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MANDATORY IMPAIRMENT REFERRAL (OAR CHAPTER 735 DIVISION 74) THE MEDICAL INFORMATION IN THIS REPORT IS CONFIDENTIAL AND WILL BE USED BY THE DRIVER AND MOTOR VEHICLE SERVICES (DMV) ONLY TO DETERMINE

How to fill out mandatory impairment referral

How to fill out mandatory impairment referral:

1. Start by obtaining the necessary form for the mandatory impairment referral. This form can usually be obtained from your employer or the relevant human resources department.
2. Fill in your personal information accurately on the form. This typically includes your full name, employee ID or social security number, contact information, and department or unit you work in.
3. Provide details about the impairment or condition that requires the referral. Be specific and concise in describing the nature of the impairment or condition, as this will help guide the subsequent evaluation or treatment process.
4. Indicate the professional or specialist to whom the referral should be directed. This could be a healthcare provider, therapist, counselor, or any other pertinent specialist who can assess and address the impairment or condition.
5. Specify any additional information or documentation that may be required. Depending on the specific circumstances, you may need to attach relevant medical records, test results, or other supporting documents to the referral form.
6. Review the completed form for accuracy and ensure that all necessary sections have been filled out. Any missing or incorrect information could delay or hinder the referral process.

Who needs a mandatory impairment referral:

1. Employees who have an impairment or condition that affects their ability to perform their job duties effectively and safely may need a mandatory impairment referral.
2. Anyone who has undergone a recent injury, illness, or mental health issue that requires professional evaluation and treatment may also require a mandatory impairment referral.
3. In certain industries or job roles where safety is critical, employers may have policies in place that require all employees to undergo mandatory impairment referrals periodically, regardless of whether they have a known impairment or condition.

Remember to comply with your company's specific guidelines and procedures when filling out a mandatory impairment referral. It is crucial to prioritize your health and well-being while adhering to any necessary protocols and requirements for a proper evaluation or treatment of your impairment or condition.

For pdfFiller’s FAQs

What is mandatory impairment referral?

Mandatory impairment referral is a process where an individual or organization is required to report concerns about impairment related to a person's ability to perform their job duties.

Who is required to file mandatory impairment referral?

Employers, supervisors, or coworkers who observe signs of impairment in an employee are required to file mandatory impairment referral.

How to fill out mandatory impairment referral?

Mandatory impairment referral forms can typically be filled out online or submitted through an organization's human resources department.

What is the purpose of mandatory impairment referral?

The purpose of mandatory impairment referral is to ensure workplace safety and address any potential issues that may impact an individual's ability to perform their job duties.

What information must be reported on mandatory impairment referral?

Information such as the observed behavior or signs of impairment, the date and time of the incident, and any relevant details should be included in the mandatory impairment referral.

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