FIRST REPORT OF INJURY

ON THE JOB INJURY INSTRUCTIONS

If you are injured on the job, you should get appropriate first aid or emergency medical treatment as soon as possible.

Cuisine Unlimited is contracted with

Utah Worker’s Compensation Fund — Policy Number : 1125931

REQUIRED STEPS:

Step One: Contact Aaron Turner at (801) 554-4833.

Step Two: Employee is directed to the nearest IHC WorkMed facility, Emergency Room, or InstaCare dependent on severity of injury and facility availability (Preferred is Workmed —  201 E 5900 S, Murray, UT 84107 — (801) 288-4900).

Step Three:  Provide the medical facility with the Authorization Policy Number 1125931.  You are required to submit to a drug and alcohol screening.  Please be sure to request this test at the time you are seen.

Step Four:  Complete Worker’s Compensation Form Online.  Form #122 (below) is to be submitted within 24 hours of the injury to Cuisine Unlimited HR. (online form will be submitted for you)

In accordance with Cuisine Unlimited, Inc. Employment Policy all employees injured on the job are required to undergo an alcohol and drug screening.

NOTE: Please be aware that some WorkMed locations close by 5:00 p.m. Should an injury take place after hours please visit any Instacare or Emergency Room.

In an instance where the employee visits a medical facility other than IHC WorkMed the employee MUST contact Aaron Turner immediately to arrange a drug screening.

EMPLOYMENT POLICY 3.17

…If it is necessary for [an injured or sick] employee to be see by a Doctor or go to the hospital, a family member will be called to transport the employee to the appropriate facility. If an emergency arises requiring Emergency Medical Services to evaluate the injury/illness of an employee on-site, the employee will be responsible for any transportation charges. Furthermore, Cuisine Unlimited’s employees will not be responsible for transportation of another employee due to liabilities that may occur. A Physician’s “return to work” notice may be required.

Injury Form