Employment Unit

From the drop-down list box, select the required option. The combo is defaulted with the login OU for you to choose. Mandatory.

Incident Number

From the drop-down list box, select the required option. The incident number is auto- generated on click of save.

Note: You can either enter the Incident Number or select from the list edit provided. When you type in the first character or first few characters, the list edit opens up with the similar incident numbers from which you can select the required incident number.

Injury / Illness

Select either “Injury” or “Illness” radio button depending upon the incident (indicates whether any employee is injured or sick due to incident). Mandatory.

Establishment Where Incident Occurred

From the drop-down list box, select the required option. The combo is loaded with various options for you to choose. The drop-down displays “Select” by default on launch of the page. Mandatory.

Jurisdiction

The jurisdiction where the incident took place. This field is displayed on selecting the establishment from “Establishment Where Incident Occurred” combo. Mandatory.

Exact Location of the Incident

The exact location where the incident occurred. Mandatory.

Impact of Incident

From the drop-down list box, select the required option. The combo is loaded with various options for you to choose. The drop-down displays “Select” by default on launch of the page. Mandatory.

Incident Date and Time

The incident date and time. It is the date and time at which the incident took place. Mandatory.

Date of Injury / Onset of Illness

The date at which the injury or illness occurred. Mandatory.

Reported By

The name of the person who reported the incident details. Mandatory.

Help facility available.

Reported Date & Time

The date and time on which the incident is reported. Mandatory.

How Did Incident Occur

The cause of the incident in this field. Mandatory.

Action Just Before Incident

The action took place just before the incident. Mandatory.

Agency of Incident

The agency of incident. Mandatory.

Witness Employee Code

The employee code of the witness.

Witness Employee Name

The name of the person who has witnessed is displayed on entering the witness employee code. Mandatory.

Address Line 1

The address details of the witness. Mandatory.

Country

From the drop-down list box, select the country of the witness. The combo is defaulted with various options for you to choose. Mandatory.

State

From the drop-down list box, select the state of the witness. The combo is defaulted with various options for you to choose. Mandatory.

City

From the drop-down list box, select the city of the witness. The combo is defaulted with various options for you to choose. Mandatory.

Zip

The zip code of the city in numeric format (in five digits). Mandatory.

Email ID

The email id of the witness.

Phone

The phone number of the witness.

Employee Code

The employee code of the employee who is affected due to incident.

Employee Name

The name of the employee.

Case Number

A unique number for individual employee will be auto generated on click of save, This case number will be used to identify the incident details.

Remarks

Key in any remarks or feedback, if any.

Action taken to prevent future occurrence

The preventive measures to be taken in future to prevent the damages. Mandatory.

Referred to Asset Insurer

By default “Yes” radio button is selected in the screen. This indicates that asset insurer is referred to any insurance otherwise click “No”. Mandatory.

Referred to Compensation

By default “Yes” radio button is selected in the screen if the incident is referred to the compensation otherwise click “No”. Mandatory.