______________________
korxona rahbari
“______” ___________ 20__ yil
DALOLATNOMA № _____
Ishlab chiqarishdagi baxtsiz hodisalarni va xodimlar salomatligining boshqa turli zararlanishini tekshirish to’g’risida
Korxonanomi ______________________________________________________
Korxonaningmanzili ________________________________________________
(viloyat, shahar, tuman, ko’cha, uy)
Mulkchilikshakli ___________________________________________________
(davlat aktsiyadorlik, xususiy va x.)
Baxtsizhodisayuzbergan joy _________________________________________
(bo’linma, sex)
Vazirlik, korporasiya, uyushma, konsern __________________________________
Xodimniyo’llagankorxona ____________________________________________
(nomi, manzili, vazirlik)
______________________________________________________________________
(korporasiya, uyushma, konsern)
Jabrlanuvchiningfamiliyasi, ismi, otasiningismi _____________________________
________________________________________________________________________
Jinsi, erkak, ayol (tagiga chizilsin)
Yoshi (to’liq, yillar soni ko’rsatilsin) _______________________________________
Kasbilavozimi ________________________________________________________
Razryadi, klassi ____________________________________________________
Baxtsizhodisayuzbergandabajarilayotganishbo’yichaishstaji _________________
Mehnatxavfsizligibo’yichayo’riqnomao’qitish:
Kirishyo’riqnomasi (sana) _______________________________________________
Mehnatxavfsizligibo’yichao’qitish (sana) __________________________________
Birlamchi (davriy) yo’riqnoma (sana) ______________________________________
O’taxavfliishlaruchunbo’limlarnitekshirish (sana) __________________________
Ishgakirayotgandavadavriytibbiyko’rikdano’tganligi _______________________
Baxtsiz hodisa yuz bergan sana va vaqt _____________________________________
(yil, kun, oy)
________________________________________________________________________
(ishboshlashdagito’liqsoatlarsoni)
Baxtsizhodisaholati ___________________________________________________
________________________________________________________________________
________________________________________________________________________
11.1. Baxtsizhodisasabablari _______________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________
11.2. Jarohatyetkazilishigasababbo’lganasbob-uskuna _____________________________
11.3. Jabrlanuvchiningxushyorligi (alkogolyokinarkotikta’siridaligi) __________________________________________________________________________
(tibbiyxulosagabinoan)
11.4. Tashxis _______________________________________________________________
(dastlabki, oxirgi)
Baxtsiz hodisa sabablarini bartaraf etish tadbirlari:
t/r
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Tadbirlarnomi
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Bajarishmuddati
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Bajaruvchi
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Bajarilishihaqidagibelgi
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Mehnatto’g’risidagiqonunchilik, mehnatnimuhofazaqilishqoidalarivame’yorlaribuzilishigayo’lqo’yganshaxslar
________________________________________________________________________
(F.I.O, lavozimi korxona nomi)
________________________________________________________________________
(ular tomonidan buzilgan qonunlar, qoidalar va me’yoriy hujjatlarning moddalari, bandlari)
Baxtsizhodisaguvohlari __________________________________________________
Dalolatnomatuzildi _________________________________________________________
(yil, kun, oy)
Komissiyaraisi _____________________________________________________________
(F.I.O. imzo)
Komissiyaa’zolari ___________________________________________________________
(F.I.O. imzo)
Komissiyaa’zolari ___________________________________________________________
(F.I.O. imzo)
Komissiyaa’zolari ___________________________________________________________
(F.I.O. imzo)
Komissiyaa’zolari ___________________________________________________________
(F.I.O. imzo)
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