Human Resources 30-71 7/15/91 3/25/02 1 of 7 OSHA & Workers Compensation Requirements Recording Workplace Injuries & Illness VPSI, Inc. is subject to the record-keeping requirements of the Occupational Safety and Health Act of 1970, State Occupational Health & Safety Plans, and Worker s Compensation requirements. In order to comply with these requirements, each VPSI employment location is required to report certain injuries and illnesses of employees. In addition, VPSI employees who experience workplace injuries or illnesses are generally covered by the provisions of the Company s Worker s Compensation liability insurance. Definitions An injury or illness is considered to be work-related if an event or exposure in the work environment either caused or contributed to the resulting condition. An event or exposure in the work environment need not be the only contributing factor. The workplace or work environment includes any location in which work for VPSI is being conducted. An incident is not considered a work-related incident if it involves signs or symptoms that surface at work, but result solely from a non-work-related event or exposure. Whether or not a work-related event is covered by the Company s worker s compensation insurance may vary from State to State and is determined by the Company s insurance carrier and depends on the provisions of worker s compensation requirements in each State. What To Do In The Event of a Workplace Injury or Illness A Manager s first responsibility in the event an employee experiences an on-the-job injury or illness is to determine whether or not the employee requires medical attention, and to assure that such medical attention is provided. Appropriate steps to assure medical attention is provided depend upon the circumstances and may include, but are not necessarily limited to the following: Administering first aid. Directing or transporting the employee to appropriate medical care at a nearby clinic, or nearby emergency facility. (Generally, work-related injuries are not treated by an employee s personal physician. Summoning emergency medical care. If an employee experiences a life threatening injury or illness, call 911 or assist the employee in going to the nearest emergency treatment facility. Employees requiring non-emergency medical attention should be directed to a treatment facility or clinic in accordance with the following:
Human Resources 30-71 7/15/91 3/25/02 2 of 7 Employees in the following States are required to go to the facility (or one of the facilities) identified on the enclosed posting: Georgia Florida Indiana Minnesota New Jersey North Carolina Virginia Employees in the following States are required to go to the facility (or one of the facilities) identified on the enclosed posting for initial treatment visit or visits, but may not be required to continue using the Company s designated facility after the period indicated in parentheses: Arizona (after initial treatment visit employee may choose treating facility) California (after 30 days employee may choose treating facility) Michigan (after 10 days employee may choose treating facility) Employees in the following States may go to the facility (or one of the facilities) identified on the enclosed posting, or to a treatment clinic or facility of their choosing (in States identified with an asterisk, the clinic must be on a list of State-approved facilities) Hawaii Illinois * Massachusetts Ohio Oregon Pennsylvania Texas * In all cases, employees should verify with the Company s current worker s compensation carrier any further requirements, restrictions, or options regarding treatment facilities. Other State restrictions may apply. For any States not listed above, the Manager should contact the Home Office Human Resources Department for information. Initial Notification of Serious Injury or Illness After assuring the employee has received appropriate medical attention, and in the event an employee requires emergency treatment or hospitalization, or in the event of an employee fatality, the Manager is required to immediately notify the Home Office Human Resources Department. Failure to notify the Human Resources Department in a timely fashion may subject the Company to potential liabilities for failure to meet federal and State reporting requirements.
Human Resources 30-71 7/15/91 3/25/02 3 of 7 Manager s Report of Workplace Injury or Illness In the event of any workplace injury or illness, an employee s supervisor is required to complete a Manager s Report of Workplace Injury or Illness (Attachment 1). A copy of this report should be maintained in the Project Office by the Project Manager. A copy should be faxed to the Home Office Human Resources Department within one (1) business day of the occurrence of the injury or illness. It may be necessary to provide additional information after a Manager s Report has been initially submitted. If so, the Report should be amended and resubmitted with the additional information. Motor Vehicle Accidents In the event a workplace injury is the result of a motor vehicle accident involving a Companyowned vehicle, certain additional accident reporting requirements may be involved. These requirements are not covered by this procedure. Rather, these requirements are covered by the Company s accident reporting procedures. However, such accident reporting procedures are not a sufficient process for reporting work-related employee injuries resulting from an accident in a Company owned vehicle. Such injuries must also be reported according to this procedure. Additional Reporting Requirements Additional reports of an injury or illness may be required in certain jurisdictions or in certain situations. The Company s worker s compensation carrier may require additional forms or reports. OSHA 300 Log Each location with ten (10) or more employees is required to maintain an OSHA 300 Log, detailing most injuries and illnesses reported on the Manager s Report of Workplace Injury or Illness. If a location is required to maintain a log, incidents meeting any of the following requirements must be recorded on the OSHA 300 Log: Employee death Loss of consciousness Restricted Work Activity or Job Transfer Medical treatment is required beyond immediate first aid. Any injury or illness considered significant, such as an injury or illness diagnosed by a physician or licensed health care professional, cancer, chronic irreversible disease, a fractured or cracked bone, or a punctured eardrum. Any needle-stick injury from a sharp object contaminated with another person s blood Any case requiring the employee to be medically removed from the workplace
Human Resources 30-71 7/15/91 3/25/02 4 of 7 Tuberculosis. Posting Requirements The following posting requirements must be met by all VPSI locations (unless indicated otherwise): Posting of the applicable State Worker s Compensation poster. (Such posters are provided to VPSI by the Company s worker s compensation carrier, and are distributed to each field office upon receipt by the Company.) Posters in many states indicate the name of the Company s worker s compensation carrier and may include other policy information. Posters referencing expired policies should remain posted until current posters are provided. A poster noting the contact information for the Company s Worker s Compensation carrier. A posting noting the location of the nearest medical clinic or emergency facility. In 2002, if a location has ten (10) or more employees, the OSHA 200 Log, Log and Summary of Work-Related Injuries and Illnesses. Beginning in 2003, if a location has ten (10) or more employees, the OSHA 300A Form, Summary of Work-Related Injuries and Illnesses. Conclusion Questions regarding this procedure should be addressed to the Home Office Human Resources Department. George Ferrell Vice President Human Resources Attachment: Manager s Report of Workplace Injury or Illness Poster: In the Event of a Work-Related Injury or Illness (If this poster is incomplete for your location, contact the Home Office Human Resources Department) Poster: Workers Compensation Claim Information
Confidential Manager s Report of Workplace Injury or Illness OSHA Form 301 Equivalent - First Report (Due within 1 business day of injury or illness occurring) - Amended Report Use additional sheets where necessary for any requested information 1. 2. Employee Name, Address & Phone Number SSN 5. Gender Male Female 3. Date of Birth 4. Date of Hire Department State Job Title Manager Name Manager Contact Phone 11. 13. Date/Time of Incident 12. Time Employee Reported to Work Location Where Injury or Illness Occurred 18. If Employee Died, Date of Death 14. What Was The Employee Doing Just Before the Injury or Illness Occurred? 16. Nature of Injury or Illness 15. Describe how the injury or illness occurred. 17. Indicate any object or substances that caused the injury to occur. Describe any medical attention the employee has received. (Date of treatment, 6. physician name, and 7. name & address of treatment facility.) 8. Was there emergency room treatment? Yes No 9. Was there overnight hospitalization? Yes No Are there any workplace safety issues which should be considered for correction? Lost Time Summary Date Hours Lost Submit amended report for lost time occurring after initial report is submitted. Manager s Signature Date OSHA Compliance Information 10. Case No (Sequential # on OSHA 300) Check if any of the following apply. Enter on OSHA 300 Log (if applicable) Employee death Loss of Consciousness Restricted Work Activity or Job Transfer Medical Treatment Beyond First Aid Other Significant Injury or Illness Type of Incident (Check One) Injury Skin Disorder Respiratory Condition Poisoning Other Illness (not listed above) Completion of this report is required by federal OSHA regulations. Improperly completed reports may subject the Company to penalties. Incomplete forms will be returned. For assistance in completing this form, contact the Home Office Human Resources Department. VPSI HR Revised 1/02
IN THE EVENT OF A WORK- RELATED INJURY OR ILLNESS FOR ANY LIFE OR LIMB THREATENING EMERGENCY Call 911 FOR ANY OTHER MEDICAL SITUATION Troy Industrial Clinic 1663 Stephenson Highway (2 blocks north of Rankin; ¼ mile North of Maple Road) Troy, MI 48083 248-689-7100 This clinic is open 24 hours/day Sample Concentra Medical Center 264 West Maple Road Troy, MI 48083 248-362-4616 Open 24 Hours M thru F (from 7:30 a.m. Monday until 4:00 p.m. Saturday) Closed Sunday An authorization Form is generally required for services at Occupational Clinics. For copies of the appropriate authorization form, a) a copy for this local clinic should be attached to the back of this poster, b) a copy of the authorization form may be obtained from the local clinic, or c) the authorization form for any Concentra Medical Center may be obtained from the Home Office Human Resources Department. Notify the Home Office Human Resources Department of any work-related injury or illness. Clinic hours are subject to change. Contact clinic directly for current information. Use of any facility or physician other than clinic(s) listed above requires Company approval. For posting in Home Office 5/02
Workers Compensation Claim Information In the event of a job-related injury, accident, or illness 1. Notify your Supervisor or Manager. 2. Notify Hartford Claims at 800-327-3636. Identify yourself as an employee of VPSI, Inc. and provide other requested information. 3. Notify the Home Office Human Resources Department at 248-597-3500 VPSI, INC. 1220 Rankin Street Troy, MI 48083 Phone: 248-597-3500 Fax: 248-597-3596 Effective 10/1/05