Employee Resources

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CA-1: Traumatic Injury Claim Form

Filing a CA-1, Notice of Traumatic Injury (NIH-specific guide)

You must report any workplace-related injury as soon as possible to Occupational Medical Service (OMS). OMS will provide you will further instructions on how to complete the form needed in the ECOMP system.

This form should be used if you have sustained a traumatic injury on the job.

Traumatic Injury - A wound or other condition of the body caused by external force, including stress or strain. Must be identifiable by time and place of occurrence and member of the body and must be caused by a specific event of series of events or incidents within a single day or work shift.

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 employee's supervisor.  The supervisor should also discuss continuation of pay (COP) and other facts that may be pertinent to the injured employee.  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.

CA-2: Occupational Disease Claim Form

Filing a CA-2, Notice of Occupational Disease (NIH-specific guide)

You must report any workplace-related illness as soon as possible to Occupational Medical Service (OMS). OMS will provide you will further instructions on how to complete the form needed in the ECOMP system

This form should be used if you have sustained an occupational disease as a result of your job duties.

Occupational Disease - A condition produced in the work environment over a period longer than one work day or shift. May result from systemic infection, repeated stress or strain, exposure to toxins, poisons or fumes, or other continuing conditions of the work environment.

For further guidance on using ECOMP:

Procedures after completing the CA-2

Once the forms are completed in ECOMP, they should be printed, signed and given to the employee's supervisor.  The supervisor completes his/her section in ECOMP, prints the form and signs it.  An original copy of the completed, signed CA-2 form must be sent to the NIH Workers’ Compensation Program

CA-7: Claim for Compensation

Use this form to claim compensation in an established case for traumatic injury or occupational disease.

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