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Employee Incident/Accident Report Form
Employee Incident/Accident Report Form
Dispatcher: Fill Out for DA, Then Call AMZL Last-Mile Emergency Team at (844) 311-0406 Extension 3, 1, 4
51Questions
Employee Accident/Incident Report Form
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    Pick a Date
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    • AM
    • PM
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  • 10
    • Customer’s Driveway
    • Customer’s House
    • Customer’s Yard
    • Office area
    • Road
    • Van
    • Warehouse
    • Other
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  • 11
    • Ice, sleet, snow, freezing
    • Rain
    • Restricted space
    • Rubbish, debris, general untidiness
    • Sunny and fair
    • Tidy, well lit, no obstructions
    • Other
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  • 12
    • Delivering
    • Driving
    • Loading
    • Office Work
    • Packing
    • Picking
    • Put away
    • Unloading
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  • 13
    • Bending
    • Entering Van
    • Exiting Van
    • Lifting
    • Repetitive movement
    • Stair stepping
    • Turning
    • Twisting
    • Walking
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  • 14
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  • 15
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
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  • 28
    • 0 None
    • 1
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    • 3
    • 4 Most severe
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  • 32
    • N/A
    • Ankle, Left
    • Ankle, Right
    • Arm, Left
    • Arm, Right
    • Back
    • Bottom
    • Chest
    • Foot, Left
    • Foot, Right
    • Hand, Left
    • Hand, Right
    • Head
    • Groin
    • Knee, Left
    • Knee, Right
    • Neck
    • Shoulder, Left
    • Shoulder, Right
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  • 47
    Pick a Date
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  • 48
    Pick a Date
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  • 49
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  • 50
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  • 51
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