CITY OF WALTHAM
WORKERS’ COMPENSATION
INFORMATIONAL BOOKLET AND FORMS
“The Best Way To Treat An Injury Is
To Prevent It”
CITY OF WALTHAM
WC Info Booklet and Forms 9-28-2011
Workers’ Compensation Informational Booklet and Forms
Table of Contents
Page(s)
Introduction
3
Injury Reporting Requirements
5
Employer’s First Report of Injury
6-7
Employee’s Notice of Injury
8
Retirement Board Form
9
Supervisor’s Accident Investigation Report
10
Witness Report(s), if applicable
11
Medical Records Release
12
Guidelines for Using Mount Auburn Occupation Health
13
Guidelines for Deciding the Most Appropriate
Option for Care
14
WC Info Booklet and Forms
2
CITY OF WALTHAM
WORKERS’ COMPENSATION INFORMATIONAL BOOKLET AND FORMS
INTRODUCTION
The purpose of this manual is to establish consistent procedures for all employees of the City of Waltham to
enable the City to respond promptly and effectively to any work related injury and/or illness of its employees
while complying with the obligations of Chapter 152 of the Massachusetts General Laws, “The Workers’
Compensation Act.”
MANAGING INJURIES
In order to provide a prompt and effective response to any work related injury or illness, it is imperative that
personnel be instructed to manage the injury and not to react to it. Managing the injury means being proactive
and involves taking action both before and after the occurrence of an injury or illness. The difference is in the
concept of accident investigation and prevention versus just reporting the accident and watching our injury costs
grow and grow.
1.
Medical care
Once an injury or illness has occurred, the City’s primary objective is to promptly provide the
injured or ill employee with quality first aid and/or medical care. Employees must report all
work related injuries and illnesses to their supervisor, no matter how minor or insignificant they
may appear. When medical care is required, employees will be referred to Mount Auburn
Hospital Occupation Health, 725 Concord Avenue, Suite 5100, Cambridge, MA 02138, Monday
– Friday 8:00 a.m. – 4:30 p.m. No appointment is necessary, but if possible please call first 617354-0546. If it is an emergency between the hours of 4:30 pm and 8:00 am please report to
Mount Auburn Hospital Emergency Room, 330 Mount Auburn Street, Cambridge, MA, if
possible please call first 617-499-5025 or report to the closest emergency room.
SCHOOL DEPARTMENT – All work related injuries should be evaluated by the School
Nurse and reported to the building Principal or Department Head. In the event that there is no
nurse on duty, employees requiring medical care will be referred to Mount Auburn Hospital
Occupation Health, 725 Concord Avenue, Suite 5100, Cambridge, MA 02138, Monday – Friday
8:00 a.m. – 4:30 p.m. No appointment is necessary, but if possible please call first 617-354-0546.
If it is an emergency between the hours of 4:30 pm and 8:00 am please report to Mount Auburn
Hospital Emergency Room, 330 Mount Auburn Street, Cambridge, MA, if possible please call
first 617-499-5025 or report to the closest emergency room.
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2.
Communication
Within your department establish a written set of step-by-step instructions for the
communication of all work related injuries or illnesses. These instructions should be applicable
to both minor and major injuries or illnesses and should provide for the notification of the
Personnel Department. A copy of the instructions must be provided to the Personnel
Department.
3.
Accident Investigation
Designate a person to be responsible for investigating the injury or illness as well as collecting
and completing all necessary forms and reports.
4.
Prevention
Aim to reduce accident frequency by developing and enforcing safe work procedures within your
department. As the old saying goes, “An ounce of prevention is worth a pound of cure.”
ELIGIBILITY
An injured or ill employee becomes eligible for Workers’ Compensation benefits when he/she sustains a work
related injury or illness and is incapacitated from earning wages for five or more calendar days (the days do not
have to be consecutive).
If the employee is incapacitated for twenty days or less, workers’ compensation benefits shall only be paid from
the sixth day. Days one through five shall be paid from the employee’s accrued sick leave benefits unless the
employee has insufficient sick leave benefits or specifically informs the City that his/her sick leave benefits
shall not be used.
If, however, the incapacitation extends for a period of twenty-one days or more, compensation shall be paid
from the first day.
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INJURY REPORTING REQUIREMENTS
The following original completed forms must be submitted to the Personnel Department within 24 hours of the
injury or illness (all forms must be legible and in ink):
Form
Responsible for Completing
Employer’s First Report of Injury
Personnel
Employee’s Notice of Injury
Employee
City of Waltham Retirement System Notice of Injury
Employee
Supervisor’s Accident Investigation Report
Supervisor
Witness Report(s), if applicable
All witnesses to the injury
Medical Records Release
Employee
It is the responsibility of every Department Head and School Principal to ensure that all required information is
provided to the Personnel Department within the specified time. Delays in providing this information are
unacceptable and contribute to our inability to provide prompt and effective services to injured employees, and
could result in substantial fines being levied against the City by the Industrial Accident Board. We anticipate
your full cooperation.
If there are any questions or comments, or if you require additional forms or information, the Personnel
Department can be reached at 781-314-3355 or e-mail address is kmurphy@city.waltham.ma.us
Mailed correspondence should be addressed as follows:
Personnel Department
City of Waltham
119 School Street
Waltham, MA 02451
781-314-3358 (FAX)
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FORM 101
The Commonwealth of Massachusetts
DIA USE ONLY
Department of Industrial Accidents – Department 101
600 Washington Street – 7th Floor, Boston, Massachusetts 02111
Info. Line 800-323-3249 ext. 470 in Mass. Outside Mass. - 617-727-4900 ext. 470
http://www.mass.gov/dia
EMPLOYER’S FIRST REPORT OF INJURY
OR FATALITY
THIS FORM MUST BE FILED BY THE EMPLOYER IN THE EVENT OF AN INJURY THAT RESULTS IN DEATH
OR FIVE OR MORE CALENDAR DAYS OF TOTAL OR PARTIAL INCAPACITY FROM EARNING WAGES.
INSTRUCTIONS AND CODES ON THE REVERSE SIDE - Please Print legibly or type - Unreadable forms will be returned.
E
M
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1. Employee’s Name (Last, First, MI):
2. Home Telephone Number:
3. Social Security
Number*:
4. Sex: M F
5. Home Address (No., Street, City, State & Zip Code):
6. Marital Status: M S
7. No. of Dependents:
8. Date of Hire (mm/dd/yyyy):
10. Average Weekly Wage: Estimated Actual$
9. Date of Birth (mm/dd/yyyy):
11. Employer’s Name:
12. Federal Tax I.D. Number:
13. Employer’s Address (No., Street, City, State & Zip Code):
14. Employer’s Telephone Number:
15. Industry Code (See Reverse Side):
16. Workers’ Compensation Insurance Carrier and Tel. No. (NOT LOCAL AGENT/ADMINISTRATOR):
17. W.C. Policy Number:
18. Self-Insured? Yes No If Yes, Self-Insurer Number:
19. Business Type : Service Wholesale Mfg. Retail
Other ________________________
20. DATE OF INJURY (mm/dd/yyyy):
I
N
J
U
R
Y
I
N
F
O
R
M
A
T
I
O
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21. Was Employee Injured on Employer’s Premises? Yes No
22. Location of Injury if not on Employer’s Premises:
23. FIRST day of Total or Partial Incapacity to Earn Wages
(mm/dd/yyyy):
24. FIFTH day of Total or Partial Incapacity to Earn Wages
(mm/dd/yyyy):
25. If Employee has Died, Date of Death (mm/dd/yyyy):
26. Source of Injury (Chemicals, Machinery, etc.):
27. Briefly Describe How Injury/Exposure Occurred and Body Part(s) involved:
28. Person to Whom Injury was Reported (list position):
29. Date Reported (mm/dd/yyyy):
30. Date Reported as work related
(mm/dd/yyyy):
31. Injury Code(s) a. to body part b. to body part c. to body part Body Part
Code(s) a. b. c.
32. Witness(es) to Injury - Give Full Name(s), if none state as such:
33. Has Employee Returned to Work? Yes No
34. Date Employee Returned to Work(mm/dd/yyyy):
35. Employee’s Regular Occupation:
36. Has Employee Returned to Regular Occupation: Yes No
37. EMPLOYER’S Name (SEE INSTRUCTIONS ON REVERSE SIDE):
38. Title:
39. EMPLOYER’S Signature (SEE INSTRUCTIONS ON REVERSE
SIDE):
40. Date Prepared (mm/dd/yyyy):
*Disclosure of Social Security Number is Voluntary. It will aid in the processing of your report. Form 101 -Revised 8/2001 - Reproduce as needed.
THIS FORM DOES NOT CONSTITUTE AN EMPLOYEE’S CLAIM FOR BENEFITS UNDER WORKERS’ COMPENSATION.
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EMPLOYER’S FIRST REPORT OF INJURY OR FATALITY
FILING INSTRUCTIONS
1
2
3
4
WHEN TO FILE: File this form within 7 calendar days, not including Sundays and legal holidays, of receipt of notice of any injury alleged to
have arisen out of and in the course of employment, which totally or partially incapacitates an employee for a period of 5 or more calendar days
from earning wages. This form is not an admission of liability, but must be filed even though the Employer may believe that the Employee is not
injured, or that the Employee is not entitled to benefits under M.G.L. Chapter 152.
WHERE TO FILE: This form should be mailed to the Department of Industrial Accidents at the address shown on the front of the form. Copies
must also be provided to the Employee and to the Employer’s Workers’ Compensation insurer.
PENALTIES: Failure to report injuries on this form may result in a fine of $100.00 in accordance with M.G.L. Chapter 152, Section 6.
EMPLOYER’S NAME & SIGNATURE IN BOXES 37 & 39: This form must be filed by the employer or an authorized agent/representative of
the employer.
INDUSTRY CODES
Agriculture, Forestry and Fishing 01
Agriculture Production - Crops 02
Agriculture Production - Livestock 07
Agricultural Services 08 Forestry 09 Fishing,
Hunting and Trapping Mining 10 Metal
Mining 12 Coal Mining 13 Oil and Natural
Gas 14 Nonmetallic Minerals, Except Fuels
Construction 15 General Building
Contractors 16 Heavy Construction, Ex.
Building 17 Special Trade Contractors
Manufacturing 20 Food and Kindred
Products 21 Tobacco Products 22 Textile
Mill Products 23 Apparel and Other Textile
Products 24 Lumber and Wood Products 25
Furniture and Fixtures 26 Paper and Allied
Products 27 Printing and Publishing
28 Chemicals and Allied Products 29 Petroleum and Coal Products 30 Rubber and Misc. Plastic
Products 31 Leather and Leather Products 32 Stone, Clay and Glass Products 33 Primary Metal
Industries 34 Fabricated Metal Products 35 Industrial Machinery and Equipment 36 Electronic and
Other Electrical Equipment 37 Transportation Equipment 38 Instruments and Related Products 39
Miscellaneous Manufacturing Industries Transportation and Public Utilities 40 Railroad
Transportation 41 Local and Interurban Passenger Transit 42 Trucking and Warehousing 43 U.S.
Postal Service 44 Water Transportation 45 Transportation by Air 46 Pipelines, Except Natural Gas 47
Transportation Services 48 Communications 49 Electric, Gas and Sanitary Services Wholesale Trade
50 Wholesale Trade - Durable Goods 51 Wholesale Trade - Non-durable Goods Retail Trade 52
Building Materials and Garden Supplies 53 General Merchandizing 54 Food Stores 55 Automotive
Dealers and Service Stations 56 Apparel and Accessory Stores 57 Furniture and Home Furnishing
Stores 58 Eating and Drinking Establishments 59 Miscellaneous Retail Finance, Insurance and Real
Estate 60 Depository Institutions 61 Non-depository Institutions 62 Security and Commodity Brokers
63 Insurance Carriers 64 Insurance Agents, Brokers and Service 65 Real Estate 67 Holding and Other
Investment Officers Services 70 Hotels and Other Lodging Places 72 Personal Services 73 Business
Services 75 Auto Repair Services and Parking 76 Miscellaneous Repair Services
78 Motion Pictures 79 Amusements and Recreation
Services 80 Health Services 81 Legal Services 82
Educational Services 83 Social Services 84
Museums, Botanical, Zoological Gardens 86
Membership Organizations 87 Engineering and
Management Services 88 Private Households 89
Services, NEC Public Administration 91 Executive,
Legislative and Garden 92 Justice, Public Order,
and Safety 93 Finance, Taxation, and Monetary
Benefits 94 Administration of Human Services 95
Environmental Quality and Housing 96
Administration of Economic Program 97 National
Security and International Affairs Non-classifiable
Establishments 99 Non-classifiable Establishments
NATURE OF INJURY OR ILLNESS CODES
100 Amputation or Erucloation 110 Asphyxia
or Strangulation Etc. 120 Burns (Heat) 130
Burns (Chemical) 140 Concussion 160
Contusion, Crushing, Bruise 170 Cut,
Laceration, Puncture 190 Dislocation 200
Electric Shock, Electrocution 210 Fracture
250 Hernia, Rupture 300 Scratches,
Abrasions 310 Sprains, Strains 400 Multiple
Injuries 900 No Injury 950 Damage to
Prosthetic Devices 995 No Other Injury,
NEC** 999 Non-classifiable Infective or
Parasitic Disease 150 Infective or Parasitic
Disease, UNS* 151 Amebiasis 152 Anthrax
153 Brucellosis 154 Conjunctivitis and
Opthalmia 156 Tetanus
157 Tuberculosis 159 Other Infective or Parasitic Diseases Dermatitis 180 Dermatitis, UNS* 183
Primary Infections of the Skin 184 Other Skin Conditions 185 Dermatitis, Allergenic or Contact 189
Skin Condition, NEC** Poisoning Systemic 270 Poisoning, Systemic, UNS* 271 Due to Toxic
Materials other than Lead 272 Diseases of the Blood and Blood Forming Organs 273 Upper
Respiratory Conditions 274 Influenza, Pneumonia, Etc. 276 Other Diseases of the Gastro-Intestinal
Tract 278 Effects of Lead 279 Other Toxic Effects of One System Only Respiratory Systems,
Conditions of 570 Respiratory Systems, Conditions of 571 Upper Respiratory 572 Asthma, Influenza,
Pneumonia Pneumoconiosis 280 Pneumoconiosis 281 Aluminosis 282 Anthracosis 283 Asbestosis
284 Byssinosis 285 Siderosis 286 Silicosis 287 Other Pneumoconioses 289 Pneumoconiosis and
Tuberculosis Nervous System, Conditions of 560 Nervous System, Conditions of - NEC** 561
Diseases of the Central Nervous System 562 Diseases of the Nerves and Peripheral Ganglia
Neoplasm Tumor 550 Neoplasm Tumor, UNS* 551 Malignant 552 Benign Radiation Effects 290
Radiation Effects, UNS* 291 Non-Ionizing Radiation 292 Microwaves 293 Ionizing Radiation - XRay 294 Ionizing Radiation - Isotopes 295 Welder’s Flash
Other 265 Carpal Tunnel Syndrome 510
Cardiovascular and Other Conditions of the
Circulatory System 520 Complications Peculiar to
Medical Care 500 Effects of Changes in
Atmospheric Pressure 240 Effects of
Environmental Heat 220 Effects of Exposure to
Low Temperature 530 Eye, other Diseases of the
Eye 230 Hearing Loss or Impairment 991 Heart
Condition ,Excludes Heart Attack 320 Hemorrhoids
330 Hepatitis, Serum and Infective 275 Hepatitis,
Toxic 260 Inflammation of Joints, Etc. 540 Mental
Disorders 900 No Illness 999 Non-classifiable 990
Occupational Disease, NEC** 580 Symptoms and
Ill-defined Conditions
BODY PART AFFECTED CODES
Head 100 Head, UNS* 110 Brain 120 Ear(s),
UNS* 121 Ear(s), External 124 Ear(s),
Internal 130 Eye(s), UNS* 140 Face, UNS*
141 Jaw, Chin 144 Mouth and Throat (vocal
chords, larynx) 146 Nose 148 Face, Multiple
Parts 149 Face, NEC** 150 Scalp
*UNS - UNSPECIFIED
WC Info Booklet and Forms
160 Skull 198 Head Multiple 200 Neck & Cervical Vertebrae UPPER EXTREMITIES 300 Upper
Extremities, NEC** 310 Arm(s), UNS* 311 Upper Arm 313 Elbow(s) 315 Forearm(s) 318 Arm(s),
Multiple 319 Arm(s), NEC** 320 Wrist(s) 330 Hand(s), Not Wrists or Fingers 340 Finger(s) 398
Upper Extremities, Multiple 400 Trunk, UNS* 410 Abdomen, Internal Organs, Inguinal Hernia 420
Back 430 Chest, Ribs, Breastbone, Internal Organs 440 Hip(s)..,Pelvis, Organs and Buttocks 450
Shoulder(s) 498 Trunk, Multiple LOWER EXTREMITIES 500 Lower Extremities 510 Leg(s), UNS*
513 Knee(s) 515 Lower Leg(s) 518 Leg(s),
Multiple 519 Leg(s), NEC** 520 Ankle(s) 530
Foot or Feet, Not Ankle 540 Toe(s) 598 Lower
Extremities, Multiple 700 MULTIPLE PARTS
Applies when more than one major body part as
been effected such as an arm and a leg 999 NONCLASSIFIABLE - Insufficient infor
mation to
identify part of body effected. Includes damage to
prosthetic devises.
**NEC - NOT ELSEWHERE LASSIFIED
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CITY OF WALTHAM
EMPLOYEE’S NOTICE OF INJURY
(PLEASE ANSWER ALL QUESTIONS ACCURATELY AND COMPLETELY)
NOTE:
Each time an employee is injured or suffers a recurrence of a previous job related injury;
this form must be completed by the employee and submitted to his/her Supervisor or
Department Head and the Personnel Department immediately.
Name of Injured Employee
__Telephone Number_____________
Home Address
Zip Code
______
Date of Birth
Marital Status
No. of Dependents
Department
Position
Date of Hire
Date of Accident
______
Time of Accident
______
_______
_______
Location of Accident
______
Name(s) of any Witness (es)
_______
Description of Accident:
What were you doing at the time of the accident?
_________
_________
________
Describe how the accident occurred
______
______
______
Describe any injuries you sustained
_______
_________
______
Detail all medical services received
______
______
Could the accident have been avoided? (Yes/No/Explain)
______
______
Equipment, Tools & Materials Involved
_______
Weather conditions leading to or causing the incident
______
Have you returned to work?
______
Date you returned to work
Please list any days absent due to the injury
Signature
_______
Date
_______
(Injured Employee)
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NOTE: This form should be filed with the Retirement Board “By the member or in his behalf WITHIN 90 DAYS” from the date of
accident or hazard undergone after July 1, 1937.
CITY OF WALTHAM RETIREMENT SYSTEM
NOTICE OF INJURY
This is to notify you that
received injuries incurred through
(Full name of employee)
accident in the line of duty or due to a hazard which occurred in like line of duty while employed in the service at
the
on
(Name of Dept. or Institution)
and whose home address is
(Month)
(Day)
(Street and Number)
(Year)
(City or Town)
(Write the word)
If married
SINGLE
1.
1a. Husband of
MARRIED
2.
(Give maiden name of wife in full)
Date of Birth
2a. Date of entry in service
(Month)
3.
(Day)
(Year)
The cause of injury was
(Describe cause of injury)
(If statement requires more space use other side of this blank and write in this space –SEE OTHER SIDE)
(Important: Sign your name after what you write on other side)
4.
The nature of injury is as follows
Describe injury with such exactness as possible
IMPORTANT—Nos. 5, 6, and 7 must not be left blank. Some statement must be made. EXAMPLE: Not taken to a hospital; No witness, etc.
5.
NAME AND ADDRESS OF DOCTOR WHO ATTENDED EMPLOYEE
(Full Name)
Address
(Street and number)
6.
(City)
(State)
NAME AND ADDRESS OF HOSPITAL
(Full Name)
Address
(Street and number)
7.
NAME AND ADDRESS OF WITNESS
(City)
(State)
(If possible give two names of eyewitnesses.)
1. Name
Address No.
City or town
State
2. Name
Address No.
City or town
State
Street
(Zip)
Street
(Zip)
IMPORTANT—Nos. 5, 6, and 7 must not be left blank. Some statement must be made. EXAMPLE: Not taken to a hospital; No witness, etc.
Signature
(Of employee or other informant)
(If other informant, relationship or title of superior officer)
IMPORTANT
The Law requires that injuries incurred in line of duty AFTER JULY 1, 1938, shall be reported to the RETIREMENT BOARD WITHIN NINETY DAYS to
give unlimited time coverage for (1) retirement based upon accidental injuries or (2) an accidental death benefit.
IF the NOTICE OF INJURY is not so filed WITHIN NINETY DAYS an APPLICATION for (1) accidental disability retirement, or (2) for a death benefit
based upon accidental injuries incurred MORE THAN TWO YEARS PRIOR to the date of application, IS VOID.
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CITY OF WALTHAM
SUPERVISOR’S ACCIDENT INVESTIGATION REPORT
(PLEASE ANSWER ALL QUESTIONS ACCURATELY AND COMPLETELY)
Name of Injured Employee
Date of This Report
Department
Position
Date of Accident
Time of Accident
Date of Hire
______
___________
______
Location of Accident
____________
Name(s) of any Witness
____________
When the injury was first reported?
______________________________
If more than 24 hours after accident occurred, explain reason for the delay.
_______
_______
______
______
Nature of the injury (i.e., left/right ankle, wrist, shoulder, etc.)
_______
_______
______
______
Describe how the accident happened. (Detail employee’s actions as well as all relevant circumstances)
______
____________
Was the employee using proper safety equipment and observing all relevant safety
precautions/procedures? (Yes/No/Explain)
______
Department Head Comments
__________________
______
Signature
Signature
Supervisor
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______
Department Head
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CITY OF WALTHAM
WITNESS REPORT
(PLEASE ANSWER ALL QUESTIONS ACCURATELY AND COMPLETELY)
NOTE:
A separate form is to be completed by ALL witnesses to any job related accident involving
a City of Waltham employee.
Witness’ Name
Date
______
Department
Position
______
Home Address
City
Name of Injured Employee
Date of Injury
Zip Code
__________
______
Time of Injury
Description of the Accident:
Describe what you saw and heard at the time of the accident.
___________
_________
__________
__________
__________
What did the employee say at the time he/she was injured?
__________
__________
_________
________
__________
Did the employee continue to work after the accident?
_________
______
______
_________
__________
Could the accident have been avoided? (Yes/No/Explain)
______
______
_______
______
Signature
_____
Date
Witness
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Authorization to Use and Disclose Protected Health Information for
Purposes Other Than Payment, Treatment and Healthcare Operations
Patient Name:
Home Address:
Tel. No.
Date of Birth:
RECORDS/INFORMATION TO BE DISCLOSED:
All medical records or information of any kind created and/or maintained by your office with respect to the
above-named patient.
RECIPIENT: You may disclose this information by mailing the records to:
Kristin Murphy
City of Waltham Personnel Director
119 School Street,
Waltham, MA 02451.
TERM:
This Authorization will remain in effect for one (1) year from the date of execution.
By my signature below, I hereby authorize you to use and/or disclose to the recipient my health information for
the term of this Authorization notwithstanding and/or subject to the following:
I understand that once you disclose my health information to the recipient, you cannot guarantee that the
recipient will not re-disclose my health information to a third party. Any such third party may not be required to
abide by this Authorization or applicable federal and state law governing the use and disclosure of my health
information.
I understand that I may refuse to sign or may revoke (at any time) this Authorization for any reason and that
such refusal or revocation will not affect the commencement, continuation or quality of your treatment of me;
except, however, if my treatment by you is for the sole purpose of creating health information for disclosure to
the recipient identified in this Authorization, in which case you may refuse to treat me if I do not sign this
Authorization.
I understand that this Authorization will remain in effect until the term of this Authorization expires or I provide
a written notice of revocation to you at your usual business address. The revocation will be effective
immediately upon your receipt of my written notice, except that the revocation will not have any effect on any
action taken by you in reliance on this Authorization before you received my written notice of revocation.
I have read and understand the terms of this Authorization and I have had an opportunity to ask questions about
the use and disclosure of my health information. By my signature below, I hereby, knowingly and voluntarily,
authorize you to use and/or disclose my health information in the manner described above.
A copy of this document will suffice as proper authorization.
________________________________
Signature of Patient
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________________________________
Date
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Guidelines for Mount Auburn Occupation Health
Employers frequently ask the question, “When should I send an injured employee to Mount Auburn Occupation
Health or to a hospital emergency department?”
The answer depends on the situation and the severity of the injured employee’s condition. When dealing with
this issue, keep in mind a key point:
IF IN DOUBT WHETHER AN INJURY IS APPROPRIATE TO BE SENT TO MOUNT AUBURN
OCCUPATION HEALTH OR THE EMERGENCY ROOM PLEASE CALL 617-354-0546
In non-emergency situations, there are a number of disadvantages to using the hospital emergency department.

Hospital emergency department charges are considerably higher than those at Mount Auburn
Occupation Health.

Life and limb threatening emergencies take precedence over most work-related injuries. Your
employees may, therefore, have an extended wait in the emergency department before being seen by a
clinician.

Managing work-related injuries requires close communication between the provider, the employee and
the employer. Emergency departments are not set up to offer this level of communication.

Emergency department physicians are generally not trained and experienced in managing work
restrictions and facilitating return to work.

Occupational health providers are trained to manage work-related injuries and illnesses. This results in
significant cost savings for employers through reductions in both medical expenses and lost workdays.
Reduced lost workdays means reduced indemnity costs for employers. Since both medical and
indemnity costs are reduced, total case cost, and ultimately workers’ compensation insurance premiums,
are reduced.
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Guidelines for Deciding the Most Appropriate
Option for Care
Please call 1st if possible 617-354-0546
Monday – Friday 8:00 am – 4:30 pm
I.
Conditions appropriate for treatment at Mount Auburn Occupation Health:
 All musculoskeletal sprains and strains
 Rashes or burns
 Simple lacerations
 Mild eye injuries, such as abrasions or foreign body
 Possible fractures
 Blood exposures
 Repetitive strain injuries
 Animal bites
 Chemical exposures not causing life threatening symptoms (except eye exposures)
Please call 1st if possible 617-499-5025
24/7
II.
Conditions appropriate for hospital emergency department treatment:
 Complaints of chest pain
 Injuries resulting in significant loss of blood (shock) or uncontrolled bleeding
 Respiratory distress including shortness of breath resulting from allergic reactions (bee sting) and
acute toxic exposures
 Loss of consciousness
 Obviously deformed fractures
 Severe eye injuries: acid/base or other chemical splashes or sever direct trauma
 Obviously abnormal mental status
 Extensive or very deep injuries or lacerations
 Electrical injuries (which may be more serious than they appear on the surface)
 Chemical exposures causing life threatening symptoms
This is a partial list intended to respond to the most common questions from employers regarding triage.
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