| Name | Description | Type | Additional information |
|---|---|---|---|
| Would you like to submit a Vehicle claim? | string |
None. |
|
| Incident ID (System Generated) | string |
None. |
|
| Incident Internal ID (System Generated) | string |
None. |
|
| Incident Title (No Personal data to be entered) | string |
None. |
|
| Incident Type | string |
None. |
|
| Date of Incident | date |
None. |
|
| Time of Incident | string |
None. |
|
| Time Undetermined | string |
None. |
|
| Day Of Week | string |
None. |
|
| Work Shift | string |
None. |
|
| TimeWorkDayBegan | string |
None. |
|
| Incident Severity | string |
None. |
|
| Description of Incident | string |
None. |
|
| Incident Occurred on Employer's Premises | string |
None. |
|
| Address of Incident Location | string |
None. |
|
| City | string |
None. |
|
| County | string |
None. |
|
| Country | string |
None. |
|
| State/Province | string |
None. |
|
| Postal Code/Zip Code | string |
None. |
|
| Department | string |
None. |
|
| Asset Involved Yes/No | string |
None. |
|
| Assets | string |
None. |
|
| Date Reported To Employer | string |
None. |
|
| Time Reported To Employer | string |
None. |
|
| OccurredonEmployersPremises | string |
None. |
|
| ContractorInvolvedYN | string |
None. |
|
| ContractorName | string |
None. |
|
| ContractorDetails | string |
None. |
|
| ContractorTrainedYN | string |
None. |
|
| Confirm Significance level of incident | string |
None. |
|
| Vehicle Incident Type | string |
None. |
|
| Please identify the weight of the vehicle? | string |
None. |
|
| Company Vehicle Type (please provide description of Vehicle) | string |
None. |
|
| Please identify the condition of the employee? | string |
None. |
|
| Length of Service (L.O.S.) as Company Driver | string |
None. |
|
| Is company driver a Commercial Driver's License holder? | string |
None. |
|
| Please select type of Commercial Driver's License | string |
None. |
|
| Driver's License Number | string |
None. |
|
| State of License | string |
None. |
|
| Date of Expiration | date |
None. |
|
| Number of vehicles / parties involved in accident | integer |
None. |
|
| Insurance Information | Collection of VehicleInsuranceOutboundDetails |
None. |
|
| Is Claim Form Completed? | string |
None. |
|
| Claim Submission Status | string |
None. |
|
| Claim Submitted By | string |
None. |
|
| Claim Submitted Date | date |
None. |
|
| Claim Status | string |
None. |
|
| Date Claim Closed | string |
None. |
|
| Total Cost Incurred | string |
None. |
|
| Total Cost Paid | string |
None. |
|
| Total Outstanding Cost | string |
None. |
|
| Total Developed Cost | string |
None. |
|
| Incident Severity ID | integer |
None. |
|
| Incident Severity SIF | string |
None. |
|
| Actual Severity | string |
None. |
|
| Potential Secction YN | string |
None. |
|
| Display Cause YN | string |
None. |
|
| Are there any Witnesses identified? | string |
None. |
|
| Witness Information | Collection of WitnessOutboundDetails |
None. |
|
| Incident Status | string |
None. |
|
| Created By | string |
None. |
|
| Created Date | date |
None. |
|
| Last Updated By | string |
None. |
|
| Last Updated Date | date |
None. |
|
| Employee details | Collection of vehEmpoyeeDetails |
None. |
|
| Vehicle details | Collection of VehDetail |
None. |
|
| Investigation Responsibility Details | Collection of InvResponsilbilityDetails |
None. |
|
| Investigation Responsibility assignee Details | Collection of InvResponsebilityAssignee |
None. |
|
| Investigation questions Details | Collection of InvestigationQuestionsDetails |
None. |
|
| Contributing Factors Details | Collection of ContributingFactor |
None. |
|
| 5Y Details | Collection of _5WhyMethodology |
None. |
|
| 5Ys | Collection of Why |
None. |
|
| Root Cause Details | Collection of RootCause |
None. |
|
| Final root cause statement Details | Collection of FinalrootCauseSTMT |
None. |
|
| Reportability and Chargability Details | VehReportabilityAndChargabilityDetails |
None. |
|
| Injured Parties Details | VehInjuredPartiesList |
None. |
|
| Action Items Details | Collection of ActionItemsDetails |
None. |
|
| Management review Details | Collection of ManagementReview |
None. |
|
| ManagementReviewStatus | string |
None. |