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MEDINA COUNTY HEALTH DEPARTMENT
4800 Ledge wood Drive, Medina, Ohio 44256
(330) 7239523 TOLL FREE (888) 7239688 option #3
FAX (330) 7239650 Email: env×medinahealth.attention FOOD EMPLOYEES AND CONDITIONAL
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How to fill out illness reporting form
How to fill out illness reporting form
01
Begin by obtaining the illness reporting form from your employer or the health department.
02
Provide your personal details such as name, contact information, and date of birth.
03
Fill out the details of the illness, including the onset date, symptoms experienced, and any medical treatments received.
04
Include any relevant information about potential sources of illness, such as recent travel history or exposure to sick individuals.
05
Describe any impact the illness may have had on your ability to work or perform regular activities.
06
Sign and date the form to certify the accuracy of the provided information.
07
Submit the completed illness reporting form to the designated authority or department as instructed.
Who needs illness reporting form?
01
Individuals who have experienced an illness that is reportable according to local regulations or workplace policies.
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What is illness reporting form?
The illness reporting form is a document used to report any illnesses or diseases that may have been contracted by individuals.
Who is required to file illness reporting form?
Employers are usually required to file illness reporting forms on behalf of their employees.
How to fill out illness reporting form?
The illness reporting form can typically be filled out online or in paper format, providing details about the illness and the affected individual.
What is the purpose of illness reporting form?
The purpose of the illness reporting form is to track and monitor the spread of illnesses, and to take necessary actions to prevent further transmission.
What information must be reported on illness reporting form?
Information such as the name of the affected individual, the type of illness, symptoms, date of onset, and possible sources of exposure must be reported.
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