                                                          PAGE 3      
                                                                     





                   REPORTING INJURIES


IT IS NECESSARY THAT YOU REPORT TO YOUR SUPERVISOR IMMEDIATELY
ANY WORKRELATED INJURY OR ILLNESS.

THE PROMPT REPORTING OF EVERY WORK-RELATED INJURY OR ILLNESS 
PROVIDES YOU WITH THE EARLIEST POSSIBLE MEDICAL TREATMENT AND A 
RECORD  OF THE EVENT TO SUBSTANTIATE PAYMENT FOR ANY  FUTURE MEDICAL
TREATMENT. ANY REQUEST FOR PAYMENT FROM  A MEDICAL FACILITY OR 
PHYSICIAN FOR TREATMENT OF ANY INJURY OR ILLNESS MUST BE VALIDATED BY
A RELATED REPORT  OF INJURY OR ILLNESS ON FILE  IN OUR FACILITY.

THE MEDICAL FACILITY AND PHYSICIANS IDENTIFIED BELOW ARE 
DESIGNATED TO TREAT EMPLOYEES WITH WORK-RELATED INJURY OR ILLNESS.

WHEN AN EMERGENCY ARISES, OTHER PROFESSIONAL MEDICAL TREATMENT MAY  
BE PROVIDED.
TREATMENT AFTER THE EMERGENCY VISIT SHALL, EXCEPT AS 

          
NOTED BELOW, BE THE FACILITY'S DESIGNATED MEDICAL FACILITY AND 
PHYSICIANS.
               THIS FACILITY HAS SELECTED-
____________________________________________________________________
_____________________________________________________________________
               AS IT'S MEDICAL FACILITY AND -
___________________________________________________________________
__________________________________________________________________

               AS IT'S PHYSICIAN.


ALTERNATE MEDICAL TREATMENT
IN ACCORDANCE WITH THE PROVISIONS OF THE LABOR CODE OF THE STAT OF CA
AN EMPLOYEE MUST NOTIFY HIS OR HER EMPLOYER IN WRITING PRIOR TO THE
DATE OF INJURY THAT HE OR SHE CHOOSES TO USE HIS OR HER 
'PERSONAL PHYSICIAN FOR ALL INDUSTRIAL INJURIES.
THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE PERSONAL PHYSICIAN 
MUST BE INCLUDED IN THE NOTIFICATION.
