| 1 | English French Notes Complete/Exclude
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| 2 | Invalid character entered, (~,`, @,#,$,%,^,*,_,|,\,},{,[,],>, or <),
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| 3 | Max length for field is
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| 4 | characters, you have entered
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| 5 | . Please Edit.
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| 6 | 126 CAUSE OF INJURY CODE.......
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| 7 | 217 14. NATURE OF DISEASE OR ILLNESS~
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| 8 | Max length for field is 264 characters, you have entered
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| 9 | 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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| 10 | 219 16. IF A SEPARATE NARRATIVE STATEMENT IS NOT SUBMITTED WITH THIS FORM, EXPLAIN REASON FOR DELAY~
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| 11 | 220 17. IF MEDICAL REPORTS ARE NOT SUBMITTED WITH THIS FORM, EXPLAIN REASON FOR DELAY~
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| 12 | Federal Employee's Notice of Traumatic Injury and
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| 13 | Claim for Continuation of Pay/Compensation (Form CA-1)
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| 14 | Description of Injury
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| 15 | 108 9. PLACE WHERE INJURY OCCURRED...
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| 16 | 183 ADDRESS WHERE INJURY OCCURRED.
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| 17 | 184 CITY WHERE INJURY OCCURRED....
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| 18 | 185 STATE WHERE INJURY OCCURRED...
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| 19 | 181 ZIP CODE WHERE INJURY OCCURRED
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| 20 | 109 10. DATE/TIME INJURY OCCURRED..//^S X=OOPS(2260,IEN,4,
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| 21 | 110 11. DATE OF THIS NOTICE........//^S X=DT
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| 22 | 112 13. CAUSE OF INJURY (DESCRIBE WHAT HAPPENED AND WHY)
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| 23 | 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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| 24 | Employee Signature
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| 25 | 114 15. REQUEST PAY OR LEAVE.......
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| 26 | 6////SIGNED WITNESS STATEMENT TO FOLLOW.
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| 27 | No electronic signature on file!
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| 28 | No electronic signature block on file!
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| 29 | Enter Signature Code:
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| 30 | Enter your Electronic Signature code to verify this action.
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| 31 | ... Not Signed.
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| 32 | .01 SITE NAME...............
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| 33 | 1 OWCP AGENCY CODE........
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| 34 | 2 OWCP DISTRICT OFFICE....
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| 35 | 3 1. TYPE OF INCIDENT...........
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| 36 | 6 2. DATE OF BIRTH..............
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| 37 | 8 5. HOME STREET ADDRESS........
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| 38 | 11 8. ZIP CODE...................
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| 39 | 12 9. HOME PHONE NUMBER..........
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| 40 | 13 10. STATION NUMBER.............
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| 41 | 53.1 12. SECONDARY SUPERVISOR.......
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| 42 | File is currently locked by another user
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| 43 | .01 UNION NAME.................
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| 44 | 1 UNION ACRONYM..............
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| 45 | 2 UNION REPRESENTATIVE.......
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| 46 | Enter PAY RATE PER data for a single case or all cases.
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| 47 | PAY RATE PER field must be blank or have invalid data to access the record.
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| 48 | Select 1 for ALL Cases, 2 for a Single Case:
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| 49 | No Cases Selectable
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| 50 | OOPS GUI EMPLOYEE HEALTH MENU
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| 51 | OOPS GUI EMPLOYEE
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| 52 | OOPS GUI SUPERVISOR MENU
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| 53 | OOPS GUI SAFETY OFFICER MENU
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| 54 | OOPS GUI UNION MENU
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| 55 | OOPS GUI WORKERS' COMP MENU
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| 56 | User not Authorized to sign form
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| 57 | No Signature Entered
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| 58 | No Electronic Signature on File
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| 59 | Invalid Signature Entered.
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| 60 | FULL CSRS
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| 61 | PER ANNUM
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| 62 | PER HOUR
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| 63 | Invalid Input, cannot continue.
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| 64 | Invalid data on claim
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| 65 | not found in file 2260
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| 66 | not valid, must be CA1,CA2, or 2162
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| 67 | IEN,NODE)
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| 68 | IEN,NODE,LINE,0)
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| 69 | IEN,NODE,0)
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| 70 | VALID DATE
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| 71 | DATE ERROR
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| 72 | FLAG ERROR
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| 73 | UPDATE FAILED
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| 74 | UPDATE COMPLETE
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| 75 | WITNESS CREATION FAILED
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| 76 | WITNESS CREATION SUCCESSFUL
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| 77 | DELETION FAILED
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| 78 | SUCCESSFULLY DELETED
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| 79 | EDIT FAILED
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| 80 | EDIT SUCCESSFULL
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| 81 | Need Record Number to proceed
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| 82 | Another User Editing Record, Try Again Later.
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| 83 | RECORD LOCKED
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| 84 | RECORD UNLOCKED
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| 85 | XREF,ITEM)
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| 86 | XREF,ITEM,PTR)
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| 87 | PTR,0)
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| 88 | DA(1),NODE,DA)
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| 89 | IEN,NODE,REC)
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| 90 | IEN,NODE,REC,0)
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| 91 | DATA,0)
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| 92 | IEN,NODE,DA)
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| 93 | IEN,NODE,DA,0)
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| 94 | INVALID STATION
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| 95 | UNABLE TO CREATE RECORD
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| 96 | Injury
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| 97 | Illness/Disease
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| 98 | UPDATE COMPLETED
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| 99 | No Changes Filed
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| 100 | Record Successfully Deleted
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| 101 | Failed
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| 102 | union added
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| 103 | Union Update Successful.
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| 104 | Union Update NOT Successful.
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| 105 | No Site Parameter File was Found
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| 106 | This option in use by another user, try again later.
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| 107 | Successfully Added
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| 108 | Missing Record Identifiers, Cannot file.
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| 109 | Deletion did not occur.
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| 110 | Record successfully deleted
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| 111 | Filing
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| 112 | Missing Station, Cannot continue.
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| 113 | Missing Station, cannot file.
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| 114 | Update Successful
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| 115 | Update was not Successful
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| 116 | Cannot File Changes, no Record Number
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| 117 | Update Site data Successful
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| 118 | Update Site data was NOT Successful
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| 119 | Missing Record Identifier, cannot file.
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| 120 | Case transmitted to DOL, cannot change status to Deleted.
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| 121 | Case Status has been changed to:
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| 122 | OOPS XMIT 2162 DATA
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| 123 | Invalid Transmission Date
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| 124 | Invalid Queue Date.
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| 125 | TRANSMIT NATIONAL DATABASE 2162 DATA
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| 126 | SUCCESSFULLY QUEUED
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| 127 | No data. Missing Record Identifier.
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| 128 | No data. Missing File or Field information.
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| 129 | OOPS ISO NOTIFICATION
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| 130 | G.OOPS WC MESSAGE
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| 131 | ASISTS ISO NOTIFICATION Mail Group Error
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| 132 | The OOPS ISO NOTIFICATION Mail Group does not exist.
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| 133 | There are no members in mail group OOPS ISO NOTIFICATION.
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| 134 | G.OOPS ISO NOTIFICATION
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| 135 | OOPS SENSITIVE DATA
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| 136 | BULLETIN SENT
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| 137 | Safety Officer
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| 138 | Employee Health
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| 139 | approves the WCP signing for the Employee:
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| 140 | Missing Information, Cannot Continue
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| 141 | You have approved as
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| 142 | Emp Health Rep
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| 143 | and cannot sign as Employee.
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| 144 | Three different individuals must be involved.
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| 145 | Safety Officer has not approved WCP signing for employee.
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| 146 | Employee Health has not approved WCP signing for employee.
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| 147 | All required fields not completed
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| 148 | You have signed as
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| 149 | , Cannot sign.
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| 150 | You have already signed as
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| 151 | Both signatures cannot be made by the same person.
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| 152 | has already signed, re-signing is not required.
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| 153 | Clearing Signatures
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| 154 | The following fields must be completed before the
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| 155 | can be signed.
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| 156 | must be on or after the
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| 157 | cannot be blank if date in
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| 158 | Processing...
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| 159 | Input parameters missing, cannot run report.
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| 160 | Union
|
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| 161 | Illness
|
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| 162 | Friday
|
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| 163 | Monday
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| 164 | Thursday
|
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| 165 | Tuesday
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| 166 | Wednesday
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| 167 | Type of Incidents
|
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| 168 | Occupation Code
|
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| 169 | Characterization of Injury
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| 170 | Body Parts
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| 171 | Day of Week
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| 172 | Time of Day
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| 173 | Employee
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| 174 | Supervisor
|
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| 175 | Case Number Name SSN Date/Time of Incident
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| 176 | Un-Signed
|
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| 177 | Safety Officer:
|
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| 178 | Starting Date for the Report
|
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| 179 | Select a Starting Date from the range displayed.
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| 180 | Ending Date for the Report
|
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| 181 | Select a Ending Date from the range displayed
|
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| 182 | The Ending Date cannot be before or on the Starting Date, please re-enter this data.
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| 183 | for Period
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| 184 | Employees and volunteers only
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| 185 | Cases to be included:
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| 186 | Include names of persons involved
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| 187 | Log of Needlestick Incidents
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| 188 | Log of Federal Occupational Injuries and Illnesses
|
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| 189 | All cases
|
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| 190 | Replaced by amendment
|
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| 191 | Illness/disease
|
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| 192 | Log Summary
|
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| 193 | Injuries.:
|
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| 194 | Fatal Injuries....:
|
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| 195 | Lost Time Injuries....:
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| 196 | Illnesses:
|
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| 197 | Fatal Illnesses...:
|
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| 198 | Lost Time Illnesses...:
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| 199 | Total....:
|
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| 200 | Total.............:
|
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| 201 | Total.................:
|
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| 202 | Lost Time
|
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| 203 | Inj/Ill
|
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| 204 | Type of Incident
|
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| 205 | Char. of Injury
|
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| 206 | Body Part Affected
|
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| 207 | Activity at time of Injury
|
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| 208 | Object Causing Injury
|
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| 209 | Model and Brand of Object Causing Injury
|
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| 210 | Location of Injury
|
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| 211 | Description of Injury
|
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| 212 | Run report for 'ALL' Stations
|
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| 213 | Enter 'Y'es to run for all Stations or 'N'o to run
|
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| 214 | for just one Station.
|
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| 215 | No Station selected, report will not run
|
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| 216 | No data for that Station Number, Please select again.
|
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| 217 | Description of Injury:
|
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| 218 | OOPS CASE
|
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| 219 | OOPS INJURY
|
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| 220 | OOPS UNION
|
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| 221 | OOPS EH
|
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| 222 | OOPS SAFETY
|
|---|
| 223 | OOPS WCPBOR
|
|---|
| 224 | OOPS CONSENT
|
|---|
| 225 | OOPS WC EDITED
|
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| 226 | OOPS WC SIGNED
|
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| 227 | OOPS WORKERS COMP
|
|---|
| 228 | OOPS SUPERVISOR
|
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| 229 | OOPS EMPLOYEE
|
|---|
| 230 | OOPS BILL OF RIGHTS
|
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| 231 | You do NOT have the required Security Key.
|
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| 232 | Press Enter to continue
|
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| 233 | No Transmission. Press Enter to continue
|
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| 234 | Enter 'Y' if you want the 2162 data placed in mail
|
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| 235 | TRAMSIT NATIONAL DATABASE 2162 DATA
|
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| 236 | The Queue Q-ASI.MED.VA.GOV has not been created.
|
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| 237 | Install Patch XM*999*130, complete manual
|
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| 238 | Transmission of NDB Data.
|
|---|
| 239 | OOPS NDB MESSAGES
|
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| 240 | The Mail Group OOPS NDB MESSAGES is missing.
|
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| 241 | to the AAC. Then contact IRM to complete manual
|
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| 242 | There are no members of the OOPS NDB MESSAGES
|
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| 243 | ASISTS NDB data to and from the AAC. After adding member
|
|---|
| 244 | contact IRM to complete manual transmission of NDB data.
|
|---|
| 245 | Mail Message was not created. Contact IRM to comlete
|
|---|
| 246 | the manual transmission of ASISTS NDB data.
|
|---|
| 247 | ASISTS NATIONAL DATABASE
|
|---|
| 248 | XXX@Q-ASI.MED.VA.GOV
|
|---|
| 249 | has missing data
|
|---|
| 250 | that must be entered prior
|
|---|
| 251 | to transmitting to AAC.
|
|---|
| 252 | Missing SSN
|
|---|
| 253 | Missing DOB
|
|---|
| 254 | Missing SEX
|
|---|
| 255 | ASISTS Records Missing Necessary Data Elements
|
|---|
| 256 | G.OOPS NDB MESSAGES@
|
|---|
| 257 | ASISTS NDB Error Notification Message
|
|---|
| 258 | IN;SP1;IP;PW.3;SC0,22,0,29,1;
|
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| 259 | DT@,1;SD1,277,2,1,4,9,5,0,6,1,7,23;
|
|---|
| 260 | PU.5,28.8;LBOfficial Supervisor's Report of Occupational Disease: Please complete information requested below@;
|
|---|
| 261 | 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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| 262 | SD1,277,2,1,4,9,5,0,6,0,7,16901;
|
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| 263 | PU.5,27.9;LB19. Agency name, and address of reporting office (Include city, state, and zip code)@;
|
|---|
| 264 | PU16.2,28.2;PD16.2,27.3;PU16.3,27.9;LBOWCP Agency Code@;
|
|---|
| 265 | 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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| 266 | PU.5,27.3;PD21,27.3;PU.5,26.4;PD21,26.4;
|
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| 267 | PU.5,25.6;PD21,25.6;
|
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| 268 | PU.5,25.3;LB20. Employee's duty station (Street address and zip code)@;
|
|---|
| 269 | PU.5,24.7;PD21,24.7;
|
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| 270 | 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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| 271 | 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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| 272 | 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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|---|
| 273 | 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.@;
|
|---|
| 274 | 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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| 275 | PU11,23.8;EA11.2,24;PU11.4,23.8;LBSun.@;PU12.3,23.8;EA12.5,24;PU12.7,23.8;LBMon.@;
|
|---|
| 276 | PU13.6,23.8;EA13.8,24;PU14,23.8;LBTues.@;PU14.9,23.8;EA15.1,24;PU15.3,23.8;LBWed.@;
|
|---|
| 277 | PU16.2,23.8;EA16.4,24;PU16.6,23.8;LBThurs.@;PU17.7,23.8;EA17.9,24;PU18.1,23.8;LBFri.@;
|
|---|
| 278 | PU18.8,23.8;EA19,24;PU19.2,23.8;LBSat.@;
|
|---|
| 279 | PU.5,23.5;PD21,23.5;PU.5,23.2;LB23. Name and address of physician first providing medical care@;
|
|---|
| 280 | LB (Include city, state, zip code)@;
|
|---|
| 281 | 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.@;
|
|---|
| 282 | PU14.5,22.9;LBmedical@;PU14.5,22.6;LBcare received@;PU13.9,22.3;PD21,22.3;
|
|---|
| 283 | 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;
|
|---|
| 284 | PU14,22;LB25. Do medical reports@;PU14.5,21.7;LBshow employee is@;PU14.5,21.4;LBdisabled for work?@;
|
|---|
| 285 | 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@;
|
|---|
| 286 | PU.5,22.6;PD13.9,22.6;PU.5,21.8;PD13.9,21.8;PU.5,21;PD21,21;
|
|---|
| 287 | PU.5,20.7;LB26. Date employee@;PU3.4,20.7;LBMo.@;PU4.3,20.7;LBDay@;PU5.3,20.7;LBYr.@;
|
|---|
| 288 | 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.@;
|
|---|
| 289 | PU1.1,20.4;LBfirst reported@;PU1.1,20.1;LBcondition to@;PU1.1,19.8;LBsupervisor@;
|
|---|
| 290 | 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;
|
|---|
| 291 | PU6.9,20.4;LBhour employee@;PU6.9,20.1;LBstopped work@;
|
|---|
| 292 | 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;
|
|---|
| 293 | 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;
|
|---|
| 294 | 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.@;
|
|---|
| 295 | PU.5,19.7;PD21,19.7;
|
|---|
| 296 | 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;
|
|---|
| 297 | LB29. Date employee was last@;
|
|---|
| 298 | PU14.2,19.4;LBMo.@;PU15,19.4;LBDay@;PU16,19.4;LBYr.@;
|
|---|
| 299 | 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;
|
|---|
| 300 | 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;
|
|---|
| 301 | 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.@;
|
|---|
| 302 | PU10.6,19.1;LBexposed to conditions@;PU10.6,18.8;LBalleged to have caused@;PU10.6,18.5;LBdisease or illness@;
|
|---|
| 303 | #################### #################### ####################
|
|---|
| 304 | #################### #################### ####################
|
|---|
| 305 | #################### #################### ####################
|
|---|
| 306 | #################### #################### ####################
|
|---|
| 307 | #################### #################### ####################
|
|---|
