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{"sheet":"EMP Injury Form","index":0,"n_rows":37,"n_cols":8,"rows_kept":37,"cut":false,"hidden":false,"merged":[[30,3,30,7],[19,3,19,7],[16,5,16,7],[9,1,9,2],[21,0,21,1],[27,0,27,1],[29,0,29,2],[9,4,9,7],[11,1,11,2],[10,1,10,2],[15,1,15,2],[16,1,17,1],[14,1,14,2],[28,3,29,7],[0,0,0,7],[1,0,1,7],[2,0,2,7],[3,0,3,7],[5,6,5,7],[6,3,7,3],[12,3,12,7],[10,4,10,7],[20,3,20,7],[18,3,18,7],[17,3,17,7],[16,3,16,4],[8,4,8,6],[13,4,13,6],[14,4,14,6],[15,4,15,6],[36,0,37,0],[36,1,37,7],[25,0,25,1],[20,0,20,1],[24,0,24,1],[26,3,26,6],[34,3,34,7],[22,3,23,7],[21,3,21,7],[24,3,24,6],[33,3,33,7],[31,3,31,6],[32,3,32,7],[25,3,25,6],[35,3,35,6],[27,3,27,4]]}
["Cypress-Fairbanks Independent School District"]
["EMPLOYEE INJURY REPORT"]
["It is the responsibility of the injured employee's SUPERVISOR to have this form completed and"]
["e-mailed within 24 hours of the accident/injury to:  Deborah.Kreger@cfisd.net"]
[]
["LAST NAME","FIRST NAME","MIDDLE INITIAL","Date of Injury (mm-dd-yy)","Time Employee:",null,"Date Lost Time Began (mm-dd-yy)"]
[null,null,null,null,"Began Work"]
["Employee Number","Phone Number","Gender",null,"Was injured",null,null,"Date Injury Reported"]
[null,null,"CHOOSE ","Type of Claim Reporting:","CHOOSE FROM LIST BELOW"]
["Social Security Number","Building Assignment",null,"Nature (Type) of Injury:","CHOOSE FROM LIST BELOW"]
[null,"CHOOSE FROM LIST BELOW",null,"Cause of Injury:  ","CHOOSE FROM LIST BELOW"]
["Occupation Code","CHOOSE FROM LIST BELOW"]
[null,"Date of Birth (mm-dd-yy)","Employment Status","Part(s) of body Injured or Exposed,i.e. leg, arm, head, etc. (List most prominently injured part first.)"]
["CHOOSE FROM LIST BELOW",null,"CHOOSE FROM LIST"," (Injured part   #1) ","CHOOSE FROM LIST BELOW",null,null,"CHOOSE"]
["Title",null,null," (Injured part   #2) ","CHOOSE FROM LIST BELOW",null,null,"CHOOSE"]
["WC Classification Code","CHOOSE FROM LIST BELOW",null,"  (Injured part   #3) ","CHOOSE FROM LIST BELOW",null,null,"CHOOSE"]
["Specify language spoken",null,"Number of Dependent Children:","Initial Medical Treatment that applies",null,"CHOOSE FROM LIST BELOW"]
["CHOOSE FROM LIST",null,null,"Building Name Where Injury or Exposure occurred?"]
["Race","Ethnicity","Marital Status","CHOOSE FROM LIST BELOW"]
["CHOOSE FROM LIST","CHOOSE FROM LIST ","CHOOSE FROM LIST","Worksite location of injury (stairs, room #, etc)"]
["Employee's Mailing Address",null,"County"]
[null,null,null,"How and why did this injury occur? (Be very specific)"]
["City","State Abbreviation","ZIP Code"]
[]
["Spouse's Name",null,"Spouse's Work or Cell Phone","Was the employee doing his/her regular job when the accident/injury occurred?"]
[null,null,null,"Was the action that caused this injury appropriate for this employee's job?"]
["Doctor's Name for this Injury",null,"Doctor's Phone Number","Has the accident been investigated by the supervisor?"]
[null,null,null,"Were safeguards or safety equipment provided?",null,null,"Were they used?"]
["Doctor's Mailing Address",null,null,"List all equipment (including safety equipment), materials, and chemicals the employee was using when the accident or exposure occurred."]
[]
["City","State","ZIP Code"]
[null,null,null,"Has the employee been counseled about accident prevention & safety in regards to this accident?"]
["Supervisor's Name","Title","Supervisor's Phone Number","List Witnesses (Names and Phone Numbers)"]
[]
["Person completing this form","Title","Phone Number"]
[]
["Additional information you want to add:"]

{"sheet":"Sheet1","index":1,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Buildings","index":2,"n_rows":137,"n_cols":1,"rows_kept":137,"cut":false,"hidden":true,"merged":[]}
["CHOOSE FROM LIST BELOW"]
["OFF DISTRICT SITE - ODS"]
["ADAM ES - 107"]
["ADAPTIVE BEHAVIOR CENTER - 860"]
["AG CENTER @ ELDRIDGE - 924"]
["AG CENTER @ TELGE - 925"]
["AG CENTER @ WESTGREEN - 927S"]
["ALTERNATIVE LEARN CTR-E - 006"]
["ALTERNATIVE LEARN CTR-W - 014"]
["ANDRE' ES - 146"]
["ANTHONY MS - 058"]
["ARAGON MS - 051"]
["ARENA & EXHIBIT CENTER @ SRC - 913b"]
["ARNOLD MS - 041"]
["AULT ES - 133 "]
["BANE ES - 101"]
["BANG ES - 125"]
["BARKER-CYPRESS TRANS CTR - 922"]
["BARKER EARLY LEARN CTR-922"]
["BERRY EDUC SUPT CTR - 929"]
["BIRKES ES - 139"]
["BLACK ES - 148"]
["BLEYL MS - 043"]
["BRAUTIGAM CTR - 008"]
["BRIDGELAND HS - 016"]
["BROSNAHAN ES - 161"]
["CAMPBELL MS - 044"]
["CARLTON CENTER - 040"]
["COOK MS - 047"]
["COPELAND ES - 130"]
["CY-FAIR ANNEX - 802"]
["CY-FAIR HS - 002"]
["CYPRESS CREEK HS - 004"]
["CYPRESS FALLS HS - 007"]
["CYPRESS LAKES HS - 013"]
["CYPRESS PARK HS - 015"]
["CYPRESS RANCH HS - 012"]
["CYPRESS RIDGE HS - 010"]
["CYPRESS SPRINGS HS - 009"]
["CYPRESS WOODS HS - 011"]
["DANISH ES- 145"]
["D.A.R.E. BUILDING @ SECURITY - 926B"]
["DEAN MS - 042"]
["DURYEA ES - 142"]
["EARLY LEARNING CTR @ ANDRE' - 956S"]
["EARLY LEARNING CTR I - 953"]
["EARLY LEARNING CTR II - 954"]
["ELDRIDGE EARLY LEARN CTR-924"]
["ELDRIDGE TRANSP - 924"]
["EMERY ES - 154"]
["EMMOTT ES - 120"]
["FALCON TRANSPORTATION CTR - 920"]
["FALCON EARLY LEARN CTR-920"]
["FARNEY ES - 135"]
["FIEST ES - 124"]
["FOOD PRODUCTION CENTER - 910"]
["FOOD PRODUCTION RECYCLING CTR - 910R"]
["FOOD PRODUCTION WAREHOUSE - 910W"]
["FOOD SERV VENDING WHOUSE ANNEX - 914"]
["FRANCONE ES - 112"]
["FRAZIER ES - 117"]
["GLEASON ES - 136"]
["GOODSON MS - 052"]
["HAIRGROVE ES - 128"]
["HAMILTON ES - 126"]
["HANCOCK ES - 108"]
["HEMMENWAY ES - 151"]
["HOLBROOK ES - 106"]
["HOLMSLEY ES - 121"]
["HOOVER ES - 159"]
["HOPPER MS - 055"]
["HORNE ES - 113"]
["INSTRUCT SUPPORT CTR - NORTH - 950N"]
["INSTRUCT SUPPORT CTR - SOUTH - 950S"]
["INSTRUCT SUPPORT CTR - WEST - 950W"]
["JERSEY VILLAGE HS - 003"]
["JARVIS TRANSPORTATION CTR - 546"]
["JOWELL ES - 122"]
["KAHLA MS - 053"]
["KEITH ES - 143"]
["KIRK ES - 134"]
["LABAY MS - 046"]
["LAMKIN ES - 103"]
["LANGHAM CREEK HS 005"]
["LEE ES - 144"]
["LIEDER ES - 111"]
["LOWERY ES - 116"]
["MAINTENANCE/OPERATIONS CENTER - 907"]
["MARK HENRY ADMIN BUILDING - 960"]
["MCFEE ES - 150"]
["MCGOWN ES - 160"]
["METCALF ES - 127"]
["MILLSAP ES - 110"]
["MOORE ES - 115"]
["NATURE TRAILS @ MILLSAP ES"]
["NEW MATZKE - 105N"]
["O HAMILTON MS - 049"]
["OWENS ES - 119"]
["POLICE DEPT - 926A"]
["POPE ES - 156"]
["POST ES - 104"]
["POSTMA ES - 147"]
["PRIDGEON NATATORIUM - 902"]
["PRIDGEON STADIUM - 401"]
["RECORDS & REPAIR CT (Falcon Annex) - 952"]
["REED ES - 129"]
["RENNELL ES - 155"]
["R.O.P.E.S. COURSE @ MILLSAP ES"]
["R.O.P.E.S. COURSE @ MOORE ES"]
["R.O.P.E.S. COURSE @ SHERIDAN ES"]
["ROBINSON ES - 152"]
["ROBISON ES - 140"]
["ROWE MS - 059"]
["SALYARDS MS - 057"]
["SAMPSON ES - 138"]
["SCIENCE RESOURCE CENTER - 913A"]
["SHERIDAN ES - 132"]
["SMITH MS - 056 "]
["SPILLANE MS - 054"]
["SPRAGUE MS - 063"]
["BROS"]
["TELGE TRANSPORTATION CTR - 921"]
["TELGE EARLY LEARN CTR-921"]
["THORNTON MS - 050"]
["TIPPS ES - 141"]
["TRUITT MS - 048"]
["VISUAL PERFORMING ARTS CENTER - 961"]
["WALKER ES - 137"]
["WARNER ES - 149"]
["WATKINS MS - 045"]
["WELLS ES - 158"]
["WESTGREEN TRANSPORTATION - 918"]
["WILLBERN ES - 131"]
["WILSON ES - 118"]
["WINDFERN ANNEX/DISTRIBUTION CTR  - 908"]
["WOODARD ES - 157"]
["YEAGER ES - 109"]

{"sheet":"Responses","index":3,"n_rows":51,"n_cols":3,"rows_kept":51,"cut":false,"hidden":true,"merged":[]}
["CHOOSE ","CHOOSE FROM LIST","CHOOSE FROM LIST BELOW"]
["FEMALE","SINGLE","010 PROFESSIONAL/PARAPROFESSIONAL"]
["MALE","MARRIED","020 MAINTENANCE (Hourly)"]
[null,"DIVORCED","030 NUTRITION SERVICE (Hourly)"]
["CHOOSE","WIDOWED","040 CUSTODIAL (Hourly)"]
["AM","SEPARATED","050 DRIVERS & MECHANICS (Hourly)"]
["PM","UNKNOWN"]
[]
[null,"CHOOSE FROM LIST BELOW","CHOOSE FROM LIST"]
[null,"NO MEDICAL TREATMENT","REGULAR (Full Time Emp)"]
[null,"MINOR BY CAMPUS NURSE","PART-TIME EMPLOYEE"]
[null,"MINOR BY CLINIC/HOSPITAL","SUBSTITUTE"]
["CHOOSE","EMERGENCY CARE","STUDENT TEACHER"]
["YES",null,"TEMPORARY WORKER"]
["NO",null,"VOLUNTEER (Not-employee)"]
[]
[null,"CHOOSE FROM LIST","CHOOSE FROM LIST BELOW"]
[null,"WHITE","INCIDENT REPORT ONLY"]
["CHOOSE","BLACK","MEDICAL SERVICES ONLY"]
["NONE","ASIAN","MEDICAL SERVICES  & LOST TIME "]
["RIGHT","OTHER"]
["LEFT",null,"CHOOSE FROM LIST BELOW"]
["LOWER","CHOOSE FROM LIST ","010 ADMINISTRATOR"]
["MIDDLE","HISPANIC","010 PARA CLASSROOM AIDE"]
["UPPER","NATIVE AMERICAN","010 PARA CLERICAL"]
["BOTH","OTHER","010 PARA SP ED AIDE"]
[null,null,"010 TEACHER, REGULAR"]
[null,"CHOOSE FROM LIST BELOW","010 TEACHER, SP ED"]
[null,"7380 BUS DRIVER/MECHANIC","010 OTHER PROFESSIONAL"]
[null,"8868 PROFESSIONAL & PARAPROFESSIONAL","010 SUB - ADMIN, TEACHER or PARA"]
[null,"9101 ALL OTHERS","010 SUB - SP ED TEACHER or AIDE"]
[null,null,"010 STUDENT EMPLOYEE"]
[null,"CHOOSE FROM LIST","020 CRAFTSMAN (Hourly)"]
[null,"ENGLISH","020 GROUNDS CREWMAN (Hourly)"]
[null,"SPANISH","020 MAINTENANCE MAN (Hourly)"]
[null,"VIETNAMESE","020 MAIL CARRIER (Hourly)"]
[null,"OTHER","020 POLICE OFFICER"]
[null,null,"020 PRINTING TECH (Hourly)"]
[null,null,"020 SECURITY (Hourly)"]
[null,null,"020 WAREHOUSEMAN (Hourly)"]
[null,null,"030 FOOD PROD CTR (Hourly)"]
[null,null,"030 NUTRITION SERVICE CAMPUS STAFF"]
[null,null,"030 NUTRITION SERVICE ANNEX STAFF"]
[null,null,"030 NUTRITION SERVICE SUBSTITUTE"]
[null,null,"040 CUSTODIAN"]
[null,null,"040 CUSTODIAN SUBSTITUTE"]
[null,null,"040 POOL TECH"]
[null,null,"050 BUS DRIVER"]
[null,null,"050 BUS ATTENDANT"]
[null,null,"050 DRIVER SUBSTITUTE"]
[null,null,"050 TRANSPORTATION MECHANIC"]

{"sheet":"Occupation Codes","index":4,"n_rows":5,"n_cols":1,"rows_kept":5,"cut":false,"hidden":true,"merged":[]}
["010 Professional / Cleriacal / Admin"]
["020 Building Maintenance"]
["030 Nutrition Service"]
["040 Custodial"]
["050 Driver & Vehicle Maintenance"]

{"sheet":"Nature (Type) of Injury","index":5,"n_rows":53,"n_cols":1,"rows_kept":53,"cut":false,"hidden":true,"merged":[]}
["CHOOSE FROM LIST BELOW"]
["01   No Physical Injury"]
["02   Amputation"]
["03   Angina Pectoris"]
["04   Burn"]
["07   Concussion"]
["10  Contusion (Bruise)"]
["13  Crushing"]
["16  Dislocation"]
["19  Electric Shock"]
["22 Enucleation"]
["25  Foreign Body"]
["28  Fracture"]
["29  Not Used"]
["30  Freezing"]
["31  Hearing Loss or Impairment"]
["32  Heat Prostration"]
["34  Hernia"]
["36  Infection"]
["37  Inflammation"]
["40  Laceration  (skin cut)"]
["41  Myocardial Infraction"]
["42  Poisoning-Not OD or Cumulative"]
["43  Puncture"]
["47  Severance"]
["49  Sprain"]
["52  Strain"]
["53  Syncope"]
["54  Asphyxiation"]
["55  Vascular Loss"]
["58  Vision Loss"]
["59  All Other"]
["60  Dust Disease NOC"]
["61  Asbestosis"]
["62  Black Lung"]
["63  Byssinosis"]
["64  Silicosis"]
["65  Respiratory Disorders (Fumes)"]
["66  Poisoning-Chemical; Not Metals"]
["67  Metal Poisoning"]
["68  Dermatitis"]
["69  Mental Disorder"]
["71  All Other Occupation Disease"]
["72  Loss of Hearing"]
["73  Contagious Disease"]
["74  Cancer"]
["75  AIDS"]
["76  VDT - Related Disease"]
["77  Mental Stress"]
["78  Carpel Tunnel Syndrome"]
["80  All Other Cumulative Injuries"]
["90  Multiple Injuries-Physical Only"]
["91  Multiple Injuries-Physical Psych"]

{"sheet":"Cause of Injury","index":6,"n_rows":73,"n_cols":1,"rows_kept":73,"cut":false,"hidden":true,"merged":[]}
["CHOOSE FROM LIST BELOW"]
["01 Chemicals"]
["02 Hot Objects of substances"]
["03 Temperature Extremes"]
["04 Fire or Flame"]
["05 Steam or Hot Fluids"]
["06 Dust, Gases, Fumes or Vapors"]
["07 Welding Operations"]
["08 Radiation"]
["09 Burn: Miscellaneous"]
["10 Caught In/Between Machine(ry)"]
["11 Cold Objects of Substances"]
["12 Caught In/Between Obj. Handled"]
["13 Caught In/Between/Under, NOC"]
["14 Abnormal Air Pressure"]
["15 Cut/Scrape by Broken Glass"]
["16 Cut/Scrape by Hand Tool"]
["17 Object Being Lifted or Handled"]
["18 Cut/Scrape Power Tool"]
["19 Cut/Scrape Miscellaneous"]
["20 Collapsing Materials"]
["25 Fall/Slip From Diff. Level"]
["26 Fall/Slip From Ladder/Scaffold"]
["27 Fall/Slip From Grease/Liquid"]
["28 Fall/Slip: Into Openings"]
["29 Fall/Slip on Same Level"]
["30 Slipped, Did Not Fall"]
["31 Fall.Slip Miscellaneous"]
["32 Fall/Slip: On Ice or Snow"]
["33 Fall/Slip: On Stairs"]
["40 Crash of Water Vehicle"]
["41 Crash of Rail Vehicle"]
["45 Collision With Another Vehicle"]
["46 Collision With Fixed Object"]
["47 Crash of Airplane"]
["48 Vehicle Upset"]
["50 Motor Vehicle Miscellaneous"]
["52 Strain/Injury: Continual Noise"]
["53 Strain/Injury: Twisting"]
["54 Strain/Injury: Jumping"]
["55 Strain/Injury: Hold or Carry"]
["56 Strain/Injury: Lifting"]
["57 Strain/Injury: Push or Pull"]
["58 Strain/Injury: Reaching"]
["59 Strain/Injury: Using Tool/Mach"]
["60 Strain/Injury: Miscellaneous"]
["61 Strain/Injury: Wield or Throw"]
["65 Strike/Step Moving Parts"]
["66 Strike/Step Obj Lifted/Used"]
["67 Strike/Step Sand, Scrape, clean"]
["68 Strike/Step Stationary Obj."]
["69 Stepping on Sharp Object"]
["70 Strike/Step Miscellaneous"]
["74 Struck/Injured: Fellow Worker"]
["75 Struck/Injured: Falling Object"]
["76 Struck/Injured: Tools"]
["77 Struck/Injured: Vehicle"]
["78 Struck/Injured: Moving Machine"]
["79 Struck/Injured: Obj. Lifted"]
["80 Struck/Injured: Obj. HDLD. OTH"]
["81 Struck/Injured: Miscellaneous"]
["82 Absorbed/Ingested/Inhaled NOC"]
["84 Contact With Electric Current"]
["85 Animal or Insect"]
["86 Explosion or Flare Back"]
["87 Foreigh Body in Eye"]
["89 Person in Act of a Crime"]
["90 Not a Physical Cause of Injury"]
["94 Rubbed/Abraded: Repetitive Motion"]
["95 Rubbed/Abraded: Miscellaneous"]
["97 Strain/Injury: Repetitive Motion"]
["98 Cumulative (All Other)"]
["99 Other"]

{"sheet":"Body Part","index":7,"n_rows":58,"n_cols":3,"rows_kept":58,"cut":false,"hidden":true,"merged":[]}
["CHOOSE FROM LIST BELOW",null,"CHOOSE FROM LIST BELOW"]
["10  Multiple Head Injury",null,"00  No other part injured"]
["11  Skull",null,"10  Multiple Head Injury"]
["12  Brain",null,"11  Skull"]
["13  Ear(s)",null,"12  Brain"]
["14  Eye(s)",null,"13  Ear(s)"]
["15  Nose",null,"14  Eye(s)"]
["16  Teeth",null,"15  Nose"]
["17  Mouth",null,"16  Teeth"]
["18  Soft Tissue: Head",null,"17  Mouth"]
["19  Facial Bones",null,"18  Soft Tissue: Head"]
["20  Multiple Neck Injury",null,"19  Facial Bones"]
["21  Neck Vertebrae",null,"20  Multiple Neck Injury"]
["22  Neck Disc",null,"21  Neck Vertebrae"]
["23  Spinal Cord (Neck)",null,"22  Neck Disc"]
["24  Larynx",null,"23  Spinal Cord (Neck)"]
["25  Soft Tissue:  Neck",null,"24  Larynx"]
["26  Trachea",null,"25  Soft Tissue:  Neck"]
["30  Multiple Upper Extremities",null,"26  Trachea"]
["31  Upper Arm, Clav, Scapula",null,"30  Multiple Upper Extremities"]
["32  Elbow",null,"31  Upper Arm, Clav, Scapula"]
["33  Lower Arm",null,"32  Elbow"]
["34  Wrist",null,"33  Lower Arm"]
["35  Hand",null,"34  Wrist"]
["36  Finger(s)",null,"35  Hand"]
["37  Thumb",null,"36  Finger(s)"]
["38  Shoulder(s)",null,"37  Thumb"]
["39  Wrist(s) and Hand(s)",null,"38  Shoulder(s)"]
["40  Multiple Truck",null,"39  Wrist(s) and Hand(s)"]
["41  Upper Back Area (Thoracic)",null,"40  Multiple Truck"]
["42  Lower Back (Lumbar/Lumbo-Sacral)",null,"41  Upper Back Area (Thoracic)"]
["43  Disc: Truck",null,"42  Lower Back (Lumbar/Lumbo-Sacral)"]
["44  Chest, Ribs, Sternum, Soft Tissue",null,"43  Disc: Truck"]
["45  Sacrum and Coccyx",null,"44  Chest, Ribs, Sternum, Soft Tissue"]
["46  Pelvis",null,"45  Sacrum and Coccyx"]
["47  Spinal Cord",null,"46  Pelvis"]
["48  Internal Organs",null,"47  Spinal Cord"]
["49  Heart",null,"48  Internal Organs"]
["50  Multiple Lower Extremities",null,"49  Heart"]
["51  Hip",null,"50  Multiple Lower Extremities"]
["52  Upper Leg",null,"51  Hip"]
["53  Knee",null,"52  Upper Leg"]
["54  Lower Leg",null,"53  Knee"]
["55  Ankle",null,"54  Lower Leg"]
["56  Foot",null,"55  Ankle"]
["57  Toe(s)",null,"56  Foot"]
["58  Great Toe",null,"57  Toe(s)"]
["60  Lungs",null,"58  Great Toe"]
["61  Abdomen Including Groin",null,"60  Lungs"]
["62  Buttocks",null,"61  Abdomen Including Groin"]
["63  Lumbar and/or Sacral Vertebra",null,"62  Buttocks"]
["64 Artificial Appliance",null,"63  Lumbar and/or Sacral Vertebra"]
["65  Insufficient Info to Identify",null,"64 Artificial Appliance"]
["66  No Physical Injury",null,"65  Insufficient Info to Identify"]
["90  Multiple Body Parts",null,"66  No Physical Injury"]
["91  Body Systems-Single and Multiple",null,"90  Multiple Body Parts"]
["99  Whole Body Impairment",null,"91  Body Systems-Single and Multiple"]
[null,null,"99  Whole Body Impairment"]