This Department Order establishes a programmed approach in the management of employee health conditions which affects the ability to work, and establishes procedural guidelines to assist in the management of employee absences. The Department shall make every effort to return the employee to his/her assigned duty when possible, by providing temporary work assignments, modified duty, appropriate leave, or reasonable accommodation in accordance with applicable laws.

519.01    INDUSTRIAL INJURIES/ILLNESSES - Employees who sustain an injury, illness or disease arising out of and in the course of employment, may be eligible for worker's compensation benefits. Failure to follow reporting and industrial injury/illness time frames result in sanctions to the Department.

1.1    The Department of Administration, Risk Management Division, is the State's insurance carrier. The Department's policy number is WC-520. The Personnel Liaison, Occupational Health Nurse (OHN), and Occupational Safety Consultant at each work site are the designated resource team for worker's compensation issues.

1.2    Employees shall report industrial injuries and illnesses as they occur. This provides the basis for a claim.

1.2.1    A claim for benefits may be filed within one year after the date of injury.

1.2.2    Claims denied by Risk Management may be appealed through the Industrial Commission of Arizona, within the time frames designated on the notice of claim status.

1.3    Reporting/Management of Industrial Injuries and Illnesses:

1.3.1    Employees shall:

1.3.1.1    Report all incidents involving an injury/illness to their immediate supervisor, shift commander or the next available person in their chain-of-command, as applicable. The individual to whom the claim is reported is designated as the responsible supervisor.

1.3.1.1.1    COTA Class Sergeant's are responsible for ensuring that claims are completed properly and reported timely when a COTA Cadet is injured.

1.3.1.2    Upon submitting an injury claim for Workers Compensation coverage relating to a slip, trip or fall in a known High Risk Area:

1.3.1.2.1    Provide their supervisor with documented evidence that their footwear met the Department's standards for slip resistant work shoes at the time of purchase and/or use. If there is evidence to the contrary or the employee fails to provide the documentation, he/she may be referred to the Deputy Warden/Warden for further assessment and may be subject to disciplinary action as outlined in Department Order #508, Employee Discipline.

1.3.1.2.2    Be required to wear footwear that is slip resistant to reduce the likelihood of an industrial injury.

1.3.1.3    Complete the Employee/Supervisor Report of Industrial Injury, Form 519-2, with their supervisor. If medical treatment is necessary, the employee shall present a copy of the form to the physician at the initial medical visit, which identifies the visit as industrial-related.

1.3.1.4   By the end of the shift on the day in which an industrial incident occurs, whether or not medical treatment is required, report the incident by calling Risk Management's Early Claims Notification Hotline, 24-hours a day, 7 days a week at (602) 542-WORK for Maricopa County or (800) 837-8583 (Statewide).

1.3.1.5    Notify the onsite Occupational Health Nurse (OHN) that an industrial injury has occurred, provide a description of the incident, whether or not medical attention has been or will be sought, and a telephone number where the employee may be contacted for follow-up, if necessary.

1.3.1.6    If medical treatment is initially declined but later determined to be necessary, notify his/her supervisor and the OHN.

1.3.1.7    If injured, be referred to a Risk Management-approved occupational healthcare provider for the initial visit, where available and when practical, to determine the nature and extent of the employee's injury. After the initial visit, the employee may visit his/her personal physician or another healthcare provider.

1.3.1.8    If medical care is sought, notify the healthcare provider that the visit is industrial related and complete the employee portion of the Worker's and Physician's Report of Injury, ICA Form 102, available at the healthcare provider's office.

1.3.1.9    When restricted in his/her duties, present a completed Health Status Report, Form 519-3, to the health care provider to be completed, signed and returned to the OHU.

1.3.1.10    Report recuperation progress to their supervisor, and OHN, as directed.

1.3.1.11    Submit a healthcare provider written recuperation progress report to the OHN as directed.

1.3.1.12    If admitted to the hospital or in-patient care facility due to an industrial injury, notify or arrange for notification of their first line supervisor by telephone as soon as possible.

1.3.2    Supervisors shall:

1.3.2.1    Provide the employee with the prompt opportunity to obtain medical evaluation and treatment on the day of injury, if applicable. The reporting process shall not delay necessary medical attention. In the event the employee becomes incapacitated, the supervisor shall be responsible for completing all necessary documents.

1.3.2.2    Ensure that all actions above are completed within the mandated time frames as outlined in this policy and state law.

1.3.2.3    Provide the employee a copy of the Employee/Supervisor's Report of Industrial Injury form, which is to be presented to the physician during the initial visit if medical treatment is sought.

1.3.2.4    FAX the completed Employee/Supervisor's Report of Industrial Injury form to the applicable OHN by the end of shift in which the claim is reported. If the employee is incapacitated and unable to provide details of the incident, the supervisor shall interview witnesses and complete the report as thoroughly as possible.

1.3.2.5    Allow time for the employee to confer with the OHN, if determined necessary by the OHN and instruct the employee, when able, to call the OHN for follow up on their industrial injury.

1.3.2.6    Notify the OHN of any industrial injury/illness that requires the employee to miss work, and provide the OHN with updated information regarding the employee's progress.

1.3.2.7    Upon return to work, direct the employee to provide a written progress report from their provider to the OHN.

1.3.2.8    Place the employee on FMLA to run concurrently with Industrial Leave, if the absence meets the provisions of FMLA and the employee is eligible. Notify the employee verbally and in writing that the leave is being designated as FMLA, using the Family and Medical Leave Request/Notification, Form 519-1.

1.3.3    Managers shall:

1.3.3.1    In consultation with the OHN and Occupational Safety Consultant, ensure that the Occupational Safety and Health Administration (OSHA) is notified within eight hours of a work-related death or a hospitalization of three or more employees.

1.3.3.2    In consultation with the OHN, assign employees to temporary work assignments (TWA) that are consistent with medical needs, restrictions and work limitations specified by the physician.

1.3.4    OHN's shall:

1.3.4.1    Review the Employee/Supervisor's Report of Industrial Injury to determine if the employee has sought medical care and/or is unable to work.

1.3.4.2    Input coding and entry of the Employee/Supervisor's Report of Industrial Injury form, into the web-based Webenvision system, which shall be a shared responsibility between OHU, Personnel and Risk Management personnel.

1.3.4.3    Coordinate posting of the OSHA report during the month of February as required by Federal Regulation.

1.3.4.4    Maintain the OSHA log.

1.3.4.5    Receive notices of claim status and other related documents from Risk Management, maintain Workers Compensation files, and label it as such on the work status log.

1.3.4.6    In consultation with management staff, ensure that TWAs are made and monitored in accordance with section 519.06.

1.3.4.7    Place the report in the employee's confidential occupational medical record.

1.3.4.8    Notify appropriate management staff of an employee's claims status, and provide updates of the employee's condition and expected date of return to work.

1.3.4.9    Coordinate case management efforts with the ADOA Workers Compensation Disability Management Specialist.

1.3.4.10    Maintain contact with the employee to monitor their progress, determine their return-to-work-status and health limitations, and otherwise take action as outlined in this order.

1.3.5    The Occupational Safety Administrator shall file the Department's OSHA 200 Log with the Industrial Commission, indicating the total injuries and illnesses and reports required by other state agencies.

1.4     Time Reporting

1.4.1    Workers Compensation shall not be paid if the employee is absent from work for seven calendar days or less. The employee shall be charged sick leave during this period.

1.4.1.1    After the seven day waiting period, the employee shall use sick leave until exhausted and then other forms of approved leave, at a rate necessary to receive total pay (a combination of Workers Compensation payments and leave payments), that does not exceed the gross salary of the employee.

1.4.1.2    After sick leave is exhausted and if the employee does not make a request to use other accrued leave, he/she shall be placed on Leave Without Pay.

1.4.2    Supervisors shall ensure that the Positive Attendance Records (PARs) for employees on industrial leave are completed according to Department Order #512, Employee Assignments, Work Hours, Compensation and Leave, to include coding the absence as industrial leave.

1.4.3    Payroll shall:

1.4.3.1    Ensure that employees on industrial leave are charged for leave taken in accordance with applicable statutes, Personnel Rules, Department Order #512, Employee Assignments, Work Hours, Compensation and Leave, and/or other applicable written instructions.

1.4.3.2    If the employee receives a retroactive Workers Compensation payment for the initial period of sick leave, and if the employee has received a leave payment for that period, require the employee to reimburse the Department for the amount of used sick leave, and restore the equivalent value of leave to the employee's leave account.

1.4.4    Upon full medical release, an employee returning from industrial leave shall return to the position occupied at the start of the leave. If this position or a position in the same class is not available or not funded, the agency shall conduct a reduction in force.

1.4.5    For Correctional Officer Retirement Plan (CORP) members, Personnel Liaisons shall:

1.4.5.1    Ensure that CORP members who are on Industrial Leave for two weeks or longer receive a Contributions During Period of Industrial Leave (CORP Form C19). (See Attachment H.)

1.4.5.1.1    The CORP member must elect to continue/discontinue contributions to CORP during the period of industrial leave. If the employee does not make an election, the time absent from work shall be considered as service but not credited service.

1.4.5.1.2    It is the CORP member's responsibility to complete a Contributions During Period of Industrial Leave form and forward it to the CORP Local Board Office, Central Office, Department of Corrections.

1.4.5.2    Notify the CORP Coordinator in the Human Services Bureau, by fax, email and/or phone, when a CORP member is unable to work for two weeks or longer due to an industrial injury/illness. The CORP Coordinator shall also be notified when the CORP member returns to work.

1.5    Contracted medical providers may be available at some locales to provide initial services for industrial injury/illness. Contact the OHN, Personnel Liaison or Occupational Safety Consultant for specific locations.

1.5.1    Risk Management shall cover initial visits to the contracted medical provider, regardless of the outcome of the claim.

1.5.2    When initial care is provided by a personal healthcare provider and the claim is subsequently denied, the employee shall be liable for payment, except for treatment received prior to claim denial.

1.5.3    The OHU shall distribute updates of contract medical providers, as changes occur, to the Personnel Liaisons and Occupational Safety Consultants, who shall ensure updated lists are distributed as appropriate.

1.6    Employee/Supervisor's Report of Industrial Injury - The Occupational Health Administrator shall procure Employee/Supervisor Report of Industrial Injury forms from ACI. Personnel Liaisons, Occupational Safety Consultants and Occupational Health Nurses shall maintain a supply of these forms and, when needed, contact the Central Office OHU to replenish supplies.

519.02    FAMILY MEDICAL LEAVE ACT (FMLA) - In accordance with the FMLA, the Department shall grant job-protected family and medical leave to eligible employees for up to 12 weeks per 12-month period, calculated from the effective date of the current request. (See Attachment D.)

1.1    Upon approved application or designation by management, FMLA shall be granted for any one or more of the following reasons:

1.1.1    The birth of a child and in order to care for such child or the placement of a child with the employee for adoption or foster care. Leave time for this reason shall be taken within the 12-month period following the child's birth or placement with the employee.

1.1.2    In order to care for a spouse, child or parent if the family member has a serious health condition.

1.1.3    The employee's own serious health condition that makes the employee unable to perform the functions of his/her position.

1.2    If both the employee and spouse work for the State of Arizona, their total leave in any 12-month period may be limited to a combined total of up to 12 weeks, if the leave is taken for the same qualifying event.

1.3    Coverage and Eligibility Criteria

1.3.1    For the purposes of the FMLA, an eligible employee is an individual who:

1.3.1.1    Is an employee of the State of Arizona.

1.3.1.2    Has been employed by the State of Arizona for at least 12 months.

1.3.1.3    Has worked for at least 1,250 hours during the 12-month period immediately preceding the commencement of the leave. Work time is actual hours worked and excludes any type of leave taken.

1.3.2    For part-time employees and those who work variable hours, the FMLA entitlement is calculated on a pro rata basis. A weekly average of the hours worked over the 12- weeks prior to the beginning of the leave shall be used for calculating the employee's normal work week, not to exceed 40 hours per week.

1.3.3    If, at any time, it is determined that an employee on approved FMLA shall not be returning to work, the FMLA leave entitlement shall cease.

1.4    Intermittent or Reduced Leave - When medically necessary, an employee may take leave intermittently, such as a few days or a few hours at a time, or on a reduced work schedule for an FMLA qualifying event.

1.4.1    To reduce or eliminate the adverse effects of intermittent leave on workplace staffing and operations, the employee may be temporarily transferred to an alternative position that better accommodates recurring periods of leave. Management shall consult with the Employee Relations Unit prior to any temporary reassignment to accommodate intermittent leave.

1.5    FMLA Provisions

1.5.1    Health insurance remains in effect once all paid leave has been exhausted. Employees on leave without pay must remit the employee portion of the premium or health insurance benefits shall cease.

1.5.2    Job Protection/Rights Upon Return to Work - The employee shall return to work after an approved period of FMLA to his/her former position or to an equivalent position with the equivalent pay, benefits, status, RDOs, shift and authority.

1.5.3    Neither the Department nor any staff member shall:

1.5.3.1    Interfere with, restrain, or deny the exercise of any right provided under FMLA.

1.5.3.2    Discharge or discriminate against any person for opposing any practice made unlawful by the FMLA, or for involvement in any proceeding under or relating to FMLA.

1.5.4    Managers shall ensure a copy of, "Your Rights Under the Family and Medical Leave Act of 1993" (Attachment C.) is posted on all employee bulletin boards.

1.6.1    An employee on FMLA shall be required to use appropriate accrued leave as outlined in ADOA Personnel Rules. Leave Without Pay and Medical Leave Without Pay (LWOP/MLWOP) shall be approved only when all other applicable leave is exhausted with the exception of parental leave where an employee may choose to use LWOP in lieu of exhausting accrued leave.

1.6.2    The Department shall designate all leave taken for an FMLA-qualifying event as FMLA leave whether or not an actual application is made by the employee. When leave is designated as FMLA, the employee shall be notified in writing via the FMLA Request form.

1.6.3    Leave may be designated as FMLA after the employee returns to work only when:

1.6.3.1    The employee was absent for a qualifying reason and the Department did not learn of the reason for the absence until the employee's return. This designation shall occur within two days of such disclosure.

1.6.3.2    The Department is aware of the reason for the leave and receipt of substantiating medical documentation is delayed. (This action shall occur within two days of receiving the documentation.)

1.6.4    If applicable, the FMLA leave shall apply on the first day the employee began leave.

1.6.5    FMLA does not provide for the intermittent care of a child for such commonplace illnesses as colds and flu. In such cases, if appropriate, the employee may apply for sick family leave, annual, compensatory, holiday, or LWOP, as approved by their supervisor.

1.7    Request For FMLA - Completed FMLA requests (Family and Medical Leave Request/Notification form and Certification of Health Care Provider, Form 519-4) shall be submitted to the OHN and shall include:

1.7.1    A beginning and ending date for the leave time requested. Absences categorized as indefinite shall not be approved.

1.7.2    A Certification of Health Care Provider form completed by the employee's or family member's health care provider.

1.7.3    Thirty days notice prior to the commencement of the leave. In unexpected or unforeseeable situations, the employee shall provide as much notice as practical and indicate the reason for the delayed request.

1.7.4    Medical information to document the leave necessity. This shall be submitted in accordance with FMLA regulations, and prior to the approval of leave.

1.8    If there is reason to doubt the validity of the employee's medical certification, managers may, in consultation with the OHN and Employee Relations Unit, schedule the employee for a medical evaluation with a health care provider selected by the Department.

1.9    If there is disagreement as to the results of the second medical certification, managers may, in consultation with the OHN and Employee Relations Unit, schedule the employee for a medical evaluation with a health care provider jointly selected by the Department and the employee. The results of this evaluation shall be binding. (See Attachment E.)

1.10    Processing FMLA Requests - Management shall ensure that the FMLA process is completed as follows:

1.10.1    Personnel Liaisons shall:

1.10.1.1    Verify that the employee has been employed with the State of Arizona for 12 months and has worked 1250 hours within the past 12 months.

1.10.1.2    Determine the amount of FMLA leave charged within the previous 12 months using the "rolling 12-month method", which is calculated backward from the effective date of the current request.

1.10.1.3    Approve or deny the FMLA Request within two days of receiving the request and disseminate copies as indicated on the form. Employees shall receive a copy of the form in a timely manner. Denials shall occur only if eligibility requirements and procedures are not followed.

1.10.1.4    Contact the OHN and Employee Relations Unit if the Department received information that casts doubt upon the continuing validity of the FMLA Request or certification.

1.10.2    The OHN shall:

1.10.2.1    Evaluate medical certification for FMLA eligibility and advise management.

1.10.2.2    Maintain an Employee Health Record, Form 519-7, for each employee and provide appropriate authorities with access to this information for business-related reasons only.

1.10.2.3    Upon request of the manager, and with authorization from the employee, obtain medical clarification and or re-certification.

1.10.2.4Monitor employees on leave and/or notify management 30 days prior to the expiration of the leave.

1.11    Supervisors shall ensure approved FMLA leave time is properly coded on the PAR, utilizing established FMLA payroll codes.

1.12    Unpaid FMLA leave is not considered credited service for retirement, leave accrual and/or seniority.

1.13    Continuation of Benefits during FMLA - The Department shall pay the employer's portion of the premiums for health insurance benefits the employee was enrolled in prior to the approved FMLA leave. The employee shall be responsible for making the employee's portion of the premiums while on unpaid FMLA leave. To retain insurance coverage, employees shall contact their Personnel Liaison.

1.13.1    Failure to make timely payments may result in cancellation of health insurance.

1.14    Managers shall ensure that an employee who returns to work from FMLA leave:

1.14.1    Is restored to the same or equivalent position.

1.14.2    Does not lose any employment benefits and/or status, such as shift, RDO's, and/or specialty assignment, to which the employee would have been entitled had the leave not occurred.

1.15    Questions regarding FMLA shall be referred to the OHN or the Employee Relations Unit.

1.16    An employee whose request for FMLA leave has been disapproved may file a grievance in accordance with Department Order #517, Employee Grievances.

1.17    Once approved for FMLA, the employee is not required to call in or otherwise provide periodic updates until the conclusion of their leave.

1.1    Return to Work - Full Duty - Prior to returning to work, an employee shall provide to management and the OHN a Health Care Provider "return to work release" with no restrictions.

1.2    Return to Work - Restrictions - Prior to returning to work, an employee shall provide management with a Health Care Provider "return to work release" indicating applicable restrictions. In consultation with the OHN, management shall determine an appropriate TWA assignment, if available. An employee shall not return to work until this determination is made by management.

1.3    No Return to Work

1.3.1    In consultation with the Employee Relations Unit and OHN, management shall make contact with an employee who fails to return, or is incapable of returning, from medical leave.

1.3.2    An employee who fails to return to work upon expiration of approved leave shall be subject to appropriate administrative action. Such action shall be coordinated with the Employee Relations Unit.

1.4    In conjunction with a return-to-work provision, managers may schedule an employee for a Fitness-for-Duty Evaluation in consultation with the Employee Relations Unit, as outlined in section 519.05.

1.5    An employee who has become disabled may be subject to the provisions of the Americans with Disabilities Act (ADA) as outlined in section 519.04.

1.1    An employee may submit a request for reasonable accommodation to their immediate supervisor, when that employee:

1.1.1    Has a physical or mental impairment that substantially limits one or more major life activity.

1.1.2    Has a record of such an impairment.

1.1.3    Is regarded as having such an impairment.

1.1.4    Is prevented from enjoying equal employment opportunities due to their impairment.

1.2    If the employee meets the criteria for reasonable accommodation, the employee shall:

1.2.1    Complete a Request for Reasonable Accommodation, Form 519-5, and forward it, with supporting documentation, through their chain of command.

1.2.2    Identify the requested accommodation(s) and examples which may include, but may not be limited to; modification of duties, specialized equipment or furniture, restructuring the physical environment and reassignment.

1.3    Managers shall:

1.3.1    Begin the interactive process by meeting with the employee to discuss the accommodation request.

1.3.2    In consultation with the OHN, determine if the employee shall be placed in a temporary work assignment or on appropriate leave pending review of their accommodation request, if the impairment precludes the employee from performing any of the essential functions of the position.

1.3.3    Consult with the OHN and the Employee Relations Unit, review the essential functions of the position, evaluate the request, and determine the ability to accommodate.

1.3.4    Complete the Request for Reasonable Accommodation form indicating the recommendation and forward it to the Employee Relations Unit.

1.3.5    In consultation with the Employee Relations Unit, if medical documentation indicates the employee no longer qualifies for their current position, remove them from the position.

1.4    Employee Relations Unit shall:

1.4.1    Handle accommodation requests as a priority and as expeditiously as possible.

1.4.2    Continue the interactive process with the employee.

1.4.3    Evaluate requests and consult with management, the Staffing Unit, and the OHN, as necessary.

1.4.4    Determine if additional health documentation or other professional consultation is needed.

1.4.5    Determine if an employee is a qualified individual under the ADA and submit an analysis and recommendation to the ADA Coordinator for final approval.

1.5    The ADA Coordinator shall:

1.5.1    Request additional information from the Employee Relations Unit, if necessary.

1.5.2    Approve, deny or modify the request in writing and return the document to the Employee Relations Unit.

1.6    The Employee Relations Unit shall:

1.6.1    Notify the employee and management of the decision.

1.6.2    Assist in coordinating the accommodation.

1.6.3    Ensure appropriate records are maintained.

1.7    Managers shall:

1.7.1    Implement the approved accommodation.

1.7.2    Record the approved accommodation for future reference.

1.7.3    Ensure the accommodation continues as necessary.

1.8    Dispute Resolution - Employees may utilize the employee grievance procedure to address allegations of discrimination related to their disability or concerns with their ADA accommodation request, as outlined in Department Order #517, Employee Grievances.

1.9    Prohibited Accommodation - Informal accommodations requested outside of this process shall not be granted and if approved in error, shall not be binding or permanent.

1.1    Managers, in consultation with the Employee Relations Unit, may approve or direct an employee to undergo a Fitness-for-Duty evaluation to determine whether an employee is able to perform the duties of their position. (See Attachment F.)

1.2    Some evidence of problems related to job performance or safety that may have a health origin may trigger the need for the evaluation. Fitness-for Duty evaluations may:

1.2.1    Only be conducted if they are job-related and consistent with business necessity.

1.2.2    Also be requested when required by:

1.2.2.1    The Family Medical Leave Act (FMLA), as outlined in section 519.02 of this Department Order.

1.2.2.2    Requests for Accommodation Under the American's With Disabilities Act (ADA), as outlined in section 519.04 of this Department Order. (See Attachment G and K.)

1.2.2.3    Temporary Work Assignments or Modified Duty, as outlined in section 519.06 of this Department Order.

1.3    Confidentiality and Availability of Evaluations - The request for a Fitness-for-Duty evaluation and the results of any Department-ordered evaluation shall be held in strict confidence. Information shall be disclosed on a business need-to-know basis only. The employee shall not be provided with a copy of the Fitness-for-Duty Report.

1.4    Following consultation with the Employee Relations Unit, the manager shall:

1.4.1    Determine if the employee shall be placed in a temporary work assignment or be placed on appropriate leave, excluding paid administrative leave, pending the outcome of the evaluation.

1.4.2    Schedule an appointment with an approved health care provider and notify the employee in writing of the scheduled appointment using Attachment F.

1.4.3    Utilize the Fitness for Duty Checklist (Attachment J), compile all related documentation and submit to the healthcare provider a comprehensive referral packet containing the following:

1.4.3.1    A letter that includes a summary of the employee and their background, the events leading to the referral, management's concerns regarding the employee's health, and what the manager needs to know from the evaluation.

1.4.3.2    Copies of relevant documents, which may include but are not limited to information reports, investigative summaries, medical/psychological records, performance documents, job description, disciplinary notices, memoranda or other relevant written communications.

1.5    An employee who has been ordered to attend a Fitness-for-Duty evaluation shall:

1.5.1    Attend the evaluation as ordered. The employee shall not change the appointment date and time.

1.5.2    An employee who refuses to attend the appointment, or otherwise refuses to cooperate, may be subject to disciplinary action.

1.5.3    Present their Department identification card at the time of the appointment.

1.5.4    Sign a "Release of Information" form at the healthcare provider's office.

1.6    An employee shall be considered "on-duty" when traveling to/from and attending the evaluation. Use of a state vehicle is authorized, unless an employee's condition dictates otherwise. If the employee or management believes that he/she is unable to drive due to medication or other medical reasons, management shall arrange transportation to and from the health care provider's office. Travel expenses may be authorized and shall be reimbursed in accordance with State of Arizona Travel Policies.

1.7    The Employee Relations Unit shall:

1.7.1    Coordinate with healthcare providers to obtain Fitness-for-Duty reports as soon as possible within contract limits.

1.7.2    Review Fitness-for-Duty reports and information.

1.7.3    Provide management, the OHN and others who have a business need to know the results of the Fitness-for-Duty evaluation.

1.7.4    Consult with management when the evaluation indicates restrictions or limitations to duty.

1.7.5    Coordinate with management to assist with follow up evaluations as indicated.

1.1    Assignments shall be approved in 30-day increments based on documented need, but in every event, shall not exceed 90 days in the aggregate.

1.1.1    In extreme cases, a TWA may be granted for a combined total of no more than 180 days, based upon documented medical necessity when such assignment conclusively allows a full and complete return to unrestricted regular duties.

1.1.2    Temporary Work Assignment - Temporary reassignment to a different job, the duties of which are compatible with health limitations.

1.1.2.1    TWA's shall exclude sole and/or direct control or supervision of inmates and Incident Management System (IMS) response.

1.1.2.2    Uniformed staff shall remain in uniform unless the health condition requires an exception from the Warden.

1.2    Employees who become temporarily unable to perform the duties of their job due to a health restriction, as certified by a health care provider, may request and may be assigned to modified duty or a temporary work assignment as appropriate, using the Request for Reasonable Accommodation, Form 519-5.

1.3    Assignment to Modified Duty or a Temporary Work Assignment

1.3.1    The employee shall provide management with a healthcare provider's report, which shall include a statement as to the nature, severity and duration of the employee's health condition and shall include any limitations/restrictions.

1.3.2    Management shall provide a copy of the employee's health care provider's report to the appropriate OHN for evaluation and identification of an available modified duty or temporary work assignment. The OHN shall advise on assignments that:

1.3.2.1    Minimize the risk of further injury to the employee.

1.3.2.2    Reduces the risk of jeopardizing the safety of co-workers.

1.3.2.3    Reduces the risk of negatively effecting security concerns.

1.3.3    Upon rendering a decision, management shall notify the employee in writing and forward all documentation and confidential medical records to the OHU. When a modified duty or temporary work assignment involves movement of an employee to a different work unit, management shall notify the Personnel Liaison.

1.3.4    During a period of authorized modified duty or temporary work assignments:

1.3.4.1    Supervisors shall monitor an employee's work performance and attendance with respect to the modified duty or TWA, and their compliance with health limitations/restrictions.

1.3.4.2    Supervisors may return an employee who does not meet the attendance requirements of the TWA to leave status.

1.3.5    When an employee is on modified duty or TWA, the OHN shall:

1.3.5.1    Document the beginning and ending dates of the modified duty or TWA in the OHAS.

1.3.5.2    Monitor time frames.

1.3.5.3    Ensure that updated health reports are received a minimum of every 30 days. Health reports may be received less frequently, if directed, or may be required every time the employee visits their health care provider, as appropriate to the health condition.

1.3.6    The employee shall provide management with an appropriate release or clearance to return to their normal duty assignment upon the conclusion of the authorized modified duty or TWA.

1.3.6.1    The OHN shall evaluate return to work releases and provide a recommendation to management.

1.3.6.1.1    If approved, management shall notify the employee in writing of his/her return to full duty.

1.3.7    Extensions of Modified Duty or TWA in excess of 90 days shall only be considered when conclusive health care information indicates that an extension would enable the employee to make a full return to duty without restrictions or limitations within the approved extension period.

1.3.7.1    Management shall, in consultation with the OHN, determine whether or not an extension of the modified duty or TWA is approved, and the duration of the extension.

1.3.7.1.1    If approved, management shall notify the employee in writing.

1.3.7.1.2    If denied, management shall place the employee on leave and notify them in writing. The Employee Relations Unit shall be contacted for assistance in the development of this notification.

1.3.8     Support Roles:

1.3.8.1    OHN's shall maintain documentation of confidential medical records in the employee's health file, and shall provide relevant information to staff with a bona fide need to know.

1.3.8.2    Employee Relations Unit shall be available to provide guidance and assistance to management, OHN's, and employees.

1.3.8.3    TWA supervisors shall:

1.3.8.3.1    With technical assistance from the OHU, ensure that daily assignments given to employees are consistent with the conditions of the approved temporary work assignment.

1.3.8.3.2    Supervise the employee's daily work related activities.

1.3.8.3.3    Complete performance documentation and ensure that the documentation is forwarded to the employee's permanent position supervisor at the end of the temporary work assignment.

1.3.9    Employees on modified duty or temporary work assignment may work overtime, but only when consistent with their medical restrictions.

1.3.10    Employees may apply for more than one modified duty/temporary work assignment without time restraints between requests as long as the request is for a newly diagnosed qualifying medical condition.

1.3.11    An employee who, upon the expiration of a temporary work assignment, including extensions, and who has not found another position in State service, shall request to be placed on paid leave to the extent of the employee's leave balances. If leave balances do not exist they shall submit a request for medical leave without pay, not to exceed 180 days.

1.1    When an employee fails to meet the firearms training and qualification standards due to a medical and/or physical reason, as outlined in Department Order #510, Firearms Qualification/Firearms Instructor Certification, management shall, depending on the available medical information, authorize a temporary work assignment or refer/recommend a Fitness-for-Duty evaluation, as outlined in section 519.05 or this Department Order.

1.1   An employee who is pregnant may submit a written request for a temporary work assignment at any time during her pregnancy, for the entire duration of her pregnancy and recovery.

1.2    Upon request, management shall coordinate placement of the employee in a temporary work assignment in accordance with section 519.06.

1.1    Upon receipt of information indicating an employee is permanently unable to return to their job assignment for medical or mental health reasons, management shall consult with the Employee Relations Unit who shall assist in the preparation of a memorandum advising the employee of his/her leave status and available employment options, and identify time frames for action.

1.2    The Employee shall:

1.2.1    Request appropriate leave authorization, or a continuation thereof, through his/her chain-of-command.

1.2.2    While on leave, act upon one or more of the available options, such as resignation, retirement, or seek other job for which qualified and eligible, within the stated time frames.

1.2.2.1    If an employee elects to seek another job which is more consistent with his/her condition, he/she shall complete an ADC Employment Application, Form 504-2, and forward it to the Employment Unit for assistance with alternative job identification.

1.2.2.2    An employee may, at any time, pursue and/or accept another position in State service for which he/she is eligible and qualified.

1.3    Within five work days of receiving the employee's employment application, the Employment Unit shall evaluate the application and prepare a return memorandum, with a copy to the Employee Relations Unit that:

1.3.1    Identifies job classification for which the employee may be eligible and qualified.

1.3.2    Instructs the employee on the Department employment process.

1.3.3    Outline other State Services employment processes.

1.4    Employees who are qualified as defined under the American's With Disabilities Act, and who are unable to perform the essential functions of their current position, may prepare and submit a Request for Reasonable Accommodation. If a requested reasonable accommodation cannot be provided, the requesting employee may be referred to vacant positions for which they are eligible and qualify, at the same or lower pay grade.

1.5    An employee may be separated without prejudice if an employee:

1.5.1    Declines a job offer.

1.5.2    Is unable or unwilling to return to their regular assignment upon expiration of an approved leave.

1.5.3    Cannot be accommodated and has not accepted an offer of permanent reassignment.

1.1    All records and documents shall be retained in accordance with Department Order #103, Correspondence/Records Control ,or applicable Statutes.

1.2    Health records are confidential, and shall not be placed in an employee's personnel file, institution file, or a supervisor's or personnel liaison's working file.

1.3    Health records shall be maintained in the Occupational Health Unit (OHU) at the employee's current work location. The Employee Relations Unit may also maintain confidential health records.

1.4    The OHU shall ensure that health records are released only to those who have a need to know based on business necessity.

1.5    Questions regarding medical records or information shall be directed to the OHU.

1.1    Medical Leave Without Pay - Shall be approved when a permanent status employee, excluding an employee on original probation, is unable to work due to a non-job related, seriously incapacitating and extended illness or injury when:

1.1.1    A physician selected by the employee documents such illness or injury. At the Department's expense, this documentation shall be subject to confirmation by a Department selected physician, whose opinion shall be used to determine whether medical leave without pay should be granted.

1.1.2    The employee exhausts all leave balances, including any leave donated to the employee. Medical leave without pay terminates upon the employee's return to work or when the employee is absent for 180 days, whichever occurs first.

1.2    Parental Leave - Employees may request parental leave, which consists of a combination of annual leave, sick leave, compensatory leave, or leave without pay due to pregnancy, childbirth, miscarriage, abortion or adoption of children. Approval for requests for parental leave are subject to the following conditions.

1.2.1    Sick leave may be taken only for periods of disability as certified by a physician.

1.2.2    Parental leave following childbirth, miscarriage, abortion or adoption shall not exceed 12 weeks, unless the supervisor approves a request for a longer period.

1.2.3    The employee shall specify the number of hours of annual leave, sick leave, compensatory leave and leave without pay to be used when requesting parental leave.

1.2.4    The supervisor shall not require the employee to exhaust all annual, compensatory or sick leave before taking parental leave without pay.

1.2.5    If leave under this section qualifies for FMLA leave, a supervisor shall designate it as FMLA leave and notify the employee in writing.

1.2.6    An employee returning to work from leave without pay taken as part of parental leave shall return to the position occupied at the start of the parental leave. If this position no longer exists, a reduction in force shall be conducted.

1.3    Donation of Annual Leave - An employee may donate annual leave to an individual who has no accumulated annual leave if the individual is:

1.3.1    Another employee in the same agency as the donating employee.

1.3.2    A family member of the donating employee who is employed in another agency.

1.3.3    Eligible due to a qualifying extended illness or injury, or is required to care for an immediate family member who has a serious incapacitating illness or injury.

1.3.3.1    To receive this benefit, employees are required to apply for donation of annual leave, as outlined in Department Order #512, Employee Assignments, Work Hours, Compensation and Leave.

1.3.3.2    For additional information regarding annual leave donations, contact the Personnel Liaison in Personnel Services.

The Division Director for Support Services shall ensure:

ESSENTIAL JOB FUNCTION - A fundamental and material job action, distinguished from a non-critical or peripheral duty, required to perform the duties of the assignment.

EXTENDED ILLNESS OR INJURY - A period of at least three weeks to a maximum of six consecutive months for the purposes of annual leave donation. (R2-5-403)

FUNCTIONAL CAPACITY - The employee's physical ability to perform job-related tasks.

HEALTH CONDITION - Any diagnosed illness, disease or injury, including those that are physical or psychological in nature. A health condition may be temporary or permanent.

HEALTH STATUS REPORT - A Department form used to define the extent of work limitations for an employee capable of working, but not at full capacity.

HEALTHCARE PROVIDER (PHYSICIAN, PRACTITIONER) - Includes the following providers if they are authorized to practice medicine or surgery, as appropriate, by the state or country in which the doctor practices and are certified to perform within the scope of their practice as defined under the state or country in which they practice:

MODIFIED DUTY - A temporary modification of an employee's normal job assignment to meet health limitations.

PREGNANCY RELATED CONDITION - A temporary secondary medical condition or concern precipitated by the pregnancy.

Dora B. Schriro

Director

Attachment A - Essential Functions Outline, Worksheet and Sample

Attachment B - Health Care Provider Prognosis Request (Letter)

Attachment C - FMLA Rights Notice

Attachment D - FMLA Reference Material

Attachment E - Fitness-for-Duty Notice to Evaluator (Letter)

Attachment F - Fitness-for-Duty Notice to Employee (Letter)

Attachment G - ADA Reference Material

Attachment H - CORP Form C-19: Contributions During Period of Industrial Leave (elections form)

Attachment I - Fitness-for-Duty Checklist

Attachment J- ADA Determination & Request for Reasonable Accommodation Checklist

Attachment K- FMLA Process Checklist

519-1, Family and Medical Leave Request/Notification

519-2, Employee/Supervisor Report of Industrial Injury

519-3, Health Status Report

519-4, Certification of Health Care Provider (Family and Medical Leave Act of 1993)

519-5, Request for Reasonable Accommodation

519-7, Employee Health Record

A.R.S. 23-901 et seq, Industrial Injury and Disease.

A.R.S. 38-741 et seq, Arizona State Retirement System.

A.R.S. 38-881 et seq, Correctional Officer Retirement Plan; Membership; Credited Service.

A.R.S. 41-1492 et seq, Public Accommodation and Services (Arizonans With Disabilities Act of 1992).

A.R.S. 41-1661 et seq, Correctional Officer Training Standards.

A.R.S. 41-1821 et seq, Peace Officer Standards and Training Board.

A.A.C. R2-5-101, Definitions.

A.A.C. R2-5-401, et seq, Benefits.

A.A.C. R2-5-403, Annual Leave.

A.A.C. R2-5-404, Sick Leave.

A.A.C. R2-5-405, Industrial Disability.

A.A.C. R2-5-405.C., Light Duty.

A.A.C. R2-5-411, Parental Leave.

A.A.C. R2-5-413, Medical Leave Without Pay.

A.A.C. R2-5-414, Leave Without Pay.

A.A.C. R2-5-417, Life and Disability Income Insurance Plan.

A.A.C. R2-5-902, Reduction in Force.

Pregnancy Discrimination Act, 42 U.S.C. 2000e (k).

Americans With Disabilities Act of 1990, Titles I-V.

28 CFR Part 35.130 et seq, Nondiscrimination on Basis of Disability by State & Local Government Services.

Family and Medical Leave Act of 1993.

U.S. Civil Rights Act of 1964.

Rehabilitation Act of 1973.