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Page 1 of 3 MARICOPA COUNTY INTERNAL POLICY Policy Title: REPORTING INDUSTRIAL INJURY OR ILLNESS Policy Number: A2218 Current Adoption Date: MM-DD-YYYY Current Implementation Date: MM-DD-YYYY Approved by: BOARD OF SUPERVISORS Board Agenda Number: C-49-15-058-6-01 Original Adoption Date: 11-1991 I. PURPOSE To establish guidelines for reporting Industrial Injuries and Illnesses. II. APPLICATION This Policy applies to all Maricopa County elected and appointed departments as well as the Flood Control District of Maricopa County, the Maricopa County Library District, and the Maricopa County Stadium District (Special Districts). The Board of Supervisors is authorized to jointly adopt policies applying to the Special Districts under the Intergovernmental Agreement, C-06-18-393-6-00, approved on April 11, 2018. II. AUTHORITY A. It is the responsibility of designated department and special district employees to promptly and accurately submit the appropriate Risk Management Incident Reporting Form. These reports must be submitted within 24 hours of the injury. The employee’s supervisor is responsible for directing the employee to the nearest approved occupational health facility, arranging for transportation if the employee cannot transport themselves , collaborating with the County’s Risk Management Workers Compensation division on all work status documents and providing modified transitional work assignments. (See Policy A2216, Transporting Injured/Ill County Employees). 1. Employees needing assistance completing the appropriate Risk Management Incident Reporting Form may call 602-506-8041. B. It is the responsibility of Risk Management to: 1. Manage claims administration under the County’s Risk Management Trust Fund. 2. Evaluate and initiate cost containment programs, manage defense counsel, record all injuries and pursue recoveries from parties that caused or contributed to injury to employees. C. It is the responsibility of the injured employee to: 1. Notify their supervisor of the injury by the end of their shift on the day of the injury, if possible 2. If the injury is serious go to the nearest approved occupational health facility or hospital emergency room. Policy Title: REPORTING OF INDUSTRIAL INJURY OR ILLNESS Policy Number: A2218 Current Adoption Date: 5-20-2015MM- DD-YYYY Page 2 of 3 3. Attend all medical appointments 4. Receive approval for therapy and follow-up doctor appointments during their regular working hours (employees may use sick or vacation time for these appointments) 5. Promptly present to their supervisor a doctor’s written release to work status with or without restrictions III. DEFINITIONS A. Appointing Authority: An elected official, the single administrative or executive head of a Department/Special District, or the designated representative authorized to act in this capacity. B. Industrial Injury or Illness: An injury or illness that results from an event or exposure in the work environment arising out of and within the course and scope of employment. IV. POLICY A. Reporting Requirements For assistance completing the appropriate Risk Management Incident Reporting Form, call 602-506- 6828. 1. All accidents and injuries, regardless of severity, are required to be reported by the end of the business day of the incident to the Appointing authority or designee. Failure to report the incident within 24 hours may jeopardize the benefit eligibility of the injured or ill employee. 2. In the event of an industrial injury or illness, the Appointing Authority or their designee must complete the Risk Management Incident Reporting Form within 24 hours of being notified. 3. If an accident involves a fatality, an immediate initial telephone report shall be made to Risk Management, followed by submission of the Risk Management Incident Reporting Form. 4. The Form is to be completed by the injured employee's supervisor or manager who has knowledge of the occurrence. Under no circumstances should the injured employee complete the Form on their own behalf. B. Employee Responsibilities 1. Notify supervisor of the illness or injury by the end of shift on the day of the injury, if possible. 2. If the injury is serious, go to the nearest approved occupational health facility or hospital emergency room. 3. Attend all medical appointments. 4. Receive approval for therapy and follow-up doctor appointments during regular working hours (employees may use sick or vacation time for these appointments). 5. Promptly present to supervisor a doctor’s written release to work status with or without restrictions. C. Supervisor Responsibilities 1. Direct the employee to the nearest approved occupational health facility. Policy Title: REPORTING OF INDUSTRIAL INJURY OR ILLNESS Policy Number: A2218 Current Adoption Date: 5-20-2015MM- DD-YYYY Page 3 of 3 2. Arrange for transportation if the employee cannot transport themselves (See County Policy A2216 Transporting Injured/Ill County Employees). 3. Collaborate with the County’s Risk Management Workers Compensation division on all work status documents 4. Provide modified transitional work assignments. D. Risk Management Responsibilities 1. Manage claims administration under the County’s Risk Management Trust Fund. 2. Evaluate and initiate cost containment programs, manage defense counsel, record all injuries and pursue recoveries from parties that caused or contributed to injury to employees. A. All accidents and injuries, regardless of severity, are required to be reported by the end of the business day of the incident to the Appointing authority or designee. Failure to report the incident within 24 hours may jeopardize the benefit eligibility of the injured or ill employee. In the event of an industrial injury or illness, the department or special district designee must complete, within 24 hours of being notified, the Risk Management Incident Reporting Form here. B. If an accident involves a fatality, an immediate initial telephone report shall be made to Risk Management, followed by the Risk Management Incident Reporting Form here. C. The Form is to be completed by the injured employee's supervisor or manager who has knowledge of the occurrence. Under no circumstances should the injured employee complete the Form on their own behalf. Revision History Version Revision Date Description of Revision 1 Nov 11- 1991 Initial version 2 5-20-2015 This policy has been modified to conform to ARS § 23-901 and modified policy A2216 Transporting Injured-Ill County Employees. This revised policy now incorporates language related to the new Risk Management Incident Reporting Web Form that has been recently developed by OET. (C- 49-15-058-6-00) 3 8-31-2017 Reviewed by Risk Management. Administrative update to correct hyperlinks, corresponding to new Intranet site. No content or policy changes. 4 MM-DD-YYYY Update format and links, add Application section; move content of Authority section to Policy section.