INJURY IN LINE OF DUTY


Report it to supervisor within 24 hours and fill out: Office of School Safety Incident Form: The principal must file this report, which describes what happened, within 24 hours of the incident. (If Principal fills out one, and you are asked to sign it, you can append a statement)

Comprehensive Accident Report: This report details the nature of your injuries. The principal must file it within 24 hours of the incident. Attach witness statements to accident/incident report. Cite the specific cause of injury and if it is a duty an administrator assigned you to perform. Under the "Safety" article of the Contract, you have the right to see the principal's report of the accident, sign such a report, obtain a copy of the Comprehensive Accident Report and the Incident Report (if applicable.) One copy of the above goes to Superintendent within 24 hours and he/she must make ILOD determination within 5 school days. Write the Superintendent asking him/her to determine if it was ILOD. Superintendent has 5 days from receipt to reply. DO NOT ALLOW THE SUPERINTENDENT TO DRAG HIS/HER FEET ON THIS!!! If denied, call district rep. It can be grieved under Art 21H3 and Article 20. File grievance within 30 days of denial.

UFT Incident Form (if assaulted): This report notifies the UFT Safety Committee of what happened, so the union can offer you assistance and inform you of your rights. Get it from chapter leader.

If you will be out from work, fill out Standard Absence Form (OP 198): You should submit a new absence form for every month out. Check box C.

Confidential Medical Form (OP 407): To be filled out by your physician and returned to the board's Medical Bureau immediately. Staff members who are injured in the line of duty and are absent for more than a few days should report to the Medical Bureau; phone 718-935-2721. They determine the nature of your injury and whether it is job related. Make an appointment with Medical Bureau 935-2000 during your worst condition. According to Article 21H, if you are in a no pay status, the Med. Bureau must make its determination within 10 days of your examination. Write requesting the Exec. Dir. of the Div. of Personnel to forward your personal doctor the results of the medical exam (Article 21H4), within 25 days after the exam by the Med. Div. If the Medical Bureau denies injury in the line of duty status, you should immediately contact your UFT borough office. Our contract provides for medical arbitration in these cases.

Assignment Form (OP 200): This legal form, which must be notarized, states that if you sue and collect and the settlement is larger than the salary paid during the period of convalescence, you will refund your salary to the board. IF YOU PLAN LEGAL ACTION AGAINST THE BOARD, SEE AN ATTORNEY AND FILE A "NOTICE OF CLAIM" WITHIN 90 DAYS OF THE INCIDENT!! (You can call boro office to speak to an attorney for free.

IF APPLICABLE USE THE FOLLOWING FORMS Request for Reimbursement of Medical Expenses (OP 505): The board will reimburse you for medical expenses over and above medical plan coverage if you have been in an accident or Medical Expense Form OP505A for an assault.

Request for Reimbursement for Loss or Damage to Personal Property (OP 504): The board will reimburse you for stolen or destroyed property up to $100-but only if the property is the type that is normally brought to school. The board's claim units unit has these forms; phone 718-935-2742

EDUCATIONAL ASSISTANTS MUST FILL OUT FORMS C2 and PD 19 {IF IT IS AN ASSAULT, ED. ASSTS SHOULD GET ILOD STATUS & SHOULD FILL OUT ALL THE ABOVE FORMS AS WELL} CONTACT UFT OFFICE FOR AN ATTORNEY FOR WORKERS COMPENSATION VICTIM SUPPORT PROGRAM 212-598-6853 June Feder UFT BROOKLYN BOROUGH OFFICE 718-852-4900 District Rep A. Holloway
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