12.01.13 - Appointments for Work-Related Injuries
CITY OF BOYNTON BEACH, FLORIDA ADMINISTRATIVE POLICY MANUAL CHAPTER: 12 Risk Management Policy No. 12.01.13 SECTION: 01 Risk Management Policies Page 1 of 3 SUBJECT: 13 Appointments
for Work-Related Injuries PURPOSE: To provide a procedure for the maintenance of records of scheduled doctor visits and physical therapy visits which are for work-related injuries. PROCEDURE:
1. When an employee has a scheduled appointment with a doctor or physical therapist during working hours, the attached form must be completed by the employee and brought to the appointment
by the employee. The “time in” and “time out” must be completed and signed by the doctor or therapist. This form must be submitted to Payroll with the timesheet in order for time to
be paid as workers compensation. 2. The employee will only be paid for the time spent at the doctor or therapist office and reasonable travel time. Any additional time taken off by the
employee will not be paid as workers compensation. If extra time is taken without authorization, the employee’s sick time will be used. 3. All follow-up appointments with a physician
or appointments for physical therapy should be made within one hour and a half (1-1/2 hours) of the time the employee’s workday ends (i.e. If employee works until 4:30 p.m., appointment
should not be scheduled before 3:00 p.m.). If it is not possible to get an appointment at the end of the workday, then Risk Management must be notified. 4. If the employee has exhausted
all means of providing for his/her own transportation to the appointment, the City will provide the necessary resources to ensure the employee gets to the scheduled appointment (i.e.
City vehicle or reimbursement for public transportation). 5. Mileage reimbursement forms will be distributed to the employee when they report to Risk Management to sign appropriate forms.
These forms must be returned to Risk Management for submission to PGCS for payment. 1
6. The department may allow the employee a reasonable amount of time to shower and change clothes at City facilities prior to a scheduled appointment. 7. The City is not required to
reimburse an employee’s time if an appointment cannot be scheduled during working hours. DEVELOPED BY: Risk Management EFFECTIVE DATE: April 27, 1994 REVISED: February 20, 2008 Kurt
Bressner Kurt Bressner City Manager 2
3 CITY OF BOYNTON BEACH PAYROLL AUTHORIZATION FOR DOCTOR/PHYSICAL THERAPY VISIT Name of Employee: __________________________________________________ Department/Division: _____________________________
_____________________ Name of Doctor or Physical Therapist: _____________________________________ Date & Time of Appointment: ____________________________________________ Employee Signature:
_________________________________________________ Supervisory Signature: __________________________________________________ ……………………………………………………………………………………………………… FOR PHRSICIAN OR PHYSICAL
THERAPIST SIGNATURE: The employee named above was treated by me on ___________________________ . Time In: __________ Time Out: __________ If there are any employee restrictions on returning
to work after this therapy or doctor visit, please note below: _________________________________________________ ___________________________________ __________________________ Doctor
or Therapist Signature Date Distribution: Payroll (Original) Risk Management Personnel Department Rules and Regulations