How to Edit Incident Forms using the API

To update incidents and their respective forms, please call POST v2/incidents/update.

Incident

The Incident itself has two enums available in the Insurance Claim Information section.

Insurance Claim Information
  • [Reporting Status] Enum
    • InHouse

    • ReportedToCarrier

    • ReportedToThirdPartyCarrier

  • [Insurance Claim Types] Enum
    • Auto / Fleet

    • Builder's Risk

    • Contractors Equipment

    • Cyber

    • Environmental

    • General Liability

    • Inland Marine

    • Pollution

    • Professional

    • Property

    • Uninsured

    • Workers Compensation

    • Other

List Answer Types

Some forms allow List-styled Answer types that come in distinct formats with distinct primary keys and editable fields.

List Answer Types
  • [Attachments] List
    • Primary Key: Name

    • Editable: AttachmentUrl

    • Editable: MimeType

  • [Passengers] List
    • Primary Key: Name

    • Editable: Address

    • Editable: Address2

    • Editable: City

    • Editable: State

    • Editable: ZipCode

    • Editable: Country

    • Editable: MobilePhone

    • Editable: HomePhone

  • [OtherVehicles] List
    • Primary Key: LicensePlate

    • Editable: DriverName

    • Editable: Make

    • Editable: Model

    • Editable: Year

    • Editable: VinNumber

    • Editable: State

    • Editable: Carrier

    • Editable: PolicyNumber

  • [OtherPassengers] List
    • Primary Key: Name

    • Editable: Vehicle

    • Editable: MobilePhone

    • Editable: HomePhone

    • Editable: Address1

    • Editable: Address2

    • Editable: City

    • Editable: State

    • Editable: Zip

    • Editable: Country

  • [Items] List
    • Primary Key: ItemDescription

    • Editable: EstimatedValue

Different forms will also have questions that allow/require different Enum-styled and Bool-styled Answer types (and a small amount of encoded string Answers), so this is documentation of those types where they exist.

Property

Form for collection of information about property damage.

Property
  • [Property Type] Enum
    • Damage to Existing Structure

    • Damage to Stored Equipment / Vehicles

    • Other Property

  • [Description of Property] Enum
    • Existing

    • Current Project

    • Other Property

    • Stored Equipment

  • [Reported to Authorities] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Other Equipment

Form for collection of information about other equipment involved in the incident.

Other Equipment
  • [Owner Contacted] Bool
    • True

    • False

  • [Equipment Type] Enum
    • Rented

    • Leased

    • N/A

  • [Fluids Spilled] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Vehicle

Form for collection of information about the vehicle involved in the incident.

Vehicle
  • [The Owner was the Driver of the Vehicle] Bool
    • True

    • False

  • [Equipment Type] Enum
    • Rented

    • Leased

    • N/A

  • [State/Territory] Enum
    • US and Canada two-letter state abbreviations

  • [Root Cause Analysis?] Bool
    • True

    • False

Utility Strike

Form for collection of information about the utility strike involved in the incident.

Utility Strike
  • [Right of Way Location] Enum
    • Public:City Street

    • Public:State Highway

    • Public:County Road

    • Public:Interstate Highway

    • Public:Public-Other

    • Private:Business

    • Private:Land Owner

    • Private:Easement

    • Private:Pipeline

    • Private:Dedicated Public Utility Easement

    • Private:Federal Land

    • Private:Railroad

    • Private:Unknown/Other

  • [Utility Operations Affected] Enum
    • Cable Television

    • Electric

    • Fiber Optic

    • Liquid Pipeline

    • Natural Gas

    • Sewer

    • Steam

    • Telecommunications

    • Water

    • Unknown/Other

  • [Utility Affected] Enum
    • Distribution

    • Gathering

    • Service/Drop

    • Transmission

    • Unknown/Other

  • [Part of a Joint Trench] Bool
    • True

    • False

  • [Cross Bore Involved] Bool
    • True

    • False

  • [Facility Owner is a One-Call Center Member] Bool
    • True

    • False

  • [Estimated Measured Depth From Grade] Enum
    • Embedded in Concrete/Asphalt Pavement

    • <18in /46cm

    • 18-36in /46-91cm

    • >36in /91cm

  • [Excavation Equipment] Enum
    • Auger

    • Backhoe/Trackhoe

    • Boring

    • Bulldozer

    • Drilling

    • Directional Drilling

    • Excavator

    • Explosives

    • Farm Equipment

    • Grader/Scraper

    • Handtools

    • Milling Equipment

    • Probing Device

    • Trencher

    • Vaccuum Equipment

    • Other

  • [Work Performed] Enum
    • Agriculture

    • Bldg. Construction

    • Bldg. Demolition

    • Cable Television

    • Curb/Sidewalk

    • Drainage

    • Driveway

    • Electric

    • Engineering/Survey

    • Fencing

    • Grading

    • Irrigation

    • Landscaping

    • Liquid Pipeline

    • Milling

    • Natural Gas

    • Pole

    • Public Transit Auth.

    • Railroad

    • Roadwork

    • Sewer

    • Site Development

    • Steam

    • Storm Drain/Culvert

    • Street Light

    • Telecommunication

    • Traffic Signal

    • Traffic Sign

    • Water

    • Waterway Improvement

    • Unknown/Other

  • [Equipment Incurred Downtime] Bool
    • True

    • False

  • [Estimated Cost of Downtime] Enum
    • $0

    • $1-1,000

    • $1,001-5000

    • $5,001-25,000

    • $25,001-50,000

    • >$50,000

  • [One Call Center Notified] Bool
    • True

    • False

  • [Type of Locator] Enum
    • Facility Owner

    • Contact Locator

    • Unknown/Other

  • [Work Are was White-Lined] Bool
    • True

    • False

  • [Excavation Activity and/or Excavator Type is Exempt from Notification] Bool
    • True

    • False

  • [One Call Active] Bool
    • True

    • False

  • [Utility Marks Visible] Bool
    • True

    • False

  • [Utilities Marked Correctly] Bool
    • True

    • False

  • [Estimated Cost of Damage/Repair/Restoration] Enum
    • $0

    • $1-1,000

    • $1,001-5000

    • $5,001-25,000

    • $25,001-50,000

    • >$50,000

  • [Incurred Downtime] Bool
    • True

    • False

  • [Damages Caused an Interruption to Service] Bool
    • True

    • False

  • [Estimated Duration] Enum
    • <1 hr

    • 1-6 hrs

    • 6-12 hrs

    • 12-24 hrs

    • 24-48 hrs

    • 48 hrs +

  • [Estimated Number of Customers Affected] Enum
    • Unknown

    • 0

    • 1

    • 2-10

    • 11-50

    • 50+

  • [Notification Issue] Enum
    • No Notification Made to One Call Center/811

    • Excavator Dug Outside Area Described on Ticket

    • Excavator Dug Prior to Valid State Date/Time

    • Excavator Dug After Valid Ticket Expired

    • Excavator Provided Incorrect Notification Information

  • [Contractor Issue] Enum
    • Excavator Dug Prior to Verifying Marks by Test-Hole (Pothole)

    • Excavator Failed to Maintain Clearance After Verifying Marks

    • Excavator Failed to Protect/Shore Support Facilities

    • Improper Backfilling Practices

    • Marks Faded or Not Maintained

    • Improper Excavation Practice Not Listed Above

  • [Locating Issue] Enum
    • Abandoned Facility

    • Incorrect Facility Records/Maps

    • Locator Error

    • No Response from Operator/Contract Locator

    • Tracer Wire Issue

    • Unlocatable Facility

  • [Miscellaneous Issue] Enum
    • Deteriorated Facility

    • One Call Center Error

    • Previous Damage

    • Root Cause Not Listed (Comment required)

  • [Root Cause Analysis?] Bool
    • True

    • False

Employee Involved Form

Form for collection information about the employee involved in the incident.

Employee Involved Form
  • [Employee] Encoded
    • "{Employee.ID} {Employee.Code}: {Employee.FirstName} {Employee.MiddleInitial} {Employee.LastName}"

  • [State/Territory] Enum
    • US and Canada two-letter state abbreviations

  • [Years With Company] Enum
    • Less Than 6 Months

    • 6 Months to 1 Year

    • 1 Year to 5 Years

    • 5 Years to 10 Years

    • 10 Years to 20 Years

    • 20 Years Or More

  • [Years In Construction] Enum
    • Less Than 6 Months

    • 6 Months to 1 Year

    • 1 Year to 5 Years

    • 5 Years to 10 Years

    • 10 Years to 20 Years

    • 20 Years Or More

  • [Drug/Alcohol Test] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Theft Report

Form for collection of information about a theft involved in the incident.

Theft Report
  • [Officer Responded to the Scene] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Employee Injury

Form for collection information about the employee injury involved in the incident.

Employee Injury
  • [Employee] Encoded
    • {Employee.ID} {Employee.Code}: {Employee.FirstName} {Employee.MiddleInitial} {Employee.LastName}

  • [State/Territory] Enum
    • US and Canada two-letter state abbreviations

  • [Years With Company] Enum
    • Less Than 6 Months

    • 6 Months to 1 Year

    • 1 Year to 5 Years

    • 5 Years to 10 Years

    • 10 Years to 20 Years

    • 20 Years Or More

  • [Years In Construction] Enum
    • Less Than 6 Months

    • 6 Months to 1 Year

    • 1 Year to 5 Years

    • 5 Years to 10 Years

    • 10 Years to 20 Years

    • 20 Years Or More

  • [Injury/Illness Classification] Enum
    • Injury

    • Skin Disorder

    • Respiratory Condition

    • Poisoning

    • Hearing Loss

    • All Other Illnesses

  • [Nature of Injury] Enum
    • Multiple Injuries

    • Occupational Disease or Cumulative Injury

    • Specific Injury

    • 90-Multiple physical injuries only

    • 91-Multiple injuries, including both physical and psychological

    • 60-Dust disease, NOC - All other Pneumoconiosis

    • 61-Asbestosis - Lung disease, a form of Pneumoconiosis, resulting from protracted inhalation of asbestos particles

    • 62-Black lung - The chronic lung disease of Pneumoconiosis found in coal miners

    • 63-Byssinosis - Pneumoconiosis of cotton, flax, hemp workers

    • 64-Silicosis - Pneumoconiosis resulting from the inhalation of silica (quartz) dust

    • 65-Respiratory disorders - Gases, fumes, chemicals, etc.

    • 66-Poisoning--chemical (other than metals) - Man-made or organic

    • 67-Poisoning--metal - Man-made

    • 68-Dermatitis - Rash, skin, or tissue inflammation including boils, etc., generally resulting from direct contact with irritants or sensitizing chemicals such as drugs, oils, biologic agents, plants, woods, or metals, which may be in the form of solids, pastes, liquids, or vapors, and which may be contacted in the pure state or in compounds or in combination with other materials; do NOT include skin tissue damage resulting from corrosive action of chemicals, burns from contact wit hot substances, effects of exposure to radiation, effects of exposure to low temperatures or inflammation or irritations resulting from friction or impact.

    • 69-Mental disorders - A clinically significant behavioral or psychological syndrome or pattern typically associated with either a distressing symptom or impairment of function, i.e., acute anxiety, neurosis, stress, nontoxic depression.

    • 70-Radiation - All forms of damage to tissue, bones, or body fluids produced by exposure to radiation.

    • 71-All other occupational disease injury, NOC

    • 72-Loss of hearing

    • 73-Contagious diseases

    • 74-Cancer

    • 75-AIDS

    • 76-VDT-related disease - Video display terminal diseases other than Carpal Tunnel Syndrome

    • 77-Mental stress

    • 78-Carpal Tunnel Syndrome - Soreness tenderness, and weakness of the muscles of the thumb caused by pressure on the Median Nerve at the point at which it goes through the Carpal Tunnel of the wrist.

    • 80-All other cumulative injury, NOC

    • 01-No physical injury - i.e., glasses, contact lenses, artificial appliance, replacement of artificial appliance

    • 02-Amputation - Cut off extremity, digit, protruding part of body, usually by surgery (i.e., leg, arm)

    • 03-Angina pectoris - Chest pain

    • 04-Burn - (Heat) burns or scald: the effect of contact with hot substances; (Chemical) burns; tissue damage resulting from corrosive action chemicals, fumes, etc. (i.e., acids, alkalies)

    • 07-Concussion - Brain, cerebral

    • 10-Contusion - Bruise - intact skin surface hematoma

    • 13-Crushing - To grind, pound, or break into small bits

    • 16-Dislocation - -Pinched nerve, slipped/ruptured disc. herniated disc, sciatica, complete tear, HNP subluxtion, MD dislocation

    • 19-Electric - shock Electrocution

    • 22-Enucleation - Removal of organ or tumor

    • 25-Foreign body

    • 28-Fracture - -Breaking of a bone or cartilage

    • 30-Freezing - Frostbite and other effects of exposure to low temperatures

    • 31-Hearing loss or impairment - Traumatic only, a separate injury, not the sequelae of another injury

    • 32-Heat prostration - Heat stroke, sun stroke, heat exhaustion, heat cramps, and other effects of environmental heat, does not include sunburn

    • 34-Hernia - -Abnormal protrusion of an organ or part through the containing wall of its cavity

    • 36-Infection - -Invasion of host by organisms such as bacteria, fungi, viruses, protozoa or insects, with or without manifest disease

    • 37-Inflammation - -The reaction of tissue to injury characterized clinically by heat, swelling, redness, and pain

    • 40-Laceration - -Cut, scratches, abrasions, superficial wounds, calluses; wound by tearing

    • 41-Myocardial infarction - -Heart attack, heart conditions, hypertension; the inadequate blood flow to the muscular tissue of the heart

    • 42-Poisoning - -general (not OD or cumulative injury) A systematic morbid condition resulting from the inhalation, ingestion, or skin absorption of a toxic substance affecting the metabolic system, the nervous system, the circulatory system, the digestive system, the respiratory system, the excretory system, the musculoskeletal system, etc. Includes chemical or drug poisoning, metal poisoning, organic diseases, and venomous reptile and insect bites. Does NOT include effects of radiation, pneumoconiosis, corrosive effects of chemicals, skin surface irritations, septicemia, or infected wounds.

    • 43-Puncture - -A hole made by the piercing of a pointed instrument.

    • 46-Rupture

    • 47-Severance - To separate, divide, or take off

    • 49-Sprain - Internal derangement, a trauma or wrenching of a joint, producing pain and disability depending upon the degree of injury to ligaments

    • 52-Strain - Internal derangement, the trauma to the muscle or the musculotendinous unit from violent contraction or excessive forcible stretch

    • 53-Syncope - Swooning, fainting, passing out, no other injury

    • 54-Asphyxiation - Strangulation, drowning

    • 55-Vascular - Cerebrovascular and other conditions of circulatory systems, NOC. Excludes heart and hemorrhoids. Includes strokes, varicose veins - nontoxic.

    • 58-Vision loss

    • 59-All other specific injuries, NOC

  • [Incident Cause] Enum
    • Burn or Scald - Heat or Cold Exposure

    • Caught In, Under or Between

    • Cut, Puncture, Scrape, Injured By

    • Fall, Slip or Trip Injury

    • Miscellaneous Causes

    • Motor Vehicle/Heavy Equipment

    • Rubbed or Abraded by

    • Strain or Injury By/Overexertion

    • Striking Against or Stepping on

    • Struck or Injured By - Includes Kicked, Stabbed, Bit, Etc.

    • 01-Chemicals

    • 02-Hot objects or substances

    • 03-Temperature extremes

    • 04-Fire or flame

    • 05-Steam or hot fluid

    • 06-Dust, gases, fumes, or vapors

    • 07-Welding operations

    • 08-Radiation

    • 09-Contact with, NOC

    • 11-Cold objects or substances

    • 14-Abnormal air pressure

    • 84-Electrical current

    • 10-Machine or machinery

    • 12-Object handled

    • 13-Caught in, under, or between, NOC

    • 20-Collapsing materials (slides of earth) either manmade or natural

    • 15-Broken glass

    • 16-Hand tool, utensil (not powered)

    • 17-Object being lifted or handled

    • 18-Powered hand tool, appliance

    • 19-Caught, puncture, scrape, NOC

    • 25-From different level (elevation) - off wall, catwalk, bridge, etc.

    • 26-From ladder or scaffolding

    • 27-From liquid or grease spills

    • 28-Into openings - shafts, excavations, floor openings, etc.

    • 29-On same level

    • 30-Slipped, did not fall

    • 31-Fall, slip, or trip, NOC

    • 32-On ice or snow

    • 33-On stairs

    • 82-Absorption, ingestion, or inhalation, NOC

    • 87-Foreign matter in eye(s)

    • 89-Person in act of a crime - robbery or criminal assault

    • 90-Other than physical cause of injury

    • 98-Cumulative, NOC - all other

    • 99-Other--miscellaneous, NOC

    • 40-Crash of water vehicle

    • 41-Crash of rail vehicle

    • 45-Collision or sideswipe with another vehicle - both vehicles in motion

    • 46-Collision with a fixed object - standing vehicle or stationary object

    • 47-Crash of airplane

    • 48-Vehicle upset - overturned or jackknifed

    • 50-Motor vehicle, NOC

    • 94-Repetitive motion - callous, blister, etc.

    • 95-Rubbed or abraded by, NOC

    • 52-Continual noise

    • 53-Twisting

    • 54-Jumping

    • 55-Holding or Carrying

    • 56-Lifting

    • 57-Pushing or Pulling

    • 58-Reaching

    • 59-Using tool or machinery

    • 60-Strain or injury by, NOC

    • 61-Wielding or throwing

    • 97-Repetitive motion - Carpal Tunnel Syndrome

    • 65-Moving parts of a machine

    • 66-Object being lifted or handled

    • 67-Sanding, scraping, cleaning operation

    • 68-Stationary object

    • 69-Stepping on a sharp object

    • 70-Striking against or stepping on, NOC

    • 74-Fellow worker, patient - not in act of a crime

    • 75-Falling or flying object

    • 76-Hand tool or machine in use

    • 77-Motor vehicle

    • 78-Moving parts of machine

    • 79-Object being lifted or handled

    • 80-Object handled by others

    • 81-Struck or injured, NOC - includes kicked, stabbed, bit, etc.

    • 85-Animal or insect

    • 86-Explosion or flare back

  • [Injured Body Part] Enum
    • Head

    • Neck

    • Trunk

    • Upper Extremities

    • Lower Extremities

    • Multiple Body Parts

    • 10-Multiple head injury - Any combination of below parts

    • 11-Skull

    • 12-Brain

    • 13-Ear(s) - Includes: hearing, inside eardrum

    • 14-Eye(s) - Includes: optic nerves, vision, eye lids

    • 15-Nose - Includes: nasal passages, sinus, sense of smell

    • 16-Teeth

    • 17-Mouth - Includes: lips, tongue, throat, taste

    • 18-Soft tissue

    • 19-Facial bones - Includes: jaw

    • 20-Multiple neck injuries - Any combination of below parts

    • 21-Vertebrae - Includes: spinal column bone, cervical segment

    • 22-Disc - Includes: spinal column cartilage, cervical segment

    • 23-Spinal cord - Includes: nerve tissue, cervical segment

    • 24-Larynx - Includes: cartilage and vocal cords

    • 25-Soft tissue - Other than larynx or trachea

    • 26-Trachea

    • 40-Multiple trunk - Any combination of below parts

    • 41-Upper back area (Thoracic area) - upper back muscles, excluding vertebrae, disc, spinal cord

    • 42-Lower back area Lumbar area and lumbo sacral - lower back muscles, excluding sacrum, coccyx, pelvis, vertebrae, disc, spinal cord

    • 43-Disc - Spinal column cartilage other than cervical segment

    • 44-Chest - Including ribs, sternum, soft tissue

    • 45-Sacrum and coccyx - Final nine vertebrae - fused

    • 46-Pelvis

    • 47-Spinal cord - Nerve tissue other than cervical segment

    • 48-Internal organs - Other than heart and lungs

    • 49-Heart

    • 60-Lungs

    • 61-Abdomen, including groin - Excluding injury to internal organs

    • 62-Buttocks - Soft tissue

    • 63-Lumbar and/or sacral vertebrae (vertebrae NOC trunk) - Bone portion of the spinal column

    • 30-Multiple upper extremities - Any combination of below parts, excluding hands and wrists combined

    • 31-Upper arm - Humerus and corresponding muscles, excluding clavicle and scapula

    • 32-Elbow - Radial head

    • 33-Lower arm - Forearm - radius, ulna, and corresponding muscles

    • 34-Wrist - Carpals and corresponding muscles

    • 35-Hand - Metacarpals and corresponding muscles, excluding wrist or fingers

    • 36-Finger(s) - Other than thumb and corresponding muscles

    • 37-Thumb(s)

    • 38-Shoulder(s) - Armpit, rotator cuff, trapezius, clavicle, scapula

    • 39-Wrist(s) and hand(s)

    • 50-Multiple lower extremities - Any combination of below parts

    • 51-Hip

    • 52-Upper leg - Femur and corresponding muscles

    • 53-Knee - Patella

    • 54-Lower leg - Tibia, fibula, and corresponding muscles

    • 55-Ankle - Tarsals

    • 56-Foot - Metatarsals, heel, Achilles tendon, and corresponding muscles - excluding ankle or toes

    • 57-Toe(s)

    • 58-Great Toe

    • 64-Artificial appliance - Braces, etc.

    • 65-Insufficient information to properly identifiy--unclassified - Insufficient information to identify part affected.

    • 66-No physical injury - Mental disorder

    • 90-Multiple body parts (including body system and body parts) - Applies when more than one major body part has been affected, such as an arm and a leg and multiple internal organs

    • 91-Body systems and multiple body systems - Applies when the functioning of an entire body system has been affected without specific injury to any other part, as in cases of poisoning, corrosive action, inflammation, affecting internal organs, damage to nerve centers, etc.; does NOT apply when the systemic damage results from an external injury affecting an external part, such as a back injury that includes damage to the nerves of the spinal cord.

  • [Injured Side] Enum
    • Right

    • Left

    • Both

    • N/A

  • [Drug/Alcohol Test] Bool
    • True

    • False

  • [First Aid/Med Only] Bool
    • True

    • False

  • [Treated Away From Work Site] Bool
    • True

    • False

  • [Treated in an Emergency Room] Bool
    • True

    • False

  • [Hospitalized Overnight as an Inpatient] Bool
    • True

    • False

  • [Recordable] Bool
    • True

    • False

  • [Exclude Name From OSHA Reports] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Subcontractor/Visitor

Form for collection of information about a subcontractor/visitor involved in the incident.

Subcontrator/Visitor
  • [Injury/Illness Classification] Enum
    • Injury

    • Skin Disorder

    • Respiratory Condition

    • Poisoning

    • Hearing Loss

    • All Other Illnesses

  • [Nature of Injury] Enum
    • Multiple Injuries

    • Occupational Disease or Cumulative Injury

    • Specific Injury

    • 90-Multiple physical injuries only

    • 91-Multiple injuries, including both physical and psychological

    • 60-Dust disease, NOC - All other Pneumoconiosis

    • 61-Asbestosis - Lung disease, a form of Pneumoconiosis, resulting from protracted inhalation of asbestos particles

    • 62-Black lung - The chronic lung disease of Pneumoconiosis found in coal miners

    • 63-Byssinosis - Pneumoconiosis of cotton, flax, hemp workers

    • 64-Silicosis - Pneumoconiosis resulting from the inhalation of silica (quartz) dust

    • 65-Respiratory disorders - Gases, fumes, chemicals, etc.

    • 66-Poisoning--chemical (other than metals) - Man-made or organic

    • 67-Poisoning--metal - Man-made

    • 68-Dermatitis - Rash, skin, or tissue inflammation including boils, etc., generally resulting from direct contact with irritants or sensitizing chemicals such as drugs, oils, biologic agents, plants, woods, or metals, which may be in the form of solids, pastes, liquids, or vapors, and which may be contacted in the pure state or in compounds or in combination with other materials; do NOT include skin tissue damage resulting from corrosive action of chemicals, burns from contact wit hot substances, effects of exposure to radiation, effects of exposure to low temperatures or inflammation or irritations resulting from friction or impact.

    • 69-Mental disorders - A clinically significant behavioral or psychological syndrome or pattern typically associated with either a distressing symptom or impairment of function, i.e., acute anxiety, neurosis, stress, nontoxic depression.

    • 70-Radiation - All forms of damage to tissue, bones, or body fluids produced by exposure to radiation.

    • 71-All other occupational disease injury, NOC

    • 72-Loss of hearing

    • 73-Contagious diseases

    • 74-Cancer

    • 75-AIDS

    • 76-VDT-related disease - Video display terminal diseases other than Carpal Tunnel Syndrome

    • 77-Mental stress

    • 78-Carpal Tunnel Syndrome - Soreness tenderness, and weakness of the muscles of the thumb caused by pressure on the Median Nerve at the point at which it goes through the Carpal Tunnel of the wrist.

    • 80-All other cumulative injury, NOC

    • 01-No physical injury - i.e., glasses, contact lenses, artificial appliance, replacement of artificial appliance

    • 02-Amputation - Cut off extremity, digit, protruding part of body, usually by surgery (i.e., leg, arm)

    • 03-Angina pectoris - Chest pain

    • 04-Burn - (Heat) burns or scald: the effect of contact with hot substances; (Chemical) burns; tissue damage resulting from corrosive action chemicals, fumes, etc. (i.e., acids, alkalies)

    • 07-Concussion - Brain, cerebral

    • 10-Contusion - Bruise - intact skin surface hematoma

    • 13-Crushing - To grind, pound, or break into small bits

    • 16-Dislocation - -Pinched nerve, slipped/ruptured disc. herniated disc, sciatica, complete tear, HNP subluxtion, MD dislocation

    • 19-Electric - shock Electrocution

    • 22-Enucleation - Removal of organ or tumor

    • 25-Foreign body

    • 28-Fracture - -Breaking of a bone or cartilage

    • 30-Freezing - Frostbite and other effects of exposure to low temperatures

    • 31-Hearing loss or impairment - Traumatic only, a separate injury, not the sequelae of another injury

    • 32-Heat prostration - Heat stroke, sun stroke, heat exhaustion, heat cramps, and other effects of environmental heat, does not include sunburn

    • 34-Hernia - -Abnormal protrusion of an organ or part through the containing wall of its cavity

    • 36-Infection - -Invasion of host by organisms such as bacteria, fungi, viruses, protozoa or insects, with or without manifest disease

    • 37-Inflammation - -The reaction of tissue to injury characterized clinically by heat, swelling, redness, and pain

    • 40-Laceration - -Cut, scratches, abrasions, superficial wounds, calluses; wound by tearing

    • 41-Myocardial infarction - -Heart attack, heart conditions, hypertension; the inadequate blood flow to the muscular tissue of the heart

    • 42-Poisoning - -general (not OD or cumulative injury) A systematic morbid condition resulting from the inhalation, ingestion, or skin absorption of a toxic substance affecting the metabolic system, the nervous system, the circulatory system, the digestive system, the respiratory system, the excretory system, the musculoskeletal system, etc. Includes chemical or drug poisoning, metal poisoning, organic diseases, and venomous reptile and insect bites. Does NOT include effects of radiation, pneumoconiosis, corrosive effects of chemicals, skin surface irritations, septicemia, or infected wounds.

    • 43-Puncture - -A hole made by the piercing of a pointed instrument.

    • 46-Rupture

    • 47-Severance - To separate, divide, or take off

    • 49-Sprain - Internal derangement, a trauma or wrenching of a joint, producing pain and disability depending upon the degree of injury to ligaments

    • 52-Strain - Internal derangement, the trauma to the muscle or the musculotendinous unit from violent contraction or excessive forcible stretch

    • 53-Syncope - Swooning, fainting, passing out, no other injury

    • 54-Asphyxiation - Strangulation, drowning

    • 55-Vascular - Cerebrovascular and other conditions of circulatory systems, NOC. Excludes heart and hemorrhoids. Includes strokes, varicose veins - nontoxic.

    • 58-Vision loss

    • 59-All other specific injuries, NOC

  • [Incident Cause] Enum
    • Burn or Scald - Heat or Cold Exposure

    • Caught In, Under or Between

    • Cut, Puncture, Scrape, Injured By

    • Fall, Slip or Trip Injury

    • Miscellaneous Causes

    • Motor Vehicle/Heavy Equipment

    • Rubbed or Abraded by

    • Strain or Injury By/Overexertion

    • Striking Against or Stepping on

    • Struck or Injured By - Includes Kicked, Stabbed, Bit, Etc.

    • 01-Chemicals

    • 02-Hot objects or substances

    • 03-Temperature extremes

    • 04-Fire or flame

    • 05-Steam or hot fluid

    • 06-Dust, gases, fumes, or vapors

    • 07-Welding operations

    • 08-Radiation

    • 09-Contact with, NOC

    • 11-Cold objects or substances

    • 14-Abnormal air pressure

    • 84-Electrical current

    • 10-Machine or machinery

    • 12-Object handled

    • 13-Caught in, under, or between, NOC

    • 20-Collapsing materials (slides of earth) either manmade or natural

    • 15-Broken glass

    • 16-Hand tool, utensil (not powered)

    • 17-Object being lifted or handled

    • 18-Powered hand tool, appliance

    • 19-Caught, puncture, scrape, NOC

    • 25-From different level (elevation) - off wall, catwalk, bridge, etc.

    • 26-From ladder or scaffolding

    • 27-From liquid or grease spills

    • 28-Into openings - shafts, excavations, floor openings, etc.

    • 29-On same level

    • 30-Slipped, did not fall

    • 31-Fall, slip, or trip, NOC

    • 32-On ice or snow

    • 33-On stairs

    • 82-Absorption, ingestion, or inhalation, NOC

    • 87-Foreign matter in eye(s)

    • 89-Person in act of a crime - robbery or criminal assault

    • 90-Other than physical cause of injury

    • 98-Cumulative, NOC - all other

    • 99-Other--miscellaneous, NOC

    • 40-Crash of water vehicle

    • 41-Crash of rail vehicle

    • 45-Collision or sideswipe with another vehicle - both vehicles in motion

    • 46-Collision with a fixed object - standing vehicle or stationary object

    • 47-Crash of airplane

    • 48-Vehicle upset - overturned or jackknifed

    • 50-Motor vehicle, NOC

    • 94-Repetitive motion - callous, blister, etc.

    • 95-Rubbed or abraded by, NOC

    • 52-Continual noise

    • 53-Twisting

    • 54-Jumping

    • 55-Holding or Carrying

    • 56-Lifting

    • 57-Pushing or Pulling

    • 58-Reaching

    • 59-Using tool or machinery

    • 60-Strain or injury by, NOC

    • 61-Wielding or throwing

    • 97-Repetitive motion - Carpal Tunnel Syndrome

    • 65-Moving parts of a machine

    • 66-Object being lifted or handled

    • 67-Sanding, scraping, cleaning operation

    • 68-Stationary object

    • 69-Stepping on a sharp object

    • 70-Striking against or stepping on, NOC

    • 74-Fellow worker, patient - not in act of a crime

    • 75-Falling or flying object

    • 76-Hand tool or machine in use

    • 77-Motor vehicle

    • 78-Moving parts of machine

    • 79-Object being lifted or handled

    • 80-Object handled by others

    • 81-Struck or injured, NOC - includes kicked, stabbed, bit, etc.

    • 85-Animal or insect

    • 86-Explosion or flare back

  • [Injured Body Part] Enum
    • Head

    • Neck

    • Trunk

    • Upper Extremities

    • Lower Extremities

    • Multiple Body Parts

    • 10-Multiple head injury - Any combination of below parts

    • 11-Skull

    • 12-Brain

    • 13-Ear(s) - Includes: hearing, inside eardrum

    • 14-Eye(s) - Includes: optic nerves, vision, eye lids

    • 15-Nose - Includes: nasal passages, sinus, sense of smell

    • 16-Teeth

    • 17-Mouth - Includes: lips, tongue, throat, taste

    • 18-Soft tissue

    • 19-Facial bones - Includes: jaw

    • 20-Multiple neck injuries - Any combination of below parts

    • 21-Vertebrae - Includes: spinal column bone, cervical segment

    • 22-Disc - Includes: spinal column cartilage, cervical segment

    • 23-Spinal cord - Includes: nerve tissue, cervical segment

    • 24-Larynx - Includes: cartilage and vocal cords

    • 25-Soft tissue - Other than larynx or trachea

    • 26-Trachea

    • 40-Multiple trunk - Any combination of below parts

    • 41-Upper back area (Thoracic area) - upper back muscles, excluding vertebrae, disc, spinal cord

    • 42-Lower back area Lumbar area and lumbo sacral - lower back muscles, excluding sacrum, coccyx, pelvis, vertebrae, disc, spinal cord

    • 43-Disc - Spinal column cartilage other than cervical segment

    • 44-Chest - Including ribs, sternum, soft tissue

    • 45-Sacrum and coccyx - Final nine vertebrae - fused

    • 46-Pelvis

    • 47-Spinal cord - Nerve tissue other than cervical segment

    • 48-Internal organs - Other than heart and lungs

    • 49-Heart

    • 60-Lungs

    • 61-Abdomen, including groin - Excluding injury to internal organs

    • 62-Buttocks - Soft tissue

    • 63-Lumbar and/or sacral vertebrae (vertebrae NOC trunk) - Bone portion of the spinal column

    • 30-Multiple upper extremities - Any combination of below parts, excluding hands and wrists combined

    • 31-Upper arm - Humerus and corresponding muscles, excluding clavicle and scapula

    • 32-Elbow - Radial head

    • 33-Lower arm - Forearm - radius, ulna, and corresponding muscles

    • 34-Wrist - Carpals and corresponding muscles

    • 35-Hand - Metacarpals and corresponding muscles, excluding wrist or fingers

    • 36-Finger(s) - Other than thumb and corresponding muscles

    • 37-Thumb(s)

    • 38-Shoulder(s) - Armpit, rotator cuff, trapezius, clavicle, scapula

    • 39-Wrist(s) and hand(s)

    • 50-Multiple lower extremities - Any combination of below parts

    • 51-Hip

    • 52-Upper leg - Femur and corresponding muscles

    • 53-Knee - Patella

    • 54-Lower leg - Tibia, fibula, and corresponding muscles

    • 55-Ankle - Tarsals

    • 56-Foot - Metatarsals, heel, Achilles tendon, and corresponding muscles - excluding ankle or toes

    • 57-Toe(s)

    • 58-Great Toe

    • 64-Artificial appliance - Braces, etc.

    • 65-Insufficient information to properly identifiy--unclassified - Insufficient information to identify part affected.

    • 66-No physical injury - Mental disorder

    • 90-Multiple body parts (including body system and body parts) - Applies when more than one major body part has been affected, such as an arm and a leg and multiple internal organs

    • 91-Body systems and multiple body systems - Applies when the functioning of an entire body system has been affected without specific injury to any other part, as in cases of poisoning, corrosive action, inflammation, affecting internal organs, damage to nerve centers, etc.; does NOT apply when the systemic damage results from an external injury affecting an external part, such as a back injury that includes damage to the nerves of the spinal cord.

  • [Injured Side] Enum
    • Right

    • Left

    • Both

    • N/A

  • [Treated away from work site] Bool
    • True

    • False

  • [Treated in an emergency room] Bool
    • True

    • False

  • [Hospitalized overnight as an inpatient] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Environment

Form for collection of information about environmental data involved in the incident.

Environment
  • [Environmental Type] Enum
    • Spills of Oil, Fuel or Chemicals

    • Discharge/Spill into Waterway

  • [Contacted] Bool
    • True

    • False

  • [Spill Entered Waterway] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Company Owned Equipment

Form for collection of information about company owned equipment involved in the incident.

Company Owned Equipment
  • [Equipment ID] Encoded
    • "{Equipment.ID} {Equipment.Code}: {Equipment.Description}"

  • [Operator Name] Encoded
    • "{Employee.ID} {Employee.Code}: {Employee.FirstName} {Employee.MiddleInitial} {Employee.LastName}"

  • [Was this a backing related incident] Bool
    • True

    • False

  • [Were fluids spilled] Bool
    • True

    • False

  • [Root Cause Analysis?] Bool
    • True

    • False

Witness Statement

Witness Statement forms may not be edited and will throw an error if attempted.

Troubleshooting

If you encounter issues, refer to the Getting Started with Request Tokens guide or contact support for assistance.