Ўзбекистон республикаси Олий ва ўрта махсус таълим вазирлиги Навоий кон-металлургия комбинати

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.