| Description | Columns for accident number, check number, name of injured person, age, occupation, address, date and hour of accident, date of report to doctor, date of return to work, notice of resumption of incapacity (date of resumption and date of return to work), nature of injury, average weekly earnings, length of period of disablement, total compensations paid (number of weeks, weekly rate, £/s/d), and remarks. |