ATLANTA POLICE DEPARTMENT

Supervisor’s Checklist for Injured Employee

Employee’s Name

Rank or classification

Social Security #

Zone/Unit

Watch

Location of Incident

Incident #

The following MUST be completed for each injury in the line of duty.

Worker’s Comp: Employer’s First Report	Must be submitted within 3 days

of Injury (Form WC-1)

Authorization for Treatment (Form 6-A-52)	Must be submitted within 3 days

Incident Report	Must be submitted within 3 days

Employer’s Supplemental Report of Injury	Must be submitted upon the injured

(Form 29-S-24)	employee’s return to work.

I/O Request	Must be submitted upon injured employee’s return to work with time sheet as long as employee remains I/O.

If the employee was injured in a car accident, the following MUST also be submitted:

Accident Report	Must be submitted within 3 days

Supervisor’s Accident Report	Must be submitted within 3 days

Supervisor’s Supplement	Must be submitted within 3 days

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The supervisor must submit all necessary documents through the chain of command to the division commander.

I certify that the above reports have been completed and are in compliance with Standard Operating Procedure APD.SOP.2.17.

_________________________________	________________

Immediate Supervisor’s Signature	Date

________________________________________	___________________

Section Commander’s Signature	Date

Form APD 718 Revised 3/25/02

ATLANTA POLICE DEPARTMENT

VWarnic

2002-04-15

Richard Clarke

APD