Forms

ACOA designed some forms that you might find useful. Please remember to send us a copy when you submit them to the proper authority.

Annual Physicals

You “walk the toughest beat in Alaska”. You also walk one of the most infectious beats in Alaska. We urge all Correctional Officers to get a physical once a year that includes screening for the risks addressed in Article 24.2 of our contract. Correctional Officers who have been with the department one or more years can seek reimbursement for up to $200 once a year to cover their out of pocket expenses. The State's instructions to DOC Admin personnel and the form to submit are linked above.

In addition to once a year screening, we urge Correctional Officers that suffer a specific on-the-job exposure to follow the procedures enumerated in DOC P&P 202.03; to immediately see a physician; and to file a Workers' Compensation “report of Occupational Injury or Illness” and a precautionary “Request for Injury Leave”.

Injury Leave

LOOK OUT FOR YOURSELF NOW, NOT AFTER IT IS TOO LATE

Injury Leave is a significant benefit in which Correctional Officers need to be aware. Subject to availability of funds, Injury Leave provides qualifying Correctional Officers with up to a maximum of one thousand (1000) hours of paid leave, if the required paperwork is filed in a timely manner.

All too often, Correctional Officers are denied Injury Leave because they fail to complete the paperwork required until it is too late. All too often, members have found themselves wishing they had taken the time to fill out Injury Leave Requests when unexpected complications cropped up later. Shoulder injuries, back injuries, knee injuries, and pathogen exposures are prime examples of injuries that often seem minor at the time, but often end up needing significant time off when complications arise a month or two later.

EVEN IF YOU DO NOT THINK YOUR INJURY WILL REQUIRE TIME OFF, PROTECT YOURSELF BY FILING AN INJURY LEAVE REQUEST WITHIN 21 DAYS OF BEING INJURED ANYWAY. BETTER SAFE THAN SORRY!

“REPORTING” REQUIREMENTS:

1. Make sure that a Workers' Compensation Report of Occupational Injury or Illness is submitted (Keep a Copy); and
2. Make sure that an Incident Report is submitted (Keep a Copy); and
3. Make sure that an Injury Leave Request is submitted within 21 days to your Superintendent, even if you don’t think your injury will result in time off; and
4. After the Superintendent signs off on the Injury Leave Request, it should be faxed to the Director of Institutions for final approval; and
5. A copy should also be faxed to ACOA for our records.

THE INJURY LEAVE REQUEST IS SIMPLE:

Other Forms you might need

State Workers' Compensation Form (Report of occupational injury or illness)
What to do if you are Injured - Workers' Compensation Instructions
State Employee Notice of Pay Problem