The Stanwood-Camano School District is dedicated to providing a safe and healthful work environment for all employees and strives for prevention of work related injuries. Should a work injury occur, the District has developed a work injury process that includes a team approach to assist employees with prompt, quality medical treatment and a safe and successful return to work.
To enable the District to adequately support an employee’s safe return to work after a medical-related leave, the returning employee will be required to submit a doctor’s note or Activity Prescriptions Form (APF) which outlines the injured worker’s restrictions or a release to full duty without restrictions. The doctor’s note or APF is to be submitted to the HR Return to Work Coordinator prior to return work in order to allow review, any needed approvals and communication of necessary information to the employee’s supervisor.
Forms
Please see the following required forms for claim processing:
Activity Prescription Form (APF)
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Puget Sound Workers' Compensation Trust considers the effective use of the Activity Prescription Form (APF) as a best practice in occupational medicine. The form communicates an injured worker's physical restrictions and ability to work as well as the provider's treatment plans. In addition, workers' time-loss benefits depend on the APF and your chart notes.
Provider's Initial Report (PIR)
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A Provider’s Initial Report (PIR) is completed by the Provider and the Employee and establishes a claim. When the completed PIR is received by the HR/Return to Work Coordinator or Puget Sound Workers' Trust, the PIR will be matched with your claim number. If you have not yet filed a claim please call the Nurse Triage line at 833-WCT-NURS (833-928-6877) or select HERE to complete the online claim process.
Time Loss Election Form
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Employees who are injured on the job and will be off work for more than three days following the date of injury, may be eligible to supplement their time-loss benefits with sick, personal, vacation, comp or another similar leave accrual benefit. If an employee is found eligible for time loss payments, the employee has a choice on how they wish to supplement the time loss payments. The required Time Loss Election Form should be completed at the time of filing a claim. Please print this form and see our Employee-Work Injury and Compensation FAQ information below for a further definitions of supplemental options.
Employee-Work Injury and Compensation FAQs
Q. If I want to reserve my paid leave accrual while off work, do I have this option?
A. Yes, the only time an employee has an option in reserving sick leave during an illness or recovery, is during a work injury recovery. All employees who wish to reserve leave accrual, should complete a time loss election form and choose option #1. This will stop your sick leave and revert to unpaid time while you continue your recovery.
Q. Do I have the option to use part of my leave accrual and receive time loss payments?
A. Yes, if your claim is approved and you receive time loss payments from Puget Sound Workers' Trust, you may choose to participate in our sick leave buy back process. The District will receive a copy of your time loss payments and calculate a value that will determine the amount of sick leave you may buy back. We will then deduct this amount from your next available paycheck and reimburse your sick leave balance. All employees who wish to use this option, should complete a time loss election form and choose option #2.
Q. Do I have the option to use all of my leave accrual while receiving time loss payments?
A. Yes, employees may elect to use all leave accrual such as sick leave, personal leave and/or vacation while off work. In addition to your paycheck from the District you may also receive time loss payments from Puget Sound Workers' Trust. The District will apply all available leave to missed days from work, until all leave accrual is exhausted. All employees who wish to use their leave accrual AND receive time loss payments should complete the time loss election form and choose option #3.
Q. If Puget Sound Workers' Trust requires me to attend an Independent Medical Exam, am I required to use my sick leave?
A. Yes, if you have been asked to attend an Independent Medical Exam by Puget Sound Workers' Trust, please notify the HR/RTW Coordinator with notification of this appointment.
Q. If I am cleared by my doctor to return to work, but I have work restrictions, what should I do?
A. If you have been cleared by your doctor to return to work with restrictions, you should be in immediate contact with the HR/RTW Coordinator to discuss your return to work options.
More information
Please also visit the Worker Compensation Claims – WCT for additional questions and answers regarding work injury claims.