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Trainers Report BWC-2955 - Ohio

Trainers Report Form. This is a Ohio form and can be used in Employers Workers Comp .
 Fillable pdf Last Modified 12/4/2008
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TRAINER'S REPORTINSTRUCTIONS: Please print or type. Make sure to enter 4 digits for the year in all date fields. Please rate injured worker by marking the appropriate boxes below and record observations for each item checked. Follow the distribution list at the bottom.Name of training facilityInjured workerClaim numberName of trainerPresent skill levelPeriod of reportBeginningIntermediateAdvancedTo:From: Type of trainingBELOW AVERAGE ABOVE AVERAGE AVERAGEOBSERVATIONSGeneral progress Ability to follow instructions InitiativeAttitudeSafety habits Use of tool or equipment Manual dexterity Study habits (if applicable)Is the progress of the injured worker such that he/she is expected to continue training?YesNoComment:Is the injured worker expected to complete training by the scheduled completion date?YesNoComment:Additional comments and/or recommendations:TRAINING ATTENDANCE RECORD Please place an "A" in the block for any date which the trainee was scheduled to work but did not report.Date: Month/dayYearNumber of hoursDateEvaluator signature & titleDistribution: BWC claim file, Injured worker, Injured worker representative, Employer, Employer representativeBWC-2955 (Rev. 3/10/1999) RH-52002 © American LegalNet, Inc.
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