adjutant general’s department procedures 9/7/20151

Adjutant General’s DepartmentProcedures

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Process for Reporting a Work-Related InjurySupervisor Promptly Notify State

Human Resources Office

◦ All reported incidents

◦ When employee begins to lose time from work

◦ Sustains a re-injury

◦ Can’t work within restrictions

◦ Receipt of Doctor’s Notes

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Process (continued) Employee’s role

◦ Immediately notify supervisor of on-the-job injury, accident, or illness

◦ First aid or seek medical attention (Call (785) 296-2364 before seeking treatment unless Emergency Treatment needed.)

◦ Complete ◦ Employee Incident Report◦ Return medical report to Human Resources◦ Follow medical imposed work restrictions at work AND

outside of work◦ Stay in touch with supervisor/HR◦ Work with departmental payroll person on lost time

claims◦ Cooperate

◦ HR ◦ State Self Insurance Fund Contact

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Process (continued) Supervisor’s role

◦ Make sure employee gets medical attention (call State Self Insurance Fund for prior authorization unless emergency)

◦ Dial 911 if injury is potentially life threatening ◦ Complete

◦ First Report of Injury◦ Forward medical reports/Dr Notes to Human

Resources◦ Stay in touch with employee◦ Cooperate

◦ HR ◦ State Self Insurance Fund

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Process (continued) Seek medical attention

Emergencies: nearest hospital Burns: nearest hospital emergency

room Eye Injuries: nearest hospital

emergency room or Ophthalmologist

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Process - Employee FORMS

Employee Incident Report ○ Complete as soon as possible following the

incident

○ Forward to Supervisor

○ Supervisor sends to Human Resources

Medical Report/Dr. Notes○ FAX or deliver a copy to Human Resources

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Process – Supervisor

FORMSFirst Report of Injury (paper or electronic

version) Complete for ALL incidents, except minor

incidents such as paper cuts unless develops into more serious injury

Complete within 8 business HOURS (1 day)

Forward to Human Resources

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Process – Supervisor

• FORMS• Give injured employee paper

copies of:• W.C. Info Sheet

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Marti StadlerTel. 785-274-1392FAX: 785-274-1679Martha.l.stadler@us.army.mil

Jo BoswellTel. 785-274-1391FAX: 785-274-1679Jo.h.boswell@us.army.mil

Stephanie BurdettTel. 785-274-1460FAX: 785-274-1679Stephanie.k.burdett@us.army.mil

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Main Telephone Number:785-296-2364FAX: 785-296-6995

CORVEL Provider Search site:

http://www.corvel.com/provider_lookup/findProvider/findsearchparams.aspx

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Questions?Thank you for your time!

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