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    Dharmendra Yadav (Qcon) - Illness and Injury Report

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    Victoria Gomez
    Dharmendra Yadav, a 32-year-old Indian welder, reported to the GV Camp Clinic on August 27, 2012 with a chief complaint of left ocular pain for 2 months. His vital signs were taken and he was sent to the RLMC/Almadina for further management and then to the Al-Khor Hospital Opthalmologist with a referral. The incident is being classified for work-relatedness and he was attended to by Nurse Dante V. Austerio.

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    Dharmendra Yadav (Qcon) - Illness and Injury Report

    Uploaded by

    Victoria Gomez
    12 views1 page
    Dharmendra Yadav, a 32-year-old Indian welder, reported to the GV Camp Clinic on August 27, 2012 with a chief complaint of left ocular pain for 2 months. His vital signs were taken and he was sent to the RLMC/Almadina for further management and then to the Al-Khor Hospital Opthalmologist with a referral. The incident is being classified for work-relatedness and he was attended to by Nurse Dante V. Austerio.

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    Dharmendra Yadav(Qcon)-Illness and Injury Report

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    Dharmendra Yadav, a 32-year-old Indian welder, reported to the GV Camp Clinic on August 27, 2012 with a chief complaint of left ocular pain for 2 months. His vital signs were taken and he was sent to the RLMC/Almadina for further management and then to the Al-Khor Hospital Opthalmologist with a referral. The incident is being classified for work-relatedness and he was attended to by Nurse Dante V. Austerio.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xls, pdf, or txt
    12 views1 page

    Dharmendra Yadav (Qcon) - Illness and Injury Report

    Uploaded by

    Victoria Gomez
    Dharmendra Yadav, a 32-year-old Indian welder, reported to the GV Camp Clinic on August 27, 2012 with a chief complaint of left ocular pain for 2 months. His vital signs were taken and he was sent to the RLMC/Almadina for further management and then to the Al-Khor Hospital Opthalmologist with a referral. The incident is being classified for work-relatedness and he was attended to by Nurse Dante V. Austerio.

    Copyright:

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    of 1

    ILLNESS AND INJURY REPORT

    Patient Information Name: Dharmendra Yadav Age: 32 Nationality: Indian Area of Assignment: CORRIDOR Section A. To be filled by the Doctor: Position: WELDER Company: QCON BADGE NO: JBOG-80822

    JBOG Recovery Project

    Incident 00/06/2012 Time of Incident: 0000 HOURS Reported to GV Camp Clinic: 27/08/2012 at 15:10 Hrs. ROOM NO: C5/40 GF1 MOBILE NUMBER: 66237167

    CHIEF COMPLAINT:LEFT OCULAR PAIN FOR 2 MONTHS Sick Leave: (Pls. tick) > VS: BP: 137/96 PR: 78 T: 36 > (-) swelling; redness Yes If yes, no. of days: No

    15:15> Sent to RLMC/ALMADINA for further management >QRC/FLUOR NURSE/CAMP MANAGEMENT informed 16:35 Cameback to GV MAC Only with refferal to HMC/Alkhor- Opthalmologist >QRC/ FLUOR NURSE/ CAMP MANAGEMENT INFORMED

    ristan Palacpac

    Classification: (Pls. tick) Work-related Injury Work-related Illness Non-work-related Illness/Injury

    Referral: (Pls. tick) Yes If yes, referred to: __________________

    Attended by: DANTE V. AUSTERO - GV MAC NURSE JBOG Recovery Project

    RLIC/Al Madinah Medical Center Al-Khor Hospital Hamad Medical Center

    Note: Please attach all relevant documentation including sick leave forms issued by RLIC, Al-Khor Hospital, etc. before forwarding to HSE for classification.

    Section B. To be filled by Health Safety and Environment (HSE) Manager

    Classification: (Pls. tick) First Aid Medical Treatment Restricted Work LTA

    If LTA, how many days?

    If Restricted Work, state details:

    Comments / Justification of Classification:

    Classified by:

    Section C. Return To Work (RTW) Certification - To be filled by JBOG Recovery Project Doctor Comments: (Please provide details) Fit to return to work Unfit to return to work Reassignment

    Important: Please fax signed copy to Qatargas Medical Center at 4473-6189.

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