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 8 of 538 Doc u m e n t Id e n tif icat ion TO C 000 P age Nu m b e r 6 of 7 DOCU M E NT F ORM S P A G E NO F R M 016 Eme r g e nc y R e spons e No ti c e 462 F R M 017 He a lt h S a fe t y A g e nd a 463 F R M 018 He a lt h S a fe t y Me e ti ng Mi nutes 464 465 F R M 019 I MR TW Of fe r L e tt e r of Sui table Empl o y ment 466 467 F R M 020 I MR TW F irst Aid Att e nda nt C he c kli st 468 F R M 020A I MR TW W orke r I nstr uc ti ons 469 F R M 020B I MR TW S a fe t y R e pre se ntative or S upe rvisor C he c kli st 490 471 F R M 020C I MR TW B r a nc h man a g e r or I MR TW C oordina tor Chec kli st 472 F R M 020D I MR TW R e turn to W ork Pl a n 473 F R M 020E I MR TW C omm unica ti on L o g 474 F R M 021 I MR TW L e tt e r to Em plo y e e s P h y sicia n 475 F R M 022 I MR TW P h y sicia ns P h y sica l Ass e ssm e nt R e po rt 476 477 F R M 023 I MR TW Me dica l R e le a se F o rm 478 F R M 024 I MR TW P h y sica l D e mand A na l y sis 479 480 F R M 025 R e a sona ble Ca use P os t I nc id e nt Dr u g Alc oh ol Te sti ng R e f e rr a l C he c kli st 481 482 F R M 026 R e a sona ble Ca use Dr u g a nd Alc ohol Te sti n g R e f e rr a l F orm 483 F R M 027 P ost I nc ident D ru g a nd A lcohol Te sti ng R e f e rr a l F orm 484 F R M 028 Dr u g a nd Alc ohol R e turn to W ork Ag re e ment 485 F R M 028A Dr u g Alc ohol C ondit ions o f E mpl o y ment P otential Empl o y e e s 486 488 F R M 028B Dr u g Alc ohol C ondit ions o f E mpl o y ment C u rr e nt Em plo y e e s 489 490 F R M 029 C onfine d S pa c e Moni tori ng a nd E ntr y Ex it L o g 491 F R M 030 C onfine d S pa c e Entr y P l a n 492 F R M 031 C onfine d S pa c e Entr y P e rmit 493 494 F R M 032 W orke r Rig ht t o R e fuse Notific a ti on to Em plo y e r 495 F R M 033 Empl o y e r Re spons e to W orke r Rig ht t o R e fuse Notific a ti on 496