Recording Injuries & Workers Compensation Using SMART HR

Recording Injuries & Workers Compensation Using SMART HR Region IV - RMIC Page 1 Revised 01/2010

Introduction... 3 Employment Notes... 3 Disclaimer... 3 Minnesota Workers Compensation... 4 Coverage Requirements... 4 Logging onto SMART HR... 4 Human Resource Modules... 5 Menus... 5 Icons Defined... 6 Binoculars... 7 Dropdown Listboxes (DDLB)... 7 Print Screen... 7 Supervisor s Report of Accident (SRA)... 8 Click on YES or NO... 10 First Report of Injury (FROI) - OSHA Form 301... 12 Filing Claims... 12 Death or Serious Injury... 12 Record Retention... 12 Work-Related Injury or Illness... 12 Recording Work-Related Injuries and Illnesses... 13 Additional Criteria... 13 Medical Treatment... 13 Employer Reporting and Payment Requirements... 13 Employer Penalties... 14 Form 300 Log of Work-Related Injuries and Illnesses... 20 AUDIT BEFORE YOU POST!!!... 22 Form 300A Summary... 22 Employee and Union Rep Claim Review... 23 Workers Compensation Claim (WCC)... 25 Optional Qualified Rehabilitation Consultant (QRC) Information... 27 Notes Icon... 27 Related Websites... 28 Assigning work comp codes to SHR pay codes... 29 Overriding work comp code assignment on an employee... 29 Workers Compensation Wage Tally... 30 Workers Compensation Code Maintenance... 31 Paying Sick Leave to Employees Receiving Workmans Comp... 31 Region IV - RMIC Page 2 Revised 01/2010

Injuries & Workers Compensation Introduction There are times when employees are injured at work or sustain injuries from repeatedly performing work related tasks using inappropriate techniques or equipment. Tracking these types of incidents can help a district manage the injuries that occur at the workplace. If an employee suffers an injury or illness, the employee may qualify for disability. The SMART HR Personnel Module provides member districts with the opportunity to record and track disability claim activity. In general, recording incidents of occupational deaths, injuries, and illnesses have several distinct functions or uses for employers, employees, and OSHA. One is to provide information to employers about hazards in their workplaces that are injuring or making their employees ill. Employers and employees can then use the information to implement safety and health programs at individual workplaces. Analysis of injury and illness data is a widely recognized method for discovering workplace safety and health problems and for tracking progress in solving those problems. Recording claims into the SMART HR database will give you historical information at the click of a button you would otherwise not have. The Personnel Module automates the task of completing the Supervisor s Report of Accident, First Report of Injury and the OSHA required Form 300 (by location) and OSHA Form 300A (by location) summary that is required to be posted. It also provides a window to track a workers compensation claim if one is filed. Recording claims in SMART HR also ensures accuracy in the reporting of the hours worked and days lost that are required for OSHA Form 300 and 300A reporting. If OSHA audits your district they will look for consistency in the way these items are recorded. Employment Notes The employment notes icon is available on all employee windows throughout SHR. This tool is useful to record information about an employee s employment with your district that would be found in a personnel file. There is an option to print the note if a paper copy needs to be retained in the personnel file. The employment note you record can be marked as confidential and is not viewable to other SHR users. Disclaimer If differences exist between this documentation and the laws of OSHA, the OSHA laws govern. This documentation was developed as a tool for guiding you through the Personnel Module, Injuries and Workers Compensation windows. Region IV - RMIC Page 3 Revised 01/2010

Minnesota Workers Compensation Workers compensation laws were passed to eliminate the fault concept and the litigation brought because an employee had to prove fault on the part of the employer before collecting benefits. Workers compensation laws shift the cost or work-related injuries or diseases to the employer as a cost of doing business. Both employees and employers are protected under the laws. A covered employee who suffers a work-related injury forfeits the right to sue the employer for damages in return for certain guaranteed benefits. Benefits include payment of reasonable and necessary medical expenses and a specific schedule for payment of disability benefits. Coverage Requirements Under Minnesota Statutes 176.021, every employer is liable to pay compensation in every case of personal injury or death of an employee arising out of and in the course of employment. Minnesota Statutes 176.181, subd.2, requires employers who have not been approved for self-insurance to provide workers' compensation insurance for their employees. Employers are generally defined as those who hire others to perform services. Employees are generally defined as people performing services for another for hire, including minors and workers who are not citizens. Logging onto SMART HR Begin by clicking on the icon for the SMART HR shortcut Database: HR1234 (where 1234 is your district number) User ID: Enter your employee ID from payroll Password: Enter the password assigned to you by the Region Region IV - RMIC Page 4 Revised 01/2010

Human Resource Modules Modules are accessed by clicking on the module group at the top of the screen after you have logged in. To select a specific module, click on the item from the drop down menu. An easy way to access a module is by clicking on the shortcut icons. Heart Personnel Graph Position Budgeting Car Recruitment Diamond Benefits Dollar Sign - Payroll Mailbox Mail Box Notepad User Unique EXIT Exits the application Menus Each module offers menu GROUPS to choose from on the left with corresponding WINDOWS-REPORTS on the right. Region IV - RMIC Page 5 Revised 01/2010

Icons Defined Depending on the window or group you select you will see all or some of the following icons. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ICON Description Zoom 1) Allows you to increase or decrease the viewable report size on screen Run 2) Click on the running man to run reports where this icon is in the toolbar. Report Sort 3) Option to sort the report in a different order either ascending or descending Print 4) When you click on this icon a print specification box will pop up allowing you the option of which printer to print to and which pages of the report you want to print Save to File 5) You can save the report as a file. You can select the file type such as text, Excel, Access or Word First 6) Takes you to the first page of the report Page Previous 7) Takes you back to the previous page Page Next 8) Takes you to the next page Page Last Page 9) Allows to go to the last page of the report Retrieve 10) Click on the retrieve icon to run a report or retrieve a screen in SMART HR Refresh 11) Used to refresh the screen Print 12) Allows you to print exactly what you see on the screen Window Filter 13) Some of the reports give you an option to filter by code. For example the pay code reports will pop up a list of pay codes to further define your selection after the full report has been retrieved. Post It 14) Allows multiple users of SMART HR to share information electronically within the software regarding personnel information. Clicking this icon routes information for another user to view or approve. You can attach any window from the application to your message. Done 15) To exit a window or report Exit 16) To exit the application Region IV - RMIC Page 6 Revised 01/2010

Binoculars The binoculars are found on employee windows. The binoculars are used to look up and select an employee. Begin typing as the employee last name in the Name field, then click on Select Each district has a choice in how they want to view this feature. You can see Active Employees or All Employees. You can call Region IV RMIC staff to change your default setting at any time. Active Employees. Displays only those employees with an active status in SHR All Employees. Displays every employee ever paid in SHR Dropdown Listboxes (DDLB) Listboxes are created using the MN Setup windows in SMART HR. If you are interested in creating some district unique codes call Region IV RMIC staff to ask how. Print Screen To print a screen within the application, click on the computer monitor icon If you need to print an error message the computer monitor icon is not available. Press the Alt key and P key on your keyboard. This copies the window to the clipboard. Open up Microsoft Word. Press Ctrl and V keys. This will paste the print screen into word so you can save the error message or print screen window. Region IV - RMIC Page 7 Revised 01/2010

Personnel Module Injuries and Workers Comp Menu Supervisor s Report of Accident (SRA) The Supervisor s Report of Accident is often the first reporting of the injury that the central office receives. It also serves as a way to investigate the cause of the accident so corrective action can be taken. The SRA will auto-populate fields on the FROI if completed in SHR. This is not an OSHA required form. Personnel Module Injuries & Workers Comp Supervisor Report of Accident Select Employee ID. Enter the employee s id OR use the binoculars to select the employee. The employee s name will be displayed. Incident Date. The cursor initially will be positioned in the Incident Date field. Today s date will be the default. If this is the correct date, press ENTER. If the injury or illness occurred on another date, enter the date then press ENTER. Be sure you RETRIEVE the window! Region IV - RMIC Page 8 Revised 01/2010

Supervisor s Report of Accident (SRA) Employer Name: This defaults as a view only field from the Setup Federal Entities window, Dist Name (Rpts) field. Employee ID and Name. View only field from what was entered into the Select box for employee ID. ID of Reporting Supervisor. Click on the dropdown listbox to select the employee s supervisor. Note: Supervisors are setup in the Employee Info window, Basic Information tab, User Class field. Date of Report. Enter the date of the report in mm/dd/yyyy format. Department. Limit 18 characters. The department this employee is assigned to. Date and Time of Incident. Enter the date and time the incident occurred. Hours Lost on Date of Accident. Enter the hours lost the day of the incident. Note: This information can be updated later if this information is not available at the time of the report. Job Title. Limit 18 characters. The employee s job title. Did employee lose time from work? Click on YES or NO Has employee returned to work? Click on YES or NO Service with company. This defaults using a calculation based on the employee s date of employment compared to the incident date divided by 365 1/4. If the default calculation is not correct you can manually enter the service in this field. Note: Date of hire is recorded on the Employee Info window, Status Changes tab, Orig Hire Date field. Years in Present Job. This defaults using a calculation based on the employee s date of employment compared to the incident date. If the default calculation is not correct you can manually enter the years in present job in this field. Note: Date of hire is recorded on the Employee Info window, Status Changes tab, Orig Hire Date field. GIVE US YOUR HONEST COMMENTS ON QUESTIONS BELOW. WE ARE NOT TRYING TO BLAME ANYONE. YOUR OPINION MAY HELP US PREVENT ACCIDENT REPETITION. 1. Was injured person properly instructed in safe and efficient methods? Supervisors should instruct their employees on how to do the job efficiently and safely. Was proper instruction given to the employee on how to do the job safely? Click on YES or NO 2. Did injured person violate any instructions? If proper instruction was given to this employee on how to do their job safely, did the employee violate those instructions? Click on YES or NO 3. Was necessary protective equipment worn? (if applicable) The supervisor should have told the employee what personal protective equipment is necessary to do the job. Did the employee wear the personal protective equipment when this job was being done? Click on YES or NO 4. Did poor housekeeping contribute to injury? Was the work area clean and well organized? i.e. scraps on the floor, blocked aisles, wet floor, spilled food, etc. Click on YES or NO 5. Did horseplay cause the injury? Region IV - RMIC Page 9 Revised 01/2010

Was there inadequate supervision? Did horseplay or practical jokes contribute to the accident? Click on YES or NO 6. Was it caused by something which needed repairs? Was the injured person using equipment that was unsafe and in need of repair? i.e. broken ladder, bad electric cord on drill, etc. Click on YES or NO 7. Should a guard be provided? Would a guard prevent another accident from happening? i.e. guard around the belts and pulleys, railing properly in place, guard on saw, etc. Click on YES or NO 8. Did any bodily defect contribute to injury? Did this person have any bodily defects that might have helped cause the accident? i.e. poor vision, previous back injury, etc. Click on YES or NO 9. Was it caused by an unsafe act? Most injuries are caused in part by unsafe acts. An Unsafe Act is something that the injured person or another person did, that he or she should not have done, which led to the accident. Click on YES or NO Below is a list of the most common unsafe acts and contributing factors: Operating without authority Operating at unsafe speed Using equipment, tools, materials or vehicles unsafely Failure to use personal protective equipment Unsafe loading, placing and mixing Taking an unsafe position Distracting, teasing Disregard of instructions Act of other than injured Failure to warn or secure Making safety devises inoperative Using defective equipment, materials, tools or vehicles Failure to use equipment provided (except personal protective equipment) Unsafe lifting and carrying (including insecure grip) Adjusting, clearing jams, cleaning machinery in motion Poor housekeeping practices Lack of knowledge or skill Others. 10. Did injured report the injury to you, the supervisor, immediately? The accident should have been reported immediately to the supervisor; was it? Click on YES or NO Application allows you to enter up to 254 characters in most description fields. FROI may limit fields differently to fit on the faxable form. Accident. 1. Describe what the injured was doing at the time of the accident. 2. What happened? 3. Who was involved? 4. What injuries resulted? Example: John was drilling a hole in the ceiling and chips of plaster fell into his eye. (This answers questions 1 and 2.) John got chips of plaster in Region IV - RMIC Page 10 Revised 01/2010

his eye resulting in a scratch to his eye. John was wearing his prescription glasses. (This answers questions 3 and 4.) Witness Name and Phone. Enter the name and phone number of anyone who witnessed the accident/illness/injury if applicable. Unsafe Act. Describe the Unsafe Act that led to the injury. An Unsafe Act is something that the injured person or another person did, that he or she should not have done, which led to the accident. (Unsafe Acts are described in question #9 above). Example: John was not wearing proper personal protective equipment. Unsafe Conditions. Describe what unguarded or unsafe condition of machinery, equipment, building or premise was involved. Defective tools, equipment, substances Unsafe design or construction Hazardous arrangement Improper illumination Improper ventilation Improper dress Poor housekeeping Congested area Other Action Taken. Example: John has been re-instructed to wear proper personal protective equipment such as goggles or face shield when drilling overhead. Remedy. Example: Standard safety policy should be adopted that requires use of personal protective equipment. This policy should be strictly enforced by the supervisors. Medical Care. Include all medical information that is known at this time. Do not delay the completion of this form for more complete information. Did Employee Go to Doctor or Hospital? Click on YES or NO. Date of Initial Visit. Enter the date the employee first went to the doctor or hospital. Treating Physician. The name, address and phone number of the physician who treated the employee. Hospital / Clinic. The name and address of the medical facility where the treatment was received. As supervisor, do you feel this injury should be covered under workers compensation benefits? Click on YES or NO. Reasons Why. As a general rule, if the employee is injured while at work, that injury is covered under workers compensation. However, if you as supervisor have reason to suspect that the injury did not occur at work, please tell the workers compensation company. This is only an opinion and by itself will not deny benefits. Save. The SRA window information can be saved by clicking on the save icon or by going to File Save. Retrieve. To view the information you just saved you can enter the employee number or use the binoculars press ENTER. to select the employee. TAB, select the Incident Date and Region IV - RMIC Page 11 Revised 01/2010

Making Corrections to the SRA. Review all of the information you entered on the Supervisor s Report of Accident. If you need to make a correction enter the information into the correct field and save the changes by clicking on the SAVE icon. Print. To print the SRA information to paper click on the PRINT button in the upper right hand corner of the screen. First Report of Injury (FROI) - OSHA Form 301 The First Report of Injury Form 301 Report is one of the first forms you must fill out when a recordable work-related injury or illness has occurred. Together with the Form 300 Log and Form 300A Summary Log, these forms help the employer and OSHA develop a picture of the extent and severity of work-related incidents. If an employee is injured or becomes ill at work, documentation of the injury or illness is required to be kept. The First Report of Injury window allows you to enter the basic information about the incident immediately. This approach will allow you to meet your regulatory reporting requirements as well as store history about your districts incident reports. Note: If a claim does not involve any claimed disability beyond the waiting period and doesn't include possible permanent partial disability (PPD), the statute does not require that it be reported to the department. Requirements for filing subsequent documents apply to this type of claim only if the First Report of Injury (FROI) form has already been (perhaps mistakenly) sent to the Department of Labor and Industry. Filing Claims Within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred, you must fill out this form. Filing promptly will help your district avoid penalties for late reporting and late payment of benefits. Death or Serious Injury If the claim involves death or serious injury (including injuries that later result in death), you must notify the Department and your insurer within 48 hours of the occurrence by telephone. The FROI must still be sent in within 7 days of the incident. Note: Some work comp companies require notice within 24 hours of a death of serious injury by telephone. Record Retention According to Public Law 91-596 and 29 CFR 1904, OSHA s record keeping rule, you must keep the FROI form on file for 5 years following the year to which it pertains. Work-Related Injury or Illness If an event or exposure in the work environment caused or contributed to the condition or significantly aggravated a preexisting condition. Work-relatedness is presumed for injuries and illnesses resulting from events or exposures occurring in the workplace, unless an exception Region IV - RMIC Page 12 Revised 01/2010

specifically applies. The work environment includes the establishment and other locations where one or more employees are working or are present as a condition of their employment. Recording Work-Related Injuries and Illnesses Record those work-related injuries and illnesses that result in: Death, Loss of consciousness, Days away from work, Restricted work activity or job transfer, or Medical treatment beyond first aid. You must also record work-related injury or illness that is diagnosed by a physician or other licensed health care professional. You must record any work-related case involving cancer, chronic irreversible disease, a fractured or cracked bone, or a punctured eardrum. Additional Criteria You must record the following conditions when they are work-related: Any needle stick injury or cut from a sharp object that is contaminated with another person s blood or other potentially infectious material; Any case requiring an employee to be medically removed under the requirements of an OSHA health standard; Tuberculosis infection as evidenced by a positive skin test or diagnosis by a physician or other licensed health care professional after exposure to a known case of active tuberculosis. An employee s hearing test (audiogram) reveals 1) that the employee has experienced a Standard Threshold Shift (STS) in hearing in one or both ears and 2) the employee s total hearing level is 25 decibels (db) or more above audiometric zero in the same ears(s) as the STS. Medical Treatment This includes managing and caring for a patient for the purpose of combating disease or disorder. The following are not considered medical treatments and are NOT recordable: Visits to a doctor or health care professional solely for observation or counseling; Diagnostic procedures, including administering prescription medications that are used solely for diagnostic purposes; and Any procedure that can be labeled first aid. Employer Reporting and Payment Requirements The employer is required to report all employee injuries that involve more than three days of lost time to the workers compensation division. Self-insured employers may make this report through their self-insurance administrator. Reports must be made to insurers within 10 days. The employer is required to pay disability benefits or file a denial of liability within 14 days of finding out about a lost time injury. Region IV - RMIC Page 13 Revised 01/2010

Employer Penalties An employer who refuses to offer continued employment to an injured employee when work within the employee s limitations is available will be penalized if unable to show reasonable cause. The penalty for not returning the injured employee to work is equal to the employee s yearly wage up to a maximum of $15,000. Personnel Module Injuries & Workers Comp First Report of Injury This window meets OSHA reporting requirements. If the SRA has been completed prior to using this window some fields will be auto-populated. Select Employee ID. Enter the employee s id OR use the binoculars to select the employee. The employee s name will be displayed. Incident Date. The incident date will default to today s date. If this is the correct you can continue to update the window. If the injury or illness occurred on another date, enter the date in mm/dd/yyyy format then press ENTER. First Report of Injury Information OSHA Case #: This number is assigned by the SMART HR application. The first four digits define the calendar year and the remaining digits define the case number in order of succession. Example: 200700004 defines the calendar year 2007, fourth case reported for your district. Date/Time of Injury. Record the date and time of the injury or illness. Enter the hour and minutes. Click on AM or PM. Note: If the SRA window has been completed this will display the time entered on that window. Time employee began work on day of injury. Enter the employee s start time the day of the injury. Click on AM or PM. First Name, Middle, Last, Address, City, State, Zip. These defaults to the employee name and address found on the Employee Info window, Basic Information and Name/Address tabs. You can manually update these fields. ID. Employee s ID. This is a view only field. Region IV - RMIC Page 14 Revised 01/2010

Marital Status. Select the employee s marital status from the listbox. Choices are Married or Unmarried. SSN. Employee s social security number. This is a view only field. Gender. Designation of male or female. This is a view only field. Home Phone. This defaults to the employee s home phone number found on the Employee Info window Supp Info tab Home field. You can manually update this field. Birthdate. This defaults to the employee s birthdate found on the Employee Info window, Basic Information tab. Occupation. If the SRA was completed it will default the Job Title into this field. You can manually update this field. This field is limited to 18 characters. Department. If the SRA was completed it will default the Department into this field. You can manually update this field. This field is limited to 18 characters. Note: There is a documented mismatch with the occupation (job) and department fields used in other areas of SHR. These fields will auto-populate if they are used elsewhere in SHR. If you get a database error when you save this window, click OK, shorten up the field(s) and click on the file cabinet again to SAVE your entries. Date Hired. Defaults to the employee s date of hire. Note: Date of hire is recorded on the Employee Info window, Status Changes tab, Orig Hire Date field. Avg Weekly Wage. Fill in all the wage information. If the employee Rate/Hour. does not work a regularly scheduled work week, Hours/Day. attach a *26 week wage statement so your insurer Days/Week. can calculate the appropriate average weekly wage. *Run the following report in SMART HR to satisfy this requirement: PAYROLL Module MN YTD Reports MN Earnings Register Employment Status. Select the status from the dropdown listbox. Choices are: Full-time, Seasonal, Part-time, and Volunteer Weekly Value Of: Meals. Record the value of meals provided to this employee. Lodging. Record the value of lodging provided to this employee. 2 nd Income. Apprentice. Is the employee an inexperienced or probationary employee? Click on YES or NO. Tell how the injury occurred and what the employee was doing before the incident (give details). Be as specific as possible in describing the events causing the injury. What was the injury or illness (include the part(s) of body)? Be as specific as possible in describing the nature of the injury (cut, sprain, burn, etc.), and the part(s) of the body injured (back, arm, etc.). What tools, equipment, machines, objects, or substances were involved? Be as specific as possible in describing the tools, equipment, machines, objects or substances involved. Did injury occur on employer s premises? Did the injury take place on school property? Click on YES or NO. If No, indicate name and address of place of occurrence. If the incident did not happen on school property record the name and address of the location the incident occurred. Region IV - RMIC Page 15 Revised 01/2010

Date of first day of any lost time. Fill in the first day the employee lost any time from work (including time lost for medical treatment), even if you paid the employee for the lost time. Employer paid for lost time on day of injury (DOI)? Select the appropriate answer from the dropdown listbox to indicate if there was lost time on the date of the injury and whether you paid for that lost time. Choices are: YES, NO, No Lost Time Date employer notified of injury. Fill in the date you first became aware of the injury or illness. Date employer notified of lost time. Fill in the date you became aware that the lost time indicated in Employer paid for lost time on day of injury was related to the claimed injury. Date Returned Work. Leave the box blank if the employee has not returned to work by the time you file this form. If the employee has returned to work, fill in the date and notify your insurer if the employee misses time due to this injury after that date. Date of death. If the incident resulted in the employee s death, record the date of death. Treating Physician. Record the treating physician s Name, Address, City, State, Zip and Phone Number. Hospital/Clinic. Record the hospital or clinic Name, Address, City, State and Zip. Emergency Room Visit. Was the employee treated in an emergency room? Click on YES or NO Overnight in-patient. Was the employee kept overnight in the hospital as an in-patient? Click on YES or NO Employer Contact Name and Phone. Enter the name and office phone number of the contact person in your district that should be contacted with questions regarding this incident. Witness Name and Phone. Enter the name of anyone who witnessed the accident/illness/injury if applicable. Note: If the SRA window has been completed this will display the witness name and phone number entered on that window. Date This Form Was Completed. This defaults to today s date. If this is not correct, enter the date. Region IV - RMIC Page 16 Revised 01/2010

Additional OSHA Form 300 Information OSHA Form 300 location that will report this incident. This defaults to the employee location found on the active employee status row. Note: The location assigned to the employee can be found in the PAYROLL Module Employee Information Employee Info Location field. Should this incident be reported on OSHA Form 300? Click the yes or no radio button. See criteria below and additional information on page 13 to determine a recordable case. No Did the employee experience an injury or illness? Yes No Is the injury or illness work-related? Yes Is the injury or illness a new case? No Update the previously recorded injury or illness entry if necessary. Yes No Does the injury or illness meet the *general recording criteria or the application to specific cases? Yes Do not record the injury or illness on the OSHA 300 and 300a logs. Record the injury or illness on the OSHA 300 and 300a logs. *Basic requirement. You must consider an injury or illness to meet the general recording criteria, and therefore to be recordable, if it results in any of the following: death, days away Region IV - RMIC Page 17 Revised 01/2010

from work, restricted work or transfer to another job, medical treatment beyond first aid, or loss of consciousness. You must also consider a case to meet the general recording criteria if it involves a significant injury or illness diagnosed by a physician or other licensed health care professional, even if it does not result in death, days away from work, restricted work or job transfer, medical treatment beyond first aid, or loss of consciousness. Should Privacy Case be printed instead of the employee name on OSHA Form 300? Click on YES or NO You must consider the following types of injuries or illnesses to be privacy concern cases: an injury or illness to an intimate body part or to the reproductive system, an injury or illness resulting from a sexual assault, a mental illness, a case of HIV infection, hepatitis, or tuberculosis, a needle stick injury or cut from a sharp object that is contaminated with blood or other potentially infectious material (see 29 CFR Part 1904.8 for definition), and other illnesses, if the employee independently and voluntarily requests that his or her name not be entered on the log. You must not enter the employee s name on the OSHA 300 Log for these cases. Instead, enter privacy case in the space normally used for the employee s name. Optional description if discretion is needed for column F on the OSHA Form 300. If you have a reasonable basis to believe that information describing the privacy concern case may be personally identifiable even though the employee s name has been omitted, you may use discretion in describing the injury or illness on both the OSHA 300 and 301 forms. You must enter enough information to identify the cause of the incident and the general severity of the injury or illness, but you do not need to include details of an intimate or private nature. Where the event occurred (e.g. loading dock north end) for column E on the OSHA Form 300. Tell where the incident occurred. Outcome (OSHA Form 300 Column G, H, I, J). Choose ONE of these categories. Classify the case by recording the most serious outcome of the case, with column G (Death) being the most serious and column J (Other recordable cases) being the least serious. (G) Death (H) Days away from work Remained at work: (I) Job transfer or restriction (J) Other recordable cases Enter the number of days the injured or ill worker was: Away From Work (OSHA Form 300 Column K). Record the number of days absent due to the injury or illness. Region IV - RMIC Page 18 Revised 01/2010

On Job Transfer or Restriction (OSHA Form Column L). Record the number of days the employee worked in a job transfer or restriction related to the injury or illness. Illness Type (OSHA Form 300 Column M). Note whether the case involves an injury or illness. (M) Select the Injury column or choose one type of Illness (1) Injury. An injury is any wound or damage to the body resulting from an event in the work environment. (2) Skin Disorders. Skin diseases or disorders are illnesses involving the worker s skin that are caused by work exposure to chemicals, plants, or other substances. (3) Respiratory Conditions. Respiratory conditions are illnesses associated with breathing hazardous biological agents, chemicals, dust, gases, vapors, or fumes at work. (4) Poisoning. Poisoning includes disorders evidenced by abnormal concentrations of toxic substances in blood, other tissues, other bodily fluids, or the breath that are caused by the ingestion or absorption of toxic substances into the body. (5) Hearing Loss. Noise-induced hearing loss is defined for record keeping purposes as a change in hearing threshold relative to the baseline audiogram of an average of 10 db or more in either ear at 2000, 3000, and 4000 hertz, and the employee s total hearing level is 25 decibels (db) or more above audiometric zero (also averaged at 2000, 3000, and 4000 hertz) in the same ear(s). (6) All other illnesses. All other occupational illnesses. Save. The FROI window information can be saved by clicking on the icon or by going to File Save. Retrieve. To view the information you just saved you can enter the employee number or use the binoculars to select the employee. TAB, select the Incident Date and press ENTER. Making Corrections to the FROI. Review all of the information you entered on the First Report of Incident. If you need to make a correction enter the information into the correct field and save the changes by clicking on the SAVE icon. Create Report. Click on the Create Report button in the upper right hand corner of the screen print a faxable copy of the FROI form. o Fax the form to your work comp company Create Report (File). When you click on the Create Report button it creates a file as well as a printable copy of the report. 1. To view the file go to: c:\smarthr\client\froi\file is named: c:\smarthr\client\froi\export_200900016.fdf 2. We recommend renaming this file. Example: AndersonC_200900016.fdf 3. Move the renamed file into the FROI/Sent Folder. If you are audited by OSHA they will want to see the FROI with the original information submitted. 4. We recommend keeping the electronic file for 5 years. Region IV - RMIC Page 19 Revised 01/2010

Print Screen. To print the FROI information to paper click on the PRINT button in the upper right hand corner of the screen. DO NOT fax this copy to your work comp company it will be rejected. The print screen option was added to give districts a paper copy of the data entered on this window. Form 300 Log of Work-Related Injuries and Illnesses The Form 300 is used to classify work-related injuries and illnesses and to note the extent and severity of each case. When an incident occurs, use the log to record specific details about what happened and how it happened. Employers must keep a log for each establishment or site (building location). If you have more than one establishment, you must keep a separate log and summary for each physical location that is expected to be in operation for one year or longer. Cases listed on the Log of Work-Related Injuries and Illnesses are not necessarily eligible for workers compensation or other insurance benefits. Listing a case on the log does not mean that the employer or worker was at fault or that an OSHA standard was violated. You do not send the completed Form 300 and 300A to OSHA unless they specifically ask you to do so. Claim Lookup. Use the Form 300 Log window to view past claims. Enter the Incident Year in yyyy format Location. Enter a location code if you want a specific location Union. Enter a union code if you want a specific union Show All Location. Y returns all locations Privacy Issues. You must consider the following types of injuries or illnesses to be privacy concern cases: an injury or illness to an intimate body part or to the reproductive system, an injury or illness resulting from a sexual assault, a mental illness, a case of HIV infection, hepatitis, or tuberculosis, a needle stick injury or cut from a sharp object that is contaminated with blood or other potentially infectious material (see 29 CFR Part 1904.8 for definition), and Region IV - RMIC Page 20 Revised 01/2010

other illnesses, if the employee independently and voluntarily requests that his or her name not be entered on the log. You must not enter the employee s name on the OSHA 300 Log for these cases. Instead, enter privacy case in the space normally used for the employee s name. You must keep a separate, confidential list of the case numbers and employee names for the establishment s privacy concern cases so that you can update the cases and provide information to the government if asked to do so. Record Retention. You must keep the Form 300 Log and Form 300 A Summary Log for 5 years following the year to which they pertain. OSHA Log 300 OSHA Form 300. The OSHA Log 300 will be auto-filled if the FROI window has been completed and saved using SMART HR. Region IV - RMIC Page 21 Revised 01/2010

AUDIT BEFORE YOU POST!!! Take time to audit your Form 300 and Form 300A before you post them February 1 st. You might need to go back and update the number of Away From Work (Days), OSHA Form 300, Column K) before posting. You need to try to be as accurate as possible when posting these forms so if you are ever audited by OSHA you will not be issued penalties. If your district uses SMART HR to record leave you should be able to check with your payroll/hr department to find out the total number of days absent for the employee s injury. The region suggests using a work comp leave reason to make this recording process easier. Form 300A Summary The summary shows the totals for the year in each category. At the end of the year, post the summary in a visible location so that your employees are aware of the injuries and illnesses occurring in their workplace. This summary page must be posted even if no work-related injuries or illnesses occurred during the year. You must post the Summary only NOT the Form 300 Log by February 1 st of the year following the year covered by the form and keep it posted until April 30 th of that year. You post ONLY the Summary (Form 300A Log) at the end of the year. Region IV - RMIC Page 22 Revised 01/2010

Employee and Union Rep Claim Review Employees have the right to review your injury and illness records. The First Report of Injury meets the review requirement. FROI instructions state: You must file this form with your insurer, and give a copy to the employee and the employee s local union office. Jana Williams, Supervisor of Compliance, MN Department of Labor and Industry, Worker s Compensation Division, defines local union office as the local union representative. For more information, see 29 Code of Federal Regulations Part 1904.35, Employee Involvement. VII. Access to Injury and Illness Records The final rule continues OSHA's long-standing policy of allowing employees and their representatives to access the occupational injury and illness information kept by their employers, with some limitations. Part 1904 requires an employer to provide limited access to the OSHA injury and illness recordkeeping forms to current and former employees, as well as to two types of employee representatives. The first is a personal representative of an employee or former employee, who is a person that the employee or former employee designates, in writing, as his or her personal representative, or is the legal representative of a deceased or legally incapacitated employee or former employee. The second is an authorized employee representative, which is defined as an authorized collective bargaining agent of one or more employees working at the employer's establishment. 29 CFR 1904.35 accords employees and their representatives three separate access rights. First, it gives any employee, former employee, personal representative, or authorized employee representative the right to a copy of the current OSHA 300 Log, and to any stored OSHA 300 Log(s), for any establishment in which the employee or former employee has worked. The employer must provide one free copy of the OSHA 300 Log(s) by the end of the next business day. The employee, former employee, personal representative, or authorized employee representative is not entitled to see, or to obtain a copy of, the confidential list of names and case numbers for privacy cases (as discussed above). Second, any employee, former employee, or personal representative is entitled to one free copy of the OSHA 301 Incident Report describing an injury or illness to that employee, by the end of the next business day. Finally, an authorized employee representative is entitled to copies of the right-hand portion of all OSHA 301 forms for the establishment(s) where the representative represents one or more employees under a collective bargaining agreement. The right-hand portion of the 301 form contains the heading "Information about the case," and elicits information about how the injury or illness occurred, including the employee's actions just prior to the incident, the materials and tools involved, and how the incident occurred, but does not contain the employee's name. No information other than that on the right-hand portion of the OSHA 301 form may be disclosed to an authorized employee representative. The employer must provide the authorized employee representative with one free copy of all the 301 forms for the establishment within seven calendar days. Part 1904 also includes a number of provisions requiring employers to protect the privacy of employees when recording injuries and illnesses. For certain injuries and illnesses listed under 1904.29, the employer must omit the employee's name from the OSHA 300 Log. Instead, the employer simply enters "privacy case," and keeps a separate, confidential list containing the identifying information. The separate listing is needed to allow OSHA and other government representatives to obtain the employee's name during a workplace inspection and to assist employers in keeping track of such cases in the event future revisions to the entry become necessary. This approach also allows the employer to provide OSHA 300 Log data to employees, former employees and employee representatives, as required by 1904.35, while at the same time protecting the privacy of workers who have experienced occupational injuries and illnesses that have privacy concerns. Under Part 1904, privacy cases include injury and illness to an intimate body part or the reproductive system; injury or illness resulting from sexual assault; mental illnesses; HIV infection, hepatitis, or tuberculosis; needlestick injuries and cuts from sharp objects that are contaminated with another person's blood or other potentially infectious material; and, other illnesses, if the employee voluntarily requests that his or her name not be entered on the log. Mental illnesses are not considered work-related unless the employee voluntarily provides the employer with an opinion from a physician or other licensed health care professional with appropriate training and experience stating that the employee has a mental Region IV - RMIC Page 23 Revised 01/2010

illness that is work- related. Also, if the employer has a reasonable basis to believe that information describing the privacy concern case may be personally identifiable even though the employee's name has been omitted, the employer may use discretion in describing the injury or illness. In such cases, the employer must enter enough information to identify the incident and the general severity of the injury or illness. The Privacy Act of 1974, 5 U.S.C. 552a (2000) regulates the collection, maintenance, use, and dissemination of personal information by Federal agencies. Section 552a(e)(4) of the Privacy Act requires that all Federal agencies publish in the Federal Register a notice of the existence and character of their systems of records. The Privacy Act permits the disclosure of information about individuals without their consent pursuant to a published routine use where the information will be used for a purpose that is compatible with the purpose for which the information was originally collected. OSHA anticipates that Federal agencies will develop agency-specific data systems for recording illness and injury information to meet the requirements of the revised Part 1960, Subpart I. While OSHA does not require that Federal employee illness and injury records be retrieved by individual identifiers, some Federal agencies developing illness and injury data systems may find it useful to do so. Each agency is responsible for assuring its own compliance with the Privacy Act, and for establishing Privacy Act systems of records when the agency determines such compliance is required. As noted above, the revised recordkeeping rules include mandatory access rights to certain illness and injury records, such as an employee's right to copy the OSHA 300 Log and an employee representative's right to view the nonidentifying right-hand portion of the OSHA 301 Incident Report (29 CFR 1904.35). Where an agency determines that all or part of the records required under the revised OSHA recordkeeping rule are part of a Privacy Act records system, the agency is responsible for issuing appropriate Notices of Routine Use to ensure that all access rights prescribed in Part 1960, Subpart I, are preserved. Note: In Privacy Cases, as defined above under Privacy Issues, we recommend you call the Minnesota Department of Labor and Industry, Workers Compensation Division, at 651-284- 5030 before releasing any information. OSHA Form 300A. The OSHA Log 300A Summary Report will be auto-filled if the FROI window has been completed and saved using SMART HR. There are some calculated fields you will need to verify for accuracy. Annual average number of employees and Total hours worked by all employees last year. These fields are populated using the DEED Unemployment reporting data for the four calendar quarters. Region IV - RMIC Page 24 Revised 01/2010

OSHA Log 300A Workers Compensation Claim (WCC) If an employee suffers an injury or illness, the employee may qualify for Worker s Compensation. This window provides you with the opportunity to record and track additional information about the workers compensation claim. The cost of workers compensation insurance is significant. By tracking claims, your district will have the information to pro-actively address the causes of the claims. Your district also will have the information about each employee to contest claims if there is doubt to their validity. Tracking will allow your district to manage its responses and ensure that all claims are addressed in a timely manner. Region IV - RMIC Page 25 Revised 01/2010

Employee ID. Enter the employee s id OR use the binoculars to select the employee. The employee s name will be displayed. Claim Date. The cursor initially will be positioned in the Claim Date field. It will default to today s date. If this is the correct date, press ENTER. If the date the workers comp claim was filed occurred on another date, enter the date then press ENTER. Incident Date. Enter the date the injury or illness occurred. Claim Number. The work comp company issues the claim number. Record the claim number issued to this employee for the injury or illness reported. OSHA Number. The OSHA number will be displayed as a view only field for reference. State/Prov. Select the State or Province where the incident occurred. Disposition of Claim. There are three statuses: Pending, Approved or Disapproved. Select the appropriate code. Provider. Select the workers compensation company from the Provider list. Note: Providers are built in Setup Validation Codes PROVIDER table. Representative. Enter the name of the workers compensation company contact person. Phone. Enter the phone number for the work comp company representative. Physician. Name of the physician who treated the employee. Facility. Medical Facility where treatment was received Left Work Date and Time. Record the date and time of the injury or illness. Enter the hour and minutes. Click on AM or PM. Returned Date and Time. Record the date and time the employee actively returned to work. Full Days Lost. Enter the number of full days the employee was absent due to this injury or illness. Addl Hours Lost. If a partial day of work was lost, enter the lost hours in the additional hour lost field. Reassignment. Was the employee reassigned due to this injury or illness? Click on the radio button to make your choice of: NONE (no reassignment), TEMP (temporary reassignment) or PERM (permanent reassignment). Work Restricted. Was the employee s work restricted by the injury or illness? Click on YES or NO Restricted work activity occurs when, as the result of a work-related injury or illness, an employer or health care professional keeps, or recommends keeping, an employee from doing the routine functions or his or her job or from working the full workday that the employee would have been scheduled to work before the injury or illness occurred. Restriction Began. If work was restricted enter the date the restriction began. Ended. If work was restricted enter the date the restriction ended. Restriction Description. If the employee s work was restricted record the work restriction description in this field. Date Claim Closed. If the claim has been closed record the closed date. Employee Died. Did the employee die as a result of this injury or illness? Click on YES or NO Date of Death. Record the date of death if the employee died as a result of this injury or illness. Region IV - RMIC Page 26 Revised 01/2010

Optional Qualified Rehabilitation Consultant (QRC) Information Scroll down on the Work Comp Claim window to view the QRC information Name. Name of the QRC (Qualified Rehabilitation Consultant) Address. Record the address, city, state, zip for the QRC Phone. Record the phone number for the QRC Work E-mail. Record the e-mail address of the QRC Save. Save the recorded information by clicking on the SAVE FILE icon or by going to the menu to File Save. Retrieve. To view the information you just saved you can enter the employee number or you can click on the binoculars icon to look up the employee s name. Making Corrections to the WCC. Review all of the information you entered on the Workers Compensation Claim window. If you need to make a correction enter the information into the correct field and save the changes by clicking on the SAVE icon. Print. To print the WCC information to paper click on the PRINT button in the upper right hand corner of the screen. Notes Icon The notes icon is available on the SRA, FROI, OSHA Form 300 and OSHA Form 300A. Notes. Click on the Notes button Date. Enter a date to be used for this note. Confidential. Notes marked as confidential are only visible to the person who entered them. This is controlled by the user id from the login window. Description. Enter a brief description of what the note is about. Region IV - RMIC Page 27 Revised 01/2010

Related Websites Instructions for Completing the FROI (Form 301), Form 300, Form 300A http://www.osha.gov/recordkeeping/rkforms.html U.S. Department of Labor Occupational Safety & Health Administration (OSHA) www.osha.gov U.S. Department of Labor www.dol.gov OSHA Fact Sheet http://www.osha.gov/oshdoc/data_recordkeepingfacts/rkfactsheet1.pdf U.S. Department of Labor Occupational Safety & Health Administration (OSHA) Record Keeping http://www.osha.gov/recordkeeping/index.html MN Department of Labor & Industry Workers Compensation http://www.doli.state.mn.us/workcomp.html MN Department of Labor & Industry Workplace Posters http://www.doli.state.mn.us/posters.html MN Department of Labor & Industry Workers Compensation Insurance Links http://www.doli.state.mn.us/wcinsurlinks.html Region IV - RMIC Page 28 Revised 01/2010

Tracking Workers Comp Codes for Reporting in Smart HR Payroll Module MN Payroll Setup MN Change Paycodes Assigning work comp codes to SHR pay codes You can change the work comp code default setting using this window. Payroll Module MN Employee Information MN Paycheck Data Overriding work comp code assignment on an employee You can override the default setting for a specific pay code by employee Region IV - RMIC Page 29 Revised 01/2010

Workers Compensation Wage Tally This report was developed to help you complete the self-audit form that is sent out by some work comp companies. It displays pay detail by work comp code, employee id and name, fiscal year, check date, pay calendar, pay code and gross amount. Scroll through the report to spot check employees. If you find an employee has been coded wrong use the Workers Compensation Wage Tally window to make corrections. Note: If you date pay-off checks June, July and August be sure you enter the fiscal year in the retrieval box so the correct wages are calculated for this report. To get the summary totals needed to complete the audit report click on the Show/Hide Detail Row icon Note: If there is an amount listed without a code you will need to look at the detail to see why. Region IV - RMIC Page 30 Revised 01/2010

Workers Compensation Code Maintenance Use this window to change the work comp code assigned to an employee if corrections need to be made. SELECT Employee ID. Enter the employee ID you want to verify work comp codes for Check Date. Enter the From and Through check dates you want to verify. This is an optional field. If check dates or fiscal years are not entered it will retrieve all data in history for this employee id. Fiscal Year. Enter the From and Through dates for the fiscal year(s) you want to verify. This is an optional field. Note: You can use the date selection or the fiscal year selection or both. If check dates or fiscal years are not entered it will retrieve all data in history for this employee id. Click on the retrieve icon to retrieve the data rows Paying Sick Leave to Employees Receiving Workmans Comp DCP, PERA and TRA retirement are not withheld from workers compensation payments you make to employees. Workers compensation represents 2/3 of the employee s gross wages. Many districts allow the other 1/3 to be deducted and paid from the employee s sick leave balance. Use one of the following pay codes in SHR to make the workers compensation payment to your employee: NORETIRE, NORET_HR, NORET2_HR, NORET3_HR, XNORETIRE, XNORET_HR, XNORET2_HR, XNORET3_HR Region IV - RMIC Page 31 Revised 01/2010

NOTES: Region IV - RMIC Page 32 Revised 01/2010