Administrative Manual

Appendix

1. Title 19 Appendix and Exhibits

   Title 19 Appendix and Exhibits

   Appendix A - Employee Instruction/ Training Requirements

   Exhibit A - Glenn County Department Head & Division Phone List

   Exhibit B - Glenn County General Safety Inspection Checklist/Office Safety Checklist

   Exhibit C - Accident Investigation Form

   Exhibit D - Employee Report of Unsafe Condition or Hazard

   Exhibit E - Safety and Health Orientation Checklist

   Exhibit F - Job Safety Analysis Form

   Exhibit G - Employee's Claim for Worker's Compensation Benefits

   Exhibit H - Employer's Report of Occupational Injury or Illness

   Exhibit I - Certification of a Serious Health Condition and Return to Work Authorization

   Exhibit J - Ergonomic Evaluation Request Form

   Exhibit K - County of Glenn Incident Report

   Exhibit L - Insurance Identification Card

   Exhibit M - Vehicle Incident Information

   Exhibit N - First Aid Kit Locations Form

   Exhibit O - Recommended First Aid Kit Supply List

   Exhibit P - Medical/Safety Supply Monthly Check Sheet