Date of Accident definition

Date of Accident. Time: ________ a.m/p.m. Did the Accident occur on Company property? Yes |_| No |_| Working Shift: From __________ to ___________ a.m/p.m. How Many Hours Had Employee Been on Job? ______________________________________________________ Date injury first reported to Company: _______________ Name of Person Notified: __________________________________________________________________ Describe the injury/illness in detail and indicate the part of the body and the side of the body affected: _____________________________________________ What was the employee doing when the accident occurred? ____________________ ____________________________________________________________________________ How did the accident occur? (Describe all activity leading up to the accident. Tell what material or tools were involved. Tell what happened just before, at the time of, and just after the accident.) ______________________ ____________________________________________________________________________ ____________________________________________________________________________ What machine, tool, substance or object was most closely connected with the accident? __________________________________________________________________ Did injury occur because of: Intoxication? |_| Yes |_| No Failure to obey rules? |_| Yes |_| No Unsafe condition? |_| Yes |_| No Was Weather a factor? |_| Yes |_| No Failure to use safety devices? |_| Yes |_| No Unsafe act by injured or others? |_| Yes |_| No Unsafe Personal Factors (attitude, etc.) |_| Yes |_| No If yes, how? __________________________________________ What personal protective equipment is required for the job? ______________ Was it used? |_| Yes |_| No What safety measures could the Company have taken to prevent the accident? ____________________________________________________________________________ ____________________________________________________________________________ Names and addresses of witnesses: __________________________________________ ____________________________________________________________________________ (Name) (No. & Street) (City or Town) (State) (Zip) [LOGO] KN Energy, Inc. and Affiliates Safety and Environmental Affairs Policy Manual Seatbelt Policy Section: 02.09 Issue Date: 8/30/96 Revision Date:
Sample 1Sample 2
Date of Accident means the day when any of the Injury and other covered incident(s):
Sample 1

Examples of Date of Accident in a sentence

  • Name of injured Worker: Social Security No.: Date of Accident: OJCC # (Case Number) of Injured Worker: Name and Address of Employer: 5b.

  • The insurer or its designated representative should complete all of the information requested at the top of the form.3. Type or legibly print all information on the form for each employee, including the VWC File Number, Social Security Number, and Date of Accident, along with a breakdown of the medical expenses incurred.

  • Patient Name Patient Signature Date Patient Information Last Name: First Name: Sex: M FIf patient is a minor, name of parent or guardian accompanying patient: Relationship to Patient: Phone # (if different): Address: City: State: Zip Code: Home Phone: 2nd Phone: Email: Date of Birth: SS# Married Single Divorced WidowedReferred by: Phone: Location: Family Doctor: Phone: Location: INSURANCE Date of Accident (if applicable): Type of Accident: Please briefly describe the accident.

  • DateofInjury(DN0031):For Date of Accident, if the employee or other relevant individual providing the data is uncertain about the exact date, use the earliest date about which there is some degree of certainty or the date that you received notice of the accident, whichever is earlier.

  • Date of Accident: , County (or nearest city if county unknown): DMV cannot locate the report by the police report number, if the above information is not provided your request will not be processed and returned back to you.

  • Date of Accident or Injury - If a “Yes” block was checked in item 10, please indicate the date.

  • Date of Injury (DN0031):For Date of Accident, if the employee or other relevant individual providing the data is uncertain about the exact date, use the earliest date about which there is some degree of certainty or the date that you received notice of the accident, whichever is earlier.

  • The Company shall develop facilities to send SMS / Mail alerts to Surveyors about their appointment containing Date of Accident, Claim Number, Mobile number of contact person and type of claim.

  • Written notice of Injury on which claim may be based must be given to Us within fourteen (14) days after the Date of Accident causing such Injury.

  • Date of Accident (if applicable) Date of Initial Examination by Provider Provider Name Provider Phone ( ) Provider Address City State ZIP If auto accident, the Claimant was: .

Related to Date of Accident

  • Policy Commencement Date means the date of commencement of the Policy as specified in the Schedule.

  • Benefit Commencement Date means, for any Participant or beneficiary, the date as of which the first benefit payment, including a single sum, from the Participant’s Account is due, other than pursuant to a withdrawal under Article VIII.

  • Occupation Date means the date upon which occupation of the Unit is tendered to the Purchaser, provided that such date shall not be prior to the issuing of the Occupancy Certificate for the Section by the relevant Authority and provided that such date shall not be prior the date the electricity is to be connected to the Section and subject to compliance of the provisions of clause 9.1 to the satisfaction of the Seller;

  • Employment Commencement Date means the date on which the Employee first performs an Hour of Service.

  • Date of Hire means the date on which a person shall perform his first Hour of Service. Notwithstanding the foregoing, in the event a person incurs one or more consecutive Breaks after his initial Date of Hire which results in the forfeiture of his pre-Break Service pursuant to Section 3.3, his "Date of Hire" shall thereafter be the date on which he completes his first Hour of Service after such Break or Breaks.

  • Date of Commercial Operation or “COD” means

  • Accumulation Commencement Date means January 1, 2021, or such later date as the Calculation Agent on behalf of the Issuer determines in accordance with Section 2.11 hereof.

  • Reemployment Commencement Date means the date on which an Employee who terminates employment with the Employer and all Related Employers first performs an Hour of Service following such termination of employment.

  • Date of Acceptance means the date, which appears on the Notice of Acceptance and if no date appears is the date on which the Principal sent the Notice of Acceptance accepting the Contractor’s Tender.

  • Date of Service means the date on which the client receives medical services or items, unless otherwise specified in the appropriate provider rules. For items that are mailed or shipped by the provider, the date of service is the date on which the order was received, the date on which the item was fabricated, or the date on which the item was mailed or shipped.

  • insurance period means a contribution period or an equivalent period;

  • Effective Date of Coverage means the date of commencement of Coverage in respect of a Life Insured under the Policy pursuant to the provision on Commencement of Coverage.

  • Pay Out Commencement Date means the date on which a Trust Pay Out Event is deemed to occur pursuant to Section 9.01 of the Agreement or a Series 2001-D Pay Out Event is deemed to occur pursuant to Section 7 hereof.

  • Date of Commencement means the date designated in the Notice to Proceed for Contractor to commence the Work.

  • Commencement Date of the Contract means the date of signing of the Contract between the Purchaser and the Contractor.

  • Policy Date means the date on which the Search Report was prepared.

  • Date of Lodging means the date this Decree is filed for lodging with the Clerk of the Court for the United States District Court for the District of Colorado.

  • Annuity Commencement Date means the first day of any month upon which an annuity begins under the Contract. However, for any Participant, this date shall not be later than the required beginning date as defined in the applicable sections of the Code and Regulations issued thereunder.

  • major accident means an incident involving loss of life inside or outside the establishment or ten or more injuries inside and/or one or more injuries outside or release of toxic chemical or explosion or fire or spillage of hazardous chemical resulting in ‘on-site’ or ‘off-site’ emergencies or damage to equipment leading to stoppage of process or adverse effect to the environment;

  • Normal Retirement Date means the later of the Normal Retirement Age or Termination of Employment.

  • Payment Commencement Date means the date payments of amounts deferred begin pursuant to Article III, Section 6.

  • Lease Commencement Date has the meaning specified in Section 3.2 of the Master Lease.

  • Billing Commencement Date means the earlier of:

  • Offer Commencement Date means the date on which Purchaser commences the Offer, within the meaning of Rule 14d-2 under the Exchange Act.

  • the commencement date means the date on which the Contract shall take effect, as notified by the Authority to the Contractor in a letter awarding the Contract.

  • Start Date for Term Calculation Purposes Only: Regardless of actual award/effective date of Contract, for Agreement “term” calculation purposes only, the Agreement “start date” is the last day of the month that Award Notifications are anticipated as published in the Solicitation. Example: If the anticipated award date published in the Solicitation is August 27, 2020 but extended negotiations delay award until September 24, 2020 the end date of the resulting initial “two-year” term Agreement, (which is subject to an extension(s)) will still be August 31, 2022 in this example