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City of Charlottesville, VA Fire
Department
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| Chapter: | V - Personnel Policies and Procedures |
| Subject: | Off Duty Employment |
| Code: | 1-V-10 |
| Revised: | 6-10-96 |
A. To establish uniform guidelines regarding the reporting
of injuries and/or illnesses which are suffered by
Fire Department members in the course of or as a result of
their official duties.
B. To establish Fire Department policy in relation to
on-duty injury and/or illness.
A. All injuries and/or illnesses occurring to Fire Department
members, arising from the performance of their official
duties, shall be reported on Workmen's Compensation Form
#3 and signed by the Officer-In-Charge within twenty-four
(24) hours of the injury. Additional forms which must be
completed are the: Supervisor's Investigation Report,
Authorization for Medical Treatment Form, and Light Duty
Verification Form (CFD Form #74).
B. The on-duty Fire Battalion Chief shall be notified
immediately of on-duty injuries and/or illnesses occurring
to Fire Suppression personnel.
C. The Deputy Fire Chief shall be notified as soon as possible
if any member of the Fire Department suffers an on-duty
injury and/or illness that requires a person to be relieved
from duty.
D. Members suffering on-duty injuries and/or illnesses which
require medical treatment at a medical facility shall be
treated at one of the City of Charlottesville's designated
medical treatment facilities. If the doctors are
unavailable for treatment of the employee or the injury
needs immediate emergency care, then the employee may report
to the emergency room of the closest medical facility.
E. Regardless of where the medical treatment is obtained, the
employee must have the treating physician fill out the
Authorization for Medical Treatment Form and a Light Duty
Verification Form, CFD From #74. Return these forms with
the initial report to the Executive Secretary.
F. Members returning to work after an injury and/or illness
must complete and submit to their Fire Battalion Chief a
City of Charlottesville Leave Request Form (CHPER 4).
Injury leave is recorded hour for hour.
To cover those policies and procedures concerning work related
injuries and/or illnesses.
A. All members are responsible to operate in a safe manner,
following all safety guidelines and procedures as well as
using safety equipment provided by the Department.
B. All members are responsible to report any on-duty injury
or illness to their direct supervisor as soon as possible.
C. All supervisors are responsible to make sure that those
members who are injured and/or ill and who are in need of
medical attention, receive medical attention promptly.
D. All supervisors are responsible to insure that the required
forms, reports and log entries are made concerning injured
and/or ill members.
A list of approved medical treatment facilities officially
designated for treatment of injuries and/or illnesses incurred
by City employees on the job is available in the Executive
Secretary's Office and/or the City of Charlottesville Personnel
Department.
A. When a Fire Department member incurs an injury and/or
illness in the line of duty, said member shall report the
incident as soon as possible to his/her supervisor.
B. The member must complete and submit a Workmen's Compensation
Form #3 to the Officer-In-Charge within twenty-four (24)
hours of the injury and/or illness.
C. The Officer-In-Charge will investigate the incident
immediately and will write a Supervisors Investigation
Report - Yeager and Company Form Y-50 and attach same
to the Workmen's Compensation Form.
D. The supervisor shall make note of the injury and/or
illness in the Journal relating to the member's name, a
brief description of the injury and the current disposition
of the case.
E. If the injury and/or illness occurs while operating on
an alarm, this shall be noted in the Incident Report.
F. The Deputy Fire Chief and the on-duty Fire Battalion
Chief shall be notified as soon as possible whenever a Fire
Department member is injured.
G. Members requiring treatment at a medical facility shall
receive said treatment at a City designated facility in
accordance with current policy. (See l0.02)
H. Members shall identify themselves as a City of
Charlottesville employee at the medical facility.
H. Members receiving medical treatment at a medical facility
must have the attending physician complete the Authorization
for Medical Treatment Form and a Light Duty Verification
Form. These forms must be attached to the Workman's
Compensation Form and the Supervisor's Investigation Report.
I. After receiving initial medical care following an injury
and/ or illness, the member shall bring back to the
supervisor a completed Light Duty Verification Form which
addresses ability to work. Should the member be absent
after the doctor indicates ability to do restricted or
regular work, or should he/she decline a light duty
assignment, that person will be referred back to the
treating physician for another examination and another
determination of ability to work. If both documents
indicate ability to work, the member will not be paid for
the period of absence.
J. If members are unable (due to their injuries and/or illness)
to fill out the Workmen's Compensation Form, their immediate
Supervisor shall complete this form and make note of this
action next to the supervisors signature.
K. Members who have returned to work after an illness and/or
injury shall complete and submit a City of Charlottesville
Leave Request Form in accordance with the policy established
in this manual (See l-V-6 Leave of Absence).
L. Any employee who has incurred an injury which is compensable
under the Workmen's Compensation Act shall receive injury
leave for the time missed.
M. An employee who is placed on injury leave may remain in that
status as long as there is satisfactory medical evidence
that he/she is unable to perform his/her regular duties, is
unable to perform any other work that is then available in
the City service or until it has been determined that the
employee should be retired or terminated.
N. As long as an employee is on injury leave, he/she shall
receive the same net pay received before the injury,
according to the following formula: the pay shall consist
of Workmen's Compensation (not taxed) and an injury leave
payment, taxed like a salary. The amount of the injury
leave payment will be gross pay minus Workmen's
Compensation. The employee's rate of pay will be subject to
the same non-performance related changes as other City
employees.
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