Workplace Injury Reporting for GSA Supervisors

Workplace Injury Reporting for GSA Supervisors

An Employee is Hurt! What Now? Employees who are injured on the job must immediately notify their supervisor about the time, place, type, and severity of the injury.

What if the Injury Requires Medical Treatment? Ensure your injured employee receives immediate and appropriate medical attention. Direct the employee to one of the authorized primary care facilities, unless it is a life threatening injury. If necessary, escort your employee!

What is the Next Step? For any injury resulting in lost time (beyond day of injury) Give the employee an “ Employee Claim for Workers’ C ompensation Benefits (RM-135 /DWC-1)” within 24 hours of knowledge of the injury.

Employee’s Claim for Workers’ Compensation Benefits (RM-135/DWC-1)

What Else Does the Supervisor Need to Give the Employee? Also give the employee a “Physician’s Notice of Return to Work” for m (RM-505) ” to present to the treating physician for completion.

Physician’s Notice of Return to Work” (RM-505)

What if the Employee is Unavailable? The Workers’ Compensation Claim form (RM135) must be mailed (by certified post) or hand delivered to the employee within 24 hours

What’s Next? Complete the “ Employer’s Report of Occupational Injury or Illnes s” (RM-75) Be sure to note date when the claim form was given to the employee. If in doubt – fill it out!

Employer’s Report of Occupational Injury or Illness (RM-75)

To Whom do I Send the Employer’s Report? Within 24 hours, send the Employer’s Report to GSA Personnel #1060 [email protected] /FAX 662-6764 Follow your departmental procedures to notify your management of the employee injury.

What Does the Supervisor Do in the Event of a Severe Injury? Severe injuries are defined as: hospitalization for 24 hours; amputations; disfigurement; or death. They must be reported immediately to: 1) CorVel Risk Management at (866) 785-2835 or (805) 389-4200 2) Cal/OSHA (805) 654-4581

What if the Injury is Minor? If the injury doesn’t require medical treatment (other than first aid) Document the injury. Complete Employer’s Report of Occupational Injury or Illness” (RM-75) and note “for reporting purposes only.” Forward to GSA Personnel/Safety #1060 If in doubt – fill it out!

Always Investigate Workplace Accidents & Near-Misses Investigate as soon as possible & to prevent a reoccurrence - immediately correct any unsafe condition. Complete the “ Accident / Incident / Near- Miss Investigation R eport” & forward a copy to GSA Personnel/Safety #1060.

Accident / Incident / Near-Miss Investigation Report

Security Incident Report Option In the event that a third party report would be helpful, call Security at (805) 654-2932 to request an independent investigation. The supervisor must still conduct an their own investigation.

Reporting Checklist Provide Workers’ Compensation claim form (RM- 135) to employee If form is returned by employee forward to GSA/HR #1060 Complete Employer’s Report of Occupational Injury or Illness (RM75) Ecopy Employer’s Report to Personnel & mail original #1060 Follow-up with Incident/Accident Investigation

Helpful Numbers CORVEL Risk Management – Phone: (805) 389-4200 or (866) 785-2835 – FAX: (805) 389-4231 GSA Safety & Personnel – Phone: (805) 662-6506 or (805) 645-1329 – [email protected] – FAX: (805) 662-6764 Workers Compensation Risk Management – Phone: (805) 662-6536 – FAX: (805) 648-9238 Local State Workers’ Comp Office (805) 485-3528 Cal/OSHA Ventura Office (805) 654-4581 Security (805) 654-2931

Reporting Forms Employee’s Claim for Workers’ Compensation (RM-135/DWC-1) Employer's First Report of Occupational Injury or Illness (RM-75) Physicians Notice of Return to Work or Temporary Medical Restrictions (RM-505) Accident / Incident / Near-Miss Investigation Report (CEORM-75I)

Helpful Websites CA Dept of Industrial Relations – Workers’ Comp http://www.dir.ca.gov/dwc/dwc home page.htm Cal/OSHA http://www.dir.ca.gov/dosh/dosh1.html OSHA http://www.osha.gov/ VC Web Risk Management Workers Compensation & Disability http://vcweb/ceo/Risk/WorkComp.htm VC Web Risk Management Health & Safety http://vcweb/ceo/Risk/HSLP HMAP.htm