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Information About Person/S Involved

No.
Question
Options
1
What is the Person Name? (Person 1)
Please fill your answer here
2
What is the Contact Number of the person?
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3
What is the Sex of the person?
Male
Female
Transgender
Not Disclosed
4
What is the Age of the person?
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5
What is the Job Title of the Person?
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6
What is the Job Status of the Person??
Full-Time
Part-Time
Contractual
Other
Please specify
7
What is the Injury Severity of the personnel?
None
Minor
Serious
Major
Fatal
8
What is the Person Disposition Status?
Returned to Work
Modified Duties
Sent Home
Sent to Doctor / Hospital
N/A