To: All Employees

From: Management              

Subject: Designated Medical Providers for Work Related Injuries and/or Illnesses

Effective Immediately

All Employees Must Obtain Treatment for Work-Related Injury and/or Illness From:

In the event of a non-emergency, after hours injury, contact one of the providers at the non-emergency numbers listed above.

In the unfortunate event of a life–or-limb-threatening emergency, you will certainly be sent to the nearest emergency medical facility. However, one of the medical providers designated above must provide all follow-up care.           

If an unauthorized medical provider treats an employee, the employee will be responsible for payment of said treatment.

All employees must sign below, acknowledging this company policy.

I have read and am fully aware of the organization’s policy regarding medical treatment for work-related injuries and/or illnesses. I further understand that I must immediately report any work-related injury and/or illness to my supervisor.