Select or as appropriate to indicate if the incident resulted in any “Yes” “No” deaths. Incident Involved Injury: required field (Screen print #6.) Select or as appropriate to indicate if there were any injuries that “Yes” “No” required medical attention. Screen #6. Describe Injuries Suffered (Screen print #7.) This field is required only if was selected for question 24, “Yes” “Incident Involved Injury”. Use the text box to describe the nature of the injuries sustained and what medical action was taken. Work-Related Injury Report or W/C Claim Filed (Screen print #7.) This field is required only if was selected for question 24, “Yes” “Incident Involved Injury”. Use the drop down menu to select the appropriate response. Description of Incident: required field (Screen print #7.) Use the text box to describe the nature of the incident and include other relevant information. If there are more than three victims, identify here. Law Enforcement Officials Contacted (Screen print #7.) Select or as appropriate. “Yes” “No” Screen print #7. Responding Law Enforcement Agency (Screen print #8.) This field is required only if was selected for question 28, “Yes” “Law Enforcement Officials Contacted”. Use the drop down menu to select the type of agency. Use the text box to specify an agency not available in the drop “other” down list. Was Anyone Arrested (Screen print #8.) Select or as appropriate. “Yes” “No” SEAP Contacted by Agency: required field (Screen print #8.) Use the drop down menu to select the appropriate response.
Select “Yes” or “No” as appropriate to indicate if the incident resulted in any deaths. Incident Involved Injury: required field (Screen print #6.) Select “Yes” or “No” as appropriate to indicate if there were any injuries that required medical attention. Screen #6. Describe Injuries Suffered (Screen print #7.) This field is required only if “Yes” was selected for question 24, “Incident Involved Injury”. Use the text box to describe the nature of the injuries sustained and what medical action was taken. Work-Related Injury Report or W/C Claim Filed (Screen print #7.) This field is required only if “Yes” was selected for question 24, “Incident Involved Injury”. Use the drop down menu to select the appropriate response. Description of Incident: required field (Screen print #7.) Use the text box to describe the nature of the incident and include other relevant information. If there are more than three victims, identify here. Law Enforcement Officials Contacted (Screen print #7.) Select “Yes” or “No” as appropriate. Screen print #7. Responding Law Enforcement Agency (Screen print #8.) This field is required only if “Yes” was selected for question 28, “Law Enforcement Officials Contacted”. Use the drop down menu to select the type of agency. Use the “other” text box to specify an agency not available in the drop down list. Was Anyone Arrested (Screen print #8.) Select “Yes” or “No” as appropriate. SEAP Contacted by Agency: required field (Screen print #8.) Use the drop down menu to select the appropriate response.