Claim Maintenance - Cause

Describe what happened immediately prior to the accident?  Describe the physical task you were carrying out. Note any strenuous activity.

Incident Mechanism  Choose a physical catalyst from the first list. Choose an environmental mechanism from the second list.

Agency of Incident  What did you come into contact with that caused you to be injured?

Part of the body affected?  Specify the body part that was injured. Select from the list, or click on the button to select a body part from the same diagram that appears on the Injury tab of the Incident Register.

Type of injury?  Select a description of the injury from the list.

Was a motor vehicle involved?  Select "Yes" or "No".

Details of any witnesses to the incident  The full name(s) of any witnesses are required.