Medical Assessment Form (MAF) NON-occupational injury

Question 1

Medical Assessment Form (non-occupational injury)

When off of work due to a NON-occupational injury.

You are required to get a MAF

1. if you’ve been off for how long?

Answer 1

• 3 DAYS or MORE
• 36 hours or more

IT says three days = 36 hours 🤷‍♂️

Question 2

Medical Assessment Form (non-occupational injury)

VERY VERY IMPORTANT

ADDITIONAL CRITERIA FOR A MAF

*Along with being off for more than 36 hours,

additional criteria for requiring a MAFF are when ?*

1. Coming TO what ? (after an off the job injury)
2. Coming back to what ? (after an off the job injury)
3. Coming back to what ? From what ? (after an off the job injury)
4. Coming back to FULL duties after what kind of pain ?
5. Every month if you are (two things)

Answer 2

• Coming TO modifed after an off the job injury
• Coming back to FULL duties afer an off the job injury
• Coming back to full duties from modified after an off the job injury
• **Coming back to full duties after CHEST PAIN**

EVERY MONTH

OFF WORK or ON MODIFIED

Question 3

Medical Assessment Form (non-occupational injury)

MAFF

When OFF or ON MODIFIED

Due to an OFF the job injury (non-occupational)

1. How OFTEN do you need to get a MAFF ?

Answer 3

You need a MAFF

every month

Question 4

Medical Assessment Form (non-occupational injury)

IMPORTANT

Who completes and signs the MAF

1. Section A-B are filled out by who ?
2. Section C-D are filled out by whom ?
3. Which four people sign the form

Answer 4

SECTION A-B

They employee

SECTION C-D

The physician

1. Employee
2. Captain
3. DC/Division
4. Admin