Your  Account:

Appendix A

Appendix A - Supervisor Checklist 


□ STEP NO. 1: When the injury/illness occurs during work, the injured/ill employee is sent or taken to a medical care provider by an appropriate administrator. Alternate transportation (family, friend, taxi, bus, etc.) may be arranged for the employee. Serious injury/illness will be managed by responding emergency personnel.

□ STEP NO. 2: If employee has pre-designated his/her primary care physician to provide treatment for work-related injuries, fax a copy of the employee’s job description to the specified treating physician.

□ STEP NO. 3: Complete verbal injury reporting process immediately to the Worker’s Compensation Coordinator.

□ STEP NO. 4: Inform the employee about the University’s RTW program and provide contact information for the University’s Workers Compensation Coordinator. For non-industrial injury/illness, complete and forward the Transitional Employment Referral form to the Risk Manager.

□ STEP NO. 5: Explain the campus’ Transitional Employment process to the physician and review the job duties. Ask the physician which of the tasks of the employee’s regular job the employee can perform. Ask the physician to indicate this information on their status form.

□ STEP NO. 6: If the employee is able to perform all the essential job tasks, have the physician sign the status form and return a copy directly to RMS. If possible, hand-carry a copy to RMS as well.

□ STEP NO.7 If the employee cannot perform all the essential job tasks on their job description, hand-carry a signed copy of physician’s status report (which lists employee’s physical capabilities) to RMS. Ask physician to fax same to RMS.

□ STEP NO.8: Together, the supervisor, employee, and Risk Manager or WC Claims Coordinator develops a Transitional Employment Plan to allow the employee to work within restrictions. This plan should be signed by the employee and the supervisor and reviewed/signed by the Risk Manager. Give a copy of the plan to the employee.

□ STEP NO.9: If the physician finds the employee unable to return to any kind of work for more than 48 hours, ensure that the physician faxes the paperwork documenting this to RMS immediately following the medical evaluation. Alternatively, the supervisor may hand-carry the form to RMS.

□ STEP NO.10: Stay in touch with the employee if they are unable to work. The nature of these contacts should be:

  • Weekly
  • Usually over the telephone
  • Showing concern
  • Inquiring about anything the employee needs

Important: Be sure not to ask about medical treatment or diagnostic information. Furthermore, do not try to investigate the claim during these conversations.

□ STEP NO.11: Participate as requested in RTW Committee meetings; help to upgrade Transitional Employment Plans regularly until your employee is able to return to regular work.

(Note:If an employee is found to have permanent work restrictions, they may need to be assessed for ADA eligibility or other alternatives.)