2010 Section 1 To 6 020310 WB 818 Medics

User Manual: WB 818

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Position Safety Responsibilities For
In addition to their Health and Safety responsibilities, Set Medics are responsible for gathering and
recording injury and illness-related information required by state and federal law and Warner Bros.
company policy. Regardless of payroll company, WB First Aid needs the information listed below on
every employee who suffers a work-related injury or illness.
Please remember that the forms you are required to fill out are legal documents, so be as accurate and
thorough as possible. If you have any questions when filling out forms, call WB First Aid at (818) 9541201.
AND IMMEDIATELY CALL: WB SAFETY at (818) 954-2800, or WB FIRST AID at (818) 954-1201 or
FAX FORM 5020 TO (818) 954-4234 AND (818) 954-2805.
When you start work:
1. Obtain Location Set Medic Packet from WB First Aid or your Production Coordinator.
2. Review the paperwork requirements. If you have any questions, call WB First Aid at (818) 9541201.
Participate in the Injury & Illness Prevention Program:
1. Read and understand safety literature:
a) Obtain and review the General Safety Guidelines for Production (Form 1), sign the
Employee Acknowledgement Form and turn it in to the POC. Additional information is
available from the IIPP Manual, which can be obtained at www.wbsafety.com along with all
AMPTP Safety Bulletins and other safety info.
b) Read the distributed AMPTP Safety Bulletins related to the specific hazards that you may
come into contact with on the production (i.e. helicopters, firearms, appropriate clothing, etc.)
2. Attend and participate in safety meetings to review the following:
a) Safety aspects of the day’s activities and the particular hazards of the location.
b) Elements of the Emergency Action Plan, such as the location of emergency equipment, exits
and telephones on site, and emergency procedures, such as evacuation plans in case of fire,
nearest hospital name, location and phone number, etc. Set up your equipment accordingly.
TRASNPORTATION OF THE PATIENT TO A HOSPITAL. (Ensure the employee’s supervisor has
arranged for a return ride from the hospital.)
If there is a work-related injury or illness:
When an employee reports a work injury, the following steps must be taken :
If the injury is NOT severe, but requires medical attention:
1. Provide the employee with a medical authorization slip.
2. Refer the employee to a clinic from the Workers’ Compensation list of approved clinics.
3. Arrange for transportation of the employee to the clinic if the employee is not capable of driving.
4. For follow-up treatment, have the doctor’s office of hospital contact the Workers’ Compensation
Department for proper authorization. If referral to a specialist is needed, contact the Workers’
Compensation Department and they will make the necessary arrangements.
5. Offer the employee Form DWC-1.
Injury & Illness Prevention Program for Warner Bros. Production – Revised February 2010


6. Complete Form 5020 and fax it immediately to the Workers’ Compensation Department at (818)
977-6787, WB First Aid at (818) 954-4234 and WB SAFETY at (818) 954-2805.
7. Mail the original Form 5020 to: Warner Bros. Entertainment Inc., Workers’ Compensation
Department, 4000 Warner Blvd., Burbank, CA 91522.
If the employee “may have been injured” or does not want to go to a clinic:
1. You must offer Form DWC-1 to the employee.
2. Tell the employee if he or she later decides to seek medical attention for the injury to first call the
Workers’ Compensation Department at (818) 977-3232.
3. You must complete Form 5020 (to the best of your knowledge) and send it to WB First Aid. When
completing (#25) record what the patient says. Do not speculate.
4. Document the injury on the Log Sheet and in your Nursing Notes.
Document work-related injuries and illnesses:
1. Log Sheets – follow instructions below. At end of week, send ORIGINAL log sheets and nursing
notes to WB First Aid.
a. Use one log sheet for each day if patients are seen.
b. If no patients are seen, use one sheet for several days (Write the date and “No Patients Seen.”)
c. Complete ALL information on log sheet –
• DOI: Date of Injury
• TOI: Time of Injury
• MOI: Mechanism of Injury
• LOI: Location of Injury
d. Narrative – if you complete detailed nursing notes on a separate form, circle “yes” in the
narrative column and return your original notes to WB First Aid.
e. WC Packet – you are to give WC Packets to employees who sustain significant injuries, even if
they decline further treatment at the time of the injury. Circle “yes” on the log to document the
WC Packet.
2. Work Comp (WC) Packet contains 8 documents. They are described below.
a. Authorization to Treat: Set Medic completes, gives to employee to take to treating facility.
b. Form DWC1: Employee completes top section, Set Medic completes bottom.
c. “Facts about Workers’ Compensation” (Bugs Bunny on cover): give to employee to keep.
d. Acknowledge Form: Employee completes – states that employee received “Facts about
Workers’ Compensation.”
e. Mileage Reimbursement Form: give to employee to keep.
f. Employee’s Report of Work Injury: employee completes (if possible).
g. Authorization for Release of Medical Records: have employee sign and date.
h. 5020 State Form: Set Medic completes. DO NOT allow employee to complete this form.
Distribute completed paperwork:
1. Employee Receives:
a. Order for Treatment
b. “Facts about Workers’ Compensation” (Bugs Bunny)
c. DWC1- Top page: Notice of Potential Eligibility
d. Reimbursement of Mileage Form
2. Production Office Receives:
a. DWC – 3rd copy
b. Form 5020: bottom copy
3. WB First Aid Receives:
a. DWC1 – top and 2nd copy
b. Acknowledgment Form for “Facts about Workers’ Compensation”
c. Employee’s Report of Work Injury
d. Authorization for Release of Medical Records
e. Form 5020 – top and 2nd copy
Injury & Illness Prevention Program for Warner Bros. Production – Revised February 2010



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