CA-1: Traumatic Injury Claim Form

The CA-1 form should be used if you have sustained a traumatic injury on the job.  A Traumatic Injury is a wound or other condition of the body caused by external force, including stress or strain. The workplace injury must be identifiable by time and place of occurrence, member of the body affected, and must be caused by a specific series of events or incidents within a single day or work shift.

All workplace-related injuries must be reported as soon as possible to the Occupational Medical Service (OMS). OMS will provide you with further instructions on how to complete the form needed in the ECOMP system.

For further guidance on using ECOMP:

Procedures after completing the CA-1

Once the forms are completed in ECOMP, they must be printed and given to the supervisor for completion. The supervisor should discuss continuation of pay (COP) and other facts that may be pertinent to the injured.  Please note that a copy of the CA-1 form may be required by your office to apply COP to your timecard.  After the supervisor has completed the form in ECOMP, he/she must also print and sign it.  An original copy of the completed, signed CA-1 form must be sent to the NIH Workers’ Compensation Program.

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