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Austin Fire Department IOJ Employee Resource Packet

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Austin Fire Department IOJ Employee Resource Packet Austin Fire Department IOJ Employee Resource Packet We want to ensure you receive the best care possible. This packet is designed to provide you with the information you need to navigate the IOJ process. If you have any questions, please contact AFD Workers' Compensation: Monday - Friday 7:00AM - 3:30PM Office 512-974-1310 / Fax 512-974-4102 Email: [email protected] Location: 517 S. Pleasant Valley Rd, Austin 78741 WC RN: Dawn Pepe, MSN, RN WC Admin: Rocio Hernandez WC Admin: Jenni Garcia SPECIAL INSTRUCTIONS FOR INJURED EMPLOYEE Bring the following 5 forms to each of your medical visits: 1) TX Workers' Compensation Work Status Report (DWC Form 73) or Emergency Room Work Status Report for ER / Urgent Care visits 2) Essential Job Tasks and Descriptions - Operational Firefighter 3) Essential Job Tasks and Descriptions - Chief's Aide Light Duty 53-hour Assignment 4) Chief's Aide Qualification Checklist - In order to be considered for the Chief's Aide position, the Checklist must be completed and signed by your medical provider. 5) Essential Job Tasks and Descriptions - Light Duty 40-hour Assignment Return completed forms immediately after your medical visit to: AFD Workers' Compensation via email [email protected] or fax 512-974-4102 If Released to Work with Restrictions (Light Duty): 1) Contact AFD WC immediately for further direction. Do not assume that you can just show up to shift without direction from AFD WC, the Return to Work process starts with the WC office. 2) Please make sure the Chief's Aide form is complete. This form is required to be considered for the Light Duty 53 hour program, otherwise the default is a 40 hour Assignment. Wellness Center is closed Friday, Saturday, Sunday and all COA Holidays Austin Fire Department IOJ Employee Resource Packet – Rev. Oct19 Steps of the IOJ Light Duty (aka Alternate Duty) Job Assignment Process: 1st – Your Provider changes your work status to allow you to Return-to-Work with Restrictions. 2nd – Send your completed Work Status paperwork to the AFD Workers' Compensation Office immediately after seeing a Doctor or ER Visit. *Take pic with phone and email to [email protected] or Fax: 512-974-4102 3rd – Call AFD WC Team for your Light Duty Processing appointment AND call Wellness for an appt. with Dr. Parrish The Workers' Compensation Team is the central point of contact for all IOJ activity. Telephone: 512-974-1310 / Fax 512-974-4102 WC Team: Rocio Hernandez, Jenni Garcia and Dawn Pepe, RN Operating Hours: Monday-Thursday 0700-1530 If released to Light Duty Saturday or Sunday, Call the WC Office Monday Morning. 4th – Light Duty Intake Processing is with WC and Dr. Parrish/Wellness Center. IOJ paperwork required by the WC Team to process your Light Duty assignment: 1. Work Status (DWC-73) Form or Emergency Room Work Status Report 2. Chief’s Aide Checklist Form 3. Physical Therapy prescribed plan (preferred, not required) 5th – Complete intake paperwork and Bona Fide Offer of Light Duty Job Assignment at the WC Office. 6th – Medical Consultation. with Dr Parrish. 7th – Fitness evaluation by Wellnes s Fitness team. Your prescribed Physical Therapy plan will be reviewed, if applicable. 8th – Report to your Light Duty Job Assignment. 9th – Report to Physical Rehabilitation & Conditioning Program at the Wellness Center Gym 0730-0830. Chief’s Aide Light Duty 53-Hour Firefighter reports at 0730, the morning ending their shift, when the shift ends on Monday, Tuesday, Wednesday, or Thursday (excluding CoA holidays). Light Duty 40-Hour Firefighter reports at 0700, Monday through Thursday (excluding CoA holidays). Change in your Work Restrictions or Duty Status: 1st – Your Provider changes your Work Restrictions. 2nd – Call the AFD WC office to determine if an appt. is required; Send updated Work Status Form (DWC-73 & Chief’s Aide Form, if applicable) to AFD WC Office. 3rd – Contact the Wellness Center to schedule a Medical Consultation with Dr. Parrish. Returning to Full Duty: 1st – Your Provider changes your Work Status to allow you to Return-to-Work without Restrictions. 2nd – Send updated Work Status Form to AFD Workers' Compensation Office. 3rd – Contact the Wellness Center to schedule a Return-to-Work Medical Consultation with Dr. Parrish. If you have been released by your Provider, you must also be seen by Dr. Parrish. • Note – If Dr. Parrish is unavailable to assess you before your next scheduled shift, you may return to work if cleared by WC Team, but you must be seen by Dr. Parrish at his next available opportunity. 4th – Complete the Return-to-Work Fitness Consultation with Wellness Fitness team. 5th – Meet with Wellness Division Chief for exit review of the Physical Rehabilitation & Conditioning Program. 6th – Report to AFD Workers' Compensation Office to complete the injury process. Austin Fire Department IOJ Employee Resource Packet – Rev. OCT19 AUSTIN FIRE DEPARTMENT WORKERS’ COMPENSATION REGISTERED NURSE ADMINISTRATOR ADMINISTRATOR Dawn Pepe Rocio Hernandez Jenni Garcia Office Hours: Monday – Friday 7:00AM to 3:30PM [email protected] 512-974-1310 FIREFIGHTER YOU HAVE A DECISION TREE MEDICAL WORKERS AFD WC IS WORK-RELATED CARE INJURY INJURY-ON-JOB COMP CENTRAL POINT OF CONTACT FOR ALL IOJ AFD POLICY CAN YOU SAFELY WORK STATUS ACTIVITY REPORT TO COMPLETE PERFORM YOUR REPORT SUPERVISOR FROI DUTIES? YOU MUST A.S.A.P. SEND OR WITHIN IMMEDIATELY 24 HOURS FIREFIGHTER TO AFD WC WORK RESPONSIBILITY STATUS EMPLOYEE NO YES IF BLOOD OR SECTION AND DESCRIPTION DISEASE FULL OF INJURY NO EXPOSURE DUTY GO TO SEEKING CARE DUTY HOSPITAL ER ON YOUR OWN TRIAGE SUPERVISOR FOR TRAUMA, ANY PROVIDER CONFIRM CONTACT BC & SAFETY INFECTION OR WHO TAKES WC STATUS WITH AFD WC LOGS BILL COLL RESPONSIBILITY SERIOUS INSURANCE AFD WC TIMEKEEPING 512-978-0030 INJURY INJURY 512-422-3796 INVESTIGATION SEEKING CARE MEDICAL LIGHT YOU WILL NEED AT WORK EVIDENCE DUTY A FULL DUTY EXPOSURE SUBMIT FROI RELEASE FROM YOUR CHOICE GET AS SOON 10 DAYS RECEIVE EMAIL YOUR OF WC FACILITY AS POSSIBLE TO GET WITH IOJ IN AUSTIN PROVIDER RESOURCE BC LOGS BASELINE TIMEKEEPING BLOOD TEST PACKET You will need to WORK STATUS WORK STATUS be released by REPORT REPORT Dr. Parrish CHIEF’S AIDE AFD WORKERS’ and Work Comp COMPENSATION YOU MUST GET YOU MUST GET LIGHT DUTY COMPLETED AT COMPLETED AT OPTION 53- 512-974-1310 FACILITY EACH MD VISIT HOUR WEEK [email protected] RR1 ³ C ³ MAYS CEDAR PARK CP4 FM 685 REGIONAL ³ RED BUD CP3 MED CENTER ³ FM SB1 2 ³ 24 3 FM 1431 CO 0 N 2 NO 6 RR2 R ³ M F RR5 CP1 ³ ³ GATTIS SCHOOL RR4 SB2 ³ ³ RR3 102 ³ ³ STATE HWY 45 !45 SHULTZ P CP2 A 106 ³ R ³ FM 1325 M STATE HWY 45 E R IH 35 204 KELLY ³ 203 ³ 34 MC NEIL FM 620 ! BURNET ANDERSON MILL 202 PFLUGER ³ FM 685 JV1 FM 1825 PECAN ³ HOWARD RAILROAD S ER ³ T A 38 ER ³ FIRST CHOICE T ! E JESSE AUSTIN EMERGENCY P PFLUGERVILLE 201 FL H BOHLS MC NEIL ³ U W CENTER ANDERSON MILL FM 1825 GE R Y V S IL 1 S \ L I E 3 US HWY 183 E FM 2769 E 0 P A W 1401 Canyon A ST BULLICK HOLLOW R ³ 44 ME ! R MOPAC HOWARD Creek J O L L Y V CAMERON IL L 28 E 25 DUVAL !TEXAS MED CLINIC ! C ³ S P H ³ IC SETON S E P W ST DAVID'S FM 620 R NORTHWEST O H ³ IN O NORTH AUSTIN G D 39 S 40 ! Y U A G ! A 33 E S FM 620 R S ! ER ³ B E 604 FIRST CHOICE RA D ³ K ARBORETUM ER J 601 E YA H S ³ G C S E T N P METRIC R A E I S C 30 R R E B P ! 1203 ³ R S W I I O N O R G D R S A H FUCHS GROVE RU 8 ND ! BE RON E FM 2222 21 BALCONES RG M 605 ! CA ³ ³ C CITY PAR K NOVA BURNET CE LA NORTH P R E E 31 L QUINLAN PARK V K I ! IH 35 N B I L R 47 23 UE R G ! ER ³ ! P O ANDERSON O S SE 41 AUSTIN EMERGENCY ! CENTER FAR WEST FERGUSON 1201 ³ !16 GILES WESTLAKE 19 CAMERON US HWY 290 CAPITAL OF TEXAS ! S I R R O M Y \ MANOR N 4 12 LAMAR 1001 5T N ³ Loop H! H 5 1S O T 18 J 35TH ! 360 HEART DELL HOSPITAL R E CHILDREN'S IV SETON MEDICAL R DECKER FM 2244 9 D CENTER H ³ E ³ H ³ ! H ST DAVID'SR AUSTIN EMERGENCY ³ FASTMED OCC CENTER MUELLER 14 ER ³ 606 LAMAR ER ³ HEALTH ³ ! FASTMED 10 MUELLER 26 ! 3 ER ³ ! LOYOLA ! ³ 901 AUSTINLAKE 24TH C ³ ST DAVID'S BEE CAVES C ³ MAIN MARTIN LUTHER KING A H P - O 2 UT HEALTH M ! DELL SETON 5 S A 902 ³ 12TH ³ C I ! T R 302 4 US HWY 183 A ³ P T ! 3 6TH O 7 E 9 R H ³ DELL H T M W 5TH SETON UT F B SPRINGDALE Y A R 7 32 T 1 O 1 7TH ! N S C!E P SA RINGS R C HAV EZ 7 ! !15 FM 969 FASTMED Y 11 RIVERSIDE E ! L SO L 48 UT A 37 H V ! WE AUSTIN 6 ! T S k T ³ ! ER kN EMERGENCY A CENTER S. LAMAR AFDS OL ER ³ A TO E RF FIRST WELLNESSL STATE HWY 130 P 301 US HWY 290 S CHOICE ³ \ S ER ³ E RIVERSIDE Travis R G N C ³ 22 RIVERSIDE ER ³ O ! Country CHIRO FX C FIVE STAR H ³ 27 ! 17 ST SETON AT !³ DRIPPING H E H SOUTHWEST IH 35 W SPRINGS BEN Y SOUTH AUSTIN WHITE 71 42 MONTOPOLIS MEDICAL CENTER US HWY 183 ! TODD W IL L C ³ 35 IAM ! C AN NOVA BURLESON NO 20 1ST N ! SOUTH BRODIE A STASSNEY ! FM 1826 29 1103 ! ³ STATE HWY 45 LS MANCHACA L C A A 24 F P Y - ! SLAUGHTER E O B N M L ³ N ER U I F 43 FIVE STAR K F ! C S SOUTH AUSTIN M P 36 R I ! N G S PEARCE C ³ DIRECT FM 812 ORTHOPEDIC FM 973 CARE \ DT RAN 46 B Moore's ELROY ! Crossing !49 \ 501 Goodnight THAXTON ³ Ranch FM 1626 1101 ³ FM 1625 FM 812 IH 35 FM 1327 OLD LOCKHART FM 967 1102 ³ STATE HWY 130 AFD Battalions with ! AFD Fire Station Batt 1 Batt 3 Batt 5 Batt 7 C ³ Clinics Clinics, ERs, and Hospitals ³ ESD Fire Stations ER ³ Emergency Rooms Updated February 2019 Funded Future Document Path: G:\Planning\GIS Files\ArcView P rojects\2019_Battalions_ER_Hosp_Clinics_Letter.mxd Batt 2 Batt 4 Batt 6 Batt 8 \¬ Fire Station H ³ Hospitals Austin Fire Department Emergency Room Work Status Report EMPLOYEE: DOB: DOI: Date of Birth Date of Injury/Illness Nature of Injury Part(s) of Body Injured PART I – WORK STATUS (Medical Provider completes this section.
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