Template

Authorization for Medical Treatment and Release of Records

by Josh McComas, from the Community

10+

An employer-focused consent form that authorizes approved providers to deliver medically necessary treatment after an occupational injury and to release medical records to the employer. Includes fields for employee details, incident description, manager authorization, pharmacy information, and instructions for required drug and alcohol screening. Suitable for workplace health, safety, and workers' compensation documentation.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
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Refusal for Medical Treatment and Observation Form

Use this form to record an employee decision to refuse medical treatment or observation after a workplace incident. Capture the incident date, preparer, employer details, confirmation that treatment or observation was offered in good faith, understanding of potential costs and lost wages, and the employee signature. Suitable for workplace health and safety documentation and incident follow up. Review and adapt to meet your requirements.

by Joshua Kelsey, from the Community

10+

Get

Template

Workers' Compensation CCIP Claim Report Form

This Workers' Compensation CCIP Claim Report Form helps construction teams capture key details after a workplace incident and meet 24-hour reporting requirements. The template includes sections for employee and employer information, incident date and time, body part and injury type, type of work performed, cause of injury, medical treatment details, and witness statements. It also provides fields for supervisor and project manager sign-offs to support accurate documentation, faster claims processing, and safety compliance on construction projects.

by Kat La Chapelle, from the Community

20+

Get

Template

First Aid Treatment Form

A comprehensive digital first aid treatment form designed for university first aiders and medical professionals. This template enables systematic documentation of casualty details, incident information, and medical treatments administered. The form includes sections for patient personal information, incident details, treatment records, medical referrals, and necessary signatures. It features options for referring patients to various medical facilities including A&E, GP, and University Medical Centre. The digital format allows for easy submission and record-keeping through email integration, making it an essential tool for maintaining accurate medical incident records in educational institutions.

by Paul Turnbull, from the Community

50+

Get

Template

First Report of Injury Template

This First Report of Injury template helps employers document workplace incidents for workers compensation and safety compliance. Capture employer and carrier information, employee demographics, wages, job and hire date, accident date and location, activity at time of injury, description of how the incident occurred, affected body parts, and harmful objects. Record medical provider details, treatment location, emergency room and hospitalization status, and dates last worked or death if applicable. Includes fields for report preparer and signature to complete the incident record.

by Kelly Phillips, from the Community

10+

Get

Authorization for Medical Treatment and Release of Records

About author

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Refusal for Medical Treatment and Observation Form

Workers' Compensation CCIP Claim Report Form

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You might also like

Refusal for Medical Treatment and Observation Form

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