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Supervisor Incident Protocol

What to do when injury occurs

Related Supervisor Incident Report Form Late Incident Reporting Increased Lost Days, Costs, and Litigation Transitional Work Program Temporary work modification to facilitate medical recovery

Upon knowledge of injury there are three (3) immediate actions a supervisor must take. If the employee loses time from work, there are an additional three (3) actions.

Immediately:

1. Refer the employee to UCSF's Designated Medical Provider.
2. Remove, tag, and store any broken equipment that caused injury.
3. Complete the Supervisor Incident Report (SIR) form and fax to DMS at (415) 476-2328.

Detailed procedure

1. A) Emergency (serious injury)

   1. Escort the employee to the nearest emergency medical care facility.

   2. Call an ambulance if necessary.

   3. For follow-up care, refer the employee to either:

   • Occupational Health Services (415) 885-7580

   • 2330 Post Street, Suite 460, San Francisco, California 94115

   • St. Francis Memorial Health Center at SBC Park (415) 972-2249

   • 24 Willie Mays Plaza San Francisco, California 94107-2134

   4. Call Disability Management Services (415) 476-2621 as soon as possible to report all Serious or Fatal injuries by phone.

   B) Acute care (non-emergency)

   1. Advise the employee to call Employee Health Services (415) 885-7580 or St. Francis Memorial Health Center at SBC (415) 972-2249 for a medical appointment.

   2. If injury occurs after clinic hours, refer the employee to Long Emergency Department.

2. Remove and store any broken equipment that caused injury.

   Do not discard equipment or furnishings that have caused injury:

   • Remove the equipment from service.

   • Tag the equipment for identification.

   • Call Environmental Helath & Safety at (415) 476-1300 for inspection.

3. Send FMLA materials to the employee, if employee meets FMLA criteria.

   Send the FMLA materials if:

   1. You receive notice that W/C Temporary Disability payments have been made, and

   2. The employee has at least 12 months of aggregate University service (need not be continuous), and

   3. The employee has at least 1,250 hours of actual work in the 12 months immediately preceding the leave.

4. Provide Transitional (Modified) Work

   • Make every effort to reduce lost workdays by providing medically appropriate modified work during the transitional stages of your employee's medical recovery.

   • Call Disability Management Services (415) 476-2621 for assistance and consultation in designing transitional/modified work.

   • The day your employee returns to work, call: Sedgwick CMS (510) 302-3180, to prevent overpayment of disability benefits.

By taking the above actions, campus supervisor will:

1. Minimize the severity of the employee's injury.

2. Prevent future injuries by maintaining a safe work environment.

3. Avoid legal fines and penalties being assessed against their departments.

4. Minimize financial loss to the employee, the department, and the university as a whole.

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