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55b23  Form

55b23 Form

Use a 55b23 template to make your document workflow more streamlined.

Number(s) Description of how the injury, exposure, or illness occurred (What happened?) Description of the nature of the injury, exposure, or illness (What you see — signs and symptoms) Description of the treatment given (What did you do?) Name of witnesses 1. 2. Arrangement made relating to the worker (return to work/medical aid/ambulance/follow-up) Provided worker handout Yes No Alternate duty options were discussed Yes No First aid attendant’s name (please print) A form to...
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Quick steps to complete and design Aid record template online:

  1. Use Get Form or simply click on the template preview to open it in the editor.
  2. Start completing the fillable fields and carefully type in required information.
  3. Use the Cross or Check marks in the top toolbar to select your answers in the list boxes.
  4. Utilize the Circle icon for other Yes/No questions.
  5. Look through the document several times and make sure that all fields are completed with the correct information.
  6. Insert the current Date with the corresponding icon.
  7. Add a legally-binding signature. Go to Sign -Sgt; Add New Signature and select the option you prefer: type, draw, or upload an image of your handwritten signature and place it where you need it.
  8. Finish filling out the form with the Done button.
  9. Download your copy, save it to the cloud, print it, or share it right from the editor.
  10. Check the Help section and contact our Support team if you run into any issues while using the editor.

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