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FIRST AID FORM INSTRUCTION SHEET <br /> EAIPL0YEE,NAME: <br /> The employee's full name is required here,including middle initial. <br /> SSN(SOCIAL SECURITY NUMBER): <br /> The employee's correct Social Security number is required. Supervisory employees <br /> completing the form should ensure entry of the correct number. <br /> DATE AND TIAIEOFINJURY.• <br /> The exact(late of injury as provided by the injured employee should be entered here. It is <br /> important to be as precise as possible. <br /> INJURY: <br /> A brief description of the cause(s)of injury,including body parts involved. <br /> TYPE OF FIRST AID: <br /> A brief description of the first aid rendered should be entered here,along with the name of the <br /> adininistrator. <br /> ( <br /> OUTSIDE IIIEDICAL TREATAIENT OF°FERED: <br /> Whether professional medical treatment by legally certified doctors or nurses was offered,yes <br /> or no. <br /> SIGNATURE OF INJURED: <br /> The injured employee should both sign and provide the date of signature in this entry. It is <br /> mandatory that the injured employee complete both items. <br /> SIGNATURE OFPREPARER: <br /> The supervisory/administrative employee that questioned the injured employee and completed <br /> the general entries should sign here and enter the date. <br /> ALL ENTRIES MUST BE COMPLETED AS INSTRUCTED. THESE GENERAL INSTRUCTIONS <br /> SHOULD BE KEPT IN A FIRST AID LOG BINDER FOR EASY REFERENCE BY THE SAFETY <br /> DIRECTOR. IT IS NOT NECESSARY TO COMPLETE A FIRST AID LOG ENTRY ON <br /> OCCASIONS WHEN ASPIRIN, ETC., ARE PROVIDED TO EMPLOYEES FOR NON-WORK- <br /> RELATED CONDITIONS. <br />