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HomeMy WebLinkAbout110.003 - On-The-Job Injury (OJI) ReportingADMINISTRATIVE MANUAL MEDICAL ADMINISTRATIVE POLICY 110.003 ON-THE-JOB INJURY (OJI) REPORTING EFFECTIVE: OCTOBER 2007 Current Revision Date: 04/26/21 Next Revision Date: 04/26/22 Author’s Name/Rank: Bradley Dandridge, Battalion Chief Review Level: 1 Administrative Support: Evelyn Yin-Zepeda, Management Analyst II PURPOSE This policy outlines the documentation responsibilities of members, supervisors, and management staff when an employee suffers an on-the-job injury (OJI) or illness. APPLICATION Because it is recognized firefighting is an inherently hazardous occupation and injuries will occur, it is of utmost importance all members use their safety equipment and follow Fresno Fire Department (FFD or Department) procedures when performing their duties. When members in any assignment suffer an injury in the course of their employment, it is the goal of the Department to assist the member in a speedy recovery and timely return to full duty. The procedures established below will assist the injured member and supervisor in ensuring all documentation requirements are addressed. OPERATIONAL POLICY It is the policy of the Department to require documentation of all on-the-job injuries, exposures, and illnesses. OPERATIONAL GUIDELINE This section intentionally left blank. PROCESS When members receive on-the-job injuries, exposures, or illnesses, the first and foremost consideration is for the member’s well-being. Immediate and appropriate first aid or medical care will be given (see Administrative Manual, Section 110.002, Appropriate Level of Care for On-the-Job Injuries). The member’s immediate supervisor will notify his/her assigned battalion chief of the injury as soon as possible. When an injured member requires immediate medical care, he/she will be transported to the nearest or appropriate medical facility for treatment. Treatment will not be delayed. In these cases, the supervisor will complete the required documentation as soon as possible. In all other cases, the required documentation will be completed prior to a member being placed on leave to recuperate or seek medical care. DOCUMENTATION/NOTIFICATION REQUIREMENTS The following documentation/notifications are required in all instances of on-the-job injuries: Notification to an immediate supervisor. Notification to member’s assigned battalion chief. Electronic entry in the Department’s Record Management System (RMS). Supervisor’s Report of Injury (FC-06). In addition, the following forms may be required, depending on the level of care provided: Medical Service Order (MSO)/Occupational Health Providers List (FC-11). Employees Claim for Workers’ Compensation Benefits, DWC-1 (FC-17). Medical Status Report Form (FD-79). Additional documentation is required under the casualty tab of the Department’s National Fire Incident Reporting System (NFIRS) program when completing an incident report for injuries or exposures which occurred while on an emergency incident. LOSS OF TIME In instances when a member is injured in the course of his/her duties and there is loss of time or the potential for loss of time, the supervisor will notify the battalion chief, duty chief, and the Safety and Wellness Officer via email (see Administrative Manual, Section 101.001, Administrative Assignments). The supervisor will state: Section 110.003 Page 2 of 7 Employee’s name. Nature of the injury. Incident number. Date and time of injury. Confirm proper documentation has been completed. Indicate if there was time loss by the member. Indicate whether member is seeking medical care. Estimate of time member will be off duty due to injury (if known). ROUTING OF DOCUMENTATION A completed FC-06, with a completed FC-11 and FC-17 (if applicable), will be submitted through the RMS prior to the end of the shift in which the injury occurred. In the event this option is not available, forms may be accessed through the File Center, Forms, in the Department’s Learning Management System. The completed forms may be scanned and sent electronically, or hand delivered to the Safety and Wellness Office at Headquarters. Note: Telephone contact with the Safety and Wellness Officer at headquarters will be attempted prior to sending any electronic communications to provide notification documents are being sent in this manner. PRE-DESIGNATION OF PHYSICIAN Members may pre-designate their personal physician to provide medical treatment in the event of a work-related industrial injury or illness by completing a City of Fresno Medical Provider Network (MPN) Employee Physician Pre-Designation Form (FC-19). This form, with the physician’s signature, must be on file with the City of Fresno’s Risk Management Division prior to the injury or illness of the member. Note: Members may not pre-designate a chiropractor. Members who have pre-designated a personal physician may utilize pre-designated physician when medical treatment above and beyond basic first aid is required. Section 110.003 Page 3 of 7 Note: A personal physician is defined as, "The member's regular physician and/or surgeon, who has previously directed the medical treatment of the member, and who retains the member's medical records, including his/her medical history." Members who have not pre-designated a physician must utilize a Risico approved Occupational Health Provider. A current list of Occupational Health Providers can be found in the Administrative Manual, Section 106.018, Medical Service Order (MSO)/Occupational Health Providers list (FC-11). In all cases, members needing immediate emergency medical care will be taken to a hospital emergency room. MEMBER’S RESPONSIBILITES It is the member’s responsibility to notify his/her immediate supervisor of any injury, illness, or exposure incurred while on duty, no matter how trivial. This will be done as soon as possible after the injury occurs. In cases of non-emergencies, using the normal chain of command, the member may consult with his/her battalion chief to decide the appropriate level of care needed. This may or may not include a physician’s visit (see Administrative Manual, Section 110.002, Appropriate Level of Care for On-the-Job Injuries). If the member seeks medical treatment, he/she will request a completed MSO (FC-11) from the supervisor authorizing treatment by a designated medical provider or the member’s pre-designated physician. The member will also receive an Employee’s Claim for Workers’ Compensation Benefits Form (FC-17) for completion of the member’s section. Note: Upon determination by the physician the member’s injury will not require further medical care, the injury can be classified as necessitating first aid only and the FC-17 will not have to be filed. Once treated, the member will request the physician complete the appropriate FD-79, explaining the member's physical disposition. This form includes the date and nature of the injury, any work restrictions, and the expected date the member may return to work (maximum medical improvement). Once completed, the appropriate FD-79 will be delivered to the Safety and Wellness Officer at headquarters. While on injured status, the member will refrain from all activities, which will aggravate the injury or delay return to full duty. If the member will be on injured status for longer than two weeks, he/she will contact the Safety and Wellness Officer at headquarters Section 110.003 Page 4 of 7 every two weeks with status updates. The member will also be responsible to contact the Safety and Wellness Officer immediately when his/her work status changes, regardless of the duration of his/her injured status. Note: Work permits are not valid during periods of Temporary Total Disability (TTD). SUPERVISOR’S RESPONSIBILITIES Upon being notified by a member of an on-the-job injury, illness or exposure, the supervisor will ensure the well-being of the member and assist in delivering appropriate patient care if needed. The supervisor is responsible for ensuring all required documentation is completed. With any on-the-job injury, illness or exposure, the supervisor must complete the Supervisor’s Report of Injury form (FC-06), paying particular attention to the sections describing what the member was doing and how the member was injured. If the member sees a physician for first aid or requires medical treatment as defined in Administrative Manual, Section 110.002, the supervisor will issue a Medical Service Order (FC-11). When the member requires medical treatment above and beyond basic first aid or loses time beyond the day of injury, an Employee’s Claim for Workers’ Compensation Benefits Form (FC-17) will be provided to the member within one workday. The supervisor will complete an electronic entry in the RMS, describing the “who, what, where, when, and how” of the injury, indicating whether or not there was time loss, and documenting the completion of all appropriate Department forms (FC-06, FC-11, and FC-17). If the member’s injury occurred during an emergency incident, the supervisor will make appropriate documentation under the casualty tab of the Department’s NFIRS program. MSO An MSO will be issued by a fire officer or supervisor only for injuries and exposures occurring on the job when a member is seen by a physician. The MSO must be completed prior to the member seeking medical care unless the member requires immediate care. An MSO will not be issued for complaints of stress or illness. For complaints other than injuries and exposures, members will seek his/her own medical care and file a non-industrial, employee health benefit claim through his/her physician. Section 110.003 Page 5 of 7 EMPLOYEE’S CLAIM FOR WORKERS’ COMPENSATION BENEFITS The FC-17 will be given to the member for completion of the member’s (EMPLOYEE) portion. Upon completion of the EMPLOYEE portion, the form will be returned to the company officer or direct supervisor; and a copy of the form, with the EMPLOYEE section completed and signed, will be given to the member. The company officer or direct supervisor will complete the supervisor’s (EMPLOYER) portion of the form and ensure the form is delivered to the Safety and Wellness Officer at headquarters immediately upon completion. Note: Upon determination by the physician the member’s injury will not require further medical care, the injury can be classified as necessitating first aid only and the FC-17 will not have to be filed. MEMBER SEEKING DELAYED MEDICAL CARE If a member who sustained and originally reported an on-the-job injury or illness but did not seek medical care determines at a later point that medical care is needed, he/she must request the FC-11 and FC-17. If possible, the request will be made at the station where the injury occurred. The company officer at appropriate station will confirm all appropriate documentation was completed on the original injury date. Note: If the request for the FC-11 and FC-17 is not made at the station where the injury occurred, the company officer must contact the original station, confirm appropriate documentation, and have the original entries amended and identified as late entries. When a member requests delayed medical care for an injury not previously reported, the company officer will make all pertinent entries in the RMS. If the injury occurred during an emergency event, the NFIRS report will be updated utilizing the casualty tab and the appropriate battalion chief will be advised. Note: The injured member will be required to submit a memorandum through channels to the Fire Chief, as outlined below in “Delayed Reporting of Injuries.” Section 110.003 Page 6 of 7 DELAYED REPORTING OF INJURIES If a member is reporting an injury at a date later than the shift or day when the injury occurred, the member will submit a memorandum through channels to the Fire Chief, indicating the reasons for the delay in reporting the injury. The memorandum will state all pertinent information related to the injury. The supervisor on duty at the station where the delayed injury report is being submitted will complete all required documentation. If applicable, the company officer will contact the station where the injury occurred and request all pertinent documentation to be made. INFORMATION This section intentionally left blank. DEFINITIONS This section intentionally left blank. CROSS-REFERENCES Administrative Manual Section 101.001, Administrative Assignments Section 106.015, Supervisor’s Report of Injury (FC-06) Section 106.018, Medical Service Order (MSO)/Occupational Health Providers List (FC-11) Section 106.020, Employee Claim for Workers’ Compensation Benefits (FC-17) Section 106.022, Employee Physician Pre-Designation form (FC-19) Section 106.141, Medical Status Report Form (FD-79) Section 110.001, Guidelines and Responsibilities Section 110.002, Appropriate Level of Care for On-the-Job Injuries (OJI) Section 110.003 Page 7 of 7