The First Responder's Employer Certification of Injury is the form an employer or a volunteer's supervisor completes to certify that a first responder's injury was caused by service in the line of duty, under Section 196.102, Florida Statutes. It is one of the Sarasota County property tax forms published by the Sarasota County Property Appraiser, and it is filed with the county property appraiser. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the official PDF is published by the Sarasota County Property Appraiser.
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What is First Responder's Employer Certification of Injury – Sarasota County, FL?
The First Responder's Employer Certification of Injury is a one-page certificate, issued under Section 196.102, Florida Statutes, in which an employer or a volunteer's supervisor states that a first responder's injury or injuries were caused by service in the line of duty and are the sole cause of the first responder's total and permanent disability.
The form is headed "To be completed by employer or volunteer's supervisor." It collects the employee's name and job title, the supervisor's name, the employing entity's name and address, a description of the incident (location, date and details) and a signed certification. The certification says the injury was directly and proximately caused by service in the line of duty, without willful negligence on the part of the first responder, and that the statement is true and correct to the best of the signer's knowledge.
The certificate does not stand alone. The form states that it must be supplemented with existing documentation of the incident or event that caused the injury, such as an accident or incident report.
A printed note sets a special rule for cardiac events: a total and permanent disability resulting from a cardiac event does not qualify for the exemption unless the event occurs no later than 24 hours after the first responder performed nonroutine stressful or strenuous physical activity in the line of duty, and the first responder gives the employer a certificate from the treating cardiologist. The form tells the employer to file it with the county property appraiser.
Who needs to file First Responder's Employer Certification of Injury – Sarasota County, FL?
The main user is the employer of a first responder, or a volunteer's supervisor, who must certify that the first responder's injury occurred in the line of duty. The form states it is "to be completed by employer or volunteer's supervisor," and the signature block is for the employer or its designee, with the signer's title and the date.
It concerns a first responder whose injuries are the sole cause of a total and permanent disability. The employer certifies that the injury was directly and proximately caused by service in the line of duty and that the first responder was not willfully negligent.
First responders whose disability results from a cardiac event face an added condition. The event must occur no later than 24 hours after nonroutine stressful or strenuous physical activity in the line of duty, and the first responder must give the employer a certificate from the treating cardiologist, with any pertinent supporting documentation, covering the two statements printed on the form. Without that, the form says the disability does not qualify for the exemption.
The form is not completed by the first responder alone. The form names no representative or other signer besides the employer or its designee.
When to file First Responder's Employer Certification of Injury – Sarasota County, FL
The form is completed when an employer or volunteer's supervisor certifies a first responder's line-of-duty injury that has resulted in total and permanent disability. No separate due date is printed on the form, which tells the employer only to file it with the county property appraiser.
For a disability resulting from a cardiac event, the timing rule on the form applies to the event itself: it must occur no later than 24 hours after the first responder performed nonroutine stressful or strenuous physical activity in the line of duty. The employer needs the treating cardiologist's certificate from the first responder before certifying such a case. For any deadline tied to the exemption itself, contact the Sarasota County Property Appraiser.
Documents you need
- An accident report, incident report or other existing documentation of the incident or event that caused the injury; the form says the employer certificate must be supplemented with it.
- For a total and permanent disability resulting from a cardiac event: a certificate from the first responder's treating cardiologist, provided by the first responder to the employer, stating within a reasonable degree of medical certainty the two points printed on the form.
- For a cardiac event: any pertinent supporting documentation that accompanies the treating cardiologist's certificate.
How to fill out First Responder's Employer Certification of Injury – Sarasota County, FL
Enter the employee name and job title
In the top section, to be completed by the employer or volunteer's supervisor, write the first responder's name under Employee Name and the position under Job Title.
Enter the supervisor and employing entity
Write the Supervisor Name and the Employing Entity Name.
Enter the employing entity address
Write the full address on the Employing Entity Address line.
Give the location and date of the incident
Under Description of Incident, enter the Location of Incident and the Date of Incident.
Describe the incident details
Write what happened in Incident Details, covering the incident or event that caused the injury.
Gather supporting incident documentation
Collect an accident or incident report or similar existing documentation to supplement the certificate, as the form requires.
Check the cardiac event note
If the disability resulted from a cardiac event, confirm the event happened within 24 hours of nonroutine stressful or strenuous activity in the line of duty and that you hold the treating cardiologist's certificate.
Sign the employer certification
The employer or designee enters Signature (employer/designee), Title and Date to certify that the injury was caused by service in the line of duty and is the sole cause of the total and permanent disability.
Review and download the completed PDF
Check each entry against the incident documents, then download or print the completed PDF from FillingPDF and file it as described under How to submit.
How to submit First Responder's Employer Certification of Injury – Sarasota County, FL
The form instructs: "File this form with the county property appraiser." For Sarasota County, the form is published by the Sarasota County Property Appraiser.
- Filing office: the county property appraiser. The form prints no street address, mailing address, portal or email, so confirm the current filing method with the Sarasota County Property Appraiser before sending.
- What goes with it: the signed certificate must be supplemented with existing documentation of the incident, such as an accident or incident report. For a cardiac event, include the treating cardiologist's certificate and any pertinent supporting documentation the first responder provided to the employer.
The form mentions no fee. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Filing the certificate without existing documentation of the incident, such as an accident or incident report, which the form says must supplement it.
- Certifying a disability from a cardiac event without the treating cardiologist's certificate from the first responder.
- Certifying a cardiac event that occurred more than 24 hours after the nonroutine stressful or strenuous physical activity; the form says such a disability does not qualify for the exemption.
- Leaving the signature, title or date blank; the certification is made by the employer or designee over their signature.
- Having the first responder complete the form; it is headed to be completed by the employer or volunteer's supervisor.
- Signing the certification when the injury was not the sole cause of the total and permanent disability, or when the first responder was willfully negligent.
- Sending the form somewhere other than the county property appraiser, which the form names as the filing office.
Frequently asked questions
What is the First Responder's Employer Certification of Injury?
It is a form under Section 196.102, Florida Statutes, on which an employer or volunteer's supervisor certifies that a first responder's injury was caused by service in the line of duty and is the sole cause of a total and permanent disability. It is filed with the county property appraiser.
Is this a Sarasota County property tax form?
It is published by the Sarasota County Property Appraiser and the form says to file it with the county property appraiser. It cites Section 196.102, Florida Statutes and refers to an exemption; contact the office for how it fits with your property tax filing.
Who completes and signs the form?
The employer or the volunteer's supervisor completes it. The signature block is for the employer or designee, with title and date. The first responder does not complete it, but may need to give the employer a cardiologist's certificate for a cardiac event.
What must I attach to the employer certificate?
Existing documentation of the incident, such as an accident or incident report. For a disability from a cardiac event, the employer also needs the treating cardiologist's certificate from the first responder, with any pertinent supporting documentation.
Does a cardiac event qualify for the exemption?
Only under conditions. The cardiac event must occur no later than 24 hours after nonroutine stressful or strenuous physical activity in the line of duty, and the treating cardiologist must certify that the activity directly caused it and that preexisting vascular disease did not.
Where do I file the First Responder's Employer Certification of Injury?
File it with the county property appraiser, which is the Sarasota County Property Appraiser for Sarasota County. The form prints no address or portal, so confirm the current filing method with that office.
Can I fill out this form online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file the form; you submit it to the county property appraiser yourself.
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