HomeMy WebLinkAbout02-04-2004MINUTES OF THE BOARD OF PUBLIC WORKS AND SAFETY
OF THE CITY OF JEFFERSONVILLE, INDIANA
FEBRUARY 4, 2004
Mayor Waiz called the meeting to order at 9:30 a.m. and on call of the r011 those members present were:
City Engineer Miller and Councilperson Sellers.
Also present were: Wastewater Treatment Employee Wright, Administrator Rich Davis, Fire Chief
Miles, Building Commissioner Seagraves, Vehicle Maintenance Director Drury, Street Commissioner
Ellis, Planning and Zoning Director Padgett, Police Chief Ashabrarmer, Personnel Director Calabro,
Redevelopment Director Becket, Asst. Police Chief Lovan, Youth Coordinator Knight, City Attorney
Merkley, Parks Director Poff, and Deputy Clerk Lynne Mayfield.
Engineer Miller made the motion to approve the payroll as presented, seconded by
Councilperson Sellers and carried unanimously.
HANDICAPPED PARKING
Inspector Steve Hardin told the Board that Thelma Lovans of 719 Meigs Avenue is requesting
handicapped parking sign in front of her house. The police department will look at the location and
report back to the Board.
POLICE SIGNS
Assistant Police Chief Lovan said addi~tional Signs need to be posted on Meigs Avenue for police officer
parking. The signs will be marked "Police Uniform Division". Police Chief Ashabrarmer said he is
working with the Greater Clark County Schools on acquiring additional parking.
PERSONNEL MATTER
Fire Chief Miles asked the Board to approve promoting Dennis Dierking from Lieutenant to Captain.
Engineer Miller made the motion to approve the promotion, seconded by Councilperson Sellers and
carried unanimously.
STREET CLOSURE
Engineer Miller made the motion to close Penn Street between Ninth and Tenth Streets sometime in
March approximately two days for grade work, seconded by Councilperson Sellers and carried
unanimously.
PLAN COMMISSION APPOINTMENT
Conncilperson Sellers made the motion to approve appointing Dennis Dierking to the Plan Commission,
seconded by Engineer Miller and carried unanimously.
CITATION
Building Commissioner Seagraves said he received a complaint on 12-22-03 on Marilyn Werblo of 1502
Nina Road for open storage and garbage on her property. A citation was sent to her by certified letter,
which was not picked up, and by registered letter, which was returned. Building Commissioner
Seagraves asked what could be done next. Engineer Miller said she can be fined or the Street
Department can clean it up and bill her property taxes. City Attorney Merkley said she would need to be
notified again to appear before the Board. Mayor Waiz asked that it be done as quickly as possible.
WATER MAIN BREAK
Street Commissioner Ellis said a water main broke on Spring Street Tuesday night north of Magnolia
Avenue. That portion of Spring Street will be closed Wednesday. Some concrete broke up as a result of
the water main break.
NEXTEL CONTRACT
Street Commissioner Ellis asked the status of getting phone service from Nextel. The Nextel
representative was present to answer any questions. The Police and Fire Departments use Nextel and
are pleased with the service.
GREEN MACHINE
Street Commissioner Ellis said people would be coming on 3-3-04 at 10:00 a.m. to demonstrate the
sweeper called the Green Machine.
DEPARTMENT HEAD MEETING
Animal Shelter Director Wilder said the shelter would be open on Saturdays from 8 a.m. to 4 p.m.
starting in March.
Street Commissioner Ellis said he doesn't have any CDL drivers to lend to EMC. He said his driver's
could only drive 10 hours. Mayor Waiz said that EMC should have one of their employees get their
Class A CDL license.
Councilperson Sellers said that when we got the snow almost two weeks ago that the Meadow's
Subdivision was not cleared by the Street Department. She took pictures of several surrounding
subdivisions and they looked pretty clear. Street Commissioner Ellis said the snow plows have rubber
blades that just slide over ice, which was under the snow. He said he concentrated mostly on the main
roadways. Councilperson Sellers said her streets had never looked this way before.
Personnel Director Calabro passed out new workman's compensation forms for Department Heads.
Personnel Director Calabro said she has ordered a training video from Midwest Toxicology for the
Street Department. She said they have not been trained properly.
~'iPersonnel Director Calabro said she would be going over job descriptions with the Police and Fire
Departments.
Personnel Director Calabro reported that the Dare To Care boxes are here. She will be collecting the
donations to turn in.
Vehicle Maintenance Director Drury asked if there would be an auction in April. Mayor Waiz said there
would be. There was discussion on possibly doing it on E-Bay or doing it the conventional way.
There being no further discussion to come before the Board the motion was made by Engineer Miller to
adj~.m., seconded by Councilperson Sellers and carried unanimously.
M~OR '
ATTEST:
CLEf~ASURER
Date: February 3, 2004
To: Department Directors
From2 Klm Calabro, ~luman Resources Director
Re: ~47orkers Compensatio~ Claims
Attachedplease findclean copies of allforms relatedto the filing of
a workers compensation report. Severaloftheseforms have been
revised so please discard any old forms you currently have on file.
An instruction sheet has also been attached for you convenience.
All of these forms can be located and down~oaded from the
Downey Insurance Inc. website at www.downeyins.com~ I plan to
complete and file the reports via the Internet. Please visit the site
and familiarize yourself with the information required for
reporting, as this will expedite the reporting jrrocess and keep me
--llsu~ervisors or additional informatio~ The
from having to c~ w f~
Supervisor's Incident Investigation Report is a new document. It
is imperative that the immediate supervisor accurately completes
· this section andbe very specific when descr~b~ g the incident.
Additionally, the Authorization For Release of:Medical
Information is also a new fornu :Make sure that the employee signs
this document as this will allow for the sharing of medical
information related to the injury.
If you have any questions regarding the attached forms please let
me knc~v.
I willbe meeting with representatives from Do~vney Insurance
Company to discuss %Torkers Compensation reports and claims on
Thursday February 26, 2o04 at I~:30 a~m~ If you would like to
attend the meeting let me know.
Thanks for your support!
INSTRUCTIONS
General Instructions:
l. plea.se enter information into all of the shaded areas of the First Report form, except the boxes at the top right comer of the form
which ii for Office use only.
2. Enter all dates in MM/DDPfY format.
3. Ple~e ~ completed forms m:
4. For answers to questions, please call
Indiana Worker's Compensation l~ard
402 W. Washla~on St., Room W196
Indianapolis, IN 462042753
Definitions:,
AGENT NAME & CODE NUMBER: Entcr the name of your insurance agent and his/her code number if known. This infatuation
can be found on your insutanc~ policy.
ALL EQUIPMENT, MATERIALS OR CHEbI[ICAI~ EMPLOYEE WAS USING WHEN ACCIDEI¢I' OR EXPOSURE
oCC1JR~,ED: Lis~ ~nythi~$ the empl°yee was u'sing' applylng' handlin$ °r °perad=g whtm the injury or exp°sure °courted' ' If the
injur~ involws a fall, indicaIe any surfaces and/or obi ~'~s the claimant fell on and where theft fell from. Enter'HA" if no eqorpmen[,
marerial$ or ch~mlcals wer~ being'used (e.g. Ac~ylene cutting toech, meal plate, e~c.).
AVG WG/WK: Claimant's average wcekty wage, calculated by totalling the latest 52 w~Ics of wages (incinding overtime, tips, eto.)
and dividing by ~.
CLAIMS ADMINISTRATOR: Enter the name of the carrier, li~rd-part,ff adminisu'ator, stem fund, or self-lnsured ~-ponsible for
administering thc claim.
cONTACT NAME/~tlONE NUMBER: l:~-the r~me of the individual at thc employer's premises ~o be contac~l for a~iduna!
information (Lo. Supurv[sor, HR P~soa, Nurse,
DAT£ DISABILITY ~EGAN: 'the ffa~ day un which the claimant originally Iosx dine flora work. due to the occ~oaa~ hju~. or
...... ,-...,, tho fo.o ,boil:
EM]PLOYEE STATUS: indicate tan empm~ . -. -- - -- ,,,~--- t~ .~-ac~ Disabled, I~i~d, I~ot ~.~p~oy~
T~ra~, Appr~ . .e, -- . ..~ ,~- ,t-r ant vt~ SW. PW OS, DL RE, lie or
(you may aiso abbt~'~'.at~ lllo a~ovc as. r l, r~,,z'~ l
· uenc¢ of cvcata leading to the injury or (e.g. Wod(~
OW INJURYflLLNESS OCCUIIRED. Desan'be the seq bruxhed ' ~he h~t m~
H . ~ some me,al. As woflc~r f~lL he , ~ · ' fall
of the scaffolding, lost balance and fell slx te~t to me con~,, ,,,~-....e __
NCCI CLASS CODE: A four-digit cod= claaaifyin§ the occupation of the claimant.
OCCU PATIONIJOB '11 it LE:' Enter h~ p~mary occupation of the claimant at the time of the accid~at or expusu~.
pART OF BODY AFFEt. ~ ED: Indicale the part of body affec~d by the injury£dlness (e.g. Right forearm, Low Back, etc.).
REPORT pURI'OSE CODE: 00 = Original Fkat P,~o ~ of Iajtn3", 02=updatod or Amended F'u~t Report.
RTW DATE [Kalum to Work Da~): ~utm' th~ da~ following the mo.~ recant dlaab ~t~ period un which the ~nployee r~arned to
SIC CODE: This ia the code which ropr~unts lhe nacre of the employor's lousiness which a aontained in the Sumdard Indusuial
Classification Manual publish~'d by the F~derai Office of Manage'hoot and Budget.
pr~For:ation for painting)."
TYPE OF INJUP, Y/ILL4NE~g: Briefly describe file n~mre of the mju~ or Lliness (e.g.: Conats~on, Lacel~un, Fr'~mre, otc
Enter "NA" if
Indiana Worker's Compensation
First Report of Employee Injury/Illness
PLEASE TYPE or PRINT IN INK
EMPLOYEE INFORPt~'RON
3CCUPA~ONJJOE TITLE NCCI CLAES CODE
PHONE · OF DEPENO~S $ OyR 'O0~
~PLOYER INACTION
SELF
INSU~CE
~CU~THE~ INACTION
MIN~ BY EMPLOYER
DOWNEY
INSURANCE
Downey Insurance Inc.
P.O Box 1247
Kokomo, 1N 46903-1247
Toll free: 1-800-382-8837
Local: 1-765-45%9161
Claims fax: 1-765-868-3310
Adjuster: Claim No:
AUTHORIZATION FOR RELEASE OF
MEDICAL, MILITARY, EDUCATION AND WAGE INFORMATION
To any physician, dentist, hospital, health care practioner, military authority, education authority, employer or insurance
carrier:
The requested information is needed to accurately evaluate, adjust and pay the patient's insurance claim.
I hereby authorize any health care professional (including health care physicians, medical practinners or other health care
providers, hospitals, medical attendants, narsas~ x-ray technicians, or any other person), military authority, education authority,
employer or insurance cartier, to furnish to the insurance company named above or its authorized vendors and representatives,
wage toss and individually identifiable health information regarding my injuries, payment, treatment rendered, or health care
received or provided. I understand that this authorization is voluntary.
I agree that a photocopy or fax of the original authorization shall have the same force and effect as the original.
I understand that my health care records may contain information regarding the diagnosis or treatment of HIV (AIDS virus), other
sexually transmitted diseases, drug and/or alcohol abuse, mental iliness, or psychiatric treatment. I give my specific authorization
for these records to be released.
I understand that 1 may revoke this authorization at any time by notifying the health care professional(s) in ~vriting, but if [ do it
will not have any affect on any actions taken before receipt of the revocation.
I understand that once disclosed, the information and documentation released may be re-disclosed and may no longer he subject to
the HI, AA Privacy Rule.
This disclosure is made at the request of the individual named below for the purposes of evaluation, adjusting and paying an
insurance claim.
Unless other,vise required by law, this authorization shall expire upon the final resolution of the insurance claim.
By signing below, the patient acknowledges that he/she has read the fraud statement printed below.
PATIENT OR REP SIGNATURi~
PATIEN'r NAME OR REP (PLEASE pRINT)
REPRESENTATIVE'S RELATIONSHIP TO PATIENT
PATIENT ADDRESS
CITY. STATE, ZIP
PATIENT PHONE NUMBER
SOC SEC NUMBER
DATE OF BIRTH
ANY PERSON ~,VHO KNOWINGLY AND WITH INTENT TO DEFRAUD AN INSURER, FILES A STATEMENT OF
CLAIM CONTAINING ANY FALSE, INCOMPLETE. OR MISLEADING INFORMATION COMMITS A FELONY.
12/03
1. Company or Location
INDIANA PUBLIC EMPLOYERS' P~_AN, INC.
SUPERVISOR'S INCIDENT INVESTIGATION REPORT
(Please Complete All Sections~
2. Department
3. Date of IncidentJDay of Week
4. Exact Location of Incident
5. Time of Occurrence {am/pm)
6. Date RepoAed
7. Name of Injured
8. Occupation
9. Body PaA Affe~ed
10. Nature of Injury or illness
11 Item Inflicting Injury/Illness
12. Type of Accident
13. Person With Most Control of Item 11.
14. Description of the Incident
15. Direct Causes of Incident
16. Why Each Cause Exists
17. Actions Taken or Needed to Prevent Recurrence
18. Date Completed
19. Investigated By
20. Date
21. Reviewed By
22. Date
Please mail form to: IPEP
P.O. Box 690
Kokomo, Indiana 46903-0690
Toll ffee:
ClaimsF~x:
Loc~:
[-800-382-8837
1-765-868-33 I0
t-765-457-9161
Type of Accident.
Bite by Animal
Bite by Human
Bite by InsectJSting
Body Reaction
Burn
Caught in/Between/On
Contacted Harmful Substance
Contagious Disease
Exposure
Electrical Contact
Fail From
Fall Level
Fell Through
Foreign Body
Gunshot
Motor Vehicle
Other
Overexertion
Pierced/Punctured By
Public Transportation
Repetitive Action/Motion
Slipped (Not Fall)
Smoke inhalation
Stepped In/On
Stress
Struck Against
Struck By
Struggle/Resistive Subject
Nature of Iniury
Abrasion
Amputation
Asphyxia
Avulsion
Bruise, Contusion
Burn Caused by Chem.
Burn Caused by Heat
Carpal Tunnel Syndrome
Concussion
Cut, Laceration
Crush
Death
Dermatitis
Dislocation
Electrical Shock
Fracture
Frostbite/Freezing
Hearing Loss
Heart Attack
Heat Stroke
Hernia
Infection
inflammationlSwelling
Multiple Injudes
Other
No Injuries
Poisoning
Puncture
Radiation
Soreness/Pain
Sprain/Strain
Stress
Tendonitis
Part of Body
Abdomen
Arm - Lower
Arm - Upper
Back/Spinal, Back/Non-spinal
Buttocks
Chest
Ears, External
Ears, Internal
Elbow
Eyes
Face
Fingers
Foot
Groin
Hand
Head
Hips
Jaw
Knee
Leg - Lower
Leg - Upper
Mouth
Multiple Parts
Neck/Spinal, Neck/Non-spinal
Nervous System
Nose
Other
Respiratory System
Shoulder
Teeth
Thigh
Thumb
Toes
Trunk/Non-spinal
Wrist