HPM 10.7

Question 1

: A CHP 121 filed by an employee who is currently under an internal investigation shall be marked

Answer 1

“questionable.”

Question 2

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

Answer 2

shall

Question 3

An MIS-Web Message shall be transmitted to the appropriate Assistant Commissioner and DRU within _____hours of occurrence

Answer 3

24

Question 4

Injuries and illnesses sustained by job applicants ___ be included in departmental occupational safety statistics.

Answer 4

shall not

Question 5

. Within ___ hours of reporting a recurrence of an injury or illness, the employee shall prepare a CHP 51, Memorandum, detailing the circumstances surrounding the recurrence and a description of the injury or illness.

Answer 5

24

Question 6

. In the interim, the employee’s supervisor ___prepare a CHP 51 detailing the reported circumstances surrounding the recurrence to include a description of the injury or illness and the reason(s) for the employee’s inability to document the incident.If the employee is incapable of preparing the CHP 51 within 24 hours of reporting the recurrence

Answer 6

shall

Question 7

Information identifying the employee’s medical care provider (if applicable) ____be included within the CHP 51.

Answer 7

shall

Question 8

The following injuries and illnesses shall be recorded

Answer 8

(1) All occupational illnesses.
(2) All occupational deaths.
(3) All occupational injuries other than record only or first aid without medical expenses.

Question 9

All injuries (unless record only or first aid without medical expenses) and illnesses ____be entered on the Log and lined out if subsequently denied by State Fund.

Answer 9

shall

Question 10

(a) Injuries and illnesses which occur to employees on temporary assignment shall be recorded on the Log of the command of temporary assignment ___ the assignment is for control of civil disturbance.

Answer 10

unless

Question 11

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.

Answer 11

five

Question 12

. By____each year, Areas, communications centers, enforcement facilities, and headquarters commands shall total their previous year’s Logs and forward signed copies to their respective Divisions.

Answer 12

January 15

Question 13

Commands must save the OSHA 300 Log, the privacy case list (if one exists), and the annual summary for ______following the end of the calendar year that these records cover.

Answer 13

five years

Question 14

CHP 121s____ also be maintained five years for each injury or illness recorded on the Log.

Answer 14

shall

Question 15

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

Answer 15

24 hours

Question 16

CHP 121 ___ be typed.

Answer 16

shall

Question 17

the commander or designee shall ensure the CHP 121 (unless record only or first aid without medical expenses incurred) is filed with the appropriate SCIF office within _____ of notification of an injury or illness.

Answer 17

five days

Question 18

Completed SCIF 3301s ____be forwarded to SCIF within five days of command receipt of the forms.

Answer 18

shall

Question 19

Upon request, an employee ___ be provided with a copy of the CHP 121, CHP 121A, CHP 121B, and CHP 121C.

Answer 19

shall

Question 20

Employees desiring to predesignate a treating physician for an industrial injury must fill out a

Answer 20

CHP 242, Employee Predesignation of Treating Physician

Question 21

A supervisor ____ notify the commander when the supervisor becomes aware an employee is suffering from any condition which might limit the employee’s physical or psychological ability to perform the essential duties of the employment classification.

Answer 21

shall

Question 22

(1) Supervisors shall notify the commander if

Answer 22

it appears an employee is not making a good-faith effort toward prescribed medical rehabilitation.

Question 23

(2) Supervisors shall notify the commander of

Answer 23

any significant status change of an employee’s injury or illness.

Question 24

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

Answer 24

two years.

Question 25

Supervisors ____ contact State Fund directly to cooperatively manage injury and illness cases.

Answer 25

shall