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HEAD OFFICE CONTIGENCY PSMM/HOCP-07

PLAN Version : 00
PROCEDURE : HEAD OFFICE CONTIGENCY
Date: 04.01.2022
PLAN Page: 1/ 1

PERSONAL INJURY

1. Date and time of injury :........................................................................................


2. Detail of injury (fall, traffic incident...):................................................................
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3. Bone broken? Yes /No
a) May be ( )
b) Prominent ( )
c) Positive when having X-RAY ( )

4. Areas
a) Skull ( )
b) Face ( )
c) Cervix ................limit ( )
d) Back bone ( )
e) rib ..............side .............how many ( )
f) Pelvis ( )
g) Upper leg
Left ( ) Right ( )
h) Lower leg
Left ( ) Right ( )
i) Other parts ( )

5. Is there any wound ? Locate wound, especially chest or belly wound with dimension and
depth.
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6. Is much blood ? ............................................................................................................

7. Comment:.....................................................................................................................
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