What Form Do I Fill Out?

Question 1

When do I fill out out a Medical Exposure Report?

Answer 1

• in contact with patient with possible communicable disease (TB, HIV, Hep.C, large amounts of blood

Question 2

Who do I call if I have a SIGNIFICANT medical exposure?

Answer 2

Designated Officer

Question 3

What are examples of a SIGNIFICANT medical exposure? (2)

Answer 3

1. blood in the eye

2. patient with TB coughs in face

Question 4

When do I fill out a WIIR after filling out a Medical Exposure Report?

Answer 4

if I see a Doctor

Question 5

What does WIIR stand for?

Answer 5

Workplace Injury/ Illness Report

Question 6

When do I fill out a Hazardous Materials Exposure Report?

Answer 6

any time in contact with hazmat.

Question 7

What are examples of hazmat? (5)

Answer 7

1. house fire
2. pot on the stove
3. car fire
4. asbestos
5. unknown odour

Question 8

What form do I fill out after I see a Doctor after a Hazmat Exposure?

Answer 8

WIIR

Question 9

When do I fill out a WIIR? (3)

Answer 9

1. after seeing a Dr. after a Medical Exposure
2. after seeing a Dr after a Hazmat
3. every time you get hurt at work (cut finger doing dishes, hurt back lifting patient, slip on ice)

Question 10

What other report needs to be filled out, along with a WIIR, when injured in responding to and during any type of incident?

Answer 10

Casualty Report (required by Office of the Fire Marshal Incident and Casualty Reporting Manual)

Question 11

What type of injury is a Medical Assessment Form (MAF) to be filled out?

Answer 11

Non-occupational

Question 12

When must you fill out a MAF? (5)

Answer 12

1. off 36hrs (1.5days) or more and coming back to work
2. coming back to modified duties after an off the job injury
3. coming back to full duties after an off the job injury
4. coming back to full duties after being on modified duties due to off the job injury
5. coming back to full duties after chest pains

Question 13

How often is a MAF submitted? (2)

Answer 13

1. submitted monthly if off

2. submitted monthly if on modified duties

Question 14

What is a FAF?

Answer 14

Functional Abilities Form

Question 15

What type of injury is a FAF suitable for?

Answer 15

Occupational injury

Question 16

When is a FAF filled out? (3)

Answer 16

1. coming back to full duties after a work place injury
2. for every Worplace Injury resulting in lost time and/ or medical care
3. if returning or not returning to modified duties after a workplace injury and monthly after 1st Dr. visit

Question 17

What is a PDA Document?

Answer 17

Physical Demands Analysis

Question 18

1. What is a PDA document used for?

2. What form can be used in conjunction with?

Answer 18

1. used to assist the member in describing demands of firefighting to physician; useful when Dr. deciding the appropriate return to work date or modified duties restrictions
2. MAF/ FAF