Incident - Exposure Plan for BBP Incident - Exposure Plan for BBPReporting Procedures Reporting Procedures for Employee and Supervisor for Exposure IncidentINCIDENT – UNSAFE OR NEAR MISSReport to one of the following –District Secretary or the District Safety Committee member (Luis). AND fill out the SAFETY REPORT FORM.
Turn the completed form into one of the above staff.
The person who receives the report and form is responsible to
1. Submit the report to the safety committee, and/or
2. A. assure that the problem is addressed by taking care of the problem, or
B. placing it on the repair list and notify appropriate staff.NO TIME LOSS, NO MEDICAL ATTENTIONEmployee: Report to your immediate supervisor (this is the person under whose direction you are working and can be different depending on what /where you are working) and complete the Accident Report Form.
Reporting supervisor: Complete the supervisor portion of the report. Send the original to the District Office and a copy to the Principal.
District Office: Provide a copy to the safety committee and file the original in the current year accidents reported file.MEDICAL ATTENTION ONLYEmployee: If the injury is such that you require immediate medical attention, notify your reporting supervisor and seek immediate medical attention. REMEMBER: Orondo School District is SELF-INSURED. The paperwork does not go to L&I.This form ( Provider Initial Report ) may be used to give to the provider for their initial report. A copy of the initial report MUST be sent to Orondo School District attn: business office 100 Orondo School Rd Orondo, WA 98843 or faxed to (509)784-0633 in order for a valid claim number to be assigned by the business office to result in payment to the provider. Your provider will be called and given the assigned claim number.
Reporting Supervisor: Notify the Principal and District Office of the incident. The district office will provide a claim number for the employee.
Reporting by Employers. Under WAC 296-27-031 employers are required to report to the nearest L&I office in person or by phone (1-800-423-7233) within 8 hours, any employee death or probable death, or the in-patient hospitalization of any employee. A serious violation must be cited for failure to report. If an employer does not learn about an incident at the time it occurs, he/she must report it to L&I within 8 hours of learning of it. Also report it to the NCESD HR/Workers Compensation department (509)667-7100 or (509)667-3635
Employee: In all other accidents, complete the Employee portion of the accident report and bring it to the district office before going to a medical facility.
District Office: Collect the report and provide the employee the SIF-2 form and the Physician Initial Report form to take to the doctor. Also provide the pamphlet, ‘A Guide to Industrial Insurance Benefits' (Spanish).
Employee: Please bring a release to return to work from the doctor and if you are given any work restrictions you must notify the district office and the Principal.
District office: Provide a copy of the Accident Report to the appropriate reporting supervisor for their portion of the form to be completed. Return of completed form to the District Office and a copy to the Safety committee.
MEDICAL ATTENTION AND TIME LOSSFind a L&I Provider: http://www.lni.wa.gov/ClaimsIns/Claims/FindaDoc/
All of the above steps for Medical Attention apply. PLUSEmployee:You must provide a note from the physician indicating how long you are unable to work.
You must stay in contact with the district office about your medical status and ability to work throughout your time off of work. Employees will be offered light duty work, approved by the physician, and must return and perform the approved assigned duties. An employee off work for more than 3 days must bring a release to work from the attending physician.Election of Leave Choice regarding Loss of Time Due to InjuryRCW 51.32.090
If you are off work because of temporary disability that has been certified by a doctor, you have a choice on how any leave (sick, personal, or other) will be paid. Please fill out the form Time Loss Choice for Leave and turn in as soon as possible.