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City of Charlottesville, VA Fire Department


Chapter: V - Personnel Policies and Procedures
Subject: Off Duty Employment
Code: 1-V-10
Revised: 6-10-96

10.01  PURPOSE

       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.

l0.02  POLICY

       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.

l0.03  SCOPE

       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


       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

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