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Edu. Injured employee s name Name of witness Phone number of witness Job title of witness How long witness employed at UT Dallas Home address of witness City State ZIP Code Location of accident loading dock bathroom etc Date of accident Time of accident Weather Conditions Describe fully how accident occurred including events that occurred immediately before the accident Please indicate specifically which part s of the body were injured Recommendation on how to prevent this accident from...
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How to fill out pleaseindicatespecificallywhichpartsofformbodywereinjured
01
To fill out the form, first gather all the necessary information about the injuries to specific parts of the body.
02
Start by providing your name, contact information, and any identification number required on the form.
03
Locate the section on the form that pertains to the injured party's body parts.
04
Please indicate specifically which part(s) of the body were injured by writing or checking the appropriate boxes.
05
If there is not enough space provided on the form, you may attach additional documentation to provide more details.
06
Follow any additional instructions or guidelines mentioned on the form.
07
Ensure that all information is accurate, legible, and complete.
08
Double-check the form for any errors or missing information before submitting it.
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Submit the completed form to the designated recipient or organization as instructed.
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Keep a copy of the filled-out form for your records.
Who needs pleaseindicatespecificallywhichpartsofformbodywereinjured?
01
Individuals who have suffered injuries to specific parts of their body and need to report or document it.
02
Medical professionals or personnel responsible for collecting injury-related information.
03
Legal representatives or insurance agents handling claims or cases related to specific body part injuries.
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Companies or organizations requiring detailed information about specific body part injuries for record-keeping or legal purposes.
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