Successful incident management includes several components, but the most important may be communication. The Grab N Go Kit will help you communicate your RTW program with injured employees, medical providers and MSF claims examiners. Injured employees take the Grab N Go kit with them to the medical provider for their initial medical appointment and return completed documents to their employers.

The basic components of this kit include:

• Letter to the Medical Provider: This document tells the treating medical provider about your company’s RTW policy and your commitment to get your injured employee back to work as soon as medically appropriate.
• Medical Status Form: This form outlines the physical activities the employee is able to do, and should be completed by the treating medical provider at the initial medical appointment and each follow-up visit as necessary. The injured employee should return the form to your RTW specialist immediately following each appointment.
• Job Description: Outlines the physical requirements of the injured employee’s job. Having a job description with the physical requirements of the job developed before an injury occurs can aid the medical provider in identifying duties that are medically appropriate for the injured employee’s condition. This form should be given to the treating medical provider at the initial medical appointment. Click here to view samples in our Job Description Bank.
• First Report of Injury (FROI): The employee and employer should complete the First Report of Injury Form as soon as an injury occurs, and forward it to the Montana State Fund. The report is required by law.
• Incident Investigation Report: Since prevention is the best management, be sure you investigate the cause of any incident whether it results in time off work or not. Investigating the incident may lead to changes that prevent recurrences. Involve the employee(s) and the direct supervisor in searching for solutions.

Grab n Go Kit Forms

• Letter to Medical Provider
• Medical Status Form
• Job Description Template
• First Report of Injury
• Incident Investigation Report
• Customizable Grab n Go Envelope

Customize Your Grab n Go Envelope

1. Open the Grab n Go Envelope template in Microsoft Word.
2. Then click on the “Insert” tab.
3. Now click on the Picture icon and select your JPG logo from your file.
4. To size your logo go to the “Format” tab on the top right hand corner of the page. Click on text wrapping and then square.
5. Print on a 9″ x 6″ White Booklet Envelope.

ADDITIONAL INCIDENT MANAGEMENT RESOURCES

Incident Management Checklist