| Name | Description | Type | Additional information |
|---|---|---|---|
| name_of_injured_employee | string |
None. |
|
| time_employee_began_work | date |
None. |
|
| date_of_injury_illness | string |
None. |
|
| time_of_occurrence_cannot_be_determined | boolean |
None. |
|
| time_of_occurrence | date |
None. |
|
| last_work_date | string |
None. |
|
| date_employer_notified | string |
None. |
|
| date_disability_began | string |
None. |
|
| contact_name | string |
None. |
|
| contact_phone | string |
None. |
|
| contact_id | globally unique identifier |
None. |
|
| type_of_injury_illness | string |
None. |
|
| part_of_body_affected | string |
None. |
|
| equipment_materials_or_chemicals_employee_was_using | string |
None. |
|
| activity_employee_was_engaged | string |
None. |
|
| work_process_employee_was_engaged | string |
None. |
|
| how_injury_or_illness_occurred | string |
None. |
|
| cause_of_injury_code | string |
None. |
|
| date_return_to_work | string |
None. |
|
| date_of_death | string |
None. |
|
| were_safeguards_or_safety_equipment_provided | boolean |
None. |
|
| were_they_used | boolean |
None. |
|
| injury_occured_on_employers_premises | boolean |
None. |
|
| type_of_injury_illness_code | string |
None. |
|
| part_of_body_affected_code | string |
None. |
|
| database_id | globally unique identifier |
None. |
|
| claim_number | string |
Required |
|
| status | string |
None. |
|
| street | string |
None. |
|
| city | string |
None. |
|
| state | string |
None. |
|
| zip | string |
None. |
|
| county | string |
None. |
|
| date_of_loss | string |
None. |
|
| describe_location | string |
None. |
|
| police_or_fire | string |
None. |
|
| report_number | string |
None. |
|
| additional_comments | string |
None. |
|
| description_of_loss | string |
None. |
|
| insured_database_id | globally unique identifier |
None. |
|
| insured_email | string |
None. |
|
| insured_first_name | string |
None. |
|
| insured_last_name | string |
None. |
|
| insured_commercial_name | string |
None. |
|
| policy_number | string |
None. |