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WORK INJURY CI &SSIFIC1TIONS <br />CAUGHT IN, ON OR BETWEEN <br />41 Machine or machine parts <br />42 Other mechanical apparatus <br />43 Objects being handled and other objects <br />44 Other (describe on form) <br />CONTACT WITH TEMPERATURE EXTREMES <br />51 Steam or hot fluids <br />52 Welding flash <br />53 Hot or molten metal <br />54 Frostbite, heat exhaustion, heat stroke, hypothermia, <br />etc. <br />INHALATION, ABSORPTION, SWALLOWING <br />61 Absorption or other skin contact with substance <br />62 Breathing gases, vapors, fumes, or dust <br />63 Swallowing substances <br />64 Poisonous plants <br />MISCELLANEOUS <br />91 Accident involving moving motor vehicle (lift truck, <br />backhoe, etc.) <br />92 Foreign body in eye <br />93 Insect bite <br />94 Animal bite <br />95 Contact with electrical current <br />96 Assault <br />97 Other (describe on form) <br />STRUCK BY OBJECT <br />01 Hand tool or machine in use <br />02 Falling or flying object <br />03 Tipping, sliding, or rolling object <br />04 Object handled by other person <br />05 Other (describe on form) <br />STRAIN <br />11 In lifting <br />12 In using tool or machine <br />13 In pushing or pulling <br />14 In holding or canying <br />15 In reaching and bending <br />FALL OR SLIP <br />21 On same level <br />22 To or from different levels (stairs, <br />dock, scaffold, ladder, etc.) <br />23 Slip, loss of balance (no contact) <br />STRIKING AGAINST OBJECT <br />31 Object being handled <br />32 Contact with sharp object <br />33 Stationary object <br />34 Moving parts of machine <br />PART OF BODY <br />01 Head 21 Left hip <br />02 Face 22 Right hip <br />03 Teeth 23 Buttocks <br />04 Left ear 24 Left leg <br />05 Right ear 25 Right leg <br />06 Left eye 26 Left knee <br />07 Right eye 27 Right knee <br />08 Neck 28 Left ankle <br />09 Left shoulder 29 Right ankle <br />10 Right shoulder 30 Left foot <br />11 Left arm 31 Right foot <br />12 Right arm 32 Toes-left foot <br />13 Left elbow 33 Toes-right foot <br />14 Right elbow 34 Chest <br />15 Left wrist 35 Abdomen <br />16 Right wrist 36 Groin <br />17 Left hand 37 Upper back <br />18 Right hand 38 Middle back <br />19 Fingers-left hand 39 Lower back <br />20 Fingers-right hand 40 Pelvis <br />TYPE OF INJURY/ILLNESS <br />01 Cut <br />02 Bump/bruise <br />03 Puncture wound <br />04 Scratch/scrape <br />05 Strain/sprain <br />06 Muscular/skeletal disorder (carpal tunnel, tendentious, etc.) <br />07 Hernia <br />08 Fracture <br />09 Dislocation <br />10 Amputation <br />11 Burn-thermal <br />12 Burn-chemical <br />13 Electrical shock <br />14 Foreign body <br />15 Rash/dermatitis <br />16 Dust disease of the lung <br />17 Respiratory conditions due to toxic agent <br />18 Poisoning (lead, carbon monoxide, etc.) <br />19 Disorder due to physical agents (heat stroke, noise, etc.) <br />20 Skin disorder or disease