| Description | Pre-printed by HMSO, reference Miners and Quarries Form 22, comprising particulars of Form 21 sent to HM Inspectors of Mines. Fields for whether mine or quarry, name of mine or quarry, county, name of person killed or injured, age last birthday, ordinary occupation, date and hour of accident, hour of shift when accident occurred, place of accident, cause and description of dangerous accident, nature and extent of personal injury, residence of injured person, and place to which injured person removed. Mostly for Colliery No. 2. |