Appraisal Plan - Captain
Employee Performance Appraisal
Plan - Engineer
Workers' Compensation Forms
CA-1 Form (Federal Employee's Notice of Traumatic Injusry and Claim for Continuation of Pay/Compensation)
CA-2 Form (Notice of Occupational Disease and Claim for Compensation)
CA-16 Form, Authorization for Examination And/Or Treatment - this form must be filled out by the supervisor and sent to the medical facility upon an employee's traumatic injury. The CA-16 is valid up to 60 days from date of injury i.e. it can be used to support medical referrals beyond the initial visit until OWCP evaluates the CA-1 and issues a claim number. The supervisor must complete Part A in full. The authorization is not valid unless the name and address of the physician or hospital is entered in Item 1 and the signature of the authorizing official appears in Item B. Ensure B1 or B2 or Item 6 is checked, whichever is appropriate. Send original to the treating physician and a copy to the HR office as soon as possible.
CA-17 Form, Duty Status Report - This form is provided to the physician to complete. The purpose of this form is to obtain a duty status report for the employee. Supervisors complete Side A and refer the form to the physician to complete Side B. Enter the OWCP file number in the top right corner, if issued. Return completed form to HR office within 2 days to prevent interruption of the employee's income.
CA-7 Form (Claim for Compensation)
CA-20 Form, Attending Physician's Report - This medical report is required by OWCP BEFORE payment of compensation for loss of wages can be made to the employee. Recommend this form used in lieu of a narrative medical report issued by the physician. NOTE: If you submitted a FORM CA-16 TO OWCP WITHIN THE PAST 10 DAYS, YOU NEED NOT SUBMIT THIS FORM CA-20. However, any medical beyond this date WILL require a CA-20 for compensation purposes.
DOI Safety Management Information System (SMIS)
Department of Labor - Division of Federal Employees' Compensation (DFEC) Website
BLM COSO Internal Guidance
Step by Step Instructions for a Traumatic Injury