File FSA_2162_REPORT(6924) Data List
| LOCAL ENGINEERING # |
CASE NUMBER |
FIRST/MIDDLE INITIALS |
SSN |
SEX |
PERSONNEL STATUS |
AGE |
PAY PLAN |
OCCUPATIONAL CODE |
GRADE |
HOME ADDRESS |
HOME PHONE # |
REPORT TYPE |
WORK PHONE # |
CA1/CA2 |
TIME ON DUTY |
DUTY STATUS |
ACCIDENT ACTIVITY |
SERVICE/DIVISION # |
SEVERITY OF INJURY |
CULMINATION |
RESTRICTED WORK DAYS |
LOST WORK DAYS |
RESULT |
INJURY/ILLNESS NATURE |
BODY PART AFFECTED |
CAUSE OF INJURY |
NEEDLE STICK? |
PROPERTY OWNERSHIP |
AMOUNT OF DAMAGE |
PROPERTY DAMAGED |
YEAR MANUFACTURED |
WEATHER FACTOR |
SOURCE OF ACCIDENT |
CAUSE OF ACCIDENT |
ACCIDENT CLASS |
ADDITIONAL CAUSE |
FIRE-FORM OF IGNITION |
FIRE..MATERIAL BURNED |
FIRE..MATERIAL FORM |
BEST PREVENTATIVE |
CORRECTIVE ACTION |
ACCIDENT NARRATIVE |
WITNESSES |
CORRECTIVE NARRATION |
INITIATOR NAME |
OCCURRENCE DATE |
INITIATOR TITLE |
INITIATOR DATE SIGNED |
INITIATOR PHONE # |
REVIEW AUTHORITY NAME |
REVIEW AUTHORITY TITLE |
REVIEW AUTHORITY DATE |
REVIEW AUTHORITY PHONE |
EVALUATION OF REPORT |
REPORT STATUS |
OCCURRENCE TIME |
SITE |
SPECIFIC LOCATION |
TORT CLAIM |
LAST NAME OF INVOLVED |