STANDARD DATA DICTIONARY #2260 -- ASISTS ACCIDENT REPORTING FILE 3/24/25 PAGE 1
STORED IN ^OOPS(2260, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file contains all information associated with an accident that results in injury and/or illness.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
IDENTIFIED BY: DATE/TIME OF OCCURRENCE (#4)[R]
"WRITE1": D:$G(UNION)'="Y" EN^DDIOL($P(^(0),U,2),"","?3")
POINTED TO BY: ASISTS RECORD field (#.7) of the ASISTS COMPENSATION CLAIM (CA7) File (#2264)
CROSS
REFERENCED BY: PERSONNEL STATUS(AC), DATE/TIME OF OCCURRENCE(AD), INCLUDE ON OSHA LOG(AE), NEEDS XMIT TO NDB(AN),
DATE TRANSMITTED TO NDB(ANC), TRANSMIT TO WCMIS(AW), DATE TRANSMITTED TO WCMIS(AWC), CASE NUMBER(B),
CASE NUMBER(BS5), SSN(BS5), PERSON INVOLVED(C), STATION NUMBER(D), SSN(SSN)
INDEXED BY: DATE/TIME OF OCCURRENCE & INCLUDE ON OSHA LOG (AF)
2260,.01 CASE NUMBER 0;1 FREE TEXT (Required)
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.
2260,1 PERSON INVOLVED 0;2 FREE TEXT (Required)
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",$E(X,1,30),DA)
2260,2 PERSONNEL STATUS 0;3 SET (Required)
'1' FOR Employee;
'2' FOR Volunteer;
'3' FOR Contractor;
'4' FOR Visitor;
'5' FOR Other;
'6' FOR Non-PAID Employee;
'7' FOR Medical Student;
'8' FOR Nursing Student;
'9' FOR Other Student;
'10' FOR Resident Physician;
LAST EDITED: JUN 22, 2004
HELP-PROMPT: Enter the status. Non-PAID Employee includes student and resident.
DESCRIPTION: The personnel status of the individual involved in the incident is either employee, volunteer,
contractor, visitor or other. Non-PAID Employee includes students and residents.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 2260^AC
1)= S ^OOPS(2260,"AC",$E(X,1,30),DA)=""
2)= K ^OOPS(2260,"AC",$E(X,1,30),DA)
2260,3 TYPE OF INCIDENT 0;4 POINTER TO ASISTS CRITICAL TRACKING ISSUES FILE (#2261.2) (Required)
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.
2260,4 DATE/TIME OF OCCURRENCE 0;5 DATE (Required)
22. DATE OF INJURY
INPUT TRANSFORM: S %DT="ETX",%DT(0)="-NOW" D ^%DT K %DT S X=Y K:Y<1 X I $G(X),($$FMDIFF^XLFDT(DT,X,1)>1095) D EN^DDI
OL("DATE OF OCCURRENCE must be within 3 years","","!!?5") K X
LAST EDITED: SEP 01, 2004
HELP-PROMPT: Enter the date and time of injury, date only if illness.
DESCRIPTION: If this is an injury, this is the date and time the incident happened. If this is an illness, this
is the date the employee first became aware of the disease or illness.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 2260^AD
1)= S ^OOPS(2260,"AD",$E(X,1,30),DA)=""
2)= K ^OOPS(2260,"AD",$E(X,1,30),DA)
RECORD INDEXES: AF (#567)
2260,5 SSN 2162A;1 FREE TEXT (audited)
SSN
INPUT TRANSFORM: S X=$TR(X,"-","") K:$L(X)>9!($L(X)<9)!'(X?9N)!'(X) X
OUTPUT TRANSFORM: S Y=$E(Y,1,3)_"-"_$E(Y,4,5)_"-"_$E(Y,6,9)
LAST EDITED: JUN 22, 2004
HELP-PROMPT: Answer must be 9 characters in length.
DESCRIPTION:
This is the Social Security Number of the person involved in this incident.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 2260^SSN
1)= S ^OOPS(2260,"SSN",$E(X,1,30),DA)=""
2)= K ^OOPS(2260,"SSN",$E(X,1,30),DA)
CROSS-REFERENCE: 2260^BS5^MUMPS
1)= S ^OOPS(2260,"BS5",$E($P(^OOPS(2260,DA,0),U,2),1)_$E(X,6,9),DA)=""
2)= K ^OOPS(2260,"BS5",$E($P(^OOPS(2260,DA,0),U,2),1)_$E(X,6,9),DA)
This index sets up the first letter last name, last 4 digits of the SSN index.
2260,6 DATE OF BIRTH 2162A;2 DATE
DATE OF BIRTH
INPUT TRANSFORM: S %DT="E",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),'$$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
2260,7 SEX 2162A;3 SET
SEX
'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.
2260,8 HOME STREET ADDRESS 2162A;4 FREE TEXT
HOME STR. ADDRESS
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.
2260,9 CITY 2162A;5 FREE TEXT
HOME CITY
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.
2260,10 STATE 2162A;6 POINTER TO STATE FILE (#5)
HOME STATE
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.
2260,11 ZIP CODE 2162A;7 FREE TEXT
HOME ZIP CODE
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
2260,12 HOME PHONE NUMBER 2162A;8 FREE TEXT
HOME PHONE NUM
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
2260,13 STATION NUMBER 2162A;9 POINTER TO INSTITUTION FILE (#4) (Required)
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
2260,14 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.
2260,15 OCCUPATION 2162A;11 FREE TEXT
12. OCCUPATION
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.
2260,16 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.
2260,17 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.
2260,18 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.
2260,19 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.
2260,20 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.
2260,21 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.
2260,22 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.
2260,23 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.
2260,24 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.
2260,25 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.
2260,26 GENERAL SETTING OF INCIDENT 2162B;1 SET (Required)
GENERAL SETTING OF INCIDENT
'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
2260,27 LOCATION OF INJURY 2162B;2 POINTER TO ASISTS SETTING OF INJURY FILE (#2261.4) (Required)
LOCATION OF INJURY
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.
2260,28 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.
DESCRIPTION OF INCIDENT
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Provide information to fully narrate the incident.
2260,29 CHARACTERIZATION OF INJURY 2162B;3 POINTER TO ASISTS CHARACTERIZATION OF INJURY FILE (#2261)
CHARACTERIZATION OF INJURY
LAST EDITED: MAR 06, 2001
HELP-PROMPT: Enter the best description of the injury.
DESCRIPTION:
This is the general description of the injury.
2260,29.5 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.
2260,30 BODY PART MOST AFFECTED 2162B;4 POINTER TO ASISTS DOL ANATOMICAL LOCATION CODES FILE (#2261.1)
BODY PART MOST AFFECTED
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
2260,30.1 ADDITIONAL BODY PART AFFECTED 2162B;8 POINTER TO ASISTS DOL ANATOMICAL LOCATION CODES FILE (#2261.1)
ADD. BODY PART AFFECTED
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
2260,31 SIDE OF BODY AFFECTED 2162B;5 SET
SIDE OF BODY AFFECTED
'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.
2260,32 DUTY RETURNED TO 2162B;6 SET
DUTY RETURNED TO
'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.
2260,33 LOST TIME 2162B;7 SET
LOST TIME
'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.
2260,34 PATIENT SOURCE 2162D;1 SET
PATIENT SOURCE
'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.
2260,35 CONTAMINATION 2162D;2 SET
CONTAMINATION
'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.
2260,36 PURPOSE OF SHARP OBJECT 2162D;3 POINTER TO ASISTS PURPOSE FOR USING SHARPS FILE (#2261.5)
PURPOSE OF SHARP OBJ.
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.
2260,37 ACTIVITY AT TIME OF INJURY 2162D;4 POINTER TO ASISTS OCCURRENCE OF SHARPS INJURY FILE (#2261.6)
ACTIVITY AT TIME OF INJURY
LAST EDITED: MAR 06, 2001
HELP-PROMPT: What was happening when the injury occurred?
DESCRIPTION:
This is the activity when the injury occurred.
2260,38 OBJECT CAUSING INJURY 2162D;5 POINTER TO ASISTS DEVICE/EQUIPMENT FILE (#2261.7)
OBJECT CAUSING INJURY
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 $P(^(0),U,2)'=16"
EXPLANATION: This selection is no longer valid, Please select another device.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,39 AREA EXPOSED TO BODILY FLUID 2162E;0 SET Multiple #2260.039 (Add New Entry without Asking)
DESCRIPTION:
This is a description of the exposed body parts.
2260.039,.01 AREA EXPOSED TO BODILY FLUID 0;1 SET (Multiply asked)
AREA EXPOSED TO BODILY FLUID
'S' FOR Skin;
'E' FOR Eyes (conjunctiva);
'N' FOR Nose (mucosa);
'M' FOR Mouth (mucosa);
'O' FOR Other;
'B' FOR Both Eyes and Mouth;
LAST EDITED: MAR 06, 2001
HELP-PROMPT: Enter the exposed body part(s).
DESCRIPTION:
This is a description of the exposed body parts.
CROSS-REFERENCE: 2260.039^B
1)= S ^OOPS(2260,DA(1),"2162E","B",$E(X,1,30),DA)=""
2)= K ^OOPS(2260,DA(1),"2162E","B",$E(X,1,30),DA)
2260,40 PERSONAL PROTECTIVE EQUIPMENT 2162F;0 POINTER Multiple #2260.01 (Add New Entry without Asking)
DESCRIPTION:
This is a description of the protective items worn at the time of the exposure.
2260.01,.01 PERSONAL PROTECTIVE EQUIPMENT 0;1 POINTER TO ASISTS PERSONAL PROTECTIVE EQUIPMENT FILE (#2261.3) (Multiply asked)
PERSONAL PROTECTIVE EQUIPMENT
LAST EDITED: MAR 06, 2001
HELP-PROMPT: Enter the protective items worn at the time of the exposure.
DESCRIPTION:
This is a list of the protective items worn at the time of the exposure.
CROSS-REFERENCE: 2260.01^B
1)= S ^OOPS(2260,DA(1),"2162F","B",$E(X,1,30),DA)=""
2)= K ^OOPS(2260,DA(1),"2162F","B",$E(X,1,30),DA)
2260,41 BODILY FLUID EXPOSURE SOURCE 2162D;6 POINTER TO ASISTS RESULTS FILE (#2261.8)
BODILY FLUID EXPOSURE SOURCE
LAST EDITED: MAR 06, 2001
HELP-PROMPT: How was the employee exposed?
DESCRIPTION:
This explains how the exposure happened.
2260,42 EQUIPMENT/DEVICE FAILURE 2162D;7 FREE TEXT
EQUIP/DEVICE FAILURE
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3) X
LAST EDITED: MAR 06, 2001
HELP-PROMPT: Answer must be 3-80 characters in length.
DESCRIPTION: If there was an equipment, device or product failure, this is the type of equipment and
manufacturer name.
2260,42.5 EQUIP/DEVICE FAILURE OCCURRED 2162D;9 SET
'N' FOR No;
'Y' FOR Yes;
LAST EDITED: OCT 07, 1999
HELP-PROMPT: Enter whether there was an equipment or device product failure involved with the incident.
DESCRIPTION: Indicates whether there was an equipment or device product failure involved with the incident. If
yes, user will be prompted to enter comments.
2260,43 SAFETY DESIGN DEVICE USED 2162D;8 SET
SAFETY DESIGN DEVICE USED
'Y' FOR Yes;
'N' FOR No;
LAST EDITED: MAR 06, 2001
HELP-PROMPT: Was a safety design device used?
DESCRIPTION:
This states whether or not a safety device was used.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,44 SUPERVISOR 2162ES;1 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 08, 1998
HELP-PROMPT: Enter the name of the supervisor completing the 2162.
DESCRIPTION:
This is the supervisor completing the information on the Report of Accident (2162).
2260,45 SUPERVISOR ELECTRONIC SIG 2162ES;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<6) X
LAST EDITED: APR 08, 1998
HELP-PROMPT: Answer must be 6-20 characters in length.
DESCRIPTION:
This is the supervisor's electronic signature.
2260,46 SUPERVISOR SIGNATURE DATE 2162ES;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 08, 1998
HELP-PROMPT: Enter the date the 2162 was signed by the supervisor.
DESCRIPTION:
This is the date the supervisor signed the 2162.
2260,47 CORRECTIVE ACTION 2162G;0 WORD-PROCESSING #2260.047
CORRECTIVE ACTION TAKEN
DESCRIPTION: This is a statement of any corrective action that was taken to prevent further incidents of this
kind.
CORRECTIVE ACTION
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Enter corrective action taken for this case.
DESCRIPTION: This is a statement of any corrective action that was taken to prevent further incidents of this
kind.
2260,48 SAFETY OFFICER NAME 2162ES;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 10, 1998
HELP-PROMPT: Enter the name of the safety officer.
DESCRIPTION:
This is the name of the safety officer.
2260,49 SAFETY OFF. ELECT. SIGNATURE 2162ES;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<6) X
LAST EDITED: APR 10, 1998
HELP-PROMPT: Answer must be 6-20 characters in length.
DESCRIPTION:
This is the safety officer's electronic signature.
2260,50 SAFETY OFF. DATE SIGNED 2162ES;6 DATE
INPUT TRANSFORM: S %DT="ET" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 10, 1998
HELP-PROMPT: Enter the date the safety officer signed.
DESCRIPTION:
This is the date of the safety officer's signature.
2260,51 CASE STATUS 0;6 SET
'0' FOR Open;
'1' FOR Closed;
'2' FOR Deleted;
'3' FOR Replaced by amendment;
LAST EDITED: JUN 20, 2001
HELP-PROMPT: Enter the status of this case.
DESCRIPTION:
This is the status of the case.
CROSS-REFERENCE: ^^TRIGGER^2260^54
1)= X ^DD(2260,51,1,1,1.3) I X S X=DIV S Y(1)=$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 $P(^(0),U,18)=D
IV,DIH=2260,DIG=54 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(2260,51,1,1,69.2) S X=X="Closed",Y(2)=X S X=$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 N
DB="")
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.
2260,52 INJURY/ILLNESS 0;7 SET (Required)
'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).
2260,53 SUPERVISOR 0;8 POINTER TO NEW PERSON FILE (#200) (Required)
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.
2260,53.1 SECONDARY SUPERVISOR 0;9 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 27, 1998
DESCRIPTION: Enter the name of the secondary supervisor of the person involved.
2260,54 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.
2260,55 SAFETY OFF. COMMENTS 2162H;0 WORD-PROCESSING #2260.055
SAFETY OFF. COMMENTS
DESCRIPTION:
These are comments from the safety officer about this case.
SAFETY OFF. COMMENTS
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Enter any comments you have about this case.
DESCRIPTION:
These are comments from the safety officer about this case.
2260,56 PERSON ENTERING STUB RECORD 0;10 POINTER TO NEW PERSON FILE (#200) (Required)
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.
2260,57 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 $P(^(0),U,19)=DIV,DIH=2260,DIG=59 D ^DICR
CREATE VALUE)= "Y"
DELETE VALUE)= @
FIELD)= TRANSMITTED TO NDB
This trigger sets the TRANSMITTED TO NDB field (#59) to 'Y'es when the DATE TRANSMITTED TO NDB
field (#57) is entered or a blank if the DATE TRANSMITTED TO NDB is deleted. By setting a value in
the TRANSMITTED TO NDB field (#59) the trigger in the TRANSMITTED TO NDB field (#59) is executed
which either sets or deletes the entry in the NEEDS XMIT TO NDB field (#54) which updates the "AN"
cross reference.
2260,58 REASON FOR DELETION 0;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<3) X
LAST EDITED: OCT 15, 2001
HELP-PROMPT: Answer must be 3-60 characters in length.
DESCRIPTION:
Enter the reason the case is being deleted.
TECHNICAL DESCR: When an ASISTS case is being deleted; a reason why the case is being deleted should be given. This
field will store this free text.
2260,59 TRANSMITTED TO NDB 0;19 SET
'Y' FOR YES;
'N' FOR NO;
LAST EDITED: JUL 12, 2001
HELP-PROMPT: Enter "Y" if 2162 has been transmitted to NDB, "N" if it hasn't.
WRITE AUTHORITY: ^
UNEDITABLE
NOTES: TRIGGERED by the DATE TRANSMITTED TO NDB field of the ASISTS ACCIDENT REPORTING File
CROSS-REFERENCE: ^^TRIGGER^2260^54
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$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 $P(^(0),U,18)=DIV,DIH=2260,DIG=54 D ^DICR
2)= Q
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= NEEDS XMIT TO NDB
This field is set to 'Y'es when the DATE TRANSMITTED TO NDB field (#57) is entered and a blank when
the DATE TRANSMITTED TO NDB field (#57) is deleted. When setting this field to 'Y', the value in
the NEEDS XMIT TO NDB field (#54) is blanked and the entry in it's cross reference ("AN") is
updated (removed).
2260,60 EMP RETIREMENT COVERAGE CA;4 SET (Required)
EMP RETIREMENT COVERAGE
'1' FOR CSRS;
'2' FOR FERS;
'3' FOR OTHER;
LAST EDITED: APR 13, 2000
HELP-PROMPT: Enter the Employee's type of Retirement Coverage.
DESCRIPTION: This is the type of retirement coverage the employee has. If the type of Coverage is 'Other' then
the user will be prompted to enter a description for that coverage in field, EMP RETIREMENT
COVERAGE DESC (#61). This field will be used for the CA1 and CA2.
2260,61 EMP RETIREMENT COVERAGE DESC CA;5 FREE TEXT
EMP RETIREMENT COVERAGE DESC
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3) X
LAST EDITED: APR 13, 2000
HELP-PROMPT: Answer must be 3-80 characters in length.
DESCRIPTION: This field will need to be answered if the response to EMP RETIREMENT COVERAGE (field #60) is
'OTHER'. The response to this field should be a description of the type of other retirement
coverage the employee has.
2260,62 NOI CODE CA;3 POINTER TO ASISTS DOL NATURE OF INJURY CODES FILE (#2263.3)
OWCP USE - NOI CODE
LAST EDITED: APR 13, 2000
HELP-PROMPT: Enter the NOI code that best describes the Injury/Illness
DESCRIPTION: Enter the NOI Code from the ASISTS DOL NATURE OF INJURY CODE Table that best describes the
Injury/Illness. This field is required prior to the electronic transmission of the CA1/CA2.
2260,63 PAY PLAN 0;13 FREE TEXT
INPUT TRANSFORM: K:$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).
2260,66 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.
2260,67 TRANSMIT TO WCMIS WCES;1 POINTER TO NEW PERSON FILE (#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.
2260,68 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).
2260,69 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).
2260,70 OWCP CHARGEBACK CODE CA;2 POINTER TO ASISTS OWCP CHARGEBACK CODES FILE (#2263.6)
OWCP CHARGEBACK CODE
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.
2260,71 EMPLOYEE BILL OF RIGHTS OK 0;14 SET (Required)
'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.
2260,72 EMPLOYEE CONSENT 0;15 SET (Required)
'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.
2260,73 OWCP DISTRICT OFFICE 0;16 POINTER TO ASISTS DOL DISTRICT OFFICE FILE (#2262.1)
OWCP DISTRICT OFFICE
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.
2260,74 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.
2260,75 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.
2260,76 NAME OF SAFETY OFFICER WCSE;1 POINTER TO NEW PERSON FILE (#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.
2260,77 SAFETY OFFICER ELEC. SIGN WCSE;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<6) X
LAST EDITED: JAN 22, 2001
HELP-PROMPT: Enter your electronic signature.
DESCRIPTION: This is the electronic signature of the Safety Officer who is approving the Workers' Compensation
personnel to sign electronically for the employee
2260,78 SAFETY OFF. ELEC. SIGN DATE WCSE;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 22, 2001
HELP-PROMPT: Enter the date of your signature.
DESCRIPTION: This is the date that the Safety Officer electronically signed the claim giving their approval that
the Workers' Compensation personnel could electronically sign the claim for the employee.
2260,79 EMPLOYEE HEALTH NAME WCSE;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JAN 22, 2001
HELP-PROMPT: Enter the name of the Employee Health representative.
DESCRIPTION: This is the name of the Employee Health representative who is giving their approval for the
Workers' Compensation personnel to electronically sign the claim for the employee.
2260,80 EMP HEALTH ELECT. SIGNATURE WCSE;5 FREE TEXT
INPUT TRANSFORM: K:$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.
2260,81 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.
2260,82 BRAND 2162B;10 POINTER TO ASISTS NEEDLESTICK BRANDS FILE (#2262.3)
BRAND
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.
2260,83 DEVICE SIZE 2162B;11 POINTER TO ASISTS DEVICE SIZE FILE (#2262.2)
DEVICE SIZE
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
2260,84 SAFETY CHARACTERISTICS 2162B;12 POINTER TO ASISTS SAFETY CHARACTERISTICS FILE (#2261.9)
SAFETY DEV CHARACTERISTICS
LAST EDITED: MAR 05, 2001
HELP-PROMPT: Enter the SAFETY CHARACTERISTICS for the device.
DESCRIPTION:
Enter the appropriate ENGINEERED SAFETY CHARACTERISTICS.
2260,85 SAFETY DEVICE NOT USED 2162S;1 FREE TEXT
EXPLAIN WHY SAFETY DEVICE NOT USED
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.
2260,86 SERVICE 0;17 POINTER TO SERVICE/SECTION FILE (#49)
SERVICE
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.
2260,87 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.
2260,88 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)
2260,89 FATALITY 2162A;22 SET
FATALITY
'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.
2260,90 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
2260,95 INCIDENT OUTCOME OUTC;0 DATE Multiple #2260.095 (Add New Entry without Asking)
DESCRIPTION: This subfile contains information regarding the employees ability to work as a result of the
incident.
INDEXED BY: STATUS & INCIDENT OUTCOME (AC)
2260.095,.01 START DATE INCIDENT OUTCOME 0;1 DATE (Required) (Multiply asked)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 09, 2004
HELP-PROMPT: Enter the first day for this outcome.
DESCRIPTION:
This is the first date for the incident being entered.
2260.095,1 END DATE INCIDENT OUTCOME 0;2 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 15, 2004
HELP-PROMPT: Enter the last date for this outcome
DESCRIPTION:
This is the ending date for the incident information for this outcome.
2260.095,2 INCIDENT OUTCOME 0;3 SET
'D' FOR Death;
'A' FOR Away Work;
'J' FOR Job Transfer/Restriction;
'O' FOR Other Recordable;
LAST EDITED: SEP 01, 2004
HELP-PROMPT: Enter the type of incident outcome.
DESCRIPTION: This is the incident outcome type for this incident. Valid choices are: Death, Away Work, Job
Transfer/Restriction, or Other Recordable.
RECORD INDEXES: AC (#568)
2260.095,3 DAYS AWAY WORK 0;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUL 15, 2004
HELP-PROMPT: Type a Number between 0 and 999999, 0 Decimal Digits
DESCRIPTION:
This will contain the number of days away from work for this incident.
2260.095,4 DAYS JOB TRANSFER/RESTRICTION 0;5 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUL 15, 2004
HELP-PROMPT: Type a Number between 0 and 999999, 0 Decimal Digits
DESCRIPTION:
This will contain the number of days of job transfer or restriction for this incident.
2260.095,5 ESTIMATED RETURN DATE 0;6 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 15, 2004
HELP-PROMPT: Enter the date the employee is expected to return to work.
DESCRIPTION: This contains the estimated return to work date determined by the workers' compensation
specialist or the safety official.
2260.095,6 DATE OUTCOME CREATED 0;7 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 the incident outcome was created.
DESCRIPTION:
This system generated date will store the date this incident outcome was created.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260.095,7 INCIDENT CREATED BY 0;8 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: AUG 09, 2004
HELP-PROMPT: Enter the person who created the record.
DESCRIPTION:
The application will automatically store the user who created the incident outcome record.
2260.095,8 LAST EDIT DATE 0;9 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 the incident record was last edited
DESCRIPTION:
The application will automatically store the date the incident outcome record was edited.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260.095,9 LAST EDITED BY 0;10 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: AUG 09, 2004
HELP-PROMPT: Enter the person who last edited the incident record
DESCRIPTION:
The application will store the user who last edited this incident outcome record.
2260.095,10 STATUS 0;11 SET
'A' FOR Added;
'D' FOR Deleted;
LAST EDITED: SEP 24, 2004
HELP-PROMPT: Enter A if the incident is active, a D if it is deleted
DESCRIPTION: This is the status of the incident outcome. If the incident has been entered in error, the user
can mark the record deleted and it will not be used when determining the total number of days the
individual's work was impacted.
RECORD INDEXES: AC (#568)
2260,100 HOME PHONE NUMBER CA1A;1 FREE TEXT
5. HOME PHONE
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)
2260,101 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)
2260,102 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)
2260,103 EMPLOYEE STREET ADDRESS CA1A;4 FREE TEXT
7. STREET ADDRESS
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)
2260,104 EMPLOYEE CITY ADDRESS CA1A;5 FREE TEXT
7. CITY
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)
2260,105 EMPLOYEE STATE ADDRESS CA1A;6 POINTER TO STATE FILE (#5)
7. STATE
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Enter the state.
DESCRIPTION:
This is the employee's state address. (Injury)
2260,106 EMPLOYEE ZIP CODE CA1A;7 FREE TEXT
7. ZIP CODE
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
2260,107 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)
2260,108 PLACE WHERE INJURY OCCURRED CA1A;9 FREE TEXT
9. PLACE WHERE INJURY OCCURRED
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)
2260,109 DATE/TIME INJURY OCCURRED CA1A;10 DATE
10. DATE/TIME INJURY OCCURRED
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)
2260,110 DATE OF THIS NOTICE CA1A;11 DATE
11. DATE OF THIS NOTICE
INPUT TRANSFORM: S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,0)),U,5)\1>X D EN^DDIOL("
DATE OF THIS NOTICE cannot be prior to the DATE/TIME OF OCCURRENCE","","!!?5") K X
LAST EDITED: JAN 31, 2001
HELP-PROMPT: Enter the date the CA-1 was completed.
DESCRIPTION: This is the date the employee completed the Federal Employee's Notice of Traumatic Injury and Claim
for Continuation of Pay/Compensation (CA-1). (Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,111 OCCUPATION CA1A;12 FREE TEXT
12. EMPLOYEE'S OCCUPATION
INPUT TRANSFORM: K:$L(X)>30!($L(X)<2) X
LAST EDITED: MAR 31, 2000
HELP-PROMPT: Answer must be 2-30 characters in length.
DESCRIPTION:
This is a short description of the employee's occupation. (Injury)
2260,112 CAUSE OF INJURY CA1B;1 FREE TEXT
13. CAUSE OF INJURY
INPUT TRANSFORM: K:$L(X)>200!($L(X)<1) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 1-200 characters in length.
DESCRIPTION:
This is a short description of what happened and why. (Injury)
2260,113 NATURE OF INJURY CA1C;1 FREE TEXT
14. NATURE OF INJURY
INPUT TRANSFORM: K:$L(X)>100!($L(X)<1) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 1-100 characters in length.
DESCRIPTION: This is a description of the injury and the part of the body affected, e.g., fracture of left leg.
(Injury)
2260,114 REQUEST PAY OR LEAVE CA1A;13 SET
15. REQUEST PAY OR LEAVE
'COP' FOR Continuation of regular pay;
'L' FOR Sick and/or annual leave;
LAST EDITED: MAY 05, 1998
HELP-PROMPT: Select Continuation of regular pay (COP) or leave (L).
DESCRIPTION: This is the employee's choice of either continuing regular pay (COP) or taking sick or annual leave
(L). If you (the employee) are disabled for work as a result of this injury and file CA-1 within
thirty days of the injury, you are entitled to receive continuation of pay (COP) from your
employing agency. COP is paid for up to 45 days of disability, and is not charged against sick or
annual leave. You may elect sick or annual leave if you wish, but compensation from OWCP may not
be claimed during the 45 days of COP entitlement. (You may not claim compensation to repurchase
leave used during this period.) Also, if you change your election within one year, the agency is
obliged to convert past periods of leave to COP, which qualify. (Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,115 NAME OF WITNESS CA1D;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: APR 07, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the name of the person who witnessed the incident. (Injury)
2260,116 WITNESS ADDRESS CA1D;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 27, 1998
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the street address of the witness. Form CA-1 item 16.
2260,116.1 WITNESS CITY CA1D;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>26!($L(X)<1) X
LAST EDITED: APR 27, 1998
HELP-PROMPT: Answer must be 1-26 characters in length.
DESCRIPTION: This is the city address of the witness. Form CA-1 item 16.
2260,116.2 WITNESS STATE CA1D;5 POINTER TO STATE FILE (#5)
LAST EDITED: APR 27, 1998
DESCRIPTION: This is the state address of the witness. Form CA-1 item 16.
2260,116.3 WITNESS ZIP CODE CA1D;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5) X
LAST EDITED: APR 27, 1998
HELP-PROMPT: Answer must be 5-10 characters in length.
DESCRIPTION: This is the zip code of the witness. Form CA-1 item 16.
2260,117 DATE OF WITNESS SIGNATURE CA1D;3 DATE
INPUT TRANSFORM: S %DT="ET" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 07, 1998
HELP-PROMPT: Enter the date the witness intends to sign the statement.
DESCRIPTION:
This is the date the witness signed the statement of witness on the CA-1.
2260,118 STATEMENT OF WITNESS CA1E;0 WORD-PROCESSING #2260.0118
DESCRIPTION: This is the statement of the witness that describes what the witness saw, heard, or knows about the
injury.
LAST EDITED: APR 07, 1998
HELP-PROMPT: Enter a statement of what the witness saw, heard or knows about the injury.
DESCRIPTION: This is the statement of the witness that describes what the witness saw, heard, or knows about
the injury.
2260,119 NAME OF EMPLOYEE CA1ES;1 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 07, 1998
HELP-PROMPT: Enter the name of the injured employee.
DESCRIPTION:
This is the name of the employee injured during the incident. (Injury)
2260,120 EMPLOYEE ELECT. SIGNATURE CA1ES;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<6) X
LAST EDITED: APR 07, 1998
HELP-PROMPT: Enter your electronic signature.
DESCRIPTION:
This is the electronic signature of the employee. (Injury)
2260,121 EMPLOYEE DATE OF SIGNATURE CA1ES;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 07, 1998
HELP-PROMPT: Enter the date of your signature.
DESCRIPTION:
This is the date the employee electronically signed his/her statement. (Injury)
2260,122 OCCUPATION CODE CA1B;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<3) X
LAST EDITED: APR 07, 1998
HELP-PROMPT: Answer must be 3-20 characters in length.
DESCRIPTION:
This is the employee's occupation code.
2260,123 TYPE CODE CA1B;3 POINTER TO ASISTS DOL TYPE OF INJURY CODES FILE (#2263)
14b. TYPE CODE
LAST EDITED: APR 03, 2000
HELP-PROMPT: Enter the Type Code that best describes the type of injury
DESCRIPTION: This is the type code for this injury. It stands for the action and is used along with the source
code which stands for the object or substance to form a brief description of how the incident
occurred. (Injury)
2260,124 SOURCE CODE CA1B;4 POINTER TO ASISTS DOL SOURCE OF INJURY CODES FILE (#2263.1)
14c. SOURCE CODE
LAST EDITED: APR 03, 2000
HELP-PROMPT: Enter the Source code for this Injury
DESCRIPTION: This is the source code for this injury. It stands for the object or substance and is used along
with the type code, which stands for the action, to form a brief description of how the incident
occurred. (Injury)
2260,125 WITNESS NAME CA1W;0 Multiple #2260.0125 (Add New Entry without Asking)
DESCRIPTION: This is the name of the person who witnessed the incident and is willing to provide their name,
address and a statement describing what occurred. (Injury)
2260.0125,.01 WITNESS NAME 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM:K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<3) X I $D(X),'$$NMCHK^OOPSUTL3(X) D NMERR^OOPSUTL3
K X
LAST EDITED: AUG 31, 2000
HELP-PROMPT: Enter the Witness Name - if no witness, leave blank. Do not enter NONE
DESCRIPTION: Enter the name of the individual that witnessed the incident. Note: Only the first witness entered
will be transmitted to DOL (Department of Labor) electronically. Therefore, enter the witness
information that you want to be transmitted electronically. Other witness data may be submitted
via hard copy to DOL. The name must be entered in the following format: LASTNAME,FIRSTNAME with no
spaces in the last name.
TECHNICAL DESCR:This is the name of the person who witnessed the incident and is willing to provide additional
information concerning the incident
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:2260.0125^B
1)= S ^OOPS(2260,DA(1),"CA1W","B",$E(X,1,30),DA)=""
2)= K ^OOPS(2260,DA(1),"CA1W","B",$E(X,1,30),DA)
2260.0125,1 WITNESS ADDRESS 0;2 FREE TEXT
INPUT TRANSFORM:K:$L(X)>30!($L(X)<1) X
LAST EDITED: FEB 03, 2000
HELP-PROMPT: Answer must be 1-30 characters in length
DESCRIPTION: This is the address of the individual who witnessed the incident where they can be contacted, if
necessary.
2260.0125,2 WITNESS CITY 0;3 FREE TEXT
INPUT TRANSFORM:K:$L(X)>20!($L(X)<1) X
LAST EDITED: FEB 03, 2000
HELP-PROMPT: Answer must be 1-20 characters in length
DESCRIPTION:
This is the City portion of the Witness's address where they can be contacted, if necessary.
2260.0125,3 WITNESS STATE 0;4 POINTER TO STATE FILE (#5)
LAST EDITED: FEB 03, 2000
HELP-PROMPT: Enter the Witness's State
DESCRIPTION:
This is the State portion of the Witness's address where they can be contacted, if necessary.
2260.0125,4 WITNESS ZIP CODE 0;5 FREE TEXT
INPUT TRANSFORM:K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
LAST EDITED: MAR 28, 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 portion of the Witness's address where they can be contacted, if necessary.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260.0125,5 DATE OF WITNESS SIGNATURE 0;6 DATE
INPUT TRANSFORM:S %DT="ETX",%DT(0)="-NOW" D ^%DT K %DT S X=Y K:Y<1 X
LAST EDITED: MAR 20, 2000
HELP-PROMPT: Enter the Date the Witness signed the Statement
DESCRIPTION:
Enter the date that the Witness signed the Witness Statement
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260.0125,6 WITNESS STATEMENT 1;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>200!($L(X)<3) X
LAST EDITED: FEB 03, 2000
HELP-PROMPT: Answer must be 3-200 characters in length
DESCRIPTION: This is the Statement that the Witness has provided concerning details of the incident and what
occurred.
2260,126 CAUSE OF INJURY CODE CA;1 POINTER TO ASISTS DOL CAUSE OF INJURY CODES FILE (#2263.2)
CAUSE OF INJURY CODE
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).
2260,130 AGENCY NAME CA1F;1 FREE TEXT
17. AGENCY NAME
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)
2260,131 AGENCY ADDRESS CA1F;2 FREE TEXT
AGENCY ADDRESS
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)
2260,132 AGENCY CITY CA1F;3 FREE TEXT
AGENCY CITY
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)
2260,133 AGENCY STATE CA1F;4 POINTER TO STATE FILE (#5)
AGENCY STATE
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)
2260,134 AGENCY ZIP CODE CA1F;5 FREE TEXT
AGENCY ZIP CODE
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
2260,135 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)
2260,136 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)
2260,138 REGULAR HRS FROM TIME CA1F;9 FREE TEXT
20. REGULAR HRS FROM TIME
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
2260,139 REGULAR HRS TO TIME CA1F;10 FREE TEXT
20. REGULAR HRS TO TIME
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
2260,140 REGULAR WORK SCHEDULE CA1F;11 FREE TEXT
21. REGULAR WORK SCHEDULE
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)
2260,141 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)
2260,142 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^DDIO
L("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
2260,143 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
2260,144 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),'$$DTVAL^OOPSUTL4(X,144,142) K X,%DT
LAST EDITED: JUN 26, 2008
HELP-PROMPT: Enter the date the 45 day period began.
DESCRIPTION:
This is the date the 45 day period began for COP. (Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,145 DATE/TIME RETURNED TO WORK CA1G;3 DATE
INPUT TRANSFORM: S %DT="ERX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),'$$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
2260,146 INJURED PERFORMING DUTY CA1G;4 SET
28. WAS EMPLOYEE INJURED IN PERFORMANCE OF DUTY
'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)
2260,147 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)
2260,148 INJURY CAUSED BY EMPLOYEE CA1G;6 SET
29. WAS INJURY CAUSED BY EMPLOYEE'S WILLFUL MISCONDUCT
'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)
2260,149 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)
2260,150 INJURY CAUSED BY 3RD PARTY CA1G;8 SET
30. WAS INJURY CAUSED BY 3RD PARTY
'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)
2260,151 3RD PARTY NAME CA1H;1 FREE TEXT
31. 3RD PARTY NAME
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<3) X
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: If the injury was caused by someone other than the injured employee, this is the name of that third
party. (Injury)
2260,152 3RD PARTY ADDRESS CA1H;2 FREE TEXT
31. 3RD PARTY ADDRESS
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3) X
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Answer must be 3-80 characters in length.
DESCRIPTION:
This is the street address of the third party. (Injury)
2260,153 3RD PARTY CITY CA1H;3 FREE TEXT
31. 3RD PARY CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the city address of the third party. (Injury)
2260,154 3RD PARTY STATE CA1H;4 POINTER TO STATE FILE (#5)
31. 3RD PARTY STATE
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Enter the state address of the third party.
DESCRIPTION:
This is the state address of the third party. (Injury)
2260,155 3RD PARTY ZIP CODE CA1H;5 FREE TEXT
31. 3RD PARTY ZIP CODE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
DESCRIPTION:
This is the third party's Zip code. (Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,156 PHYSICIAN NAME CA1I;1 FREE TEXT
32. PHYSICIAN NAME
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the name of the physician who first provided medical care to the employee. (Injury)
2260,157 PHYSICIAN ADDRESS CA1I;2 FREE TEXT
32. PHYSICIAN ADDRESS
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: OCT 14, 2009
HELP-PROMPT: Answer must be 3-35 characters in length.
DESCRIPTION:
This is the physician's street address. (Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,158 PHYSICIAN CITY CA1I;3 FREE TEXT
32. PHYSICIAN CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the physician's city address. (Injury)
2260,159 PHYSICIAN STATE CA1I;4 POINTER TO STATE FILE (#5)
32. PHYSICIAN STATE
LAST EDITED: SEP 12, 2000
HELP-PROMPT: Enter the physician's state address.
DESCRIPTION:
This is the physician's state address. (Injury)
2260,160 PHYSICIAN ZIP CODE CA1I;5 FREE TEXT
32. PHYSICIAN ZIP CODE
INPUT TRANSFORM: K:$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
2260,161 FIRST DATE MEDICAL CARE CA1I;6 DATE
32. FIRST DATE MEDICAL CARE RECEIVED
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
2260,162 DISABLED FOR WORK CA1I;7 SET
34. DO MEDICAL REPORTS SHOW EMPLOYEE IS DISABLED FOR WORK
'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)
2260,163 SUPERVISOR AGREE/DISAGREE CA1I;8 SET
35. DOES YOUR KNOWLEDGE OF THE FACTS AGREE WITH THE STATEMENTS OF THE EMPLOYEE
'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)
2260,164 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)
LAST EDITED: APR 08, 1998
HELP-PROMPT: Enter the reasons why you disagree with the employee and/or witness statements.
DESCRIPTION: This is why the supervisor does not agree with the statements of the employee and/or witness
regarding the injury.
2260,165 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)
LAST EDITED: APR 25, 2000
HELP-PROMPT: Enter the reasons why the COP is controverted.
DESCRIPTION:
This is a detailed reason why the employing agency controverts continuation of pay.
TECHNICAL DESCR: If the statement exceeds 528 characters, additional documentation and narrative may be forwarded
to OWCP upon receipt of the claim number. The 9 reasons for controversions can be found in the
OWCP Publication CA-810, "Injury Compensation for Federal Employees". Disputes to an employee's
right to receive COP can be for other grounds such as: employee was not performing the assigned
duties when the injury occurred, or the condition claimed is not the result of a work-related
injury. Any such objections should be supported by factual evidence such as witness statements,
pictures, accident investigation reports or time sheets. Unless one of the 9 reasons are used,
COP must be given to the employee if they have provided appropriate medical documentation
supporting lost time within 10 days of the date(s) claimed.
2260,165.1 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)
2260,165.2 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)
2260,166 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)
2260,167 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)
2260,168 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)
2260,169 NAME OF SUPERVISOR CA1ES;4 POINTER TO NEW PERSON FILE (#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)
2260,170 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)
2260,171 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)
2260,172 SUPERVISOR TITLE CA1L;4 FREE TEXT
38. SUPERVISOR TITLE
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)
2260,173 SUPERVISOR OFFICE PHONE CA1L;5 FREE TEXT
38. SUPERVISOR OFFICE PHONE
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)
2260,173.1 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)
2260,174 FILING INSTRUCTIONS CA1L;6 SET
38. FILING INSTRUCTIONS
'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)
2260,175 DATE NOTICE RECEIVED CA1L;7 DATE
23. DATE OF NOTICE RECEIVED
INPUT TRANSFORM: S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,0)),U,5)\1>X D EN^DDIOL("
DATE NOTICE RECEIVED cannot be prior to DATE/TIME OF OCCURRENCE","","!!?5") K X
LAST EDITED: JAN 31, 2001
HELP-PROMPT: Enter the date the notice was received.
DESCRIPTION:
This is the date the supervisor received notice that the employee filed a CA-1. (Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,176 EMPLOYEE DUTY STATION CA1M;1 FREE TEXT
18. EMPLOYEE'S DUTY STATION
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 27, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the station where the employee works. (Injury)
2260,177 DUTY STATION ADDRESS CA1M;2 FREE TEXT
DUTY STATION ADDRESS
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 05, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the duty station street address. (Injury)
2260,178 DUTY STATION CITY CA1M;3 FREE TEXT
DUTY STATION CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 05, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the duty station city address. (Injury)
2260,179 DUTY STATION STATE CA1M;4 POINTER TO STATE FILE (#5)
DUTY STATION ST.
LAST EDITED: MAY 05, 2000
HELP-PROMPT: Enter the duty station state.
DESCRIPTION:
This is the duty station state address. (Injury)
2260,180 DUTY STATION ZIP CODE CA1M;5 FREE TEXT
DUTY STATION ZIP CODE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
LAST EDITED: MAY 05, 2000
HELP-PROMPT: Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
DESCRIPTION:
This is the duty station's Zip code. (Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,181 ZIP CODE WHERE INJURY OCCURRED CA1A;14 FREE TEXT
ZIP CODE WHERE INJURY OCCURRED
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
LAST EDITED: AUG 29, 2000
HELP-PROMPT: Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
DESCRIPTION: This is the Zip Code of the location where the injury occurred and is used on the CA1 only.
(Injury)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,182 PHYSICIAN TITLE CA1I;9 POINTER TO ASISTS DOL PROVIDER TITLE FILE (#2263.5)
31. PHYSICIAN TITLE
LAST EDITED: SEP 11, 2000
HELP-PROMPT: Enter the Title for the Physician
DESCRIPTION: This is the appropriate title for the Physician who first saw the employee This field is used for
CA1 claims. (Injury)
2260,183 INJURY OCCURRED ADDRESS CA1N;1 FREE TEXT
9. STREET WHERE INJURY OCCURRED
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: SEP 11, 2000
HELP-PROMPT: Answer must be 3-30 characters in length and is the Street address where the injury occurred.
DESCRIPTION: This is the street address where the injury occurred. Generally, this will be the same address as
the duty station street address. (Injury)
2260,184 INJURY OCCURRED CITY CA1N;2 FREE TEXT
9. CITY WHERE INJURY OCCURRED
INPUT TRANSFORM: K:$L(X)>20!($L(X)<3) X
LAST EDITED: SEP 11, 2000
HELP-PROMPT: Answer must be 3-20 characters in length and is the City where the Injury occurred.
DESCRIPTION: This is the City portion of the address where the injury occurred. Generally, this will be the
same as the individual's duty station city. (Injury)
2260,185 INJURY OCCURRED STATE CA1N;3 POINTER TO STATE FILE (#5)
9. STATE WHERE INJURY OCCURRED
LAST EDITED: SEP 11, 2000
HELP-PROMPT: Enter the State portion of the address where the injury occurred.
DESCRIPTION: This is the State portion of the address where the injury occurred. Generally, this will be the
same as the individual's duty station state. (Injury)
2260,199 WORKER'S COMP EDIT CA;8 SET
'Y' FOR Yes;
'N' FOR No;
LAST EDITED: MAR 10, 2000
HELP-PROMPT: Enter whether the Worker's Compensation Personnel edited a field that should trigger a bulletin to
the Supervisor
DESCRIPTION: This field will indicate whether one of the following fields was edited by the Worker's
Compensation Personnel in preparation for sending the claim to DOL (Department of Labor): INJURED
PERFORMING DUTY (#146), NOT INJURED PERFORMING DUTY (#147), INJURY CAUSED BY EMPLOYEE (#148),
INJURY CAUSED BY EMPLOYEE EXPLAIN (#149), SUPERVISOR AGREE/DISAGREE (#163), SUPERVISOR NOT AGREE
EXPLAIN (#164), and REASON AGENCY CONTROVERTS COP (#165). (Injury)
WRITE AUTHORITY: ^
2260,200 HOME PHONE NUMBER CA2A;1 FREE TEXT
5. HOME TELEPHONE
INPUT TRANSFORM: K:$L(X)>18!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Enter Area Code and number separated by hyphens, 3-18 characters.
DESCRIPTION: This is the home phone number of the person involved in this incident. Enter the Area Code and
number separated by hyphens or spaces. E.g., 123-122-3456 or 123 122 3456 (Illness/disease)
2260,201 GRADE AS OF LAST EXPOSURE CA2A;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>18!($L(X)<1) X
LAST EDITED: APR 20, 1998
HELP-PROMPT: Answer must be 1-18 characters in length.
DESCRIPTION:
This is the employee's grade as of the date of last exposure. (Illness/disease)
2260,202 STEP AS OF DATE OF ILL. CA2A;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: APR 08, 1998
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
This is the employee's step as of date of last exposure. (Illness/disease)
2260,203 EMPLOYEE STREET ADDRESS CA2A;4 FREE TEXT
7. STREET ADDRESS
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the employee's street address. (Illness/disease)
2260,204 EMPLOYEE CITY ADDRESS CA2A;5 FREE TEXT
7. CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the employee's city address. (Illness/disease)
2260,205 EMPLOYEE STATE ADDRESS CA2A;6 POINTER TO STATE FILE (#5)
7. STATE
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Enter the state in which the employee resides.
DESCRIPTION:
This is the employee's state address. (Illness/disease)
2260,206 EMPLOYEE ZIP CODE CA2A;7 FREE TEXT
7. ZIP CODE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
LAST EDITED: MAR 24, 2000
HELP-PROMPT: Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
DESCRIPTION:
This is the employee's Zip code. (Illness/disease)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,207 DEPENDENTS CA2A;8 SET
8. DEPENDENTS
'1' FOR Wife, Husband;
'2' FOR Children under 18;
'3' FOR Other;
'4' FOR Wife, Husband + Children under 18;
'5' FOR Wife, Husband + Other;
'6' FOR Children under 18 + Other;
'7' FOR Wife, Husband + Children under 18 + Other;
LAST EDITED: JUN 10, 1998
HELP-PROMPT: Enter the types of dependents.
DESCRIPTION:
These are the employee's dependents. (Illness/disease)
2260,208 EMPLOYEE OCCUPATION CA2A;9 FREE TEXT
9. EMPLOYEE'S OCCUPATION
INPUT TRANSFORM: K:$L(X)>30!($L(X)<2) X
LAST EDITED: MAR 31, 2000
HELP-PROMPT: Answer must be 2-30 characters in length.
DESCRIPTION:
This is a short description of the employee's occupation. (Illness/disease)
2260,209 ILLNESS OCCURRED (LOCATION) CA2B;1 FREE TEXT
10. LOCATION
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: This is the location where the employee worked when the disease or illness occurred.
(Illness/disease)
2260,210 ILLNESS OCCURRED ADDRESS CA2B;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: APR 10, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the street address of the location where the illness occurred. (Illness/disease)
2260,211 ILLNESS OCCURRED CITY CA2B;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: APR 10, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the city of the location where the illness occurred. (Illness/disease)
2260,212 ILLNESS OCCURRED STATE CA2B;4 POINTER TO STATE FILE (#5)
LAST EDITED: APR 10, 1998
HELP-PROMPT: Enter the state where the illness occurred.
DESCRIPTION:
This is the location's state where the illness occurred. (Illness/disease)
2260,213 ILLNESS OCCURRED ZIP CODE CA2B;5 FREE TEXT
INPUT TRANSFORM: K:$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
2260,214 DATE FIRST AWARE OF ILLNESS CA2B;6 DATE
11. DATE YOU FIRST BECAME AWARE OF DISEASE OR ILLNESS
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
2260,215 DATE FIRST REALIZED CAUSE CA2B;7 DATE
12. DATE YOU FIRST REALIZED THE DISEASE OR ILLNESS WAS CAUSED
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^DD
IOL("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
2260,216 RELATIONSHIP OF ILLNESS TO EMP CA2C;0 WORD-PROCESSING #2260.0216
13. EXPLAIN THE RELATIONSHIP TO YOUR EMPLOYMENT, AND WHY YOU CAME TO THIS REALIZATION
LAST EDITED: JUN 16, 1998
DESCRIPTION: This is why you (the employee) feel the illness is related to your employment and how you came to
this realization.
2260,217 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)
14. NATURE OF DISEASE OR ILLNESS
LAST EDITED: JUN 16, 1998
HELP-PROMPT: Enter a complete description of the disease or illness.
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).
2260,218 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)
LAST EDITED: APR 08, 1998
HELP-PROMPT: Explain your reason for the delay in filing this notice.
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.
2260,219 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)
LAST EDITED: APR 08, 1998
HELP-PROMPT: If no attached employee statement, explain reason for delay.
DESCRIPTION: If a seaparate 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.
2260,220 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)
LAST EDITED: APR 08, 1998
HELP-PROMPT: Enter the reason medical reports are not submitted with this notice.
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.)
2260,221 NAME OF EMPLOYEE CA2ES;1 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 27, 1998
2260,222 EMPLOYEE ELECT. SIGNATURE CA2ES;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<6) X
LAST EDITED: APR 08, 1998
HELP-PROMPT: Answer must be 6-20 characters in length.
DESCRIPTION:
This is your (the employee's) electronic signature. (Illness/disease)
2260,223 DATE OF EMPLOYEE SIGNATURE CA2ES;3 DATE
INPUT TRANSFORM: S %DT="ET" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 08, 1998
HELP-PROMPT: Enter the date you signed this notice/claim.
DESCRIPTION:
This is the date you (the employee) signed the notice/claim for compensation. (Illness/disease)
2260,224 OCCUPATION CA2B;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<3) X
LAST EDITED: APR 08, 1998
HELP-PROMPT: Answer must be 3-20 characters in length.
2260,225 OWCP USE NOI CODE CA2B;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: APR 08, 1998
HELP-PROMPT: Answer must be 1-10 characters in length.
2260,226 TYPE CODE CA2B;10 POINTER TO ASISTS DOL TYPE OF INJURY CODES FILE (#2263)
TYPE CODE
LAST EDITED: MAY 12, 2000
HELP-PROMPT: Enter the Type Code that best describes the type of injury
DESCRIPTION: This is the Type code for this claim. The Type code stands for an action and is associated with
the Source code which is an object or substance. Both are used to summarize the incident.
(Illness/disease)
2260,227 SOURCE CODE CA2B;11 POINTER TO ASISTS DOL SOURCE OF INJURY CODES FILE (#2263.1)
SOURCE CODE
LAST EDITED: MAY 12, 2000
HELP-PROMPT: Enter the Source code for this claim
DESCRIPTION: This is the Source code for this claim. It is the object or substance that is used along with the
Type code which is an action. Both are used to summarize the incident. (Illness/disease)
2260,230 AGENCY NAME CA2H;1 FREE TEXT
19. AGENCY NAME
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the agency name of the station reporting the incident. (Illness/disease)
2260,231 AGENCY ADDRESS CA2H;2 FREE TEXT
AGENCY ADDRESS
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: APR 03, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the street address of the agency reporting the incident. (Illness/disease)
2260,232 AGENCY CITY CA2H;3 FREE TEXT
AGENCY CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 01, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the city address of the agency reporting the incident. (Illness/disease)
2260,233 AGENCY STATE CA2H;4 POINTER TO STATE FILE (#5)
AGENCY STATE
LAST EDITED: APR 03, 2000
HELP-PROMPT: Enter the agency's state address.
DESCRIPTION:
This is the state address of the agency reporting the incident. (Illness/disease)
2260,234 AGENCY ZIP CODE CA2H;5 FREE TEXT
AGENCY ZIP CODE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
LAST EDITED: APR 03, 2000
HELP-PROMPT: Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
DESCRIPTION:
This is the Zip code of the agency reporting the incident. (Illness/disease)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,235 OWCP AGENCY CODE CA2H;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: APR 09, 1998
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is a four digit (or four digit plus two letter) code used by the OWCP to identify the
employing agency. The proper code may be obtained from your personnel or compensation office, or
by contacting OWCP. (Illness/disease)
2260,236 OSHA SITE CODE CA2H;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: APR 09, 1998
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is the Occupational Safety and Health Administration (OSHA) Site code for the reporting
agency. (Illness/disease)
2260,237 EMPLOYEE DUTY STATION CA2I;1 FREE TEXT
20. EMPLOYEE'S DUTY STATION
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the agency/site where the employee actually works. (Illness/disease)
2260,238 DUTY STATION ADDRESS CA2I;2 FREE TEXT
DUTY STATION ADDRESS
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 05, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the address of the site where the employee works. (Illness/disease)
2260,239 DUTY STATION CITY CA2I;3 FREE TEXT
DUTY STATION CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 05, 2000
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the city where the employee works. (Illness/disease)
2260,240 DUTY STATION STATE CA2I;4 POINTER TO STATE FILE (#5)
DUTY STATION ST.
LAST EDITED: APR 19, 2000
HELP-PROMPT: Enter the state address of the site where the employee works.
DESCRIPTION:
This is the state address for where the employee works. (Illness/disease)
2260,241 DUTY STATION ZIP CODE CA2I;5 FREE TEXT
DUTY STATION ZIP CODE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5)!'(X?5N!(X?5N1"-"4N)) X
LAST EDITED: MAY 05, 2000
HELP-PROMPT: Answer with 5 numerics or 5 numerics, a dash ("-") and 4 numerics. e.g. 12345 or 12345-1234
DESCRIPTION:
This is the Zip code for the employee's duty station. (Illness/disease)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,242 REGULAR HRS FROM TIME CA2I;6 FREE TEXT
21. REGULAR HRS FROM TIME
INPUT TRANSFORM: D TI^OOPSUTL3
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-7 characters in length.
DESCRIPTION:
This the time the employee generally starts work. (Illness/disease)
EXECUTABLE HELP: D HLP^OOPSUTL3
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,243 REGULAR HRS TO TIME CA2I;7 FREE TEXT
21. REGULAR HRS TO TIME
INPUT TRANSFORM: D TI^OOPSUTL3
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-7 characters in length.
DESCRIPTION:
This is the time the employee generally stops work. (Illness/disease)
EXECUTABLE HELP: D HLP^OOPSUTL3
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,244 REGULAR WORK SCHEDULE CA2I;8 FREE TEXT
22. REGULAR WORK SCHEDULE
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
OUTPUT TRANSFORM: D RWSOT^OOPSUTL2
LAST EDITED: NOV 09, 2001
HELP-PROMPT: Answer must be 1-14 characters in length.
DESCRIPTION: At the time of the incident, this was the work schedule for the employee. Examples: For Monday
through Friday, enter 2-6 For Sunday, Wednesday through Saturday, enter 1,4-7 or 1,4,5,6,7
(Illness/disease)
2260,245 NAME OF PHYSICIAN CA2J;1 FREE TEXT
23. NAME OF PHYSICIAN
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the name of the physician first providing medical care for the employee. (Illness/disease)
2260,246 PHYSICIAN ADDRESS CA2J;2 FREE TEXT
23. PHYSICIAN ADDRESS
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the street address of the physician providing medical care. (Illness/disease)
2260,247 PHYSICIAN CITY CA2J;3 FREE TEXT
23. PHYSICIAN CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the city address of the physician providing medical care. (Illness/disease)
2260,248 PHYSICIAN STATE CA2J;4 POINTER TO STATE FILE (#5)
23. PHYSICIAN STATE
LAST EDITED: MAY 04, 1998
HELP-PROMPT: Enter the state address of the physician providing medical care.
DESCRIPTION:
This is the state address of the physician providing medical care. (Illness/disease)
2260,249 PHYSICIAN ZIP CODE CA2J;5 FREE TEXT
23. PHYSICIAN ZIP CODE
INPUT TRANSFORM: K:$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
2260,250 FIRST DATE MEDICAL CARE CA2J;6 DATE
24 1ST DATE MEDICAL CARE RECEIVED
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^DD
IOL("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
2260,251 DISABLED FOR WORK CA2J;7 SET
25. DO MEDICAL REPORTS SHOW EMPLOYEE IS DISABLED FOR WORK
'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)
2260,252 DATE NOTICE RECEIVED CA2J;8 DATE
26. DATE EMPLOYEE FIRST REPORTED CONDITION TO SUPERVISOR
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^DD
IOL("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
2260,253 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
2260,254 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),'$$DTVAL^OOPSUTL4(X,254,253) K X,%DT
LAST EDITED: JUN 26, 2008
HELP-PROMPT: Enter the date/time the employee's pay stopped.
DESCRIPTION:
This is the date and time the employee's pay stopped. (Illness/disease)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,255 DATE OF LAST EXPOSURE CA2J;11 DATE
29. DATE OF LAST EXPOSURE
INPUT TRANSFORM: S %DT="EX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X I $G(X),$P($G(^OOPS(2260,DA,"CA2B")),U,5)\1>X D EN^DD
IOL("DATE OF LAST EXPOSURE cannot be prior to DATE FIRST AWARE OF ILLNESS","","!!?5") K X
LAST EDITED: JUN 25, 2001
HELP-PROMPT: Enter the date the employee was last exposed to conditions.
DESCRIPTION: This is the date the employee was last exposed to conditions alleged to have caused the disease or
illness. (Illness/disease)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2260,256 DATE/TIME RETURNED TO WORK CA2J;12 DATE
INPUT TRANSFORM: S %DT="ERX",%DT(0)="-NOW" D ^%DT S X=Y K:Y<1 X,%DT I $G(X),'$$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
2260,257 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)
LAST EDITED: APR 09, 1998
HELP-PROMPT: Enter the employee's new duties if the work assignment changed.
DESCRIPTION: If the work assignment changed when the employee returned to work, this is a description of the
employee's new duties.
2260,258 INJURY CAUSED BY 3RD PARTY CA2L;1 SET
32. WAS INJURY CAUSED BY 3RD PARTY
'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)
2260,259 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)
2260,260 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)
2260,261 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)
2260,262 3RD PARTY STATE CA2L;5 POINTER TO STATE FILE (#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)
2260,263 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
2260,264 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)
2260,265 NAME OF SUPERVISOR CA2ES;4 POINTER TO NEW PERSON FILE (#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)
2260,266 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)
2260,267 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)
2260,268 SUPERVISOR TITLE CA2H;8 FREE TEXT
35. SUPERVISOR TITLE
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)
2260,269 SUPERVISOR PHONE CA2H;9 FREE TEXT
35. SUPERVISOR PHONE
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)
2260,269.1 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)
2260,270 PHYSICIAN TITLE CA2J;13 POINTER TO ASISTS DOL PROVIDER TITLE FILE (#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)
2260,303 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.
2260,304 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.
2260,305 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.
2260,306 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).
2260,307 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.
2260,308 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.
2260,309 EMP NAME OF DUAL BENEFIT DUAL;7 POINTER TO NEW PERSON FILE (#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.
2260,310 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.
2260,311 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.
2260,312 WC NAME FOR DUAL BENEFIT DUAL;10 POINTER TO NEW PERSON FILE (#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.
2260,313 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.
2260,314 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.
2260,330 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.
2260,331 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.
2260,332 AGENCY CONTROVERTS CODE CA1I;12 POINTER TO ASISTS REASON FOR CONTROVERT FILE (#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.
2260,333 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.
2260,334 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.
2260,335 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
2260,336 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.
2260,337 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.
2260,338 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.
2260,339 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.
2260,340 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.
2260,341 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.
2260,342 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.
2260,343 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.
2260,344 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.
2260,345 OTHER FACILITY STATE 2162L;5 POINTER TO STATE FILE (#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.
2260,346 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.
2260,347 REASON FOR DISPUTE CODE CA1I;13 POINTER TO ASISTS REASON FOR DISPUTE CODES FILE (#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.
2260,348 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.
2260,349 LOSS OF CONSCIOUSNESS 2162L;7 SET (Required)
'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.
2260,350 PRESCRIPTION STRGTH MEDS GIVEN 2162L;8 SET (Required)
'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.
2260,351 NON-SCRIPT MEDS AT SCRIPT DOSE 2162L;9 SET (Required)
'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).
2260,352 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.
2260,353 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
2260,354 WEATHER FACTOR 2162M;1 POINTER TO ASISTS INCIDENT WEATHER FACTORS FILE (#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.
2260,355 SOURCE OF INCIDENT 2162M;2 POINTER TO ASISTS INCIDENT SOURCE FILE (#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.
2260,356 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
2260,357 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.
2260,358 PREVENTIVE METHOD 2162M;5 POINTER TO ASISTS PREVENTION METHODS FILE (#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.
2260,359 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.
2260,360 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.
2260,384 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.
FILES POINTED TO FIELDS
ASISTS CHARACTERIZATION OF INJ
(#2261) CHARACTERIZATION OF INJURY (#29)
ASISTS CRITICAL TRACKING ISSUE
(#2261.2) TYPE OF INCIDENT (#3)
ASISTS DEVICE SIZE (#2262.2) DEVICE SIZE (#83)
ASISTS DEVICE/EQUIPMENT (#2261.7) OBJECT CAUSING INJURY (#38)
ASISTS DOL ANATOMICAL LOCATION
(#2261.1) BODY PART MOST AFFECTED (#30)
ADDITIONAL BODY PART AFFECTED (#30.1)
ASISTS DOL CAUSE OF INJURY COD
(#2263.2) CAUSE OF INJURY CODE (#126)
ASISTS DOL DISTRICT OFFICE
(#2262.1) OWCP DISTRICT OFFICE (#73)
ASISTS DOL NATURE OF INJURY CO
(#2263.3) NOI CODE (#62)
ASISTS DOL PROVIDER TITLE
(#2263.5) PHYSICIAN TITLE (#182)
PHYSICIAN TITLE (#270)
ASISTS DOL SOURCE OF INJURY CO
(#2263.1) SOURCE CODE (#124)
SOURCE CODE (#227)
ASISTS DOL TYPE OF INJURY CODE
(#2263) TYPE CODE (#123)
TYPE CODE (#226)
ASISTS INCIDENT SOURCE (#2261.22) SOURCE OF INCIDENT (#355)
ASISTS INCIDENT WEATHER FACTOR
(#2261.21) WEATHER FACTOR (#354)
ASISTS NEEDLESTICK BRANDS
(#2262.3) BRAND (#82)
ASISTS OCCURRENCE OF SHARPS IN
(#2261.6) ACTIVITY AT TIME OF INJURY (#37)
ASISTS OWCP CHARGEBACK CODES
(#2263.6) OWCP CHARGEBACK CODE (#70)
ASISTS PERSONAL PROTECTIVE EQU
(#2261.3) PERSONAL PROTECTIVE EQUIPMENT:PERSONAL PROTECTIVE EQUIPMENT (#.01)
ASISTS PREVENTION METHODS
(#2261.24) PREVENTIVE METHOD (#358)
ASISTS PURPOSE FOR USING SHARP
(#2261.5) PURPOSE OF SHARP OBJECT (#36)
ASISTS REASON FOR CONTROVERT
(#2262.4) AGENCY CONTROVERTS CODE (#332)
ASISTS REASON FOR DISPUTE CODE
(#2262.8) REASON FOR DISPUTE CODE (#347)
ASISTS RESULTS (#2261.8) BODILY FLUID EXPOSURE SOURCE (#41)
ASISTS SAFETY CHARACTERISTICS
(#2261.9) SAFETY CHARACTERISTICS (#84)
ASISTS SETTING OF INJURY
(#2261.4) LOCATION OF INJURY (#27)
INSTITUTION (#4) STATION NUMBER (#13)
NEW PERSON (#200) SUPERVISOR (#44)
SAFETY OFFICER NAME (#48)
SUPERVISOR (#53)
SECONDARY SUPERVISOR (#53.1)
PERSON ENTERING STUB RECORD (#56)
TRANSMIT TO WCMIS (#67)
NAME OF SAFETY OFFICER (#76)
EMPLOYEE HEALTH NAME (#79)
NAME OF EMPLOYEE (#119)
NAME OF SUPERVISOR (#169)
NAME OF EMPLOYEE (#221)
NAME OF SUPERVISOR (#265)
EMP NAME OF DUAL BENEFIT (#309)
WC NAME FOR DUAL BENEFIT (#312)
INCIDENT OUTCOME:INCIDENT CREATED BY (#7)
LAST EDITED BY (#9)
SERVICE/SECTION (#49) SERVICE (#86)
STATE (#5) STATE (#10)
EMPLOYEE STATE ADDRESS (#105)
WITNESS STATE (#116.2)
AGENCY STATE (#133)
3RD PARTY STATE (#154)
PHYSICIAN STATE (#159)
DUTY STATION STATE (#179)
INJURY OCCURRED STATE (#185)
EMPLOYEE STATE ADDRESS (#205)
ILLNESS OCCURRED STATE (#212)
AGENCY STATE (#233)
DUTY STATION STATE (#240)
PHYSICIAN STATE (#248)
3RD PARTY STATE (#262)
OTHER FACILITY STATE (#345)
WITNESS NAME:WITNESS STATE (#3)
File #2260
Record Indexes:
AF (#567) RECORD REGULAR IR SORTING ONLY
Short Descr: Reg Index on fields 4 and 88
Set Logic: S ^OOPS(2260,"AF",X(1),X(2),DA)=""
Kill Logic: K ^OOPS(2260,"AF",X(1),X(2),DA)
Whole Kill: K ^OOPS(2260,"AF")
X(1): DATE/TIME OF OCCURRENCE (2260,4) (Subscr 1) (forwards)
X(2): INCLUDE ON OSHA LOG (2260,88) (Subscr 2) (forwards)
Subfile #2260.095
Record Indexes:
AC (#568) RECORD REGULAR IR SORTING ONLY
Short Descr: S
Set Logic: S ^OOPS(2260,DA(1),"OUTC","AC",X(1),X(2),DA)=""
Kill Logic: K ^OOPS(2260,DA(1),"OUTC","AC",X(1),X(2),DA)
Whole Kill: K ^OOPS(2260,DA(1),"OUTC","AC")
X(1): STATUS (2260.095,10) (Subscr 1) (forwards)
X(2): INCIDENT OUTCOME (2260.095,2) (Subscr 2) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):