After-Injury Telephone Report name: Home phone: Employee’s supervisor: Date of injury: Employee’s Treating doctor: phone: Doctor’s Has the employer discussed compensation benefits with the employee? workers’ Yes No Has the employer discussed the return-to-work process with the employee? Yes No Log of Appointments Doctor’s Date: Time: Comments Contacted by: Date: Time: Contacted by:
After-Injury Telephone Report Employee’s name: Home phone: Employee’s supervisor: Date of injury: Treating doctor: Doctor’s phone: Has the employer discussed workers’ compensation benefits with the employee? Yes No Has the employer discussed the return-to-work process with the employee? Yes No Log of Doctor’s Appointments Date: Time: Comments Contacted by: Date: Time: Contacted by:
02%20Return%20to%20Work%20Kit-Small.docx