                          SUBMITTED BY
                            KEN SOBEL
                      SAFETY ADMINISTRATOR
                       CITY OF LOS ANGELES
                         (213) 485-4691

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The following chapter from the City of Los Angeles Safety Manual is
a draft.  It has been submitted so that others may utilize the
information in helping to meet the requirements of the Written
Injury and Illness Prevention Program required by Senate Bill 198
and the expanded General Industry Safety Order 3203.
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                                                        Chapter 6




      (EMPLOYEE'S CLAIM FOR WORKERS COMPENSATION BENEFITS)


RESPONSIBILITY

Whenever a supervisor has been made aware of a work related injury
or illness, it is the supervisor's responsibility to provide to the
employee a Form Gen. 66.  It is important to understand that the
Form Gen. 66 must be provided, even if the employee has indicated
that there is no intent to file a Workers' Compensation claim.

The Form Gen. 66 must be given to the injured worker within 24
hours or within one business day of the day that the supervisor has
knowledge of the event (e.g., the form can be provided on a Monday
following a Friday notification, if the employee does not work a
Saturday shift).  The Form Gen. 66 must be provided, even if the
supervisor has doubts about the nature or extent of the injury
claim.  Merely providing the form does not mean that the City has
accepted liability for the claim.

Note:          There is no requirement that the employee return
               the Form Gen. 66.


PROCEDURE

     1.   Prior to providing the Form Gen. 66 to the employee, the
          supervisor shall fill in two information lines on the
          claim form:

          a.   Line 9 - the date that the supervisor became aware
               of the injury or illness.

          b.   Line 10 - the date that the claim form was provided
               to employee.

     2.   The supervisor shall make a record that the employee
          employee was provided with the Form Gen. 66.  Since there
          is no requirement that the Form Gen. 66 be returned, such
          a record can protect the supervisor and the City in the
          event that the employee disputes the fact of receipt of
          the form.

     3.   The employee should complete to top section of the form
          which is marked EMPLOYEE.  If the employee's injuries are
          so severe that the employee cannot complete the form, the
          employee may request a responsible representative to
          complete the form in the employee's behalf.  If the
          employee's injuries are so severe, the Form Gen. 66
          should be given to a family member or the employee's
          union representative (if applicable).

          At no time may the supervisor be selected to be a
          representative and complete the employee's section of the
          form.  The employee (or representative) must sign the
          form and retain the last copy.  The remainder of the form
          shall be returned to the supervisor for completion.

     4.   The supervisor must complete the remainder of the form
          under the section marked EMPLOYER.  When the supervisor
          has completed the claim form, the copies shall be
          distributed as follows:

               Original  Employing Department

               Copy 1    Employee (or Representative)

               Copy 2    Personnel Department
                         Workers' Compensation Division
                         Mail Stop 391

     5.   See Chapter 7 regarding Form Gen. 166 - EMPLOYER'S REPORT
          OF OCCUPATIONAL INJURY OR ILLNESS.

If further information is required, contact Workers' Compensation
at (213) 485-5683.