1. 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: Completes Accident/Unusual Event Form Prints completed form Obtains BC signature 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

2. 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 ( 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/ s 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/ s forms to HR

3. Step 3: Returning to Work
Authorized to Return to Full Duty
Employee:
Receives completed Return to Work Forms from physician and faxes/ s 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/ s 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