The Safety Unit has been designated to control and relate any and all
information concerning an occupational injury, illness, or disease.
So that this can be performed efficiently and effectively, the following
policy has been established.

There will be basic control points designated and established under the direction of Employee & Labor Relations. They are as follows.

CONTROL OFFICE

The Safety Unit will be the main control office or center, responsible for the initial implementation and continued co-ordination of this policy.

MEDICAL CONTROL POINT

The Main Post Office Dispensary will be the control point for all
medical information and duty status.

TIMEKEEPING CONTROL POINTS

To be activated and guidelines
issued in the near future.

INITIAL CONTROL POINT

The Unit Manager or employee's immediate Supervisor will be referred to as the initial control point, responsible for the initial decision.

The Control Office (Safety Unit) is to be given full co-operation by all units regarding this policy. Compliance with the attached guidelines is required, and shall be the policy of the Cleveland Post Office from this date forward.

Sincerely,

G.H. Hammerstein

G. H. Hammerstein

Postmaster

Upon being notified by the employee that an accident occurred and the employee sustained an injury, the immediate supervisor must do the following.

Traumatic Injury.

Obtain the IOD Kit, which contains:

2 CA-1's - Employee's Notice and written statement of the injury.

2

CA-16's

2

1

Authorization for Medical Treatment

Duty Status Report

and, if necessary for family doctor or additional treatment:
CA-17's Duty Status Report

Addendum to CA-17 Limited duty Physical Endurances Factors
Return envelopes for each, marked Special Delivery

Have employee complete the CA-1's, Notice of Injury, while the Supervisor is preparing the CA-16's and the CA-17's for medical treatment.

WITNESS STATEMENT

the Supervisor must obtain any statements from any witness to the accident or injury. This eliminates any collusion by the employees.

CONTROVERT THE INJURY if accident could not have or did not happen as employee stated on CA-1, or any other justifiable reason, submitting documentation.

INFORM EMPLOYEE of his rights concerning choice of physician and choice of leave to be used during absence; if decreed by attending physician. Also inform, the employee that the Duty Status Report must be returned immediately or as soon as possible after emergency treatment and that no timecard transactions will be made until a medical report or Duty Status Report is received. Employee is to be placed in a Leave Without Pay Status following the day of injury, until the medical statement is received (employee on the clock on the day of injury). Employee is being issued instructions that he/she must phone in the duty status, as soon as practicable after emergency treatment if not returning to duty.

On all tours at the Main Office and annex, the employee is to be sent to the
Main Post Office Dispensary and the Nurse on Duty will make any necessary
arrangements, etc., as the situation requires, in a NON-EMERGENCY injury.
The Main Post Office Dispensary will handle all cases at the Main Office and
Annex in all non-emergency cases.

In all other postal facilities, if the employee does not go to an emergency facility, but wishes to go directly to a physician, the immediate Supervisor MUST contact the physician immediately and ascertain if the physician is available and will treat the employee as an industrial case. When the physician cannot be reached by phone or will NOT accept the employee as a

al Industrial case, the employee must select another physician and

. Supervisor must contact this selection.

Report by phone to the MEDICAL CONTROL POINT (Dispensary) the injury, employee's name, attending physician or emergency facility, and any other information requested by the Nurse on Duty.

EITHER the immediate Supervisor prepares the PS Form 3971, Notification of Absence, or the employee prepares the PS Form 3971, in accordance with the employee's request for type of leave to be used as indicated on the CA-1. Sick or Annual Leave, Continuation of Pay Wage Continuation, or Leave Without Pay compensated by the US Department of Labor. (Do not authorize any leave without medical justification Duty Status Report or other justification.) Complete the back of CA-1, Employee's Notice of Injury, paying particular attention to Items 40, 41, and 42. Supervisor MUST make the initial decision.

Complete PS Form 1769, Accident Report. Forward CA-1's and PS Form 1769 to the CONTROL OFFICE (Safety Unit). Forward the duplicate CA-16 and any or all medical statements, reports, etc., to the MEDICAL CONTROL POINT (Main Post Office Dispensary).

The MEDICAL CONTROL POINT must have any and all medical statements or reports concerning an employee and a duplicate copy of the CA-16, Authorization for Medical Treatment.

Place employee on an assignment in accordance with the limited duty specifications outlined by the attending physician. If no limited duty available, employee is to be sent to the Supervisor, Employee Services & Benefits, Employee & Labor Relations Office, Room 4025, Main Post Office Bldg.

Employee whose absence extends beyond three (3) days MUST BE CLEARED through the MEDICAL CONTROL POINT (Disp.) before returning to active duty, with a medical clearance from his attending physician. (Inform employee of this requirement.)

Employees whose absence DOES NOT extend beyond three (3) days may return to
active duty immediately without clearance from the MEDICAL CONTROL POINT
(M.O. Dispensary), BUT they must have the clearance (CA-17, etc.) from their
attending physician. This medical statement must be forwarded to the MEDICAL
CONTROL POINT.

The above is also necessary for transacting any timecard transactions after the day of injury.

When an employee's absence extends beyond three (3) days, any and all information regarding the duty status of the employee MUST and WILL be obtained through the Main Post Office Dispensary (MEDICAL CONTROL POINT). In the event this is not so, the CONTROL OFFICE (Safety Unit) will supply the information.

Supervisors must inform the CONTROL OFFICE (Safety Unit) that the employee has returned to active duty immediately, either by phone or in writing. At the Main Office or Annex, this can either be done by the Supervisor or PSDS Technician assigned to transacting the employee's time.

an employee has returned to active duty, the Supervisor MUST refer any all RECURRENCES to the CONTROL OFFICE (Safety Unit). DO NOTHING until nstructions are received from the CONTROL OFFICE. Transact no time, UNLESS the employee prepares and requests SICK, ANNUAL, or LEAVE WITHOUT PAY on the PS Form 3971. FORWARD A COPY TO THE CONTROL OFFICE.

Refer any and all problems to the CONTROL OFFICE (Safety Unit) concerning an :
occupational injury, if not resolved by the MEDICAL CONTROL POINT or the
PSDS Technicians Supervisor.

It is mandatory that Supervisors counsel
Safety Practices, Rules and Regulations.

employees on good and established This counselling is to be made a

matter of record on the second offense or injury within six (6) months.

On the third (3rd) injury, within one (1) year, the employee is to be issued

a letter of warning for failure to follow established safety practices, rules and regulations.

On the fourth (4th) injury, within two (2) years, the employee is to be
suspended (upon return to duty) for failure to follow and practice
established rules and regulations.

Supervisors will be reprimanded also for their failure to act in accordance with Postal Policy, procedures, and safety practices.

Each Supervisor will be required to initiate a request to change an employee's
assignment when neither the condition of the employee nor the work environment
has or can be corrected. Forward this request to:
Supervisor,

EFFECTIVE IMMEDIATELY:

Employee Services & Benefits

Main Post Office Bldg., Room 4025
Cleveland, Ohio 44101

Do not use PS Form 3956 (Authorization for Medical Treatment) for the initial injury or accident. Do not use it during the forty-five (45) calendar days of Wage Continuation (Continuation of Regular Pay), or within six months from date of injury, whichever comes first.

The PS Form 3956 is to be used for any recurrence or recheck after the six months from date of injury, or after the expiration of the forty-five days, OR for any injury that occurred prior to the six months limitation.

INSTRUCTIONS TO SUPERVISORS FOR:

OCCUPATIONAL ILLNESS OR DISEASE

In the event an employee reports an occupational illness or alleges an occupational illness or disease, the following is MANDATORY and must be adhered to.

Supply or issue to the employee the new and revised US Dept. of Labor Form
CA-2 "Employee Notice of Occupational Disease and Claim for Compensation"
(prepared in DUPLICATE).

INFORM employee of the following:

1. That you cannot authorize any treatment, etc., nor issue a
CA-16 "Authorization for Medical Treatment."

"

4.

That you will release the employee to obtain any medical
treatment he deems necessary for this illness or disease.

Tell the employee that he must either use his/her own earned
sick or annual leave or request Sick Leave Without Pay pending
approval of the claim by the US Dept. of Labor.

He may obtain medical treatment at the Main Office Dispensary
and any further treatment will be at his own expense.

5. Employee is to submit all medical statements, reports, or
hospital records to the MEDICAL CONTROL POINT (M O Dispensary)
for recording and forwarding.

6.

He or she must pay all expenses and physician's fees until the
claim or case is adjudicated by the US Dept. of Labor.

7. If the claim or case is adjudicated in the employee's favor,
then upon notification from the US Dept. of Labor, he or she
will be given the opportunity to have the leave used for this
illness or disease restored and compensated by the US Dept.
of Labor for all expenses incurred.

DO NOT ISSUE A CA-16.

Submit the CA-2 to the CONTROL OFFICE (Safety Unit).

DO NOT prepare a PS Form 1769 (Accident Report) until the claim is approved by the US Dept. of Labor and you are notified of such by the CONTROL OFFICE.

Instead, submit a statement of the incident or illness to the CONTROL OFFICE for future reference. List all pertinent data in this statement.

1

COMPLETE the back of the CA-2 to the best of your ability and as much information that you can supply. The balance will be completed by the CONTROL OFFICE.

UNDER NO CIRCUMSTANCES WILL YOU AUTHORIZE CODE 18, WAGE CONTINUATION FOR AN
OCCUPATIONAL ILLNESS OR DISEASE. ANY AND ALL COMPENSATION IS BY THE
US DEPARTMENT OF LABOR.

Upon receipt of the CA-2, the CONTROL OFFICE will forward to the employee any and all additional papers, forms required.

Any employee that claims or alleges an occupational illness or disease must be cleared by the MEDICAL CONTROL POINT (Main Office Dispensary) before he or she can return to active duty following an absence due to the illness, etc.