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Ore should not be submitted to VFIS. Personal Injury/Illness Investigation Report Emergency Service Organization Date Address Name of Injured Date of Birth Address of Injured Phone( ) Age Sex Height Weight Occupation Job Title Social Security Number Years with Dept. Date of Injury Time of Injury Date Reported Time Reported Accident Reported To Fractures Inflammation Infectious Disease Frostbite, Cold Exposure Pinched Nerve, Ruptured Disk Electric Shock Chemical Injury Nature .

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