Table of Contents
Injured Worker
- At the time of injury, report the injury to your first line supervisor and obtain an injury packet. DESCRIBE THE INCIDENT AND INCLUDE NAME(S) OF THOSE WHO MAY HAVE WITNESSED THE INCIDENT.
- If you aren’t immediately seeking medical treatment, at the time of injury you must:
- Complete the online Injured Worker Injury Form
https://mifflin-oh.gov/contact-us/human-resources/hr-employee-injury-form/ - Complete the online First Report of Injury Form
https://froi.sedgwickmco.com/
- Complete the online Injured Worker Injury Form
- If you are immediately seeking medical treatment, the injury forms must be completed at the completion of treatment and not later than 24 hours after receiving medical treatment.
- If seeking medical treatment provide the physician with the MEDCO-14, which is included in the Injury Packet.
- After the first medical visit, you must select a BWC-certified medical provider as your Physician of Record (POR) to manage the treatment for a work-related injury. The link to the BWC provider lookup is https://www.bwc.ohio.gov/provider/services/providerlookup/nlbwc/ProviderSearch.aspx
- Tell your doctor or emergency room that Mifflin Township’s MCO is Sedgwick. They will need this information to file your claim.
- If the injury results in time off, you will receive an FMLA notice via email.
- During your time off, maintain contact with HR and Sedgwick MCO.
- For questions related to a workers’ compensation claim or work-related injury, please contact Human Resources at hr@mifflin-oh.gov.
First Line Supervisor
- Meet with the injured worker for a description of the incident and names of any witnesses.
- Provide the Injury Reporting Packet to the injured worker.
- Ensure the injured worker immediately completes the online Injured Worker Injury Form if he/she isn’t immediately seeking medical treatment.
- If the injured worker immediately seeks medical treatment, the injury forms must be completed at the completion of treatment and not later than 24 hours after receiving medical treatment.
- Next, report the injury to the next level supervisor, who will serve as the Investigating Manager.
- Provide the link to witnesses who must immediately complete the online Statement of Witness to Accident form.
https://mifflin-oh.gov/contact-us/human-resources/hr-statement-of-witness-to-accident/
- Provide the link to witnesses who must immediately complete the online Statement of Witness to Accident form.
- Complete the Supervisor’s Report of Injury Form no later than the end of your shift https://mifflin-oh.gov/contact-us/human-resources/hr-supervisors-injury-form/
- If an injury or accident involves property damage or personal injury to another person or non-owned Mifflin Twp property, drug/alcohol testing is required (e.g. accident causing injury to another person, a vehicle accident involving a non-owned Mifflin Twp vehicle, road sign, signpost, etc.).
For all other incidents, refer to the reasonable suspicion guidelines below.
If drug/alcohol testing is required, a manager must transport the employee to the medical facility (or coordinate transportation) and is to remain with the employee until he/she is tested, then transport the employee back to the jobsite.
Investigating Manager
- The Investigating Manager reports to the site to ensure the accident location is safe and secure, then completes the Investigating Manager Accident Form.
https://mifflin-oh.gov/contact-us/human-resources/hr-investigating-managers-accident-form/
Human Resources
- After receiving the Injury Forms, forward to the Department Head or designee.
- If applicable, HR will notify the FMLA Coordinator.
- If the injury results in time off work, HR will notify payroll to pay Injury Leave.
- HR will submit the Wage Continuation letter to the injured worker for a signature, then submit to BWC, if applicable.
- Upon receiving RTW date, HR will update the department head.
Links to Forms
Injured Worker Injury Form
Supervisor’s Injury Form
Investigating Manager Incident Report Form
Statement of Witness to Accident Form
BWC First Report of Injury (FROI)
Post Accident Drug/Alcohol Test Guidelines
Reasonable suspicion is defined as:
Alcohol or other drug testing based on a belief that an employee is using or has used alcohol and/or drugs in violation of the employer’s policy drawn from specific objective and articulable facts and reasonable inferences drawn from those facts in light of experience, and may be based upon, among other things:
(1) Observable phenomena, such as direct observation of alcohol and/or drug use and/or the physical symptoms or manifestations of being under the influence of alcohol and/or a drug.
(2) Abnormal conduct or erratic behavior while at work, absenteeism, tardiness, or deterioration in work performance which may reasonably be considered to be caused by alcohol and/or drug abuse.
(3) A report of alcohol and/or drug use provided by reliable and credible sources, and which has been independently corroborated.
(4) Evidence that an individual has tampered with an alcohol or drug test during his/her employment with the current employer.
(5) Evidence that an employee is involved in the use, possession, sale, solicitation, or transfer of alcohol and/or other drugs while working, or while on the employer’s premises or operating the employer’s vehicle, machinery, or equipment.
(6) The occurrence of a significant incident involving an employee’s on the job actions which has resulted in the personal injury of any person, or in which expensive property damage estimated to be in excess of two thousand dollars has occurred. The personal injury situations warranting reasonable suspicion testing shall be those stipulated in the relevant collective bargaining agreements, or in the absence of any such agreement, by the director of the department of administrative services.