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SMIS User Guide for Supervisors

1. Compensation Programs OWCP This chapter also describes how to access Accident Reporting This chapter presents step by step instructions on how to electronically complete a Notice of Traumatic Injury or Illness Personal Information Entry and append an accident report to the claim Page 1 Throughout this user guide where step by step instructions are provided required user selections are identified in bold text Screens are displayed throughout this user guide to give you an idea of what a screen will look like when you are using SMIS Accident Reporting These screens are not intended to display details Terminology Used Throughout This User Guide The following list presents definitions for terms that are used throughout this user guide e Accident report An electronic notice that someone was injured or ill including property damage created by supervisors in the SMIS Accident Reporting Supervisors module an accident report includes a CA 1 or CA 2 form injury or illness details about the claimant injury information about any other parties involved in the accident and property damages sustained from the accident e Browser A computer program used to access sites or information on the Internet for example Internet Explorer and Netscape e Claimant Any person filing a compensation claim creating an Injury Report including permanent and temporary DOI workers emergency workers job corpsmen contractors Yout
2. Inthe Unknown SSN box enter the individual s last name first name and middle initial and click Submit Name SMIS will generate a fake social security number and ID Name Birth Date Address Personnel Status 3 SM IS Non DOI Personal Data for ID SMITSALLO Unsecure Test Data This individual is not in the SMIS database If you mistyped the SSN and want to try again click the Re Enter different SSN bution below Otherwise enter the required information Last Smith First Sally MI Sex Male Female Street City Responsible Org 60100000 DEP ASST SECY PLCY amp INTRNL AFFR v A Non DOI Acon Personal Data for ID x lt Name gt SMIS Supervisors User Guide April 2004 Page 31 Use the following table to enter the requested additional information and then click Add to SMIS DB to add the person to the SMIS personnel database so that you can continue entering injury information Field What You Should Enter or Select Birth Date Type the person s date of birth You can enter the date in any format that includes day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 and Feb 4 2004 Sex Select Male or Female Address Type the mailing address street city state and zip code of the person whom you are adding Personnel Status Select the status that best describes the person s employment relationship with the DO
3. though the application is still open SMIS Supervisors User Guide Page 3 April 2004 Makes the window smaller but still visible so that it does not fill your entire screen When a window is in this mode you cannot stretch it Minimize Maximize and Close buttons e Stretch the window in which SMIS Accident Reporting displays until the screens display as you would like Adobe Reader You must also have Adobe Reader 5 0 installed on your computer to be able to read online reports and forms If you have not installed Adobe Reader you will not be able to view these forms You can download Adobe Reader for free by going to the following web site http www adobe com products acrobat readstep2 html Online Help Online help is available for many of the fields that display throughout SMIS Accident Reporting When your cursor changes to a hand Oy click on the text to view information that helps you enter the correct information in the field SMIS Overview SMIS Accident Reporting includes the following components e Accident Reporting is a tool used to electronically report accidents and file workers compensation claims CA 1s and CA 2s e Safety Smart On Line is a collection of hundreds of safety talks posters management articles case studies and mote e DOI SafetyNet is a safety information source for the Safety and Health Community e Reference Library contains DOI safety statistics and reference m
4. e When you initially complete the Supervisor s Report for a claim e After you have submitted a claim see Adding Injury Reports or Property Damages After Submitting a Claim for more information on page 40 This section describes how to enter this information when you initially complete the Supervisor s Report for a claim 1 At the top of the Congratulations Supplemental Data Entry is Complete screen click Add Property Damage The Property Entry form damage occurred on lt accident date and time gt screen is displayed SMIS Property Entry form damage occurred on Feb 10 2604 12 04AM Unsecure Test Data Enter information about the item of property that was damaged Type of Property x Description Property Owner x Cause of Damage Source of Damage Y Estimated dollar value of this damage round to nearest dollar Tf this damage involves a motor vehicle were seatbelts wom Send this Info gt gt Property Entry form damage occurred on lt accident date and time gt SMIS Supervisors User Guide Page 36 April 2004 2 From the Type of Property drop down list select the option that best describes the property that was damaged 3 Inthe Description field type a description about the damaged property Include information such as make name model number size type color and license number 4 From the Property Owner drop down list select the optio
5. Addr Type the street address of the clinic or hospital City Type the city in which the clinic or hospital is located State Type the state in which the clinic or hospital is located Zip Type the zip code for the address at which the clinic or hospital is located SMIS Supervisors User Guide April 2004 Page 15 16 17 18 19 20 21 22 23 24 25 26 27 In the 33 First date medical care received box type the date on which the injured claimant first went to the doctor because of his or her injury Enter the date in one of the following formats mm dd yy OR mm dd yyyy In the 34 Do medical reports show employee is disable for work box select Yes No or Unknown In the 35 Does your knowledge of the facts about this injury agree with statements of the employee and or witness box select Yes or No Select No if you believe the injury is questionable In the box below explain in what way your knowledge of the injury differs In the 36 Does the employing agency controvert continuation of pay box select Yes or No Select Yes if you decide that the claimant s injury is not work related as determined in boxes 28 29 and 35 This means that the claimant cannot elect to use COP but rather the claimant must use his or her sick or annual leave Then in the box below explain your reasons for challenging the claim as well as any concerns you have In the 37 Pay Rate When Employee Stopped Workin
6. Field Birth Date Sex Address Personnel Status Responsible Org SMIS Supervisors User Guide April 2004 What You Should Enter or Select Type the person s date of birth You can enter the date in any format that includes day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 and Feb 4 2004 Select Male or Female Type the mailing address street city state and zip code of the person whom you are adding Select the status that best describes the person s employment relationship with the DOI Select the DOI organization responsible for the accident Page 39 Adding Injury Reports or Property Damages after Submitting a Claim After you submit a claim it awaits review and processing by an HR compensation coordinator If you determine that you need to add more information to a claim while it awaits review and processing you can do so from the Supervisor s Accident Report Entry Module screen You can e Add new injury reports for individuals not already reported as injured e Add new property damage reports You can also perform the following tasks however these tasks are not described in this user guide Additional documentation for how to complete the forms that display from this option is available in the original Supervisor s Accident Report Module WEB based Accident Reporting System USER MANUAL SMIS documentation e View and or edit information a
7. Treatment During Training including physical training During a Work Capacity Test Non Fire Fighting Related Incident If yes Date of Death During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test SMIS Supervisors User Guide April 2004 Field That You See What to Enter or Select Select the option that best describes what the employee was doing when the accident occurred Select No if the claimant did not die from the accident Select Yes if the claimant died as a direct result of the accident Type the date on which the claimant died You can enter the date in any format that includes day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 Feb 4 2004 Page 26 Option Selected in Step 1 Field That You See Non Fire Fighting Related Incident Days Lost Time During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test Non Fire Fighting Related Seatbelts Worn Incident During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test During Managem
8. box do the following Select Yes or No based on your investigation of the accident If injury was caused by another person or non person such as an organization or company select Yes Ifyou selected Yes from the The Third Party is a drop down list select whether the third party that caused the injury is a person or non person such as an organization or company 14 If you selected Yes in step 13 the 31 Name and address of third party box type the name and address of the third party another person or organization that caused the accident Use the following tables to help you complete this box If you selected No in step 13 go to step 15 If the third party is a person Field What You Should Enter or Select Last Name Type the third party s surname name First Name Type the third party s first name If the third party is an organization Field What You Should Enter or Select Org Name Type the name of organization responsible for your accident Title Type the title of the organization s official such as president personnel officer financial officer this is the person to whom you want to address your claim SMIS Supervisors User Guide Page 14 April 2004 15 Field What You Should Enter or Select Addr Type the street address at which the third party works or is located City Type the city in which the third party works or is located State Type the state in which the third p
9. Enter or Select From the Incident Mgmt Type IMT drop down list select a level between through V 1 through 5 to identify the level of fire fighting management that was performed for the fire In the Transfer of Command field select Yes if fire fighting management was transferred to a different management type Select No if fire fighting management remained the same Contact a safety manager if you do not know this information or leave this field empty Select the primary type of vegetation that was consumed by the fire e Timber e Brush e Grass e Slash Contact a safety manager if you do not know this information or leave this field empty In the Fire Nr field type the number assigned to the fire Page 25 Option Selected in Step 1 3 Use the following table to complete the fields that appear on the Injury report of lt Claimant s Name gt screen Click Send this Info when you are done NOTE The fields that you see on the screen depend on the option you selected in step 1 Non Fire Fighting Related Incident Activity During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test Non Fire Fighting Related Incident Is this a Fatality During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels
10. Internet Explorer from the Tools menu select Internet Options 2 Click the Advanced tab 3 In the Settings list scroll down until you see one of the following Use Java 2v1 4 2 for lt applet gt requires restart Enable JavaScript 4 Make sure there is a check in the checkbox Click Apply and then OK to save your settings Window Display You can change the way SMIS Accident Reporting displays You can change the e Size of the fonts that display on screens e Size of windows Larger or Smaller Fonts You can make fonts larger or smaller by changing your monitor s resolution 1 Right click your mouse or left click if you have set the mouse for left handed use any place on your desktop A menu is displayed Select Properties The Display Properties dialog box is displayed 2 Click the Settings tab 3 In the Screen resolution box select the desired screen resolution The recommended resolution for SMIS Accident Reporting is 1024 by 768 4 Click Apply and then OK to save your settings Larger or Smaller Windows You can make the browser window in which SMIS Accident Reporting displays larger or smaller e Maximize the window in which SMIS Accident Report is displayed Maximize opens a window so that it fills your entire screen When a screen is in this mode you can stretch it to any size you would like Minimize collapses the Close shuts down window so that you no a the application longer see it even
11. accident reporter and cannot log in using your last name and the last four digits of your social security number you may not be in the SMIS personnel database This could be the case if you are a new supervisor If you cannot log in contact Support at 303 236 7158 to report the problem SMIS Supervisors User Guide Page 11 April 2004 Completing the Supervisor s Portion of a CA 1 After a claimant submits a CA 1 claim form you receive an email with the subject line An Electronic CA1 for lt Claimant s Name gt requires your action The email reads as follows SUBJECT An electronic CA1 for lt CLAIMANT gt requires your action On lt DATE gt a claimant lt CLAIMANT gt filed an electronic CA1 Federal Employee s Notice of Traumatic Injury and Claim for Continuation of Pay Compensation for an injury sustained on lt DATE and TIME gt It is important that this notice claim be processed expeditiously to avoid possible hardship to the claimant Should you dispute the facts or validity of the claim you can express your doubts when you complete the Supervisor section of the claim Do not let your dispute delay your processing of the claim To process this claim go to the following Web site www smis doi gov Click on the Supervisors button and log in using your last name and last four digits of your social security number After logging in click the Complete Employee Initiated CA1 CA2 link and enter the following C
12. compensation coordinators use this module to process workers compensation claims or assist claimants to enter OWCP claims The following diagram illustrates the flow of Injury Reports and accident report information from the time someone is injured or becomes ill through SMIS Accident Reporting and finally to OWCP SMIS Supervisors User Guide Page 6 April 2004 SMIS Accident Reporting Process Overview DOI Employees Module Claimant initiates Notice of Traumatic Injury or Illness Personal Information Entry SMIS Accident Reporting Automated Process Email is sent to the claimant with a claim ID that is required to file a claim online DOI Employees Module Claimant completes his or her CA 1 or CA 2 form y SMIS Accident Reporting Automated Process An email notifying that the claimant filed a claim is sent to the claiman s supervisor and the compensation coordinator working in the bureau in which the injured or ill claimant works Supervisors Module Supervisor completes his or her portion of the CA 1 or CA 2 form SMIS Accident Reporting Automated Process Email is sent to the compensation specialist working in the bureau that the injured or ill claimant works email states that the claim is ready for processing If a worker s comp Comp Coordinators Module claim is requested Compensation coordinator completes his or her portion of the CA 1 or CA 2 form
13. complete the fields that are displayed Click Send this Info when you are done NOTE The fields that you see on the screen depend on the option you selected in step 1 Option Selected in Step 1 Field That You See What to Enter or Select Non Fire Fighting Related Place of Incident Incident Type where the accident occurred including the name of During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test SMIS Supervisors User Guide April 2004 the field or duty station city state phone number for the location for example R4 Regional Safety Office Atlanta GA 404 679 4186 fax 4183 Alligator River NWR Crest Cut Trail Page 22 Option Selected in Step 1 Field That You See Non Fire Fighting Related Incident Narrative Incident During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test Non Fire Fighting Related Corrective Action Incident During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test Non Fire Fighting Related Unsafe Act Incident During Manag
14. given to Federal state and local agencies for law enforcement purposes to obtam imformation relevant to a decision under the FECA to determune whether benefits ave being paid properly including whether prolubited dual payments are being made and where appropriate to purme salary admiustrative offset and debt collection actions required or permitted by the FECA and or the Debt Collection Act 7 Disclosure of the claimant s social security mimber SSN or tax identifying number TIN on this form is mandatory the SSN and or TIN and other information maintained by the Office may be used for identification to support debt collection effort camied on by the Federal government and for other purposes required or authorized by law 8 Failure to disclose all requested information may delay the processing of the claim or the payment of benefits or may result in an unfavorable decision or reduced level of benefits Note This notice applies to all forms requesting information that you might receive from the Office in connection with the processing and adjudication of the claim you filed under the FECA Return to Witness Form Get Witness Statement SMIS Supervisors User Guide Page 44 April 2004 In the Statement of witness field type a description of what happened In the Name of Witness fields type the witness surname first name middle name or initial In the Address field type the street address at which the witness lives In
15. no work was missed You can enter the date in any format that includes a day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 and Feb 4 2004 5 Inthe Date Returned to Work field type the date that the injured person returned to work You can enter the date in any format that includes a day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 and Feb 4 2004 6 Inthe Days Lost Time field enter the number of days that the injured person missed work because of his or her accident injuries You must enter a number in this field even if it is zero 0 7 Inthe Describe Cause of this Injury field type a description of what happened to cause the person s injury NOTE This information is entered on block 13 Cause of injury Describe what happened and why on a CA 1 form This block is limited to approximately 200 characters Any characters beyond this will not appear on the CA 1 form but will be stored in the SMIS database 8 In the Seatbelts field select Yes or No Select Yes if the injured person was involved in an automobile accident and was wearing his or her seatbelt Select No if the accident did not involve an automobile OR the injured person was involved in an automobile accident and was not wearing his or her seatbelt 9 Click Send this Info The second Injury report of lt Injured Party s Name gt screen
16. of the body and which side was injured Report injuries of other persons If other people were injured as a result of the accident that triggered the initial claim you must enter information about those people and their injuries Likewise if other people were injured as a result of someone s illness that triggered the initial claim you must enter information about those people and their injuries For example if an employee passes out because of an illness sustained on the job and during his fall he hurts another person you must note the injured person in the same claim being filed for the ill employee This ensures that the accident report includes information about all parties that were injured from a single accident Report property damage You must report property damage that was sustained in an accident Entering this information ensures that the accident report includes details about damaged property SMIS Supervisors User Guide Page 9 April 2004 The following illustration describes the workflow process for a supervisor Overview of Supervisors Module Claimant enters claim CA 1 or CA 2 Supervisor receives email about new claim and logs into Supervisors module to complete claim report Supervisor completes Supervisors Report on CA 1 or CA 2 form Supervisor enters supplemental information or details for the claimant about his or her accident injuries Supervisor enters information about other people injured in
17. the accident Supervisor enters information about property damage sustained from accident Logging into the Supervisors Module Only supervisors and authorized accident or injury reporters can log in to the Supervisors module 1 From the Safety Management Information System screen click Supervisors The Accident Reporter Validation screen is displayed Supervisors Login SMIS Supervisors User Guide April 2004 o SMIS Accident Reporter Validation The Safety Management Information System SMIS reporting module is intended for DOI supervisors and authorized Versi accident injury reporters only If you ate a DOI supervisor or reporter and cannot login using your Last Name and Last 4 of your lo ye1 93 SSN your name may not be in the SMIS database especially if you are a new supervisori contact the Department Safety Office Site G03 236 7130 Ext 232 to report the problem For additional help click here Clicktoverity Enter your supervisor login information Last Name DOI User Validation Login to the SMIS Accident Reporter Module gt gt Use the last 4 digits of your SSN as your DOI User Validation Page 10 ao PY N Type your email address here In the Last Name field type your last name In the DOI User Validation field type the last four digits of your social security number Press Enter or click Login to the SMIS Accident Reporter Module In the Pl
18. this email the claimant should be able to give you the claim ID If claimant does not know his or her claim ID contact your compensation coordinator The Supervisor s Notice of Traumatic Injury and Claim for Continuation of Pay Compensation CA 1 screen is displayed 3 Complete the 18 Employee s duty station box Use the following table to help you complete this box Field What You Should Enter or Select Addr Type the street address of the location where the injured claimant works In the City Type the city in which the claimant works State Type the state in which the claimant works Zip Type the zip code for the address at which the claimant works 4 Inthe 19 Employee s retirement coverage box select the retirement system under which the claimant is covered Contact your compensation coordinator if you do not know this information 5 Inthe 20 Regular Work Hours box enter the start and end time of the claimant s normal work day In the 21 Regular Work Schedule box select the days on which the claimant works In the 24 Date Stopped Work box enter the day and select the time on which the claimant could no longer work due to his or her injury Enter the date in one of the following formats mm dd yy OR mm dd yyyy 8 Inthe 25 Date Pay Stopped box type the date the claimant went on leave without pay LWOP If the claimant s pay did not stop leave this field blank Enter the da
19. I Responsible Org Select the DOI organization responsible for the accident Entering Injury Reporting Information There are two screens you complete when entering injury report information s SMIS Injury report of Sally Smith Unsecure Test Data Enter information about the person who was injured Activity Unknown he Is this a Fatality No Yes If yes Date of Death Date Work Stopped Date Return to Work Days Lost Time 0 Qf you are unsure you may estimate lost time days Describe Cause fell when Karen fell herself of this Injury Seathelis Yes No Send this Info gt gt Injury report of lt Name gt First screen 1 From the Activity drop down list select the option that best describes what the injured person was doing when he or she was injured 2 Inthe Is this a Fatality field select Yes or No Select Yes if the injured person died as a direct result of the accident Select No if the injured person did not die from the accident 3 Inthe If yes Date of Death field type the date on which the injured person died You can enter the date in any format that includes a day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 and Feb 4 2004 SMIS Supervisors User Guide Page 32 April 2004 4 Inthe Date Work Stopped field type the date that the injured person was unable to come to work due to the injury Leave this field empty if
20. OWCP and process a worker s compensation claim The Supervisor module is used by you a DOI supervisor to Electronically complete an accident report should a claimant such as one of your employees injure him or her self on the job or suffer an illness or disease due to his or her job There are two types of accident report forms or claims that you and a claimant can complete CA 1 and CA 2 Enter information about injuries that other people DOI personnel and non DOI personnel receive due to an accident Enter information about property damage due to an accident As a claimant s supervisor there are several tasks for you to complete Complete a supervisor s report The Supervisor s Report is acknowledgement by an injured employee s supervisor that the employee was indeed injured on the job Print and sign the CA 1 or CA 2 form Depending on your organization s procedures you might need to print sign and date all completed CA 1 and CA 2 forms Copies should be kept by the injured claimant the claimant s supervisor and the HR compensation coordinator s assigned to the injured claimant s organization Enter supplemental information Supplemental information is required and helps clarify the injuries that a claimant received in an accident This information is used by safety managers for safety analysis management reports and evaluations For OWCP s sake you should be specific about things such as which part
21. S View Edit Incident Entered 26 F eb 04 by OWCP_TESTER Q HITCHCOCK i Change Date Time or Zip Delete Incident ctio e E TE E ___ Click Add Return No Change Additional View Edit Existing Injuries Persons Existing Property Damage Bureau Specific Data Property New Outcomes Add Additional Injured Pers Add Additional Property Damage Damage to add oo 10 Feb 04 12 04 AM ee ik eet BEEE information about ais additional Naneti property damage Corr Actions G Unsafe Act G Unsafe Condition G 1 v v 2 v Management Causal Factor G View Edit Incident 2 Click View Edit for the claim that you want to enter property damages The View Edit Incident screen is displayed 3 Click Add Additional Property Damage to add information about property damages not already reported The Property Entry form damage occurred on lt accident date and time gt screen is displayed Enter property damage information see Reporting Property Damage on page 35 for instructions 4 After you complete the property damage report the View Edit Incident screen is displayed again Click Return Write Changes to save the new damage report Entering a New Accident Report You can report an accident involving property damage or injury to an individual who is not filing a claim for compensation If the claimant is injured severely enough to have missed work or incurred medical expenses have the claimant initiate a clai
22. The routine uses of the information are 1 To Provide quarterly listings of fatalities disabling injuries illnesses and property damage to the Department of Labor in compliance with 29 CFR 1960 69 2 Transfer to the U S Department of Justice in the event of litigation involving the records or the subject matter of the records 3 Transfer in the event there is indicated a violation or potential violation of a statute regulation whether civil criminal or regulatory in nature to the appropriate agency or agencies whether federal state local or foreign charged with the responsibility of investigation or prosecution of such violation or charged with enforcing or implementing the statute rule regulation order or license violated or potentially violated 4 The effect on the individual of not providing all or any part of the requested information may be to render impossible or to delay the Department s documenting the injury and or property loss Every effort will be made to obtain the factual information relating to an incident from other sources should the individual involved refuse to provide the requested information Return to SMIS Menu The main SMIS page Accident Reporting home page SMIS Supervisors User Guide Page 8 April 2004 Chapter 3 Using the Supervisors Module The Supervisors module is one of three modules intended to work together to expedite the time that it takes to receive an OWCP claim number from
23. Type the state in which the third party works or is located Zip Type the zip code for the address 18 If you believe a claim should be challenged place a check in The Agency is challenging the claim additional info will follow under separate cover checkbox Leave the checkbox empty if the claim is to be processed by OWCP 19 Place a check in the I have read and understand the above statement checkbox 20 In the Supervisor Title box type your job title 21 In the Office Phone box type your work telephone number 22 In the Local Case Notes box type any notes about the accident or claim that you feel are pertinent and that the compensation coordinator should read Information entered in this box is not submitted to OWCP it is retained within DOI 23 Click Submit your Supervisor Report After submitting your supervisor s report SMIS Accident Reporting automatically sends two emails e An email to the HR compensation coordinator s that is responsible for reviewing and processing the claim The email reads as follows SUBJECT An electronic CA2 for lt CLAIMANT NAME gt has been submitted On lt DATE and TIME gt a compensation report submitted by a claimant in your area of responsibility lt CLAIMANT NAME gt was processed by his her supervisor lt CLAIMANT S SUPERVISOR S NAME gt The claim for compensation is now awaiting review before being sent to OWCP You or a colleague with compensation coordinator authority fo
24. VIN Safety Management Information System SMIS User Guide for the Supervisors Module Developed by Office of Safety and Occupational Health Managing Risk and Public Safety Department of the Interior April 2004 Table of Contents Chapter 1 Safety Management Information System SMIS cccccceee 1 How This User Guide is Organized ceeeeeeeeeeeeeeeteeeteeeeeeeeeeees 1 Terminology Used Throughout This User Guide ceeeeeee 2 Accessing and Using SMIS Accident Reporting 0 e 2 Accessing SMIS Accident Reporting scseeeseseeeeeeeeeeeeeeeeeeees 2 BIOWSGIS reese aa aaea aaa Aa eaaa ater ieaS 2 Enable JavaScript eiie e E AER cadet 3 Window Display REEE E 3 Adobe R adlann en bie A ede a ee es 4 Online HEI Ps cc mre er aaa Eae eE E a A AAA a EEEE 4 SMIS OVEIVIOW dedno ae a bne n eosin Aor AAN T da a EE aai Eea 4 Chapter 2 Accident Reporting Overview ssceeeeeeeeeeeeeeeeseeeeeeeeeeaes 6 Chapter 3 Using the Supervisors MOdUule seeeeeeeeeeeeeeeeeeeeeeeeeeeees 9 Logging into the Supervisors Module eeeeeeeeeeeeeeeeeeeeeeeeeees 10 Completing the Supervisor s Portion of a CA 1 cceeeeeeeees 12 Completing a Supervisor s Report for a CA 1 cccccccceeceeeeeeeeeees 12 Printing the CA 1 FOr ccccccceeeceeeeeeeeeeeeeeeeseeeeseeseeeeeeesneesseees 17 Completing th
25. a throughout the Department of the Interior DOT Authorized DOI employees volunteers firefighters and others working at DOI facilities can use SMIS to e Electronically file a Notice of Traumatic Injury or Illness other types of accident reports can also be entered e Review a variety of information about managing safety in the workplace e Access DOI safety resources and reference materials e Access DOI s web site This user guide discusses how to use the Supervisors module within SMIS Accident Reporting Development and support for SMIS Accident Reporting is located in Denver Colorado 303 236 7158 How This User Guide is Organized The following table describes the chapters included in this user guide Chapter Chapter 1 Safety Management Information System SMIS Chapter 2 Accident Reporting Overview Chapter 3 Using the Supervisors Module SMIS Supervisors User Guide April 2004 Description This chapter presents a high level overview of the intent of the SMIS application and describes how this user guide is organized This chapter also describes how to access SMIS Accident Reporting This chapter presents a high level description of SMIS Accident Reporting and the different modules and activities available to you It describes the flow of Notice of Traumatic Injury or Illness Personal Information Entry and accident report information through DOI SMIS Accident Reporting and finally the Office of Workers
26. arty works or is located Zip Type the zip code for the address In the 32 Name and address of physician first providing medical care box type the name and office address of the doctor who first examined the claimant filing the claim If the physician is a private physician complete the box as described in the following table Field What You Should Enter or Select Last Name Type the physician s surname name First Type the physician s first name Middle Type the physician s middle name or initial Suffix Type the physician s suffix such as MD PA DO DDS Addr Type the street address at which the physician s office is located City Type the city in which the physician s office is located State Type the state in which the physician s office is located Zip Type the zip code for the address at which the physician s office is located If the claimant did not see a private physician but instead went to a medical clinic or hospital complete the box as described in the following table Field What You Should Enter or Select Last Name Type the name of the clinic or hospital First Type the first and last name of the physician who saw the injured claimant Middle Type the attending physician s middle name or initial Suffix Type the suffix of the person who took care of the claimant such as MD PA DO DDS
27. aterials e DOI SMIS Statistics provides historical safety and health statistics and performance measures e DOI Home Page provides access to DOI s web site SMIS Supervisors User Guide Page 4 April 2004 Edit View Favorites Tools Help http www smis doi gov Ox O AAG ci ee E Dept of Interior Safety Management Information System SMIS Microsoft Internet Explorer provided by Department of Interior aea In the Address field type Fie a Psm Jerom Au O 2 4 aA Jeo ine Welcome to the Safety Management Information System SMIS Home Page We are located in Denver Colorado and can be reached by telephone at 303 236 7158 SMIS is an automated system for reporting accidents which involve DOI employees volunteers contractors or visitors to DOI facilities The application can only be used bby authorized DOI Employees Supervisors and Safety Managers To report an accident click the Accident Reporting Button below Other components of SMIS include the following Safety Smarts is a collection of hundreds of safety talks posters management articles case studies and more Perfect for safety meetings or tailgate sessions Reference library contains reference materials for SMIS users DOI Safety Statistics contains bureau safety performance charts tables and costs by fiscal year Click one of the buttons below to use these components of SMIS SMIS components Accident Reporting Safety Smarts On Lin
28. bout existing injury reports e View and or edit information about reported property damage e View and or edit information reported for a specific bureau e Prepare incident reports Add Injury Reports for Individuals Not Already Reported as Injured 1 Log into the Supervisors module The Supervisor s Accident Report Entry Module screen lists all the claims for which you have completed a Supervisor s report 2 Click View Edit for the claim for which you want to enter injury reports The View Edit Incident screen is displayed ay x SM Lh Injury Hiness and Prepery Damage Reporting Supervisor portion of CAL CA2 Enter a New Accident Report Click the link below if an employee of yours has Click the link below if you need to report an accident filed a claim for compensation and provided you with involving property damage or injury to an individual a Claim Number ID You will be guided through the who is not filing a claim for compensation If your process of completing your portion of the employee s employee is injured severely enough to have missed claim for compensation and the Department s work or incurred medical expenses have your supplemental accident data requirements employee initiate a claim for compensation rather than enter the report here Complete employee initiated CAL CA2 Enter a NEW Report for a NEW Incident Your Previously Entered Reports Accident Reports Awaiting Review by Safety Manager View Ed
29. come lt Supervisor Name gt screen is displayed 2 Inthe Enter Employee s Claim Identifier field type the claim ID of the claim you want to print and click Submit Employee s Claim ID 3 Click Claim Status at the top of the screen to view the status of a claim The Status of Claim for Compensation filed by lt Claimant s Name gt is displayed SMIS Status of Claim for Compensation filed by OW CP_TESTER MESSICK Unsecuse Test Data Compensation Claim Status As of 26 Feb 04 02 35 PM Claim Information Type of Claim Claim for compensation of a Traumatic Injury CA 1 Accident Date 10 Feb 04 12 00 AM Accident ZIP 20171 Claimant OWCP_TESTER MESSICK Designated Rep Supervisor DOI Claim ID MESS4057 0095 Tempory ID assigned by DOL until Case Number Received from OWCP OWCP Case ID Not yet established Claim Timeline Step in Process Occured Date Completed Claim Identifier Issued by DOI Yes 26 Feb 04 09 05 AM Employee Submits Claim Yes 26 Feb 04 10 25 4M Witness Statement opt No Supervisor Processes Claim No Personnel Office Review No Electronically Sent to OWCP No Received Claim Number from OWCP No Status of Claim for Compensation filed by lt Claimant s Name gt SMIS Supervisors User Guide Page 43 April 2004 Completing a Witness Statement A witness is someone who saw an accident or can attest that someone s disease or illness is job related It is important to capture any information that you can from a witness abo
30. dent ay 3 SM I Congratulations Supplemental Data Eniry is Completa Print CA 1 Form SMIS Incident Report Add Injury Quicorne You reported an incident with an injury Thank you for completing your SMIS accident report and your employee s claim for compensation What you have corapleted is a stream lined version of the SMIS supplemental accident entry program which was designed to be appropriate and simplify the work for 95 of supervisors using the system who must report ar incident involving only one injured individual If this is the case for you you are done and can exit the program You may fall into the 5 if you must report two or more injury outcomes This might occur for example if two people were injured in an automobile accident and one was a DOI employee the person you just completed reporting on and the other was not a DOI employes If you need to add additional outcomes to this incident such as additional injured persons or property damage click the appropriate menu item above If you need to edit the information you have just entered restart a new session by clicking the Exit menu item and H then log into the system agam After logging m you will find this recently entered record m the Your Previously Entered Reports hst Congra tula tions Click the item to make any necessary comections or additions to your report Supplemental Data Entry is Complete You can report property damage
31. e DOI SafetyNet Reference Library DOI Safety Statistics DOI Home Page SMIS Home Page SMIS Supervisors User Guide Page 5 April 2004 Chapter 2 Accident Reporting Overview Accident Reporting is used to file workers compensation claims and or report on the job accidents and property damage via the Internet Accident Reporting can only be used by authorized DOI employees refer to DM485 for a list of all the types of personnel that are eligible to file claims due to on the job accidents proxies supervisors Human Resource HR compensation coordinators including compensation managers and specialists and safety managers Within Accident Reporting there are four modules DOI Employees DOI employees proxies or other authorized people use this module to create an Injury Report or file a claim when they injure themselves on the job or become ill because of their job or while visiting a DOI managed site Supervisors DOI supervisors use this module to complete Injury Reports started by claimants OR create accident reports that do not involve DOI employee compensation claims but that involve property damage motor vehicle accidents MV As contractors volunteers or anyone else that is not able or authorized to complete an Injury Report using the DOI Employees module Safety Managers Safety managers use this module to process create edit review or post accident reports Comp Coordinators HR
32. e Supervisor s Portion of a CA 2 cceeeeeeeees 18 Completing a Supervisor Report for a CA 2 cccccccccecceeeeeeeeeeeeeees 18 Printing the CA 2 Form eea a aa aa aaea 22 Entering Supplemental Information for Claims 0 0008 22 Reporting Other Injuries 22 06 ccccccccteceeneeeeeeteeteeeseedenedeneeceenteeee 28 Entering Injury Reporting Information cccccccccceeceeeeeeeeeeeeeees 32 Reporting Property Damage ssccceeeeeeeeeeeeeeeeeaaeeseeseeeees 35 SMIS Supervisors User Guide Page i April 2004 Adding Injury Reports or Property Damages after Submitting a CVA NEE cst star ca capes ender E coin sian avances Eide eaadvcvaseosns a casgh ATETA 40 Add Injury Reports for Individuals Not Already Reported as Injured 40 Add New Property Damage Reports cceeceeeeeeeeeeeeeeeeeeeeeees 42 Entering a New Accident Report cceeeeeeeeeeeeeeeeeeeeettttteaeeeees 42 Printing a Completed CA 1 or CA 2 FOorm eeeeeeeeeteteetteeeeees 43 Viewing the Status Of a Claim 2 2 2 cccccceeeee cece eee e eee eeeeeettnttaeeeeeees 43 Completing a Witness Statement cc eeeeeeeeeeeeeee rete ee eeeeeeeeeees 44 SMIS Supervisors User Guide Page ii April 2004 Chapter 1 Safety Management Information System SMIS Safety Management Information System SMIS is an automated system used to manage safety information and report dat
33. ease verify enter your Internet E Mail Address below field type or verify your email address and click Submit your E mail Address If you are logging into the Supervisors module for the first time you will be asked to verify your email address Though an email address is not required to use SMIS Accident Reporting to complete an accident report it is helpful Emails are used to notify you when a claimant submits a claim and after a compensation coordinator reviews and processes the claim Safety managers may also use emails to notify you if additional information is needed to clarify a report Ey E SM Li Welcome Your Last Name Please enter your E Mail address SMIS will notify you the reporter of this accident report via e mail at each stage in the processing of this accident report You can expect to be notified when a Safety Manager reviews and posts your report and when the report is permanently filed into the SMIS database You may also be notified if your Safety Manager needs additional information from you to clarify the report The E Mail address that you provide does not need to be your personal email address but must be an address to which you have regular access Please provide a valid internet e mail address where these notifications can be sent Please verify enter your Internet E Mail Address below Submit your E Mail Address gt gt Supervisors Email Verification If you are a supervisor or
34. ed and you will be prompted for additional info Last Name SSN First Name Middle Initial Non DOI Employee Personal Identification SMIS Supervisors User Guide Page 30 April 2004 In the Known SSN box enter the individual s social security number in the SSN field and click Submit SSN SMIS Accident Reporting looks up the individual s personal information from the database If information is not found either click X Mistyped SSN Re enter X if you want to return to the previous screen and try typing in a social security number again OR enter personal information for the person Use the following table to complete these fields and then click Add to SMIS DB to add the person to the SMIS database so that you can continue entering injury information Field What You Should Enter or Select Name Type the person s last and first names as well as a middle initial if it is used Birth Date Type the person s date of birth You can enter the date in any format that includes day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 and Feb 4 2004 Sex Select Male or Female Address Type the mailing address street city state and zip code of Personnel Status Responsible Org the person whom you are adding Select the status that best describes the person s employment relationship with the DOI Select the DOI organization responsible for the accident
35. ee Personal Identification Unsecura Tesi Data In the space provided below enter the DOI Employee ID SSN of the injured individual for whom you are preparing this report This will look up and retrieve the employee s personal information from the SMIS server Submit Personal ID gt gt DOI Employee Personal Identification a Inthe DOI Employee ID field type the employee s social security number b Click Submit Personal ID The Injury report of lt Claimant gt screen is displayed c Go on to step 4 If you selected All Others the Non Employee Personal Identification screen is displayed Do one of the following Enter the injured person s social security number Create pseudo ID for the person of the form and click the Submit Name bution Known SSN Look up Personal Data Enter the individual s SSN SMIS then looks up the individual s personal info from the database If not found you will be prompted for this data a t SMIS Non Employee Personal Identification Unsecure Test Data Ifyou know the SSN of the individual for whom you are completing this injury report enter it into the left hand side of the form and click the Submit SSN bution Otherwise enter the last name first name and middle initial of the individual into the right hand side Unknown SSN Enter this individual s last name first name and middle initial A Pseudo SSNAD will be generat
36. ement of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test SMIS Supervisors User Guide April 2004 What to Enter or Select Type a detailed description of what happened including who what where when why This is the one opportunity you have to include all pertinent facts about the accident Type any direction or corrective actions that you provided the claimant to help avoid a repeat accident Type none applicable if no action applies Examples Trail will be cleared of debris and wash out area will be filled in and leveled to reduce hazard Claimant will not drive GOV until after completion of DDC Claimant will not use equipment without proper guards attached Select the appropriate option that best describes why the accident happened For example select Inattention to footing or surroundings if the claimant fell while walking on a trail You can select up to two different reasons Page 23 Option Selected in Step 1 Field That You See Non Fire Fighting Related Unsafe Condition Incident During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test Non Fire Fighting Related Incide
37. ent of a Wildland Protective Fire Equipment for this During Suppression of a Structure Body Fan Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test SMIS Supervisors User Guide April 2004 What to Enter or Select Enter the number of days that the claimant missed work because of his or her injuries You must enter a number in this field even if it is zero 0 Select No if the accident did not involve an automobile OR the claimant was involved in an automobile accident and was not wearing his or her seatbelt Select Yes if the claimant was involved in an automobile accident and was wearing his or her seatbelt For the Required row Select Yes if protective equipment was required to be worn by the individual on the injured body part for the activity being performed Select No if protective equipment was not required to be worn Select N A if no protective equipment exists for the injured body part or protective equipment would have been inappropriate for the activity being performed Page 27 Option Selected in Step 1 Field That You See What to Enter or Select For the Provided row Select Yes if protective equipment was provided Select No if protective equipment was not provided Select N A if no protective equipment exists for the specified body part or protective equipment would have been inappro
38. g box if it is not already displayed in this box type the injured employee s salary The number you enter in the field is used in conjunction with what you enter in the next field In the next field select whether the salary you entered in the field is annual biweekly weekly daily hourly or single paid one time for services rendered If you believe a claim should be challenged place a check in the The Agency is challenging the claim additional info will follow under separate cover checkbox Leave the checkbox empty if the claim is to be processed by OWCP without contest Place a check in the I have read and understand the above statement checkbox In the Supervisor Title box type your job title In the Office Phone box type your work telephone number In 39 Filing Instructions select one of the following options No lost time and no medical expense Print and then place this form in employee s medical folder SF 66 D No lost time medical expense incurred or expected Forward this form to OWCP Lost time covered by leave LWOP or COP forward this form to OWCP First Aid Injury In the Local Case Notes box type any notes about the accident or claim that you feel are pertinent and that the compensation coordinator should read Information entered in this box is not submitted to OWCP it is retained within DOI Click Submit Your Supervisor Report The Completed Submission of your Employee s CA1 Fo
39. h Con Corps staff and enrollees volunteers Vista persons DOI employee family members tribal members CETA persons Youth Adult Con Corps staff and corps members students BIA Menominee tribe members and teachers contractors e Compensation coordinator The role of people that use the Comp Coordinators module includes DOI compensation managers specialists and coordinators throughout this user guide all HR compensation managers specialists and coordinators are referred to as compensation coordinators e Notice of Injury A CA 1 or CA 2 form also referred to as an Injury Report throughout this user guide an injury report is initiated by a claimant completed by a supervisor and then reviewed and processed by a compensation coordinator Accessing and Using SMIS Accident Reporting The following sections describe how to access and use SMIS Accident Reporting Accessing SMIS Accident Reporting You access SMIS Accident Reporting by opening a browser and typing http www smis doi gov in the Address field Browsers SMIS Accident Reporting works best with Internet Explorer 4 0 or higher e Netscape 6 0 with service pack 10A SMIS Supervisors User Guide Page 2 April 2004 Enable JavaScript Be sure to enable JavaScript This helps validate field data entry NOTE Depending on the version of your Internet browser you may not see the commands as documented in the following steps 1 Ifyou are using
40. inuation of Pay Compensation for an injury sustained on lt DATE and TIME gt It is important that this notice claim be processed expeditiously to avoid possible hardship to the claimant Should you dispute the facts or validity of the claim you can express your doubts when you complete the Supervisor section of the claim Do not let your dispute delay your processing of the claim To process this claim go to the following Web site www smis doi gov Click on the Supervisors button and log in using your last name and last four digits of your social security number After logging in click the Complete Employee Initiated CA1 CA2 link and enter the following Claim ID lt CLAIM ID gt The Supervisors module will guide you through completing the Supervisor section of the CA2 Thank you for your assistance in quickly processing this claim to better serve the claimant Completing a Supervisor Report for a CA 2 The following steps explain how to complete all the boxes on a CA 2 Supervisor s Report Depending on your organization s procedures you may not be required to complete all these boxes Contact your HR compensation coordinator to determine what boxes you are required to complete 1 From the Selection of Incident Context screen click Complete employee initiated CA1 CA2 to select to complete a claimants CA 1 or CA 2 form The Entry of Employee s Claim Number ID screen is displayed 2 Inthe Enter Employee
41. ion for his victim To do this click This victim Add injury information for a different injured individual person involved in this accident To do this click a DIFFERENT injured individual Return to the View Edit Incident screen if you are done entering injury information To do this click DONE From this screen click Return Write Changes to save the new injuty report SMIS Successfully Posted Injury Supervisor s Accident Raport Entry Module Injury ID 100004805 Incident Date Feb 10 2004 12 04AM Body Part 45 Below you have 3 choices you can enter another injury for this same individual enter injury data for another individual or indicate that you are done entering injury data If you select done entering injury data and your incident result code indicates that property damage wes also a factor in this incident you will be presented with the property damage forma otherwise you will be presented the data entry done screen Add additional injury info for THIS victim Add injury info for a DIFFERENT injured individual involved in fhis incident DONE entering injury data Successfully Posted Injury SMIS Supervisors User Guide Page 41 April 2004 Add New Property Damage Reports 1 Log into the Supervisors module The Supervisor s Accident Report Entry Module screen lists all the claims for which you have completed a Supervisor s report EF a SMI
42. irst Middle Address City State Zip Date of Statement 02 26 2004 Submit the Witness Statement gt gt Privacy Act In accordance with the Privacy Act of 1974 as amended 5 U S C 552a you are hereby notified that 1 The Federal Employees Compensation Act as amended and extended 5 U S C 8101 et seq FECA is administered by the Office of Workers Compensation Programs of the U S Department of Labor which receives and maintains personal information on claimants and their immediate families 2 Information which the Office has will be used to determine eligibility for and the amount of benefits payable under FECA and may be verified through computer matches or other appropriate means 3 Information may be given to the Federal agency which employed the claimant at the time of mury m order to verify statements made answer questions concerung the status of the claim verify billing and to consider issues relating to retention rehire or other relevant matters 4 Information niay also be given to other Federal agencies other government entities and to private sector agencies and or employers as part of rehabilitative and other retum to work programs and services 5 Information may be disclosed to physicians and other health care providers for use in providing treatment or medical vocational rehabilitation making evaluations for the Office and for other purposes related to the medical management of the claim 6 informaiton may be
43. is displayed with a new set of data entry fields a 2 SMIS Injury report of Sally Smith Unsecure Test Data Enter information about the Injury this person received Severity of Injury v Body Part Affected v Nature of Injury v Type of Injury v Cause Source Injury report of lt Name gt Second screen 10 From the Severity of Injury drop down field select the description that best fits the injuries that were incurred 11 From the Body Part Affected drop down field select the body part that was injured 12 From the Nature of Injury drop down field select the option that best describes the general nature of the injury SMIS Supervisors User Guide Page 33 April 2004 Nature codes include items such as burns fractures punctures and illnesses Nature codes are divided into two categories traumatic injuries and disease illnesses The Federal Employee Compensation Administration FECA defines a traumatic injury as an injury or condition that must be caused by a specific incident or event that occurred during a single work day or shift refer to FECA Bulletin 96 1 This means if you choose a code not beginning with a T the injury will be charged as an employee illness on the OSHA Log and OSHA Summary Report The following table describes the available Nature of Injury options Nature of Injury Categories Category Description Explanation C Cardi
44. it Mar 6 2004 10 00AM 80202 Pers Injury R lt lt Return to Login Page Injury lliness and Property Damage Reporting SMIS Supervisors User Guide Page 40 April 2004 3 Click Add Additional Injured Persons to add information about other people that were injured in the accident The Injury report of lt Claimant s Name gt screen is displayed 4 SM IS View Edit Incident Entered 26 F eb 04 by OWCP_TESTER Q HITCHCOCK Supervisor s Accident Report Entry Module Change Date Time or Zip Delete Incident Action Dania Return No Change Click Add View Edit Existing Injuries Persons Existing Property Damage Bureau Specific Data Additional New Outcomes Add Additional Injured Person Add Additional Property Damage Injured Person to _ 10 Feb 04 12 04 AM estient onan Pai Reka Prepare Incident Repot add injury reports for Plare injured a parties Corr Actions G Unsafe Act G Unsafe Condition 1 v v 2 v Management Causal Factor G y View Edit Incident 4 Enter information about the additional injured individuals See Entering Injury Reporting Information on page 32 for instructions on how to complete the fields that follow 5 After you complete the Injury report of lt Claimant s Name gt screens the Successfully Posted Injury screen is displayed From this screen do one of the following Add additional injury informat
45. k X Mistyped SSN Re enter X if you want to return to the previous screen and try typing in a social security number again OR enter personal information for the person Use the following table to complete these fields and then click Add to SMIS DB to add the person to the SMIS database so that you can continue entering injury information SMIS Supervisors User Guide Page 38 April 2004 Field Name Birth Date Sex Address Personnel Status Responsible Org What You Should Enter or Select Type the person s last and first names as well as a middle initial if it is used Type the person s date of birth You can enter the date in any format that includes day month and year For example 2 4 2004 2 4 2004 02 04 2004 4 Feb 2004 and Feb 4 2004 Select Male or Female Type the mailing address street city state and zip code of the person whom you are adding Select the status that best describes the person s employment relationship with the DOI Select the DOI organization responsible for the accident In the Unknown SSN box enter the individual s last name first name and middle initial and click Submit Name SMIS will generate a fake social security number and ID Use the following table to enter the requested additional information and then click Add to SMIS DB to add the person to the SMIS personnel database so that you can complete entering property damage information
46. laim ID lt CLAIM ID gt The Supervisors module will guide you through completing the Supervisor section of the CA1 Thank you for your assistance in quickly processing this claim to better serve the claimant Completing a Supervisor s Report for a CA 1 The following steps explain how to complete all the boxes on a CA 1 Supervisor s Report Depending on your organization s procedures you may not be required to complete all these boxes Contact your HR compensation coordinator to determine what boxes you are required to complete From the Injury Ilness and Property Damage Reporting screen click Complete employee initiated CA1 CA2 to select and complete a CA 1 or CA 2 claim The Entry of Employee s Claim Number ID screen is displayed F oy SM 1 S InjuryAliness and Propery Damage Reporting Supervisor portion of CAL CA2 Enter a New Accident Report Click the link below ifan employee of yours has filed a Click the link below if you need to report an accident claim for compensation and provided you with a Claim involving property damage or injury to an individual who Number ID You will be guided through the process of is not filing a claim for compensation If your employee is Reports that completing your portion of the employee s claim for injured severely enough to have missed work or incurred compensation and the Department s supplemental medical expenses have
47. lides compensation Supervisors Used by supervisors to either complete a claim for compensation initiated by someone in their area of Offline rt Worksheet responsibility or to initiate a SMIS accident report Safety Managers Used by permanent or collateral duty safety managers to review accident reports submitted by employees and supervisors enter reports analyze safety data statistics or perform a variety of other safety related activities Comp Coordinators Used by Compensation Coordinators in DOI Personnel offices to review and finalize compensation claims prior to being sent to OWCP Report Codes Frequenily Asked Questions Privacy Act Return To Homepage DOI Employees Supervisors Safety Managers Comp Coordinators NOTICE OF CONDITIONS UNDER WHICH THIS INFORMATION IS COLLECTED AND USED Pursuant to Section 3 e 3 of the Privacy Act of 1974 Public Law 93 579 the individual fumishing information on this form is hereby advised as follows 1 The Authority for solicitation of the information is Section 19 of the Occupational Safety and health Act of 1970 Public Law 91 596 5 U S C 7902 29 CFR 1960 Executive Order No 12196 February 26 1930 and 28 U S C 2671 80 2 The principal purpose for which the information is intended to be used is to provide summary data of injury and property loss information for analytical purposes to be used in establishing programs to reduce or eliminate loss producing problem areas 3
48. m for compensation rather than you enter the report here Additional documentation for how to complete the forms that display from this option is available in the original Swpervisor s Accident Report Module WEB based Accident Reporting System USER MANUAL SMIS documentation SMIS Supervisors User Guide April 2004 Page 42 Printing a Completed CA 1 or CA 2 Form You can print a CA 1 or CA 2 form These forms are created and displayed through Adobe Reader If you have not installed Adobe Reader you will not be able to view these forms You can download Adobe Reader for free by going to the following web site http www adobe com products acrobat readstep2 html 1 2 Log in to the Supervisors module The Welcome lt Supervisor Name gt screen is displayed In the Enter Employee s Claim Identifier field type the claim ID of the claim you want to print and click Submit Employee s Claim ID The claim is displayed on the following screen Click Print CA 1 Form or Print CA 2 Form at the top of the screen The report is displayed automatically You cannot change any information from this view From the File menu select Print The form prints exactly as it appears on screen Viewing the Status of a Claim You can view the status of a claim at any time during its process through SMIS Accident Reporting You cannot enter or change information on this screen 1 Log in to the Supervisors module The Wel
49. ment coverage box select the retirement system under which the claimant is covered Contact your compensation coordinator if you do not know this information In the 33 Was injury caused by third party box do the following Select Yes or No based on your investigation of the accident If injury was caused by another person or non person such as an organization or company select Yes If you selected Yes from the The Third Party is a drop down list select whether the third party that caused the injury is a person or non person such as an organization or company In the 34 Name and address of third party boxes enter the name and address of the third party that caused the illness If the third party is a person Field What You Should Enter or Select Last Name Type the third party s surname name First Name Type the third party s first name If the third party is an organization Field What You Should Enter or Select Org Name Type the name of organization responsible for your accident Title Type the title of the organization s official such as president personnel officer financial officer this is the person to whom you want to address your claim SMIS Supervisors User Guide Page 20 April 2004 Field What You Should Enter or Select Addr Type the street address atwhich the third party Works or is located City Type the city in which the third party works or is located State
50. n that best describes who owns the damaged property 5 From the Cause of Damage drop down list select the option that best describes what precipitated the event that caused the property damage For example an automobile skids on ice and strikes a curb damaging the axle The cause of this damage is probably the icy road surface assuming driver negligence was not an issue 6 From the Source of Damage drop down list select the option that best describes the thing that inflicted physical injury For example someone is walking slips on a wet floor and drops a computer monitor on the floor The source of the damage is the wet floor on which the monitor fell 7 Inthe Estimated dollar value of this damage field type the cost of repairing the damage A dollar sign is not required in this field Round the cost to the nearest dollar Any cents that you enter will be ignored for example if you enter 29 99 the system will interpret this as 29 8 In the If this damage involves a motor vehicle were seatbelts worn field select Yes ot No Select Yes if the involved parties were wearing seatbelts Select No if the involved parties were not wearing seatbelts 9 Click Send this Info The Responsible party ownet s Personal Category screen is displayed SMIS Responsible party owner s Personal Category Unsecure Test Data Select the appropriate personnel category from the list helow Select DOI Employees if ovner re
51. ndividual s Personal Category screen is displayed al EF SMIS Injured Individual s Personal Category Unsecure Test Data Select this injured individual s personnel category Select DOI Employees if the injured individual is a GS WG permanent or temporary DOI Employees government employee of the Department of the Interior Select All Others if the injured individual is a visitor contractor volunteer All Others emergency fire fighter or any other person whether paid or unpaid who is not a regular GS WG employee of the Department of the Interior Continue to Next Page gt gt Injured Individual s Personal Category SMIS Supervisors User Guide Page 29 April 2004 2 Select the category that best represents the injured person Select DOI Employee if the injured individual is a GS WG permanent or temporary government employee of the Department of the Interior Click Continue to Next Page Select All Others if the injured individual is a visitor contractor volunteer emergency firefighter or any other person whether paid or unpaid who is not a regular GS WG employee of the Department of the Interior Click Continue to Next Page 3 The option that you selected in step 2 determines the fields that you need to complete next If you selected DOI Employee the DOI Employee Personal Identification screen is displayed SMIS DOI Employee ID DOI Employ
52. nt Mgmt Causal Factor During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test During Management of a Wildland Fire Identifier Fire During a Prescribed Fire Fuels Treatment SMIS Supervisors User Guide April 2004 What to Enter or Select Select the appropriate option that best describes environmental conditions that contributed to the cause of the accident For example select Dress or Apparel Hazards if the claimant s accident was caused in part to pants being too long and the claimant tripped on the bottom of his pants You can select up to two different reasons Select the appropriate option that best describes how management had anything to do with why the accident happened In the Fire Name field type the name given to the fire In the Fire Nr field type the number assigned to the fire In the Fire Location field type where the fire occurred Contact a safety manager if you do not know this information or leave this field empty Page 24 Option Selected in Step 1 Field That You See During Management of a Wildland Fire Status Fire During Management of a Wildland Vegetation Fire During a Prescribed Fire Fuels Treatment During Suppression of a Structure Fire Incident Nr Fire SMIS Supervisors User Guide April 2004 What to
53. ovascular Disease Illness D Disability Disease Illness G Gastrointestinal Disease Illness M Musculoskeletal Disease Illness O Occupational Disease Illness R Respiratory Disease Illness S Skin Disease Illness T Traumatic Injury Trauma V Virological Disease Illness 13 From the Type of Injury drop down field select the accident code that describes the action that actually inflicted the injury such as exposed bitten by or contact by 14 From the Cause drop down list select the option that best describes what precipitated the event causing the injury For example someone is walking slips on a wet floor and strikes his head on a desk The cause of this injury is the wet floor not the desk 15 From the Source drop down list select the option that best describes what inflicted the physical injury For example someone is walking slips on a wet floor and strikes his head ona desk The source of this injury is the desk on which the individual struck causing a head injury 16 Click Send this Info The Successfully Posted Injury screen is displayed SMIS Supervisors User Guide Page 34 April 2004 2 2 SM fi S Successfully Posted Injury Unsecure Test Data Click Add S Click Exit Injured Individual OWCP_TESTER Q HITCHCOCK s Impairment Injury Entry to re port Date of Injury Feb 10 2004 12 04AM after you more than Body Part BW enter accident one injury re
54. port Add Injury Outcome Add Property Damage i a _ You reported an incident with an injury Thank you for completing your SMIS accident report and your employee s claim for compensation What you have completed is a stream lined version of the SMIS supplemental accident entry program which was designed to be appropriate and simplify the work for 95 of supervisors using the system who must report an incident involving only one injured individual If this is the case for you you are done and can exit the program You may fall into the 5 if you must report two or more injury outcomes This might occur for example if two people were injured in an automobile accident and one was a DOI employee the person you just completed reporting on and the other was not a DOI employee If you need to add additional outcomes to this incident such as additional injured persons or property damage click the appropriate menu item above If you need to edit the information you have just entered restart a new session by clicking the Exit menu item and then log into the system again After logging in you will find this recently entered record in the Your Previously Entered Reports list Click the item to make any necessary corrections or additions to your report Congratulations Supplemental Data Entry is Complete 1 From the Congratulations Supplemental Data Entry is Complete screen click Add Injury Outcome The Injured I
55. port and keep it on file Your personnel office is also likely to request that you provide them with a signed copy for their records In addition OWCP may conduct an audit to verify that this signed copy is on file For information about printing a CA 2 form see Printing a Completed CA 1 or CA 2 Form on page 43 Entering Supplemental Information for Claims Supplemental information is required and helps clarify the injuries that a claimant received in an accident This information is used by safety managers to help report on injuries and claims throughout DOI 1 From the Completed Submission of your Employee s CA1 Form or Completed Submission of your Employee s CA2 Form screens select the option that best describes the context in which the claimant was injured The option that you select in this field impacts the screens that follow Options include Non Fire Fighting Related Incident This is the most common selection Select one of the other options if the claimant is a firefighter performing firefighter duties or training During Management of a Wildland Fire During Suppression of a Structure Fire During a Prescribed Fire Fuels Treatment During Training including physical training During a Work Capacity Test 2 Click Complete DOI Accident Report Supplemental Information The Please enter information about the incident accident screen is displayed Use the table on the following pages to
56. ports Show Employee is Disabled for Work box select Yes No or Unknown In the 26 Date Employee First Reported Condition to Supervisor box type the date on which you were first notified by the claimant about his or her illness Enter the date in one of the following formats mm dd yy OR mm dd yyyy In the 27 Date and Hout Employee Stopped Working box enter the day and select the time on which the claimant could no longer work due to his or her illness Enter the date in one of the following formats mm dd yy OR mm dd yyyy In the 28 Date and Hout Employee s Pay Stopped box type the date on which the claimant went on leave without pay LWOP If the claimant s pay did not stop the claimant continued working leave this box blank Enter the date in one of the following formats mm dd yy OR mm dd yyyy In the 29 Date Employee was last exposed to conditions alleged to have caused disease or illness box type the date on which the claimant was last exposed at work Enter the date in one of the following formats mm dd yy OR mm dd yyyy In the 30 Date Returned to Work box type the date on which the claimant returned to work If the claimant never stopped working leave this box blank Enter the date in one of the following formats mm dd yy OR mm dd yyyy In the 31 If employee has returned to work and work assignment has changed describe new duties box describe the claimant s new position In the 32 Employee s retire
57. ports for This individual sustained multiple This individual sustained only the that injuries reporied injury This report is each person someone Ineed to report additional impairments finished involved in incurred the accident from an Add Impairment gt gt Exit Injury Entry gt gt accident Successfully Posted Injury 17 Do one of the following If the person sustained more than one injury click Add Impairment Repeat steps 1 through 16 Ifthe person only sustained injuries already reported click Exit Injury Entry When you finish an accident report it is listed on the You have recently Input an Accident Report screen in the Your Previously Entered Report Accident Reports Awaiting Review By Safety Manager list You do not need to do anything at this point However if you want to edit an accident report click the View Edit link After a safety manager reviews the accident report it will no longer display in this list Reporting Property Damage You must report property damage that was sustained in an accident Entering this information ensures that the accident report includes details about damaged property Use the Add Property Damage option at the top of the Congratulations Supplemental Data Entry is Complete screen to report any property damage SMIS Supervisors User Guide Page 35 April 2004 Click Add Property Damage to report property damages that resulted from an acci
58. priate for the activity being performed For the Worn row Select Yes if protective equipment was worn Select No if protective equipment was not worn Select N A if no protective equipment exists Reporting Other Injuries If other people not DOI employees or people who can file worker s compensation claims are injured as a result of the accident that triggered a claim you must enter information about those people and their injuries This ensures that the accident report includes information about all parties injured from a single accident IMPORTANT Each DOI employee involved in an accident must file his or her own claim There are two times when you can report accident injuries e When you initially complete the Supervisor s Report for a claim e After you have submitted a claim see Adding Injury Reports or Property Damages After Submitting a Claim for more information on page 40 This section describes how to enter this information when you initially complete the Supervisor s Report for a claim Use the Add Injury Outcome option at the top of the Congratulations Supplemental Data Entry is Complete screen to report all injuries SMIS Supervisors User Guide Page 28 April 2004 Click Add Injury Outcome to report injuries that resulted from an accident 2 q SM Li Ss Congratulations Supplemental Data Entry is Complete Unsecure Test Data Sw Print CA Form SMIS Incident Re
59. r this individual should review this claim as soon as possible to prevent potential hardship Log into the Comp Coordinators module using your compensation coordinator user ID and password then open the claim identified by the claim ID lt CLAIM ID gt e An email to the claimant letting him or her know that you have completed your section of the claim form The email reads as follows SUBJECT Your supervisor has forwarded your claim for compensation On lt DATE and TIME gt your supervisor lt CLAIMANT NAME gt processed your recently submitted CA2 Federal Employee s Notice of Traumatic Injury and Claim for Continuation of Pay Compensation for an injury sustained on lt DATE and TIME gt The next stage in the processing of your claim is a review by your personnel office Your claim has been forwarded to the appropriate personnel office for review You will again be notified when personnel has processed your claim and it is ready for dispatch to the Office of Workers Compensations Programs This message is only to advise you on the status of your claim and no action is required on your part SMIS Supervisors User Guide Page 21 April 2004 Printing the CA 2 Form After completing the Supervisor s report the Completed Submission of your Employee s CA 2 Form screen is displayed Depending on your organization s procedures you may need to print a copy of the completed CA 2 form Both you and the claimant must sign this re
60. rm screen is displayed SMIS Supervisors User Guide Page 16 April 2004 After submitting your supervisor s report SMIS Accident Reporting automatically sends two emails e An email to the HR compensation coordinator s that is responsible for reviewing and processing the claim The email reads as follows SUBJECT An electronic CA1 for lt CLAIMANT NAME gt has been submitted On lt DATE and TIME gt a compensation report submitted by a claimant in your area of responsibility lt CLAIMANT NAME gt was processed by his her supervisor lt CLAIMANT S SUPERVISOR S NAME gt The claim for compensation is now awaiting review before being sent to OWCP You or a colleague with compensation coordinator authority for this individual should review this claim as soon as possible to prevent potential hardship Log into the Comp Coordinators module using your compensation coordinator user ID and password then open the claim identified by the claim ID lt CLAIM ID gt e An email to the claimant letting him or her know that you have completed you section of the claim form The email reads as follows SUBJECT Your supervisor has forwarded your claim for compensation On lt DATE and TIME gt your supervisor lt CLAIMANT NAME gt processed your recently submitted CA1 Federal Employee s Notice of Traumatic Injury and Claim for Continuation of Pay Compensation for an injury sustained on lt DATE and TIME gt The next stage in the proce
61. rsonal Identification a Inthe DOI Employee ID field type the person s social security number b Click Submit Personal ID If you selected All Others the Non Employee Personal Identification screen is displayed Do one of the following Enter the injured person s social security number Create pseudo ID for the person a a SM 1S Non Employee Persona Identification Unsecura Test Data If you know the SSN of the individual for whom you are completing this injury report enter it into the left hand side of the form and click the Submit SSN button Otherwise enter the last name first name and middle initial of the individual into the right hand side of the form and click the Svim Name button Known SSN Look up Personal Data Unkmown SSN Enter the individual s SSN SIVIS then looks up the individual s Enter this individual s last name first name and middle initial A personal info from the database If not found you will be prompted Pseudo SSNiID will be generated and you will be prompted for for this dats additional info Last Name SSN First Name Middle Initial Submit SSN gt gt Submit Name gt gt Non DOI Employee Personal Identification In the Known SSN box enter the individual s social security number in the SSN field and click Submit SSN SMIS Accident Reporting looks up the individual s personal information from the database If information is not found either clic
62. s Claim Identifier box type the claim ID for the claimant s claim and click Submit Employee s Claim ID The claimant should have this ID If the claimant does not know the claim ID contact your compensation coordinator The Supervisor s Notice of Occupational Disease and Claim for Compensation CA 2 screen is displayed 3 Complete the 20 Employee s duty station box Use the following table to help you complete this box Field What You Should Enter or Select Addr Type the street address of the location at which the ill claimant works In the City Type the city in which the claimant works State Type the state in which the claimant works Zip Type the zip code for the address at which the claimant works SMIS Supervisors User Guide Page 18 April 2004 4 Inthe 21 Regular Work Hours box enter the start and end time of the claimant s normal work day In the 22 Regular Work Schedule box select the days on which the claimant works 6 Inthe 23 Name and address of physician first providing medical care box type the name and office address of the doctor who first examined the claimant filing the claim If the physician is a private physician complete the box as described in the following table Field What You Should Enter or Select Last Name Type the physician s surname name First Type the physician s first name Middle Type the physician s middle name or initial Suffix Type the physician s suffi
63. sponsible individual is an employee of the Department of the Interior DOI Employees Select All Others if the owmer responsible individual is a visitor contractor volunteer emergency All Others fire fighter or any other person whether paid or unpaid who is not a regular GS WG employee of the Department of the Interior Continue to Next Page gt gt Responsible party owner s Personal Category 10 Select the category that best represents the person responsible for the damaged property Select DOI Employees if the owner or responsible individual is an employee of the Department of the Interior Click Continue to Next Page Select All Others if the owner or responsible individual is a visitor contractor volunteer emergency firefighter or any other person whether paid or unpaid who is not a regular GS WG employee of the Department of the Interior Click Continue to Next Page SMIS Supervisors User Guide Page 37 April 2004 11 The option that you selected in step 10 determines the fields that you need to complete next If you selected DOI Employee the DOI Employee Personal Identification screen is displayed SMIS DOI Employee Personal Identificaton Property Unsecure Test Data Enter the employee s ID This will look up and retrieve the employee s personal information from the SMIS server DOI Employee ID Submit Personal ID gt gt DOI Employee Pe
64. ssing of your claim is a review by your personnel office Your claim has been forwarded to the appropriate personnel office for review You will again be notified when personnel has processed your claim and it is ready for dispatch to the Office of Workers Compensations Programs This message is only to advise you on the status of your claim and no action is required on your part Printing the CA 1 Form After completing the Supervisor s report the Completed Submission of your Employee s CA 1 Form screen is displayed Depending on your organization s procedures you may need to print the completed CA 1 form Both you and the claimant must sign this report and each keep a copy on file You may also need to give your compensation coordinator a copy of the claim form In addition OWCP may conduct an audit to verify that this signed copy is on file For information about printing a CA 1 form see Printing a Completed CA 1 or CA 2 Form on page 43 SMIS Supervisors User Guide Page 17 April 2004 Completing the Supervisor s Portion of a CA 2 After a claimant submits a CA 2 form you receive an email with the subject line An Electronic CA 2 for lt Claimant s Name gt requires your action The email reads as follows SUBJECT An electronic CA2 for lt CLAIMANT gt requires your action On lt DATE gt a claimant lt CLAIMANT gt filed an electronic CA2 Federal Employee s Notice of Traumatic Injury and Claim for Cont
65. te in one of the following formats mm dd yy OR mm dd yyyy SMIS Supervisors User Guide Page 13 April 2004 9 Inthe 26 Date 45 Day Period Began box type the date the claimant went on Continuation of Pay COP Usually this is the same date as the date on which the claimant stopped working because of his or her injury the date entered in step 7 However the date on which the claimant was injured is not included in the 45 day period The date of injury is a day of administrative leave The date you enter in this box should be the first day after that that the claimant lost time from work 10 In the 27 Date Returned to Work box type the date on which the employee returned to work Enter the date in one of the following formats mm dd yy OR mm dd yyyy 11 In the 28 Was the employee injured in the performance of duty box select Yes or No If you select No type an explanation of why you believe the injury is not due to the claimant s job 12 In the 29 Was injury caused by employee s willful misconduct intoxication or intent to injure self or another box select Yes or No If you select Yes type an explanation of why you believe the injury was because of claimant misconduct intoxication or intent to harm his or her self or someone else If you believe intoxication was involved be sure to submit any test results or hospital reports documenting the level of intoxication 13 In the 30 Was injury caused by third party
66. the City field type the city in which the witness lives In the State field type the state in which the witness lives OO N O R In the Zip field type the zip code for the street address at which the witness lives 10 The Date of Statement field displays today s date Change this date if the witness statement was taken on a day other than today 11 Click Submit the Witness Statement to save witness information as part of the claim SMIS Supervisors User Guide Page 45 April 2004 Index Accident Reporting Logging in 8 Modules 6 Overview 7 8 Supervisor s Module 9 Accident Reports 32 42 CA 1 12 CA 2 18 Claim Status 43 Injury Reports 32 40 Printing Claims 43 Property Damage 35 40 Safety Management Information System SMIS Accessing 2 Accident Reporting 6 Introduction 1 Modules 4 6 Overview 4 Screen display 3 Supervisors Module 9 Using 2 SMIS Supervisors User Guide April 2004 Status of a Claim 43 Supervisor s Module Accident Report 9 Claim Status 43 Injury Reports 40 Logging In 10 Overview 9 10 Printing Claims 17 43 Property Damage 35 40 Reporting Injuries 32 Supervisor s Report 9 12 Supplemental Information 9 22 Tasks 9 Witness Statement 44 Supervisor s Report CA 1 12 CA 2 18 Printing 43 Printing a CA 1 17 Printing a CA 2 22 Witness Statement 44 Page 46
67. to process the claim Y Safety Managers Module SMIS Accident Reporting Safety manager reviews the accident report and posts it into Automated Process the Risk amp Safety Management database CA 1 or CA 2 form is sent via an EDI packet to OWCP y SMIS Supervisors User Guide Page 7 April 2004 The following instructions describe how to start Accident Reporting Instructions for starting the Supervisors module are presented in Logging into the Supervisors Module on page 10 1 Open your browser and in the Address field type http www smis doi gov 2 Click Accident Reporting The Safety Management Information System screen is displayed this can also be called the Accident Reporting home page 3 Select the Accident Reporting module that you want to use Privacy Act statement DOI Employees Supervisors Safety Managers e Comp Coordinators SMIS Safety Management Information System References amp Links SMIS is divided into four major functional components User Manual DOI Employees Used by individuals or a designated representative who have been injured or sick on the job and wish to file a claim for compensation CA 1 or CA 2 or file a report for the record to preserve their rights to file a claim in the future May also be used to enter witness information about another employee s claim for SMIS Instructional S
68. ut an accident From the Witness Statement option at the top of the screen you can enter and or view a witness statement There are a number of people who can enter information in the Witness Statement form e Claimant that has access to SMIS Accident Reporting e Supervisor of the employee who had the accident or became ill e Compensation coordinator 1 Log in to the Supervisors module The Welcome lt Supervisor Name gt screen is displayed 2 Inthe Enter your Claim ID field type the claim ID for which you are adding or viewing a witness statement 3 Click Witness Statement at the top of the screen to view the Witness Statement form The Get Witness Statement screen is displayed You must also print the Witness Statement and have the witness sign it z SM Li Get Witness Statement Unsecure Test Data In the space provided below enter the requested information Note all blocks are mandatory except the middle name of the witness After adding or changing any information m the witness statement form be swe to click the Submit the Witness Statement button below to save your data Simply exiting using the Exit Witness Form menu item above does not save your data 1t only closes the form and retums you where you where when you entered the Witness Statement form Witness Statement 16 Statement of witness Describe what you saw heard or know ahout this injury Name of Witness Last F
69. x such as MD PA DO DDS Addr Type the street on which the third party works or the organization located City Type the city in which the physician s office is located State Type the state in which the physician s office is located Zip Type the zip code for the address at which the physician s office is located If the claimant did not go see a private physician but instead went to a medical clinic or hospital complete the box as described in the following table Field What You Should Enter or Select Last Name Type the name of the clinic or hospital First Type the first and last names of the physician who saw the injured claimant Middle Type the attending physician s middle name or initial Suffix Type the suffix of the person who took care of the claimant such as MD PA DO DDS Addr Type the street address of the clinic or hospital City Type the city in which the clinic or hospital is located State Type the state in which the clinic or hospital is located Zip Type the zip code for the address at which the clinic or hospital is located 7 Inthe 24 First Date Medical Care Received box type the date on which the claimant first went to the doctor because of his or her illness Enter the date in one of the following formats mm dd yy OR mm dd yyyy SMIS Supervisors User Guide Page 19 April 2004 10 11 12 13 14 15 16 17 In the 25 Do Medical Re
70. your employee initiate a claim for yo un eed to accident data requirements compensation rather than enter the report here finish are z Enter a NEW Report for a NEW Incident listed here Complete employee initiated CA1 CA2 Your Previously Entered Reports Reports that Incomplete Reports Missing Injury or Property Damage are awaiting Finish Delete Mar 6 2004 12 00AM 80202 Occ Iliness Missing Inj Person Impairment review by a Finish Delete Mar 6 200403 00AM 30202 Prop Damage Missing Property s afety a Accident Reports Awaiting Review by Safety Manager manager are View Edit Mar 6 2004 10 00AM 80202 Pers Injury listed here Injury lIness and Property Damage Reporting SMIS Supervisors User Guide Page 12 April 2004 2 Inthe Enter Employee s Claim Identifier field type the claim ID for the claimant s claim and click Submit Employee s Claim ID SMIS Entry of Employee s Claim Number ID Unsecure Test Data Enter the claim number ID which was provided to you by the employee Upon submission you will be guided through the process of completing the Supervisor portion of the CA1 or CA2 that the employee has submitted Supervisor Section of Employee s Claim for Compensation CA 1 CA 2 Enter Employee s Claim Identifier Submit Employee s Claim ID gt gt Entry of Employee s Claim Number ID The claim ID was sent to you in an email after the claimant submitted his or her claim If you do not have

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