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JSON Field | ProcessMAP System Field | |
IncidentID | Incident ID (System Generated) | |
InternalIncidentID | ||
IncidentTitle | Incident Title/Site | |
IncidentType | ||
LocationCode | Location Code | |
Location | ||
WouldyouliketosubmitaGenarlLiabilityClaim | ||
GeneralLiabilityType | ||
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 | ||
HomeAddress | ||
City | ||
State | ||
Zip | ||
PhoneNumber | ||
Whatwaspersondoingbeforeincident | ||
Wasindividualinjuredintheincident | ||
DidInjuryresultinaFatality | ||
ResultofIncident | ||
CauseofIncident | ||
InjuredBodyPart | ||
Pleasedescribepersoninjury | ||
Waspersonconsideredminor | ||
Pleaseprovideparentsname | ||
Pleaseprovideparentsphonenumber | ||
Takenfromsceneviaambulance | ||
Whatshoeswasclaimantwearing | ||
Wasclaimantstruckbyobject | ||
Ifstruckbyobjectwhatobject | ||
Didthepersonrefusetreatment | ||
IfYesexplainwhy | ||
Wastreatmentprovided | ||
DidthepersonsignthemedicalreleaseformIfyespleaseattach | ||
WereEmergencyServicescalled | ||
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 | ||
AddressofIncidentLocation | ||
City | ||
Country | ||
State | ||
Zip | ||
Department | ||
PinLocation | ||
LocationoftheIncident | ||
StoreManagerName | ||
StoreManagerPhone | ||
DistrictManagerName | ||
DistrictManagerPhoneWasanythingonfloor | ||
Floorgroundscondition | ||
Incidentoccurinsideoutside | ||
Ifinsidestorewhere | ||
IfInsidestorecause | ||
IfinStockroomwhere | ||
IfOutsidestorewhere | ||
IfOutsidestorecause | ||
Istherevideooftheincident | ||
Ifvideonotobtainedwhy | ||
IfEquipnotfunctionalwhy | ||
Didtheincidentresultinanydamagetocompanyequipment | ||
Pleasedescribeequipmentanddamage | ||
Didtheincidentresultinanystructuraldamage | ||
Pleasedescribedamage | ||
Wastheincidentareresultoftheftorasecurityrelatedactivity | ||
Pleasedescribetheftorsecurityrelatedincident | ||
Isthisanassaultorrobbery | ||
Weretheresuspects | ||
Werearrestsuspects | ||
Wastheapolicereport | ||
LossPreventionreport | ||
Askthemtotakephotographs | ||
Incidentlocationdiagrammade | ||
ProductLiability | ||
IsthisclaimaProductLiabilityclaim | ||
ProvideNameofProduct | ||
ProvideProductCode | ||
ManufacturersName | ||
ManufacturerAddress1 | ||
ManufacturerAddress2 | ||
ManufacturerCity | ||
ManufacturerState | ||
ManufacturerPostalCode | ||
ManufacturerPhone | ||
Pleaseprovideadetaildescriptionoftheproduct | ||
Wasstoreadvisedtoretaintheproduct | ||
Isstoreincurrentpossessionofproduct | ||
Briefdescriptionoffactsofloss | ||
Responsibilityforroatingproduct | ||
Didalocalvendorprovidethisproduct | ||
VendorsName | ||
VendorsPhoneNumber | ||
MedicalInformation | ||
WasindividualsenttoHospitalClinictoreceivemedicaltreatment | ||
HospitalClinicName | ||
Address | ||
City | ||
State | ||
Zip | ||
Fax | ||
ClinicDoctorName | ||
WitnessInformation | Witness Information | |
ArethereanyWitnessesidentified | Are there any Witnesses identified | |
NumberofWitnesses | Number of Witnesses | |
LastName | LastName | |
FirstName | FirstName | |
MiddleName | MiddleName | |
Notes | Notes | |
PhoneNumber | Phone Number | |
PropertyDamageIncidentDetails | Property Damage Incident Details | |
IncidentType | Incident Type | |
IsthisachargeableIncident | Is this a chargeable Incident | |
CauseofIncident | Cause of Incident | |
DamageSummary | Damage Summary | |
Wascontractorinvolvedintheincident | Was contractor involved in the incident | |
PleaseprovideContractorDetails | Please provide Contractor Details | |
Wasthecontractortrainedoncompanypolicies | Was the contractor trained on company policies | |
Describeanydamagecaused | Describe any damage caused | |
Describewhatcausedtheincidenttooccur | Describe what caused the incident to occur | |
Describeworkactivitybeingperformedduringincident | Describe work activity being performed during incident | |
Wastheapplicableregulatoryagencynotified | Was the applicable regulatory agency notifiedReportInformation | |
ReportedBy | ||
Title | ||
PhoneNumber | ||
EmailAddress | ||
InvestigationResponsibility | ||
Salutation | Salutation | |
FirstName | First Name | |
LastName | Last Name | |
TargetCompletionDate | Target Completion Date | |
Note | Note | |
NotifyImmediateSupervisor | Notify Immediate Supervisor | |
InvestigationDetails | ||
All questions | ||
ContributingFactors | ||
ContributingFactorType | Contributing Factor Type | |
ContributingFactors | Contributing Factors | |
Comments | Comments | |
5WhyMethodology | ||
SelectActionorConditionthatmayhavedirectlycausedincident | Select Action or Condition that may have directly caused incident | |
Whys | Whys | |
RootCauseStatement | ||
RootcauseType | Root cause Type | |
RootCause | Root Cause | |
Comments | Comments | |
FinalRootCauseStatement | ||
FinalRootCauseStatement | Final Root Cause Statement | |
PrimaryCountermeasure | Primary Counter measure | |
PrimaryRootCause | Primary Root Cause | |
Action Items | ||
SourceID | Source ID | |
SourceTitle | Source Title | |
ActionItemTitle | Action Item Title | |
ActionItemCategory | Action Item Category | |
ActionItemType | Action Item TypeRootCause | |
Root Cause | ActionItemDescription | Action Item Description |
ActionItemPriority | Action Item Priority | |
ActionItemDueDate | Action Item Due Date | |
Owners | Owner | |
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 | |
VerifyUser | Verify User | |
ApprovalStatus | Approval Status | |
Approvers | Approvers | |
ApprovalComment | Approval Comment | |
ApprovalDate | Approval Date | |
ActionItemStatus | Action Item Status | |
ActionTaken | Action Taken | |
ActionitemCompletedBy | Action item Completed By | |
ActionitemCompletedDateCompletedDate | 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.VerificationStatus | |
ManagementReview | ||
Verification StatusRoleName | ||
VerificationPerformedOwner | Verification Performed | |
VerifiedBy | Verified By | |
VerificationDate | Verification Date | |
approvalduedate | ||
CommentsComments | ||
CompletedByManagementReview | ||
CapitalExpenditureinvolved | Capital Expenditure involved | |
Approximatecost | Approximate cost | |
EstimatedBudget | Estimated BudgetCompletedDate | |
ManagementReviewStatus | ||
Additional Information | ||
IncidentStatus | ||
CreatedBy | ||
CreatedDate | ||
LastUpdatedDate | ||
LastUpdatedBy |