Go 40 Injury Recording And Reports

Front 1

FPDR stands for

Back 1

Fire Police Disability & Retirement

Front 2

DILD stands for

Back 2

Disability in Line of Duty

Front 3

APR stands for

Back 3

Attending Physician Report

Front 4

WSR stands for

Back 4

Work Status Report

Front 5

WC stands for

Back 5

Workers Compensation

Front 6

Under Workers Compensation what report is used for on the job injury

Back 6

801

Front 7

Which employees are eligible?

Back 7

FPDR

• sworn members
• sworn members under PERS hired after 1/1/2007

WC

• Sworn members under PERS hired prior to 1/1/2007
• Non-Sworn members

Front 8

What is the procedure for FPDR members with injury in the Line of Duty or Occupational Illness with no time loss or medical expense?

Back 8

1. Complete Personnel Injury Report in Personnel System
2. Enter injury in the Company Journal System/Entry Tab in red
3. If during hostile fire complete the "Fire Service Casualty" tab in the Incident System

Front 9

What is the procedure for FPDR members with injury in the Line of Duty or Occupational Illness with time loss or medical expense?

Back 9

1. Complete the Personal Injury Report in the Personnel System
2. Obtain purple "on-the-job" injury packet
3. Complete DILD report
4. Have attending physician complete the APR and forward it by fax and mail to FPDR
5. Line personnel enter injury in the Company Journal in red
6. If injury occurs while dealing with hostile fire complete the "Fire Service Casualty" tab in the Incident System.
7. For each period of approved time loss, have attending physician complete WSR

Front 10

T/F - A personnel injury report in the Personnel System must be completed regardless of time loss or medical expense.

Back 10

True

Front 11

For each period of approved time loss, have the attending physician complete a ____.

Back 11

WSR (Work Status Report) must be submitted prior to returning to work

Front 12

T/F - A personnel injury report in the Personnel System must be completed regardless of time loss or medical expense.

Back 12

True

Front 13

FPDR - Notify Company Officer of the injury without ______ and pick-up the ______ packet.

Back 13

without delay and pick-up the purple packet.

Front 14

In what circumstance do you notify the Company Officer after the physician's diagnosis?

Back 14

If its an occupational illness

Front 15

Can you go to your hospital of choice?

Back 15

Yes- for initial treatment of an injury. After approval must go to provider in MHN (Managed Healthcare Network)

Front 16

When should you notify the Company Officer of estimated leave time needed?

Back 16

After conferring with attending physician

Front 17

For each period of time loss, the member shall submit a ____

Back 17

WSR - Work Status Report - signed by physician. Must be turned in before end of pay period

Front 18

The member shall give ____ notice to the Company Officer of intent to return to duty

Back 18

advanced notice - normally after attending physician has signed the WSR

Front 19

T/F - If there has been no loss of time for duty a WSR is still required.

Back 19

False - only required when there is time loss

Front 20

The member shall submit a ____ to the Company Officer before returning to duty

Back 20

WSR - Work Status Report

Front 21

Who is responsible for cost if the disease or injury is non-service connected.

Back 21

The member

Front 22

Are service disabilities taxable?

Back 22

No - service disabilities are non-taxable income under both Federal and State income laws

Front 23

If a member collects damages from a third party do they have to pay the city back?

Back 23

Yes - they must reimburse FPDR for cost related to their claim. Except - money from own insurance or similar coverage

Front 24

What color of envelope is used for injury reports

Back 24

Red - Officers (callshift, details etc.) should check content and act accordingly

Front 25

As the company officer who and when do you report the disability?

Back 25

to the respective on-duty BC without delay. If the injury occurs and regular BC is not on duty send to BC who was on-duty at the time of injury.

Front 26

As the company officer which report form do you complete?

Back 26

the Personnel Injury Report in the Personnel System and forward to BC on-duty at time of injury.

Front 27

In addition to the Personal Injury Report the officer must also make an entry into the_______________

Back 27

Company Journal in red -

Front 28

If the injury is a result of a hostile fire complete the ______

Back 28

Fire Casualty Report in the Incident System.

Front 29

T/F - the member must complete the DILD report.

Back 29

False - they should fill it out, however, the officer can assist or do it for them if necessary. However, it must be signed by the injured worker.

Front 30

The officer should check the DILD for ________ and ______ and forward it to the ______

Back 30

accuracy and completeness and forward to respective BC

Front 31

When a WSR is received by a company officer they shall ____ it and forward to ____

Back 31

sign it and forward to BC

Front 32

T/F - a shift designation is required on the WSR.

Back 32

False - no shift designation is required on the WSR

Front 33

What are the BC's responsibilities

Back 33

1. Check red envelopes
2. Report disability to on-duty Deputy Chief
3. Arrange for replacement
4. Check Personnel Injury report for accuracy
5. Check for hostile fire and incident report
6. Check DILD report (sign and fax to FPDR)
7. When WSR is received check for accuracy (sign and forward to BHQ)

Front 34

To qualify for non-service disability a member must have ____ years in.

Back 34

Ten - from date of permanent appointment

Front 35

Can a member use vacation or sick leave before going on Non-service disability?

Back 35

Yes - tell the Officer or BHQ whether you wish to use it or not before going on non-service disability.

Front 36

What documents are required for non-service disability?

Back 36

1. Non-Service Disability Report
2. Attending Physicians Report (APR)
3. WSR - Work Status Report (each month) no later than last day of each month

Front 37

Before returning to work from a non-service disability a member shall turn-in a _____.

Back 37

a signed WSR. This should be advanced notice and normally given immediately after physician has signed WSR.

Front 38

When are non-service benefit checks issued?

Back 38

once a month on the second Tuesday

Front 39

Are non-service benefits taxable?

Back 39

yes - under both State and Federal tax laws

Front 40

What is the 30-day rule?

Back 40

application must be submitted for disability benefits no later than 30-days after the member is injured or illness. Unless there is good cause for failing to do so.

Front 41

T/F - failing to file a claim for disability benefits within 30-days bars you from filing later.

FPDR members only

Back 41

True - failure to file within time frame specified bars a claim.

Front 42

What is the 14-day rule?

FPDR members only

Back 42

If you used sick leave pending a claim approval you will be reimbursed 100% if you file your claim within 14-days. After 14-days reimbursement will be at 75%

Front 43

For Workers Comp Employees what color of packet do they pick-up?

Back 43

white

Front 44

What are the steps for a WC employee with time loss or medical expense?

Back 44

1. Personnel Injury Report - Personnel System
2. White Packet
3. WC Claim Form 801
4. Entry in Company Journal in red
5. Fire Service Casualty report of applicable
6. Each pay period, after disability, Continued Disability Report or Notice of Recovery Form 200.18

Front 45

For a previous injury which has been aggravated, complete the ________ (WC should complete this form).

Back 45

Notice of Claim for Aggravation which can be obtained at your doctors office

Front 46

Regardless of time loss or medical expense if you have an injury complete the ________

Back 46

personnel injury report in the Personnel System

Front 47

Members covered by Risk Management (WC) who have time loss from work due to an on the job injury must contact ________ ________

Back 47

Risk Management immediately

Front 48

Non Service Disability (PERS members)

Back 48

1. ten years - includes six month waiting period
2. off over 90 days

Front 49

Additional Rule (PERS) - employees are paid their ____ ____ when they are absent for ____ days following an on the job injury or illness upon claim acceptance.

Back 49

full wage when they are absent for three days

Front 50

For information regarding the status of City paid benefits while on disability, refer to the _______

Back 50

Labor Agreement

Front 51

Whenever a Continued Disability Report or Notice of Recovery form 200.18 is received, a Company Officer shall ______

Back 51

sign it and forward to respective BC, no shift designation required.