{"id":62,"date":"2023-03-15T08:06:07","date_gmt":"2023-03-15T08:06:07","guid":{"rendered":"https:\/\/www.ovfgportalehs.com\/?page_id=62"},"modified":"2025-07-15T08:17:12","modified_gmt":"2025-07-15T07:17:12","slug":"62-2","status":"publish","type":"page","link":"https:\/\/www.ovfgportalehs.com\/?page_id=62","title":{"rendered":"Enter H&#038;S Event Information"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_ov-style-light\" id=\"frm_form_3_container\" data-token=\"dfbb95457e7eb0fc665ed664bdc5112b\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_investigationform\" data-token=\"dfbb95457e7eb0fc665ed664bdc5112b\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Investigation Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"investigationform\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"b81a708292\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F62\" \/><div id=\"frm_field_84_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">GDPR Caution:<\/h3>\r\n\r\n\r\n<div id=\"frm_field_82_container\" class=\"frm_form_field  frm12 frm_html_container form-field\">\n<p style=\"color: palevioletred;\">Do not enter any identifying information regarding employees (names, addresses etc). Only information in the public domain can be used, ie. manager names and job titles.\u00a0Employees should either be referred to as (IP) Injured Party or by their Employee Number.<\/p>\n<\/div>\n<\/div>\n<div id=\"frm_field_20_container\" class=\"frm_form_field frm_section_heading form-field  frm3 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Incident Type:<\/h3>\r\n\r\n\r\n<div id=\"frm_field_49_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_l444t\" id=\"field_l444t_label\" class=\"frm_primary_label\">Site Name:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select  name=\"item_meta[49]\" id=\"field_l444t\"  data-sectionid=\"20\"  data-invmsg=\"Site Name: is invalid\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"OV | Harrogate\">\n\t\t\t\t\tOV | Harrogate\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"OV | St Ives\">\n\t\t\t\t\tOV | St Ives\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm12 frm_first vertical_radio\">\r\n    <div  id=\"field_j9rqv_label\" class=\"frm_primary_label\">Incident Type RadioB\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_j9rqv_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_22-20-0\">\t\t\t<label  for=\"field_j9rqv-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[22][]\" id=\"field_j9rqv-0\" value=\"Accident\"  data-sectionid=\"20\"  data-reqmsg=\"Incident Type RadioB cannot be blank.\" data-invmsg=\"Incident Type RadioB is invalid\"   aria-required=\"true\"  \/> Accident<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_22-20-6\">\t\t\t<label  for=\"field_j9rqv-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[22][]\" id=\"field_j9rqv-6\" value=\"Incident\"  data-sectionid=\"20\"  data-reqmsg=\"Incident Type RadioB cannot be blank.\" data-invmsg=\"Incident Type RadioB is invalid\"   \/> Incident<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_22-20-1\">\t\t\t<label  for=\"field_j9rqv-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[22][]\" id=\"field_j9rqv-1\" value=\"Near Miss\"  data-sectionid=\"20\"  data-reqmsg=\"Incident Type RadioB cannot be blank.\" data-invmsg=\"Incident Type RadioB is invalid\"   \/> Near Miss<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_22-20-2\">\t\t\t<label  for=\"field_j9rqv-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[22][]\" id=\"field_j9rqv-2\" value=\"Unsafe Act\"  data-sectionid=\"20\"  data-reqmsg=\"Incident Type RadioB cannot be blank.\" data-invmsg=\"Incident Type RadioB is invalid\"   \/> Unsafe Act<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_22-20-5\">\t\t\t<label  for=\"field_j9rqv-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[22][]\" id=\"field_j9rqv-5\" value=\"Unsafe Use of Equipment\"  data-sectionid=\"20\"  data-reqmsg=\"Incident Type RadioB cannot be blank.\" data-invmsg=\"Incident Type RadioB is invalid\"   \/> Unsafe Use of Equipment<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_22-20-3\">\t\t\t<label  for=\"field_j9rqv-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[22][]\" id=\"field_j9rqv-3\" value=\"Unsafe Condition of Area\"  data-sectionid=\"20\"  data-reqmsg=\"Incident Type RadioB cannot be blank.\" data-invmsg=\"Incident Type RadioB is invalid\"   \/> Unsafe Condition of Area<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_22-20-4\">\t\t\t<label  for=\"field_j9rqv-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[22][]\" id=\"field_j9rqv-4\" value=\"Unsafe Condition of Equipment\"  data-sectionid=\"20\"  data-reqmsg=\"Incident Type RadioB cannot be blank.\" data-invmsg=\"Incident Type RadioB is invalid\"   \/> Unsafe Condition of Equipment<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_sng1e\" id=\"field_sng1e_label\" class=\"frm_primary_label\">Was a person involved?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\t\t\t<span class=\"frm_off_label frm_switch_opt\">No<\/span>\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[39][]\" id=\"field_sng1e\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t\tdata-off=\"No\"\n\t\t\t\t\t\t data-sectionid=\"20\"  data-invmsg=\"Was a person involved? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_sng1e_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t<span class=\"frm_on_label frm_switch_opt\">Yes<\/span>\n\t<\/label>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_ibohw\" id=\"field_ibohw_label\" class=\"frm_primary_label\">Were they injured?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\t\t\t<span class=\"frm_off_label frm_switch_opt\">No<\/span>\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[40][]\" id=\"field_ibohw\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t\tdata-off=\"No\"\n\t\t\t\t\t\t data-sectionid=\"20\"  data-invmsg=\"Were they injured? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_ibohw_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t<span class=\"frm_on_label frm_switch_opt\">Yes<\/span>\n\t<\/label>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field frm_section_heading form-field  frm3\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Person completing this form:<\/h3>\r\n\r\n\r\n<div id=\"frm_field_50_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_6zvls\" id=\"field_6zvls_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select  name=\"item_meta[50]\" id=\"field_6zvls\"  data-sectionid=\"23\"  data-invmsg=\"Name is invalid\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Colin Clark\">\n\t\t\t\t\tColin Clark\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mark Brunskill\">\n\t\t\t\t\tMark Brunskill\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Martin Eastwood\">\n\t\t\t\t\tMartin Eastwood\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tony Hoy\">\n\t\t\t\t\tTony Hoy\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_63_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_toemz\" id=\"field_toemz_label\" class=\"frm_primary_label\">Job Title\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_toemz\" name=\"item_meta[63]\" value=\"\"  data-sectionid=\"23\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_53_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvve7\" id=\"field_nvve7_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[53]\" id=\"field_nvve7\" rows=\"5\"  data-sectionid=\"23\"  data-invmsg=\"Paragraph is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field frm_section_heading form-field  frm3\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Incident Location:<\/h3>\r\n\r\n\r\n<div id=\"frm_field_76_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_vrdfs\" id=\"field_vrdfs_label\" class=\"frm_primary_label\">General Area\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select  name=\"item_meta[76]\" id=\"field_vrdfs\"  data-sectionid=\"25\"  data-invmsg=\"General Area is invalid\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_77_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_j4g0u\" id=\"field_j4g0u_label\" class=\"frm_primary_label\">Location\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select  name=\"item_meta[77]\" id=\"field_j4g0u\"  data-sectionid=\"25\"  data-invmsg=\"Location is invalid\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_81_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_s9t8m\" id=\"field_s9t8m_label\" class=\"frm_primary_label\">Describe the exact location of the event\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[81]\" id=\"field_s9t8m\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Paragraph is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_69_container\" class=\"frm_form_field frm_section_heading form-field  frm3\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Admin<\/h3>\r\n\r\n\r\n<div id=\"frm_field_131_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_alignright\">\r\n\t<label for=\"field_aoxdl\" id=\"field_aoxdl_label\" class=\"frm_primary_label\">Accident Form Number\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_aoxdl\" name=\"item_meta[131]\" value=\"\" data-sectionid=\"69\"  data-invmsg=\"Accident Form Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_86_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_qr2go\" id=\"field_qr2go_label\" class=\"frm_primary_label\">Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qr2go\" name=\"item_meta[86]\" value=\"\"  data-sectionid=\"69\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_87_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <div  id=\"field_654lr_label\" class=\"frm_primary_label\">Time\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_time_wrap\"><span dir=\"ltr\">\r\n<select aria-label=\"Time ... hour\" name=\"item_meta[87][H]\" id=\"field_654lr_H\"  data-sectionid=\"69\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"Time is invalid\" class=\"auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"00\" >00<\/option><option value=\"01\" >01<\/option><option value=\"02\" >02<\/option><option value=\"03\" >03<\/option><option value=\"04\" >04<\/option><option value=\"05\" >05<\/option><option value=\"06\" >06<\/option><option value=\"07\" >07<\/option><option value=\"08\" >08<\/option><option value=\"09\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><\/select>\r\n<span class=\"frm_time_sep\" aria-hidden=\"true\">:<\/span>\r\n<select aria-label=\"Time ... minute\" name=\"item_meta[87][m]\" id=\"field_654lr_m\"  data-sectionid=\"69\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"Time is invalid\" class=\"auto_width frm_time_select auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"00\" >00<\/option><option value=\"01\" >01<\/option><option value=\"02\" >02<\/option><option value=\"03\" >03<\/option><option value=\"04\" >04<\/option><option value=\"05\" >05<\/option><option value=\"06\" >06<\/option><option value=\"07\" >07<\/option><option value=\"08\" >08<\/option><option value=\"09\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><option value=\"32\" >32<\/option><option value=\"33\" >33<\/option><option value=\"34\" >34<\/option><option value=\"35\" >35<\/option><option value=\"36\" >36<\/option><option value=\"37\" >37<\/option><option value=\"38\" >38<\/option><option value=\"39\" >39<\/option><option value=\"40\" >40<\/option><option value=\"41\" >41<\/option><option value=\"42\" >42<\/option><option value=\"43\" >43<\/option><option value=\"44\" >44<\/option><option value=\"45\" >45<\/option><option value=\"46\" >46<\/option><option value=\"47\" >47<\/option><option value=\"48\" >48<\/option><option value=\"49\" >49<\/option><option value=\"50\" >50<\/option><option value=\"51\" >51<\/option><option value=\"52\" >52<\/option><option value=\"53\" >53<\/option><option value=\"54\" >54<\/option><option value=\"55\" >55<\/option><option value=\"56\" >56<\/option><option value=\"57\" >57<\/option><option value=\"58\" >58<\/option><option value=\"59\" >59<\/option><\/select>\r\n<\/span>\r\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_88_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_uq8sp\" id=\"field_uq8sp_label\" class=\"frm_primary_label\">Hours since Shift Start\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_uq8sp\" name=\"item_meta[88]\" value=\"\" data-sectionid=\"69\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"24\" step=\".25\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_91_container\" class=\"frm_form_field form-field  frm_top_container frm_alignright frm frm_first 6\">\r\n    <label for=\"field_w6pir\" id=\"field_w6pir_label\" class=\"frm_primary_label\">Lost Time Incident?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[91][]\" id=\"field_w6pir\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t data-sectionid=\"69\"  data-invmsg=\"Lost Time Incident? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_w6pir_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t<\/label>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_27_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing frm_trigger\" tabindex=\"0\" role=\"button\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<path d=\"M10 .3a9.7 9.7 0 1 0 0 19.4A9.7 9.7 0 0 0 10 .3zm0 17.5a7.8 7.8 0 1 1 0-15.6 7.8 7.8 0 0 1 0 15.6zm5-8l-.7-.8a.5.5 0 0 0-.7 0L11 11.7V5.5c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v6.3L6.4 9a.5.5 0 0 0-.7 0l-.8.8c-.2.1-.2.4 0 .6l4.8 4.8c.2.2.4.2.6 0l4.8-4.8c.2-.2.2-.5 0-.6z\"><\/path>\n<\/svg><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<title>arrowdown<\/title>\n\t<path d=\"M10 19.7A9.7 9.7 0 1 0 10 .3a9.7 9.7 0 0 0 0 19.4zm0-17.5a7.8 7.8 0 1 1 0 15.6 7.8 7.8 0 0 1 0-15.6zM5 9.6l4.7-4.8c.2-.2.4-.2.6 0l4.8 4.8c.2.2.2.5 0 .6l-.8.8c-.2.2-.5.2-.7 0L11 8.3v6.2c0 .3-.2.5-.5.5h-1a.5.5 0 0 1-.5-.5V8.2L6.4 11c-.2.2-.5.2-.7 0l-.8-.8a.5.5 0 0 1 0-.6z\"><\/path>\n<\/svg> Details of Person Involved:<\/h3>\r\n\r\n<div class=\"frm_toggle_container frm_grid_container\" style=\"display:none;\">\r\n<div id=\"frm_field_100_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first\">\r\n    <label for=\"field_3git9\" id=\"field_3git9_label\" class=\"frm_primary_label\">Employee Reference No\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_3git9\" name=\"item_meta[100]\" value=\"\"  data-sectionid=\"27\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_101_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_2xx04\" id=\"field_2xx04_label\" class=\"frm_primary_label\">Full Time Employee?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[101][]\" id=\"field_2xx04\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t data-sectionid=\"27\"  data-invmsg=\"Full Time Employee? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_2xx04_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t<\/label>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_102_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_wblex\" id=\"field_wblex_label\" class=\"frm_primary_label\">Equipment Involved?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[102][]\" id=\"field_wblex\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t data-sectionid=\"27\"  data-invmsg=\"Equipment Involved? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_wblex_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t<\/label>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing frm_trigger\" tabindex=\"0\" role=\"button\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<path d=\"M10 .3a9.7 9.7 0 1 0 0 19.4A9.7 9.7 0 0 0 10 .3zm0 17.5a7.8 7.8 0 1 1 0-15.6 7.8 7.8 0 0 1 0 15.6zm5-8l-.7-.8a.5.5 0 0 0-.7 0L11 11.7V5.5c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v6.3L6.4 9a.5.5 0 0 0-.7 0l-.8.8c-.2.1-.2.4 0 .6l4.8 4.8c.2.2.4.2.6 0l4.8-4.8c.2-.2.2-.5 0-.6z\"><\/path>\n<\/svg><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<title>arrowdown<\/title>\n\t<path d=\"M10 19.7A9.7 9.7 0 1 0 10 .3a9.7 9.7 0 0 0 0 19.4zm0-17.5a7.8 7.8 0 1 1 0 15.6 7.8 7.8 0 0 1 0-15.6zM5 9.6l4.7-4.8c.2-.2.4-.2.6 0l4.8 4.8c.2.2.2.5 0 .6l-.8.8c-.2.2-.5.2-.7 0L11 8.3v6.2c0 .3-.2.5-.5.5h-1a.5.5 0 0 1-.5-.5V8.2L6.4 11c-.2.2-.5.2-.7 0l-.8-.8a.5.5 0 0 1 0-.6z\"><\/path>\n<\/svg> Injury Details:<\/h3>\r\n\r\n<div class=\"frm_toggle_container frm_grid_container\" style=\"display:none;\">\r\n<div id=\"frm_field_104_container\" class=\"frm_form_field form-field  frm_top_container frm8 frm_first\">\r\n    <label for=\"field_3x0v\" id=\"field_3x0v_label\" class=\"frm_primary_label\">Nature of Injury\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[104]\" id=\"field_3x0v\" rows=\"5\"  data-sectionid=\"31\"  placeholder=\"Make sure this is accurately described.  Note and clarify any discrepancies from the Accident Report Form.\" data-invmsg=\"Paragraph is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_106_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_two_col\">\r\n    <div  id=\"field_g6rza_label\" class=\"frm_primary_label\">Body Part Most Affected\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_g6rza_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-0\">\t\t\t<label  for=\"field_g6rza-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-0\" value=\"Head &amp; Neck\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Head &amp; Neck<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-1\">\t\t\t<label  for=\"field_g6rza-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-1\" value=\"Shoulders\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Shoulders<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-2\">\t\t\t<label  for=\"field_g6rza-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-2\" value=\"Upper Torso &amp; Stomach\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Upper Torso &amp; Stomach<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-3\">\t\t\t<label  for=\"field_g6rza-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-3\" value=\"Lower Back\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Lower Back<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-4\">\t\t\t<label  for=\"field_g6rza-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-4\" value=\"Upper Arms\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Upper Arms<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-5\">\t\t\t<label  for=\"field_g6rza-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-5\" value=\"Forearms &amp; Hands\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Forearms &amp; Hands<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-6\">\t\t\t<label  for=\"field_g6rza-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-6\" value=\"Upper Leg &amp; Knees\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Upper Leg &amp; Knees<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_106-31-7\">\t\t\t<label  for=\"field_g6rza-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[106]\" id=\"field_g6rza-7\" value=\"Lower Leg &amp; Feet\"\n\t\t   data-sectionid=\"31\"  data-invmsg=\"Body Part Most Affected is invalid\"  \/> Lower Leg &amp; Feet<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing frm_trigger\" tabindex=\"0\" role=\"button\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<path d=\"M10 .3a9.7 9.7 0 1 0 0 19.4A9.7 9.7 0 0 0 10 .3zm0 17.5a7.8 7.8 0 1 1 0-15.6 7.8 7.8 0 0 1 0 15.6zm5-8l-.7-.8a.5.5 0 0 0-.7 0L11 11.7V5.5c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v6.3L6.4 9a.5.5 0 0 0-.7 0l-.8.8c-.2.1-.2.4 0 .6l4.8 4.8c.2.2.4.2.6 0l4.8-4.8c.2-.2.2-.5 0-.6z\"><\/path>\n<\/svg><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<title>arrowdown<\/title>\n\t<path d=\"M10 19.7A9.7 9.7 0 1 0 10 .3a9.7 9.7 0 0 0 0 19.4zm0-17.5a7.8 7.8 0 1 1 0 15.6 7.8 7.8 0 0 1 0-15.6zM5 9.6l4.7-4.8c.2-.2.4-.2.6 0l4.8 4.8c.2.2.2.5 0 .6l-.8.8c-.2.2-.5.2-.7 0L11 8.3v6.2c0 .3-.2.5-.5.5h-1a.5.5 0 0 1-.5-.5V8.2L6.4 11c-.2.2-.5.2-.7 0l-.8-.8a.5.5 0 0 1 0-.6z\"><\/path>\n<\/svg> Incident Details:<\/h3>\r\n\r\n<div class=\"frm_toggle_container frm_grid_container\" style=\"display:none;\">\r\n<div id=\"frm_field_83_container\" class=\"frm_form_field form-field  frm_none_container frm7 frm_first\">\r\n    <label for=\"field_tac8k\" id=\"field_tac8k_label\" class=\"frm_primary_label\">Incident Description\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[83]\" id=\"field_tac8k\" rows=\"10\"  data-sectionid=\"29\"  placeholder=\"In as much detail as possible, describe the (potential) incident.  If relevant list what happened, how it happened and potential causes.  Also list any potential witnesses.  Photographs of the area or any other relevant files can be uploaded in the box opposite.\" data-invmsg=\"Paragraph is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_105_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_it51n\" id=\"field_it51n_label\" class=\"frm_primary_label\">Press and Hold CTRL to select more than one category\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[105][]\" id=\"field_it51n\"  data-sectionid=\"29\"  multiple=\"multiple\"  data-invmsg=\"Press and Hold CTRL to select more than one category is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Struck by moving machinery\">Struck by moving machinery<\/option><option  value=\"Hit by moving\/flying\/falling object\">Hit by moving\/flying\/falling object<\/option><option  value=\"Transportation or vehicle related accident\">Transportation or vehicle related accident<\/option><option  value=\"Hit something fixed or stationary\">Hit something fixed or stationary<\/option><option  value=\"Slip or trip same level\">Slip or trip same level<\/option><option  value=\"Injured whilst manual handling\">Injured whilst manual handling<\/option><option  value=\"Fall from height\">Fall from height<\/option><option  value=\"Cut or grazed\">Cut or grazed<\/option><option  value=\"Trapped by something collapsing or overturning\">Trapped by something collapsing or overturning<\/option><option  value=\"Drowned or asphyxiated\">Drowned or asphyxiated<\/option><option  value=\"Exposed to harmful substance\">Exposed to harmful substance<\/option><option  value=\"Exposed to fire\">Exposed to fire<\/option><option  value=\"Exposed to explosion\">Exposed to explosion<\/option><option  value=\"Contact with electricity\">Contact with electricity<\/option><option  value=\"Physically assaulted\">Physically assaulted<\/option><option  value=\"Burn or scald\">Burn or scald<\/option><option  value=\"Pinch or Crush\">Pinch or Crush<\/option><option  value=\"Other\">Other<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_89_container\" class=\"frm_form_field form-field  frm_none_container frm2\">\r\n    <label for=\"field_3pnsf\" id=\"field_3pnsf_label\" class=\"frm_primary_label\">File Upload\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"29\"  data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"   name=\"item_meta[89]\"  value=\"\" data-frmfile=\"89\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file89_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file89\" id=\"field_3pnsf\"\n\t\t\t data-sectionid=\"29\"  data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"File Upload. Drop a file here or click to upload. Maximum file size: 33.55MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"File Upload. Choose File. Maximum file size: 33.55MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 33.55MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_132_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing frm_trigger\" tabindex=\"0\" role=\"button\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<path d=\"M10 .3a9.7 9.7 0 1 0 0 19.4A9.7 9.7 0 0 0 10 .3zm0 17.5a7.8 7.8 0 1 1 0-15.6 7.8 7.8 0 0 1 0 15.6zm5-8l-.7-.8a.5.5 0 0 0-.7 0L11 11.7V5.5c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v6.3L6.4 9a.5.5 0 0 0-.7 0l-.8.8c-.2.1-.2.4 0 .6l4.8 4.8c.2.2.4.2.6 0l4.8-4.8c.2-.2.2-.5 0-.6z\"><\/path>\n<\/svg><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<title>arrowdown<\/title>\n\t<path d=\"M10 19.7A9.7 9.7 0 1 0 10 .3a9.7 9.7 0 0 0 0 19.4zm0-17.5a7.8 7.8 0 1 1 0 15.6 7.8 7.8 0 0 1 0-15.6zM5 9.6l4.7-4.8c.2-.2.4-.2.6 0l4.8 4.8c.2.2.2.5 0 .6l-.8.8c-.2.2-.5.2-.7 0L11 8.3v6.2c0 .3-.2.5-.5.5h-1a.5.5 0 0 1-.5-.5V8.2L6.4 11c-.2.2-.5.2-.7 0l-.8-.8a.5.5 0 0 1 0-.6z\"><\/path>\n<\/svg> Investigation:  To be completed by an authorised individual<\/h3>\r\n\r\n<div class=\"frm_toggle_container frm_grid_container\" style=\"display:none;\">\r\n<div id=\"frm_field_135_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n\t<label for=\"field_i4gmy\" id=\"field_i4gmy_label\" class=\"frm_primary_label\">Describe conditions in the area\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[135]\" id=\"field_i4gmy\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"If applicable: Describe the general condition of the area, i.e. tidiness, cleanliness, obstructions, damage, lighting, floor conditions etc.\" data-invmsg=\"Describe conditions in the area is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_136_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n\t<label for=\"field_fhq3p\" id=\"field_fhq3p_label\" class=\"frm_primary_label\">Describe the condition of the equipment \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[136]\" id=\"field_fhq3p\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"If Applicable: Describe what equipment was in use (if any).  Note if equipment was working incorrectly, or was worn damaged.\" data-invmsg=\"Describe the condition of the equipment  is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_138_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n\t<label for=\"field_o62k3\" id=\"field_o62k3_label\" class=\"frm_primary_label\">Describe any substances used\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[138]\" id=\"field_o62k3\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"If applicable:  Describe any substances being used at the time, including if they were fit for purpose, controlled under COSSH, used in accordance with recommendations, etc.\" data-invmsg=\"Describe any substances used is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_137_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n\t<label for=\"field_mg1sq\" id=\"field_mg1sq_label\" class=\"frm_primary_label\">State the IPs experience\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[137]\" id=\"field_mg1sq\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"If applicable:  State the IP&#039;s experience in doing the task, were they trained, or in training, etc.\" data-invmsg=\"State the IPs experience is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_139_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n\t<label for=\"field_5ycag\" id=\"field_5ycag_label\" class=\"frm_primary_label\">Was PPE provided and correctly used?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[139]\" id=\"field_5ycag\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"If applicable: Check if PPE was required for the task being performed and check that it was available  and being used. List PPE in use at the time.\" data-invmsg=\"Was PPE provided and correctly used? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_140_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n\t<label for=\"field_4v6jb\" id=\"field_4v6jb_label\" class=\"frm_primary_label\">Supervisory arrangements:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[140]\" id=\"field_4v6jb\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"Was there a supervisor\/manager on shift at the time of the accident, were they in the location  at the time?\" data-invmsg=\"Supervisory arrangements: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_141_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n\t<label for=\"field_d0meh\" id=\"field_d0meh_label\" class=\"frm_primary_label\">Policy \/ procedure adherence\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[141]\" id=\"field_d0meh\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"If applicable:  Check any procedures in place, were they being followed, were there any pre-start checks, were they completed and if so, by who.\" data-invmsg=\"Policy \/ procedure adherence is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_142_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n\t<label for=\"field_lq891\" id=\"field_lq891_label\" class=\"frm_primary_label\">Other factors:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[142]\" id=\"field_lq891\" rows=\"5\"  data-sectionid=\"132\"  placeholder=\"If applicable: Describe any other factors that may be relevant to the event that took place, but not previously listed.\" data-invmsg=\"Other factors: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_146_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_qgr0x\" id=\"field_qgr0x_label\" class=\"frm_primary_label\">What was the IMMEDIATE CAUSE?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea data-auto-grow=\"1\"  name=\"item_meta[146]\" id=\"field_qgr0x\" rows=\"3\"  data-sectionid=\"132\"  data-invmsg=\"What was the IMMEDIATE CAUSE? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_145_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_cfibe\" id=\"field_cfibe_label\" class=\"frm_primary_label\">What was the ROOT CAUSE?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea data-auto-grow=\"1\"  name=\"item_meta[145]\" id=\"field_cfibe\" rows=\"3\"  data-sectionid=\"132\"  data-invmsg=\"What was the ROOT CAUSE? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_103_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first\">\r\n    <label for=\"field_ordzq\" id=\"field_ordzq_label\" class=\"frm_primary_label\">Employee trained for the job?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\t\t\t<span class=\"frm_off_label frm_switch_opt\">No<\/span>\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[103][]\" id=\"field_ordzq\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t\tdata-off=\"No\"\n\t\t\t\t\t\t data-sectionid=\"132\"  data-invmsg=\"Employee trained for the job? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_ordzq_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t<span class=\"frm_on_label frm_switch_opt\">Yes<\/span>\n\t<\/label>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_143_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n\t<label for=\"field_753m5\" id=\"field_753m5_label\" class=\"frm_primary_label\">SSW \/ WI Available?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\n<div >\n    <label class=\"frm_switch_block\">\n\t\t\t\t\t<span class=\"frm_off_label frm_switch_opt\">No<\/span>\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[143][]\" id=\"field_753m5\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t\tdata-off=\"No\"\n\t\t\t\t\t\t data-sectionid=\"132\"  data-invmsg=\"SSW \/ WI Available? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_753m5_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t<span class=\"frm_on_label frm_switch_opt\">Yes<\/span>\n\t<\/label>\n<\/div>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_144_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n\t<label for=\"field_xfeu8\" id=\"field_xfeu8_label\" class=\"frm_primary_label\">Has the IP had another accident in the past 12 mths?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\n<div >\n    <label class=\"frm_switch_block\">\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[144][]\" id=\"field_xfeu8\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t data-sectionid=\"132\"  data-invmsg=\"Has the IP had another accident in the past 12 mths? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_xfeu8_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t<\/label>\n<\/div>\n\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing frm_trigger\" tabindex=\"0\" role=\"button\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<path d=\"M10 .3a9.7 9.7 0 1 0 0 19.4A9.7 9.7 0 0 0 10 .3zm0 17.5a7.8 7.8 0 1 1 0-15.6 7.8 7.8 0 0 1 0 15.6zm5-8l-.7-.8a.5.5 0 0 0-.7 0L11 11.7V5.5c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v6.3L6.4 9a.5.5 0 0 0-.7 0l-.8.8c-.2.1-.2.4 0 .6l4.8 4.8c.2.2.4.2.6 0l4.8-4.8c.2-.2.2-.5 0-.6z\"><\/path>\n<\/svg><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<title>arrowdown<\/title>\n\t<path d=\"M10 19.7A9.7 9.7 0 1 0 10 .3a9.7 9.7 0 0 0 0 19.4zm0-17.5a7.8 7.8 0 1 1 0 15.6 7.8 7.8 0 0 1 0-15.6zM5 9.6l4.7-4.8c.2-.2.4-.2.6 0l4.8 4.8c.2.2.2.5 0 .6l-.8.8c-.2.2-.5.2-.7 0L11 8.3v6.2c0 .3-.2.5-.5.5h-1a.5.5 0 0 1-.5-.5V8.2L6.4 11c-.2.2-.5.2-.7 0l-.8-.8a.5.5 0 0 1 0-.6z\"><\/path>\n<\/svg> Corrective Actions:<\/h3>\r\n\r\n<div class=\"frm_toggle_container frm_grid_container\" style=\"display:none;\">\r\n<div id=\"frm_field_90_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"field_yze7j\" id=\"field_yze7j_label\" class=\"frm_primary_label\">Corrective Action\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[90]\" id=\"field_yze7j\" rows=\"5\"  data-sectionid=\"33\"  placeholder=\"Describe what steps can be taken to prevent reoccurrence of the (potential) incident?\" data-invmsg=\"Paragraph is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing frm_trigger\" tabindex=\"0\" role=\"button\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<path d=\"M10 .3a9.7 9.7 0 1 0 0 19.4A9.7 9.7 0 0 0 10 .3zm0 17.5a7.8 7.8 0 1 1 0-15.6 7.8 7.8 0 0 1 0 15.6zm5-8l-.7-.8a.5.5 0 0 0-.7 0L11 11.7V5.5c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v6.3L6.4 9a.5.5 0 0 0-.7 0l-.8.8c-.2.1-.2.4 0 .6l4.8 4.8c.2.2.4.2.6 0l4.8-4.8c.2-.2.2-.5 0-.6z\"><\/path>\n<\/svg><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<title>arrowdown<\/title>\n\t<path d=\"M10 19.7A9.7 9.7 0 1 0 10 .3a9.7 9.7 0 0 0 0 19.4zm0-17.5a7.8 7.8 0 1 1 0 15.6 7.8 7.8 0 0 1 0-15.6zM5 9.6l4.7-4.8c.2-.2.4-.2.6 0l4.8 4.8c.2.2.2.5 0 .6l-.8.8c-.2.2-.5.2-.7 0L11 8.3v6.2c0 .3-.2.5-.5.5h-1a.5.5 0 0 1-.5-.5V8.2L6.4 11c-.2.2-.5.2-.7 0l-.8-.8a.5.5 0 0 1 0-.6z\"><\/path>\n<\/svg> RIDDOR:<\/h3>\r\n\r\n<div class=\"frm_toggle_container frm_grid_container\" style=\"display:none;\">\r\n<div id=\"frm_field_111_container\" class=\"frm_form_field form-field  frm_top_container frm8 frm_first vertical_radio\">\r\n    <div  id=\"field_torad_label\" class=\"frm_primary_label\">Please select if relevant\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_torad_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-0\">\t\t\t<label  for=\"field_torad-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-0\" value=\"1\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Work related death<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-1\">\t\t\t<label  for=\"field_torad-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-1\" value=\"2\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Fracture other than to fingers, thumbs and toes<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-2\">\t\t\t<label  for=\"field_torad-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-2\" value=\"3\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Amputation<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-3\">\t\t\t<label  for=\"field_torad-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-3\" value=\"4\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Any injury likely to lead to a permanent loss of sight or reduction in sight<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-4\">\t\t\t<label  for=\"field_torad-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-4\" value=\"5\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Any crush injury to the head or torso causing damage<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-5\">\t\t\t<label  for=\"field_torad-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-5\" value=\"6\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Serious burns\/scalds which covers more than 10% of the body<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-6\">\t\t\t<label  for=\"field_torad-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-6\" value=\"7\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Serious burns\/scalds which causes significant damage to the eyes, respiratory system or other vital organs<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-7\">\t\t\t<label  for=\"field_torad-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-7\" value=\"8\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Any scalping requiring hospital treatment<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-8\">\t\t\t<label  for=\"field_torad-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-8\" value=\"9\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Any loss of consciousness caused by head injury or asphyxia<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-9\">\t\t\t<label  for=\"field_torad-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-9\" value=\"10\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Any other injury arising from working in an enclosed space which leads to hypothermia or heat-induced illness<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-10\">\t\t\t<label  for=\"field_torad-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-10\" value=\"11\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Any other injury arising from working in an enclosed space which requires resuscitation or admittance to hospital for more that 24hrs<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_111-37-11\">\t\t\t<label  for=\"field_torad-11\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[111][]\" id=\"field_torad-11\" value=\"12\"  data-sectionid=\"37\"  data-invmsg=\"Please select if relevant is invalid\"   \/> Any other injury leading to more than 7 days absence at work<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_112_container\" class=\"frm_form_field  frm4 frm_html_container form-field\">\n<h4 style=\"text-align: center;\"><strong>The answers given indicate that this is a reportable accident.<\/strong><\/h4>\n<h4 style=\"text-align: center;\"><strong>Check the current guidance and take action as necessary.<\/strong><\/h4>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing frm_trigger\" tabindex=\"0\" role=\"button\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<path d=\"M10 .3a9.7 9.7 0 1 0 0 19.4A9.7 9.7 0 0 0 10 .3zm0 17.5a7.8 7.8 0 1 1 0-15.6 7.8 7.8 0 0 1 0 15.6zm5-8l-.7-.8a.5.5 0 0 0-.7 0L11 11.7V5.5c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v6.3L6.4 9a.5.5 0 0 0-.7 0l-.8.8c-.2.1-.2.4 0 .6l4.8 4.8c.2.2.4.2.6 0l4.8-4.8c.2-.2.2-.5 0-.6z\"><\/path>\n<\/svg><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" aria-expanded=\"false\" aria-label=\"Toggle fields\" class=\"frmsvg frm-svg-icon\">\n\t<title>arrowdown<\/title>\n\t<path d=\"M10 19.7A9.7 9.7 0 1 0 10 .3a9.7 9.7 0 0 0 0 19.4zm0-17.5a7.8 7.8 0 1 1 0 15.6 7.8 7.8 0 0 1 0-15.6zM5 9.6l4.7-4.8c.2-.2.4-.2.6 0l4.8 4.8c.2.2.2.5 0 .6l-.8.8c-.2.2-.5.2-.7 0L11 8.3v6.2c0 .3-.2.5-.5.5h-1a.5.5 0 0 1-.5-.5V8.2L6.4 11c-.2.2-.5.2-.7 0l-.8-.8a.5.5 0 0 1 0-.6z\"><\/path>\n<\/svg> Sign and Date:<\/h3>\r\n\r\n<div class=\"frm_toggle_container frm_grid_container\" style=\"display:none;\">\r\n<div id=\"frm_field_97_container\" class=\"frm_form_field form-field  frm_inline_container frm4 frm_first\">\r\n    <label for=\"field_fgnbb\" id=\"field_fgnbb_label\" class=\"frm_primary_label\">Manager Signing Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fgnbb\" name=\"item_meta[97]\" value=\"\"  data-sectionid=\"35\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_98_container\" class=\"frm_form_field form-field  frm_inline_container frm4\">\r\n    <label for=\"field_trs4n\" id=\"field_trs4n_label\" class=\"frm_primary_label\">EHS Manager Signing Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_trs4n\" name=\"item_meta[98]\" value=\"\"  data-sectionid=\"35\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_99_container\" class=\"frm_form_field form-field  frm_inline_container frm4\">\r\n    <label for=\"field_ef4zq\" id=\"field_ef4zq_label\" class=\"frm_primary_label\">MD Signing Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ef4zq\" name=\"item_meta[99]\" value=\"\"  data-sectionid=\"35\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_108_container\" class=\"frm_form_field  frm4 frm_first frm_html_container form-field\">\n<p>I have carried out the investigation to the best of my ability and have taken\/recommended the actions detailed to minimise the likely recurrence of similar accidents<\/p>\n<\/div>\n<div id=\"frm_field_109_container\" class=\"frm_form_field  frm4 frm_html_container form-field\">\n<p>I have carried out the investigation to the best of my ability and have taken\/recommended the actions detailed to minimise the likely recurrence of similar accidents<\/p>\n<\/div>\n<div id=\"frm_field_110_container\" class=\"frm_form_field  frm4 frm_html_container form-field\">\n<p>(All RIDDOR accidents must be reviewed as a minimum) I am satisfied with the quality of this report and the remedial action taken or proposed<\/p>\n<\/div>\n<div id=\"frm_field_94_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first\">\r\n    <label for=\"field_uyjv5\" id=\"field_uyjv5_label\" class=\"frm_primary_label\">Manager Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad94' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:rgba(243,97,120,1);--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[94][typed]\" class=\"name\" id=\"field_uyjv5\" autocomplete=\"off\" value=\"\"  data-sectionid=\"35\"  style=\"width:400px !important\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"94\" data-fieldname=\"item_meta[94]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[94][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_95_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_jynio\" id=\"field_jynio_label\" class=\"frm_primary_label\">H&S Manager Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad95' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:rgba(243,97,120,1);--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[95][typed]\" class=\"name\" id=\"field_jynio\" autocomplete=\"off\" value=\"\"  data-sectionid=\"35\"  style=\"width:400px !important\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"95\" data-fieldname=\"item_meta[95]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[95][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_92_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_8yhpt\" id=\"field_8yhpt_label\" class=\"frm_primary_label\">MD Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad92' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:rgba(243,97,120,1);--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[92][typed]\" class=\"name\" id=\"field_8yhpt\" autocomplete=\"off\" value=\"\"  data-sectionid=\"35\"  style=\"width:400px !important\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"92\" data-fieldname=\"item_meta[92]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[92][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_114_container\" class=\"frm_form_field frm_section_heading frm_hidden frm_invisible_section form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Hidden Fields<\/h3>\r\n\r\n\r\n<input type=\"hidden\" name=\"item_meta[55]\" id=\"field_jc9x\" value=\"\" data-frmval=\"\"\/>\n<input type=\"hidden\" name=\"item_meta[65]\" id=\"field_buvbe\" value=\"\"  data-sectionid=\"114\"     \/>\n<input type=\"hidden\" name=\"item_meta[78]\" id=\"field_3samh\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[113]\" id=\"field_9qvz9\" value=\"\"     \/>\n<\/div>\n<div id=\"frm_field_125_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<input name=\"frm_state\" type=\"hidden\" value=\"Up05xcAX1dmPOJJ4\/yTDzMljGf352QTKwtjKqAgUAhw=\" \/><script>    \r\njQuery(document).ready(function($){\r\n    $('#field_l444t').change(function(){ \r\n        var sourceField = $('#field_l444t').val();\r\n        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