TFD On-the-Job Injury and Illness Reporting Policy

• This document outlines the TFD's policies for reporting and recording on-the-job injuries and illnesses.
• It provides procedures for reporting on-the-job injuries/illnesses and time off or medical treatment resulting from them.
• This policy applies to all TFD personnel.
• This document supersedes TFD Policy 5013, which was about reporting on-the-job injuries or illnesses and was dated November 2001.

Associated Forms

• LEOFF II and Civilian: 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: FIR 139 (Physician’s Report on TFD employee), HRE 002 (Supervisor’s Report), and PER 879 (Application for Sick and/or Disability Benefits).
• Exposure: FR 609100001 (Source Patient Consent Form) and HRE 003 (Exposure Report).

Related TFD Policies

• Users should consult TFD Policy 1015 (Transitional Assignment).
• Reference TFD Policy 3505 (Exposure Control Plan for Bloodborne Pathogens).
• Refer to TFD Policy 5005 (Safety Committee).
• Reference TFD Policy 5007 (Vehicle, Apparatus and Specialty Trailer Accidents).
• Reference TFD Policy 5014 (Reporting and Investigating Serious Injuries or Fatalities) for related information.

Responsibilities

• The Fire Chief or their designee ensures a safe and healthy work environment for all TFD personnel.
• The Deputy Chief of Support Services coordinates worker's compensation issues and manages transitional assignments/return to work for injured TFD employees.
• The Administrative Battalion Chief for Safety investigates reported injuries/illnesses, tracks all injuries, monitors injury/illness trends, reviews cases with the TFD Safety Committee, and maintains this document.
• Station Captains provide LEOFF 2 OJI packets, LEOFF I OJI forms, and exposure packets.
• They also order additional forms/packets and ensure OSHA Form 300A is posted. Company Officers document and report employee reports of on-the-job injuries/illnesses.
• The Financial Assistant for Payroll at Fire Headquarters receives and processes employee paperwork related to on-the-job injury/illness reports.
• TFD personnel must report on-the-job injuries/illnesses and submit paperwork according to guidelines.

Definitions

• EMIR: Emergency Medical Incident Report.
• Health Care Provider: Doctors of medicine or osteopathy authorized to practice medicine or surgery.
• State licensed professionals considered health care providers include Podiatrists, Dentists, Clinical psychologists, Clinical social workers, Optometrists, Chiropractors (limited to certain spinal manipulations), Nurse practitioners, and Nurse-midwives.
• Also included are Christian Science practitioners listed with the First Church of Christ, Scientist in Boston, Massachusetts and other health care providers recognized by the employer's group health plan.
• LEOFF I Personnel: Includes members with prior rights (employed under the old 41.18 pension act and actively employed on March 1, 1970) and members with no prior rights (hired prior to October 1977).
• LEOFF II Personnel: Individuals hired on or after October 1, 1977.
• Occupational Exposure: Reasonably anticipated contact with blood or other potentially infectious materials through skin, eye, mucous membrane, or parenteral contact.
• OJI: On-the-job injury, illness, or disability.
• OSHA: Occupational Safety and Health Administration.

Rules and Guidelines

• All on-the-job injuries and illnesses (OJI) sustained by TFD employees must be reported and documented.
• TFD personnel must report any occupational accident causing injury/illness or any apparent illness caused by occupational exposure to their supervisor before end of duty period/within 24 hours of incident.
• The injured/ill employee or someone designated makes the report.
• If symptoms aren't apparent at the time of the incident, report them within 48 hours of awareness.
• The Financial Assistant for Payroll maintains records of all reported on-the-job injuries and illnesses including every occupational death and each injury involving unconsciousness, inability to perform duties/work full-time, transitional assignment, or medical treatment beyond first-aid.
• The TFD Safety Office posts an annual summary of occupational injuries/illnesses on the safety bulletin board at each station/facility.
• The summary includes totals from OSHA Form 300A, calendar year covered, company/establishment name, and certification signature/title/date.
• The summary is completed/posted by February 1 each year and remains in place until March 1 of the same year.

Procedures

• LEOFF 1, LEOFF 2, and Civilian Employees must notify their supervisor and refer to other TFD policies.
• For OJI involving bloodborne pathogen exposure, follow TFD Policy 3505.
• Complete HRE 002 with supervisor and send it to the Financial Assistant for Payroll at Fire Headquarters.
• Supervisors should refer employees to other TFD policies that may contain additional reporting requirements related to the circumstances of the employee’s reported OJI.
• In the event of bloodborne pathogen exposure, procedures outlined in TFD Policy 3505 must be followed.
• Note the time and circumstances of the employee's OJI in the company's daybook.
• Complete HRE 002 with the employee and route it to the Payroll Clerk at Fire Headquarters.
• If the OJI occurred during an emergency, input details into the Incident Reporting System and ensure an EMIR is completed if it involved a medical incident.
• LEOFF 2 and Civilian Employees taking time off due to injury/illness should have operations personnel call the sick line recorder (591-KISS) or non-operations personnel call the supervisor.
• Next, obtain an OJI packet with required forms/instructions and arrange a visit with Health Care Provider (HCP) as soon as possible.
• When visiting the HCP, state that your employer is self-insured and ask the HCP to complete "Physician's Initial Report" and send medical bills to the Workers Compensation Third Party Administrator as identified on the report.
• If applicable, ask your HCP to fill out/submit the Medical Fitness Report to the Financial Assistant for Payroll at TFD Headquarters.
• Complete SIF-2 and route it to the Financial Assistant for Payroll and keep the Deputy Chief of Support Services informed on your OJI/return to work status.
• LEOFF 1 Personnel assigned to Operations: Leave a message on the sick leave recorder (591-KISS).
• LEOFF 1 Personnel not assigned to Operations, call your supervisor and complete PER 879.
• Note the OJI date in the "reasons" section and leave the "days/hours" and "ending date" blank if off work for extended period and do not wait to submit until you return to work.
• 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) sign/complete the physician's part, and route the completed FIR 139 to the Financial Assistant for Payroll at TFD Headquarters.