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