WebThe CA-1 injury form covers questions such as: When did the event or injury occur? You will be required to fill in the date and time of the injury within the form. What is the nature … WebFiling Form CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation Use this form if you have sustained a traumatic injury on the job. A traumatic injury is a condition of the body caused by a specific event or incident, or series of events or incidents, within a single workday or shift.
Forms U.S. Department of Labor - DOL
WebWhen a notice of traumatic injury or occupational disease is filed, the immediate supervisor is responsible for doing the following: Immediately ensuring that appropriate medical care is provided. Providing the employee a Form CA–1 or a Form CA–2. WebIf your injury results from a specific event or a series of events during one day or shift, complete a Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation as soon as possible, but not later than 30 days after your injury online in the Safety Management Information System (SMIS). canucks ottawa game
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WebThe injury was proximately caused by the employee's willful misconduct, intent to bring about injury or death to self or another person, or intoxication; e) The injury was not reported on Form CA-1 within 30 days following the injury; Work stoppage first occurred 45 days or more following the injury; WebCA1 - Notice of Traumatic Injury . CA2 - Notice of Occupational Disease . CA2a - Notice of Recurrence . CA7 - Claim for Compensation . CA7a - Time Analysis Form . CA7b - Leave Buy Back . CA10 - What a Federal Employee Should Do When Injured at Work . CA16 - Authorization for Examination and/or Treatment . Web542.11 Traumatic Injury 542.111 Notice The notice of traumatic injury is given on Form CA–1. 542.112 Time Limit FECA requires that written notice of a traumatic injury be given by the employee, or person acting on behalf of the employee, within 3 years of the injury. bridgerton tainies online