Purpose 1. ) Create a user-friendly tool 2. ) Develop more accurate injury information 3. ) Create consistency from company to company
Column A – Case Number (pre-filled) Column B – Employee’s Name Column C – Job Title selected from drop down Column D – Date of Injury
Column E – Part 1 – Area of injury selected from drop down Part 2 – Additional descriptive information
Column F – Part 1 – Type of injury selected from drop down Part 2 – Additional descriptive information
Classify the case– -Death - Days away from work - Job transfer or restricted duty - Other Recordable Select only 1 per case per row. If you select more than one, the offending cells will turn red until they are corrected
Column K – Number of days away from work - No more than 180 days Column L – Number of days transferred or restricted - No more than 180 days Column K and L should not be collectively more than 180 days. If you enter more than 180 cumulatively for the columns, the offending cells will be turn red until they are corrected
Column M – Mark only 1 - Injury - Skin Disorder - Respiratory Condition - Poisoning - Hearing Loss - All Other Illnesses Select only 1 per case per row.