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Policy 1022Santa Ana Police Department Santa Ana PD Policy Manual Copyright Lexipol, LLC 2020/07/30, All Rights Reserved. Published with permission by Santa Ana Police DepartmentIndustrial and Non-Industrial Injury and Illness Reporting - 1Industrial and Non-Industrial Injury and Illness Reporting 1022.1 PURPOSE AND SCOPE This policy provides guidance regarding the timely reporting of occupational diseases, mental health issues, and work-related injuries. 1022.1.1 DEFINITIONS Definitions related to this policy include: Occupational disease or work-related injury - An injury, disease or mental health issues arising out of employment (Labor Code § 3208; Labor Code § 3208.3; Labor Code § 3212 et seq.). 1022.2 POLICY The Santa Ana Police Department will address occupational diseases and work-related injuries appropriately, and will comply with applicable state workers’ compensation requirements (Labor Code § 3200 et seq.). 1022.3 RESPONSIBILITIES 1022.3.1 MEMBER RESPONSIBILITIES - REPORTING INDUSTRIAL INJURIES AND ILLNESSES Any member sustaining any occupational disease or work-related injury shall report such event as soon as practical, but within 24 hours, to a supervisor, and shall seek medical care when appropriate (8 CCR 14300.35). If an un-witnessed injury occurs, the employee must submit a memo detailing the circumstances surrounding the injury to his/her supervisor within 24 hours of reporting the incident. All injuries must be reported on a DWC Form 1 (Employee's Claim for Workers' Compensation Benefits). The employee shall complete the top portion of the DWC Form 1, sign it and submit it to his/her supervisor. A supervisor's approval is required to obtain medical treatment. The supervisor will provide a Medical Service Order indicating an approved medical facility to be used for the treatment of work- related injuries. Following the medical visit, a copy of the medical service order completed by the treating physician must be returned to the supervisor with notification of the employee's work status to Police Human Resources. 1022.3.2 MEMBER RESPONSIBILITIES - REQUIRED REPORTING FOLLOWING RECEIPT OF TREATMENT 1.After examination by the treating physician, the member will obtain a written statement from the doctor describing the medical restrictions, if any, or release to unrestricted duty. The member shall submit the document to his/her supervisor or the Watch Commander and notify Police Human Resources staff. Santa Ana Police Department Santa Ana PD Policy Manual Industrial and Non-Industrial Injury and Illness Reporting Copyright Lexipol, LLC 2020/07/30, All Rights Reserved. Published with permission by Santa Ana Police DepartmentIndustrial and Non-Industrial Injury and Illness Reporting - 22.The member must obtain a physician’s note for each visit to the doctor or physical therapy. Following each visit, the member shall immediately call in or fax his or her updated work status to his/her supervisor and Police Human Resources staff. (a)If a member's medical visit for an industrial injury/illness occurs during on-duty hours, the member will submit an IOD chit with the corresponding physician’s note as supporting documentation to the member’s supervisor which must be forwarded to Police Human Resources for processing. (b)If the medical visit for an industrial injury/illness occurs during off-duty hours, an IOD chit is not required. 1022.3.3 MEMBER RESPONSIBILITIES - REPORTING NON-INDUSTRIAL INJURIES AND ILLNESSES 1.The employee taking sick leave shall notify his/ her immediate supervisor or designee not less than one hour prior to the time he/ she is scheduled to report for duty. When the absence is more than three consecutive working days, on the fourth day, the employee must present to the Police Chief or designee, a physician’s certificate stating, in the physician’s opinion, the employee could not report to work. A physician’s certificate of illness or injury may be required after an absence of any duration of less than three days. 2.An employee may need extended medical leave due to a non-industrial injury or illness. Extended medical leave is an absence that lasts longer than five consecutive workdays. On such occasions, the employee is required to provide his/her supervisor with a physician’s certificate that indicates he/ she cannot work and the estimated date he/she may return to full duty. 3.Upon the employee's release to modified duty, the physician’s certificate must provide the exact limitations in writing and the estimated date the employee may return to full duty. The supervisor will attempt to provide a temporary modified duty assignment when available until the physician releases the employee to full unrestricted duty. 4.A physician’s certificate is required from the physician releasing the employee to full unrestricted duty. Such physician’s certificate shall be forwarded to Police Human Resources. 1022.3.4 SUPERVISOR RESPONSIBILITIES - REPORTING INDUSTRIAL INJURIES AND ILLNESSES 1.It shall be the responsibility of each supervisor to investigate and document all reports of industrial injuries- which are brought to his/her attention. 2.Each injury shall be documented by the employee on a DWC Form 1 (Employee’s Claim for Workers’ Compensation Benefits) and by the supervisor on the Supervisor’s Accident Investigation Report. The DWC Form 1 and the Supervisor’s Accident Investigation Report shall be submitted to Police Human Resources. 3.If an employee reports an injury and does not want or need medical treatment, the supervisor shall complete the Supervisor’s Accident