TFD On-the-Job Injury and Illness Reporting Policy

• This document establishes the TFD's policy on reporting and recording on-the-job injuries and illnesses.
• Procedures for reporting on-the-job injuries/illnesses and time off/medical treatment due to injury/illness are included.
• This policy applies to all TFD personnel.
• This document replaces TFD Policy 5013, which was dated November 2001.

Associated Forms

• The document includes various forms for different personnel categories
• LEOFF II and Civilian employees use HRE 002 (Supervisor’s Report), SIF-2 (Self Insurer Accident Report), Physician’s Initial Report, Medical Fitness Report (MFR), and OSHA Form 300A.
• LEOFF I employees use FIR 139 (Physician’s Report), HRE 002 (Supervisor’s Report), and PER 879 (Application for Sick/Disability Benefits).
• Exposure-related incidents require FR 609100001 (Source Patient Consent Form) and HRE 003 (Exposure Report).

Related TFD Policies

• Further TFD-specific information is available in TFD Policy 1015 (Transitional Assignment), 3505 (Exposure Control Plan for Bloodborne Pathogens), 5005 (Safety Committee), 5007 (Vehicle/Apparatus Accidents), and 5014 (Serious Injuries/Fatalities).

Responsibilities

• The Fire Chief or designee ensures a safe work environment for all TFD personnel.
• The Deputy Chief of Support Services coordinates workers’ compensation issues and manages transitional assignments for injured TFD employees.
• The Administrative Battalion Chief for Safety investigates/tracks injuries/illnesses, monitors trends, reviews cases with the Safety Committee, and maintains the policy document.
• Station Captains provide LEOFF 2 OJI packets, LEOFF I OJI forms, exposure packets, and ensure OSHA Form 300A is posted.
• Company Officers document and report employee on-the-job injuries/illnesses per provided guidelines.
• The Financial Assistant for Payroll at Fire Headquarters receives and processes employee paperwork related to on-the-job injuries and illnesses.
• TFD personnel are responsible for reporting on-the-job injuries/illnesses and submitting related paperwork as per the guidelines.

Definitions

• EMIR means Emergency Medical Incident Report.
• Health Care Providers are defined as doctors of medicine/osteopathy authorized to practice in the state and also includes state-licensed professionals (Podiatrist, Dentist, Clinical psychologist, Clinical social worker, Optometrist, Chiropractors, Nurse practitioners, and Nurse-midwives), Christian Science practitioners, and health plan benefits manager.
• LEOFF I personnel includes members with prior rights (employed under the old 41.18 pension act, actively employed on March 1, 1970) and members with no prior rights (hired before October 1977).
• LEOFF II personnel are individuals hired on or after October 1, 1977.
• Occupational Exposure is defined as reasonably anticipated contact (skin, eye, mucous membrane, or parenteral) with blood or potentially infectious materials during employee duties.
• OJI means on-the-job injury, illness, or disability.
• OSHA means Occupational Safety and Health Administration.

General Rules

• All on-the-job injuries/illnesses (OJI) sustained by TFD employees must be reported and properly documented.
• TFD personnel must report occupational accidents causing injury/illness or illnesses from occupational exposure to their supervisor within 24 hours or before the end of their duty period.
• Reports can be made by the injured/ill employee or someone designated on their behalf.
• Employees must report symptoms of injuries/illnesses within 48 hours of awareness, if the symptoms were not initially apparent.
• The Financial Assistant for Payroll must maintain records of all reported on-the-job injuries/illnesses, which includes every occupational death and injuries involving unconsciousness, inability to perform regular duties or work full-time, transitional assignment, or medical treatment beyond first-aid.
• The TFD Safety Office must post an annual summary of occupational injuries/illnesses at each TFD station/facility.
• The summary must include totals from OSHA Form 300A, the calendar year covered, the company and establishment name, and a certification signature, title, and date.
• The summary must be completed/posted by February 1 each year and remain posted until March 1 of the same year.

Reporting Procedures: LEOFF 1, LEOFF 2, Civilian Employees

• Notify supervisor.
• Refer to other TFD policies that may contain additional reporting requirements related the circumstance of your injury or illness.
• In case of exposure to bloodborne pathogens, follow procedures in TFD Policy 3505.
• Fill out HRE 002 with your supervisor.
• Route the completed HRE 002 to the Financial Assistant for Payroll at Fire Headquarters.

Supervisor Responsibilities

• Refer to other TFD policies for additional reporting requirements related to the circumstances of the employee’s reported OJI.
• If there is exposure to bloodborne pathogens, follow procedures in TFD Policy 3505.
• Note the time and circumstances of the employee's OJI in the company's daybook.
• Fill out HRE 002 with the employee.
• Route the completed HRE 002 to the Payroll Clerk at Fire Headquarters.
• Enter relevant information into the Incident Reporting System if the OJI occurred during an emergency incident.
• Ensure an EMIR is completed, if the OJI generated a medical incident.

Procedures for Time Off/Medical Treatment: LEOFF 2 and Civilian Employees

• Operations personnel call the sick line recorder (591-KISS).
• Non-operations personnel call your supervisor.
• Obtain an OJI packet that contains the required forms and detailed instructions.
• Arrange to be seen by your Health Care Provider (HCP) as soon as possible.
• Inform your HCP that your employer is self-insured.
• Ask doctor to complete a "Physician's Initial Report" and send all medical bills to the Workers Compensation Third Party Administrator.
• If applicable, ask HCP to fill out the Medical Fitness Report and submit it to the Financial Assistant for Payroll at TFD Headquarters.
• Complete SIF-2 and route it to the Financial Assistant for Payroll at TFD Headquarters.
• Keep the Deputy Chief of Support Services informed about your OJI and return to work status.

Procedures for Time Off/Medical Treatment: LEOFF 1 Personnel

• For Operations personnel, leave a message on the sick leave recorder (591-KISS).
• If you are not assigned to Operations, call your supervisor.
• Complete PER 879, noting the OJI date and leaving "days/hours" and "ending date" blank if off for an extended period; submit right away.
• Route PER 879 to the Financial Assistant for Payroll at TFD Headquarters.
• Complete FIR 139, fill out the employee's part of the "Verification of On-the-Job Injury" section
• Have your doctor (M.D. or D.O. only) complete and sign the physician's part of the "Verification of On-the-Job Injury" section.
• Route the completed FIR 139 to the Financial Assistant for Payroll at TFD Headquarters.