Access Success TM

1. Access SuccessTM Workplace Injuries If necessary, click on the Maximize button above to enlarge this window. Left click to begin slideshow.

2. Access SuccessTM Access SuccessTM Pay Policy Workplace Injuries Hiring Procedures Equal Opportunity Affirmative Action Workplace Injuries Workplace Injuries Antiharassment Leaves of Absence Performance Management Progressive Discipline

3. Access SuccessTM Workplace Injuries Workplace Injuries • Successful completion of this topic will enable you to: • Understand the steps to follow if an employee or non-employee is injured on the job • Ensure compliance with Occupational Safety and Health Administration (OSHA) and the Worker’s Compensation and Occupational Disease Act of Indiana • Accurately complete the First Report of Injury form • Determine when to contact Liberty Mutual regarding a workplace injury • Accurately distribute and file copies of the First Report of Injury form • Identify forms of compensation of lost wages for workplace injuries • Communicate First Report of Injury information to staff members • Identify resources for further information on workplace injuries 3 of 23

4. Access SuccessTM Workplace Injuries Workplace Injuries • Reporting Injuries in a timely and accurate manner is crucial to ensure • Purdue University Calumet: • Prevents recurrence of workplace injury incidents • Is compliant with OSHA and The Worker’s Compensation and Occupational Disease Act of Indiana • The information in this important module is designed to provide you • with a quick and easy way to remember what you need to do if an • incident occurs in your area. 4 of 23

5. Access SuccessTM Reporting Workplace Injuries Workplace Injuries What are the steps to reporting employee workplace injuries? Step 1 Step 2 5 of 23

6. Access SuccessTM Reporting Workplace Injuries Workplace Injuries What are the steps to reporting employee workplace injuries? Step 3 Step 4 Step 5 The following slides provide detailed information for Steps 3 through 5 of the Reporting Workplace Injuries process. 6 of 23

7. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • Guidelines for Step Three: • A report form should be used for each incident that occurs. • Indiana law requires that the First Report of Injury form be received by the Worker’s Compensation Board within seven days of the injury.Without exception, the supervisor of the injured employee must complete both sides of the First Report of Injury form within 24 hours of the incident. 7 of 23

8. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • Print a copy of the First Report of Injury Form • NOW • to follow along with the remaining instructions. 8 of 23

9. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • First Report of Injury Instructions • Locate the small box on the left side of the page and complete the following information about you, the supervisor: • Completed by • Title • Phone • Date 9 of 23

10. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • How to Complete the Form: • In the Information about the Employee section, provide the following: • Name and Social Security • Address and Home Phone • Date of Birth • Date Hired • Gender 10 of 23

11. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • How to Complete the Form (cont.): Under the Information about Physician section, provide the following: • Name of physician or healthcare professional. • Address of treatment facility, if given. • Information about ER. • Information about hospitalization. • *If no treatment was received, write “N/A” in the blanks. 11 of 23

12. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • How to Complete the Form (cont.): • The third column requires specific information about the case. • Case number (Leave this blank). • Date of injury or illness. • Time employee began work. • Time of event. • What was the employee doing just before incident occurred? • What happened? • What was the injury or illness? • What object or substance directly harmed the employee? • If the employee died, when did death occur? Let’s look at some examples for items 14 through 17 12 of 23

13. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • Items 14 through 17 require thorough details about the incident. Read below for appropriate examples to guide you in completing these areas: • What was the employee doing just before the incident? • “Climbing a ladder while carrying lighting repair materials.” • What happened? • “Ladder slipped on wet floor and the worker fell 20 feet.” • What was the injury or illness? • Do not use words like “hurt” or “sore,” instead use specific phrases. • For example: “strained back” or “sprained right ankle.” • What object or substance directly harmed the employee? • “Concrete floor” 13 of 23

14. Access SuccessTM Step Three: Supervisor of the Injured Party Completes First Report of Injury Form Workplace Injuries • How to Complete the Form (cont.): • Additional Employee & Accident Information • This information is required by REM and Liberty Mutual and must be completed. Answer each question to the best of your ability and then determine what the root cause of the accident was. • Once a root cause has been determined you must decide on an appropriate corrective action. When determining corrective action remember that it should prevent this incident from occurring again. • Finally, Document the Corrective Action! 14 of 23

15. Access SuccessTM Step Four: If Required, Supervisor Contacts Liberty Mutual Workplace Injuries • Guidelines for Step Four: • After completing the First Report of Injury Form, you may need to contact Liberty Mutual if: • The injured party received medical treatment and/or; • The injured party spent time away from work other than date of injury • If the above criteria are met, call Liberty Mutual (1-800-362-0000). The number is also located at the top of the First Report of Injury form. • The Liberty Mutual intake operator will ask you questions from the form. These questions will come from the front page and top of second page. Remember, If there is no medical treatment or time away from work, do NOT call Liberty Mutual. Simply move on to Step Five. 15 of 23

16. Access SuccessTM Step Five: Supervisor Sends Copy of First Report of Injury form to Human Resources Workplace Injuries • Guidelines for Step Five • After completing the First Report of Injury Form, and calling Liberty Mutual (if necessary), send a copy of the completed form to HR-Calumet and REM in West Lafayette. • Must be sent within 48 hours of incident • Address to Human Resources, Calumet/LAWS 212 • Address to West Lafayette, REM/Safety Section/Civil • Place another copy of form in employee’s file If you have any questions when completing the form or completing the Reporting Workplace Injuries steps, contact Human Resources, 989-2251. 16 of 23

17. Access SuccessTM Reporting Workplace Injuries Workplace Injuries • In short, reporting employee injuries is an easy process when the steps are • followed accurately. • Remember, its as simple as. . . • Contact PUC Police • PUC Police will exercise due diligence • Complete the First Report of Injury form • Call Liberty Mutual (if necessary) • Send copy of form to Human Resources at PUC and REM in West Lafayette and file a copy in employee file 17 of 23

18. Access SuccessTM Pay Status and Compensation Workplace Injuries • During the employee’s initial visit to the doctor to be treated for a work-related injury, the employee is considered to be in regular pay status. If the employee is able to return to work but further doctor’s visits or treatment is necessary during regular scheduled time the employee’s time will be recorded as “other leave with pay.” This applies to regular, student, and temporary employees. • Note: The maximum “other leave with pay” allowance is as follows: • 2 hours for local area visits/treatment • 4 hours for visits/treatment requiring travel of 50 miles or more • The supervisor may contact Human Resources for verification that treatment is due to a work-related injury. 18 of 23

19. Access SuccessTM Pay Status and Compensation Workplace Injuries Bills for treatment of work-related injuries that the department or employee receive should be forwarded to Human Resources. Worker’s Compensation for lost wages is not effective until the eighth calendar day. Sick leave or vacation may be taken during the first seven calendar days if available. If lost time exceeds seven calendar days, Liberty Mutual will pay Worker’s Compensation to the employee based on the amount provided by the Worker’s Compensation and Occupational Disease Act of Indiana. Sick leave or vacation, if available, may be used to make up the difference between the amount of the compensation payment and the employee’s average earnings. 19 of 23

20. Access SuccessTM Reporting Non-Employee Injuries Workplace Injuries • The process for reporting injuries for Non-Employees is managed through • the Purdue University Calumet Police Department. Please note the steps: • Contact Purdue University Calumet Police Department (ext. 2911) • Police will exercise due diligence if first aid is required • Risk Management (WL) will make the determination if the injury requires subsequent action and may ask Police to do a supplemental report to query witnesses of the injured • Risk Management (WL) will manage ensuing processes Remember, contact campus Police (ext. 2911) if a non-employee is injured. 20 of 23

21. Access SuccessTM Communicating How to Report Workplace Injuries Workplace Injuries • Communicating how to report injuries assists employees in understanding the information you’ll need to ask of them if an incident occurs. • A recommended communication approach is discussing the steps and a copy of the First Report of Injury form with your employees during a staff meeting. • Answer questions or refer to Human Resources for assistance. 21 of 23

22. Access SuccessTM Additional Workplace Injuries Resources Workplace Injuries • Revised Environmental Health and Safety Compliance Policy (C-36) • Worker’s Compensation Policies and Guidelines • Worker's Compensation and Occupational Disease Act of Indiana • First Report of Injury • Further questions or comments? Contact Human Resources at 989-2251, or email Mary Beth Rincon, Assistant Vice Chancellor for Human Resources atmbrincon@calumet.purdue.edu 22 of 23

23. Access SuccessTM Workplace Injuries You have successfully completed the Purdue University Workplace Injuries Policy Click on to close this window. X 23 of 23