| Name | Description | Type | Additional information |
|---|---|---|---|
| IncidentID(SystemGenerated) | string |
None. |
|
| IncidentInternalID(SystemGenerated) | string |
None. |
|
| IncidentTitle | string |
None. |
|
| IncidentType | string |
None. |
|
| LocationCode | string |
None. |
|
| Location | string |
None. |
|
| WouldyouliketosubmitaGeneralLiabilityClaim? | string |
None. |
|
| GeneralLiabilityType | string |
None. |
|
| Sub-incidentType | string |
None. |
|
| DateOfIncident | date |
None. |
|
| TimeOfIncident | string |
None. |
|
| TimeUndetermined | string |
None. |
|
| DayOfWeek | string |
None. |
|
| WorkShift | string |
None. |
|
| TimeWorkDayBegan | string |
None. |
|
| HasPotentialToSerious | string |
None. |
|
| DescriptionofIncident | string |
None. |
|
| DateReportedToEmployer | date |
None. |
|
| TimeReportedToEmployer | date |
None. |
|
| OccurredonEmployersPremises | string |
None. |
|
| ContractorInvolvedYN | string |
None. |
|
| ContractorName | string |
None. |
|
| ContractorDetails | string |
None. |
|
| ContractorTrainedYN | string |
None. |
|
| WasAssetinvolved | string |
None. |
|
| Assets | string |
None. |
|
| ConfirmSignificanceLevelIDOfIncident | string |
None. |
|
| Wereindividualsinvolvedintheincident? | string |
None. |
|
| Numberofinvolvedindividuals | string |
None. |
|
| PersonDetails | Collection of PersonDetails |
None. |
|
| EmployeeInvolvedYN | string |
None. |
|
| PersonnelType | string |
None. |
|
| EmployeeInvolved | string |
None. |
|
| EmployeeId | string |
None. |
|
| PayRateType | string |
None. |
|
| EmployeeDepartment | string |
None. |
|
| DoyouwanttoclassifyUnsupervisedContractEmployee? | string |
None. |
|
| TypeofClientPersonnel | string |
None. |
|
| ClientCompany | string |
None. |
|
| NameofContractor | string |
None. |
|
| NameofSubContractor | string |
None. |
|
| IncidentOccurredonEmployersPremises | string |
None. |
|
| AddressofIncidentLocation | string |
None. |
|
| CityOfLocation | string |
None. |
|
| County | string |
None. |
|
| StateOfIncident | string |
None. |
|
| ZipOfLocation | string |
None. |
|
| Department | string |
None. |
|
| LocationoftheIncident | string |
None. |
|
| StoreManagerName | string |
None. |
|
| StoreManagerPhone | string |
None. |
|
| DistrictManagerName | string |
None. |
|
| DistrictManagerPhone | string |
None. |
|
| Wasanythingonfloor? | string |
None. |
|
| Floorgroundscondition | string |
None. |
|
| Incidentoccurinside/outside | string |
None. |
|
| IfInsidestorewhere? | string |
None. |
|
| IfInsidestorecause | string |
None. |
|
| IfinStockroomwhere? | string |
None. |
|
| IfOutsidestorewhere? | string |
None. |
|
| IfOutsidestorecause | string |
None. |
|
| Istherevideooftheincident? | string |
None. |
|
| Ifvideonotobtainedwhy? | string |
None. |
|
| IfEquipnotfunctionalWhy? | string |
None. |
|
| Didtheincidentresultinanydamagetocompanyequipment? | string |
None. |
|
| Pleasedescribeequipmentanddamage | string |
None. |
|
| Didtheincidentresultinanystructuraldamage? | string |
None. |
|
| Pleasedescribedamage | string |
None. |
|
| Wastheincidentaresultoftheftorasecurityrelatedactivity? | string |
None. |
|
| Pleasedescribetheftorsecurityrelatedincident | string |
None. |
|
| Isthisanassaultorrobbery? | string |
None. |
|
| Weretheresuspects? | string |
None. |
|
| Werearrestsmade? | string |
None. |
|
| Wasthereapolicereport? | string |
None. |
|
| LossPreventionreport | string |
None. |
|
| Askthemtotakephotographs | string |
None. |
|
| Incidentlocationdiagrammade | string |
None. |
|
| IsthisclaimaProductLiabilityclaim? | string |
None. |
|
| NameofProduct | string |
None. |
|
| ProductCode | string |
None. |
|
| ManufacturersName | string |
None. |
|
| ManufacturerAddress1 | string |
None. |
|
| ManufacturerAddress2 | string |
None. |
|
| ManufacturerCity | string |
None. |
|
| ManufacturerState | string |
None. |
|
| ManufacturerPostalCode | string |
None. |
|
| ManufacturerPhone | string |
None. |
|
| Pleaseprovideadetaildescriptionoftheproduct | string |
None. |
|
| Wasstoreadvisedtoretaintheproduct? | string |
None. |
|
| Isstoreincurrentpossessionofproduct? | string |
None. |
|
| Briefdescriptionoffactsofloss | string |
None. |
|
| Responsibilityforrotatingproduct | string |
None. |
|
| LocalVenderProduct? | string |
None. |
|
| VendorName | string |
None. |
|
| VendorPhoneNumber | string |
None. |
|
| WasemployeesenttoHospital/ClinictoreceiveMedicalTreatment? | string |
None. |
|
| Hospital/Clinic Name | string |
None. |
|
| HospitalAddress | string |
None. |
|
| HospitalCity | string |
None. |
|
| HospitalState | string |
None. |
|
| HospitalPostalCode/ZipCode | string |
None. |
|
| HospitalPhone | string |
None. |
|
| HospitalFax | string |
None. |
|
| Clinic/DoctorName | string |
None. |
|
| Incident Severity ID | integer |
None. |
|
| Incident Severity SIF | string |
None. |
|
| Actual Severity | string |
None. |
|
| ArethereanyWitnessesidentified? | string |
None. |
|
| WitnessInformation | Collection of WitnessInformation |
None. |
|
| ReportedBy | string |
None. |
|
| Title | string |
None. |
|
| ReporterPhoneNumber | string |
None. |
|
| ReporterEmailAddress | string |
None. |
|
| IncidentStatus | string |
None. |
|
| CreatedBy | string |
None. |
|
| CreatedDate | date |
None. |
|
| LastUpdatedBy | string |
None. |
|
| LastUpdatedsDate | date |
None. |
|
| InvestigationResponsibilityDetail | Collection of InvResponsibilityDetail |
None. |
|
| InvestigationResponsibilityassigneeDetails | Collection of InvResponsibilityAssignee |
None. |
|
| InvestigationquestionsDetails | Collection of InvestigationQuestionsDetails |
None. |
|
| ContributingFactorsDetails | Collection of ContributingFactor |
None. |
|
| 5YDetails | Collection of _5WhyMethodology |
None. |
|
| 5Ys | Collection of Why |
None. |
|
| RootCauseDetails | Collection of RootCause |
None. |
|
| FinalrootcausestatementDetails | Collection of FinalrootCauseSTMT |
None. |
|
| LessonsLearnedStatementDetails | Collection of LessonLearnedSTMT |
None. |
|
| ActionItemsDetail | Collection of ActionItemsDetail |
None. |
|
| ManagementreviewDetail | Collection of ManagementReviews |
None. |