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Quick Reference for SMIS Accident Reporting – Supervisors Module Accessing SMIS Accident Reporting 1. Open your browser and in the Address field, type http://www.smis.doi.gov. 2. Click Accident Reporting. 

3. Click Supervisors. 

Logging In 1. From the main “Safety Management Information System” screen, click 

Supervisors. 

2. In the Last Name field, type your last name. 3. In the DOI User Validation field, type the last four digits of your social 

security number. 

4. Press Enter or click Employee Login. 

5. In the Please verify/enter your Internet E-Mail Address below field, type 

or verify your email address and click Submit your E-mail Address. 

Overview of Validating a Claim As a claimant’s supervisor, you must complete several tasks to validate a claim: 1. Complete a supervisor’s report – The Supervisor’s Report is 

acknowledgement by an injured employee’s supervisor that the employee 

was indeed injured on the job. 

2. Print and sign the CA-1 or CA-2 

form – Depending on your organization’s procedures, you might need to print, sign, and date all completed CA-1 and CA-2 

forms. Copies should be kept by the injured claimant, the claimant’s supervisor, and your HR compensation coordinator(s). 

3. Enter supplemental information – Supplemental information is required 

and helps clarify the injuries that a claimant received in an accident. 

4. Report injuries of other persons – If other people were injured as a result of 

the accident that triggered the initial claim, you must enter information about those people and their injuries. This ensures that the accident report includes information about all parties that were injured from a single accident. 

5. Report property damage – You must report 

sustained in an accident. Entering this informareport includes details about damaged proper

Validating a CA-1 or CA-2 

Validating a CA-1 Though there are several fields that you can comp1. Complete the fields in the 18. Employee’s du2. In box 38, check the I have read and unders

checkbox. 

3. In the Supervisor Title box, type your job title4. In the Office Phone box, type your work telep

5. Print, sign, and date the claim form. 

What a Supervisor Does to V

Supervisor receives email about ne

Supervisor’s module to comp

Supervisor validates a claim b

Supervisor’s Report on a CA

Supervisor enters supplemental info

the claimant about his or her a

Supervisor enters information a

injured in the acci

Supervisor enters information abo

sustained from acc
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Validating a CA-2 Though there are several fields that you can complete, at a minimum, you must: 1. Complete the fields in box 20. Employee’s duty station. 2. In the 26. Date Employee First Reported Condition to Supervisor box, 

type the date (mm/dd/yy OR mm/dd/yyyy) on which you were first notified by the claimant about his or her illness. 

3. Check the I have read and understand the above statement checkbox. 

4. In the Supervisor Title box, type your job title. 5. In the Office Phone box, type your work telephone number. 

6. Print, sign, and date the claim form. 

Printing a Completed CA-1 or CA2 Form 1. Log in to the Supervisors module. 2. In the Enter Employee’s Claim Identifier field, type the claim ID of the 

claim you want to print and click Submit Employee’s Claim ID. The claim is displayed on the following screen. 

3. Click Print CA-1 Form or Print CA-2 Form at the top of the screen, 

depending on the type of report you want to print. The report is displayed automatically. You cannot change any information from this view. 

4. From the File menu, select Print. The form prints as it appears on screen. Reporting Only Property Damage 1. Log in to the Supervisors module. 2. Click Enter a NEW Report for a NEW Incident in the Enter a New 

Accident Report box to report an accident involving property damage or injury to an individual who is not filing a claim for compensation. 

3. Select the option that best describes the type of accident and click Continue 

Entering Report. 

4. In the Incident ID box, enter the date and time which the accident took 

place, as well as the zip code for the location. 

5. In the Place of Incident box, type a detailed description of where the 

accident took place. Include street address, city, park, state, and other 

information that help describe the location. 

6. From the Result list, select the option that describes the accident’s outcome. 

For example, only property damage or property damage and injuries. 

7. In the Incident Narrative box, type a description of what happened. 

8. In the Correct Actions box, type a descriptio

can do to prevent such an accident from happ

9. From the Unsafe Act drop-down list, select u

describe the unsafe acts that took place that l

10. From the Unsafe Condition drop-down list, s

best describe condition that led to the acciden

11. From the Management Casual Factor drop-d

best describes how management had anythin

12. Click Send this Info. 

13. From the Type of Property drop-down list, se

describes the property that was damaged. 

14. In the Description box, type a description abo

Include information such as make, name, modand license number. 

15. From the Property Owner drop-down list, sel

describes who owns the damaged property. 

16. From the Cause of Damage drop-down 

list, select the option that best describes what precipitated the event that caused the property damage. For example, an automobile skids on ice and strikes a curb, damaging the axle. The cause of this damage is probably the icy road 

surface, assuming driver negligence was not 

17. From the Source of Damage drop-down list, 

describes the thing that inflicted physical injurwalking, slips on a wet floor, and drops a comsource of the damage is the wet floor on whic

18. In the Estimated dollar value of this damag

repairing the damage. A dollar sign ($) is not cost to the nearest dollar. 

19. In the If this damage involves a motor vehi

box, select Yes if the involved parties were wethe involved parties were not wearing seatbel

20. Click Send this Info. 21. Select the category that best represents the p

damaged property and click Continue to Nex

22. Enter the requested information about the res

Property Damage report.