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Plant/Site
*
Select Plant/Site
Plant/Site is required
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Department/Sub-Department
*
Department/Sub-Department is required
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Agency/Sub-Agency
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Location/ Sub-Location
*
Location/ Sub-Location is required
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Shift
*
Select Shift
Shift is required.
Event Date
*
Event Time
*
Enter Valid Date and Time
Event Date & Time is required
Incident At
*
On Site
Off Site
Nature of Injury
*
{{cat.CategoryName}}
Incident Classification
{{cat.CategoryName}}
Other Sub Category
Equipment Involved
Select Equipment Involved
If other, provide details
Material Involved
Select Material Involved
If other, provide details
Description of what happened
*
Description of what happened is required
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Immediate Action Taken (Also mention who visited site first and what action was proposed by him? if applicable)
{{incidentFIRDetail.ImmediateAction | countCharactersRemaining : MaxDescriptionChar}} characters remaining
Employee(s) / Contractor(s) Injured
Employee(s) / Other
*
Name
*
Employee Code
Age
*
Department
Gender
*
Action
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{{victim.Name}}
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No record found
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Reported By
Name
*
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Department/ Sub-Department
Contact #
Invalid Contact Number.
Employment Type
*
Select Employment Type
Employment Type is required
Witness 1
Name
Only alphabets are allowed
Department/ Sub-Department
Contact #
Invalid Contact Number.
Witness 2
Name
Only alphabets are allowed
Department/ Sub-Department
Contact #
Invalid Contact Number.
Attachments
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