Incident & Accident Report Form

Form OHS-017

Worker's Particulars
Particulars of Accident
Worker's Declaration (Fill in if injury has been sustained)

I hereby authorise Edmen's RTW Coordinator to take all necessary steps involved in my return to work for the injury sustained on above date. This may include discussion and liaison with my treating doctor, rehabilitation provider, any other relevant allied health professional or persons involved in the process, as well as obtain any relevant documents and forwarding those documents on to my treating doctor, allied health professionals and the nominated insurance company. I understand this consent is required to assist with rehabilitation and return to work and that all information obtained is treated in confidence.

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