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JSON Field | ProcessMAP System Field |
GeneralLiabilityIncidentDetails | General Liability Incident Details |
IncidentID | Incident ID (System Generated) |
InternalIncidentID | |
IncidentTitle | Incident Title/Site |
IncidentType | Incident Type |
LocationCode | Location Code |
Location | |
GeneralDetails | General Details |
WouldyouliketosubmitaGenarlLiabilityClaim | Would you like to submit a Genar lLiability Claim? |
GeneralLiabilityType | General Liability Type |
Sub-incidentType | |
DateOfIncident | Date of incident |
TimeOfIncident | Time of incident |
TimeUndetermined | |
DayOfWeek | Day Of Week |
WorkShift | Job Shift |
TimeWorkDayBegan | Time Work Day Began |
DescriptionofIncident | Description of Incident |
DateReportedtoEmployer | Date Reported to Employer |
TimeReportedtoEmployer | Time Reported to Employer |
IncidentOccurredonEmployerPremises | Incident Occurred on Employer's Premises |
WasAssetinvolved | Was Asset involved? |
Assets | Select Asset(s) |
Significance | Significance of Incident |
PersonDetails | Person Details |
WasEmployeeinvolvedintheIncident | Was an Employee / Individual involved in the Incident? |
Numberofinvolvedindividuals | No. of individual involved |
Name | |
Gender | |
DateOfBirth | Date Of Birth |
HomeAddress | Home Address |
City | |
State | |
Zip | ZipCode / PostalCode |
PhoneNumber | Phone Number |
Whatwaspersondoingbeforeincident | What was person doing before incident? |
Wasindividualinjuredintheincident | Was individual injured in the incident? |
DidInjuryresultinaFatality | Did Injury result in a Fatality? |
ResultofIncident | Result of Incident |
CauseofIncident | Cause of Incident |
InjuredBodyPart | Injured Body Part |
Pleasedescribepersoninjury | Please describe person injury |
Waspersonconsideredminor | Was person considered minor? |
Pleaseprovideparentsname | Please provide parents name |
Pleaseprovideparentsphonenumber | Please provide parents phonenumber |
Takenfromsceneviaambulance | Taken from scene via ambulance |
Whatshoeswasclaimantwearing | What shoes was claimant wearing? |
Wasclaimantstruckbyobject | Was claimant struck by object? |
Ifstruckbyobjectwhatobject | If struck by object. what object? |
Didthepersonrefusetreatment | Did the person refuse treatment? |
IfYesexplainwhy | If Yes. explain why? |
Wastreatmentprovided | Was treatment provided? |
DidthepersonsignthemedicalreleaseformIfyespleaseattach | Did the person sign the medical release form ? If yes please attach. |
WereEmergencyServicescalled | Were Emergency Services called? |
EmployeeDetails | Employee / Individual Details |
PersonnelType | Personnel Type |
EmployeeInvolved | Employee / Individual Involved( Last, First, M.I.) |
EmployeeId | Employee Id |
PayRateType | Pay Rate Type |
EmployeeDepartment | Employee / Individual Department |
Contractor | Contractor |
DoyouwanttoclassifyUnsupervisedContractEmployee | Do you want to further classify Unsupervised Contract Employee |
TypeofClientPersonnel | Type of Client Personnel |
ClientCompany | Client Company |
NameofContractor | Name of Contractor |
NameofSubContractor | Name of SubContractor |
LocationOfIncident | Location of Incident |
IncidentOccurredonEmployersPremises | Incident Occurred on Employers Premises |
AddressofIncidentLocation | Address of Incident Location |
City | |
Country | |
State | |
Zip | ZipCode / PostalCode |
Department | |
PinLocation | |
LocationoftheIncident | Location of the Incident |
StoreManagerName | Store Manager Name |
StoreManagerPhone | Store Manager Phone |
DistrictManagerName | District Manager Name |
DistrictManagerPhone | District Manager Phone |
Wasanythingonfloor | Was anything on floor? |
Floorgroundscondition | Floor grounds condition |
Incidentoccurinsideoutside | Incident occur inside/outside |
Ifinsidestorewhere | If inside store where |
IfInsidestorecause | If Inside store cause |
IfinStockroomwhere | If in Stock room where |
IfOutsidestorewhere | If Outside store where |
IfOutsidestorecause | If Outside store cause |
Istherevideooftheincident | Is there video of the incident |
Ifvideonotobtainedwhy | If video not obtained why |
IfEquipnotfunctionalwhy | If Equip not functional why |
Didtheincidentresultinanydamagetocompanyequipment | Did the incident result in any damage to company equipment? |
Pleasedescribeequipmentanddamage | Please describe equipment and damage |
Didtheincidentresultinanystructuraldamage | Did the incident result in any structural damage |
Pleasedescribedamage | Please describe damage |
Wastheincidentareresultoftheftorasecurityrelatedactivity | Was the incident are result of the ftor a security related activity? |
Pleasedescribetheftorsecurityrelatedincident | Please describe the ftor security related incident? |
Isthisanassaultorrobbery | Is this an assault or robbery? |
Weretheresuspects | Were there suspects? |
Werearrestsuspects | Were arrest suspects? |
Wastheapolicereport | Was the a police report? |
LossPreventionreport | Loss Prevention report |
Askthemtotakephotographs | Ask them to take photographs |
Incidentlocationdiagrammade | Incident location diagram made |
ProductLiability | Product Liability |
IsthisclaimaProductLiabilityclaim | Is this claim a Product Liability claim? |
ProvideNameofProduct | Provide Name of Product |
ProvideProductCode | Provide Product Code |
ManufacturersName | Manufacturer's Name |
ManufacturerAddress1 | Manufacturer Address1 |
ManufacturerAddress2 | Manufacturer Address2 |
ManufacturerCity | Manufacturer City |
ManufacturerState | Manufacturer State |
ManufacturerPostalCode | Manufacturer Postal Code |
ManufacturerPhone | Manufacturer Phone |
Pleaseprovideadetaildescriptionoftheproduct | Please provide a detail description of the product |
Wasstoreadvisedtoretaintheproduct | Was store advised to retain the product? |
Isstoreincurrentpossessionofproduct | Is store in current possession of product? |
Briefdescriptionoffactsofloss | Brief description of facts of loss |
Responsibilityforroatingproduct | Responsibility for roating product |
Didalocalvendorprovidethisproduct | Did a local vendor provide this product? |
VendorsName | Vendor's Name |
VendorsPhoneNumber | Vendor's Phone Number |
MedicalInformation | |
WasindividualsenttoHospitalClinictoreceivemedicaltreatment | Was individual sent to Hospital/Clinic to receive medical treatment |
HospitalClinicName | Hospital/ClinicName |
Address | |
City | |
State | |
Zip | |
Fax | |
ClinicDoctorName | Clinic/DoctorName |
WitnessInformation | Witness Information |
ArethereanyWitnessesidentified | Are there any Witnesses identified |
NumberofWitnesses | Number of Witnesses |
LastName | LastName |
FirstName | FirstName |
MiddleName | MiddleName |
Notes | Notes |
PhoneNumber | Phone Number |
ReportInformation | |
ReportedBy | Reported By |
Title | Title |
PhoneNumber | Phone Number |
EmailAddress | Email Address |
InvestigationResponsibility | Investigation Responsibility |
Salutation | Salutation |
FirstName | First Name |
LastName | Last Name |
TargetCompletionDate | Target Completion Date |
Note | Note |
NotifyImmediateSupervisor | Notify Immediate Supervisor |
InvestigationDetails | Investigation Details |
All questions | |
ContributingFactors | Contributing Factors |
ContributingFactorType | Contributing Factor Type |
ContributingFactors | Contributing Factors |
Comments | Comments |
5WhyMethodology | 5 Why Methodology |
SelectActionorConditionthatmayhavedirectlycausedincident | Select Action or Condition that may have directly caused incident |
Whys | Whys |
RootCauseStatement | Root Cause Statement |
RootcauseType | Root cause Type |
RootCause | Root Cause |
Comments | Comments |
FinalRootCauseStatement | Final Root Cause Statement |
FinalRootCauseStatement | Final Root Cause Statement |
PrimaryCountermeasure | Primary Counter measure |
PrimaryRootCause | Primary Root Cause |
ActionItems | Action Items |
SourceID | Source ID |
SourceTitle | Source Title |
ActionItemTitle | Action Item Title |
ActionItemCategory | Action Item Category |
ActionItemType | Action Item Type |
ActionItemDescription | Action Item Description |
ActionItemPriority | Action Item Priority |
ActionItemDueDate | Action Item Due Date |
Owners | |
ResponsibleDepartment | Responsible Department |
Countermeasure | Countermeasure |
ApplicabletoExpansion | Applicable to Expansion? |
DescriptionofActionstobeExpanded | Description of Actions to be Expanded * |
ApplicabletoEEMEPMInfo | Applicable to EEM/EPM Info? |
EEMEPM | EEM / EPM * |
EEMEPMInfoSubmitted | EEM/EPM Info Submitted? |
DocumentNumber | Document Number * |
AssignedBy | Assigned By |
Verificationrequired | Verification required |
ActionItemStatus | Action Item Status |
ActionTaken | Action Taken |
ActionitemCompletedBy | Action item Completed By |
CompletedDate | Action item Completed Date |
DueDateExtension | Due Date Extension |
RequestedDueDateExtension | Requested Due Date Extension |
ReasonforDueDateExtension | Reason for Due Date Extension |
DueDateExtensionRequestApproved | Due Date Extension Request Approved? |
ReasonfornotextendingtheDueDate. | Reason for not extending the DueDate. |
ManagementReview | Management Review |
RoleName | Role Name |
Owner | |
approvalduedate | approval due date |
Comments | |
CompletedByManagementReview | Completed By Management Review |
CompletedDate | Completed Date |
ManagementReviewStatus | Management Review Status |
Additional Information | |
IncidentStatus | Incident Status |
CreatedBy | Created By |
CreatedDate | Created Date |
LastUpdatedDate | Last Updated Date |
LastUpdatedBy | Last Updated By |