Embedded Files
Proper data collection is vital to reducing risk in our city because it informs proactive measures that attack root causes.
Proper data collection is vital to reducing risk in our city because it informs proactive measures that attack root causes.
The Personnel Department's Workers' Compensation and Occupational Safety and Health Divisions provide a number of forms and templates that support healthy data collection in the city. Your timely participation and adherence to established policies is at the core of reducing the city's claims. General Managers can conduct their quarterly reporting here.
The documents below can be accessed through Personnel Department’s intranet at http://per.ci.la.ca.us/Safety/Safety_Page.htm
- Form 5020 – Employer’s Report of Injury
- Employee’s Report of Injury/Illness Form
- Supervisor’s Investigation Form
- Accident/Incident Witness Statement Form
- Near Miss Reporting and Investigation Form
- Safety Concern or Suggestion Form
- Hazard Abatement Form
- Cal/OSHA Accident Reporting Worksheet
- Safety and Health Training Form
- Safety Training Needs Analysis Form
- Sample Hazard Assessment and Safety Inspection Checklist
- Safety | City of L.A. Personnel Department
- Sample Hazard Assessment, PPE Evaluation, and Certification Form
Templates:
Templates:
- Injury and Illness Prevention Program Template
- Hazard Communication Program Summary Template
- Emergency Action Plan
- Fire Prevention Templates
- Worksite Specific Heat Illness Prevention Program (HIPP) Plan
Additional Guiding Documents:
Additional Guiding Documents:
- Occupational Safety and Health Division Staff Directory
- Guidelines to Developing a Safety Committee
- A Guide to Personal Protective Equipment
- Quick Reference Workers’ Compensation Guide
- Citywide Temporary Modified Duty Program for IOD Cases
- Revision to Executive Directive No. PE-1
- City of Los Angeles Reasonable Accommodation Process
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