Page Comparison

JSON Field

ProcessMAP System Field

IncidentID

Incident ID (System Generated)

InternalIncidentID

IncidentTitle

Incident Title/Site

IncidentType

Incident Type

LocationCode

Location Code

Location

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

Pleaseprovideparentsname

Pleaseprovideparentsphonenumber

Takenfromsceneviaambulance

Whatshoeswasclaimantwearing

Wasclaimantstruckbyobject

Ifstruckbyobjectwhatobject

Didthepersonrefusetreatment

IfYesexplainwhy

Wastreatmentprovided

DidthepersonsignthemedicalreleaseformIfyespleaseattach

WereEmergencyServicescalled

EmployeeDetails

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

DistrictManagerNameDistrictManagerPhoneWasanythingonfloor

District Manager Name

FloorgroundsconditionDistrictManagerPhoneIncidentoccurinsideoutside

District Manager Phone

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

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

OwnersOwner

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