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0 0 <br /> Was the employee's supervisor notified?When? <br /> Did the employee contact WorkCare for medical direction?When? <br /> List emer enc medical services, fire, or law enforcement agencies summoned for the inured employee: <br /> Provide names and phone numbers of witnesses: <br /> Inured employee was transported to: <br /> Name of person preparing this report: <br /> Title: Date: <br />