __ hours of reporting an injury or illness

Answer 24

24
Note: Signatures are all within 24 hours

Question 25

CHP 121C, MEDICAL INFORMATION RELEASE AUTHORIZATION shall sign CHP 121C within __ hours of reporting an injury or illness

Answer 25

24

Question 26

True or False - CHP 121D, INJURY/ILLNESS STATUS REPORT. Commanders shall maintain a CHP 121D for employees who are off duty or assigned to limited duty as a result of an occupational injury or illness.

Answer 26

True

Question 27

MPN Designated Medical Care Provider (If an employee fails to predesignate
a medical care provider and/or facility prior to the reported injury or illness, the employee should/shall be directed by the command to a provider and/or facility within the MPN.

Answer 27

Shall

Note: If at anytime the employee objects to the physician chosen by the employer, the commander or designee shall provide the employee the name, address, and
phone number of another MPN provider and/or facility.

Question 28

Fitness for Duty: 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. Who two ways can it be done?

Answer 28

1) Department-ordered fitness-for-duty (FFD) examination
2) State Compensation Insurance Fund (SCIF)- initiated medical examination.

Question 29

Fitness for Duty: A Department-ordered FFD examination is a medical examination performed by a physician chosen by the Department to determine an employee’s ability to perform the essential duties of his/her employment classification. Who authorizes it?

Answer 29

Commanders shall obtain authorization from the appropriate Assistant Commissioner prior to initiating a Department-ordered FFD examination.
Note: Verbal authorization is all that is needed by ACF/ACS

Question 30

A SCIF-initiated medical examination may be
requested if the employee has a previous or current
related occupational injury or illness claim on file with SCI-FI. A SCIF-initiated medical examination is the equivalent of a Department-ordered FFD examination.
The medical examination is conducted by a physician
chosen by the _______, from a list provided by the
Division of Workers’ Compensation’s Medical Unit

Answer 30

Employee.

Note: The examination is cooperatively initiated by the commander and SCIF, and does not require the Assistant Commissioner’s authorization.

Question 31

Fitness for Duty: Commanders should/shall contact the Disability and Retirement Unit (DRU) to
discuss the potential conflicts of using a Department- ordered FFD examination when the involved
employee has an active, related injury or illness claim on file with SCIF.

Answer 31

Shall

Question 32

What form does a commander utilize to request a fitness for duty exam?

Answer 32

Memo

Question 33

True or False - Fitness for Duty: every effort shall be made to ensure the examining medical care provider has access to the employee’s medical history. An employee can be administratively ordered to sign the CHP 121C (release of med records).

Answer 33

False – write refusal to sign

Question 34

True or False - It is the policy of the Department that Commanders shall ensure that disabled employees return to work in a limited-duty capacity as soon as medically appropriate.

Answer 34

True

Question 35

Commanders shall assign an employee to limited duty when: (3 things)

Answer 35

1. The employee has been deemed medically unable to perform the essential duties, but approved by med provider
2. The needs of the Department require such assignment.
3. An employee has filed an application for disability retirement and is awaiting a decision by the CalPERS to approve or deny the application.

Question 36

Limited Duty: commanders may/shall revoke a uniformed employee’s peace officer powers and secure all state-issued firearms whenever the uniformed employee is on limited duty as a result of a psychological reason, to include stress.

Answer 36

Shall
Note: In those instances where commanders identify extenuating circumstances, the commander may provide justification through channels to the Office of the Commissioner, requesting a waiver.

Question 37

At the commanders approval, can an employee wear a uniform while performing a limited duty assignment?

Answer 37

employees shall not wear a uniform, display a badge, or operate an enforcement vehicle.

Question 38

Limited Duty: Can a non-uniformed employee, who is a janitor, be given a temporary assignment as an office tech, because they can not lift more than 10 pounds?

Answer 38

Yes

Question 39

When a commander becomes aware that a physician has placed an employee off work from full duty, utilizing a __________________________Report, medical restrictions shall be requested from the appropriate physician.

Answer 39

CHP 443, Limited Duty Assignment - Physician’s

Question 40

The duration of the limited duty assignment shall be directed by the nature of the injury or illness and the needs of the Department on a case-by-case basis not to exceed ___ years.

Answer 40

2

Question 41

Commanders may authorize limited duty assignments of less than one year. __________ can authorize extension every ______ months.

Answer 41

Assistant Comm. Three months

Question 42

True or False - Employees who are eligible for Labor Code Section 4800.5 time, Industrial Disability Leave, or temporary disability benefits, and are awaiting a disability retirement decision by CalPERS, shall be assigned limited duty (not to exceed the two year maximum duration).

Answer 42

True

Question 43

True or False - Employees who have depleted available leave credits and are awaiting a disability retirement decision, and have attained the minimum age for service retirement, shall be approved for limited duty assignments.

Answer 43

False – shall NOT

Note: If not old enough for service retirement, appropriate comm can approve limited duty not to exceed two years

Question 44

What shall a commander do if an employee refuses to complete a limited duty assignment?

Answer 44

Request through channels to the appropriate Commissioner to expeditiously render a departmental decision to order the employee to perform the limited duty.

Note: If an employee refuses to perform the medically approved and Department-ordered limited duty, he/she shall be removed from pay status, and action to terminate his/her employment shall be initiated

Question 45

An employee has been on limited duty for 18 months and is returning to a uniformed assignment. Can he be retrained and recertified at his local command or does he need to go to the academy for complete refresher training.

Answer 45

Academy (12-24 months off)

Note: If less than a year can do it at command. 2+ years must do reinstatement training at
academy.

Question 46

Departmental representation at a WCAB hearing is not legally required unless specifically requested by SCIF. However, the commander or designee may arrange for departmental representation if
deemed appropriate by the commander. What should be prepared after attendance?

Answer 46

Memorandum of Attendance

Question 47

A blood pressure of below _____ is required to complete in the Annual Fitness Challenge.

Answer 47

140/90
Note: commander selects an AFC coordinator, officer or sgt.

Question 48

Options Letter: In an effort to reduce the impact injuries and illnesses have on employees, the Dept shall make all reasonable efforts to fully advise injured employees of their employment options and assist them in making appropriate decisions. Commanders should/shall ensure that an employee who is medically determined to be permanently precluded from returning to his/her regular job duties is promptly provided an Options Letter.

Answer 48

Shall