APPENDIX 4 (SAMRASS 4) 1 13 DAY INJURIES – NAME OF MINE DMR-MINE CODE Codes to be used on this Form are specified in the Code Book DATE OF ACCIDENT OR DANGEROUS OCCURRENCE MINE ACCIDENT OR DANGEROUS OCCURRENCE NO. NAME OF INJURED IDENTITY NUMBER PASSPORT NUMBER INDUSTRY NUMBER DATE OFF WORK RETURNED TO WORK DAYS ABSENT ACCIDENT OR DANGEROUS OCCURRENCE
APPENDIX 4 (SAMRASS 4) 1 – 13 DAY INJURIES NAME OF MINE DMR-MINE CODE Codes to be used on this Form are specified in the Code Book DATE OF ACCIDENT OR DANGEROUS OCCURRENCE MINE ACCIDENT OR DANGEROUS OCCURRENCE NO. NAME OF INJURED IDENTITY NUMBER PASSPORT NUMBER INDUSTRY NUMBER DATE OFF WORK RETURNED TO WORK DAYS ABSENT ACCIDENT OR DANGEROUS OCCURRENCE
dmr_220_samrass_04_1_-_13_days_injuries.docx