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YANSAB ATTACHMENT D

DAILY FIRST AID / ILLNESS RECORD


COMPANY NAME DOCTOR’S NAME

PROJECT LOCATION SIGNATURE DATE

TREATMENT TREATMENT ADMINISTERED/


NAME ID NUMBER CRAFT/BRASS SUPERVISOR NATURE & CAUSE OF INJURY / DISPOSITION DATE TIME
F.A. DR. REC.
NO. ILLNESS

LEGEND F.A. – FIRST AID DR. – DOCTOR REC. – OSHA RECORDABLE

H:\000_General\Share\103\Safety\13d-First-Aid-Log.doc

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