NameDescriptionTypeAdditional 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.