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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...Show details
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