Worker's Comp Flashcards
ALL on-duty injuries require what workers’ compensation report forms
Employee incident form
Supervisors incident investigation report
Workers’ Compensation Claim Form (DWC-1)
-to be completed if seeking medical treatment
Who to notify for workers’ comp
BC who will then notify DC
How can an employee use their own doctor for WC
Employee’s designated physician must be on file with City Risk Manager BEFORE an injury.
Otherwise, must use physician outlined in the Green Binder
Notice of Claim Form (DWC-1)
Must be given to employee within 24 hours
Must be given for all injuries
Where/how to submit WC paperwork
- Supervisor completes DWC-1, employee incident report, supervisor investigative report then sends to Fire Admin (Laura Costello). Follow up with an e-mail.
- Fill out Post Exposure Evaluation Form if needed (OPIM for example)
- Send copies to WC/risk management division.
***if city hall is closed must be in Admin and WC
By 0830 the next working day.
How long before risk/safety must notify OSHA of on duty injury?
Within 8 hours if employee is in hospital for more than observation (overnight stay)
Exposure to BBP/OPIM required forms (employee seeking treatment)
Employee Incident Report
Supervisors Investigative Report
DWC-1
Post Exposure Evaluation Form
Incident involving HAZMAT exposure.
Fill out employee incident report
Suoervisor’s investigative report
DWC-1 (if applicable)
Post Exposure Form
Hazardous Materials Exposure Form
***send to admin for department head initials
BBP/OPIM Exposure treatment
Work hours 0800-1800 Monday-Friday:
Work Partners
After Hours:
Tri-City ED or PMC
Occupational Clinics (work hours)
Concentra
Work Partners
OPIM/BBP exposure process
Decon and assessment
Possible exposure: Contact with mucous membranes or non-intact skin
- Notify Designated Officer
- complete employee and supervisor report
- DWC-1
- post exposure evaluation form
No contact/minor contact intact skin
- complete employee and supervisor report
- no lost of time off of work
