Completed Form Must Remain Confidential

FIRST AID REPORT AR 48/2000 First Aid Regulation, Occupational Health and Safety Act Report Record No. of

Date of injury or illness Tim AM PM e Day Month Year Date injury or illness reported Tim AM PM e Day Month Year Full name of worker Employee No. Description of the injury or illness

Description of where the injury or illness occurred/began

Cause of injury or illness First Aid Provided? Yes No (if yes, complete sections below) Name of First Aider Qualifications of First Aider Standard First Aider Emergency First Aider Other

Actions taken by First Aider:

The completed report shall be given to your supervisor. This First Aid Record must be retained by the employer for at least three (3) years from the date of injury or illness (AR 48/2000).

A copy must be provided to the injured/ill worker (WCB Regulation). Worker shall sign this report as being received:

Worker’s signature: ______Day Month Year

Department Copy Worker Copy

Revised March 25, 2003 First Aid Regulation

The purpose of Alberta’s first aid requirements is to ensure that every work site in the province has the equipment, supplies, and trained staff to be able to provide first aid care in the event of workplace injury or illness. The first aid requirements are the minimum standards that must be met; employers are free to exceed them.

How to use these records?

In the past, bound first aid record books were often kept in first aid kits and were available to anyone having access to the kits. The books served as a record of all first aid administered and may have contained information of a personal nature. In respecting worker privacy, the 2000 regulatory requirements limit access to first aid records and may prevent employers from continuing to use bound record books. Bound record books may continue to be used in situations where only first aiders have access to the books. If first aid treatment records are kept in kits to which all persons at the work site have access, then single-page forms should be used rather than books.

The employer should number each first aid record – a space is provided at the top of each record. All first aid records should be kept. If one of the records becomes unusable, mark “void” across it and keep it with all of the properly completed records. This helps to demonstrate due diligence with respect to record keeping. Completed forms should be sent to an individual designated by the employer as the record keeper of all first aid records and kept for at least 3 years from the date of the injury or illness. Completed records should not be kept in the first aid kits.

Worker’s duty to report an injury or illness

Workers are required to report to their employer any work-related physical injury or sudden occurrence of illness experienced while at work. The employer should establish to whom the report is made (e.g. first aider, foreman, nurse, supervisor, safety person, or some other individual). The University has established the supervisor of the injured worker as the designated person to whom this report shall be made. This first aid report does not replace the WCB Report of Accident form. Prompt reporting ensures complete and accurate information and allows the injury or illness to be assessed and treated as necessary. Such information is also useful in injury surveillance. Similar, recurrent injuries reported by several workers may suggest the need to change some aspect of the work site or the tasks performed by workers.

Written record of injury or illness

The employer is required to create and maintain an accurate written record of all work-related physical injuries or sudden occurrences of illness that workers experience while at work. Each injury or illness record must be retained for at least 3 years from the date on which the injury or illness occurred. Where the record is retained in a bound book, then the entire book must be kept for a minimum of 3 years from the date of the final entry.

The cause of the injury or illness may be unknown at the time it is being treated. Every effort should be made to determine the cause within a reasonable period of time and add this information to the written record. Even if no first aid is administered, an injury or illness reported by a worker must be recorded.

Access to records To maintain confidentiality of medical information, access to first aid records is limited to the worker and those persons involved in medical treatment, work site inspections, accident and incident investigations, the evaluation of health and safety programs and statistics, or the Workers’ Compensation Board for the purpose of reviewing work site health and safety programs and statistics. Any person with access to the records must keep the information they obtain confidential except when using or disclosing the information for the purposes listed above. Revised March 25, 2003 page 2