A Safe & Healthy Workforce: General Manager Quarterly Reporting Metrics
Mayor Garcetti's Executive Directive 18, A Safe and Healthy Workplace (link below), establishes a revamped, data-driven approach to worker safety and risk management.

The metrics captured through this form will inform city-wide measures that can keep employees safer, prevent incidents and injuries and provide clarity around employee wellness at all levels.

To view more details about Executive Directive 18, click here: http://bit.ly/ed18metrics
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Email *
Quarter Reporting For:
Department You Lead. *
New workers' compensation (WC) claims filed in your department in the previous quarter: *
New WC Claims per 100 FTE's in previous quarter. *
Accident Investigation Forms (Form 5020)  submitted in previous quarter. *
Supervisor's Accident Investigation Forms completed in previous quarter. *
Provide a general summary of the most prevalent root causes of WC claims in the previous quarter. *
Provide a general summary of corrective actions taken to prevent injuries in the previous quarter. *
List specific safety OSHA training efforts in the previous quarter. Format: topic, quantity of employees trained. If none, write 0. (You can copy and paste content) *
Number of employees who were out on injury leave during the previous quarter. (Include all employees who were out, regardless of when the claim was originally filed). *
Number of reasonable accommodations for temporarily disabled employees requested in the previous quarter. *
Number of reasonable accommodations for temporarily disabled employees approved in the previous quarter. *
Number of reasonable accommodations for temporarily disabled employees denied in the previous quarter. *
Reasons for denial of request for reasonable accommodations for temporarily disabled employees in the previous quarter. *
List any site visits or correspondence from outside regulatory agencies, such as OSHA and SCAQMD. If none, type 0. *
General comments or clarifications, if any.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of City of Los Angeles.