308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
English French Notes Complete/Exclude
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Invalid character entered, (~,`, @,#,$,%,^,*,_,|,\,},{,[,],>, or <),
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Max length for field is
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characters, you have entered
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. Please Edit.
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126 CAUSE OF INJURY CODE.......
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217 14. NATURE OF DISEASE OR ILLNESS~
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Max length for field is 264 characters, you have entered
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218 15. IF THIS NOTICE AND CLAIM WAS NOT FILED WITH THE EMPLOYING AGENCY WITHIN 30 DAYS AFTER DATE SHOWN ABOVE IN ITEM #12, EXPLAIN THE REASON FOR THE DELAY~
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219 16. IF A SEPARATE NARRATIVE STATEMENT IS NOT SUBMITTED WITH THIS FORM, EXPLAIN REASON FOR DELAY~
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220 17. IF MEDICAL REPORTS ARE NOT SUBMITTED WITH THIS FORM, EXPLAIN REASON FOR DELAY~
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Federal Employee's Notice of Traumatic Injury and
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Claim for Continuation of Pay/Compensation (Form CA-1)
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Description of Injury
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108 9. PLACE WHERE INJURY OCCURRED...
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183 ADDRESS WHERE INJURY OCCURRED.
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184 CITY WHERE INJURY OCCURRED....
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185 STATE WHERE INJURY OCCURRED...
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181 ZIP CODE WHERE INJURY OCCURRED
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109 10. DATE/TIME INJURY OCCURRED..//^S X=OOPS(2260,IEN,4,
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110 11. DATE OF THIS NOTICE........//^S X=DT
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112 13. CAUSE OF INJURY (DESCRIBE WHAT HAPPENED AND WHY)
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113 14. NATURE OF INJURY (IDENTIFY BOTH THE INJURY AND THE PART OF THE BODY e.g. FRACTURE OF LEFT LEG)
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Employee Signature
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114 15. REQUEST PAY OR LEAVE.......
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6////SIGNED WITNESS STATEMENT TO FOLLOW.
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No electronic signature on file!
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No electronic signature block on file!
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Enter Signature Code:
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Enter your Electronic Signature code to verify this action.
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... Not Signed.
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.01 SITE NAME...............
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1 OWCP AGENCY CODE........
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2 OWCP DISTRICT OFFICE....
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3 1. TYPE OF INCIDENT...........
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6 2. DATE OF BIRTH..............
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8 5. HOME STREET ADDRESS........
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11 8. ZIP CODE...................
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12 9. HOME PHONE NUMBER..........
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13 10. STATION NUMBER.............
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53.1 12. SECONDARY SUPERVISOR.......
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File is currently locked by another user
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.01 UNION NAME.................
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1 UNION ACRONYM..............
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2 UNION REPRESENTATIVE.......
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Enter PAY RATE PER data for a single case or all cases.
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PAY RATE PER field must be blank or have invalid data to access the record.
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Select 1 for ALL Cases, 2 for a Single Case:
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No Cases Selectable
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OOPS GUI EMPLOYEE HEALTH MENU
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OOPS GUI EMPLOYEE
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OOPS GUI SUPERVISOR MENU
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OOPS GUI SAFETY OFFICER MENU
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OOPS GUI UNION MENU
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OOPS GUI WORKERS' COMP MENU
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User not Authorized to sign form
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No Signature Entered
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No Electronic Signature on File
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Invalid Signature Entered.
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FULL CSRS
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PER ANNUM
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PER HOUR
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Invalid Input, cannot continue.
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Invalid data on claim
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not found in file 2260
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not valid, must be CA1,CA2, or 2162
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IEN,NODE)
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IEN,NODE,LINE,0)
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IEN,NODE,0)
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VALID DATE
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DATE ERROR
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FLAG ERROR
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UPDATE FAILED
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UPDATE COMPLETE
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WITNESS CREATION FAILED
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WITNESS CREATION SUCCESSFUL
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DELETION FAILED
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SUCCESSFULLY DELETED
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EDIT FAILED
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EDIT SUCCESSFULL
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Need Record Number to proceed
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Another User Editing Record, Try Again Later.
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RECORD LOCKED
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RECORD UNLOCKED
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XREF,ITEM)
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XREF,ITEM,PTR)
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PTR,0)
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DA(1),NODE,DA)
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IEN,NODE,REC)
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IEN,NODE,REC,0)
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DATA,0)
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IEN,NODE,DA)
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IEN,NODE,DA,0)
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INVALID STATION
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UNABLE TO CREATE RECORD
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Injury
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Illness/Disease
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UPDATE COMPLETED
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No Changes Filed
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Record Successfully Deleted
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Failed
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union added
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Union Update Successful.
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Union Update NOT Successful.
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No Site Parameter File was Found
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This option in use by another user, try again later.
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Successfully Added
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Missing Record Identifiers, Cannot file.
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Deletion did not occur.
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Record successfully deleted
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Filing
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Missing Station, Cannot continue.
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Missing Station, cannot file.
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Update Successful
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Update was not Successful
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Cannot File Changes, no Record Number
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Update Site data Successful
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Update Site data was NOT Successful
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Missing Record Identifier, cannot file.
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Case transmitted to DOL, cannot change status to Deleted.
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Case Status has been changed to:
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OOPS XMIT 2162 DATA
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Invalid Transmission Date
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Invalid Queue Date.
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TRANSMIT NATIONAL DATABASE 2162 DATA
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SUCCESSFULLY QUEUED
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No data. Missing Record Identifier.
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No data. Missing File or Field information.
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OOPS ISO NOTIFICATION
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G.OOPS WC MESSAGE
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ASISTS ISO NOTIFICATION Mail Group Error
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The OOPS ISO NOTIFICATION Mail Group does not exist.
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There are no members in mail group OOPS ISO NOTIFICATION.
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G.OOPS ISO NOTIFICATION
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OOPS SENSITIVE DATA
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BULLETIN SENT
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Safety Officer
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Employee Health
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approves the WCP signing for the Employee:
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Missing Information, Cannot Continue
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You have approved as
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Emp Health Rep
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and cannot sign as Employee.
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Three different individuals must be involved.
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Safety Officer has not approved WCP signing for employee.
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Employee Health has not approved WCP signing for employee.
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All required fields not completed
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You have signed as
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, Cannot sign.
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You have already signed as
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Both signatures cannot be made by the same person.
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has already signed, re-signing is not required.
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Clearing Signatures
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The following fields must be completed before the
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can be signed.
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must be on or after the
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cannot be blank if date in
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Processing...
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Input parameters missing, cannot run report.
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Union
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Illness
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Friday
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Monday
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Thursday
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Tuesday
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Wednesday
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Type of Incidents
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Occupation Code
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Characterization of Injury
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Body Parts
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Day of Week
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Time of Day
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Employee
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Supervisor
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Case Number Name SSN Date/Time of Incident
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Un-Signed
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Safety Officer:
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Starting Date for the Report
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Select a Starting Date from the range displayed.
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Ending Date for the Report
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Select a Ending Date from the range displayed
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The Ending Date cannot be before or on the Starting Date, please re-enter this data.
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for Period
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Employees and volunteers only
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Cases to be included:
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Include names of persons involved
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Log of Needlestick Incidents
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Log of Federal Occupational Injuries and Illnesses
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All cases
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Replaced by amendment
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Illness/disease
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Log Summary
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Injuries.:
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Fatal Injuries....:
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Lost Time Injuries....:
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Illnesses:
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Fatal Illnesses...:
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Lost Time Illnesses...:
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Total....:
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Total.............:
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Total.................:
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Lost Time
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Inj/Ill
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Type of Incident
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Char. of Injury
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Body Part Affected
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Activity at time of Injury
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Object Causing Injury
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Model and Brand of Object Causing Injury
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Location of Injury
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Description of Injury
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Run report for 'ALL' Stations
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Enter 'Y'es to run for all Stations or 'N'o to run
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for just one Station.
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No Station selected, report will not run
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No data for that Station Number, Please select again.
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Description of Injury:
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OOPS CASE
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OOPS INJURY
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OOPS UNION
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OOPS EH
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OOPS SAFETY
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OOPS WCPBOR
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OOPS CONSENT
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OOPS WC EDITED
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OOPS WC SIGNED
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OOPS WORKERS COMP
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OOPS SUPERVISOR
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OOPS EMPLOYEE
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OOPS BILL OF RIGHTS
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You do NOT have the required Security Key.
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Press Enter to continue
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No Transmission. Press Enter to continue
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Enter 'Y' if you want the 2162 data placed in mail
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TRAMSIT NATIONAL DATABASE 2162 DATA
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The Queue Q-ASI.MED.VA.GOV has not been created.
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Install Patch XM*999*130, complete manual
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Transmission of NDB Data.
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OOPS NDB MESSAGES
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The Mail Group OOPS NDB MESSAGES is missing.
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to the AAC. Then contact IRM to complete manual
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There are no members of the OOPS NDB MESSAGES
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ASISTS NDB data to and from the AAC. After adding member
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contact IRM to complete manual transmission of NDB data.
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Mail Message was not created. Contact IRM to comlete
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the manual transmission of ASISTS NDB data.
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ASISTS NATIONAL DATABASE
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XXX@Q-ASI.MED.VA.GOV
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has missing data
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that must be entered prior
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to transmitting to AAC.
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Missing SSN
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Missing DOB
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Missing SEX
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ASISTS Records Missing Necessary Data Elements
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G.OOPS NDB MESSAGES@
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ASISTS NDB Error Notification Message
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IN;SP1;IP;PW.3;SC0,22,0,29,1;
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DT@,1;SD1,277,2,1,4,9,5,0,6,1,7,23;
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PU.5,28.8;LBOfficial Supervisor's Report of Occupational Disease: Please complete information requested below@;
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PU.4,28.2;FT10,10;RA21,28.6;PU.5,28.6;PD21,28.6;PU.5,28.3;LBSupervisor's Report@;PU.5,28.2;PD21,28.2;
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SD1,277,2,1,4,9,5,0,6,0,7,16901;
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PU.5,27.9;LB19. Agency name, and address of reporting office (Include city, state, and zip code)@;
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PU16.2,28.2;PD16.2,27.3;PU16.3,27.9;LBOWCP Agency Code@;
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PU15.2,26.4;PD15.2,27.3;PU15.3,27;LBOSHA Site Code@;PU12,26.1;LBZip Code@;PU17.5,25.3;LBZip Code@;
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PU.5,27.3;PD21,27.3;PU.5,26.4;PD21,26.4;
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PU.5,25.6;PD21,25.6;
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PU.5,25.3;LB20. Employee's duty station (Street address and zip code)@;
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PU.5,24.7;PD21,24.7;
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PU.5,24.4;LB21. Regular@;PU1.1,24.1;LBwork@;PU1.1,23.8;LBhours@;PU2.2,23.8;LBFrom@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU3.4,23.8;LB:@;
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PU4.1,24.2;EA4.3,24.4;PU4.5,24.2;LBa.m.@;PU4.1,23.8;EA4.3,24;PU4.5,23.8;LBp.m.@;PU5.8,23.8;LBTo@;
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SD1,277,2,1,4,9,5,0,6,5,7,23;PU6.8,23.8;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;
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PU7.4,24.2;EA7.6,24.4;PU7.8,24.2;LBa.m.@;PU7.4,23.8;EA7.6,24;PU7.8,23.8;LBp.m.@;
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PU8.9,24.7;PD8.9,23.4;PU9,24.4;LB22. Regular@;PU9.6,24.1;LBwork@;PU9.6,23.8;LBschedule@;
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PU11,23.8;EA11.2,24;PU11.4,23.8;LBSun.@;PU12.3,23.8;EA12.5,24;PU12.7,23.8;LBMon.@;
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PU13.6,23.8;EA13.8,24;PU14,23.8;LBTues.@;PU14.9,23.8;EA15.1,24;PU15.3,23.8;LBWed.@;
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PU16.2,23.8;EA16.4,24;PU16.6,23.8;LBThurs.@;PU17.7,23.8;EA17.9,24;PU18.1,23.8;LBFri.@;
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PU18.8,23.8;EA19,24;PU19.2,23.8;LBSat.@;
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PU.5,23.5;PD21,23.5;PU.5,23.2;LB23. Name and address of physician first providing medical care@;
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LB (Include city, state, zip code)@;
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PU13.9,23.5;PD13.9,21;PU14,23.2;LB24. First date@;PU17.5,23.2;LBMo.@;PU18.4,23.2;LBDay@;PU19.3,23.2;LBYr.@;
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PU14.5,22.9;LBmedical@;PU14.5,22.6;LBcare received@;PU13.9,22.3;PD21,22.3;
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PU17.3,22.4;PD19.9,22.4;PU17.3,22.4;PD17.3,22.6;PU18.2,22.4;PD18.2,22.6;PU19.1,22.4;PD19.1,22.6;PU19.9,22.4;PD19.9,22.6;
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PU14,22;LB25. Do medical reports@;PU14.5,21.7;LBshow employee is@;PU14.5,21.4;LBdisabled for work?@;
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PU17.5,21.7;EA17.7,21.9;PU17.9,21.7;LBYes@;PU18.9,21.7;EA19.1,21.9;PU19.3,21.7;LBNo@;
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PU.5,22.6;PD13.9,22.6;PU.5,21.8;PD13.9,21.8;PU.5,21;PD21,21;
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PU.5,20.7;LB26. Date employee@;PU3.4,20.7;LBMo.@;PU4.3,20.7;LBDay@;PU5.3,20.7;LBYr.@;
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PU6.2,20.7;PD6.2,19.7;PU6.3,20.7;LB27. Date and@;PU9.4,20.7;LBMo.@;PU10.2,20.7;LBDay@;PU11.2,20.7;LBYr.@;
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PU1.1,20.4;LBfirst reported@;PU1.1,20.1;LBcondition to@;PU1.1,19.8;LBsupervisor@;
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PU3.2,20.1;PD5.9,20.1;PU3.2,20.1;PD3.2,20.3;PU4.1,20.1;PD4.1,20.3;PU5,20.1;PD5,20.3;PU5.9,20.1;PD5.9,20.3;PU6.2,21;PD6.2,19.7;
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PU6.9,20.4;LBhour employee@;PU6.9,20.1;LBstopped work@;
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PU9.2,20.1;PD11.8,20.1;PU9.2,20.1;PD9.2,20.3;PU10,20.1;PD10,20.3;PU10.9,20.1;PD10.9,20.3;PU11.8,20.1;PD11.8,20.3;
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PU12.1,20.1;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU13.7,20.1;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;
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PU14.5,20.4;EA14.7,20.6;PU14.9,20.4;LBa.m.@;PU14.5,20;EA14.7,20.2;PU14.9,20;LBp.m.@;
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PU.5,19.7;PD21,19.7;
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PU.5,19.4;LB28. Date and@;PU3.5,19.4;LBMo.@;PU4.4,19.4;LBDay@;PU5.3,19.4;LBYr.@;PU10.1,19.7;PD10.1,18.4;PU10.2,19.4;
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LB29. Date employee was last@;
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PU14.2,19.4;LBMo.@;PU15,19.4;LBDay@;PU16,19.4;LBYr.@;
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PU1,19.1;LBhour employee's@;PU1,18.8;LBpay stopped@;PU3.4,18.8;PD5.9,18.8;PU3.4,18.8;PD3.4,19;PU4.2,18.8;PD4.2,19;PU5.1,18.8;PD5.1,19;PU5.9,18.8;PD5.9,19;
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PU6.3,18.8;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU7.7,18.8;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;
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PU8.5,19.1;EA8.7,19.3;PU8.9,19.1;LBa.m.@;PU8.5,18.7;EA8.7,18.9;PU8.9,18.7;LBp.m.@;
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PU10.6,19.1;LBexposed to conditions@;PU10.6,18.8;LBalleged to have caused@;PU10.6,18.5;LBdisease or illness@;
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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