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What To Do When Injured on the Job | ![]() |
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Click here to view What To Do When Injured on the Job |
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Incident/Accident forms | ![]() |
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Madison Location Accident/Illness Reporting Instructions Listed below are the documents that need to be completed and returned to Terri Gureno (terri.gureno@ars.usda.gov) within 24 hours of the Incident/Accident.
Form CA-16 Authorization for Examination And/Or Treatment - authorizes an injured employee to obtain immediate examination and/or treatment from a physician chosen by the employee for an on-the-job injury. Forms are available from Terri Gureno, Julie Grogan, or from SHEM stations within each building. Form CA-20 Attending Physician’s Report – If you decide to see a medical professional 48 hours or more after the incident, you will need to take the CA-20 form and give to the attending physician to complete. This form along with the appointment bill is then sent to the Worker’s Compensation Specialist in Beltsville. Form CA-1 Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation – Please complete all boxes 1-15. Do not complete shaded areas. Witness (If there is a witness) Complete bottom section 16. Supervisor completes all of the 2nd page. I will complete OWCP Agency Code and OSHA Site Code. If a question is not applicable to you or the situation enter N/A in the boxes. All boxes must be filled in or the form will be rejected at Headquarter’s. Form CA-2 Notice of Occupational Disease and Claim for Compensation Form CA-2A Notice of Recurrence
OSHA Forms 300, 300A, 301 Instructions OSHA Forms 300, 300A, 301 - Log of Work-Related Injuries and Illness
160.0M - Safety, Health, and Environmental Management Program P&P
Basic Program Elements for Federal Employees OSHA Executive Order 12196 – Occupational Safety and Health Programs for Federal Employees |
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Pandemic Plan | ![]() |
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Click here to view the Pandemic Plan (login required) |
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Biosecurity Plan | ![]() |
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Click here to view the Biosecurity Plan. |
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IACUC Executive Summaries | ![]() |
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Annual EMS Policy | ![]() |
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Click here to view the annual Environmental Management System Policy. |
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Current SHEM Committee Members | ![]() |
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Click here to see the current SHEM Committee members: http://usda.wisc.edu/safety/forms/SHEMCommitteeRosterFY21.pdf |
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Location Emergency Plans | ![]() |
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To download the Occupant Emergency Plan for the Madison location, click here: http://usda.wisc.edu/safety/forms/OccupantEmergencyPlan-Madison.pdf
To download the Emergency and Waste Incidence Reporting plan, click here: http://usda.wisc.edu/safety/forms/MadisonEmergencyandIncidentReportingPlan-2016.pdf |
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Supervisor Safety Training | ![]() |
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*** If you are having trouble viewing this video, click here to download: http://usda.wisc.edu/safety/training/SupervisorsTraining.mp4
Safety and health posters: http://www.afm.ars.usda.gov/shem/safetyhealth/
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Midwest Area ATV Safety Training | ![]() |
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*** If you are having trouble viewing this video, click here to download: http://usda.wisc.edu/safety/training/ATVTraining.mp4 |
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2019-2020 Meeting Schedule | ![]() |
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Page last updated on: March 24, 2022
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