Defining Serious Harm
Appendix 3: Input record format for prescribed manner of written notice to Department of Labour of serious harm
Sub-category: Employer details
| Field | Field Name | Format | Required | Editing rules |
|---|---|---|---|---|
| 1 | Business name | X(60) | Yes | |
| 2 | Business address 1 | X(30) | Yes | |
| 3 | Business address 2 | X(30) | Yes | |
| 4 | Business address 3 | X(30) | Yes | |
| 5 | Postcode | 9(4) | Yes | Valid values: NZ Post Postcodes www.nzpost.net.nz/nzpost/control/business/postcode_finder#post_code_finder |
| 6 | Relationship to injured person | X(1) | Yes | Valid values: E employer P principal S/E self-employed |
| 7 | ACC number | 9(9) | See above | |
| 8 | Industry of person completing | X(30) 9(4) |
Yes | NZSIC code (from text description) |
| 9 | Surname of person completing | X(30) | Yes | |
| 10 | Other names of person completing | X(60) | Yes | |
| 11 | Title of person completing | X(30) | No | |
| 12 | Contact phone number | 9(9) | No | Phone no. (incl. area code) |
| 13 | Signature | X(1) | Yes | Valid fields Y yes N no |
| 14 | Date of completion | DDMMYYYY | Yes |
Sub-category: Injured person details
| Field | Field Name | Format | Required | Editing rules |
|---|---|---|---|---|
| 1 | Surname | X(30) | Yes | |
| 2 | Other names | X(60) | Yes | |
| 3 | Date of birth | DDMMYYYY | Yes | Important for interaction and verification of records with injury manager and NZHIS |
| 4 | Sex | X(1) | Yes | Valid values M - Male F - Female. |
| 5 | Ethnicity | 9(2) | Yes | |
| 6 | Home address 1 | X(30) | Yes | |
| 7 | Home address 2 | X(30) | Yes | |
| 8 | Home address 3 | X(30) | Yes | |
| 9 | Postcode | 9(4) | Yes | Valid values: NZ Post Postcodes www.nzpost.net.nz/nzpost/control/business/postcode_finder#post_code_finder |
| 10 | Contact phone number | 9(9) | No | Phone no. incl. area code |
| 11 | Occupation or job title of injured person (where applicable) | X(30) | Yes | Alternatively, could be coded as NZSC095, 5-digit identifier |
| 12 | Employment status of injured person (where applicable) | 9(2) | Yes | Valid fields: To be derived from existing fields on form |
| 13 | Duration of employment of injured person (where applicable) | 9(3) | Yes | Numerical codes attached to existing categories |
Sub-category: Cause/agency of harm details
| Field | Field Name | Format | Required | Editing rules |
|---|---|---|---|---|
| 1 | Location of place of work (text description) | X(3000) into 9(3) |
Yes | Could translate description into NDS-IS But translated code for statistical purposes May need clearer prescription of location description |
| 2 | Time of accident/serious harm | HHMM | No | Not necessary where it is a case of serious harm other than an injury related to a specific accident or event |
| 3 | Date of accident/serious harm | DDMMYYYY | Yes | Not necessary where it is a case of serious harm other than an injury related to a specific accident or event |
| 4 | Shift | X(1) | Yes | Valid values D day A afternoon N night |
| 5 | Period (hours) at work before harm occurred | 9(2) | Yes | |
| 6 | Mechanism of accident/serious harm | 9(2) | Yes | Department of Labour mechanism of injury codes The mechanism or action that caused the injury See below |
| 7 | Agency of harm | 9(3) | Yes | Department of Labour agency codes The object or condition that caused the injury See below |
| 8 | How the accident/harm happened (text description) | X(3000) into 9(3) |
Yes | Text description in the respondent's own but translated words, and which will inform the completion of the agency and mechanism fields by the Department of Labour staff member completing the data entry. |
| 9 | Has a formal investigation been carried out? | X(1) | Yes | Valid values: Y yes N no |
| 10 | Was a significant hazard involved? | X(1) | Yes | Valid values: Y yes N no |
Sub-category: Injury details
| Field | Field Name | Format | Required | Editing rules |
|---|---|---|---|---|
| 1 | Fatal | X(1) | Yes | Valid values: Y yes N no |
| 2 | Date of death (if applicable) |
DDMMYYYY | If Y above | |
| 3 | Body part | 9(2) | Yes | Valid values: Refer to ACC injury site codes |
| 4 | Nature of injury or disease | 9(2) | Yes | Valid values: as described above |
| 5 | Level of treatment given | 9(1) | Yes | Valid values: Tick boxes: Nil First-aid Doctor (not hospitalised) Medical specialist Hospital admission |