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RETREATED ILLNESS WORKSHEET Reporting Agency Name and TelephonePatient First Name and Last NameDOBRaceSex EthnicityResidence Street Addressable of Illness WeekResidence City, State Dislocation where
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How to fill out MO Heat-Related Illness Worksheet

01
Obtain the MO Heat-Related Illness Worksheet from your local health department or online.
02
Fill in the date at the top of the worksheet.
03
Record the individual's name and contact information in the designated fields.
04
Indicate the date of onset of symptoms if applicable.
05
Describe any heat-related symptoms observed, being as detailed as possible.
06
Document any prior heat-related illnesses experienced by the individual.
07
Complete sections covering environmental factors, including temperature and humidity levels.
08
List any specific activities the individual was engaged in at the time of symptoms.
09
Provide information on any first aid measures taken and their outcomes.
10
Review the completed worksheet for accuracy and sign it where required.

Who needs MO Heat-Related Illness Worksheet?

01
Individuals working in hot environments, such as construction workers or agricultural workers.
02
Supervisors and managers responsible for employee health and safety during heat waves.
03
Healthcare professionals assessing potential heat-related illnesses.
04
Emergency responders who may need to evaluate cases of heat exhaustion or heat stroke.
05
Public health officials monitoring heat-related health risks in the community.

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The MO Heat-Related Illness Worksheet is a document used in Missouri to record instances of heat-related illnesses that occur in the workplace, particularly during periods of extreme heat.
Employers in Missouri are required to file the MO Heat-Related Illness Worksheet if a heat-related illness occurs in their workplace, particularly in outdoor and high-temperature environments.
To fill out the MO Heat-Related Illness Worksheet, employers must provide details such as the date and time of the incident, the employee's information, a description of the heat-related illness, and any actions taken in response to the incident.
The purpose of the MO Heat-Related Illness Worksheet is to track incidents of heat-related illnesses in the workplace, ensure proper reporting and documentation, and promote awareness and prevention of such illnesses.
The information that must be reported on the MO Heat-Related Illness Worksheet includes the employee's name, job title, date of the incident, symptoms experienced, temperature conditions, duration of exposure, and any first aid or medical treatment provided.
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