Home > NOAA OCAO-Boulder > Safety Program Office > Accident/Illness Reporting |
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| Accident & Illness Reporting | |||||||||
| Traumatic Injury (Acute, one exposure) 1. Department of Labor Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation Employee fills out a portion and gives to supervisor, supervisor completes and sends to: CCSI. L.P. P.O. Box 542528 Dallas, Texas 75354-2528 Phone: (800) 743-2231 Fax: (888) 467-1273 Send FedEx materials to: CCSI, L.P. 300 E. Royal Lane Suite 200 Irving, TX 75039 2. Department of Commerce Form CD-137, Report of Accident/Illness Employee fills out top portion and gives to supervisor, supervisor or safety representative completes bottom of the form and sends to: US DOC/NOAA/MASC/FLD Attn: Regional Safety Manager 325 Broadway MC4X1 Boulder, CO 80305 Phone: 303-497-3912 or Rhonda.S.Carpenter@NOAA.gov, Occupational Illness (Chronic, repeated exposures) 1. Department of Labor Form CA-2, Federal Employee's Notice of Occupational Disease and Claim for Compensation Employee fills out a portion and gives to supervisor, supervisor completes and sends to: Department of Commerce Office of Labor and Employee Relations Worker's Compensation Branch Room H-1088 14th and Constitution Ave NW Washington, DC 20230 Phone: 202-273-3325 2. Department of Commerce |
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Last update: 2 Feb 2006
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