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@ Suffolk Law School Last updated 2023-04-02

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Microsoft Word - III Employers First Report of Injury.REV.03.31.2014

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Alabama state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

  • Sourced from eforms.alacourt.gov (2023-03)
  • Page(s): 1
  • Fields(s): 89
  • Average fields per page: 89
  • Reading Level: Grade 6
  • LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

 
 
 

Here are the fields we could identify.

  • ssn was 2 SSN (0.56 conf)
  • undefined__1 was undefined (0.38 conf)
  • undefined__2 was undefined_2 (0.39 conf)
  • date_birth was 3 Date of Birth (0.35 conf)
  • undefined__3 was undefined_3 (0.39 conf)
  • undefined__4 was undefined_4 (0.39 conf)
  • from was From (0.41 conf)
  • to was To (0.43 conf)
  • work was Work (0.37 conf)
  • employee_email_address was 8 Employee Email address (0.38 conf)
  • employing_agency_number was 10 Employing Agency Agency Number (0.44 conf)
  • division_location_etc was 11 Division District Location etc (0.31 conf)
  • date_injury was 13 Date of Injury (0.41 conf)
  • date_employer_notified was 14 Date Employer Notified (0.41 conf)
  • undefined__5 was undefined_6 (0.39 conf)
  • yes_taken_prevent_another was If yes what steps have been taken to prevent another accident (0.41 conf)
  • yes_name_address was If yes name and address of medical providerfacility (0.38 conf)
  • room_parking_lot_possible was 20 Exact location where injury occurred include street address building room parking lot etc if possible (0.39 conf)
  • yes_provide_names was If yes provide names (0.45 conf)
  • describe_accident_occurred was 23 Describe exactly what the injured employee was doing and how the accident occurred (0.45 conf)
  • strain_twist_pull_etc_give was strain twist pull etc Give details below 1 (0.32 conf)
  • d_other was D Other (0.33 conf)
  • users1_name was Name (1.00 conf)
  • daytime_phone__1 was Daytime Phone (0.38 conf)
  • name was Name_2 (0.30 conf)
  • daytime_phone__2 was Daytime Phone_2 (0.33 conf)
  • supervisor_reporting_incident was 26 Signature of supervisor reporting incident (0.43 conf)
  • daytime_phone__3 was Daytime Phone_3 (0.33 conf)
  • signature_date was Date (1.00 conf)
  • employee_mailing_address was Employee Mailing Address (0.35 conf)
  • employee_address_city was Employee Address City (0.34 conf)
  • employee_address_state was Employee Address State (0.41 conf)
  • employee_zip_code was Employee Zip Code (0.28 conf)
  • m was M (0.30 conf)
  • f was F (0.34 conf)
  • am was AM (0.45 conf)
  • pm was PM (0.35 conf)
  • check_box__1 was Check Box34 (0.37 conf)
  • check_box__2 was Check Box35 (0.37 conf)
  • check_box__3 was Check Box36 (0.37 conf)
  • check_box__4 was Check Box37 (0.37 conf)
  • check_box__5 was Check Box38 (0.37 conf)
  • check_box__6 was Check Box39 (0.37 conf)
  • text was Text42 (0.35 conf)
  • check_box__7 was Check Box43.0 (0.37 conf)
  • check_box__8 was Check Box43.2 (0.37 conf)
  • check_box__9 was Check Box43.3 (0.37 conf)
  • check_box__10 was Check Box43.4 (0.37 conf)
  • check_box__11 was Check Box43.5 (0.37 conf)
  • check_box__12 was Check Box1.0.0 (0.37 conf)
  • check_box__13 was Check Box1.0.1 (0.37 conf)
  • check_box__14 was Check Box1.0.2 (0.37 conf)
  • check_box__15 was Check Box1.1.0 (0.37 conf)
  • check_box__16 was Check Box1.1.1 (0.37 conf)
  • check_box__17 was Check Box1.1.2 (0.37 conf)
  • check_box__18 was Check Box1.2.2 (0.37 conf)
  • y0 was Y0 (0.42 conf)
  • n__1 was N0 (0.37 conf)
  • y1 was Y1 (0.34 conf)
  • n__2 was N1 (0.34 conf)
  • y2 was Y2 (0.34 conf)
  • n__3 was N2 (0.34 conf)
  • check_box__19 was Check Box65 (0.37 conf)
  • check_box__20 was Check Box64 (0.37 conf)
  • check_box__21 was Check Box63 (0.37 conf)
  • check_box__22 was Check Box62 (0.37 conf)
  • check_box__23 was Check Box61 (0.37 conf)
  • check_box__24 was Check Box60 (0.37 conf)
  • check_box__25 was Check Box59 (0.37 conf)
  • check_box__26 was Check Box58 (0.37 conf)
  • check_box__27 was Check Box57 (0.37 conf)
  • check_box__28 was Check Box56 (0.37 conf)
  • check_box__29 was Check Box55 (0.37 conf)
  • check_box__30 was Check Box54 (0.37 conf)
  • check_box__31 was Check Box53 (0.37 conf)
  • check_box__32 was Check Box52 (0.37 conf)
  • check_box__33 was Check Box51 (0.37 conf)
  • check_box__34 was Check Box50 (0.37 conf)
  • check_box__35 was Check Box49 (0.37 conf)
  • home was Home (0.41 conf)
  • cell was Cell (0.45 conf)
  • users1_address_line_one was Address (1.00 conf)
  • users1_address_city was City (1.00 conf)
  • users1_address_state was State (1.00 conf)
  • users1_address_zip was Zip (1.00 conf)
  • job_title_code was 7 Job Title Job Code (0.36 conf)
  • employee_number was Employee Number (0.41 conf)
  • print_name was Print Name (0.42 conf)
  • supervisor_email was SupervisorEmail (0.37 conf)

Create an Interactive Version of this Form:

The Weaver creates a draft guided interview from a template form, like the one provided here. You can use the link below to open this form in the Weaver. To learn more, read "Weaving" your form into a draft interview.

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