Were you injured in the last 3 years? YesNo Type of injury Accident at workRoad traffic accidentSlip/tripSerious injuryFatal accidentDefective productMotorbike accidentOther How severe was your injury? MinorModerateSevereVery severe Was the accident your fault? YesNo Did you receive medical attention? YesNo Where was your injury? HeadNeckShoulderArmElbowWristPelvis/HipLegBackHandFoot Did you take time off work due to your injury? YesNo Full Name Email Address Telephone Number Please enter an accurate e-mail address and telephone number to receive your results.