Page 11 - Supervisor Orientation Handbook version 2

Remember:

 We do not diagnose in first-aid situations.
 We do not accept responsibility or place blame when dealing with first-aid situations.
 If you have a first aid, you must document whether the injured party was taken to first
aid, if treatment was administered, or if treatment was refused.

 Keep records of the incident – ask for help when needed.

NOTICE OF ACCIDENT OR OCCUPATIONAL DISEASE DISABLEMENT

These forms are kept in the “RIGHT TO KNOW CENTER” above the time clock located in the Employee
Area. This form is completed by the TEAM MEMBER when they are injured on the job. After completing
this form, the TEAM MEMBER separates the copies and gives this to their Supervisor who will then turn
it into their Department Manager. The TEAM MEMBER keeps one copy for their records. After

receiving this form, the company will then generate a Work Compensation Report on the TEAM MEMBER.

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