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    Type of Accident

    Airplane AccidentAmusement Park AccidentAuto CollisionBicycle AccidentConstruction Site HazardDangerous ProductDangerous RoadwayDog Bite or AttackMotorcycle AccidentPedestrian AccidentTrain AccidentTruck CollisionOther

    Airplane AccidentAmusement Park AccidentAuto CollisionBicycle AccidentConstruction Site HazardDangerous ProductDangerous RoadwayDog Bite or AttackMotorcycle AccidentPedestrian AccidentTrain AccidentTruck CollisionOther

    Type of Injury

    Brain or Spinal Cord InjuriesBroken Limbs or DislocationsBurnsDeep or Severe CutsInjuries to Muscles, Tendons or LigamentsOther

    The Injury Occurred:

    On Private PropertyOn Public PropertyDue to a Private Individual's NegligenceDue to a Public Employee's NegligenceNot Sure / Other

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