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”.
State’s Annual Physical Reimbursement Form
Instructions given Institutional Administrative personnel
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.
The Correctional Officers Bargaining Agreement from July 1, 2009 through June 30, 2012 changes the submission and approval procedures from those that existed in the previous contract. In recognition that the employer is given a copy of the Workers’ Compensation Report of Occupational Injury or Illness when the claim is filled, the requirement to submit an Injury Leave request to the Superintendent within 21 days of the injury no longer exists. This requirement is replaced with Article 20.7 B 5 Notice, which states:
“The member shall provide to the member’s superintendent documentation that the member’s workers’ compensation claim has been accepted. The superintendent will then initiate injury leave for the member, effective with the date that workers’ compensation benefits began.”
“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. After the Workers' Compensation claim has been approved, make sure and give a copy to your Superintendent; and
5. Fax a copy to ACOA for our records.
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
|
