| Name | Description | Type | Additional information |
|---|---|---|---|
| Employee Name | string |
None. |
|
| Classification Of Case Id | integer |
None. |
|
| Classification of Case | string |
None. |
|
| Date Reported | date |
None. |
|
| Date First Aid Provided | date |
None. |
|
| Date other Recordable case Occurred | date |
None. |
|
| First Day of Restricted Duty | date |
None. |
|
| Last Day of Restricted Duty | date |
None. |
|
| First Day of Lost Time | date |
None. |
|
| Last Day of Lost Time | date |
None. |
|
| Date Fatality Occurred. | date |
None. |
|
| Reason for Classification | string |
None. |
|
| Reason for Classification Pick List | string |
None. |
|
| Is This A Defense Based Act Case? | string |
None. |
|
| Is This A Compensable Case? | string |
None. |
|
| Comments | string |
None. |
|
| Official Medical Diagnosis (Nature of Injury / Illness) | string |
None. |
|
| Was the Corporate Medical Director contacted? | string |
None. |
|
| Was Medical Treatment Rejected? | string |
None. |
|
| Reason for Refusal | string |
None. |
|
| Was Treatment Provided beyond First Aid? | string |
None. |
|
| Was Treatment provided offsite? | string |
None. |
|
| Hospital/Clinic Name | string |
None. |
|
| Type | string |
None. |
|
| Physician/Health care Provider | string |
None. |
|
| Street | string |
None. |
|
| City | string |
None. |
|
| Country | string |
None. |
|
| State | string |
None. |
|
| Postal Code/Zip Code | string |
None. |
|
| Phone | string |
None. |
|
| FAX | string |
None. |
|
| Was the employee treated in an emergency room | string |
None. |
|
| Was employee hospitalized overnight as an in-patient | string |
None. |
|
| Recording/Revision Date | date |
None. |