Enter, or use to select, the previously saved internal case number established on the Manage Accident Information screen. 

This field displays the ID number and name of the employee for whom you are recording an accident or illness. This non-editable information comes from the Manage Accident Information screen.

This non-editable field displays the filing number that was assigned to this case by the state Workers' Compensation Office. This information comes from the Workers Compensation tab of the Manage Accident Information screen.

This non-editable field displays the OSHA Case Number from the OSHA 200 or OSHA 300 subtask of the Manage Accident Information screen.

Enter, or use to select, the code being used for FMLA tracking. A description of the code is displayed to the right. This is a required field.

Click and enter the date, in MM/DD/YYYY format, on which an action or processing step was completed for this injury/illness for this employee. This is a required field.

Enter, or use to select, the code for the accident-processing step you want to record. This is a required field.

This non-editable field displays the description of the step you entered.

Use the drop-down list to indicate whether the employee was transferred or terminated as a result of this accident or illness. Valid options are:

• None
• Transferred
• Terminated