1. Adjutant General’s Department Procedures 9/7/20151

2. Process for Reporting a Work- Related Injury  Supervisor Promptly Notify State Human Resources Office ◦ All reported incidents ◦ When employee begins to lose time from work ◦ Sustains a re-injury ◦ Can’t work within restrictions ◦ Receipt of Doctor’s Notes 9/7/20152

3. Process (continued)  Employee’s role ◦ Immediately notify supervisor of on-the-job injury, accident, or illness ◦ First aid or seek medical attention (Call (785) 296-2364 before seeking treatment unless Emergency Treatment needed.) ◦ Complete ◦ Employee Incident Report ◦ Return medical report to Human Resources ◦ Follow medical imposed work restrictions at work AND outside of work ◦ Stay in touch with supervisor/HR ◦ Work with departmental payroll person on lost time claims ◦ Cooperate ◦ HR ◦ State Self Insurance Fund Contact 9/7/20153

4. Process (continued)  Supervisor’s role ◦ Make sure employee gets medical attention (call State Self Insurance Fund for prior authorization unless emergency) ◦ Dial 911 if injury is potentially life threatening ◦ Complete ◦ First Report of Injury ◦ Forward medical reports/Dr Notes to Human Resources ◦ Stay in touch with employee ◦ Cooperate ◦ HR ◦ State Self Insurance Fund 9/7/20154

5. Process (continued)  Seek medical attention  Emergencies: nearest hospital  Burns: nearest hospital emergency room  Eye Injuries: nearest hospital emergency room or Ophthalmologist 9/7/20155

6. Process - Employee  FORMS Employee Incident Report ○ Complete as soon as possible following the incident ○ Forward to Supervisor ○ Supervisor sends to Human Resources Medical Report/Dr. Notes ○ FAX or deliver a copy to Human Resources 9/7/20156

7. Process – Supervisor  FORMS First Report of Injury (paper or electronic version)  Complete for ALL incidents, except minor incidents such as paper cuts unless develops into more serious injury  Complete within 8 business HOURS (1 day)  Forward to Human Resources 9/7/20157

8. Process – Supervisor FORMS Give injured employee paper copies of: W.C. Info Sheet 9/7/20158

9. Marti Stadler Tel. 785-274-1392 FAX: 785-274-1679 Martha.l.stadler@us.army.mil Jo Boswell Tel. 785-274-1391 FAX: 785-274-1679 Jo.h.boswell@us.army.mil Stephanie Burdett Tel. 785-274-1460 FAX: 785-274-1679 Stephanie.k.burdett@us.army.mil 9/7/20159

10. Main Telephone Number: 785-296-2364 FAX: 785-296-6995 CORVEL Provider Search site: http://www.corvel.com/provider_lookup/findProvider/findsearchparams.aspx 9/7/201510

11. Questions?  Thank you for your time! 9/7/201511