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7. Kasbi, lavozimi _______________________________________________________
7.1. Razryadi, klassi ______________________________________________________
8. Baxtsizhodisayuzbergandabajarilayotganishbo‘yichaishstaji ________________
9. Mehnatxavfsizligibo‘yichayo‘riqnoma, o‘qitish:
9.1. Kirish yo‘riqnomasi (sana)______________________________________________
9.2. Mehnatxavfsizligibo‘yichao‘qitish (sana)_________________________________
9.3. Dastlabki (davriy) yo‘riqnoma (sana)______________________________________
9.4. O‘ta xavfli ishlar uchun bilimlarni tekshirish (sana)___________________________
________________________________________________________________________
9.5. Ishga kirayotganda va davriy tibbiy ko‘rikdan o‘tganligi ______________________
_______________________________________________________________________
10. Baxtsiz hodisa yuz bergan sana va vaqt ____________________________________
(yil, kun, oy)
_______________________________________________________________________
(ish boshlashdagi to‘liq soatlar soni)
11. Baxtsiz hodisa holati ___________________________________________________
________________________________________________________________________
11.1. Baxtsiz hodisa sabablari _______________________________________________
________________________________________________________________________
11.2. Jarohatetkazilishigasababbo‘lganasbob-uskuna ___________________________
11.3. Jabrlanuvchining hushyorligi (alkogol yoki narkotiklar ta’siridaligi)____________
(tibbiy hulosaga binoan)
11.4. Tashhis _______________________________________________________
(dastlabki, ohirgi)
12. Baxtsiz hodisa sabablarini bartaraf etish tadbirlari:
Tartib
raqami
Tadbirlar nomi
Bajarish
muddati
Bajaruvchi
Bajarilishi
haqida belgi
13. Mehnat to‘g‘risidagi
qonunchilik, mehnat muhofaza qilish qoidalari va me’yorlari
buzilishiga yo‘l qo‘ygan shaxslar __________________________________________________
_____________________________________________________________________________
(ismi, sharifi, lavozimi, korxona nomi)
_____________________________________________________________________________
(ular tomonidan buzilgan qonunlar, qoidalar va
_____________________________________________________________________________
me’yoriy hujjatlarning moddalari, bandlari)
14. Baxtsiz hodisa guvohlari________________________________________________
Dalolatnoma tuzildi _______________________________
(yil, kun, oy)
