Common use of Departmental Accident Report Form for Workers’ Compensation Benefits Clause in Contracts

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK. • QUESTIONS REGARDING AN EMPLOYEE'S SICK LEAVE SHOULD BE DIRECTED TO HIS/HER SUPERVISOR OR DEPARTMENTAL ADMINISTRATOR. Printed by Columbia University Print Services, a Local 2110 Shop.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of Full day sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick bank leave is exhaustedexhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), an the employee must use their remaining annual allotment will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of sick leavethe 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. See: Section 7 – What You Should Know About New York State Disability. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum First 5 days of sick leave charged at the rate of a full day for each day of absence. Thereafter, sick leave is charged at the rate of 1/2 day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of 1/2 day per day of continuing disability). After the 26-week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. NOTE: 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK. • QUESTIONS REGARDING AN EMPLOYEE'S SICK LEAVE SHOULD BE DIRECTED TO HIS/HER SUPERVISOR OR DEPARTMENTAL ADMINISTRATOR. NOTES Printed by Columbia University Print Services,a Local 2110 Shop.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES:  EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE.  AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF.  AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE.  IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of Full day sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick bank leave is exhaustedexhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), an the employee must use their remaining annual allotment will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of sick leavethe 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. See: Section 7 – What You Should Know About New York State Disability. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum First 5 days of sick leave charged at the rate of a full day for each day of absence. Thereafter, sick leave is charged at the rate of 1/2 day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of 1/2 day per day of continuing disability). After the 26-week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. NOTE: 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK. • QUESTIONS REGARDING AN EMPLOYEE'S SICK LEAVE SHOULD BE DIRECTED TO HIS/HER SUPERVISOR OR DEPARTMENTAL ADMINISTRATOR. Printed by Columbia University Print Services, a Local 2110 Shop.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK. • QUESTIONS REGARDING AN EMPLOYEE'S SICK LEAVE SHOULD BE DIRECTED TO HIS/HER SUPERVISOR OR DEPARTMENTAL ADMINISTRATOR. Printed by Columbia University Print Services, a Local 2110 Shop.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year -A-5ftedray1s yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES:  EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE.  AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF.  AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE.  IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK.

Departmental Accident Report Form for Workers’ Compensation Benefits. REMEMBER… In addition to filing the necessary forms, you must provide your supervisor with medical documentation (a doctor’s note) to cover your absence as well as keep him/her properly updated with respect to your anticipated return to work date. You do not fill out a disability claim form (DB-450) unless you receive a “C-7” (Notice of Controversion) from the insurance carrier or the Worker's Workers’ Compensation Board. WHO TO CALL TO FOLLOW UP ON YOUR CLAIM OR IF YOU NEED INFORMATION: Xxxxxxxxx Xxxxxxx Tel. 000-000-0000 OR Disability Benefits Office Tel. 000-000-0000 Sick Leave, Disability & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers’ Compensation HIRED ON OR AFTER 3/1/96 After 4 months-1 year -- 1 day per month, retroactive to date of hire, up to a maximum of 12 days per year After 1 year -- 12 days per year BANK: 60 days maximum The first five (5) days of sick leave charged to the employee’s annual allotment at the rate of a full day for each day of absence. Thereafter, for continuing absences of more than five (5) consecutive days, each full day of sick leave is charged to the employee’s sick bank for each day of absence until the sick leave bank is used up. Once the sick bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. Employee may chose to: 1) receive N.Y. State Workers' Compensation benefits to the extent he/she is entitled, or 2) use 10 days sick leave, if available and thereafter, use sick leave, if any, to maintain the full difference between the Workers' Compensation benefits and a full day's pay for each day of absence, according to the following schedule: Less than 1 year -- 1 work week 1-3 years -- 2 work weeks 3-5 years -- 3 work weeks 5-7 years -- 4 work weeks 7-9 years -- 5 work weeks 9+ years -- 6 work weeks NOTE: An employee will not receive N. Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N. Y. State Disability (26 weeks during a period of 52 consecutive weeks), the employee will receive N.Y. State Disability benefits, to the extent to which he/she is entitled, for the balance of the 26-week period. NOTE: Upon exhausting his/her sick leave or having supplemented his/her pay to the extent provided by the above schedule (whichever comes first), the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired after 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 6 continuous months from the date of injury. See: Section 7 – What You Should Know About New York State Disability. Sick Leave, Disability, & Worker's Compensation (TWU, Local 241) Sick Leave Disability Workers' Compensation HIRED PRIOR TO 1/1/77 30 days per anniversary year BANK: 60 days maximum The first five (5) days of disability leave will be charged to the employee’s annual allotment at the rate of one (1) full day for each day of absence. Day six (6) through thirteen (13) will be charged at the rate of ½ day for each day of absence from the employee’s annual allotment. Thereafter, disability leave is charged to the employee’s leave bank at the rate of ½ day for each day of continuing disability up to 26 weeks. (Note: An employee receives full pay while his/her sick leave is being charged at the rate of ½ day per day of continuing disability). After the 26 week period, any remaining sick leave is charged at the rate of a full day for each day of continuing absence. Once the sick leave bank is exhausted, an employee must use their remaining annual allotment of sick leave. NOTE: An employee will not receive N.Y. State Disability benefits while he/she is receiving sick leave pay. If the employee's sick leave is exhausted during the period covered by N.Y. State Disability (26 weeks during a period of 52 consecutive weeks), the 6 weeks at 80% of salary. Employee can receive 6 weeks at 100% of salary by charging 1/3rd day for each day of absence from his/her sick leave bank, if no prior compensation injury for one year. NOTE: Upon exhausting his/her salary continuation, as outlined above, the employee will receive the statutory Workers' Compensation benefits to the extent to which he/she is entitled. Security Officers hired before 3/1/96, injured as a result of direct interaction with person(s) arrested, receive 100% compensation for a period of up to 8 continuous months from the date of if injury, providing all procedures have been followed. employee will receive N.Y. State Disability benefits to the extent to which he/she is entitled, for the balance of the 26-week period. Sick Leave Disability Workers' Compensation HIRED ON OR AFTER 1/1/77 BUT PRIOR TO 10/1/78 20 days per anniversary year BANK: 60 days maximum Same as above. Same as above. HIRED ON OR AFTER 10/1/78 BUT PRIOR TO 3/1/96 4 months but less than 1 year --5 days After 1 yr. but less than 2 years --10 days After 2 yrs. but less than 3 years --12 days After 3 yrs. but less than 5 years --14 days After 5 yrs. but less than 7 years --16 days After 7 yrs. but less than 9 years --18 days After 9 years --20 days BANK: 60 days maximum Same as above. Same as above. GENERAL NOTES: • EACH EMPLOYEE RECEIVES A STATEMENT OF HIS/HER AVAILABLE SICK LEAVE ON HIS/HER ANNIVERSARY DATE. • AN EMPLOYEE WHO HAS USED HIS/HER ENTIRE SICK LEAVE BENEFIT AND WHO HAS AN EXTENDED DISABILITY MAY, UPON REQUEST, RECEIVE A LUMP SUM PAYMENT FOR ANY ACCRUED, UNUSED VACATION OR ANY PORTION THEREOF. • AN EMPLOYEE DOES NOT RECEIVE HOLIDAY PAY OR ACCRUE VACATION (EXCEPT FOR THE FIRST TWO MONTHS) OR SICK LEAVE WHILE ON A LEAVE OF ABSENCE. • IN NO EVENT MAY AN EMPLOYEE RECEIVE MORE IN TAKE HOME PAY THAN HE/SHE WOULD HAVE RECEIVED IF WORKING AT HIS/HER REGULARLY SCHEDULED HOURLY RATE, FOR HIS/HER REGULARLY SCHEDULED HOURS OF WORK.