4-19/015.00 - Person Injured/Ill

4-19/015.00
PERSON INJURED/ILL

Adult

SH-R-49 required only if crime involved.  If SH-R-49 or CHP-555 is required, draw a separate file number and make no cross reference to the SH-AD-92 or the SH-AD-92 file number.

Aircraft accident

SH-R-49
URN
48

Aero Bureau

A

Notify Aero Bureau immediately and follow their instructions.

See "Aircraft."

Alleged mentally
ill person

See "Mentally Ill Person, Alleged."

Animal bite

See "Animals."

Employee of
Sheriff's
Department
injured on duty

SH-AD-92
URN
50

Disabilities Management and Compliance Unit

Designate SRD copy to Chief or Division Director of the concerned Division.  Report to include all witnesses, resume of case and responsible party.  If Reserve Forces member, designate SRD copy to Reserve Forces Bureau.  SH-R-49 required only if crime involved.  One SH-AD-92 will be filled out for each injured employee, and the same sequence number shall be issued for each related occurrence to maintain statistical accuracy.

If Deputy, also complete Form SH-CR-563.

Code 502 - Injury to County Employee (Non-traffic).

--Deputy injured as result of gunshot, crime involved

See "Shots Fired at Deputy."

Fire

See "Fires."

Gunshot, by
citizen, accidental

SH-R-49
URN
48 or 49

Station/Unit
Detective

A

Hold gun for lab checks.

Code as applicable.

Gunshot, by
Deputy, accidental

See "Shots Fired by Deputies."

Hazardous
Materials, Toxic
Substances:

--Sheriff's Deputy
exposed to

SH-R-426
URN

Disabilities Management and Compliance Unit

Prepare an original and one copy of form SH-R-426 for each Deputy involved.  Submit original to Return to Work Unit.  Use the original URN.  If a Reserve Deputy is involved, send a copy to Reserve Forces Bureau.  Additional copies to meet Unit needs.

Code 502 - Injury to County Employee.

Industrial accident or
illness (other than a
Sheriff’s Department
employee)

Notify the nearest district office of CAL-OSHA immediately by telephone.

Log entry only.

Injury or illness reported shall not include any injury or illness caused by the commission of a Penal Code violation (except the violation of 385 PC) or a collision on a public street or highway.

Injury to person
occurred on/in:

--Amusement ride

SH-R-49
URN
48

Station/Unit
Detective

A

Notify County Engineer-Facilities immediately by phone.  Mail copy of report to County Engineer-Facilities and designate SRD to Major Crimes Bureau.

Code 481 - Accidents, Non-traffic.

--Boating Accident

SH-R-49
URN
48

Station/Unit
Detective

A

See section 4-05/030.00 - Boats - Reports, Owner/Operator Responsibility.

Code 481 - Accidents, Non-traffic.

--County property

SH-AD-668
SH-R-49
URN
48

Station/Unit
Detective

A

Incidents involving injury to non-employees, except prisoners, however minor, while on County property (owned or leased) must be reported on the Non-Employee Injury Report Form (SH-AD-668) and distributed as indicated on the form.

Code 481 - Accidents, Non-traffic.

--Government agency
(other than L.A. County)

SH-R-49
URN
48

Station/Unit
Detective

A

Notify agency concerned immediately by phone.  Copy of report to concerned agency.

Code 481 - Accidents, Non-traffic.

--Health facility, patient

Local police agencies and L.A. County Health Services shall receive an immediate telephone notification and a written report within 36 hours from hospitals that admit a patient who exhibits a physical injury and has been a patient in a health facility.  See Section 1161.8 PC and 1250 H&S for references.

To ensure that Health Services is advised and knowledgeable in such cases, the Program Manager, Long-Term Care Services, has requested that Sheriff's Department personnel contact him at (213) 974-7961 if, during any Department investigation, it is determined that such a condition exists and has not previously been reported by a hospital.

--Public park

SH-R-49
URN
48

Station/Unit
Detective

A

Notify the concerned park department immediately by phone.  If city park, copy of report to appropriate city manager and park department. If county park, copy to Department of Parks and Recreation and two copies to County Auditor-Controller, Warrant Investigation Section.  Also, fill out form SH-AD-668 and follow same procedure as on County property.

Code 481 - Accidents, Non-traffic.

--School or playground,
public or private

SH-R-49
URN
48

Station/Unit
Detective

A

Make a report in all cases except when the injury occurs during a school sanctioned or school supervised activity.  Copy of report to be sent to authorities of concerned school.

Code 481 - Accidents, Non-traffic.

--Sheriff's
Administrative
Headquarters

SH-AD-668
SH-R-49
URN
48

Employee's
Unit of
Assignment

A

For immediate medical attention for either a County employee or a visitor, contact the Sheriff’s Headquarters Bureau.

If the injury/illness involves Sheriff's Department employees, notify Disabilities Management and Compliance Unit.

NOTE:  If the injury/illness involves any other County employee, and does not require immediate medical attention, refer questions to Disabilities Management and Compliance Unit.

Incidents involving injury to non-employees, however minor, while on County property (owned or leased) must be reported on the Non-Employee Injury Report Form (SH-AD-668) and distributed as indicated on the form.

Code 481 - Accidents, Non-traffic.

Juvenile

SH-R-49
URN
41

Station/Unit
Detective

A

Medical treatment of persons under 18 years of age, unless lawfully married or on active duty with any of the Armed Services of the U.S., requires the consent of the parent or guardian.

When a minor (under 18) is found in any street or public place and is in need of medical attention and the parent or guardian cannot be located to give medical consent, the Deputy taking the minor into temporary custody may take the person to the nearest contract hospital and explain to the examining doctor that no medical consent is available.

If the Probation Department, through its Intake and Detention Control, authorizes the doctor to treat the minor, a Deputy Probation Officer will be sent to the hospital to authorize the treatment.  Custody of the minor shall be turned over to the DPO by the detaining Deputy.

If admittance for treatment is refused and the sick person is a juvenile (under 18), the Deputy shall contact Intake and Detention Control and transport the juvenile to LAC/USC Medical Center or MacLaren Children's Center, as instructed by the Probation Department.

See Volume 5, Chapter 2.

Code 410 - Juvenile, Lack of Supervision.

Law Enforcement Explorer
injured on-duty

SH-AD-668
URN
50

Explorer's
Assigned Post Advisor

A

Copy of the incident report to Reserve Forces Bureau, Attn:  Explorer Coordinator.

Incidents involving injury to non-employees, however minor, while on County property (owned or leased) must be reported on the Non-Employee Injury Report Form (SH-AD-668) and distributed as indicated on the form.

Code as applicable.

Prisoner ill:

--While in court or court lockup

SH-J-212
URN
68

Court Services

I

Copy to the Medical Services Unit where the inmate is housed.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code - 687 - Inmate Sick / Injured.

--While in custody of Transportation

SH-J-212
URN
68

CST

I

Copy to the Medical Services Unit where the inmate is housed.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code - 687 - Inmate Sick/Injured.

--While in custody at station

SH-J-212
URN
68

JIU

I

If an inmate requires hospital treatment and will be transferred to IRC, forward all paperwork to the IRC Medical Clinic.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code - 687 - Inmate Sick/Injured.

Prisoner Injured:

--While in court or court
lockup, or in custody of
Transportation Bureau

SH-J-212
URN
68

Court Services
or CST

I

Copy to the Medical Services Unit where the inmate is housed.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code - 687 - Inmate Sick / Injured.

-Minor Injury

-Major Injury

--While in court or court
lockup or in custody of
Transportation Bureau
with crime involved

SH-R-49/B
SH-J-212
URN

JIU

A

Copy to the Medical Services Unit where the inmate is housed.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours. 

Stat Code as applicable pending the nature of the crime.

--As result of
gunshot by deputy,
crime involved

See "Shots Fired by Deputies."

--Minor injury while
at a custody facility
(other than a Station)
or in custody of
Transportation Bureau

SH-J-212
URN
68

Reporting Unit

I

Copy to the Medical Services Unit where the inmate is housed.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code - 687 - Inmate Sick/Injured.

--Major injury while
at a Custody facility
(other than a Station)
or in custody of
Transportation Bureau

SH-J-212
Supervisor’s Memo
URN
68

Reporting Unit

I

Copy to the Medical Services Unit where the inmate is housed.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code - 687 - Inmate Sick/Injured.

-- While at anycustody
facility, any court, court
lock-up or Transportation
Bureau, with crime involved

SH-R-49/B
SH-J-212
URN
68

JIU

A

Copy to the Medical Services Unit where the inmate is housed.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code as applicable pending the nature of the crime.

--While at IRC or CJ,
with crime involved

SH-R-49/B
SH-J-212
URN

JIU

A

Copy to the Medical Services Unit where the inmate is housed or forward all paperwork to the IRC Medical Clinic.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code as applicable pending the nature of the crime.

--While engaged in fire
suppression activities
such as:

Training; actual fire
fighting; while being
transported to or from
a fire; clearing brush
for fire prevention
purposes; or while
building fire breaks

SH-AD-92
(FORM 5020)
SH-J-212
Supervisor’s Memo
Medical Services Order
URN
68

Disabilities Management and Compliance Unit

A

Extent of injuries usually considered reportable are those requiring attention of a physician.  In emergency, utilize nearest contract hospital or physician and contact Medical Services Bureau for further instruction.

In non-emergency cases requiring physician's care, and no physician available at facility, contact Medical Services for instructions.

Prepare an original and four copies of Form SH‑AD-92.  Show prisoner's name, booking number and charge on the line calling for employee's name and address.

Give original of the form to responding patrol car.  Place one copy in the prisoner's Case Summary, route one copy to the County Fire Department, Construction and Maintenance Division and if the prisoner is sent to MCJ, for treatment, place the remaining copy in an envelope marked for Men’s Central Jail Medical Services and mark it "rush."  Envelope to be forwarded with the prisoner.

Station/Unit responding shall electronically archive the SH-AD-92 from into SECDA.

NOTE:  When any report made on prisoners is made for record purposes, it should indicate "Record Purposes Only - Inactive."

Stat Code - 687 - Inmate Sick / Injured.

--While in Station/Unit
area, in court or in
transit, minor or major
crime involved

SH-R-49/B
SH-J-212
URN
68

Station/Unit
Detective or JIU

A

Any injury requiring investigation.  Necessity of report and URN to be determined by the reporting Deputy's Watch Commander.

If criminal action involved, assignment shall be to Jail Investigations Unit.

If an inmate requires treatment from a hospital, forward the hospital paperwork to the Medical Services Unit where the inmate is housed.

If an inmate is admitted into the hospital, send an email to Medical Services Bureau, Comp Care Team. If after business hours, send an email to Medical Services Bureau, Medical Command Center or call them at 213-893-5544. However, it is mandatory that the reporting party follow up with the Medical Services Bureau, Comp Care Team during normal business hours.

Stat Code as applicable pending the nature of the crime.

--Work release inmates

SH-AD-92
(FORM 5020)
SH-J-212
Supervisor’s Memo
Medical Services Order
URN
70

Disabilities Management and Compliance Unit

Handle as a Department employee injury, including a full investigation.

NOTE:  The inmate’s social security number must be placed in box #8 of the SH-AD-92; all additional reports shall also bear the inmates’s social security number.  Occupation shall be listed as "Work release program" in box #12.

Code 706 - Injury or illness, Work Release Inmate.

Scuba diving

SH-R-49
URN
48

Station/Unit
Patrol and ESD

A

Notify ESD immediately and follow their instructions.

See section 4-05/030.00 - Boats - Reports, Owner/Operator Responsibility.

Suspected carbon monoxide poisoning

See "Poisoning."

Traffic collisions:

--Employee of any
government agency
or public utility

CHP-555
URN
47

Station/Unit
Patrol, Traffic

A

Notify agency concerned if serious injury is involved.  If County employee on duty, send two copies of report to County Auditor-Controller, Warrant Investigation Section.

If a fatal or serious injury collision and an L.A. County on-duty permittee, or Contract City vehicle is involved, immediately notify Traffic Services Detail for possible response by Traffic Collision Response Team.

Code 471 - Collision, Traffic With Injury.

--Employee of
Sheriff's Department

SH-AD-665
CHP-555
URN
47

Station/Unit
Patrol, Traffic

A

If employee on duty when injured, also prepare Form SH-AD-92, as in regular industrial injury. Notify Disabilities Management and Compliance Unit as soon as possible.

If Deputy injured in line of duty, complete Form SH-CR-563.

Immediately notify the Traffic Services Detail on all traffic collisions involving an on-duty employee resulting in ANY bodily injury (including complaint of pain) for possible response by the Traffic Collision Response Team.

If employee is off duty and prosecution of the employee may result from the collision, immediately notify the Watch Commander and Unit Commander, and Traffic Services Detail for review and monitoring of the investigation.

For vehicle damage, see "Property Damage."

Code 471 - Collision, Traffic With Injury.

--Hit and Run
(Felony)

CHP-555
URN
25

Station/Unit
Patrol, Traffic

A

SH-R-49 necessary only if a suspect is arrested.

If victim in critical condition, advise Homicide Bureau of the circumstances.

If death possible, (0).

If a fatal collision or victim is in critical condition and maximum technical expertise is needed to support criminal prosecution, notify Traffic Services Detail for possible response by the Traffic Collision Response Team.

Code 251 - Hit and Run, Felony.

--Hit and Run
(Misdemeanor)

CHP-555
URN
25

Station/Unit
Patrol, Traffic

A

Code 250 - Hit and Run, Misdemeanor.

If no injury or workable information, use CHP-555-03.  No URN required for this form.

--Injury to person

CHP-555
URN
47

Station/Unit
Patrol, Traffic

A

If a person is injured by a Sheriff's or permittee's vehicle, forms SH-AD-665 County of Los Angeles Report of Vehicle Accident or Incident and SH‑R‑257 shall be completed.  Also, it is mandatory that the Watch Commander notify Traffic Services Detail within 48 hours of the occurrence by FAX (562) 402-8421 and relay the information from the SH‑AD-665.  Traffic Services Detail shall be responsible for notifying the contract insurance company.

Immediately notify the Traffic Services Detail on all traffic collisions involving an on-duty employee resulting in ANY bodily injury (including complaint of pain) for possible response by the Traffic Collision Response Team.

Incidents involving injury to non-employees, however minor, while on County property (owned or leased) must be reported on the Non-Employee Injury Form (SH-AD-668) and distributed as indicated on the form.

Code as applicable.

--No damage to
Department/permittee
vehicle involved in
collision/incident

SH-AD-665
SH-R-257
URN
47

Unit of
Assignment or
Station/Unit
Patrol, Traffic

A

Code 471 - Collision, Traffic With Injury.

--Person injured by a
vehicle on private
property

CHP-555
URN
48

Station/Unit
Patrol, Traffic

A

Code 481 - Accident, Non-traffic.

Unidentified person

SH-R-49
URN
40

Homicide
Bureau

A

On all cases involving unidentified persons, make every effort to determine the identity of the person.

When unable to identify, immediate notification to that effect shall be made to Homicide Bureau, Missing Persons Detail.

All available identification shall be obtained, including an accurate and complete physical description, fingerprint cards and photographs. (Request for photographs and fingerprints may be made through Records and Identification Bureau.) Forward identification data to Missing Persons Detail.

Code as applicable:

400 - Adult, Missing, Lost, or Found.
402 - Juvenile, Lost, Runaway or Missing.

Other than circumstances
listed in any of the preceding groups

SH-R-49 necessary only when a crime may be involved or when gross negligence is indicated.  In all other cases, a log entry will suffice.

See under appropriate crime classification for code and retention period.