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Health and Safety Plan <br /> 1319 & 1327 South Madison Street, Stockton,CA <br /> 432770 <br /> AE I <br /> Consultants <br /> MEMORANDUM <br /> TO: All AEI Staff <br /> FROM: Kathleen Baxter, Interim Director of Health and Safety <br /> Holly Neber,CEO <br /> SUBJECT: Injury,Illness and Near Miss Reporting Procedure <br /> DATE ISSUED: June 21, 2017 <br /> In an effort to continue to update our employees, AEI is providing this memorandum to all <br /> employees to help direct them on injuries,or other near miss incidents. This memorandum should <br /> help clarify and outline the steps consistent with our Corporate Health and Safety Manual for <br /> reporting an injury, illness or near miss. <br /> 1. In the event that you sustain an injury on a project site,please seek immediate and proper <br /> attention to the injury or illness. For emergencies dial 911. AEI personnel must seek <br /> medical attention for serious injuries. <br /> 2. AEI Personnel must immediately report all work-related injuries and illnesses and near <br /> miss incidents to their supervisor/manager. <br /> 3. The supervisor or manager must report the incident to the Corporate Health and Safety <br /> Director,Human Resources Representative, Craig Hertz, and Holly Neber immediately via <br /> email (safetvfirstCciaaeiconsultants.com). These representatives can help answer any <br /> questions. <br /> 4. The injured person must fill out the Employee's Report of Injury Form. <br /> 5. The supervisor/manager must fill out IIPP FORM 3: Incident Investigation Report. <br /> 6. If applicable, the following forms must also be completed: IIPP FORM 1: Report of <br /> Unsafe Condition or Hazard and IIPP FORM 2: Hazard Correction Report. If <br /> these forms are not applicable, then it must be indicated on Form 3. <br /> 7. Should an injury or illness require medical attention, required forms must be submitted to <br /> Human Resources Representative, who will complete the required forms for Workers <br /> Compensation. Our Workers Compensation provider is The Hartford. <br /> 8. A copy of all forms must be returned to the Corporate Health and Safety Director and <br /> Human Resources Representative (safetyfirst(baeiconsultants.com) on the first full day <br /> back to work from the injury. <br /> Attached to this memorandum are key personnel and contact numbers,and the three Injury and <br /> Illness Prevention Program (IIPP) forms. A copy of the Safety Manual and Injury and Illness <br /> Prevention Program can be found on the P:drive (Operations/Health and Safety/Safety Manual <br /> and IIPP),along with the forms described herein. <br />