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 Saif Form 2016

Saif Form 2016

Create a custom Saif Form 2016 that meets your industry’s specifications.

SAIF Corporation, do not sign the signature line. Your employer will give you a copy. 1. Date of injury or illness: 2. Date you left work: 5. Time of injury or illness: a.m. p.m. 3. Time you began work on day of injury: 6. Time you left work: a.m. p.m. 7. Shift on day of injury: 8. What is your illness or injury? What part of the body? Which side? (Example: sprained right foot) Left (from) (to) a.m. a.m. Right a.m. p.m. 4. Regularly scheduled days...
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