N.H. Admin. Code § Puc 1107.05 - E-5 Utility Accident Report
(a) Each utility
shall file a completed "NHPUC Accident Form" within 10 working days of when an
accident meeting the criteria contained in
Puc
1105.05(a) and (c) occurs.
(b) Each utility shall include on the "NHPUC
Accident Form" the following:
(1) Report
number, date and name and address of utility;
(2) Date and location of accident;
(3) Description of person injured including:
a. Name;
b. Age;
c. Residence;
d. Employer; and
e. Status of injured person, whether
employee, person under contract, invitee, licensee, trespasser or
other;
(4) Description
of injury, current condition, duration of disability and, if applicable,
anticipated return to work date;
(5) Description of cause and manner of
accident;
(6) If applicable, cause
of death, previous accident report number;
(7) Designation of federal or state statute
violated, if applicable;
(8)
Recommendation for guarding against repetition of accident; and
(9) Signature and title of
signatory.
Notes
(See Revision Note at Chapter heading Puc 1100) #6445, eff 1-28-97; ss and moved by #8244, eff 12-31-04 (from Puc 1107.06); ss by #10307, eff 4-9-13
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