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