Files > WITNESS NAME

parent

2260

name

WITNESS NAME

number

2260.0125

Fields

#	Name	Location	Type	Details	Index	Description
.01	witness name	0;1	FREE TEXT		B	Enter the name of the individual that witnessed the incident. Note: Only the first witness entered will be transmitted to DOL (Department of Labor) electronically. Therefore, enter the witness information that you want to be transmitted electronically. Other witness data may be submitted via hard copy to DOL. The name must be entered in the following format: LASTNAME,FIRSTNAME with no spaces in the last name.
1	witness address	0;2	FREE TEXT			This is the address of the individual who witnessed the incident where they can be contacted, if necessary.
2	witness city	0;3	FREE TEXT			This is the City portion of the Witness's address where they can be contacted, if necessary.
3	witness state	0;4	POINTER	5		This is the State portion of the Witness's address where they can be contacted, if necessary.
4	witness zip code	0;5	FREE TEXT			This is the Zip Code portion of the Witness's address where they can be contacted, if necessary.
5	date of witness signature	0;6	DATE-TIME			Enter the date that the Witness signed the Witness Statement
6	witness statement	1;1	FREE TEXT			This is the Statement that the Witness has provided concerning details of the incident and what occurred.