| Name | Description | Type | Additional information |
|---|---|---|---|
| Was an Employee/IndividuaL involved in the incident ? | string |
None. |
|
| Personnel Type | string |
None. |
|
| Employee First Name | string |
None. |
|
| Employee Middle Name | string |
None. |
|
| Employee Last Name | string |
None. |
|
| Employee ID | string |
None. |
|
| Pay Rate Type | string |
None. |
|
| EmployeeDepartment | string |
None. |
|
| Contractor | string |
None. |
|
| Do you want to further classify Unsupervised Contract Employee | string |
None. |
|
| Type of Client Personnel | string |
None. |
|
| Client Company | string |
None. |
|
| Name of Sub-Contractor | string |
None. |
|
| Was any Machine / Equipment involved? | string |
None. |
|
| Machine/Equipment Number | string |
None. |
|
| Reviewed by EHS Representative | string |
None. |
|
| Review Date | date |
None. |