O‘zbekiston respublikasi navoiy kon-metallurgiya kombinati navoiy davlat konchilik instituti

AKT №______
ishlab chiqarishda baxtsiz hodisalar va boshqa sog‘lik jarohatlarda

1. Korxonaning nomlanishi _________________________________________

2. Korxona adresi _________________________________________________
(viloyat, shahar , tuman, xususiy va x.k.)
1.2. Mulkchilik formasi _____________________________________________
1.3. Baxtsiz hodisa yo‘z bergan joy______________________________________
2. Vazirlik, korporatsiya, assotsiatsiya, konsern __________________________
3. Ishchini, jo‘natgan korxona ________________________________________
4. Jarohatlanuvchini familiyasi, ismi, otasining ismi_______________________________________________________________
5. Jinsi: erkak, ayol (tagi chizilsin)____________________________
6. Yoshi(to‘liq yili) _____________________________
7. Professiya, mansabi _ razryad, klass_______
8. Ish staji, Iish bajarishda baxtsizlik bo‘lgan paytdagi
9. Ko‘rsatma, mehnat xavfsizligi bo‘yicha o‘qitish:____________________
9.1. Kirish ko‘rsatmasi _______________________________________
(o‘tkazilgan sana)
9.2. Mehnat xavfsizligi bo‘yicha o‘qitish_______________________________
(sana)
9.3. Birlamchi (davriy) ko‘rsatma:_______________________
(sana)
9.4. Xavfliligi yuqori ishlar uchun bilimlarini sinash ______________
(sana)
9.5. Oldin va davriy tibbiy ko‘rikdan o‘tkazish_______
10. Baxtsiz hodisani sanasi va vaqti _________________________________
kun, oy , yil
11. Baxtsiz hodisani holati: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

11.1. Baxtsiz hodisa sababi ____________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________

11.2 Jihozlar, travm bo‘lishi ______________________
11.3. Jaroxatlanuvchining alkogol va narkotik holati____________________
(tibbiy xulosaga asosan)
11.4. Diagnoz ____________________________________________________
(oldingi, so‘ngi)

1. 
   Baxtsiz hodisalar sababini bartaraf etish bo‘yicha tadbirlar:
   

№	Tadbirni nomlanishi	Bajarilish muddati	Ijrochi	Bajarilganligi haqida belgi

13. Mehnat muhofazasi qoidalari va normalari, mehnat qonunchiligi bo‘zilishiga yo‘l qo‘ygan shaxs ______________________________________________________

(f.i.o., mansabi korxonani nomlanishi) __________________________________________________________________
14. Baxtsiz voqeani ko‘rganlar __________________________________________

Akt to‘zilgan _____________________

( sana, oy yil)
Komissiya raisi _________________________
(FISH, imzo)
Komissii a’zosi _______________________
(FISH, imzo)

2.