Nature of Accident Burn or Scald; Heat or Cold Exposure Contact With Chemicals 01 Hot Objects or Substances (Contact with Hot Objects) 02 Temperature Extremes 03 Fire or Flame 04 Steam or Hot Fluids 05 Dusts, Gases, Fumes or Vapors 06 Welding Operation 07 Radiation 08 Contact with, NOC (Miscellaneous) 09 Cold Objects or Substances 11 Abnormal Air Pressure 14 Electric Current 84 Caught In, Under, or Between Machine or Machinery 10 Object Handled 12 Caught In, Under, or Between, NOC (Miscellaneous) 13 Collapsing Materials - Slides of Earth (Collapsing Materials/Either Man Made or Natural Landslide) 20 Cut, Puncture, Scrape Injured By Broken Glass 15 Hand Tool, Utensil; Not Powered 16 Object Being Lifted or Handled 17 Powered Hand Tool, Appliance 18 Cut, Puncture, Scrape, NOC (Miscellaneous) 19 Fall, Slip, or Trip Injury From Different Level (Elevation) 25 From Ladder or Scaffolding 26 From Liquids or Grease Spills 27 Into Openings 28 On Same Level 29 Slipped, Did Not Fall 30 Fall, Slip, Trip, NOC (Miscellaneous) 31 On Ice or Snow 32 On Stairs 33 Footnote(s): Page 1 of 7
NATURE OF ACCIDENT Motor Vehicle Crash of Water Vehicle 40 Crash of Rail Vehicle 41 Collision or Sideswipe 45 Collision with Fixed Object 46 Crash of Airplane 47 Vehicle Upset 48 Crash of Motorcycle (State cases only) 49 Motor Vehicle, NOC (Miscellaneous) 50 Strain or Injury By Continual Noise 52 Twisting 53 Jumping 54 Holding or Carrying 55 Lifting 56 Pushing or Pulling 57 Reaching 58 Using Tool or Machinery 59 Strain or Injury By, NOC (Miscellaneous) 60 Wielding or Throwing 61 Repetitive Motion (i.e. carpal tunnel) 97 Striking Against or Stepping On Moving Parts of Machine 65 Object Being Lifted or Handled 66 Sanding, Scraping, Cleaning Operation 67 Stationary Object 68 Stepping on Sharp Object 69 Striking Against or Stepping on, NOC (Miscellaneous) 70 Struck or Injured By Fellow Worker 74 Falling or Flying Object 75 Hand Tool or Machine in Use 76 Motor Vehicle 77 Moving Parts of Machine 78 Object Being Lifted or Handled 79 Object Handled by Others 80 Struck or Injured, NOC (Miscellaneous) 81 Assault by Client (State cases only) 90 Assault by Inmate (State cases only) 91 Assault by Public (State cases only) 92 Animal or Insect 85 Explosion or Flareback 86 Footnote(s): Page 2 of 7
NATURE OF ACCIDENT Rubbed or Abraded By Rubbed or Abraded, NOC 95 Repetitive Motion (i.e. callus, blister) Miscellaneous Causes Absorption, Ingestion or Inhalation, NOC 82 Foreign Matter (Body) in Eye(s) 87 Person in Act of a Crime 89 Other Miscellaneous, NOC 99 Cumulative, NOC 98 Cumulative Stress (State cases only) 93 Cumulative Presumption (State cases only) 94 Other than Physical Injury Terrorism 96 Natural Disasters 88 Mold A1 A2 A3 Footnote(s): Page 3 of 7
NATURE OF INJURY Specific Injury Amputation A Contusion (Bruise) B Laceration C Burn (Burn/Scald) D Crushing (Crushed) E Puncture F Dislocation G Fracture H Hernia I Foreign Body (Irritant) J Strain K Sprain 4 Angina Pectoris/Chest Pain 5 Myocardial Infarction/Heart Attack 6 Poisoning General (Not OD) U All other Specific Injuries, NOC 7 Death (specific) V1 No Physical Injury (glasses, contact lenses, artificial limbs) 1 Asphyxiation 54 Concussion B1 Electrical Shock 19 Enucleation/ Removal of Organ/Tumor 22 Freezing 30 Hearing Loss or Impairment (specific) 31 Heat Prostration 32 Infection 36 Inflammation 37 Rupture 46 Severance 47 Syncope 53 Vascular 55 Vision Loss 58 Occupational Disease Or Cumulative Injury Cancer L Dermatitis N Loss of Hearing (Cumulative) O Contagious Disease (Infectious Disease) Q Mental Stress (Job Stress) R Dust disease, NOC (Pneumoconiosis, NOC) T All Other Occupational Disease Injury, NOC 8 VDT-related disease Y Carpal Tunnel Syndrome Z Footnote(s): Page 4 of 7
NATURE OF INJURY All Other Cumulative Injuries, NOC Illness (undefined) Death (Cumulative) Neurological/Muscular Not described Asbestosis Black Lung Byssinosis Silicosis Respiratory Disorders (gases/fumes/chemicals) Poisoning-Chemical Poisoning-Metal Mental Disorders Radiation Hepatitis C Multiple Injuries (Other) Multiple Physical Injuries Only Multiple Injuries including Both Physical and Psychological M P V S X 61 62 63 64 65 66 67 69 70 79 2 3 Footnote(s): Page 5 of 7
PART OF BODY Head Area Multiple Head (Any combination of Below Parts) E Ear(s) A Eye(s) C Facial Bones D Nose F Brain 6 Skull 11 Teeth 16 Mouth 17 Soft Tissue- Head 18 NECK Multiple Neck Injury (Any combination of Below Parts) H Vertebrae (neck) 21 Disc (neck) 22 Spinal Cord (neck) 23 Larynx 24 Soft Tissue Neck 25 Trachea 26 Trunk Multiple Trunk (Any Combination of Below Parts) Upper Back Area Lower Back Area Disc (back) Sacrum and Coccyx Pelvis Spinal Cord (back) Abdomen (including groin) Chest/Ribs Heart Internal Organs Lungs G 41 42 43 45 46 47 O P Q R S Buttocks 62 Lumbar and/or Sacral Vertebrae (Vertebrae NOC Trunk) 63 Footnote(s): Page 6 of 7
PART OF BODY Upper Extremities Multiple Upper Extremities (Any Combination of Below Parts) I Elbow J Finger(s) K Hand(s) L Shoulder(s) M Wrist N Wrist(s) and Hand(s) 4 Upper Arm 31 Lower Arm 33 Thumb 37 Lower Extremities Multiple Lower Extremities (Any Combination of Below Parts) 5 Ankle Foot Hip Knee Lower Leg (Leg) Toe(s) Upper Leg Great Toe U V W X Y Z 52 58 Multiple/Misc. Body Parts Insufficient Info to Properly Identify Unclassified (Not Described) 8 Multiple Body Parts -Including Body Systems & Body Parts 9 Mental/Physical (State cases only) 1 Physical/Mental (State cases only) 2 No Physical Injury (mental disorders) B Mental/Mental (State cases only) 3 Artificial Appliances 64 Body Systems & Multiple Body Systems 91 Whole Body 99 Footnote(s): Page 7 of 7