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Appendix A Log of Work-Related Injuries and Illnesses

Log of Work-Related Injuries and Illnesses . Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used …

Motor Activity Log (MAL) Manual

Upper Extremity Motor Activity Log (UE MAL) 1. General This instrument is a structured interview intended to examine how much and how well the subject uses their more-affected arm outside of the laboratory setting. Participants are asked standardized questions about the amount of use of their more-affected arm (Amount Scale or AS) and the quality

My Blood Pressure Log - Centers for Disease Control and ...

Pressure Log Try these tips for keeping track of your blood pressure at home: • Always take your blood pressure at the same time every day. • Take at least two readings, 1 or 2 minutes apart. • Visit cdc.gov/bloodpressure to learn how to correctly measure your blood pressure. Date. Morning Evening Time of reading.

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Job-search log for week ending (Month/Day/Year) …

Job-search log for week ending (Month/Day/Year) Name (Last, First, Middle): _____ ID or SSN:_____ MM/DD/YYYY EMPLOYER CONTACTS AND JOB-SEARCH ACTIVITIES Keep this log for your records. The Employment Security Department is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with ...

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Pfizer-BioNTech COVID-19 Vaccine: Temperature Log for ...

Temperature Log for Ultra-Cold Vaccine Storage (Celsius) Days 1–15 Store COVID-19 vaccine (Pfizer) between -90°C and -60°C. Using a digital data logger (DDL), check and record the temperature daily using one of the options below. Save this .

My Blood Pressure Log - American Heart Association

• Measure your blood pressure twice a day—morning and late afternoon—at about the same times every day. • For best results, sit comfortably with both feet on the floor for at least two minutes before taking a measurement.

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Daily Refrigerator / Freezer Temperature Log

Maintain this log for a minimum of three yeaand until givenrs permission to discard it. If corrective action is required on any day, circle the date in the first column and explain the action taken on the back of the chart or on an attached sheet of paper. Refrigerators should be between 36

ADULT DRIVING LOG - NCDOT

·· The driving log must be signed by a supervised driver with a valid license of the same class license or higher. ·· Log must be submitted to the Division at the time the driver seeks to obtain a license; and have not been convicted of a motor vehicle moving violation, seat belt infraction or unlawful use of a mobile phone.

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CY 862 10-04

MEDICATION LOG 55 Pa. Code §3270.133; §3280.133; §3290.133 PLEASE PRINT Page of Child’s Name: Medication: Prescription Non-Prescription Refrigeration Required: YES NO If Prescription, Prescriber’s Name: Telephone: Dosage Amount: Time to Administer: a.m. p.m. times/day Dates for Administration: From Date To Date CY 862 10/04