Work Related Injury/Illness

Classification & Case

Management

Health and Medical SMO

Updated Oct 2016

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2014 Chevron
 Early Injury Management Process

Intended to ensure that the injured person (IP) receives appropriate

medical care in a timely manner
Minimize the impact of the incident and to avoid further complications.
Engages the IPs supervisor / management immediately after an
incident occurs
Ensures that the supervisor is aware of any restrictions or limitations
prior to the IPs return to work
Strives to return personnel to meaningful work as appropriate based
on their ability to safely perform tasks without the risk of further injury
or compromise of healing

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 Injury/Illness Record Keeping In Scope

Injuries and illnesses that are work-related and, at a minimum, meet

the threshold for other recordable reportability.
Injuries including, but not limited to cuts, fractures, sprains,
amputations.
Illnesses including, but not limited to food-borne disease, skin
diseases and disorders, respiratory conditions, hearing loss,
heatstroke, sunstroke, heat exhaustion, heat stress, frostbite,
decompression sickness, blood-borne pathogenic diseases such as
HIV-AIDS, Hepatitis B or Hepatitis C.

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 Injury/Illness Record Keeping In Scope

An injury or illness is work-related if an event or exposure in the work

environment either
Caused or contributed to the resulting condition or
Significantly aggravated a pre-existing injury or illness.
Work relatedness is presumed for injuries and illnesses resulting from
events or exposures occurring in the work environment.
Dining on food provided at company camp or on an offshore platform
operated by the company is work-related for corporate reporting
purposes.
Food supplied by Chevron for business meeting or other company
function, even if Chevron purchased it from the company cafeteria, is
considered work-related.

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 OE Data Reporting Standard 2014
Injury/Illness Classification

Injury/Illness occurs

Work Related Non Work Related

Injury Illness

Fatality DAFWC RDC ORC FAC Non Recordable

Recordable

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 SMO Early Injury Management

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 SMO Early Injury Management

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 Health & Medical SMO
Organization Chart

Sr. VP Sumatra Operation Mgr H&M IBU

Sugih Wanasida

Mgr H&M SMO

Sozanolo Zega

TM Medical Clinic TM OHW Hospital QC Adv Sr Admin SMO

Alina Nasution Maulidarman Hery Pratala Yosaphat

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 First Aid

Treatment of Minor Injuries

Can Include Follow-up Treatment
First Aid Category (see table)
Cases that are more serious than first aid case are considered
Medical Treatment

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 Other Recordable Cases

Other Recordable is a classification referring to injury and illness

incidents that do not fit other classifications such as Days Away From
Work or Restricted Duty but are required to be reported to Chevron
Corporate.
Incidents that fit in the Other Recordable classification include work-
related events that result in:

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 Other Recordable Cases

Medical Treatment includes:

The use of medical glue as a wound-closing device.
Prescription medication is provided.
Cases in which oxygen is administered as a result of a worker
injury or illness. If the oxygen is used as a purely precautionary
measure, where no injury or illness exists, the event is not a
medical case for the purposes of internal OE reporting. Oxygen
saturation measurements do not negate oxygen administration as
a medical treatment where an injury or illness exists
Loss of consciousness regardless of the length of time.
Medical diagnose of cancer or chronic irreversible disease.

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 Other Recordable Cases

A fracture or cracked bone (including teeth).

A punctured eardrum.
Needle sticks and cuts from sharp objects contamination with
another persons blood or other potentially infectious material, such as
human bodily fluids, tissues, and organs; or other materials infected
with HIV or Hepatitis B virus, such as laboratory cultures.
Splashes or other exposures (not cuts or scratches) to another
persons blood or other potentially infectious material (human bodily
fluids, tissues and organs) if exposure results in diagnosis of blood-
borne illness (HIV, Hepatitis B, or Hepatitis C) or general reporting
criteria are met.

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 Restricted Duty

A Restricted Duty Case is when, because of work-related injury/illness:

A worker is assigned to another job on a temporary or permanent
basis.
A worker works at his or her permanent job but less than a full day.
A worker cannot perform routine functions (functions performed at
least once a week) associated with his or her permanent job or cannot
work the full workday.
A physician or other licensed health care professional prescribes that
a worker not perform one or more of the routine functions of his or her
permanent job, or not work the full workday that he or she would
otherwise have been scheduled to work.

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 Days Away From Work (DAFW)

A Days Away From Work case is when, due to a work-related

injury/illness, a worker is away from work for one or more complete
days after the injury/illness occurred. Incidents are still considered to
be a DAFW case even if:
The first day of work missed is several days/weeks/months after
the initial date of the incident or
The worker is prescribed days off by a physician and the worker
comes to work anyway.
To be reportable, DAFW cases must meet the medical threshold
described in the Other Recordable definition.
Days Away: the number of calendar days (including holidays, vacation
and weekends) that are lost.
The day of the incident is not counted as a Days Away day.

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 Fatality

A fatality is the death of a Chevron employee or contract employee

engaged in a work-related activity that results from an incident or
exposure in the work environment.
The individual need not actually die in the work environment.
If an injury is classified as a Restricted Duty Case or Days Away From
Work Case and the case progresses to a Fatality, re-classify the
incident as a Fatality, keeping the original incident date. The
classification should reflect the most severe outcome associated with
the reportable injury/illness.

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 OE Data Reporting Standard 2014
Injury/Illness Classification
First Aid Treatment
The following types of activities should be considered
first aid for corporate reporting purposes:
Visit to physician solely for observation or
counseling.
Diagnostic procedures (e.g. x-rays, blood tests,
prescriptions used solely for diagnostic purposes).
Using non-prescription medication at non-
prescription strength.
Immunizations that are not in response to a work-
related exposure. Tetanus immunizations are always
considered first aid
Cleaning, flushing, soaking surface wounds.
Using wound coverings such as bandages, Band-
Aids, gauze pads; butterfly bandages or Steri-Strips
Using hot or cold therapy.
Massages.
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Medical Treatment
The following are examples of Medical Treatment:
Management and care of persons to combat
disease or medical disorders and excludes visits
for observation or counseling and diagnostic
procedures.
Admission to a hospital or equivalent medical
facility for treatment
Using a prescription strength medicine, or using a
non-prescription strength medicine at prescription
strength dose.
Other Immunizations in response to an exposure,
such as Hepatitis B vaccine or rabies vaccine
Cutting away dead skin (surgical debridement)
Application of sutures (stitches), staples, or use of
medical glue as a wound closing device.
Physical therapy or chiropractic treatment are
considered medical treatment
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 OE Data Reporting Standard 2014
Injury/Illness Classification
Using non-rigid means of support, such as elastic
bandages, wraps and non-rigid back belts.
Using temporary immobilization device used to
transport accident victims (e.g. splints, neck collars,
backboards).
Removing foreign bodies from the eye with only
irrigation or cotton swab.
Removing splinters/foreign material from areas
(other than eye) by irrigation, tweezers, cotton
swabs, or other simple means.
Drinking fluids to relieve heat stress.
Damage to a workers dental bridges or dentures
(does not include damage to teeth)
Drilling fingernail or toenail, draining fluid from
blister.
Using eye patches.
Using finger guards.
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Devices with rigid stays or other systems designed
to immobilize parts of the body are considered
medical treatment.
Removal of foreign bodies embedded in eye.
Removal of foreign bodies from wound, if
procedure is complicated because of depth of
embedment, size, or location.
Intravenous administration of fluids.
A fracture or cracked bone (including teeth).
Positive X-ray diagnosis (fractures, broken bones,
etc.).
A punctured eardrum.
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 OE Data Reporting Standard 2014
Prescription Medication

Prescription medication are listed below:

All antibiotics, including those dispensed as prophylaxis where injury or illness
has occurred to the subject individual. Exceptions: Dermal applications of
Bacitracin, Neosporin, Polysporin, Polymyxin, Iodine or similar preparation.
Diphenhydramine >50 milligrams (mg) in a single application or any dose
injected.
All US prescription strength oral Analgesics and Non Steroidal Anti
Inflammatory Medication (NSAID). Exceptions:
Acetylsalicylic Acid Aspirin
Acetaminophen Paracetamol
Dermal application of NSAIDs not obtained by prescription
The following prescription medications sold Over The Counter (OTC),
when the US OTC label strength is used:
Ibuprofen, Naproxyn Sodium, Ketoprofen
Codeine analgesics used in a single dose of 16 mg or less
(exception applies to non US location only)

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 OE Data Reporting Standard 2014
Prescription Medication

All dermally applied steroid applications. Exceptions: hydrocortisone

preparations in strengths of 1% or less.
All vaccinations used for work-related exposure. Exceptions: Tetanus
All narcotic analgesics (except codeine as listed above)
All bronchodilators. Exceptions: Epinephrine aerosol 5.5 mg/ml or less
All muscle relaxants (e.g. Benzodiazepines, Methocarbamol and
Cyclobenzaprine).
All other medications (not listed above) that legally require a prescription for
purchase or use in the state or country where the injury or illness occurred.
Other exceptions: prescription given solely for the purpose of diagnostic
procedures.
If there are questions regarding medications, contact a Corporate Health
and Medical Regional Manager

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 OE Data Reporting Standard 2014
Prescription Medication

Cases in which prescription medication is provided or medication is

prescribed by a physician or other licensed health care professional,
even if:
The worker does not fill or take a prescription.
A physician later determines the prescription was unnecessary.
Any prescription medication, even antibiotics prescribed for purely
preventative reasons, is considered medical treatment.

All health care provider working for Chevron are expected to follow
established country medical standards of care for illnesses and injuries to
promote rapid healing, reduce lost time, improve productivity, and
mitigate morbidity and mortality.

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 Medical Incident Report

Any Chevron employee or Business Partner who is injured in a

Chevron location shall immediately report to a Chevron clinic or they
must contact a Chevron doctor/medic before having any medical
intervention at a medical facility outside of Chevron
The doctor/medic on duty will immediately take action for the injured
person (IP) in consultation with the Chevron doctor.
After treating or stabilizing the IP the doctor/medic on duty shall notify
the facility owner about the incident and make a written medical
incident report including attachment of MIGAS Incident Report form IIIi
and 1st Report of Industrial Injury form .
The documentation of the incident as per our Incident and Injury
Reporting (IIR) Process shall be the responsibility of the facility
owner.
HES Reviews information and Classifies the incident

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 Medical Incident Reporting

Treating Nurse or Physician must report all work related incidents immediately to TM
Medical Clinic/Hospital QC Adv or appointed doctor by phone. Life threatening condition
should be handled before making the phone call/report.
Treating Nurse or Physician must have approval from Area Medical Leader (TM Medical
Clinic/Hospital QC Adv) before giving prescription medication / medical treatment category
to the patient (by phone first followed by email).
Treating Nurse or Physician must submit 2 email reports:
Non-confidential report to: CMO, Facility Owner (Mgr & TM Operation), HES Manager
and TL HES Area
Confidential report to: TM Medical Clinic, Hospital QC Adv, CMO, TM OHW.
All should be reported within time frame as below:
Incident level 1 (first aid case) within 6 hours
Incident Level 2 and above within 2 hours
CMO will report Incident Level 2 and above or any case require medical evacuation to IBU
HM Manager and Regional medical director within 6 hours.
TM OHW will organize fatality case report for IBU, AP Regional and SKK Migas
If SMO management approval is required (chopper utilization, etc.), CMO or acting will
pursue this approval and forward the approval to evacuation team.
Drug and Alcohol test shall be done for Incident Level 2 and 3.
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 Case Management & Return to work
Reporting

Requesting CMO approval for medical evacuation shall be done by Area Medical Leader (TM Medical
Clinic/Hospital QC Adv) or Treating physician (by phone or sms and email cc HM IBU Manager):
Initial report: As soon as treating physician or TM Medical Clinic/Hospital QC Adv make the decision to
evacuate the patient. Subject to be reported: brief medical case and plan for treatment in destination
hospital.
Evacuation plan: As soon as evacuation plan has confirmed in term of timing, mode of transportation,
preparation for evacuation.
After patient handed-over at destination hospital. Subject to be reported: patient condition during
evacuation process and handover process, time of handover, other important information (fail equipment,
etc).
Regular daily report: coordinate follow up with Case Management
Return to work (RTW) FFD procedure:
CM will notified and provide discharge patient report to TM OHW, (cc to Area Medical Leader: TM
Medical Clinic or Hospital QC Adv).
OHW will coordinate and arrange RTW FFD evaluation procedure.
OHW to provide recommendation to employee supervisor based on RTW FFD procedure result. OHW /
field doctor to informed employee on RTW FFD result. (based on FFD Guideline)
Area Medical Leader and filed doctor will be notified by OHW on the result.
For contractor, OHW team to recommend contract owner to initiate RTW FFD evaluation (refer to FFD for
contractor guideline).

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 Current Procedure

Document

IBU Medical Incident Report

- Confidential (SOAP included in
email body)
IBU Emergency Assessment
Form

IBU Medical Referral Evacuation Feb 2013

Form

Attachment of MIGAS Incident

Report Form IIIi

1st Report of Industrial Injury

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 Current Procedure

Document

IBU BPP Work Injury Notification Jan 2010

IBU Air Medical Evacuation Jul 2013

(Medivac) to Singapore or
Jakarta Procedure
SMO - Incident Notification 23 June 2014
Procedure

SMO EIM Nov 2013

U&G Loss of Life Notification 2013

2016 OEDRS and IBU Case

Management for 2nd & 3rd Care
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 Investigation Criteria

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