HR Home | Jobs | Benefits | Training | Policies | Staffing/Comp | Disability Mgmt | FSAP | Publications | TEP

Username		Password		Lost password? | Help			Auto-login?
Trouble Logging in to At Your Service? Email: customer.service@ucop.edu

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.

If the employee loses time from work beyond the day of injury:

1. Initiate Workers' Compensation payroll procedures.
2. Send FMLA materials to the employee, if the employee meets eligibility criteria.
3. Provide Transitional (modified) Work during the employee's recovery period.

Detailed procedures

1. Refer the employee to UCSF's designated medical provider.

   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:

   • Employee Health Services (415) 885-7580

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

   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. Complete the Supervisor Incident Report (SIR) form.

   • Complete the SIR form within 24 hours.

   • Fax the form to Disability Management Services at (415) 476-2328.

   • Mail the original to Disability Management Services at UCSF Box 0964.

4. Initiate workers' compensation payroll procedures

   • If you process your department's payroll, initiate the procedures yourself.

   • If your department has a payroll processor, instruct the processor to initiate the procedures.

   • The employee's pay status must be changed to Sub 2, to prevent University overpayments.

   • Tell the employee:

     1. To be off work for a period of disability, written authorization from the treating physician is required.

     2. If the physician extends the period of disability, written authorization from the physician is required.

     3. In order for the employee to return to work, written authorization from the physician is required.

     4. The employee must submit all written authorizations to you.

   If you are processing the employee's payroll

   1. Change the employee's pay status from Sub 0, or Sub 1, to Sub 2.

   2. Change the employee's time code from "E" to "A".

   3. Determine whether the employee has elected to use SL or both SL & VL to supplement workers' compensation payments (See ESL Option Form).

   4. Examine the employee's Sick Leave and Vacation Leave balances.

   5. Refer to Workers' Compensation Payroll Resources.

   6. Read PPSM 44 Work Incurred Ilness and Injury, or the pertaining section in the Collective Bargaining Agreement that applies to the employee.

5. 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.

6. 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. Assure rapid provision of compensation benefits where due.

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

HR Home | Jobs | Benefits | Development & Training | Policies and Guidelines | Staffing and Compensation | Disability Management | Employee Assistance | Publications and Forms | Temporary Employment

UCSF Human Resources, 3333 California Street, Suite 305, San Francisco, CA 94143, (415) 476-1645. Contact us.