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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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