Workers Compensation Policy Statement

We believe that the best approach to controlling incidents and costs is to prevent injuries from occurring. We are committed to utilizing our resources to provide a safe work environment for everyone. When incidents do occur, it is in everyone's best interest that injuries are properly managed.

Your company will send a form for completion by the treating provider with the injured employee to help diagnose the injury and provide a treatment plan. In those cases where the provider does not complete the form, we have included a company letter that will be used to inform the provider of our intent to provide transitional duty work for a recovering employee. We will make every effort to provide transitional work intended to facilitate a return to regular work duties as soon as medically feasible. These positions may be offered at any location or any department/ shift as we can accommodate.

Studies show that these programs help speed the recovery process. Every person wins with this type of plan. The company retains productive people and minimizes costs and the workers are better able to return sooner and avoid long-term disabilities affecting their careers.

Employee Responsibilities

·  Immediately report all injuries, illnesses and incidents (regardless of severity).

·  Inform the treating provider that there are transitional duty jobs available.

·  Return to transitional duty assignment and follow recommended physical restrictions and treatment plan at home and work.

·  Stay in touch with your employer and the adjuster.

·  If you are experiencing difficulty with your transitional work assignment, contact your supervisor immediately.

I hereby understand the above responsibilities and accept them as a condition of employment.

Employee Signature Date