Use this subtask to enter detailed information pertaining to the time and location of the reported accident or illness.
Update this subtask whenever an employee has been injured in a work-related accident or reports an illness due to working conditions.
This non-editable field displays the employee ID and name of the employee for whom you are recording an accident or illness. This information defaults from the main screen.
This field displays the internal case number assigned to this record in the Accident Info screen.
Select this checkbox if the accident or illness occurred on the employer's premises.
Select checkbox if the accident or illness occurred on state property.
Enter the street address or other location where the accident occurred. You can enter up to 40 characters in this optional field.
Select this radio button if the accident or illness occurred in a city. In the unlabeled field to the right, enter up to 30 alphanumeric characters for the name of the city.
Select this radio button if the accident or illness occurred in a county. In the unlabeled field to the right, enter up to 30 alphanumeric characters for the name of the county.
Enter, or use Lookup to select, the ID number of the employee to whom this accident or illness was reported. Employee IDs are validated against the Employee table. The name of the employee is displayed in the unlabeled field to the right of the ID. This is a required field
Enter, or use Lookup to select, the ID number of the employee, if any, who witnessed this accident or illness. Employee IDs are validated against the Employee table. The name of the employee is displayed in the unlabeled field to the right of the ID. This is an optional field.
Enter the date, in "MM/DD/YYYY" format, on which the injury or illness occurred. This is a required field.
Enter the time, in "HHMM" format, at which the injury or illness occurred. For example, if an accident occurred at 11:02 a.m., you would enter "1102AM." The system automatically inserts the colon between the 11 and the 02. This is a required field.
Enter the date, in "MM/DD/YYYY" format, on which the employee became unable to work because of this injury or illness. This is an optional field.
Enter the date, in "MM/DD/YYYY" format, on which the injury or illness was reported to the employer. This is a required field.
If this injury or illness resulted in the employee's death, enter the date in "MM/DD/YYYY" format. This is an optional field.
Enter the time, in "HHMM" format, at which the employee became unable to work because of this injury or illness. For example, if an accident occurred at 11:02 a.m., you would enter "1102AM." The system automatically inserts the colon between the 11 and the 02. This is an optional field.
Enter up to two digits for the amount of time this employee is expected to be disabled. Use the radio buttons to the right of this optional field to determine whether this amount represents days, months, or years.
Select this radio button if the numeric value you entered into the Probable Length of Disability field represents days.
Select this radio button if the numeric value you entered into the Probable Length of Disability field represents months.
Select this radio button if the numeric value you entered into the Probable Length of Disability field represents years.
Use the options in this group box to enter data regarding the accident or illness.
Select this checkbox if the employee was paid for the day on which the accident or illness occurred.
Select this checkbox if the employee was paid for the day on which he became unable to work.
Select this checkbox if the employee has returned to work.
If the employee has returned to work, enter the date of return in "MM/DD/YYYY" format. If the employee has not returned to work, leave this field blank.
If the employee has returned to work, enter the hourly rate that the employee was paid upon returning. If the employee has not returned to work, leave this field blank.