Policy Text
Policy
1042Mountain View Police Department
Mountain View PD Policy Manual
Copyright Lexipol, LLC 2019/12/16, All Rights Reserved.
Published with permission by Mountain View Police
DepartmentOn Duty Injuries - 1On Duty Injuries
1042.1 PURPOSE AND SCOPE
The purpose of this policy is to provide for the reporting of on-duty injuries, occupational illnesses,
or deaths to Risk Management, to ensure proper medical attention is received, and document the
circumstances of the incident.
1042.2 WORKER'S COMPENSATION FUND REPORTS
1042.2.1 INJURIES REQUIRING MEDICAL CARE
All work related injuries and work related illnesses requiring medical care must be reported to the
Risk Management Office and a claim form shall be provided to the injured employee within 24
hours from the time the injury was discovered, excluding weekends and holidays.
1042.2.2 ACCIDENT DEFINED
Accident - is defined as any occurrence from which bodily injury or property damage may
result, regardless of whether any injury or damage actually does occur (e.g., exposure where no
immediate injury is apparent).
1042.2.3 EMPLOYEE'S RESPONSIBILITY
Any employee sustaining any work-related injury or illness, as well as any employee who is
involved in any accident while on duty shall report such injury, illness or accident as soon as
practical to his/her supervisor.
Any employee observing or learning of a potentially hazardous condition is to promptly report the
condition to his/her immediate supervisor.
Any employee sustaining a work-related injury or illness that requires relief from duty is required
to be examined/treated by a doctor.
Any employee sustaining a work-related injury or illness that requires relief from duty is also
required to comply with departmental policies and directives relating to the duty to periodically call
in during absences, as well as the duty to notify the Department of any change in condition or
anticipated duration of the absence.
When appropriate, an employee being treated for an on-duty injury should inform the attending
physician that a modified duty assignment may be available at the Department. Limited-service
duty may be available for the employees whose injuries prevent resumption of regular duties.
An injured employee or employee who has suffered a work-related illness shall report as soon as
practical to his/her immediate supervisor the medical findings concerning the injury and the extent
and duration of any work restrictions if they are known. In addition, such employees are required
to promptly submit all medical releases, whether partial or full releases, to their supervisor.
Mountain View Police Department
Mountain View PD Policy Manual
On Duty Injuries
Copyright Lexipol, LLC 2019/12/16, All Rights Reserved.
Published with permission by Mountain View Police
DepartmentOn Duty Injuries - 21042.2.4 SUPERVISOR'S RESPONSIBILITY
A supervisor learning of any work-related injury, illness or accident shall promptly prepare the
Workers' Compensation Report (FI-136) and the City of Mountain View Medical referral form
(FI-137). Updated copies of forms with instructions for completion provided by Risk Management
are kept in the Sergeant's office.
For work-related accidents, injuries or illness not requiring professional medical care, a
Supervisor's Report of Injury form shall be completed in triplicate. All copies of the completed form
shall be forwarded to the supervisor's Division Commander, through the chain of command.
When an accident, injury, or illness is reported initially on the Supervisor's Report of Injury form and
the employee subsequently requires professional medical care, the State of California Employer's
Report of Occupational Injury or Illness form shall then be completed. The injured employee shall
also sign the form in the appropriate location.
Every injured employee must be provided with an Employee's Claim for Workers' Compensation
Benefits Form (DWC-1) within 24 hours, regardless of the nature of illness or injury.
Copies of any reports documenting the accident or injury should be forwarded to the Division
Commander as soon as they are completed.
1042.2.5 DIVISION COMMANDER RESPONSIBILITY
The Division Captain receiving a report of a work-related accident or injury should review the
report for accuracy and determine what additional action should be taken. The report shall then
be forwarded to the Chief of Police.
1042.2.6 CHIEF OF POLICE RESPONSIBILITY
The Police Chief shall review and forward copies of the report to the Human Resources
Department. Any copies of the report and any related documents retained by the Department shall
be filed in the employee's confidential medical file and not in the employee's personnel file (see
Policy Manual § 1026).
1042.2.7 MANAGEMENT AND FISCAL SERVICES RESPONSIBILITY
The Personnel Services Sergeant will document and forward copies of these reports to the Office
of the Risk Manager.
1042.3 SETTLEMENT OF INJURY CLAIMS
Occasionally, an employee's work-related injury results from the negligent or wrongful acts of
another, for which the employee, the City, and/or other insurers are entitled to recover civilly. To
ensure that the City's interests are protected and that the employee has the benefit of the City's
experience in these matters, the following procedure is to be followed:
1042.3.1 EMPLOYEE TO REPORT INITIAL CONTACTS
When an employee sustains work-related injuries caused by another person and is then
approached by such person or an agent, insurance company, or attorney and offered a settlement
Mountain View Police Department
Mountain View PD Policy Manual
On Duty Injuries
Copyright Lexipol, LLC 2019/12/16, All Rights Reserved.
Published with permission by Mountain View Police
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