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AGE a* NAME Last First MI. c* SEX d. SOCIAL SECURITY NUMBER MALE e. GRADE FEMALE g. DUTY STATUS AT TIME OF ACCIDENT h. EMPLOYMENT STATUS AT TIME OF ACCIDENT f* JOB SERIES/TITLE ARMY ACTIVE PERMANENT TDY OFF DUTY VOLUNTEER FOREIGN NATIONAL SEASONAL TEMPORARY ON DUTY ARMY RESERVE STUDENT OTHER Specify GENERAL INFORMATION a* DATE OF ACCIDENT YYYYMMDD d. CONTRACTOR S NAME b. TIME OF ACCIDENT c* EXACT LOCATION OF ACCIDENT Military Time 1 PRIME hrs. e. CONTRACT NUMBER f* TYPE OF CONTRACT CONSTRUCTION ...

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