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Procedure - Dunkin' Donuts

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					                                                  In Case of an Injury/Illness

Steps To an Employee:
  1   Make certain the employee is treated properly (If necessary, call 911)

        Injury may need medical attention. Employee should go to closest hospital or Care Center. If possible, call The
  2     Hartford in advance at 1-800-327-3636 and send employee to hospital with claim number.
  3     Fill out Hartford Worker's Comp Form
  4     Immediately contact The Hartford at 1-800-327-3636 to report claim
  5     Contact Candice Millet in the Restaurant Support Center to report incident: 985-674-5840 x 10
  6     Fax Safeco Accident Report to your AD and Candice Millet immediately: 985-674-9710
        Inform employee that they will need to take a drug test within 48 hours of accident. Employee will not be allowed
  7     back to work until MRG receives Drug test results
        Employee must supply MRG with Doctors note, in regards to any restrictions, prior to his/her return. MRG will
        determine if "Reasonable Accommodations" can be made if necessary. Area Directors and Human Resources
  8     must be notified immediately in regards to this.

Steps To a Guest:
  1   Make certain the guest is treated properly (If necessary, call 911)
  2   Make certain the guest knows Miracle's 800# Issue Resolution Hotline
  3   Complete the Guest Incident Report Form
  4   Contact Candice Millet in the Restaurant Support Center to report incident: 985-674-5840 x 10
  5   Fax Guest Incident Form to Candice Millet immediately: 985-674-9710
  6   Notify your Immediate Supervisor.
      Do not speak with the Guest once Candice has been notified. Direct Guest to Contact Candice or the 800#.
  7   Limit any and all follow up conversations with the Guest. Again, direct them to Candice in the RSC
Steps Cash Shortage/Robbery/Burglary:
  1   Immediately Notify Authorities (Police, Fire)
  2   Make certain all employees are ok
  3   Make certain all guests are ok
  4   Immediately contact your Immediate Supervisor. (General Managers must notify Area Director)
  5   Complete the Cash Loss Form and Fax to Lisa at RSC 985-674-9710
  6   Complete Guest Incident Report (if necessary) and fax to Candice at RSC 985-674-9710
Steps Property Damage:
  1   Make certain the guest is treated properly
  2   Complete the Guest Incident Report Form
  3   Contact Candice Millet in the Restaurant Support Center to report incident: 985-674-5840 x 10
  4   Fax Report Form to Candice Millet immediately: 985-674-9710
  5   Notify your Immediate Supervisor.
  6   Area Directors are to notify Director of Operations and Director of Construction immediately
Steps Restaurant Visit from a Federal or State Agency (IRS, INS, Department of Labor, etc)
  1   Immediately contact your Area Director
  2   Immediately contact Andrew Face,Exec. Dir. of HR at 603-674-1621
  3   Fax any paperwork to Andrew Face at 603-424-1037
2009 Worker’s Comp Reporting Form
            If there is an employee accident which requires medical attention
   outside of the unit , you must fill out this form and call The Hartford IMMEDIATELY!
           (800) 327-3636 w 24 hours a day/7 days a week/365 days a year
                   Miracle Restaurant Group, LLC Policy #21WBAG6433
                                                                 Unit #
PLEASE PRINT CLEARLY IN PEN                               Today's Date
Employee's Personal Information:
First and last name
Date of birth
Home street address
Home city, state, zip code
Phone # where employee can be reached           (                      )
Social Security Number                          -            -                         Hire Date
Check One:                   r         Single                 r Married                      r Widowed             r Divorced
Number of dependents
Details of Accident                                                                                                         Circle One:

Date of accident                                                                   Time of accident                       AM      PM
Name of manager/employees on duty


Which part(s) of the body were injured


Explain how the accident happened




Details of Treatment Received
Where did the employee receive medical treatment?
(If employee was sent/taken to location on yellow Safety Poster, you may copy that info here.)
Name of facility
Street address of facility
City, state, and zip code
Phone number of facility         (                  )
Will employee miss any days of work?                          r Yes                          r No
If 'yes,' attach Dr.'s note listing days off.

                                 At the end of the call, record the information you receive from the operator:
Claim # _______________________________________                  Adjuster's Name
Additional Information for Supervisor/HR Follow-Up
Did employee take billing information sheet to the medical facility?                         r Yes                 r No
Did employee take Chain-of-Custody form to the medical facility for drug testing?             rYes                 r No
Was a drug test performed?                                                                   r Yes                 r No
                r Fax this form immediately to your Supervisor               r Fax this form immediately to the office: (985) 674-9710

PRINT name of manager                                                              Signature of manager
reporting this incident                                                            reporting this incident
                                             Miracle Restaurant Group
                                                   Cash Loss Report
                                 TO BE COMPLETED BY THE MANAGER ON DUTY
                Fax or Email Completed Form to: Lisa 985-674-9710 (Call Her as well 985-674-5840 x 23)
Report No. _________
                                                        Cash Loss
Unit Name:
Unit #:
General Manager's Name:
Date and Time of Loss:
Amount of Loss:
Loss Discovered By:
Date and Time of Discovery:
Area Director's Name:
Date and Time Reported to Supervisor:
                                               Cash Shortage - $15.00 or More
Was Safe Locked (not day locked)?
List employees who have safe combination:

List of employees who have key to building but not safe combination:

Petty Cash/Change Fund Shortage:
Cash Register Shortage:

         Register #               Shift #         Employee                      Amount of Loss
1
2
3
4
                                                  Missing or Late Deposit
Is a full or partial deposit missing?:
Amount:
How was missing or late deposit discovered?:
Who was assigned to take deposit to bank?:
Reason deposit was NOT taken to bank:
Was a Police Report Filed:
If yes, Where?:
Date Reported:
Police Officer Name:
Employee Reporting missing or late deposit:
Police report availability date:
                                                         Robbery
Brief description of what happened:



Was a police report filed?:
If yes, Where?:
Date Reported:
Police Officer Name:
Employee Reporting missing or late deposit:
Police report availability date:

Name of Person Completing Report:
Name (Signature):                                                           Date:
                                          Miracle Restaurant Group
                             GUEST INCIDENT INVESTIGATION REPORT FORM
                                            GENERAL LIABILITY
                             TO BE COMPLETED BY THE MANAGER ON DUTY
                            Fax or Email Completed Form to: Candice 985-674-9710
Report No. _________

                                                    Unit Name:
Unit #:
Unit Phone:
Full Address:
General Manager:
                                                  INCIDENT:
Date:
Day:
Time:
Did Guest report the incident immediately to the Manager on Duty? ���� Yes ����No
If no, why not?

                                                   REPORTED
Manager on Duty at time of incident:
Position:
Area Supervisor contacted: ���� Done
Report faxed to Office: ���� Done
                                                      WHO
Injured person:
���� Male ���� Female Age:
Full Address:
Home Phone:
Place of Employment:
Work Phone:
                                                   INJURY/LOSS
Nature/extent of injury/property damage:

Fatality? ���� Yes ���� No
                                                     WHERE
Exact location where accident occurred:
Where was the injured party taken for treatment?
                                                      WHAT
Type of accident:
Describe the accident:

What was the injured doing at the time?
                                                WITNESSES
Include all persons (employees/guests) who were present:
Name
Address
Home Phone
Work Phone


Manager on Duty Name (Print):
Name (Signature):                                                         Date:

				
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