Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 4 69 of 53 8 FI RST AID A TT END ANT C HECKL IST Doc u m e n t Id e n tif icat ion F R M 020 P age Nu m b e r 1 of 1 Doc u m e n t C r e ation Dat e J une 30 2014 Im p le m e n tat ion Dat e S e ptembe r 1 2 014 T he f ol l ow i ng i s a che c k l i st o f du t i es t he Fi r st A i d A t t en da n t i s r esp on si bl e f or w i t hi n t he I n j ury M an ag ement R e t urn t o W o r k pro gram Tr ea t t h e i n ju r ed w or k er Rep or t t h e i n ju ry t o t h e i n ju re d w or k er s s u p e rvisor or B ran c h M an ager or Saf e t y Rep r ese n t at ive as soo n as w or k er is s t ab ili z ed if w or k er is se eking f u rt h er m ed ic al aid or r eq u es t t h e w or k er t o go see h is su p er vis or imme d iat e l y t o a rran ge re t u r n t o w or k if n ot se eking f u r t h e r med ic al aid En su re t h at t h e i n ju r ed w or k er is aw are o f h is h er re sp on si b ilit i es Assist in t h e I M RTW p ro c ess Rep or t an y i n c id e n t s n ea r misses a n d or i n j u ries imm ed ia t ely t o t h ei r Su p er vis or Give t h e w or k er t h e RT W p ack age an d c om m u n ic at e t o w or k er t o en s u r e t h e d oct o r c om p letes t h e Phys i cia n Phys i ca l A s s es s m ent R epo rt f o rm a t t h e in i t ial m ed ic al assessm en t Th e c om p an y w ill p ay f or t h is re p or t if t h e p h ys ic i an re q u ir es ext r a p ayme n t In f or m w or k er t o r e p or t an y an t ic ip a t ed loss o f w or k t ime as soo n as p ossi b le a f t e r b ein g t re a t e d b y a p h ys ic ian f ollo w in g in j u r y I n f o r m w o r ke r th a t i f d e e m e d u n f i t to r e t u r n to w or k b y t h e at t e n d in g p h ys ic ian t h e w or k er mu s t c on t act t h eir s u p e rvisor i n p er son or if n o t p ract ic al b y t ele p h o n e Th e emp loye e m u st s u b mit t h e Phys i cia n Phys i c al A s s es s m ent R epo rt t o t h e B ran c h M an ager Sa f et y Rep re sen t at ive Su p er vis or I f d e c l a r e d f i t to r e tu r n t o r e g u l a r or m od i f i e d d u ti e s in f or m t h e w or k er t o re p or t imme d iat ely t o t h e Su p er vis or w it h t h e c om p let e d Phys i c i an Phys i ca l A s s es s m ent R epo rt t o c oo rd in a t e h is h er re t u r n t o w or k Fo l l o w i ng t he i ni t i al m ed i cal ev al ua t i on i n f or m t he w ork er t o m ai ntai n r e g ul ar con t act as di r ec t ed by t he B r an ch M an ag er I n j ury C oo r di na t or an d t o r ep o r t pro gres s an d any ac t i v e t r ea t m e nt I n f o r m t he w ork e r t o c arr y ou t t he a g r ee d up on su i t ab l e em pl oy m en t m od i f i ed du t i es i n a m an ne r t ha t do es no t c r ea t e a haz ard t o t h ei r ow n an do r o t he r s h ea l t h and sa f e t y Fo llo w u p an d en su r e t h e in j u re d w or k er re c eiv e s t re a t me n t i f t h e w or k er says t h ey are see k in g f u r t h er med ic al t re a t ment a n d i f re q u ir ed p ro vi d e a p p r op riat e f irst aid su p p or t w h en t h e w or k er re t u r n s t o w or k