City Of PhiladelphiaAccident, Injury & Illness Report

City of Philadelphia Office of FinanceRisk Mgmt. Division

COPA II

Today’s Goals

• Introduce the COPA II form

• Provide training on how to properly complete the COPA II form

• Demonstrate the importance of properly & completely completing the COPA II

COPA II – Information/Specifics & Fundamental Cause

Department’s Top 3 Causes & Goals

1. Overexertion

2. Motor Vehicle Accident

3. Fall Same Level

City of Philadelphia Policy

• Obtain referral slip from supervisor• Obtain copy of encounter form from the CMP• Not provide private insurance to the CMP• Other responsibilities & procedures in SMILE

Guide

Employees must (Covered in SMILE Guide):• Report the injury/illness to their immediate

supervisor at time of injury

City of Philadelphia Policy cont.

Departments are to:• Immediately report all injuries to the City’s Third

Party Administrator (CSI)• 1-866-IOD-Claims or 1-866-463-2524

• Complete and submit injury report (COPA II) to Departmental Safety Office within 48 hrs.• Phone #: 1-866-463-2524• Fax #: 215-587-1270• Address: P.O. Box 58579

Philadelphia, PA 19102

Getting Started with COPA II

• Immediate supervisor is responsible for completing the COPA II report w/ input from injured employee

• Complete COPA II immediately after incident

• Review & complete all areas of the report

The Report

Part I – Identification

Part II – Description

Part III – Motor Vehicle Accident/Crash

Part IV – Signatures

Part V – Fundamental Causes & Corrective

Action

COPA II is divided into 5 parts:

Part I: Identification

Indentification Information

Obtain the employee’s current information

• No nicknames or abbreviations

• Get CURRENT address , job title, etc

• Get CURRENT contact information

• Verify payroll number

Incident Type• Injury

– any wound or damage to the body resulting from an event in the work environment

• Illness– Adverse reactions resulting from an exposure to a

substance or environmental condition– both acute & chronic illness

• Near Miss– A “near miss” is an event that could have resulted in an

injury.

Indentificaion Information

• Job Title vs. Job title at time of injury• Work Assignment

• Routine, Non-routine, Emergency

• Immediate Supervisor vs. Immediate Supervisor at the time of the injury

• Witness Info– Get full names & job titles for all witnesses– Get contact information for all witnesses

Location of Incident

• Location (Inside)– Address– Location in Building

• Where (Outside)– Closest address or intersection– Normal work area or type

Example: Part 1

Part II: Description of Incident

Accident Type/Section 30

Body Part Effected

• Section 31: List body part(s) injured

Incident & Treatment Description

• Section 32: Give detailed description of the incident– Interview the employee & witnesses

• Section 33: Provide information on medical treatment– First Aid: give type– CMP or Other: Date & Site

Example: Part 2

Part III: Motor Vehicle Accidents/Crash

Motor Vehicle Accident/Crash

• D.C. Number– Get this from Police Report

• A.I.D. Number– Get from Police Dept is A.I.D. is involved

• Vehicle Property Number– Vehicle property # may be the only info available

when initially completing this form.• Don’t forget! Complete the City’s Accident

Report form in addition to COPA II

Part IV: Signatures & Date

• Required:– Employee– Immediate supervisor on duty– Unit Supervisor– Dept. Safety Officer

• Optional:– DC 47 Release

• DC 47 Members Only

Signatures

Part V: Fundamental Cause & Corrective Action

Fundamental Cause & Corrective Action

• Left column has four main categories for fundamental causes– You can choose multiple entries from each

category

• Identify factors that contributed to incident– Think about the incident & its root causes

Example: Part 5

Identify Possible Corrective Actions:“Correcting the Root Cause”

Possible Corrective Actions (right column):•Provides guidance to eliminating or reducing the hazards identified as the “Root Cause”•Address all “Root Causes” identified & list in Section 47.

Corrective Actions – Do’s & Don’ts

Example:A worker, parks a large truck on the road side to start the job. As he exits the truck, he steps on the curb and twists his ankle.

Don’t Recommend:• “Be more aware of your surrounding”• “Watch where you’re going”• “be more careful”Do Recommend:• Train the employee on proper lifting technique.• Provide a cart for transporting file boxes.

Example: Part 5

Fundamental Cause & Corrective Action

• The last section is the date corrective actions were implemented

• Don’t wait until corrective actions are implemented before submitting COPA II

– If necessary, resubmit after implementation of corrective actions

Fundamental Causes? (Give the letters)

What are the Correction Action?

QUESTIONS?QUESTIONS?