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100FM FlrMntInstruct2! 7/22/052:28 PM Page 1WARNING! DEATH or SERIOUS INJURY can occur if manufacturers instructions are not followed correctly. ETON Model #100 FM Floor Mount snap hooks Use only
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01
Begin by providing the necessary personal information of the individual involved in the incident, such as their full name, date of birth, and contact details. Include any additional information that may be required, like their occupation or relationship to the company or organization.
02
Describe the incident accurately and in detail, including the date, time, and location of the occurrence. Clearly explain what happened, the sequence of events, and any factors that may have contributed to the incident.
03
Include any witness statements or contact information, if applicable. Witnesses can provide essential details and corroborate the events surrounding the death or serious injury.
04
Provide a thorough account of the injuries sustained, detailing the type and extent of injuries. Include any medical treatment received, hospitalizations, surgeries, or long-term effects.
05
If applicable, describe any measures taken to prevent further harm or ensure the safety of others involved. This could involve providing information about first aid administered or steps taken to remove hazards from the scene.
06
Attach any supporting documents, such as medical reports, photographs of the scene, or incident reports from professionals or authorities who were involved or responded to the incident.

Who needs death or serious injury?

01
Employers or businesses are typically required to report death or serious injuries that occur in the workplace. This ensures that appropriate measures can be taken to prevent similar incidents from happening again.
02
Insurance companies or legal entities may require documentation of death or serious injury to process claims or legal cases related to the incident. The information gathered from such reports can help determine liability and compensation.
03
Government agencies or regulatory bodies may also need to be notified about deaths or serious injuries, especially in certain industries, to ensure compliance with safety and health regulations.
Remember, it is essential to consult local laws, regulations, or guidelines specific to your jurisdiction to ensure compliance and accuracy when filling out death or serious injury reports.
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Death or serious injury refers to an incident that results in the loss of life or severe harm to a person.
Any individual or organization involved in an incident resulting in death or serious injury is required to file a report.
The report should be filled out with details of the incident, including the date, time, location, and circumstances leading to the death or serious injury.
The purpose of reporting death or serious injury is to ensure accountability, improve safety measures, and prevent future incidents.
The report should include information about the individuals involved, the nature of the incident, any contributing factors, and any actions taken following the incident.
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