Step 1: Reporting On the Job Injury On the job injury/illness occurs Employee: Reports injury to immediate supervisor within 24-hours Immediate Supervisor: Notifies the following; BC, HR, DC Ops, Health & Safety Officer (HSO) Employee: 1. Completes Accident/Unusual Event Form 2. Prints completed form 3. Obtains BC signature 4. Forward to HSO Off the job injury/illness occurs Employee: Reports injury to on duty BC Duty BC: Notifies HR immediately Human Resources: Contacts employee for potential FMLA benefits

Step 2: Seeking Medical Attention If NON-URGENT on the job injury occurs (If urgent, seek medical attention immediately. Physician shall initiate L&I claim) Employee: Enters Claim on L&I website (www.lni.wa.gov). Print completed report with Assigned Claim Number Obtains Return to Work packet. Located: SharePoint > HR or at Stations and in Apparatus in bright green envelopes Sees physician and provides the following; - Activity Prescription Form (APF) with online claim number - Form 52 (Return to Work Authorization - Applicable Job Description Receives completed Return to Work Forms from physician and faxes/emails forms to HR Off the Job Injury (No L&I Claim) Employee: Sees physician and provides the following; - Form 52 (Return to Work Authorization) - Applicable Job Description Receives completed Return to Work Forms from physician and faxes/emails forms to HR

Step 3: Returning to Work Authorized to Return to Full Duty Employee: Receives completed Return to Work Forms from physician and faxes/emails forms to HR Human Resources: Notifies BC distribution group and DC Ops of employees return to full duty Battalion Chief: Notify employees chain of command of employees return to full duty If employee is off full duty over 90 days: Ensures employee completes fit-for-duty test during first shift back to work Authorized to Return to Light Duty Employee: Receives completed Return to Work Forms from physician and faxes/emails forms to HR Contacts HR regarding light duty work plan & schedule Human Resources: Extends a Light Duty Job Offer to employee Accepts light duty job offer and reports to HQ for light duty work. Declines light duty job duty = L&I Time Loss Benefits cease Unable to Return to Full Duty or Light Duty Employee: Provides physician with Return to Work paperwork at each visit Updates HR with Return to Work status after each physician visit