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First Aid Report Form <br />Date of Report: <br />Location of report: <br />Consulting Physician (If Applicable): <br />Address of person reporting: <br />Telephone Number: <br />Name of Person taking report: <br />Designated Medical Treatment Facility <br />Attachment 7-2 <br />Cell: <br />IN CASE OF EMPLOYEE ACCIDENT OR INJURY, THE FOLLOWING DESIGNATED MEDICAL TREATMENT FACILITY <br />HAS BEEN IDENTIFIED TO DIRECT THE INJURED EMPLOYEE FOR IMMEDIATE TREATMENT: <br />NAME OF MEDICAL TREATMENT FACILITY <br />ADDRESS: <br />TELEPHONE NUMBER: <br />EMERGENCY TELEPHONE NUMBER: <br />HOURS OF OPERATION: <br />SUPERVISOR OR SAFETY OFFICER: <br />SUPERVISOR OR SAFETY OFFICER CELL/ PAGER NUMBER: <br />ALL WORK-RELATED INJURIES OR ILLNESSES MUST BE IMMEDIATELY REPORTED TO THE SUPERVISOR. <br />25 <br />