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E AND TIME REPORTED TO FIRST AID AM / PM EMPLOYER NAME: D M Y EMPLOYER PHONE NUMBER: EMPLOYEE’S DOCTOR CONTACT PERSON EYE OPENING RESPONSE GLASGOW COMA SCALE BEST VERBAL RESPONSE BEST MOTOR RESPONSE 4 3 2 1 5 4 3 2 6 5 4 3 2 SPONTANEOUSLY SPEECH TO PAIN NO RESPONSE ORIENTED CONFUSED INAPPROPRIATE WORDS INCOMPREHENSIBLE SOUNDS OBEY’S COMMANDS LOCALIZES PAIN WITHDRAWS FROM PAIN FLEX TO PAIN (DECORTICATE) EXTENDS TO PAIN (DECEBRATE) 1 NO RESPONSE 1 NO RESPONSE VITAL SIGNS PATIE.

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How to fill out the Dominion Masonry Form-0006 online

Filling out the Dominion Masonry Form-0006 is an essential process for documenting first aid assessments. This guide provides clear and user-friendly instructions to help you navigate the online form effectively.

Follow the steps to complete the Dominion Masonry Form-0006 online.

  1. Press the ‘Get Form’ button to access the form and open it in your document management system.
  2. Begin by entering the date and time of the illness or injury. Select 'AM' or 'PM' based on the occurrence.
  3. Fill in the time of arrival at first aid, noting if the person walked in. Provide the employee's name and date of birth.
  4. Document the time spent on the scene if applicable and the date and time reported to first aid.
  5. Input the employer's name and phone number for further communication and verification.
  6. Record the name of the employee’s doctor and any contact person relevant to the situation.
  7. Assess and document the eye opening response, verbal response, and motor response using the Glasgow Coma Scale provided.
  8. Enter vital signs, including respirations and pulse, noting the time for each measurement.
  9. Describe the mechanism of injury or history of illness and document the loss of consciousness if applicable.
  10. Detail any physical findings, specifying pupil size and reactions.
  11. Mark the injured or exposed area clearly, indicating allergies and medications administered.
  12. Select any interventions performed, such as airway clearing or bleeding control, and indicate the definitive treatments provided.
  13. Provide recommendations for the individual's next steps and note the method of transportation if necessary.
  14. Document any changes in the patient’s condition with explanations.
  15. Finalize by printing or saving the completed form for your records, and ensure all signatures are acquired where indicated.

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