<p> HEALTH INCIDENT REPORT & PROTOCOL </p><p>EMPLOYEE NAME: EMPLOYEE NUMBER: LOCATION:</p><p>Reporting Requirements: (1) Phone notification of suspected case to Country/Location EH&S Manager, (2) Formal report sent within 24 hours.</p><p>SYMPTOMS – Line Manager / Supervisor indicate symptoms that the employee is experiencing.</p><p> Fever > 38 C  Shortness of Breath / Breathing Difficulty  Muscular Stiffness  Cough  Headache  Loss of appetite  Malaise  Others: ______ Rash  Diarrhea</p><p> Isolate employee to prevent further exposure to other employees. Provide employee with mask to minimize further exposure.  Isolate the employee’s work area and common areas, i.e. Pantry, until further confirmation of employee’s medical status is resolved.</p><p>Determine contact history prior to sending employee to medical professional. </p><p>NAMES/LOCATION NAMES/LOCATION</p><p> Send employee to Doctor for medical evaluation. Line Supervisor / Manager will follow up with employee on their condition.  Ensure that employee notifies a family member of the situation.</p><p>If non-Avian Flu case:</p><p> Notify Regional EH&S Manager with update on situation.  Employee will comply with Doctor’s recommendations for recovery.</p><p>If confirmed Avian Flu case: (Do not disclose name of affected person to external organizations without employee’s consent or approval by Regional HR Vice President)</p><p> When the Doctor confirms that this is the Avian Flu virus, continue with the incident report and once completed send to the Regional EH&S Manager within 24 hours.  Non-affected employees who had contact with the infected individual will:  Work from home for 10 days  Notify supervisor and seek medical care if Avian Flu symptoms develop  If symptoms develop, require a Doctor to provide release to return to work  Close site for a minimum of 12 hours to disinfect and clean before reopening site.  Follow any government directives as necessary.  Notify landlord, government agencies, and others as deemed appropriate.  Country Manager needs to determine contingency plan on how this situation will impact the organizations ability to operate and support the business.</p><p>REPORT BY (NAME): DATE:</p><p>Copyright Shoreland, Inc. 2005 Copyright Shoreland, Inc. 2005</p>