Section 7-107. SUPERVISOR REPORT OF INJURY

 

107.1In accordance with section 2320 of the Act, the official superior of an employee, or an employee, shall report by telephone to the Program any injury which results in that employee's death or probable disability. Claims shall be reported to the Program by calling the phone number for this purpose that is published on ORM’s website. 

 

107.2The official superior shall report the claim to ORM by telephone within twenty-four (24) hours of the incident, injury, or death. No later than three (3) days after the initial report, the official superior shall report the claim, in writing, using Form 1, the Employer and Employee First Report of Injury or Occupational Disease, and Form 2, Supervisor's Report.

 

107.3The official superior of the employee shall supply all information requested by the Program.

 

107.4Form 1 shall contain the following information:

 

(a) The name and address of the employer;

 

(b) The name and address of the employee;

 

(c) The year, month, day, and hour when the injury or death occurred;

 

(d) The name and telephone number of the employee's official superior;

 

(e) The employee's occupation at the time of the injury or death;

 

(f) The employee's wage or base salary information;

 

(g) The length of the employee's employment;

 

(h) The location of the accident;

 

(i) A description of the events which resulted in the death, injury, or disease;

 

(j)  The type of injury; and

 

(k) The body parts affected.

 

107.5Form 2 shall contain the following information:

 

(a) Whether the official superior witnessed the accident;

 

(b) Whether the employee reported the accident or injury, and to whom;

 

(c) Whether an incident report was prepared in connection with the injury or death;

 

(d) The nature of the injuries the employee complained of;

 

(e) Whether the employee has been placed on Continuation of Pay (COP);

 

(f) Whether the employee was in the performance of duty at the time of injury or death;

 

(g) A description of the events which resulted in the death, injury, or disease; and

 

(h) A copy of the employee's position description and all incident reports.

 

107.6The official superior shall complete and submit supplemental reports to the ORM as requested. The supplemental reports shall contain, but not be limited to:

 

(a) Statements from witnesses confirming or refuting the employee's allegations concerning the accident or injury;

 

(b) Statements, where requested, to give additional details of the accident or incident;

 

(c) Statements regarding whether the employee, to the official superior’s knowledge, had a similar injury prior to the alleged injury, and if so, full details of the prior injury or incident and associated medical reports; and

 

(d) Statements of other injuries or accidents of a similar character and the full details.

 

107.7The official superior shall complete Form CA-3, Report of Return to Duty.

 

authority

Chief Risk Officer of the Office of Risk Management (ORM), Executive Office of the Mayor, pursuant to the authority set forth in section 2344 of the District of Columbia Government Merit Personnel Act of 1978 (CMPA), effective March 3, 1979 (D.C. Law 2-139; D.C. Official Code § 1-623.44 (2012 Supp.)); section 7 of Reorganization Plan No. 1 of 2003 for the Office of Risk Management, effective December 15, 2003; and Mayor’s Order 2004-198, effective December 14, 2004

source

Notice of Final Rulemaking published at 28 DCR 2307 (May 22, 1981); as amended by Notice of Final Rulemaking published at 29 DCR 5196 (November 26, 1982); as amended by Notice of Final Rulemaking published at 47 DCR 7484 (September 15, 2000); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 9540 (October 8, 2010)[EXPIRED]; as amended by Notice of Final Rulemaking published at 57 DCR 12224, 12228 (December 24, 2010); repealed and replaced by Final Rulemaking published at 59 DCR 8766, 8770 (July 27, 2012).