Southern California CERT Regional Workshop March 6, 2014 1
Slide 2
Describe the benefits and components of the Program Explain the
revised Regulations and their application Identify the anatomy of a
workers compensation claim 2
Slide 3
Nation at war Pacific situation Fear of mass attack on CA Coast
Volunteer workforce Recruited and trained No expectation of
compensation Legislative action 3
Slide 4
Certified War Councils (renamed Disaster Councils) as
accredited Allowed registration of volunteers as DSWs Provided
workers compensation to registered volunteers Offered limited
liability protection Required Loyalty Oath For proper enrollment as
a DSW volunteer 4
Slide 5
California Governors Office of Emergency Services Approves
disaster council accreditation, regulations, classifications
Delegates registration/oath authority to state agencies Manages DSW
appropriation - Works with State Fund and Cal OES Divisions Reviews
claims, authorize settlements, issue checks Ensures compliance:
Centers for Medicare & Medicaid Services - Federal reporting
mandate: Medicare beneficiaries Ref: ESA, GC 8585.5, 8585.7
Slide 6
State Legislature Approves DSW appropriation in state budget
(annually) Source of funding: General Fund Funds pay approved
workers compensation claims State Compensation Insurance Fund
(SCIF) Processes claims Calculates benefits Communicates with Cal
OES from start of claim to closure 6 Fiscal Year (s)Amount 1988 -
2004$ 663,000 2004 - 2008$1,125,000 2008 - present$1,012,000
Slide 7
Accredited Disaster Councils or Authorized Designees*
Registration (Group or Individual): C omplete DSW registration
form: applicant & government entity. Administer Oath at meeting
or event/activity by authorized official. File and maintain DSW
records. Supervision: Decide who acts in supervisory capacity and
how supervision performed Determine criteria, i.e. experience,
training Provide Program education, workers compensation claim
instruction *Government/public entities delegated Program authority
by the ADC. 7
Slide 8
Accredited Disaster Councils or Authorized Designees* Training:
Determine Minimum emergency management experience Curriculum,
number of exercises, hours License/certification for a given
classification Background Checks: Required? Considerations 1.
Classification Duties performed? Volunteer contact? 2. Cost - $$$
Who pays? 3. How to interpret findings? What to do with
information? *Government/public entities delegated Program
authority by the ADC. 8
Registered with: Accredited Disaster Council (ADC) or
Authorized Designee (i.e. ADC designates County Animal Control) Cal
OES or authorized state agency Receives no pay Activated by
registering agency Impressed into service (rare) Auxiliary
Firefighter EXCLUDES: Volunteer Firefighters Spontaneous
Unaffiliated volunteers 11
Slide 12
Adults physically and mentally capable of performing disaster
related activities Employed, unemployed, or retired persons
Volunteers under 18 with parental or legal guardian consent 12
Slide 13
Activities authorized in: California Emergency Services Act
(ESA) Resulting from: -State of War emergency -State & Local
proclaimed emergencies -Search and rescue missions -Official
out-of-state deployments -Activities performed to mitigate imminent
threat of extreme peril to life, property -Official mutual aid
assistance Described in DSW classifications scope of duties Travel
to and from the incident site REF: GC Sections 8558 & 8585.5
CCR 2570.2(b)(1) 13
Slide 14
Training May be required by: - ADC, authorized designee,
supervising agency May include: Basic/Advanced/Refresher courses
Exercises (Person in victim role must be registered as DSW
volunteer) Out-of-state: only under very specific criteria Must be:
1.Approved in advance by the ADC or authorized agency 2.Documented
to verify participation 3.Supervised Offsite, onsite Paid staff,
volunteers 4.Commensurate with classification 14
Slide 15
Day-to-day operations Activities typically associated with
emergency response agencies (i.e., assisting with single structure
fires, traffic collisions; crowd control for concerts &
sporting events) Preparedness/Planned Activities Educational fairs,
first aid booths Parades, festivals, fundraisers, smoke detector
installations, website development, etc. Self Activation Travel to
and from the training site 15
Slide 16
Accredited Disaster Councils (ADC) All 58 counties in CA Most
cities in CA Authorized Designees of ADC Government/public agencies
Cal OES o Law Enforcement Branch o Recovery Branch o
Telecommunications Division County OES Authorized state agencies
16
Slide 17
Required: 1.Name & address of registrant 2.Classification
More than one may be identified depending on scope of duties 3.Date
enrolled (date Loyalty Oath signed) 4.Loyalty Oath Taken &
signed by applicant before authorized official Signed by authorized
official Signed prior to date of injury 5.Name of registering govt
agency w/signature & title of authorized person CCR
2573.1(a)(4) Optional: Specialty, ID #, Emergency Contact, License
#, Phone # 17
Slide 18
Animal Rescue, Care & Shelter Communications Community
Emergency Response Team Member Emergency Operations Center/Incident
Command Human Services Fire Laborer Law Enforcement Logistics
Medical & Environmental Health Safety Assessment Program
Evaluator Search & Rescue Utilities 18
Slide 19
Authorized Persons (GC 3104) Elected officials Designated
public officials County and city clerks Notary public Cal OES
Director *N O FEE MAY BE CHARGED FOR THE OATH ADMINISTRATION NOTE:
Volunteers CANNOT administer the Loyalty Oath 19
Slide 20
Registration Form Completed by ADC or authorized designee.
Completed by applicant. Applicant: subscribe, date & sign.
Official: administer oath & sign.
Slide 21
Loyalty Oath Registration Form State Agency filed within 30
days County Clerk or Official Department personnel file City Clerk
Other authorized Public Agency - designated Officer/Employee of the
agency Available for inspection by SCIF/Cal OES Registrations to be
kept current Storage: hardcopy or electronic format If electronic
format, requires written statement on file verifying that original
used to scan, e-mail, attach in database, etc. Destruction of
records: 5 years after DSWs service ends Ref: GC 3105 21
Slide 22
Required Documents: SCIF Form 3301 Claim Form SCIF Form 3267
Employers Report DSW Volunteer Registration Including Loyalty Oath
Written Incident Report If injury due to training: Training
Documentation Pre-authorization of Training Activity 22
Slide 23
Injured DSW Volunteer Completes Employee section
ADC/Supervising Agency Completes Employer section Provides copy of
completed form to volunteer Mails original to SCIF within 5
calendar days after receipt from DSW volunteer 23
Slide 24
Employee/Injured DSW Volunteer Lines 1- 7 Line 8 (Signature)
Employer/ADC or Supervising Agency Lines 9-13Supervisor Line
14Pre-filled Line 15N/A Line 16Supervisors signature Line
17Supervisors title Line 18Phone number 24
Slide 25
ADC/Supervising Agency Completes within 5 days of injury
notification Mails original to SCIF OR Calls 24 hr. Claims
Reporting Center at : (888) 222-3211 Faxes or emails copy to Cal
OES Do not wait for completed SCIF Form 3301 Do not have volunteer
complete 25
Slide 26
Lines 1-3Line 1a pre-filled Lines 4-54 pre-filled, 5 N/A Line
6Pre-filled Lines 7-10 Lines 11-16If unknown, leave blank Lines
17-26 Lines 27-29May have partial information Lines 30-34 Line
35Regular job not DSW duties Lines 36-39If unknown, leave blank
Lines 40-43 26
Slide 27
Brief, concise account of incident Completed by supervising
authority May be submitted on agency letterhead, fax cover sheet,
or by email 27
Slide 28
If injury is due to training: Training log sheet or similar
document verifying participation showing: Volunteers name Time
in/time out Supervisors name/signature Date Name of event
Pre-authorization of training activity must be: Approved in advance
Commensurate with DSW classification 28
Slide 29
DSW Volunteers & Mutual Aid Assistance Claims Submission
Requesting Agency needs DSW volunteers Sending Agency deploys DSW
volunteers DSW volunteer injured under Requesting Agencys
supervision Who is responsible for paperwork? Both Agencies
coordinate efforts to complete & submit required forms
Requesting Agency 1.SCIF 3267 Completes Form 2.SCIF 3301 Provides
Form to injured DSW volunteer 3.Incident Report Completes brief
narrative Sending Agency 1.DSW Registration & Oath Who submits
paperwork? Requesting Agency 1.Mail original 3267, 3301 to SCIF
& fax/e-mail copies to Cal OES. 2.Fax/e-mail copies: incident
report to SCIF & Cal OES; 3.Fax/e-mail training docs, if
applicable, to SCIF & Cal OES Sending Agency Fax/e-mail
Registration & Oath to SCIF & Cal OES Both Agencies provide
copies of all documents to each other.
Slide 30
DOCUMENTSCIFCAL OESCOMMENTS SCIF 3267 Fax Copy & Mail Orig
Fax or Scan Copy SCIF Fax: 707-646-0562 CAL OES Fax: 916-845-8736
SCIF 3301 DSW Registration & Oath Fax Copy Incident Report
Training Pre-Authorization* *Required for training related injuries
Training Verification* 30 Step-by-step claim information located
at:
www.calema.ca.gov/PlanningandPreparedness/Pages/Disaster-Service-
Worker-Volunteer-Program.aspx
