Table of Contents style Square
...
Background and strategic fit
The purpose of this Integration is to pull over different incident information (Near Miss and Injury Illness) to support our growing customer base to analyze the data they are entering through the ProcessMAP solution.This document provides information on how to consume the API's by the end Users.
Assumptions
- Individual APIs being used for Injury & Claim and Near Miss
- For Injury/Illness the Incident type field will have comma separate value in case it is a combined Incident with other Incident Types
- Data will be sent only for the Injury/Illness
- ProcessMAP system User permissions would not be considered while exposing the data
- ProcessMAP assumes anyone who is accessing the Outbound API has required authority to access Personal Information
- User would have to input single Location Code(e.g. Westlake) each time to consume that Location data
- Data to be accessed with a limitation of 2 years duration at a time to avoid any performance issues.
- Data will be shown in Readable JSON format
- Fields Names in the Response would be Product Field Naming. Customer will have to use mapping documentation
- User accessing this endpoint through a valid Token & ConsumerId, provided by ProcessMAP, will have access to complete data
- Witness Details Information will be as nested
- BodyParts -- Will be separated by , and side will be mentioned in braces Ex: Arm (L)(R)
- For Nature, Cause and BodyParts -- IF Other(List) is selected then others description will be appended with '-' Ex: Other(List) --- Some Text
- For Employee, Supervisor, Reported By -- LastName, MiddleName, First name and Prefix will be combined as shown as single (Prefix(if available) + Firstname+ MiddleName(if available) + LastName)
- For Witness the First Name, Middle Name, Last Name will not be appended as no field is mandatory
- Incident Status will be included in the json output
- DATETIME, INT and FLOAT data will be shown as NULL when there is no data
- Pin Location Information and Default CAPA is not considered for this release
- The data that is being shown in response is in EST Date time format ONLY
- Certain fields are auto-populated in Application but the same will not reflect in JSON until the form is saved
User Interaction
Near Miss
...
| Name | Description | Type | Additional information |
|---|---|---|---|
| locationCode | Represents the unique code of location for which Incident records to return. | string | Required |
| dateFrom | Represents the starting date of Incident records to return. | date | Required but value optional |
| dateTo | Represents the ending date of Incident records to return. | date | Required but value optional |
| lastSyncedDate | Represents the data from incident created date or incident modified date. | date | Required but value optional |
...
| Name | Description | Sample |
|---|---|---|
| Authorization | Represents the value of the authentication token. Allow multiple values: no. | Bearer eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ... |
| ConsumerId | Represents the value of the consumer id. Allow multiple values: no. | 2426 |
Response
Sample:
[
{
"Incident ID (System Generated)": "US-TESTING LOCATION-19-I-0018Sample_String",
"Incident Title/Site": "Test near MissSample_String",
"Location Code": "Testing LocationSample_String",
"Location": "Testing LocationSample_String",
"Incident Date": "2019-12-02T00:00:00.000ZSample_String",
"Time of Incident": "9:00Sample_String",
"Time Undetermined": "NoSample_String",
"Day Of Week": "MondaySample_String",
"Reported By": "Sample _String",
"Work Shift": "MorningSample_String",
"Operating UnitDepartment": "Sample _String",
"Was this an HPE (Potential life altering injury or fatality)? ((IF YES - The incident investigation is mandatory))": "YesSample_String",
"Describe what occurred to create the Near Miss/Hazard Recognition?": "Sample _String",
"Is Contractor Involved?": "YesSample_String",
"Please provide Contractor Name, Company": "Sample _String",
"Is this a stop work?": "YesSample_String",
"Employee/Individual Details": {
"Was an Employee / Individual involved in the incident?": "YesSample_String",
"Personnel Type": "EmployeeSample_String",
"First Name": "Sample _String",
"Middle Name": "Sample _String",
"Last Name": "Sample _String",
"Salutation": "Sample _String",
"Employee Id": "Sample _String",
"Gender": "MaleSample_String",
"Occupation/Job Title": "Sample _String",
"Hire Date": "2003-05-01T00:00:00.000ZSample_String",
"Employee / Individual Department": "Sample _String",
"Supervisor First Name": "Sample _String",
"Supervisor Last Name": "Sample _String",
"Supervisor Middle Name": "Sample _String",
"Supervisor's Email": "Sample _String"
},
"Are there any Witnesses identified?": "YesSample_String",
"Number of Witnesses": 1"Sample_String",
"Witness Information": [
{
"First Name": "Sample _String",
"Middle Name": "Sample _String",
"Last Name": "Sample _String",
"Phone Number": "Sample _String",
"Notes": "Sample _String"
}
],
"Incident Status": "Investigation Report CompletedSample_String",
"Created By EmployeeID": "Sample _String",
"Created DateBy": "2019-12-02T07:38:26.087ZSample_String",
"Created Date": "Sample_String",
"Modified Date": "2019-10-14T11:47:29.440ZSample_String",
"Modified By": "Sample _String",
"Investigation Responsibility": {
"Responsible Team": [
{
"Salutation": "Sample_String",
"First Name": "Sample_String",
"Last Name": "Sample_String"
},
{
"Salutation": "Sample_String",
"First Name": "Sample _String",
"Last Name": "Sample _String"
}
],
"Target Completion Date": "2019-12-24T00:00:00.000ZSample_String",
"Note/Comments": "Sample _String",
"Notify Immediate Supervisor": "YSample_String"
},
"Investigation Details": [
{
"Date Reported to Management": "12/02/2019Sample_String"
},
{
"Time Reported to Management": "10:00Sample_String"
},
{
"Is this an HPE?": "YesSample_String",
"Please select Non-HPE Type": "Sample _String",
"HPE Type": "Hoisted LoadsSample_String"
},
{
"Is this a Near Miss or a Hazard Recognition?": "Hazard RecognitionSample_String"
},
{
"Did this result in Stop Work?": "YesSample_String",
"Who performed the Stop Work?": "Sample _String"
},
{
"EHS Category": "Sample _String"
},
{
"Did this incident involve a Procedural Breakdown?": "YesSample_String"
},
{
"Are new procedures or special training needed to prevent recurrence?": "YesSample_String",
"If yes, provide the details": "Sample _String"
},
{
"Was incident reviewed with the involved employee?": "YesSample_String",
"Employee Comments (If yes to answer above)": "Sample _String"
},
{
"Could this incident have resulted in a life-altering injury?": "YesSample_String",
"What type of injury could have occurred?": {
"What type of injury could have occurred?": "Sample _String",
"Please specify": "Sample _String"
},
"How severe could the injury have been?": "Sample _String"
},
{
"Length of Normal Workday": "Sample _String"
},
{
"What tool, machine, equipment, object or substance was involved in the near-miss. If this question does not apply, enter ?not applicable?.": "Sample _String"
},
{
"Time Work Day Began": "15:10Sample_String"
},
{
"Specific Work Activity when the incident occurred": "Sample _String",
"Please specify :": "Sample _String"
},
{
"Area where near miss/hazard recognition occurred": "Sample _String",
"Please specify:": "Sample _String"
},
{
"Investigation Conducted By": "Sample _String"
},
{
"Investigation Conducted Date": "12/02/2019Sample_String"
}
],
"Contributing Factor/Immediate Cause": [
{
"Contributing Factor Type (Parent)": "Sample _String",
"Contributing Factor/Immediate Cause": [
"Sample _String"
],
"Comments": "Sample _String"
},
{
"Contributing Factor Type (Parent)": "Sample _String",
"Contributing Factor/Immediate Cause": [
"Sample _String"
],
"Comments": "Sample _String"
}
],
"5 Why? Methodology": [
{
"Select Action or Condition that may have directly caused incident": [
"Sample_String",
"Sample _String"
],
"Whys": [
{
"Why or what created the scenario above to affect the action or condition": "Sample _String"
},
{
"Final Root Cause/Basic Cause Checked": "YesSample_String"
}
]
}
],
{
"Select Action or Condition that may have directly caused incident": [
"Sample String"
],
"Whys""Root Cause/Basic Cause Analysis": [
{
"WhyRoot orcause what created the scenario above to affect the action or conditionType (Parent)": "Sample _String"
},
{
"Final Root Cause/Basic Cause Checked": [
"Sample _String"
}
]],
"Comments": "Sample_String"
}
],
"Root Cause/Basic Cause AnalysisLessons Learned": [
{
"RootLessons cause Type (Parent)": "Sample String",
"Root Cause/Basic Cause Analysis": [
"Sample String",
"Sample String"
],
"Comments": "Sample String"
Learned": "Sample_String"
}
],
"Action Items": [
{
"Source ID": "Sample _String",
"Source Title": "Sample _String",
"Action Item Title": "Sample _String",
"Action Item Category": "Sample _String",
"Action Item Type": "Corrective ActionSample_String",
"Action Item Description": "Sample _String",
"Action Item Priority": "LowSample_String",
"Action Item Due Date": "2020-01-02T00:00:00.000ZSample_String",
"Owners": [
"Sample _String"
],
"Assigned By": "Sample _String",
"Verification Required": "YesSample_String",
"Verify User": [
"Sample _String"
],
"Action Item Status": "OpenSample_String",
"Action Taken": "Sample _String",
"Action Item Completed By": "Sample _String",
"ActionCompleted Item CompletedDate": "Sample_String",
"Due Date Extension": "Sample_String",
"Requested Due Date Extension": "Sample_String",
"Verification StatusReason for Due Date Extension": "OpenSample_String",
"Verification PerformedDue Date Extension Request Approved?": "OnsiteSample_String",
"Verified ByReason for not extending the Due Date": ["Sample_String",
"Sample Verification Status": "Sample_String"
],
"Verification DatePerformed": "Sample _String",
"CommentsVerified By": [
"Sample _String",
}"Sample_String"
],
"Verification Date": "Sample_String",
"Comments": "Sample_String"
}
]
}
]
Near Miss Field List
| Section | Field Name | Database Column Size |
|---|---|---|
| Incident Detail | ||
| Incident ID (System Generated) | NVARCHAR(400) | |
| Incident Title/Site | NVARCHAR(400) | |
| General Detail | ||
| Incident Date | DATETIME | |
| Time of Incident | NVARCHAR(100) | |
| Time Undetermined | NVARCHAR(10) | |
| Day of Week | NVARCHAR(50) | |
| Reported By | NVARCHAR(200) | |
| Work Shift | NVARCHAR(200) | |
| Operating UnitDepartment | NVARCHAR(200) | |
| Was this an HPE (Potential life altering injury or fatality)? ((IF YES - The incident investigation is mandatory)) | NVARCHAR(100) | |
| Describe what occurred to create the Near Miss/Hazard Recognition? | NVARCHAR(8000) | |
| Is Contractor Involved? | NVARCHAR(50) | |
| Please provide Contractor Name, Company | NVARCHAR(500) | |
| Is this a stop work? | NVARCHAR(200) | |
| Employee / Individual Details | ||
| Was an Employee / Individual involved in the incident? | NVARCHAR(50) | |
| Personnel Type | NVARCHAR(50) | |
| First Name | NVARCHAR(200) | |
| Middle Name | NVARCHAR(200) | |
| Last Name | NVARCHAR(200) | |
| Salutation | NVARCHAR(200) | |
| Employee Id | NVARCHAR(200) | |
| Gender | NVARCHAR(200) | |
| Occupation/Job Title | NVARCHAR(200) | |
| Hire Date | DATETIME | |
| Employee / Individual Department | NVARCHAR(100) | |
| Supervisor First Name | NVARCHAR(200) | |
| Supervisor Last Name | NVARCHAR(200) | |
| Supervisor Middle Name | NVARCHAR(200) | |
| Supervisor's Email | NVARCHAR(50) | |
| Name of Contractor | NVARCHAR(800) | |
| Name of Sub-Contractor | NVARCHAR(800) | |
| Witness Information | ||
| Are there any Witness identified? | NVARCHAR(20) | |
| Number of Witnesses | INT | |
| First Name | NVARCHAR(50) | |
| Middle Name | NVARCHAR(50) | |
| Last Name | NVARCHAR(50) | |
| Phone Number | NVARCHAR(100) | |
| Notes | NVARCHAR(2000) | |
Investigation Section | ||
| Incident Status | NVARCHAR(100) | |
| Created By | NVARCHAR(100) | |
| Created Date | DATETIME | |
| Modified Date | DATETIME | |
| Modified By | NVARCHAR(100) | |
| Investigation Responsibility | ||
| Responsible Team | NVARCHAR(100) | |
| Target Completion Date | DATETIME | |
| Note/Comments | NVARCHAR(2000) | |
| Notify Immediate Supervisor | NVARCHAR(100) | |
| Investigation Details | ||
| Date Reported to Management | DATETIME | |
| Time Reported to Management | DATETIME | |
| Is this an HPE? | NVARCHAR(100) | |
| Please select Non-HPE Type | NVARCHAR(100) | |
| HPE Type | NVARCHAR(100) | |
| Is this a Near Miss or a Hazard Recognition? | NVARCHAR(100) | |
| Did this result in Stop Work? | NVARCHAR(100) | |
| Who performed the Stop Work? | NVARCHAR(100) | |
| EHS Category | NVARCHAR(100) | |
| Did this incident involve a Procedural Breakdown? | NVARCHAR(100) | |
| Are new procedures or special training needed to prevent recurrence? | NVARCHAR(100) | |
| If yes, provide the details | NVARCHAR(500) | |
| Was incident reviewed with the involved employee? | NVARCHAR(100) | |
| Employee Comments (If yes to answer above) | NVARCHAR(500) | |
| Could this incident have resulted in a life-altering injury? | NVARCHAR(100) | |
| What type of injury could have occurred? | NVARCHAR(100) | |
| Please specify | NVARCHAR(500) | |
| How severe could the injury have been? | NVARCHAR(100) | |
| Length of Normal Workday | NVARCHAR(100) | |
| What tool, machine, equipment, object or substance was involved in the near-miss. If this question does not apply, enter ?not applicable? | NVARCHAR(500) | |
| Time Work Day Began | DATETIME | |
| Specific Work Activity when the incident occurred | NVARCHAR(100) | |
| Please specify | NVARCHAR(500) | |
| Area where near miss/hazard recognition occurred | NVARCHAR(100) | |
| Please specify | NVARCHAR(100) | |
| Investigation Conducted By | NVARCHAR(100) | |
| Investigation Conducted Date | DATETIME | |
| Contributing Factor/Immediate Cause | ||
| Contributing Factor Type (Parent) | NVARCHAR(500) | |
| Contributing Factor/Immediate Cause | NVARCHAR(100) | |
| Comments | NVARCHAR(250) | |
| 5 Why? Methodology | ||
| Select Action or Condition that may have directly caused incident | NVARCHAR(100) | |
| Why or what created the scenario above to affect the action or condition | NVARCHAR(2000) | |
| Final Root Cause/Basic Cause Checked | NVARCHAR(100) | |
| Root Cause/Basic Cause Analysis | ||
| Root cause Type (Parent) | NVARCHAR(100) | |
| Root Cause/Basic Cause Analysis | NVARCHAR(100) | |
| Comments | NVARCHAR(250) | |
| Action Items | ||
| Source ID | NVARCHAR(400) | |
| Source Title | NVARCHAR(400) | |
| Action Item Title | NVARCHAR(500) | |
| Action Item Category | NVARCHAR(100) | |
| Action Item Type | NVARCHAR(100) | |
| Action Item Description | NVARCHAR(2000) | |
| Action Item Priority | NVARCHAR(100) | |
| Due Date | DATETIME | |
| Owners | NVARCHAR(100) | |
| Assigned By | NVARCHAR(100) | |
| Verification Required | NVARCHAR(100) | |
| Verify User | NVARCHAR(100) | |
| Action Item Status | NVARCHAR(100) | |
| Action Taken | NVARCHAR(2000) | |
| Completed By | NVARCHAR(100) | |
| Action Item Completed Date | DATETIME | |
| Verification Status | NVARCHAR(100) | |
| Verification Performed | NVARCHAR(100) | |
| Verified By | NVARCHAR(100) | |
| Verification Date | DATETIME | |
| Comments | NVARCHAR(2000) | |
...
| Name | Description | Type | Additional information |
|---|---|---|---|
| locationCode | Represents the unique code of location for which Incident records to return. | string | Required |
| dateFrom | Represents the starting date of Incident records to return. | date | Required but value optional |
| dateTo | Represents the ending date of Incident records to return. | date | Required but value optional |
| lastSyncedDate | Represents the data from incident created date or incident modified date. | date | Required but value optional |
...
| Name | Description | Sample |
|---|---|---|
| Authorization | Represents the value of the authentication token. Allow multiple values: no. | Bearer eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ... |
| ConsumerId | Represents the value of the consumer id. Allow multiple values: no. | 2222 |
Response
Sample:
[
{
"Injury/Illness Incident Detail": {
"Incident Details": {
"Incident ID": "Sample
...
_String",
"Incident Title/Site": "Sample
...
_String",
"Incident Type": "
...
Sample_String",
"Location Code":
...
"Sample_String",
"Location": "Sample_String",
"Were multiple people injured as part of this incident?": "
...
Sample_String"
},
"General Details": {
"Date of Incident": "Sample
...
_String",
"Time of Incident": "Sample
...
_String",
"Time Undetermined": "Sample
...
_String",
"Day Of Week": "Sample
...
_String",
"Work Shift": "Sample
...
_String",
"Time Work Day Began": "Sample
...
_String",
"Description of Incident": "Sample
...
_String",
"Incident Occurred on Employer's Premises": "Sample
...
_String",
"
...
Department": "Sample
...
_String",
"Location of Injury Scene": "Sample
...
_String"
},
"Employee / Individual Details": [
{
"Personnel Type": "
...
Sample_String",
"Employee": {
"Last Name": "Sample
...
_String",
"First Name": "Sample
...
_String",
"Middle Name": "Sample
...
_String",
"Salutation": "Sample
...
_String"
},
"Employee ID": "Sample
...
_String",
"Gender": "Sample
...
_String",
"Occupation/Job Title": "Sample
...
_String",
"Hire Date": "Sample
...
_String",
"Employee / Individual Department": "Sample
...
_String",
"Supervisor (Last,First,MI)": {
"Last Name": "Sample
...
_String",
"First Name": "Sample
...
_String",
"Middle Name": "Sample
...
_String"
},
"Supervisor's Email": "Sample
...
_String"
}
],
"
...
Injury/Illness
...
Summary":
...
[
{
"Was employee taken offsite for evaluation by a medical professional?": "Sample
...
_String",
"
...
Did this incident involve an in-patient hospitalization, amputation, or a loss of an eye?": "Sample
...
_String",
"
...
Has OSHA been contacted?": "Sample
...
_String",
"
...
Please Identify OSHA Contact Details �Name and Phone Number�": "Sample
...
_String",
"
...
Nature of Injury / Illness": "Sample
...
_String",
"
...
Cause of Injury/Illness": "Sample
...
_String",
"
...
Injured Body
...
Parts": [
"Sample
...
_String"
],
"
...
What was the employee doing just before the incident occurred?": "Sample
...
_String",
"
...
Please describe what object or substance directly harmed the employee?.If this question does not apply, enter �not applicable�?": "Sample
...
_String",
"
...
Machine/Equipment
...
Number": "Sample
...
_String",
"
...
Type": "Sample
...
_String",
"
...
Brand": "Sample
...
_String",
"
...
Model": "Sample
...
_String"
...
}
],
"
...
Witness
...
Information":
...
{
"
...
Are
...
there
...
any
...
Witnesses identified?": "Sample
...
_String",
"
...
Number
...
of Witnesses": "Sample
...
_String"
...
,
"
...
Witness
...
Information": [
{
"
...
First Name": "Sample
...
_String",
"
...
Middle
...
Name": "Sample_String",
"Last Name": "Sample
...
_String",
"
...
Phone Number": "Sample
...
_String",
"
...
Notes": "Sample
...
_String"
}
]
},
"
...
Additional
...
Incident
...
Information": {
"Incident Status": "Sample
...
_String",
"
...
Created By": "Sample
...
_String",
"
...
Created
...
Date":
...
"Sample...
_String",
"
...
Last Updated By": "Sample_String"
...
,
"
...
Last
...
Updated Date": "Sample
...
_String"
}
},
"
...
Case
...
Management": {
"Classification of Case": [
{
"Case Number": "Sample
...
_String",
"
...
Was this case Work-Related?": "Sample
...
_String",
"
...
Describe the reason for the \"Non Work Related\" classification": "Sample
...
_String",
"
...
Did this incident result in a fatality?": "Sample
...
_String"
...
,
"
...
Did
...
this incident result in an amputation, fractured/cracked bone(s) (including teeth), or loss of consciousness?": "Sample
...
_String",
"
...
Did the incident result in work restrictions, lost time or job transfer?": "Sample_String",
"Was Treatment Provided beyond First Aid? (Prescription strength medications, Application of wound closing devices, Intravenous Fluids)": "Sample_String",
"Did the injury involve a needlestick and cut(s) from sharp objects that are contaminated with another person's blood or other potentially infectious material?": "Sample_String",
"Was treatment defined as \"First Aid\" provided?": "Sample_String",
"This is a First Aid Case, identify the specific treatment(s) provided": "Sample_String",
"Is This a Bunge (US OSHA) defined Recordable Case ?": "Sample_String",
"Describe the reason for the \"Not Recordable\" classification": "Sample_String",
"Is this Case Recordable According to Local Record keeping Requirements ?": "Sample_String",
"Case Status": "Sample_String",
"Comments": "Sample_String",
"Completed By": "Sample_String",
"Title": "Sample_String",
"Phone": "Sample_String"
}
],
"Case Classification and Progress Tracking": {
"Other Recordable/MAA": [
{
"Employee Name": "Sample_String",
"Classification of Case": "Sample_String",
"Date Other Recordable/MAA Case Occurred": "Sample_String",
"Reason for Classification": "Sample_String",
"Comments": "Sample_String",
"Official Medical Diagnosis (Nature of Injury / Illness)": "Sample_String",
"Was Treatment provided offsite?": "Sample_String",
"Hospital / Clinic Name": "Sample_String",
"Type": "Sample_String",
"Physician/Healthcare Provider": "Sample_String",
"Street": "Sample_String",
"City": "Sample_String",
"Country": "Sample_String",
"State": "Sample_String",
"Postal Code/Zip Code": "Sample_String",
"Phone": "Sample_String",
"Fax": "Sample_String",
"Was the employee treated in an emergency room": "Sample_String",
"Was employee hospitalized overnight as an in-patient": "Sample_String",
"Recording/Revision Date": "Sample_String"
}
]
}
},
"Claim": {
"Claim Information": [
{
"Do you want to file a claim for this incident?": "Sample_String",
"Worker's Comp ID": "Sample_String",
"Workers Comp Claim#": "Sample_String",
"Incident Reported By": "Sample_String",
"Reporter's Email": "Sample_String",
"Reporter's Phone": "Sample_String",
"Injury Date": "Sample_String",
"Injury Day of Week": "Sample_String",
"Time of Injury": "Sample_String",
"Time Workday (Shift) Began": "Sample_String",
"Incident id/Case No": "Sample_String",
"Is this Claim work related?": "Sample_String"
}
],
"Employee/Individual Details": [
{
"Employee Name First": "Sample_String",
"Middle": "Sample_String",
"Last": "Sample_String",
"Home Address:Street": "Sample_String",
"City": "Sample_String",
"State": "Sample_String",
"Zip": "Sample_String",
"Home Phone Number": "Sample_String",
"Gender": "Sample_String",
"Date of Birth": "Sample_String",
"Marital Status": "Sample_String",
"Hire Date": "Sample_String",
"Years at Bunge": "Sample_String",
"Number of Dependants": "Sample_String",
"Type of Employment": "Sample_String",
"Occupation": "Sample_String",
"Department Name": "Sample_String",
"State Hired": "Sample_String",
"Supervisor Name": "Sample_String",
"Supervisor Phone": "Sample_String",
"Current Weekly Wage": "Sample_String",
"Hourly Wage": "Sample_String",
"Hours worked per Week": "Sample_String",
"Days worked Per Week": "Sample_String",
"Hours worked Per Day": "Sample_String",
"Employment Status": "Sample_String",
"Employee ID Number": "Sample_String",
"Was Employee Paid in Full for Date of Injury": "Sample_String",
"Any Prior WC Injuries": "Sample_String",
"OSHA Reference No.": "Sample_String",
"Will employee's salary continue?": "Sample_String"
}
],
"
...
Employer Information": [
{
"
...
Health
...
& Safety /
...
WC
...
Contact Name": "Sample
...
_String",
"
...
Telephone
...
Number": "Sample
...
_String",
"
...
Title": "Sample
...
_String",
"
...
Mailing Address": "Sample
...
_String",
"
...
City": "Sample...
_String",
"
...
State": "Sample...
_String",
"
...
Zip": "Sample...
_String",
"
...
Employer Location Code": "Sample
...
_String"
...
,
"
...
Employer SIC": "Sample
...
_String",
"
...
Nature of
...
Business":
...
"Sample_String",
"
...
Employer
...
Name":
...
"Sample...
_String"
...
}
],
"
...
Accident Information": [
{
"
...
Did
...
the
...
Accident
...
Occur
...
at
...
the
...
Work
...
Location?": "Sample
...
_String",
"If
...
no , where did the accident occur? Accident Address": "Sample
...
_String",
"
...
City": "Sample
...
_String",
"
...
State": "Sample
...
_String",
"
...
Zip": "Sample
...
_String",
"
...
Give a full Description of the Accident: (Be as Complete as Possible)": "Sample
...
_String",
"
...
What was the employee doing just before the incident occurred?": "Sample
...
_String",
"
...
Please describe what object or substance directly harmed the employee?": "Sample
...
_String",
"
...
Jurisdiction
...
State": "Sample
...
_String",
"
...
Date and Time Reported to Employer": "Sample
...
_String",
"
...
Hours: Minutes": "Sample
...
_String"
}
],
"
...
Injury
...
Information": [
{
"
...
Did incident result in a fatality?": "Sample
...
_String",
"
...
Date fatality occurred": "Sample
...
_String",
"
...
Did the employee lose any time from work?": "Sample
...
_String",
"
...
What was the first full day out": "Sample
...
_String",
"
...
Do you know the Date
...
...
Employee Last Worked?": "Sample
...
_String",
"Date Employee Last
...
Worked": "Sample
...
_String"
...
,
"
...
Has
...
the employee returned to work?": "Sample
...
_String",
"
...
Date
...
Returned
...
to Work
...
": "Sample...
_String",
"
...
Return
...
to Work Status": "Sample
...
_String",
"
...
Estimated
...
return to work date": "Sample
...
_String",
"
...
Nature
...
of
...
Injury": "Sample_String",
"Cause of Injury/illness": "Sample
...
_String",
"
...
Which
...
Part
...
of
...
the
...
Body
...
was Injured?": [
"Sample
...
_String"
],
"
...
Part of the Body Location?": "Sample
...
_String",
"
...
Needle
...
Stick
...
Injury": "Sample_String",
"Reqs Sharps Inj Log": "Sample_String"
}
],
"Medical Information": [
{
"Was employee sent to Hospital / Clinic to receive Medical Treatement?": "Sample
...
_String",
"
...
Initial
...
Medical Treatment": "Sample
...
_String",
"
...
Hospital
...
/
...
Clinic
...
Name": "Sample_String",
"Address": "Sample
...
_String",
"
...
City": "Sample
...
_String",
"
...
State": "Sample_String",
"Zip": "Sample
...
_String",
"
...
Phone": "Sample
...
_String",
"
...
Fax": "Sample
...
_String",
"
...
Clinic/Doctor Name": "Sample
...
_String"
}
],
"
...
Witness Information":
...
[
{
"Were There Any Witnesses?": "Sample
...
_String",
"
...
If Yes, Name": "Sample
...
_String",
"
...
Contact": "Sample
...
_String"
}
],
"
...
Additional
...
Comments and
...
Information": [
{
"
...
Do you question the validity of the claim":
...
"Sample_String",
"If yes, provide Details": "Sample
...
_String",
"
...
Other
...
Comments": "Sample
...
_String"
}
],
"
...
Report
...
Prepared
...
By": [
{
"Name": "Sample
...
_String",
"
...
Title": "Sample
...
_String",
"
...
Phone": "Sample
...
_String"
}
]
},
"
...
Investigation
...
Report": {
"Investigation Responsibility": {},
"
...
Investigation
...
Details": [
{
"
...
Is
...
this
...
an
...
Ergonomic
...
injury?": "Sample
...
_String"
},
{
"
...
Description of incident (please maintain in local language if other than English)": "Sample
...
_String"
},
{
"
...
Is this
...
an
...
HPE
...
incident?": "Sample
...
_String",
"
...
Please
...
select
...
Non-HPE
...
Type": "Sample
...
_String",
"HPE Type": "Sample
...
_String"
},
{
"
...
Task at time of incident": "Sample
...
_String"
...
},
{
"Did incident interrupt normal operations?": "Sample
...
_String",
"
...
Length of Downtime": "Sample
...
_String",
"
...
Describe interruption:": "Sample
...
_String"
},
{
"Was
...
it necessary to retain items involved with this incident? (tools, equipment, etc.)": "Sample_String",
"If yes, please list items retained and current location": "Sample
...
_String"
},
{
"
...
Were
...
Local
...
or
...
Government
...
Authorities
...
contacted
...
as
...
a
...
result
...
of
...
this
...
incident?": "Sample
...
_String"
...
,
"Which agencies were contacted?": {
"
...
Which
...
agencies
...
were
...
contacted?": "Sample_String",
"Please specify": "Sample_String"
}
},
...
{
"Post Accident: Drug/Alcohol Screen Conducted": "Sample
...
_String"
},
{
"
...
Date Reported to Management": "Sample
...
_String"
},
{
"
...
Time
...
Reported
...
to
...
Management": "Sample
...
_String"
},
{
"
...
Length
...
of
...
Normal Workday": "Sample
...
_String"
},
{
"
...
length of
...
employment at current position": "Sample
...
_String"
},
...
{
"length of employment at current position Unit": "Sample
...
_String"
},
{
"Was
...
any
...
Machine
...
/
...
Equipment involved
...
?...
": "Sample...
_String",
"
...
Machine/Equipment Number": "Sample
...
_String"
},
{
"
...
Specific
...
Work
...
Activity
...
when
...
the
...
incident
...
occurred": "Sample_String",
"Please specify:": "Sample
...
_String"
}
],
"
...
Ergonomic Analysis": [],
"Contributing Factor/Immediate Cause": [
{
"
...
Contributing
...
Factor
...
Type (Parent)": "Sample
...
_String",
"
...
Contributing Factor/Immediate Cause": [
"Sample_String"
],
"Comments": "Sample_String"
}
...
,
{
"
...
Contributing Factor Type (Parent)": "Sample
...
_String"
...
,
...
"...
Contributing
...
Factor/Immediate Cause": [
"Sample
...
_String"
...
],
...
"
...
Comments": "Sample
...
_String"
}
],
"5 Why? Methodology": [
{
"
...
Select Action or Condition that may have directly caused incident": [
"Sample
...
_String"
...
],
"Whys": [
{
"
...
Why or what created the scenario above to affect the action or condition": "Sample
...
_String"
},
{
"
...
Final
...
Root
...
Cause/Basic
...
Cause Checked": "Sample
...
_String"
}
]
},
{
"
...
Select Action or Condition that may have directly caused incident": [
"Sample
...
_String"
],
"
...
Whys":
...
[
{
"
...
Why
...
or
...
what
...
created the
...
scenario above to affect the action or condition": "Sample
...
_String"
},
...
{
"
...
Final Root Cause/Basic Cause Checked":
...
"Sample...
_String"
}
]
}
],
"
...
Root
...
Cause/
...
Basic Cause Analysis": [
{
"
...
Root cause Type (Parent)":
...
"Sample...
_String"
...
,
"Root Cause/Basic Cause
...
": [
"Sample
...
_String"
],
"Comments": ""
}
],
"
...
Lessons
...
Learned": [
{
"Lessons Learned":
...
"Sample...
_String"
}
]
},
"Action Items": [
{
"Source ID": "Sample
...
_String",
"Source Title": "Sample
...
_String",
"Action Item Title": "Sample
...
_String",
"Action Item Category": "Sample
...
_String",
"Action Item Type": "Sample
...
_String",
"Action Item Description": "Sample
...
_String",
"Action Item Priority": "Sample
...
_String",
"Action Item Due Date": "Sample
...
_String",
"Owners": [
"Sample_String"
],
"Assigned By": "Sample_String"
...
,
"
...
Verification
...
Required": "Sample
...
_String",
"
...
Verify
...
User": [
"Sample
...
_String"
],
"Action Item Status": "Sample
...
_String",
"Action Taken": "Sample
...
_String",
"Action Item Completed By": "Sample
...
_String",
"Completed Date": "Sample
...
_String",
"Due Date Extension": "Sample
...
_String",
"Requested Due Date Extension": "Sample
...
_String",
"Reason for Due Date Extension": "Sample
...
_String",
"Due Date Extension Request Approved?": "Sample
...
_String",
"Reason for not extending the Due Date": "Sample_String",
"Verification Status": "Sample_String",
"Verification Performed": "Sample_String",
"Verified By": [
"Sample_String",
"Sample_String"
],
"Verification Date": "Sample_String",
"Comments": "Sample_String"
}
]
}
]
Injury/Illness and Claim Field List
...