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Global: ^OOPS(2260

Package: Asists

Global: ^OOPS(2260


Information

FileMan FileNo FileMan Filename Package
2260 ASISTS ACCIDENT REPORTING Asists

Description

Directly Accessed By Routines, Total: 51

Package Total Routines
Asists 51 OOPSCA    OOPSCA1    OOPSCC    OOPSCSN    OOPSDOL    OOPSDOL1    OOPSDOL2    OOPSDOLX
OOPSEMP1    OOPSESR    OOPSF167    OOPSGUI0    OOPSGUI2    OOPSGUI3    OOPSGUI4    OOPSGUI7
OOPSGUI8    OOPSGUI9    OOPSGUIC    OOPSGUID    OOPSGUIF    OOPSGUIR    OOPSGUIS    OOPSGUIT
OOPSLOG    OOPSMBUL    OOPSNDB    OOPSNDBX    OOPSPC11    OOPSPC21    OOPSPC41    OOPSPC51
OOPSPCA    OOPSPRT    OOPSPRT1    OOPSPRT2    OOPSSOF1    OOPSSUP1    OOPSUTL1    OOPSUTL2
OOPSUTL3    OOPSUTL4    OOPSUTL5    OOPSUTL6    OOPSVAL1    OOPSWCE    OOPSWCSE    OOPSXP11
OOPSXP5    OOPSXP8    OOPSXV2    

Accessed By FileMan Db Calls, Total: 62

Package Total Routines
Asists 62 OOPSCA    OOPSCA1    OOPSCA2    OOPSCC    OOPSDIS    OOPSDOL    OOPSDOL1    OOPSDOL2
OOPSDOLX    OOPSDS12    OOPSEMP1    OOPSEMP2    OOPSEMPB    OOPSESR    OOPSF167    OOPSGUI0
OOPSGUI1    OOPSGUI2    OOPSGUI3    OOPSGUI4    OOPSGUI5    OOPSGUI6    OOPSGUI7    OOPSGUI8
OOPSGUI9    OOPSGUIC    OOPSGUID    OOPSGUIF    OOPSGUIR    OOPSGUIS    OOPSGUIT    OOPSGUIU
OOPSLOG    OOPSMBUL    OOPSNDB    OOPSNDBX    OOPSPC11    OOPSPC21    OOPSPC41    OOPSPC51
OOPSPRT    OOPSPRT1    OOPSPRT2    OOPSSOF1    OOPSSOF2    OOPSSUP1    OOPSSUP3    OOPSSUPB
OOPSUTL1    OOPSUTL2    OOPSUTL3    OOPSUTL4    OOPSUTL5    OOPSUTL6    OOPSV221    OOPSVAL1
OOPSWCE    OOPSWCE1    OOPSWCSE    OOPSXP11    OOPSXP5    OOPSXP8    

Pointed To By FileMan Files, Total: 1

Package Total FileMan Files
Asists 1 ASISTS COMPENSATION CLAIM (CA7)(#2264)[.7]    

Pointer To FileMan Files, Total: 28

Package Total FileMan Files
Asists 24 ASISTS CHARACTERIZATION OF INJURY(#2261)[29]    ASISTS DOL ANATOMICAL LOCATION CODES(#2261.1)[3030.1]    ASISTS CRITICAL TRACKING ISSUES(#2261.2)[3]    ASISTS INCIDENT WEATHER FACTORS(#2261.21)[354]    ASISTS INCIDENT SOURCE(#2261.22)[355]    ASISTS PREVENTION METHODS(#2261.24)[358]    ASISTS PERSONAL PROTECTIVE EQUIPMENT(#2261.3)[#2260.01(.01)]    ASISTS SETTING OF INJURY(#2261.4)[27]    ASISTS PURPOSE FOR USING SHARPS(#2261.5)[36]    ASISTS OCCURRENCE OF SHARPS INJURY(#2261.6)[37]    ASISTS DEVICE/EQUIPMENT(#2261.7)[38]    ASISTS RESULTS(#2261.8)[41]    ASISTS SAFETY CHARACTERISTICS(#2261.9)[84]    ASISTS DOL DISTRICT OFFICE(#2262.1)[73]    ASISTS DEVICE SIZE(#2262.2)[83]    ASISTS NEEDLESTICK BRANDS(#2262.3)[82]    ASISTS REASON FOR CONTROVERT(#2262.4)[332]    ASISTS REASON FOR DISPUTE CODES(#2262.8)[347]    ASISTS DOL TYPE OF INJURY CODES(#2263)[123226]    ASISTS DOL SOURCE OF INJURY CODES(#2263.1)[124227]    ASISTS DOL CAUSE OF INJURY CODES(#2263.2)[126]    ASISTS DOL NATURE OF INJURY CODES(#2263.3)[62]    ASISTS DOL PROVIDER TITLE(#2263.5)[182270]    ASISTS OWCP CHARGEBACK CODES(#2263.6)[70]    
Kernel 4 INSTITUTION(#4)[13]    SERVICE/SECTION(#49)[86]    STATE(#5)[10105116.2133154159179185205212233240248262345#2260.0125(3)]    NEW PERSON(#200)[44485353.156677679119169221265309312#2260.095(7)#2260.095(9)]    

Fields, Total: 297

Field # Name Loc Type Details
.01 CASE NUMBER 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<10) X
  • LAST EDITED:  APR 26, 2004
  • HELP-PROMPT:  Answer must be 10-11 characters in length.
  • DESCRIPTION:  The case number is automatically assigned when a stub record is created. It is composed of the Fiscal Year concatenated with a 5 digit sequential number. Amended cases will have a alphabetic suffix appended to the
    original case number.
  • CROSS-REFERENCE:  2260^B
    1)= S ^OOPS(2260,"B",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  2260^BS5^MUMPS
    1)= Q:$P($G(^OOPS(2260,DA,"2162A")),U)=""  S ^OOPS(2260,"BS5",$E(X,1)_$E($P(^("2162A"),U),6,9),DA)=""
    2)= Q:$P($G(^OOPS(2260,DA,"2162A")),U)=""  K ^OOPS(2260,"BS5",$E(X,1)_$E($P(^("2162A"),U),6,9),DA)
    This index sets up the first letter last name, last 4 digits of the SSN index.
1 PERSON INVOLVED 0;2 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<3)!(X?1P.E)!(X'?1U.ANP)!(X'[",") X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter a name (LAST,FIRST), 3-30 characters in length.
  • DESCRIPTION:  This is the name of the employee, volunteer, contractor or other person that was involved in the incident, sustaining an injury or illness. Use the same convention for entering a name as used when entering an employee:
    LAST,FIRST. John Doe would be entered as DOE,JOHN.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2260^C
    1)= S ^OOPS(2260,"C",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"C",$E(X,1,30),DA)
2 PERSONNEL STATUS 0;3 SET
************************REQUIRED FIELD************************
  • '1' FOR Employee;
  • '2' FOR Volunteer;
  • '3' FOR Contractor;
  • '4' FOR Visitor;
  • '5' FOR Other;
  • '6' FOR Non-PAID Employee;
  • '7' FOR Medical Student;
  • '8' FOR Nursing Student;
  • '9' FOR Other Student;
  • '10' FOR Resident Physician;

  • LAST EDITED:  JUN 22, 2004
  • HELP-PROMPT:  Enter the status. Non-PAID Employee includes student and resident.
  • DESCRIPTION:  
    The personnel status of the individual involved in the incident is either employee, volunteer, contractor, visitor or other.  Non-PAID Employee includes students and residents.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2260^AC
    1)= S ^OOPS(2260,"AC",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"AC",$E(X,1,30),DA)
3 TYPE OF INCIDENT 0;4 POINTER TO ASISTS CRITICAL TRACKING ISSUES FILE (#2261.2)
************************REQUIRED FIELD************************
ASISTS CRITICAL TRACKING ISSUES(#2261.2)

  • LAST EDITED:  APR 27, 1998
  • HELP-PROMPT:  Select the term that best categorizes the type of injury.
  • DESCRIPTION:  
    This is the critical tracking issue that best characterizes the type of injury sustained.
4 DATE/TIME OF OCCURRENCE 0;5 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETX",%DT(0)="-NOW" D ^%DT K %DT S X=Y K:Y<1 X I $G(X),($$FMDIFF^XLFDT(DT,X,1)>1095) D EN^DDIOL("DATE OF OCCURRENCE must be within 3 years","","!!?5") K X
  • LAST EDITED:  SEP 01, 2004
  • HELP-PROMPT:  Enter the date and time of injury, date only if illness.
  • DESCRIPTION:  
    If this is an injury, this is the date and time the incident happened.  If this is an illness, this is the date the employee first became aware of the disease or illness.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2260^AD
    1)= S ^OOPS(2260,"AD",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"AD",$E(X,1,30),DA)
  • RECORD INDEXES:  AF (#567)
5 SSN 2162A;1 FREE TEXT

  • INPUT TRANSFORM:  S X=$TR(X,"-","") K:$L(X)>9!($L(X)<9)!'(X?9N)!'(X) X
  • OUTPUT TRANSFORM:  S Y=$E(Y,1,3)_"-"_$E(Y,4,5)_"-"_$E(Y,6,9)
  • LAST EDITED:  JUN 22, 2004
  • HELP-PROMPT:  Answer must be 9 characters in length.
  • DESCRIPTION:  
    This is the Social Security Number of the person involved in this incident.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2260^SSN
    1)= S ^OOPS(2260,"SSN",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"SSN",$E(X,1,30),DA)
  • CROSS-REFERENCE:  2260^BS5^MUMPS
    1)= S ^OOPS(2260,"BS5",$E($P(^OOPS(2260,DA,0),U,2),1)_$E(X,6,9),DA)=""
    2)= K ^OOPS(2260,"BS5",$E($P(^OOPS(2260,DA,0),U,2),1)_$E(X,6,9),DA)
    This index sets up the first letter last name, last 4 digits of the SSN index.
6 DATE OF BIRTH 2162A;2 DATE

  • INPUT TRANSFORM:  S %DT="E",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),'$$PSDTCHK^OOPSUTL3(X,110,6) K X
  • LAST EDITED:  FEB 01, 2001
  • HELP-PROMPT:  Enter the date of birth of the person involved in this incident.
  • DESCRIPTION:  
    This is the date of birth of the person involved in this incident.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
7 SEX 2162A;3 SET
  • '1' FOR Male;
  • '2' FOR Female;

  • LAST EDITED:  MAY 30, 2000
  • HELP-PROMPT:  Enter the sex of the person involved in this incident.
  • DESCRIPTION:  
    This is the sex of the person involved in this incident.
8 HOME STREET ADDRESS 2162A;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 19, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the first line of the home street address of the person involved in this incident.
9 CITY 2162A;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 19, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city where this person resides.
10 STATE 2162A;6 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  APR 19, 2000
  • HELP-PROMPT:  Enter the State in which this person resides.
  • DESCRIPTION:  
    This is the State in which this person resides.
11 ZIP CODE 2162A;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  APR 19, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the Zip code for this person's home address.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
12 HOME PHONE NUMBER 2162A;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<4) X
  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Enter Area Code and number separated by hyphens, 4-20 characters.
  • DESCRIPTION:  
    This is the home phone number of the person involved in this incident.  Enter the Area Code and number separated by hyphens or spaces. E.g., 123-122-3456   or  123 122 3456
13 STATION NUMBER 2162A;9 POINTER TO INSTITUTION FILE (#4)
************************REQUIRED FIELD************************
INSTITUTION(#4)

  • LAST EDITED:  OCT 12, 1999
  • HELP-PROMPT:  Answer must be 3-7 characters in length.
  • DESCRIPTION:  
    This is the station number where the incident took place.
  • CROSS-REFERENCE:  2260^D
    1)= S ^OOPS(2260,"D",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"D",$E(X,1,30),DA)
    3)= This index cannot be deleted
14 COST CENTER/ORGANIZATION 2162A;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8)!'(X?8N) X
  • LAST EDITED:  APR 24, 1998
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    This is the employee's cost center/organization code.
15 OCCUPATION 2162A;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<4) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 4 characters in length.
  • DESCRIPTION:  
    This is the employee's occupation series code.
16 GRADE 2162A;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1)!'(X?1.2N) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the employee's grade as of the date of injury.
17 STEP 2162A;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the employee's step as of the date of injury.
18 EDUCATION 2162A;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>45!($L(X)<3) X
  • LAST EDITED:  APR 16, 1998
  • HELP-PROMPT:  Answer must be 3-45 characters in length.
  • DESCRIPTION:  
    This is the employee's education level.
19 HEPATITIS B 2162A;15 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter Yes or No.
  • DESCRIPTION:  
    In cases of bodily fluid exposure (including needlesticks and sharps), this shows whether or not a test for Hepatitis B was done as a result of the exposure.
20 HEPATITIS C 2162A;16 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter Yes or No.
  • DESCRIPTION:  
    In cases of bodily fluid exposure (including needlesticks and sharps), this shows whether or not a test for Hepatitis C was done as a result of the exposure.
21 HIV 2162A;17 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter Yes or No.
  • DESCRIPTION:  
    In cases of bodily fluid exposure (including needlesticks and sharps), this shows whether or not a test for HIV was done as a result of the exposure.
22 OTHER 2162A;18 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter Yes or No.
  • DESCRIPTION:  
    In cases of bodily fluid exposure (including needlesticks and sharps), this shows whether or not a test other than Hepatitis B, Hepatitis C, or HIV was done as a result of the exposure.
23 DATE ORDERED 2162A;19 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter a date the tests were ordered to be done.
  • DESCRIPTION:  
    In cases of bodily fluid exposure (including needlesticks and sharps), this shows the date ordered for lab tests.
24 DATE DRAWN 2162A;20 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter the date the lab tests were drawn.
  • DESCRIPTION:  
    For bodily fluid exposures, this is the date the tests were done.
25 FOLLOW-UP DATE 2162A;21 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter a follow-up date.
  • DESCRIPTION:  
    This is the date follow-up should take place.
26 GENERAL SETTING OF INCIDENT 2162B;1 SET
************************REQUIRED FIELD************************
  • 'P' FOR Patient care setting;
  • 'N' FOR Non-patient care setting;
  • 'U' FOR Unknown;

  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Is this a patient care or non-patient care setting?
  • DESCRIPTION:  
    This shows whether the incident took place in a patient care or non-patient care setting.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
27 LOCATION OF INJURY 2162B;2 POINTER TO ASISTS SETTING OF INJURY FILE (#2261.4)
************************REQUIRED FIELD************************
ASISTS SETTING OF INJURY(#2261.4)

  • INPUT TRANSFORM:  S DIC("S")="I $$CARE^OOPSUTL2(DA,Y)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Select the setting that best describes where the incident took place.
  • DESCRIPTION:  
    This is the general location, either a patient care or non-patient care type setting, where the incident took place.
  • SCREEN:  S DIC("S")="I $$CARE^OOPSUTL2(DA,Y)"
  • EXPLANATION:  Screen out those that are not linked to a LOCATION OF INCIDENT.
28 DESCRIPTION OF INCIDENT 2162C;0 WORD-PROCESSING #2260.028

  • DESCRIPTION:  
    This information fully narrates the accident or incident.  It explains what led up to the accident, how the accident happened, equipment failures, material defects, etc.
29 CHARACTERIZATION OF INJURY 2162B;3 POINTER TO ASISTS CHARACTERIZATION OF INJURY FILE (#2261) ASISTS CHARACTERIZATION OF INJURY(#2261)

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Enter the best description of the injury.
  • DESCRIPTION:  
    This is the general description of the injury.
29.5 MEDICAL EMERGENCY 2162B;9 SET
  • '1' FOR Normal Operations (No Emergency);
  • '2' FOR Medical Emergency;
  • '3' FOR Clean-up Following Medical Emergency;

  • LAST EDITED:  OCT 07, 1999
  • HELP-PROMPT:  Enter how the incident relates to a medical emergency, if applicable
  • DESCRIPTION:  
    Enter the response that best describes how the incident is related to a medical emergency.
  • TECHNICAL DESCR:  
    This Set of Codes field will collect the response that best describes how the incident is related to a medical emergency.
30 BODY PART MOST AFFECTED 2162B;4 POINTER TO ASISTS DOL ANATOMICAL LOCATION CODES FILE (#2261.1) ASISTS DOL ANATOMICAL LOCATION CODES(#2261.1)

  • INPUT TRANSFORM:  S DIC("S")="I "",0,3,5,6,7,8,9,10,11,12,13,14,15,16,17,21,22,27,31,""'[("",""_$P(^(0),U,2)_"","")" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 21, 2000
  • HELP-PROMPT:  Enter the body part most affected by the injury.
  • DESCRIPTION:  Enter the body part most affected by the injury.
  • SCREEN:  S DIC("S")="I "",0,3,5,6,7,8,9,10,11,12,13,14,15,16,17,21,22,27,31,""'[("",""_$P(^(0),U,2)_"","")"
  • EXPLANATION:  THIS CODE IS NO LONGER A VALID SELECTION, PLEASE ENTER A VALID CODE.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
30.1 ADDITIONAL BODY PART AFFECTED 2162B;8 POINTER TO ASISTS DOL ANATOMICAL LOCATION CODES FILE (#2261.1) ASISTS DOL ANATOMICAL LOCATION CODES(#2261.1)

  • INPUT TRANSFORM:  S DIC("S")="I "",0,3,5,6,7,8,9,10,11,12,13,14,15,16,17,21,22,27,31,""'[("",""_$P(^(0),U,2)_"","")" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 21, 2000
  • HELP-PROMPT:  Enter an additional body part that was affected by the injury.
  • DESCRIPTION:  Enter an additional body part that was affected by the injury.
  • SCREEN:  S DIC("S")="I "",0,3,5,6,7,8,9,10,11,12,13,14,15,16,17,21,22,27,31,""'[("",""_$P(^(0),U,2)_"","")"
  • EXPLANATION:  THIS CODE IS NO LONGER A VALID SELECTION, PLEASE ENTER A VALID CODE.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
31 SIDE OF BODY AFFECTED 2162B;5 SET
  • 'L' FOR Left;
  • 'R' FOR Right;
  • 'B' FOR Both;
  • 'N' FOR NA;

  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Select the side of the body most affected.
  • DESCRIPTION:  
    This is the side of the body most affected by the injury.
32 DUTY RETURNED TO 2162B;6 SET
  • 'F' FOR Full duty;
  • 'L' FOR Light duty;

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Did the employee return to light or full duty?
  • DESCRIPTION:  
    The employee returned to either light or full duty.
33 LOST TIME 2162B;7 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Was there lost time due to the injury?
  • DESCRIPTION:  
    The employee did or did not lose time due to the injury.
34 PATIENT SOURCE 2162D;1 SET
  • 'I' FOR Identifiable;
  • 'U' FOR Unidentifiable;
  • 'N' FOR NA;

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Was the source patient identifiable?
  • DESCRIPTION:  
    This defines whether or not the source patient of the body fluid exposure (including needlestick and sharps) is identifiable.
35 CONTAMINATION 2162D;2 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;
  • 'U' FOR Unknown;

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Was the needle or sharp contaminated?
  • DESCRIPTION:  
    This states whether or not the needle or sharp was contaminated.
36 PURPOSE OF SHARP OBJECT 2162D;3 POINTER TO ASISTS PURPOSE FOR USING SHARPS FILE (#2261.5) ASISTS PURPOSE FOR USING SHARPS(#2261.5)

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Enter the original purpose for the sharp item.
  • DESCRIPTION:  
    The sharp item was originally used for this purpose.
37 ACTIVITY AT TIME OF INJURY 2162D;4 POINTER TO ASISTS OCCURRENCE OF SHARPS INJURY FILE (#2261.6) ASISTS OCCURRENCE OF SHARPS INJURY(#2261.6)

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  What was happening when the injury occurred?
  • DESCRIPTION:  
    This is the activity when the injury occurred.
38 OBJECT CAUSING INJURY 2162D;5 POINTER TO ASISTS DEVICE/EQUIPMENT FILE (#2261.7) ASISTS DEVICE/EQUIPMENT(#2261.7)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,2)'=16" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Enter the device or item that caused the injury.
  • DESCRIPTION:  
    This is the device or item that caused the injury.
  • SCREEN:  S DIC("S")="I $P(^(0),U,2)'=16"
  • EXPLANATION:  This selection is no longer valid, Please select another device.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
39 AREA EXPOSED TO BODILY FLUID 2162E;0 SET Multiple #2260.039 2260.039

  • DESCRIPTION:  
    This is a description of the exposed body parts.
40 PERSONAL PROTECTIVE EQUIPMENT 2162F;0 POINTER Multiple #2260.01 2260.01

  • DESCRIPTION:  
    This is a description of the protective items worn at the time of the exposure.
41 BODILY FLUID EXPOSURE SOURCE 2162D;6 POINTER TO ASISTS RESULTS FILE (#2261.8) ASISTS RESULTS(#2261.8)

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  How was the employee exposed?
  • DESCRIPTION:  
    This explains how the exposure happened.
42 EQUIPMENT/DEVICE FAILURE 2162D;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    If there was an equipment, device or product failure, this is the type of equipment and manufacturer name.
42.5 EQUIP/DEVICE FAILURE OCCURRED 2162D;9 SET
  • 'N' FOR No;
  • 'Y' FOR Yes;

  • LAST EDITED:  OCT 07, 1999
  • HELP-PROMPT:  Enter whether there was an equipment or device product failure involved with the incident.
  • DESCRIPTION:  
    Indicates whether there was an equipment or device product failure involved with the incident.  If yes, user will be prompted to enter comments.
43 SAFETY DESIGN DEVICE USED 2162D;8 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Was a safety design device used?
  • DESCRIPTION:  
    This states whether or not a safety device was used.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
44 SUPERVISOR 2162ES;1 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Enter the name of the supervisor completing the 2162.
  • DESCRIPTION:  
    This is the supervisor completing the information on the Report of Accident (2162).
45 SUPERVISOR ELECTRONIC SIG 2162ES;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Answer must be 6-20 characters in length.
  • DESCRIPTION:  
    This is the supervisor's electronic signature.
46 SUPERVISOR SIGNATURE DATE 2162ES;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Enter the date the 2162 was signed by the supervisor.
  • DESCRIPTION:  
    This is the date the supervisor signed the 2162.
47 CORRECTIVE ACTION 2162G;0 WORD-PROCESSING #2260.047

  • DESCRIPTION:  
    This is a statement of any corrective action that was taken to prevent further incidents of this kind.
48 SAFETY OFFICER NAME 2162ES;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 10, 1998
  • HELP-PROMPT:  Enter the name of the safety officer.
  • DESCRIPTION:  
    This is the name of the safety officer.
49 SAFETY OFF. ELECT. SIGNATURE 2162ES;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  APR 10, 1998
  • HELP-PROMPT:  Answer must be 6-20 characters in length.
  • DESCRIPTION:  
    This is the safety officer's electronic signature.
50 SAFETY OFF. DATE SIGNED 2162ES;6 DATE

  • INPUT TRANSFORM:  S %DT="ET" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 10, 1998
  • HELP-PROMPT:  Enter the date the safety officer signed.
  • DESCRIPTION:  
    This is the date of the safety officer's signature.
51 CASE STATUS 0;6 SET
  • '0' FOR Open;
  • '1' FOR Closed;
  • '2' FOR Deleted;
  • '3' FOR Replaced by amendment;

  • LAST EDITED:  JUN 20, 2001
  • HELP-PROMPT:  Enter the status of this case.
  • DESCRIPTION:  
    This is the status of the case.
  • CROSS-REFERENCE:  ^^TRIGGER^2260^54
    1)= X ^DD(2260,51,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^OOPS(2260,D0,0)):^(0),1:"") S X=$P(Y(1),U,18),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S DIH=$G(^OOPS(2260,DIV(0),0)),DIV=X S $P(^(0),U,18)=DIV,DIH=2260,DIG=54 D ^DI
    CR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(2260,51,1,1,69.2) S X=X="Closed",Y(2)=X S X=$P(Y(3),U,5)'="",Y=X,X=Y(2),X=X&Y,Y(4)=X S X=$P(Y(5),U,11)="",Y=X,X=Y(4),X=X&Y
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^OOPS(2260,D0,0)):^(0),1:"") S X=$P(Y(1),U,18),X=X S DIU=X K Y S X="" S DIH=$G(^OOPS(2260,DIV(0),0)),DIV=X S $P(^(0),U,18)=DIV,DIH=2260,DIG=54 D ^DICR
    69.2)= S Y(1)=$C(59)_$P($G(^DD(2260,51,0)),U,3),Y(5)=$S($D(^OOPS(2260,D0,0)):^(0),1:""),Y(3)=$S($D(^("2162ES")):^("2162ES"),1:"") S X=$P($P(Y(1),$C(59)_Y(0)_":",2),$C(59),1)
    CREATE CONDITION)= (CASE STATUS="Closed")&(SAFETY OFF. ELECT. SIGNATURE'="")&(DATE TRANSMITTED TO NDB="")
    CREATE VALUE)= TODAY
    DELETE VALUE)= @
    FIELD)= NEEDS XMIT TO NDB
    This trigger sets Today's date into NEEDS XMIT TO NDB field (#54) when the CASE STATUS (#51) is Closed, the Safety Officer has signed the 2162 (SAFETY OFF. ELECT. SIGNATURE #49), and the DATE TRANSMITTED (#57) is blank.
    By setting a value in the NEEDS XMIT TO NDB field, the cross reference ("AN") used for transmitting 2162 cases to the NDB is set.
52 INJURY/ILLNESS 0;7 SET
************************REQUIRED FIELD************************
  • '1' FOR Injury;
  • '2' FOR Illness/disease;

  • LAST EDITED:  APR 16, 1998
  • HELP-PROMPT:  Condition related to single incident is an Injury; multiple incidents is an Illness.
  • DESCRIPTION:  
    If the employee is relating the condition to a single incident, then select Injury (CA-1).  If the employee is relating the condition to more than one incident or more than a single shift, then select Illness (CA-2).
53 SUPERVISOR 0;8 POINTER TO NEW PERSON FILE (#200)
************************REQUIRED FIELD************************
NEW PERSON(#200)

  • LAST EDITED:  APR 16, 1998
  • HELP-PROMPT:  Enter the Name of the Employee's Supervisor.
  • DESCRIPTION:  Enter the name of the supervisor of the person involved.
53.1 SECONDARY SUPERVISOR 0;9 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 27, 1998
  • DESCRIPTION:  Enter the name of the secondary supervisor of the person involved.
54 NEEDS XMIT TO NDB 0;18 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 20, 2001
  • HELP-PROMPT:  Enter date to transmit case to NDB.
  • DESCRIPTION:  
    This is the date that the case was determined to be valid for transmission to NDB.
    UNEDITABLE
  • NOTES:  TRIGGERED by the CASE STATUS field of the ASISTS ACCIDENT REPORTING File
    TRIGGERED by the TRANSMITTED TO NDB field of the ASISTS ACCIDENT REPORTING File
  • CROSS-REFERENCE:  2260^AN^MUMPS
    1)= S ^OOPS(2260,"AN",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"AN",$E(X,1,30),DA)
    This Xref will contain the date that the case was closed with the safety officer's signature.
55 SAFETY OFF. COMMENTS 2162H;0 WORD-PROCESSING #2260.055

  • DESCRIPTION:  
    These are comments from the safety officer about this case.
56 PERSON ENTERING STUB RECORD 0;10 POINTER TO NEW PERSON FILE (#200)
************************REQUIRED FIELD************************
NEW PERSON(#200)

  • LAST EDITED:  SEP 09, 1999
  • DESCRIPTION:  This field is automatically populated when the 2162 Incicent report is created and saved. Data entry for this field is not possible through the ASISTS package. The internal value for this field is a pointer to the NEW
    PERSON File (#200).  The external value (Name) is displayed on the PRINT REPORT OF ACCIDENT Report.
57 DATE TRANSMITTED TO NDB 0;11 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 20, 2001
  • DESCRIPTION:  
    The value in this field will be the last time the closed case 2162 data was transmitted to the NDB. If the case is closed, transmitted, then re-opened, this field is 'blanked' so that retransmission will be triggered.
    WRITE AUTHORITY:  ^
    UNEDITABLE
  • CROSS-REFERENCE:  2260^ANC^MUMPS
    1)= S ^OOPS(2260,"ANC",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"ANC",$E(X,1,30),DA)
    This index will contain the date the case was transmitted to NDB.
  • CROSS-REFERENCE:  ^^TRIGGER^2260^59
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^OOPS(2260,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DIU=X K Y S X=DIV S X="Y" S DIH=$G(^OOPS(2260,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=2260,DIG=59 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^OOPS(2260,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DIU=X K Y S X="" S DIH=$G(^OOPS(2260,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=2260,DIG=59 D ^DICR
    CREATE VALUE)= "Y"
    DELETE VALUE)= @
    FIELD)= TRANSMITTED TO NDB
    This trigger sets the TRANSMITTED TO NDB field (#59) to 'Y'es when the DATE TRANSMITTED TO NDB field (#57) is entered or a blank if the DATE TRANSMITTED TO NDB is deleted.  By setting a value in the TRANSMITTED TO NDB
    field (#59) the trigger in the TRANSMITTED TO NDB field (#59) is executed which either sets or deletes the entry in the NEEDS XMIT TO NDB field (#54) which updates the "AN" cross reference.
58 REASON FOR DELETION 0;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<3) X
  • LAST EDITED:  OCT 15, 2001
  • HELP-PROMPT:  Answer must be 3-60 characters in length.
  • DESCRIPTION:  
    Enter the reason the case is being deleted.
  • TECHNICAL DESCR:  
    When an ASISTS case is being deleted; a reason why the case is being deleted should be given.  This field will store this free text.
59 TRANSMITTED TO NDB 0;19 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  JUL 12, 2001
  • HELP-PROMPT:  Enter "Y" if 2162 has been transmitted to NDB, "N" if it hasn't.
    WRITE AUTHORITY:  ^
    UNEDITABLE
  • NOTES:  TRIGGERED by the DATE TRANSMITTED TO NDB field of the ASISTS ACCIDENT REPORTING File
  • CROSS-REFERENCE:  ^^TRIGGER^2260^54
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^OOPS(2260,D0,0)):^(0),1:"") S X=$P(Y(1),U,18),X=X S DIU=X K Y S X="" S DIH=$G(^OOPS(2260,DIV(0),0)),DIV=X S $P(^(0),U,18)=DIV,DIH=2260,DIG=54 D ^DICR
    2)= Q
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= NEEDS XMIT TO NDB
    This field is set to 'Y'es when the DATE TRANSMITTED TO NDB field (#57) is entered and a blank when the DATE TRANSMITTED TO NDB field (#57) is deleted.  When setting this field to 'Y', the value in the NEEDS XMIT TO NDB
    field (#54) is blanked and the entry in it's cross reference ("AN") is updated (removed).
60 EMP RETIREMENT COVERAGE CA;4 SET
************************REQUIRED FIELD************************
  • '1' FOR CSRS;
  • '2' FOR FERS;
  • '3' FOR OTHER;

  • LAST EDITED:  APR 13, 2000
  • HELP-PROMPT:  Enter the Employee's type of Retirement Coverage.
  • DESCRIPTION:  This is the type of retirement coverage the employee has. If the type of Coverage is 'Other' then the user will be prompted to enter a description for that coverage in field, EMP RETIREMENT COVERAGE DESC (#61). This
    field will be used for the CA1 and CA2.
61 EMP RETIREMENT COVERAGE DESC CA;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  APR 13, 2000
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    This field will need to be answered if the response to EMP RETIREMENT COVERAGE (field #60) is 'OTHER'.  The response to this field should be a description of the type of other retirement coverage the employee has.
62 NOI CODE CA;3 POINTER TO ASISTS DOL NATURE OF INJURY CODES FILE (#2263.3) ASISTS DOL NATURE OF INJURY CODES(#2263.3)

  • LAST EDITED:  APR 13, 2000
  • HELP-PROMPT:  Enter the NOI code that best describes the Injury/Illness
  • DESCRIPTION:  
    Enter the NOI Code from the ASISTS DOL NATURE OF INJURY CODE Table that best describes the Injury/Illness.  This field is required prior to the electronic transmission of the CA1/CA2.
63 PAY PLAN 0;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<2) X
  • LAST EDITED:  MAR 01, 2000
  • HELP-PROMPT:  Answer must be 2-20 characters in length.
  • DESCRIPTION:  
    This is the employees Pay Plan.  This field is the Type of Pay used in the transmission of CA1/CA2 claims to DOL (Department of Labor).
66 DATE TRANSMITTED TO WCMIS CA;6 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 17, 2000
  • HELP-PROMPT:  Date that the completed CA1 or CA2 claim was transmitted to DOL
  • DESCRIPTION:  
    This is the date that the completed CA1 or CA2 claim was electronically transmitted to the Austin Automation Center (AAC).  A Workers Compensation employee must verify the record prior to it being eligible for sending.
  • CROSS-REFERENCE:  2260^AWC^MUMPS
    1)= D WCS^OOPSUTL1
    2)= D WCK^OOPSUTL1
    3)= Do NOT delete this cross reference.  ALSO, do NOT reindex it.
    This xref is set when a record has been verified correct for sending to the DOL (Department of Labor) and has been included in a Mailman message for sending.  When this xref is set, the "W" xref for the record is removed.
    This signifies that the record has been transmitted to DOL for processing.  If a problem occurred in the transmission and it was unsuccessful in reaching the AAC, this xref will be used for the manual re-transmission of
    claims.  This xref should NEVER be re-indexed.
67 TRANSMIT TO WCMIS WCES;1 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAR 22, 2000
  • HELP-PROMPT:  Enter the name of the Worker's Compensation employee signing the form.
  • DESCRIPTION:  
    This is the name of the Worker's Compensation employee who has signed the CA1 or CA2 signifying that the claim is complete and is ready to be transmitted to the Austin Automation Center (AAC).
  • CROSS-REFERENCE:  2260^AW^MUMPS
    1)= D WS^OOPSUTL1
    2)= D WK^OOPSUTL1
    3)= Do NOT delete or Re-index this Cross Reference.
    This xref is populated with the DUZ of the person who approved the claim for transmission to DOL (Department of Labor) via the AAC and WCMIS system.  Once the claim is included in a Mailman message it is removed from this
    xref.  This xref is used as a control for which records need to be included for electronic transmission.  Therefore, this xref should never be re-indexed.
68 WC ELECTRONIC SIGNATURE WCES;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  MAR 22, 2000
  • HELP-PROMPT:  Answer must be 6-20 characters in length.
  • DESCRIPTION:  
    This is the electronic signature of the Worker's Compensation employee who has approved the CA1/CA2 claim for electronic transmission to DOL (Department of Labor).
69 WC DATE OF SIGNATURE WCES;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 22, 2000
  • HELP-PROMPT:  Enter the Date that the Worker's Comp employee approved the claim for transmission to DOL.
  • DESCRIPTION:  
    This is the Date that the Worker's Compensation employee signed the CA1/CA2 claim, approving the electronic transmission to DOL (Department of Labor).
70 OWCP CHARGEBACK CODE CA;2 POINTER TO ASISTS OWCP CHARGEBACK CODES FILE (#2263.6) ASISTS OWCP CHARGEBACK CODES(#2263.6)

  • LAST EDITED:  FEB 07, 2001
  • HELP-PROMPT:  Enter the OWCP Chargeback code for the claim.
  • DESCRIPTION:  
    This is the OWCP Chargeback code required by DOL (Department of Labor) for the electronic submission of a CA1/CA2 claim.
71 EMPLOYEE BILL OF RIGHTS OK 0;14 SET
************************REQUIRED FIELD************************
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  JUL 31, 2000
  • HELP-PROMPT:  I have read and understood the Employee Bill of Rights
  • DESCRIPTION:  
    Indicate your reading and understanding of the Employee Bill of Rights.  If you do not understand the Bill of Rights, select No, and contact your facility's Workers Compensation representative for assistance.
72 EMPLOYEE CONSENT 0;15 SET
************************REQUIRED FIELD************************
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  JUL 31, 2000
  • HELP-PROMPT:  Local bargaining units may review my case
  • DESCRIPTION:  If it is acceptable with you to allow the local bargaining unit to review the details of your case, select Yes, otherwise select No, and the details of your case WILL NOT be provided to the local bargaining unit. This
    review is for accident and occupational illness tracking purposes only.
73 OWCP DISTRICT OFFICE 0;16 POINTER TO ASISTS DOL DISTRICT OFFICE FILE (#2262.1) ASISTS DOL DISTRICT OFFICE(#2262.1)

  • LAST EDITED:  AUG 29, 2000
  • HELP-PROMPT:  Enter the OWCP District Office for this claim.
  • DESCRIPTION:  
    This is the OWCP District Office that the CA1/CA2 claim will be forwarded to upon completion of the claim.
74 VALIDATION CODE CA;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  NOV 20, 2000
  • HELP-PROMPT:  Type a Number between 1 and 99999999, 0 Decimal Digits
  • DESCRIPTION:  
    This field contains the validation code for the verification for the Employees electronic signature.
75 VALIDATION VERSION CA;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  NOV 20, 2000
  • HELP-PROMPT:  Type a Number between 1 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    This field contains the version number used to encode the Employee's Electronic Signature Code.
76 NAME OF SAFETY OFFICER WCSE;1 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JAN 22, 2001
  • HELP-PROMPT:  Enter the Name of the Safety Officer
  • DESCRIPTION:  
    This is the name of the Safety Officer who is giving their approval that the Workers' Compensation personnel can electronically sign for the employee.  This is because the employee is not able to sign for themselves.
77 SAFETY OFFICER ELEC. SIGN WCSE;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  JAN 22, 2001
  • HELP-PROMPT:  Enter your electronic signature.
  • DESCRIPTION:  
    This is the electronic signature of the Safety Officer who is approving the Workers' Compensation personnel to sign electronically for the employee
78 SAFETY OFF. ELEC. SIGN DATE WCSE;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 22, 2001
  • HELP-PROMPT:  Enter the date of your signature.
  • DESCRIPTION:  
    This is the date that the Safety Officer electronically signed the claim giving their approval that the Workers' Compensation personnel could electronically sign the claim for the employee.
79 EMPLOYEE HEALTH NAME WCSE;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JAN 22, 2001
  • HELP-PROMPT:  Enter the name of the Employee Health representative.
  • DESCRIPTION:  
    This is the name of the Employee Health representative who is giving their approval for the Workers' Compensation personnel to electronically sign the claim for the employee.
80 EMP HEALTH ELECT. SIGNATURE WCSE;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  JAN 22, 2001
  • HELP-PROMPT:  Enter your electronic signature.
  • DESCRIPTION:  This is the electronic signature of the Employee Health representative who is giving their approval that the Workers' Compensation personnel may electronically sign the claim for the employee. This is because the employee
    is not able to electronically sign for themself.
81 EMP HEALTH ELECT SIGN DATE WCSE;6 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 22, 2001
  • HELP-PROMPT:  Enter the date of your signature.
  • DESCRIPTION:  
    This is the date that the Employee Health Representative electronically signed the claim giving their approval that the Workers' Compensation personnel could electronically sign the claim for the employee.
82 BRAND 2162B;10 POINTER TO ASISTS NEEDLESTICK BRANDS FILE (#2262.3) ASISTS NEEDLESTICK BRANDS(#2262.3)

  • LAST EDITED:  JUN 07, 2001
  • HELP-PROMPT:  Select the Brand of the Device used during the Incident
  • DESCRIPTION:  
    This is the manufacturer of the device that was being used at the time the incident occurred.
83 DEVICE SIZE 2162B;11 POINTER TO ASISTS DEVICE SIZE FILE (#2262.2) ASISTS DEVICE SIZE(#2262.2)

  • INPUT TRANSFORM:  S DIC("S")="I $$DEVSZ^OOPSUTL2(DA,Y)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Enter the DEVICE SIZE of the object that caused the injury.
  • DESCRIPTION:  
    Enter the DEVICE SIZE of the object that caused the injury.
  • SCREEN:  S DIC("S")="I $$DEVSZ^OOPSUTL2(DA,Y)"
  • EXPLANATION:  Only valid selections are shown.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
84 SAFETY CHARACTERISTICS 2162B;12 POINTER TO ASISTS SAFETY CHARACTERISTICS FILE (#2261.9) ASISTS SAFETY CHARACTERISTICS(#2261.9)

  • LAST EDITED:  MAR 05, 2001
  • HELP-PROMPT:  Enter the SAFETY CHARACTERISTICS for the device.
  • DESCRIPTION:  
    Enter the appropriate ENGINEERED SAFETY CHARACTERISTICS.
85 SAFETY DEVICE NOT USED 2162S;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Answer must be 3-250 characters in length. Enter the reason the Safety Device was not used.
  • DESCRIPTION:  
    Enter the reason that a safety device was not used during this incident.
86 SERVICE 0;17 POINTER TO SERVICE/SECTION FILE (#49) SERVICE/SECTION(#49)

  • LAST EDITED:  MAR 06, 2001
  • HELP-PROMPT:  Enter the individual's Service area.
  • DESCRIPTION:  
    This is the individual's service area at the time of the incident.
87 INJ PRIOR TO SAFE DEV ENGAGED 2162B;13 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  JUL 12, 2001
  • HELP-PROMPT:  Enter "Yes" if the injury occurred before the safety device engaged, otherwise enter a "No".
  • DESCRIPTION:  
    This field will indicate whether the safety device on the object that caused the injury engaged before the injury occurred.
88 INCLUDE ON OSHA LOG 2162B;14 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  SEP 01, 2004
  • HELP-PROMPT:  Enter 'Y'es if this claim should appear on the OSHA Log.
  • DESCRIPTION:  This field will indicate whether the ASISTS case filed should appear on the Log of Federal Occupational Injuries and Illnesses. A Yes response will indicate to include the claim, a No response will exclude it from the
    report.
  • CROSS-REFERENCE:  2260^AE
    1)= S ^OOPS(2260,"AE",$E(X,1,30),DA)=""
    2)= K ^OOPS(2260,"AE",$E(X,1,30),DA)
    This index will be used to quickly determine if an ASISTS case should be included in the Log of Federal Occupational Injuries and Illnesses report.
  • RECORD INDEXES:  AF (#567)
89 FATALITY 2162A;22 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  DEC 04, 2001
  • HELP-PROMPT:  Enter 'Y'es if the claim resulted in a fatality, otherwise, 'N'o.
  • DESCRIPTION:  
    This field will indicate whether the incident that is being reported on this claim resulted in a fatality.  A Yes response will indicate that a fatality resulted, a No response will indicate that a fatality did not occur.
90 DATE/TIME STUB CREATED 0;20 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X K %DT
  • LAST EDITED:  NOV 29, 2006
  • HELP-PROMPT:  Enter the Date and Time the Incident Occurred.
  • DESCRIPTION:  
    This field will capture the Date and Time that the initial Stub record (Create Accident/Illness Report) was filed in the system.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
95 INCIDENT OUTCOME OUTC;0 DATE Multiple #2260.095 2260.095

  • DESCRIPTION:  
    This subfile contains information regarding the employees ability to work as a result of the incident.
  • INDEXED BY:  STATUS & INCIDENT OUTCOME (AC)
100 HOME PHONE NUMBER CA1A;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Enter Area Code and number separated by hyphens, 3-18 characters.
  • DESCRIPTION:  
    This is the home phone number of the person involved in the incident.  Enter the Area Code and number separated by hyphens or spaces. E.g., 123-122-3456   or  123 122 3456 (Injury)
101 GRADE/LEVEL DATE OF INJURY CA1A;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<3) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 3-18 characters in length.
  • DESCRIPTION:  
    This is the employee's grade/level at the time of the injury. (Injury)
102 STEP AS OF DATE OF INJURY CA1A;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the employee's step at the time of the injury. (Injury)
103 EMPLOYEE STREET ADDRESS CA1A;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the employee's street address. (Injury)
104 EMPLOYEE CITY ADDRESS CA1A;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city where the employee lives. (Injury)
105 EMPLOYEE STATE ADDRESS CA1A;6 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Enter the state.
  • DESCRIPTION:  
    This is the employee's state address. (Injury)
106 EMPLOYEE ZIP CODE CA1A;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAR 24, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the employee's Zip code. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
107 DEPENDENTS CA1A;8 SET
  • '1' FOR Wife, Husband;
  • '2' FOR Children under 18;
  • '3' FOR Other;
  • '4' FOR Wife, Husband + Children under 18;
  • '5' FOR Wife, Husband + Other;
  • '6' FOR Children under 18 + Other;
  • '7' FOR Wife, Husband + Children under 18 + Other;

  • LAST EDITED:  MAY 01, 1998
  • HELP-PROMPT:  Select the item which best describes the employee's dependents.
  • DESCRIPTION:  
    These are the employee's dependents. (Injury)
108 PLACE WHERE INJURY OCCURRED CA1A;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<3) X
  • LAST EDITED:  MAR 01, 2000
  • HELP-PROMPT:  Answer must be 3-60 characters in length.
  • DESCRIPTION:  
    This is a short description of where the injury occurred, e.g., 2nd floor, x-ray, cafeteria, etc. (Injury)
109 DATE/TIME INJURY OCCURRED CA1A;10 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 10, 1999
  • HELP-PROMPT:  Enter a date and time the injury occurred.
  • DESCRIPTION:  
    This is the date and time the injury occurred. (Injury)
110 DATE OF THIS NOTICE CA1A;11 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,0)),U,5)\1>X D EN^DDIOL("DATE OF THIS NOTICE cannot be prior to the DATE/TIME OF OCCURRENCE","","!!?5") K X
  • LAST EDITED:  JAN 31, 2001
  • HELP-PROMPT:  Enter the date the CA-1 was completed.
  • DESCRIPTION:  
    This is the date the employee completed the Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation (CA-1). (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
111 OCCUPATION CA1A;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<2) X
  • LAST EDITED:  MAR 31, 2000
  • HELP-PROMPT:  Answer must be 2-30 characters in length.
  • DESCRIPTION:  
    This is a short description of the employee's occupation. (Injury)
112 CAUSE OF INJURY CA1B;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>200!($L(X)<1) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 1-200 characters in length.
  • DESCRIPTION:  
    This is a short description of what happened and why. (Injury)
113 NATURE OF INJURY CA1C;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<1) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 1-100 characters in length.
  • DESCRIPTION:  
    This is a description of the injury and the part of the body affected, e.g., fracture of left leg. (Injury)
114 REQUEST PAY OR LEAVE CA1A;13 SET
  • 'COP' FOR Continuation of regular pay;
  • 'L' FOR Sick and/or annual leave;

  • LAST EDITED:  MAY 05, 1998
  • HELP-PROMPT:  Select Continuation of regular pay (COP) or leave (L).
  • DESCRIPTION:  This is the employee's choice of either continuing regular pay (COP) or taking sick or annual leave (L). If you (the employee) are disabled for work as a result of this injury and file CA-1 within thirty days of the
    injury, you are entitled to receive continuation of pay (COP) from your employing agency.  COP is paid for up to 45 days of disability, and is not charged against sick or annual leave.  You may elect sick or annual leave
    if you wish, but compensation from OWCP may not be claimed during the 45 days of COP entitlement.  (You may not claim compensation to repurchase leave used during this period.) Also, if you change your election within one
    year, the agency is obliged to convert past periods of leave to COP, which qualify. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
115 NAME OF WITNESS CA1D;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the name of the person who witnessed the incident. (Injury)
116 WITNESS ADDRESS CA1D;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  APR 27, 1998
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the street address of the witness. Form CA-1 item 16.
116.1 WITNESS CITY CA1D;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>26!($L(X)<1) X
  • LAST EDITED:  APR 27, 1998
  • HELP-PROMPT:  Answer must be 1-26 characters in length.
  • DESCRIPTION:  This is the city address of the witness. Form CA-1 item 16.
116.2 WITNESS STATE CA1D;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  APR 27, 1998
  • DESCRIPTION:  This is the state address of the witness. Form CA-1 item 16.
116.3 WITNESS ZIP CODE CA1D;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5) X
  • LAST EDITED:  APR 27, 1998
  • HELP-PROMPT:  Answer must be 5-10 characters in length.
  • DESCRIPTION:  This is the zip code of the witness. Form CA-1 item 16.
117 DATE OF WITNESS SIGNATURE CA1D;3 DATE

  • INPUT TRANSFORM:  S %DT="ET" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter the date the witness intends to sign the statement.
  • DESCRIPTION:  
    This is the date the witness signed the statement of witness on the CA-1.
118 STATEMENT OF WITNESS CA1E;0 WORD-PROCESSING #2260.0118

  • DESCRIPTION:  
    This is the statement of the witness that describes what the witness saw, heard, or knows about the injury.
119 NAME OF EMPLOYEE CA1ES;1 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter the name of the injured employee.
  • DESCRIPTION:  
    This is the name of the employee injured during the incident. (Injury)
120 EMPLOYEE ELECT. SIGNATURE CA1ES;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter your electronic signature.
  • DESCRIPTION:  
    This is the electronic signature of the employee. (Injury)
121 EMPLOYEE DATE OF SIGNATURE CA1ES;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter the date of your signature.
  • DESCRIPTION:  
    This is the date the employee electronically signed his/her statement. (Injury)
122 OCCUPATION CODE CA1B;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 3-20 characters in length.
  • DESCRIPTION:  
    This is the employee's occupation code.
123 TYPE CODE CA1B;3 POINTER TO ASISTS DOL TYPE OF INJURY CODES FILE (#2263) ASISTS DOL TYPE OF INJURY CODES(#2263)

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Enter the Type Code that best describes the type of injury
  • DESCRIPTION:  
    This is the type code for this injury.  It stands for the action and is used along with the source code which stands for the object or substance to form a brief description of how the incident occurred. (Injury)
124 SOURCE CODE CA1B;4 POINTER TO ASISTS DOL SOURCE OF INJURY CODES FILE (#2263.1) ASISTS DOL SOURCE OF INJURY CODES(#2263.1)

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Enter the Source code for this Injury
  • DESCRIPTION:  
    This is the source code for this injury.  It stands for the object or substance and is used along with the type code, which stands for the action, to form a brief description of how the incident occurred. (Injury)
125 WITNESS NAME CA1W;0 Multiple #2260.0125 2260.0125

  • DESCRIPTION:  
    This is the name of the person who witnessed the incident and is willing to provide their name, address and a statement describing what occurred. (Injury)
126 CAUSE OF INJURY CODE CA;1 POINTER TO ASISTS DOL CAUSE OF INJURY CODES FILE (#2263.2) ASISTS DOL CAUSE OF INJURY CODES(#2263.2)

  • LAST EDITED:  JUN 01, 2000
  • HELP-PROMPT:  Enter the Cause of Injury Code that best matches the Cause of Injury description entered by the claimant.
  • DESCRIPTION:  
    The Cause of Injury Code that best matches the Cause of Injury description entered by the Claimant.  This field is required prior to the electronic transmission of the CA1/CA2 to DOL (Department of Labor).
130 AGENCY NAME CA1F;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the name of the reporting agency (office) to which correspondence from OWCP should be sent. (Injury)
131 AGENCY ADDRESS CA1F;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    This is the street address of the reporting agency. (Injury)
132 AGENCY CITY CA1F;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 01, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city address of the reporting agency. (Injury)
133 AGENCY STATE CA1F;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Enter the state for the reporting agency.
  • DESCRIPTION:  
    This is the state address of the reporting agency. (Injury)
134 AGENCY ZIP CODE CA1F;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAY 01, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the Zip code for the reporting agency. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
135 OWCP CODE CA1F;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<3) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 3-10 characters in length.
  • DESCRIPTION:  This is a four digit (or four digit plus two letter) code used by OWCP to identify the employing agency. The proper code may be obtained from your Human Resources Management or compensation office, or by contacting OWCP.
    (Injury)
136 OSHA SITE CODE CA1F;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<5) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 5-15 characters in length.
  • DESCRIPTION:  
    This is the Occupational Safety and Health Administration (OSHA) Site Code for the reporting agency. (Injury)
138 REGULAR HRS FROM TIME CA1F;9 FREE TEXT

  • INPUT TRANSFORM:  D TI^OOPSUTL3
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 2-7 characters in length.
  • DESCRIPTION:  
    At the time of the incident, this is the employee's regular working start time. (Injury)
  • EXECUTABLE HELP:  D HLP^OOPSUTL3
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
139 REGULAR HRS TO TIME CA1F;10 FREE TEXT

  • INPUT TRANSFORM:  D TI^OOPSUTL3
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 3-7 characters in length.
  • DESCRIPTION:  
    At the time of the incident, this is the employee's regular working stop time. (Injury)
  • EXECUTABLE HELP:  D HLP^OOPSUTL3
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
140 REGULAR WORK SCHEDULE CA1F;11 FREE TEXT

  • OUTPUT TRANSFORM:  D RWSOT^OOPSUTL2
  • LAST EDITED:  NOV 09, 2001
  • HELP-PROMPT:  Answer must be 1-14 characters in length.
  • DESCRIPTION:  
    At the time of the incident, this was the work schedule for the employee. Examples: For Monday through Friday, enter     2-6 For Sunday, Wednesday through Saturday, enter    1,4-7 or 1,4,5,6,7  (Injury)
141 DATE OF INJURY CA1F;12 DATE

  • INPUT TRANSFORM:  S %DT="ET" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Enter the date the employee was injured.
  • DESCRIPTION:  
    This is the date the employee was injured. (Injury)
142 DATE/TIME WORK STOPPED CA1F;13 DATE

  • INPUT TRANSFORM:  S %DT="ERX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),$P($G(^OOPS(2260,DA,0)),U,5)>X D EN^DDIOL("DATE WORK STOPPED cannot be prior to DATE/TIME OF OCCURRENCE","","!!?5") K X,%DT
  • LAST EDITED:  JUN 26, 2008
  • HELP-PROMPT:  Enter the date and time the employee stopped work.
  • DESCRIPTION:  
    This is the date and time the employee stopped work due to the injury. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
143 DATE PAY STOPPED CA1G;1 DATE

  • INPUT TRANSFORM:  S %DT="ETX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),'$$DTVAL^OOPSUTL4(X,143,142) K X,%DT
  • LAST EDITED:  JUN 26, 2008
  • HELP-PROMPT:  Enter the date the employee's pay stopped.
  • DESCRIPTION:  
    This is the date the employee's pay stopped. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
144 DATE 45 DAY PERIOD BEGAN CA1G;2 DATE

  • INPUT TRANSFORM:  S %DT="ETX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),'$$DTVAL^OOPSUTL4(X,144,142) K X,%DT
  • LAST EDITED:  JUN 26, 2008
  • HELP-PROMPT:  Enter the date the 45 day period began.
  • DESCRIPTION:  
    This is the date the 45 day period began for COP. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
145 DATE/TIME RETURNED TO WORK CA1G;3 DATE

  • INPUT TRANSFORM:  S %DT="ERX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),'$$DTVAL^OOPSUTL4(X,145,142) K X,%DT
  • LAST EDITED:  JUN 26, 2008
  • HELP-PROMPT:  Enter the date and time the employee returned to work.
  • DESCRIPTION:  
    This is the date and time the employee returned to work. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
146 INJURED PERFORMING DUTY CA1G;4 SET
  • 'N' FOR No;
  • 'Y' FOR Yes;

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Was the employee injured in performance of duty?
  • DESCRIPTION:  
    This is a Yes/No statement of whether the employee was injured while in the performance of duty. (Injury)
147 NOT INJURED PERFORMING JOB CA1G;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    This is short description of why the injury was not incurred while the employee was in performance of duty. (Injury)
148 INJURY CAUSED BY EMPLOYEE CA1G;6 SET
  • 'N' FOR No;
  • 'Y' FOR Yes;

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Was the injury caused by the employee's willful misconduct, intoxication, or intent to injure self or another?
  • DESCRIPTION:  
    The injury was caused (Yes) or not caused (No) by the employee's willful misconduct, intoxication, or intent to injure self or another. (Injury)
149 CAUSED BY EMPLOYEE EXPLAIN CA1G;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  APR 07, 1998
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    This is a short explanation of why the employee caused the injury through willful misconduct, intoxication, or intent to injure. (Injury)
150 INJURY CAUSED BY 3RD PARTY CA1G;8 SET
  • 'N' FOR No;
  • 'Y' FOR Yes;

  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Was the injury caused by a third party?
  • DESCRIPTION:  
    The injury was caused (Yes) or was not caused (No) by a third party. (Injury)
151 3RD PARTY NAME CA1H;1 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the injury was caused by someone other than the injured employee, this is the name of that third party. (Injury)
152 3RD PARTY ADDRESS CA1H;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    This is the street address of the third party. (Injury)
153 3RD PARTY CITY CA1H;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city address of the third party. (Injury)
154 3RD PARTY STATE CA1H;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Enter the state address of the third party.
  • DESCRIPTION:  
    This is the state address of the third party. (Injury)
155 3RD PARTY ZIP CODE CA1H;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the third party's Zip code. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
156 PHYSICIAN NAME CA1I;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the name of the physician who first provided medical care to the employee. (Injury)
157 PHYSICIAN ADDRESS CA1I;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • LAST EDITED:  OCT 14, 2009
  • HELP-PROMPT:  Answer must be 3-35 characters in length.
  • DESCRIPTION:  
    This is the physician's street address. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
158 PHYSICIAN CITY CA1I;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the physician's city address. (Injury)
159 PHYSICIAN STATE CA1I;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Enter the physician's state address.
  • DESCRIPTION:  
    This is the physician's state address. (Injury)
160 PHYSICIAN ZIP CODE CA1I;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  SEP 12, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the physician's Zip code. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
161 FIRST DATE MEDICAL CARE CA1I;6 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,0)),U,5)\1>X D EN^DDIOL("FIRST DATE MEDICAL CARE cannot be prior to DATE/TIME OF OCCURRENCE","","!!?5") K X
  • LAST EDITED:  JAN 31, 2001
  • HELP-PROMPT:  Enter the date the employee first received medical care.
  • DESCRIPTION:  
    This is the first date the employee received medical care for the injury. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
162 DISABLED FOR WORK CA1I;7 SET
  • 'N' FOR No;
  • 'Y' FOR Yes;

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Do medical reports show employee is disabled for work?
  • DESCRIPTION:  
    This states whether or not medical reports show employee is disabled for work. (Injury)
163 SUPERVISOR AGREE/DISAGREE CA1I;8 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Do you agree with the statements made by the employee and/or witness?
  • DESCRIPTION:  
    The supervisor's knowledge of the facts about this injury agree (Yes) or disagree (No) with statements of the employee and/or witness. (Injury)
164 SUPERVISOR NOT AGREE EXPLAIN CA1J;0 WORD-PROCESSING #2260.0164

  • DESCRIPTION:  
    This is why the supervisor does not agree with the statements of the employee and/or witness regarding the injury. (Injury)
165 REASON AGENCY CONTROVERTS COP CA1K;0 WORD-PROCESSING #2260.0165

  • LAST EDITED:  APR 25, 2000
  • DESCRIPTION:  
    This is a detailed reason why the employing agency controverts continuation of pay. (Injury)
165.1 AGENCY CONTROVERT CA1I;10 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  SEP 19, 2000
  • HELP-PROMPT:  Enter yes to indicate that the Agency controverts this claim
  • DESCRIPTION:  
    This field will be used by the Worker's Compensation Specialist to indicate whether the Agency controverts the claim. (Injury)
165.2 AGENCY DISPUTE CA1I;11 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  SEP 19, 2000
  • HELP-PROMPT:  Enter yes to indicate that the Agency disputes this claim.
  • DESCRIPTION:  
    This field will be completed by the Worker's Compensation specialist to indicate whether the Agency disputes the claim. (Injury)
166 PAY RATE DOLLAR CA1L;1 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>200000)!(X<0) X
  • LAST EDITED:  OCT 06, 1998
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 200000, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount of the pay rate when the employee stopped work. (Injury)
167 PAY RATE PER CA1L;2 SET
  • '1' FOR WEEKLY;
  • '2' FOR BI-WEEKLY;
  • '6' FOR DAILY;
  • 'H' FOR HOURLY;
  • 'A' FOR ANNUAL;

  • LAST EDITED:  MAY 03, 2000
  • HELP-PROMPT:  Enter the Employees Pay Rate when the employee stopped work.
  • DESCRIPTION:  
    This is the rate at which the employee was receiving the pay when the employee stopped work. (Injury)
168 SUPERVISOR EXCEPTIONS CA1L;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    This is the supervisor's exception to any of the information provided on the CA-1. (Injury)
169 NAME OF SUPERVISOR CA1ES;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  SEP 18, 2000
  • HELP-PROMPT:  Enter the name of the supervisor completing the CA-1.
  • DESCRIPTION:  
    This is the name of the supervisor completing the supervisor's portion of the CA-1. (Injury)
170 SUPERVISOR ELECT. SIGNATURE CA1ES;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  SEP 29, 2000
  • HELP-PROMPT:  Answer must be 6-20 characters in length.
  • DESCRIPTION:  
    This is the supervisor's electronic signature. (Injury)
171 SUPERVISOR DATE OF SIGNATURE CA1ES;6 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Enter the date of the supervisor's signature on the CA-1.
  • DESCRIPTION:  
    This is the date the supervisor signed the CA-1. (Injury)
172 SUPERVISOR TITLE CA1L;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    This is the supervisor's title. (Injury)
173 SUPERVISOR OFFICE PHONE CA1L;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<2) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 2-15 characters in length.
  • DESCRIPTION:  
    This is the supervisor's office phone number. (Injury)
173.1 SUPERVISOR PHONE EXT CA1L;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  SEP 10, 2001
  • HELP-PROMPT:  Answer must be 3-20 characters in length.
  • DESCRIPTION:  
    This field is available so that the Supervisor's office phone extension can be entered for a CA1. (Injury)
174 FILING INSTRUCTIONS CA1L;6 SET
  • '1' FOR No lost time and no medical expenses;
  • '2' FOR No lost time, medical expenses incurred;
  • '3' FOR Lost time covered by leave LWOP or COP;
  • '4' FOR First aid injury;

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Enter the filing instructions.
  • DESCRIPTION:  These are the filing instructions for the CA-1: 1. No lost time and no medical expense: Place this form in employee's medical folder(SF-66-D). 2. No lost time, medical expense incurred or expected: forward this form to
    OWCP. 3. Lost time covered by leave, LWOP, or COP: forward this form to OWCP. 4. First Aid Injury. (Injury)
175 DATE NOTICE RECEIVED CA1L;7 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,0)),U,5)\1>X D EN^DDIOL("DATE NOTICE RECEIVED cannot be prior to DATE/TIME OF OCCURRENCE","","!!?5") K X
  • LAST EDITED:  JAN 31, 2001
  • HELP-PROMPT:  Enter the date the notice was received.
  • DESCRIPTION:  
    This is the date the supervisor received notice that the employee filed a CA-1. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
176 EMPLOYEE DUTY STATION CA1M;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 27, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the station where the employee works. (Injury)
177 DUTY STATION ADDRESS CA1M;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the duty station street address. (Injury)
178 DUTY STATION CITY CA1M;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the duty station city address. (Injury)
179 DUTY STATION STATE CA1M;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Enter the duty station state.
  • DESCRIPTION:  
    This is the duty station state address. (Injury)
180 DUTY STATION ZIP CODE CA1M;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the duty station's Zip code. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
181 ZIP CODE WHERE INJURY OCCURRED CA1A;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  AUG 29, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the Zip Code of the location where the injury occurred and is used on the CA1 only. (Injury)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
182 PHYSICIAN TITLE CA1I;9 POINTER TO ASISTS DOL PROVIDER TITLE FILE (#2263.5) ASISTS DOL PROVIDER TITLE(#2263.5)

  • LAST EDITED:  SEP 11, 2000
  • HELP-PROMPT:  Enter the Title for the Physician
  • DESCRIPTION:  
    This is the appropriate title for the Physician who first saw the employee This field is used for CA1 claims. (Injury)
183 INJURY OCCURRED ADDRESS CA1N;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 11, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length and is the Street address where the injury occurred.
  • DESCRIPTION:  
    This is the street address where the injury occurred.  Generally, this will be the same address as the duty station street address. (Injury)
184 INJURY OCCURRED CITY CA1N;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  SEP 11, 2000
  • HELP-PROMPT:  Answer must be 3-20 characters in length and is the City where the Injury occurred.
  • DESCRIPTION:  
    This is the City portion of the address where the injury occurred.  Generally, this will be the same as the individual's duty station city. (Injury)
185 INJURY OCCURRED STATE CA1N;3 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  SEP 11, 2000
  • HELP-PROMPT:  Enter the State portion of the address where the injury occurred.
  • DESCRIPTION:  
    This is the State portion of the address where the injury occurred.  Generally, this will be the same as the individual's duty station state. (Injury)
199 WORKER'S COMP EDIT CA;8 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  MAR 10, 2000
  • HELP-PROMPT:  Enter whether the Worker's Compensation Personnel edited a field that should trigger a bulletin to the Supervisor
  • DESCRIPTION:  This field will indicate whether one of the following fields was edited by the Worker's Compensation Personnel in preparation for sending the claim to DOL (Department of Labor): INJURED PERFORMING DUTY (#146), NOT INJURED
    PERFORMING DUTY (#147), INJURY CAUSED BY EMPLOYEE (#148), INJURY CAUSED BY EMPLOYEE EXPLAIN (#149), SUPERVISOR AGREE/DISAGREE (#163), SUPERVISOR NOT AGREE EXPLAIN (#164), and REASON AGENCY CONTROVERTS COP (#165). (Injury)
    WRITE AUTHORITY:  ^
200 HOME PHONE NUMBER CA2A;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Enter Area Code and number separated by hyphens, 3-18 characters.
  • DESCRIPTION:  
    This is the home phone number of the person involved in this incident.  Enter the Area Code and number separated by hyphens or spaces. E.g., 123-122-3456   or  123 122 3456 (Illness/disease)
201 GRADE AS OF LAST EXPOSURE CA2A;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
  • LAST EDITED:  APR 20, 1998
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    This is the employee's grade as of the date of last exposure. (Illness/disease)
202 STEP AS OF DATE OF ILL. CA2A;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the employee's step as of date of last exposure. (Illness/disease)
203 EMPLOYEE STREET ADDRESS CA2A;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the employee's street address. (Illness/disease)
204 EMPLOYEE CITY ADDRESS CA2A;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the employee's city address. (Illness/disease)
205 EMPLOYEE STATE ADDRESS CA2A;6 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Enter the state in which the employee resides.
  • DESCRIPTION:  
    This is the employee's state address. (Illness/disease)
206 EMPLOYEE ZIP CODE CA2A;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAR 24, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the employee's Zip code. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
207 DEPENDENTS CA2A;8 SET
  • '1' FOR Wife, Husband;
  • '2' FOR Children under 18;
  • '3' FOR Other;
  • '4' FOR Wife, Husband + Children under 18;
  • '5' FOR Wife, Husband + Other;
  • '6' FOR Children under 18 + Other;
  • '7' FOR Wife, Husband + Children under 18 + Other;

  • LAST EDITED:  JUN 10, 1998
  • HELP-PROMPT:  Enter the types of dependents.
  • DESCRIPTION:  
    These are the employee's dependents. (Illness/disease)
208 EMPLOYEE OCCUPATION CA2A;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<2) X
  • LAST EDITED:  MAR 31, 2000
  • HELP-PROMPT:  Answer must be 2-30 characters in length.
  • DESCRIPTION:  
    This is a short description of the employee's occupation. (Illness/disease)
209 ILLNESS OCCURRED (LOCATION) CA2B;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the location where the employee worked when the disease or illness occurred. (Illness/disease)
210 ILLNESS OCCURRED ADDRESS CA2B;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 10, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the street address of the location where the illness occurred. (Illness/disease)
211 ILLNESS OCCURRED CITY CA2B;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 10, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city of the location where the illness occurred. (Illness/disease)
212 ILLNESS OCCURRED STATE CA2B;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  APR 10, 1998
  • HELP-PROMPT:  Enter the state where the illness occurred.
  • DESCRIPTION:  
    This is the location's state where the illness occurred. (Illness/disease)
213 ILLNESS OCCURRED ZIP CODE CA2B;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAR 20, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the location's zip code where the illness occurred. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
214 DATE FIRST AWARE OF ILLNESS CA2B;6 DATE

  • INPUT TRANSFORM:  S %DT="ETX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$$FMDIFF^XLFDT(X,$$GET1^DIQ(2260,DA,6,"I"),2)<0 D EN^DDIOL("DATE OF BIRTH cannot be after DATE FIRST AWARE OF ILLNESS","","!!?5") K X
  • LAST EDITED:  JUL 05, 2001
  • HELP-PROMPT:  Enter the date you first became aware of the disease/illness.
  • DESCRIPTION:  
    This is the date you (the employee) were first aware of the disease or illness. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
215 DATE FIRST REALIZED CAUSE CA2B;7 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,"CA2B")),U,6)\1>X D EN^DDIOL("DATE FIRST REALIZED CAUSE cannot be prior to DATE FIRST AWARE OF ILLNESS","","!!?5") K X
  • LAST EDITED:  JUN 25, 2001
  • HELP-PROMPT:  Enter the date you first realized the illness was caused by your work.
  • DESCRIPTION:  
    This is the date you (the employee) first realized the disease or illness was caused by your employment. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
216 RELATIONSHIP OF ILLNESS TO EMP CA2C;0 WORD-PROCESSING #2260.0216
217 NATURE OF DISEASE/ILLNESS CA2D;0 WORD-PROCESSING #2260.0217

  • DESCRIPTION:  
    This is a complete description of the disease or illness.  Specify the left or right side if applicable (e.g., rash on left leg; carpal tunnel syndrome, right wrist). (Illness/disease)
218 CLAIM NOT FILED CA2E;0 WORD-PROCESSING #2260.0218

  • DESCRIPTION:  If this notice and claim was not filed with the employing agency within 30 days after the date you first realized the disease or illness was caused or aggravated by your employment, this is your (the employee's)
    explanation of the reason for the delay. (Illness/disease)
219 EMPLOYEE STATEMENT DELAYED CA2F;0 WORD-PROCESSING #2260.0219

  • DESCRIPTION:  If a separate narrative statement containing the following information will not be submitted with this form, explain the reason for the delay:
    a) A detailed history of the disease or illness from the date it started.
    b) Complete details of the conditions of employment which are believed to be responsible for the disease or illness.
    c) A description of specific exposures to substances or stressful conditions causing the disease or illness, including locations where exposure or stress occurred, as well as, the number of hours per day and days of week
    of such exposure or stress.
    d) Identification of the part of the body affected. (If disability is due to a heart condition, give complete details of all activities for one week prior to the attack with particular attention to the final 24 hours of
    such period.)
    e) A statement as to whether the employee ever suffered a similar condition.  If so, provide full details of onset, history, and medical care received, along with names and addresses of physicians rendering treatment.
    (Illness/disease)
220 MEDICAL REPORT DELAYED CA2G;0 WORD-PROCESSING #2260.02

  • DESCRIPTION:  If medical reports containing the information listed here are not submitted with this form, explain the reason for the delay.
    a) Dates of examination or treatment.  b) History given to the physician by the employee.  c) Detailed description of the physician's findings.  d) Results of x-rays, laboratory tests, etc.  e) Diagnosis.  f) Clinical
    course of treatment.  g) Physician's opinion as to whether the disease or illness was caused or aggravated by the employment, along with an explanation of the basis for this opinion. (Medical reports that do not explain
    the basis for the physician's opinion are given very little weight in adjudicating the claim.) (Illness/disease)
221 NAME OF EMPLOYEE CA2ES;1 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 27, 1998
222 EMPLOYEE ELECT. SIGNATURE CA2ES;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Answer must be 6-20 characters in length.
  • DESCRIPTION:  
    This is your (the employee's) electronic signature.   (Illness/disease)
223 DATE OF EMPLOYEE SIGNATURE CA2ES;3 DATE

  • INPUT TRANSFORM:  S %DT="ET" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Enter the date you signed this notice/claim.
  • DESCRIPTION:  
    This is the date you (the employee) signed the notice/claim for compensation. (Illness/disease)
224 OCCUPATION CA2B;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Answer must be 3-20 characters in length.
225 OWCP USE NOI CODE CA2B;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  APR 08, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
226 TYPE CODE CA2B;10 POINTER TO ASISTS DOL TYPE OF INJURY CODES FILE (#2263) ASISTS DOL TYPE OF INJURY CODES(#2263)

  • LAST EDITED:  MAY 12, 2000
  • HELP-PROMPT:  Enter the Type Code that best describes the type of injury
  • DESCRIPTION:  
    This is the Type code for this claim.  The Type code stands for an action and is associated with the Source code which is an object or substance.  Both are used to summarize the incident. (Illness/disease)
227 SOURCE CODE CA2B;11 POINTER TO ASISTS DOL SOURCE OF INJURY CODES FILE (#2263.1) ASISTS DOL SOURCE OF INJURY CODES(#2263.1)

  • LAST EDITED:  MAY 12, 2000
  • HELP-PROMPT:  Enter the Source code for this claim
  • DESCRIPTION:  
    This is the Source code for this claim.  It is the object or substance that is used along with the Type code which is an action.  Both are used to summarize the incident. (Illness/disease)
230 AGENCY NAME CA2H;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the agency name of the station reporting the incident. (Illness/disease)
231 AGENCY ADDRESS CA2H;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the street address of the agency reporting the incident. (Illness/disease)
232 AGENCY CITY CA2H;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 01, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city address of the agency reporting the incident. (Illness/disease)
233 AGENCY STATE CA2H;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Enter the agency's state address.
  • DESCRIPTION:  
    This is the state address of the agency reporting the incident. (Illness/disease)
234 AGENCY ZIP CODE CA2H;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the Zip code of the agency reporting the incident. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
235 OWCP AGENCY CODE CA2H;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  This is a four digit (or four digit plus two letter) code used by the OWCP to identify the employing agency. The proper code may be obtained from your personnel or compensation office, or by contacting OWCP.
    (Illness/disease)
236 OSHA SITE CODE CA2H;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the Occupational Safety and Health Administration (OSHA) Site code for the reporting agency. (Illness/disease)
237 EMPLOYEE DUTY STATION CA2I;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the agency/site where the employee actually works. (Illness/disease)
238 DUTY STATION ADDRESS CA2I;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the address of the site where the employee works. (Illness/disease)
239 DUTY STATION CITY CA2I;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city where the employee works. (Illness/disease)
240 DUTY STATION STATE CA2I;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  APR 19, 2000
  • HELP-PROMPT:  Enter the state address of the site where the employee works.
  • DESCRIPTION:  
    This is the state address for where the employee works. (Illness/disease)
241 DUTY STATION ZIP CODE CA2I;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAY 05, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the Zip code for the employee's duty station. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
242 REGULAR HRS FROM TIME CA2I;6 FREE TEXT

  • INPUT TRANSFORM:  D TI^OOPSUTL3
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-7 characters in length.
  • DESCRIPTION:  
    This the time the employee generally starts work. (Illness/disease)
  • EXECUTABLE HELP:  D HLP^OOPSUTL3
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
243 REGULAR HRS TO TIME CA2I;7 FREE TEXT

  • INPUT TRANSFORM:  D TI^OOPSUTL3
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-7 characters in length.
  • DESCRIPTION:  
    This is the time the employee generally stops work. (Illness/disease)
  • EXECUTABLE HELP:  D HLP^OOPSUTL3
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
244 REGULAR WORK SCHEDULE CA2I;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>14!($L(X)<1) X
  • OUTPUT TRANSFORM:  D RWSOT^OOPSUTL2
  • LAST EDITED:  NOV 09, 2001
  • HELP-PROMPT:  Answer must be 1-14 characters in length.
  • DESCRIPTION:  
    At the time of the incident, this was the work schedule for the employee. Examples: For Monday through Friday, enter     2-6 For Sunday, Wednesday through Saturday, enter    1,4-7 or 1,4,5,6,7 (Illness/disease)
245 NAME OF PHYSICIAN CA2J;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the name of the physician first providing medical care for the employee. (Illness/disease)
246 PHYSICIAN ADDRESS CA2J;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the street address of the physician providing medical care. (Illness/disease)
247 PHYSICIAN CITY CA2J;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city address of the physician providing medical care. (Illness/disease)
248 PHYSICIAN STATE CA2J;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Enter the state address of the physician providing medical care.
  • DESCRIPTION:  
    This is the state address of the physician providing medical care. (Illness/disease)
249 PHYSICIAN ZIP CODE CA2J;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAR 24, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the Zip code for the physician's address. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
250 FIRST DATE MEDICAL CARE CA2J;6 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,"CA2B")),U,6)\1>X D EN^DDIOL("FIRST DATE MEDICAL CARE cannot be prior to DATE FIRST AWARE OF ILLNESS","","!!?5") K X
  • LAST EDITED:  JUN 25, 2001
  • HELP-PROMPT:  Enter the date the employee first received medical care.
  • DESCRIPTION:  
    This is the date the employee first received medical care for the condition. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
251 DISABLED FOR WORK CA2J;7 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  MAY 05, 1998
  • HELP-PROMPT:  Do medical reports show the employee is disabled for work?
  • DESCRIPTION:  
    This states whether or not (Yes or No) the medical reports show that the employee is disabled for work. (Illness/disease)
252 DATE NOTICE RECEIVED CA2J;8 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,"CA2B")),U,6)\1>X D EN^DDIOL("DATE NOTICE RECEIVED cannot be prior to DATE FIRST AWARE OF ILLNESS","","!!?5") K X
  • LAST EDITED:  JUN 25, 2001
  • HELP-PROMPT:  Enter the date you were first notified by the employee of the condition.
  • DESCRIPTION:  
    This is the date the employee first reported the condition to the supervisor. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
253 DATE/TIME WORK STOPPED CA2J;9 DATE

  • INPUT TRANSFORM:  S %DT="ETR",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),$P($G(^OOPS(2260,DA,"CA2B")),U,6)>X D EN^DDIOL("DATE/TIME WORK STOPPED cannot be prior to DATE FIRST AWARE OF ILLNESS","","!!?5") K X,%DT
  • LAST EDITED:  JUN 26, 2008
  • HELP-PROMPT:  Enter the date and time the employee stopped work.
  • DESCRIPTION:  
    This is the date and time the employee stopped work due to the condition. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
254 DATE/TIME PAY STOPPED CA2J;10 DATE

  • INPUT TRANSFORM:  S %DT="ETR",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),'$$DTVAL^OOPSUTL4(X,254,253) K X,%DT
  • LAST EDITED:  JUN 26, 2008
  • HELP-PROMPT:  Enter the date/time the employee's pay stopped.
  • DESCRIPTION:  
    This is the date and time the employee's pay stopped. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
255 DATE OF LAST EXPOSURE CA2J;11 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,"CA2B")),U,5)\1>X D EN^DDIOL("DATE OF LAST EXPOSURE cannot be prior to DATE FIRST AWARE OF ILLNESS","","!!?5") K X
  • LAST EDITED:  JUN 25, 2001
  • HELP-PROMPT:  Enter the date the employee was last exposed to conditions.
  • DESCRIPTION:  
    This is the date the employee was last exposed to conditions alleged to have caused the disease or illness. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
256 DATE/TIME RETURNED TO WORK CA2J;12 DATE

  • INPUT TRANSFORM:  S %DT="ERX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),'$$DTVAL^OOPSUTL4(X,256,253) K X,%DT
  • LAST EDITED:  JUN 26, 2008
  • HELP-PROMPT:  Enter the date/time the employee returned to work.
  • DESCRIPTION:  
    This is the date and time the employee returned to work. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
257 WORK DUTY CHANGED CA2K;0 WORD-PROCESSING #2260.0257

  • DESCRIPTION:  
    If the work assignment changed when the employee returned to work, this is a description of the employee's new duties. (Illness/disease)
258 INJURY CAUSED BY 3RD PARTY CA2L;1 SET
  • 'N' FOR No;
  • 'Y' FOR Yes;

  • LAST EDITED:  MAY 04, 1998
  • HELP-PROMPT:  Was the injury caused by a third party?
  • DESCRIPTION:  
    This states whether or not (Yes or No) the injury was caused by a third party. (Illness/disease)
259 3RD PARTY NAME CA2L;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the name of the third party causing the injury. (Illness/disease)
260 3RD PARTY ADDRESS CA2L;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    This is the street address of the third party causing the injury. (Illness/disease)
261 3RD PARTY CITY CA2L;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the city address of the third party causing the injury. (Illness/disease)
262 3RD PARTY STATE CA2L;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Enter the state address of the third party.
  • DESCRIPTION:  
    This is the state address of the third party causing the injury. (Illness/disease)
263 3RD PARTY ZIP CODE CA2L;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
  • LAST EDITED:  MAR 24, 2000
  • HELP-PROMPT:  Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
  • DESCRIPTION:  
    This is the Zip code address for the third party that caused the injury. (Illness/disease)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
264 SUPERVISOR EXCEPTION CA2L;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    If the supervisor has any exceptions to the information provided on the claim, they are stated here. (Illness/disease)
265 NAME OF SUPERVISOR CA2ES;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Enter the name of the supervisor completing this claim.
  • DESCRIPTION:  
    This is the name of the supervisor completing this notice/claim. (Illness/disease)
266 SUPERVISOR ELECT. SIGNATURE CA2ES;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  SEP 19, 2000
  • HELP-PROMPT:  Answer must be 6-20 characters in length.
  • DESCRIPTION:  
    This is the electronic signature of the supervisor. (Illness/disease)
267 SUPERVISOR DATE OF SIGNATURE CA2ES;6 DATE

  • INPUT TRANSFORM:  S %DT="ET" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 09, 1998
  • HELP-PROMPT:  Enter the date of the supervisor's signature.
  • DESCRIPTION:  
    This is the date the supervisor signs the notice/claim. (Illness/disease)
268 SUPERVISOR TITLE CA2H;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    This is the title of the supervisor signing the notice/claim. (Illness/disease)
269 SUPERVISOR PHONE CA2H;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<2) X
  • LAST EDITED:  APR 03, 2000
  • HELP-PROMPT:  Answer must be 2-15 characters in length.
  • DESCRIPTION:  
    This is the supervisor's office phone number. (Illness/disease)
269.1 SUPERVISOR PHONE EXT CA2H;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  SEP 10, 2001
  • HELP-PROMPT:  Answer must be 3-20 characters in length.
  • DESCRIPTION:  
    This field is available so that the Supervisor's office phone extension can be entered for a CA2. (Illness/disease)
270 PHYSICIAN TITLE CA2J;13 POINTER TO ASISTS DOL PROVIDER TITLE FILE (#2263.5) ASISTS DOL PROVIDER TITLE(#2263.5)

  • LAST EDITED:  MAR 22, 2000
  • HELP-PROMPT:  Enter the Title for the Physician
  • DESCRIPTION:  
    This is the appropriate title for the Physician who first saw the employee.  This is the field to be used for a CA2 claim. (Illness/disease)
303 VETERAN DUAL;1 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  FEB 26, 2004
  • HELP-PROMPT:  Enter 'Y'es if you are a veteran.
  • DESCRIPTION:  
    This is a Yes/No field that will indicate if the employee is also a veteran.
304 RECEIVE VETERAN BENEFITS DUAL;2 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  FEB 26, 2004
  • HELP-PROMPT:  Enter 'Y'es if you are receiving benefits for a military-connected disability.
  • DESCRIPTION:  
    This is a Yes/No field that will indicate whether the employee filing the CA-7 claim is receiving military benefits.
305 PENDING DISABILITY CLAIM DUAL;3 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  FEB 26, 2004
  • HELP-PROMPT:  Enter 'Y'es if you have a claim for a military-connected disability benefit pending.
  • DESCRIPTION:  
    This is a Yes/No field that will indicate whether the user has a claim pending review.
306 VBA NUMBER DUAL;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 26, 2004
  • HELP-PROMPT:  Enter your Veteran Benefits Administration (VBA) Number.
  • DESCRIPTION:  
    If the employee is a veteran, this field will contain their veteran's benefit number (VBA number).
307 MILITARY CLAIM BODY PARTS DUAL1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>120!($L(X)<3) X
  • LAST EDITED:  FEB 26, 2004
  • HELP-PROMPT:  Enter the body parts affected in your military claim.
  • DESCRIPTION:  
    This field will contain the parts of the employee's body that are involved in the claim.
308 CONDITION ACCEPTED IN CLAIM DUAL;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  FEB 26, 2004
  • HELP-PROMPT:  Enter condition you accepted in your military claim.
  • DESCRIPTION:  
    This field contains the condition that the employee accepted in the claim.
309 EMP NAME OF DUAL BENEFIT DUAL;7 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAR 01, 2004
  • HELP-PROMPT:  Enter the name of the person signing the dual benefits form.
  • DESCRIPTION:  
    This field will contain the pointer to the New Person file (#200) of the employee who signed the Dual Benefits Form.
310 EMP DUAL BENEFITS E-SIGNATURE DUAL;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  MAR 01, 2004
  • HELP-PROMPT:  Enter your electronic signature.
  • DESCRIPTION:  
    This field will contain the employee's encrypted electronic signature.
311 EMP DUAL BENEFIT SIGN DATE DUAL;9 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 01, 2004
  • HELP-PROMPT:  Enter the date you electronically signed the dual benefits form.
  • DESCRIPTION:  
    This field will contain the date that the employee electronically signed the Dual Benefit Form.
312 WC NAME FOR DUAL BENEFIT DUAL;10 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAR 01, 2004
  • HELP-PROMPT:  Enter the WC person signing the Dual Benefits claim.
  • DESCRIPTION:  
    This field contains the pointer to the New Person file (#200) for the Workers' Compensation specialist who electronically signed the Dual Benefits Form.
313 WC DUAL BENEFITS E-SIGNATURE DUAL;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<6) X
  • LAST EDITED:  MAR 01, 2004
  • HELP-PROMPT:  Enter your electronic signature.
  • DESCRIPTION:  
    This field contains the electronic signature for the Workers' Compensation Specialist's who signed the Dual Benefits Form.
314 WC DUAL BENEFITS SIGN DATE DUAL;12 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 01, 2004
  • HELP-PROMPT:  Enter the date the WC specialist signed the Dual Benefits form.
  • DESCRIPTION:  
    This field contains the date that the Workers' Compensation Specialist electronically signed the Dual Benefits Form.
330 OWCP SUFFIX CA;17 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  MAR 18, 2004
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    This field contains a 2 character extension for the OWCP Chargeback code.  It provides flexibility to the facility to further identify the station although the extension is not required.
331 OWCP CODE (6 CHARACTER) CA;18 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<4) X
  • LAST EDITED:  MAR 18, 2004
  • HELP-PROMPT:  Answer must be 4-6 characters in length.
  • DESCRIPTION:  This field combines the OWCP Chargeback code (table driven - ASISTS OWCP CHARGEBACK CODES File (#2263.6) with the 2 character, free text OWCP suffix for the purpose of transmitting the claim to the Department of Labor and
    running reports based on the further chargeback code designation.
332 AGENCY CONTROVERTS CODE CA1I;12 POINTER TO ASISTS REASON FOR CONTROVERT FILE (#2262.4) ASISTS REASON FOR CONTROVERT(#2262.4)

  • LAST EDITED:  APR 06, 2004
  • HELP-PROMPT:  Enter the code for the agency's reason for controverts.
  • DESCRIPTION:  
    This field contains the reason for controverts code that must be used when a case has a reason for controvert code entered.
333 DATE OF DEATH 2162A;23 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 19, 2004
  • HELP-PROMPT:  Enter the date the individual died.
  • DESCRIPTION:  
    If the incident resulted in a fatality, this field contains the date of the death.
334 ILLNESS TYPE 2162B;15 SET
  • '2' FOR Skin disorder;
  • '3' FOR Respiratory condition;
  • '4' FOR Poisoning;
  • '5' FOR Hearing loss;
  • '6' FOR All other illnesses;

  • LAST EDITED:  NOV 22, 2004
  • HELP-PROMPT:  Enter the Illness type category for this incident.
  • DESCRIPTION:  
    This is the category of the Illness or Disease for the incident and is used in completing the OSHA 300 Log.
335 TIME WORK BEGAN 0;22 FREE TEXT

  • INPUT TRANSFORM:  D TI^OOPSUTL3
  • LAST EDITED:  AUG 26, 2004
  • HELP-PROMPT:  Enter the time work began.
  • DESCRIPTION:  
    This is the time that the individual involved in the incident began work on the date of the incident.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
336 HIRE DATE 2162A;24 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  AUG 26, 2004
  • HELP-PROMPT:  Enter the date the individual began working.
  • DESCRIPTION:  
    This is the date (Service Computation Date) that the individual involved in the incident first began working.
337 PRIVACY CASE 2162D;10 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  AUG 27, 2004
  • HELP-PROMPT:  Enter Y if the case is a 'privacy' case.
  • DESCRIPTION:  
    This field indicates whether the incident should be treated as a 'privacy case'.  If so, restrictions on how the name is displayed are in place.
338 NON VA ER TREATMENT RCVD 2162D;11 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  AUG 27, 2004
  • HELP-PROMPT:  Enter Y if the person received treatment from a non-VA facility.
  • DESCRIPTION:  
    This Yes/No field is used to indicate whether the individual involved in the incident was treated at a non-VA emergency treatment center.
339 HOSPITALIZED AS INPATIENT 2162D;12 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  AUG 27, 2004
  • HELP-PROMPT:  Enter a Y if the person was hospitalized as an inpatient.
  • DESCRIPTION:  
    This Yes/No field is used to indicate if the individual involved in the incident was admitted to as an inpatient to a medical center.
340 TREATING PHYSICIAN 2162D;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  AUG 27, 2004
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This field contains the name of the physician who first treated the individual involved in the incident.
341 TREATED AT DIFFERENT FACILITY 2162L;1 SET
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  AUG 27, 2004
  • HELP-PROMPT:  Enter Y if the individual was treated at a different facility.
  • DESCRIPTION:  
    This Yes/No field is used to indicate whether the individual involved in the incident was treated at a non-VA treatment center.
342 OTHER FACILITY NAME 2162L;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • LAST EDITED:  NOV 22, 2004
  • HELP-PROMPT:  Answer must be 3-35 characters in length.
  • DESCRIPTION:  
    This is the name of the facility if the individual involved in the incident was treated at a different facility.
343 OTHER FACILITY STREET 2162L;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  NOV 22, 2004
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the street address of the facility if the individual involved in the incident was treated at a different facility.
344 OTHER FACILITY CITY 2162L;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<3) X
  • LAST EDITED:  NOV 22, 2004
  • HELP-PROMPT:  Answer must be 3-25 characters in length.
  • DESCRIPTION:  
    This is the city portion of the address of the facility if the individual involved in the incident was treated at a different facility.
345 OTHER FACILITY STATE 2162L;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  NOV 22, 2004
  • HELP-PROMPT:  Enter the State portion of the facility address.
  • DESCRIPTION:  
    This is the state portion of the address of the facility if the individual involved in the incident was treated at a different facility.
346 OTHER FACILITY ZIP 2162L;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5) X
  • LAST EDITED:  AUG 27, 2004
  • HELP-PROMPT:  Answer must be 5-10 characters in length.
  • DESCRIPTION:  
    This is the zip code portion of the address of the facility if the individual involved in the incident was treated at a different facility.
347 REASON FOR DISPUTE CODE CA1I;13 POINTER TO ASISTS REASON FOR DISPUTE CODES FILE (#2262.8) ASISTS REASON FOR DISPUTE CODES(#2262.8)

  • LAST EDITED:  APR 12, 2005
  • HELP-PROMPT:  Enter the reason the agency is disputing the CA-1 claim.
  • DESCRIPTION:  
    This is the high level reason that the agency is disputing the CA-1.
348 LOCATION DETAIL 2162B;16 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 28, 2005
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This field contains the optional location detail where the injury occurred.
349 LOSS OF CONSCIOUSNESS 2162L;7 SET
************************REQUIRED FIELD************************
  • 'Y' FOR Yes;
  • 'N' FOR No;

  • LAST EDITED:  MAY 06, 2005
  • HELP-PROMPT:  Indicate whether the individual lost consciousness as a result of the incident.
  • DESCRIPTION:  
    This field indicates whether the individual lost consciousness as a result of the incident or not.
350 PRESCRIPTION STRGTH MEDS GIVEN 2162L;8 SET
************************REQUIRED FIELD************************
  • 'Y' FOR Yes;
  • 'N' FOR No;
  • 'U' FOR Unknown;

  • LAST EDITED:  MAY 06, 2005
  • HELP-PROMPT:  Indicate whether prescription strength medications were ordered/given.
  • DESCRIPTION:  
    This field indicates if the individual involved in the incident was given or ordered prescription strength medication.
351 NON-SCRIPT MEDS AT SCRIPT DOSE 2162L;9 SET
************************REQUIRED FIELD************************
  • 'Y' FOR Yes;
  • 'N' FOR No;
  • 'U' FOR Unknown;

  • LAST EDITED:  MAY 06, 2005
  • HELP-PROMPT:  Indicate whether the individual was ordered/given non-prescription medication at prescription strength.
  • DESCRIPTION:  
    This field will indicate whether the individual involved in the incident was given or ordered non-prescription medication as prescription strength.  (such as Motrin).
352 INITIAL RETURN TO WORK STATUS 2162L;10 SET
  • 'F' FOR FULL DUTY;
  • 'A' FOR DAYS AWAY WORK;
  • 'J' FOR Job Transfer/Restriction;

  • LAST EDITED:  AUG 30, 2005
  • HELP-PROMPT:  Indicate the individual's initial return to work assessment.
  • DESCRIPTION:  
    This field will indicate the initial return to work status of the individual involved in the incident.  This work status may change.
353 DUAL REFUSED DUAL;5 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  MAY 11, 2005
  • HELP-PROMPT:  EMPLOYEE WILL ANSWER YES OR NO TO REFUSAL TO ANSWER DUAL BENEFITS QUESTION
354 WEATHER FACTOR 2162M;1 POINTER TO ASISTS INCIDENT WEATHER FACTORS FILE (#2261.21) ASISTS INCIDENT WEATHER FACTORS(#2261.21)

  • LAST EDITED:  MAR 05, 2008
  • HELP-PROMPT:  Enter the weather condition most affecting the cause of incident.
  • DESCRIPTION:  
    This field contains the weather condition at the time of the incident.
355 SOURCE OF INCIDENT 2162M;2 POINTER TO ASISTS INCIDENT SOURCE FILE (#2261.22) ASISTS INCIDENT SOURCE(#2261.22)

  • LAST EDITED:  MAR 05, 2008
  • HELP-PROMPT:  Enter the most probably source of the cause of the incident.
  • DESCRIPTION:  
    This field is the most relevant source of the Incident.
356 CAUSE OF INCIDENT 2162M;3 SET
  • 'AA' FOR Equipment or Environment;
  • 'BA' FOR Person;
  • 'CA' FOR Nature;
  • 'FA' FOR Cause Unknown;

  • LAST EDITED:  MAR 05, 2008
  • HELP-PROMPT:  Enter the primary cause of the accident
  • DESCRIPTION:  
    This is the most probable cause of the accident
357 ADDITIONAL CAUSE OF INCIDENT 2162M;4 SET
  • 'AA' FOR Equipment or Environment;
  • 'BA' FOR Person;
  • 'CA' FOR Nature;
  • 'ZZ' FOR No additional Cause;

  • LAST EDITED:  MAR 05, 2008
  • HELP-PROMPT:  Enter an additional cause of the incident.
  • DESCRIPTION:  
    This field will contain the secondary cause of the incident.
358 PREVENTIVE METHOD 2162M;5 POINTER TO ASISTS PREVENTION METHODS FILE (#2261.24) ASISTS PREVENTION METHODS(#2261.24)

  • LAST EDITED:  MAR 05, 2008
  • HELP-PROMPT:  Enter the method that would have best prevented the incident.
  • DESCRIPTION:  
    This field contains the most likely way to have prevented the incident.
359 STATUS OF CORRECTIVE ACTION 2162M;6 SET
  • 'A' FOR Taken;
  • 'B' FOR Requested and Anticipated;
  • 'C' FOR Requested;
  • 'D' FOR None;

  • LAST EDITED:  MAR 05, 2008
  • HELP-PROMPT:  Enter the status of any corrective action recommended.
  • DESCRIPTION:  
    This field contains the status of any recommended corrective action to be taken.
360 SEVERITY OF INJURY 2162M;7 SET
  • '1' FOR No Treatment Required;
  • '2' FOR First Aid Only;
  • '3' FOR Medical Treatment;
  • '4' FOR Disabling Injury;
  • '5' FOR Fatality;

  • LAST EDITED:  MAR 06, 2008
  • HELP-PROMPT:  Enter the severity of the injury.
  • DESCRIPTION:  
    This field indicates how devastating the injury was to the individual.
384 OSHA 300 COLUMN F 2162R;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<3) X
  • LAST EDITED:  JUN 01, 2009
  • HELP-PROMPT:  Answer must be 3-100 characters in length.
  • DESCRIPTION:  
    This field will contain a brief description of the incident that will be used to populate column F of the OSHA 300 Log report.
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