4-12/014.00 - Inhalation Smoke/ Fire Fumes

CLASSIFICATION Crime or Incident	FORM NUMBER FILE NUMBER PRIORITY	ASSIGNMENT AND ACTION	ADDITIONAL INFORMATION AND STATISTICAL CODES
4-12/014.00 INHALATION SMOKE/FIRE FUMES
Employee exposed to smoke and/or fire fumes	SH-R-426A URN 50	Disability Management Compliance Unit A	Prepare Form SH-R-426A, Smoke and Fire Exposure Report, for each employee who responds to a fire and is exposed to fumes/smoke inhalation. Place the original report in the employee’s medical file and email a copy to the Disability Management and Compliance Unit Help Desk. A URN is not required if an employee does not seek medical treatment. If an employee seeks immediate medical attention or seeks treatment at any time due to experiencing symptoms or complications after being exposed to smoke/fumes, an industrial injury claim should be completed. At that time, a URN should be pulled. A copy of the Smoke and Fire Exposure Report (SH-R-426A) shall be attached to the injury packet, as well as the same URN from the injury packet. The original packet shall be placed in the employee’s unit medical file, and a copy sent to the Disability Management and Compliance Unit’s DMCU Injury Reports email group. If a Reserve Deputy is involved, also send a copy to Reserve Forces Bureau. Code 502 - Injury to County Employee.

CLASSIFICATION
Crime or Incident

FORM NUMBER
FILE NUMBER
PRIORITY

ASSIGNMENT
AND
ACTION

ADDITIONAL INFORMATION
AND STATISTICAL CODES

4-12/014.00
INHALATION SMOKE/FIRE FUMES

Employee exposed to smoke and/or fire fumes

SH-R-426A

URN 50

Disability Management Compliance Unit A

Prepare Form SH-R-426A, Smoke and Fire Exposure Report, for each employee who responds to a fire and is exposed to fumes/smoke inhalation. Place the original report in the employee’s medical file and email a copy to the Disability Management and Compliance Unit Help Desk.

A URN is not required if an employee does not seek medical treatment.

If an employee seeks immediate medical attention or seeks treatment at any time due to experiencing symptoms or complications after being exposed to smoke/fumes, an industrial injury claim should be completed. At that time, a URN should be pulled. A copy of the Smoke and Fire Exposure Report (SH-R-426A) shall be attached to the injury packet, as well as the same URN from the injury packet.

The original packet shall be placed in the employee’s unit medical file, and a copy sent to the Disability Management and Compliance Unit’s DMCU Injury Reports email group.

If a Reserve Deputy is involved, also send a copy to Reserve Forces Bureau.

Code 502 - Injury to County Employee.

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