Report Of Injury Instructions Form - State Of Wyoming Department Of Employment Workers' Safety And Compensation Division Page 3

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Part of Body Codes
Code
Injury
Code
Injury
01
Abdomen
02
Arm(s) Multiple
Back
04
Body system
Nature of Injury Codes
20
Neck
Code
Injury
Code
Injury
36
Mid-Back (Thoracic)
01
Amputation
02
Asphyxia
37
Low-Back (Lumbar)
03
Bruise, contusion,
04
Burn (chemical)
05
Chest
06
Ear(s)
abrasion
07
Elbow
08
Eye(s)
05
Burn or scald (heat)
06
Concussion
09
Face
10
Finger(s)
07
Cut or laceration
08
Dermatitis
11
Foot, toe(s), or ankle
12
Hand(s)
09
Dislocation
10
Electric Shock
13
Head
14
Hip(s)
11
Foreign body in eye
12
Fracture
15
Knee(s)
16
Leg(s)
13
Freezing or frost bite
14
Hearing loss
17
Lower arm(s)
18
Lower leg(s)
15
Heat exhaustion
16
Hernia
19
Multiple
20
Neck (Cervical)
17
Poisoning (systemic)
18
Puncture
21
Shoulder(s)
22
Upper arm(s)
19
Radiation effect
20
Strain or sprain
23
Upper Leg(s)
24
Wrist(s)
21
Other, please describe
22
Cancer
25
Blood
26
Kidney
23
Industrial disease
24
Mental disorder
27
Liver
28
Lung
25
Coronary condition
26
Disfigurement
29
Nervous system
30
Reproduction system
31
Other body system, please
32
Thumb
describe
Source of Injury Codes
33
Groin
34
Great Toe
Code
Injury
Code
Injury
35
Heart
36
Mid-Back (Thoracic)
01
Aircraft
02
Air Pressure
37
Low Back (Lumbar)
38
Pelvis
03
Animal, insect, bird,
04
Boat
39
Ribs
40
Teeth
reptile, fish
41
Tailbone (coccyx)
42
Buttocks
05
Bodily motion
06
Boiler pressure
07
Boxes, barrels, etc.
08
Buildings,
Event Type Codes
structures
Code
Injury
Code
Injury
09
Chemical liquids or
10
Cleaning
01
Struck by
02
Caught in or
vapors
compound
between
11
Cold (environmental or
12
Dirt, sand, stone
03
Bite, sting, or scratch
04
Fall (same level)
mechanical
05
Fall (from elevation)
06
Struck against
13
Drugs or Alcohol
14
Dust, particles,
07
Rubbed or abraded
08
Inhalation
chips
09
Ingestion
10
Absorption
15
Electrical apparatus or
16
Fire or smoke
wiring
11
Repeated motion or
12
Cardio-vascular,
pressure
respiratory system
17
Food
18
Furniture or
furnishings
13
Shock
14
Other, please
describe
19
Gases
20
Glass
15
Lifting
21
Hand tool (powered)
22
Hand tool
(manual)
Environmental Factor Codes
23
Heat (environmental or
24
Hoisting apparatus
mechanical
Code
Injury
Code
Injury
25
Ladder
26
Machine
01
Pinch point action
02
Catch point or
27
Materials handling
28
Metal products
puncture action
equipment
03
Shear point action
04
Squeeze point
29
Motor vehicle (highway)
30
Motor vehicle
action
(industrial)
05
Flying object action
06
Overhead moving
31
Motorcycle
32
Windstorm,
and/or falling object
lightning, etc.
07
Gas, vapor, dust, etc.
08
Materials handling
33
Firearm
34
Person
equipment or
35
Petroleum products
36
Pump or Prime
method
motor
09
Chemical action/reaction
10
Flammable liquid or
37
Radiation
38
Train or railroad
exposure
solid exposure
39
Vegetation
40
Waste Products
11
Temperature above or
12
Radiation condition
below tolerance level
41
Water
42
Working surface
13
Working surface or facility
14
Illumination
43
Other, please describe
44
Fumes
layout condition
45
Mists
46
Vibration
15
Over pressure or under
16
Sound level
47
Noise
48
Biological agent
pressure condition
17
Weather, earthquake, etc.
18
Other, please
condition
describe

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