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Workers' Compensation
If you are injured on the job:
- Complete First Report of Injury (required) - all injured employees must complete this form and give it to Human Resources within 24 hours of the accident. If the employee is unable to complete it, a supervisor must complete it, and have the employee complete his/her own when he/she is able.
- Choice of Provider Letter (required) - all injured employees MUST review to understand there are four choices for non-emergency care after a workplace injury.
- Accident Investigation - for workers' compensation injuries only, please see the Risk Management page for non-workers' compensation reporting.
- Exposure Incident Investigation and Post-Exposure Checklist
- Bloodborne Pathogen Checklist - Form 1 - Form 2 - Form 3
Leave Policies
- Full Time Employees Leave Policy
- Part Time Employees (PT) Leave Policy
- Part Time Non-Benefited (PP) and Temporary Employees Leave Policy
Family and Medical Leave
In an effort to provide employees with a convenient one-stop-shop approach and ensure a higher degree of confidentiality with medical certifications, HR has partnered with The Hartford to help CCOB employees navigate FMLA leave and disability accommodation requests beginning Sept. 1, 2023.
The Hartford currently administers CCOB’s Short Term Disability as well, so by combining these services under one carrier employees will only have to submit one application and one medical certification.
If you need to apply for Family and Medical Leave, please contact The Hartford. You may initiate your FMLA request with The Hartford online or by phone call to The Hartford. Please click here Version OptionsWorkers' Compensation HeadlineLeave PoliciesFamily and Medical LeaveReturn to Work to view the FMLA instructions from The Hartford.
If you also need to apply for Short Term Disability, The Hartford can help you at the same time. Click here Version OptionsWorkers' Compensation HeadlineLeave PoliciesFamily and Medical LeaveReturn to Work for more information about Short Term Disability.
The Hartford will notify Human Resources when a leave request is initiated. It is no longer necessary for employees to submit a Leave Request for Family or Medical Leave form to Human Resources.
HR is available to meet with employees to explain the leave and disability benefits in addition to providing assistance in navigating the application process with The Hartford. Please submit a Support Services ticket if you would like assistance or have any questions. There are several ways you can submit a ticket:
- Go directly to the Internal Services Portal
- Use the link within the Launcher panel on the BEACH
- Use the link within the "CCOB Bookmarks" folder within Google Chrome
- Send an email to hrsuport@broomfield.org, which will create a ticket in the system
FMLA General Notice for Employees
Return to Work
- Release to Return to Work Form - Must be completed by employee’s physician and review job description prior to returning to work.
- Access to Job Descriptions - Must be reviewed by physician during completion of Return to Work form.
- Return to Work/Inability to Return to Work Policy
Additional Forms and Information
- Leave Without Pay Requests - The employee's supervisor or manager should submit a Support Services ticket to Human Resources if Leave Without Pay has been approved by the department head. Please include the employee name, dates approved, hours to be granted and a copy of the email or other approval from the department head.
- Leave Donation Request Form
- Request for Domestic Abuse Leave form
Related Policies:
Seat Belt Policy
Bloodborne Pathogens
Electronics Recycling and Surplus Disposition
PPE Guide
Driver Evaluation Form
Chemical Hygiene Plan
HHSD Exposure Control Plan
Hazard Analysis of Broomfield Environmental Services and Field Operations
Wastewater Confined Space Policy
Water Plant Confined Space Policy
Utilities Confined Space Policy