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Low Back & Pelvis Area Consultation Patient Today s Date of Injury Please shade in all areas on this picture where you have PAIN in the past 7 days Area Severity % of Time Sharp? Dull? Ache? Other?
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Who needs low back ampamp:

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Individuals who have experienced lower back pain or discomfort and are seeking relief and support.
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Note: Please consult with a healthcare professional or licensed therapist for personalized advice and recommendations regarding any lower back issues or concerns.
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Low back ampamp stands for Lower Back Annual Maintenance Performance and is a form used to report on the maintenance performance of lower back muscles.
Employers are required to file low back ampamp for employees who are at risk of lower back injuries or have reported lower back discomfort.
Low back ampamp can be filled out by documenting any workplace changes, training provided, and any reported lower back injuries or discomfort.
The purpose of low back ampamp is to assess the maintenance performance of lower back muscles in order to prevent injuries and promote a healthy work environment.
Information such as workplace changes, training provided, reported lower back injuries or discomfort, and any preventive measures taken must be reported on low back ampamp.
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