5. Jinsi; erkak, ayol (tagiga chizilsin). 6. Yoshi. (to’liq yillar soni ko’rsatilsin.) ____________________________________________________________________7.Kasbi, lavozimi____________________________________________ 1.Razryadi, klassi________________________________________________________________
8. Baxtsiz hodisa yuz berganda bajarilayotgan ishi bo’yicha ish staji._________________________________________________________________
9. Mehnat havfsizligi bo’yicha yo’riqnoma o’qitish: 9.1. Kirish yo’riqnomasi (sana)___________________________________________________________
9.2. Mehnat havfsizligi bo’yicha o’qitish (sana)______________________________
9.3. Dastlabki(davriy) yo’riqnoma (sana)__________________________________
9.4. O’ta havfli ishlar uchun bilimlarni tekshirish (sana) __________________ 9.5. Ishga kirayotganda va davriy tibbiy ko’rikdan o’tganligi. (sana) 10. Baxtsiz hodisa yuz bergan sana va vaqt. ____________________________ (kun,oy,yil)
11.Baxtsiz hodisa holati.________________________________________________
________________________________________________________________________________________________________________________________________
11.1.Baxtsiz hodisa sabablari_____________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________
11.2 Jarohat etkazilishga sabab bo’lgan asbob-uskuna_______________________________________________________________________________________________________________________________
11.3 Jabrlanuvchining xushyorligi (alkogol va narkotiklar ta’siridagi)__________ (Tibbiy xulosaga binoan)
________________________________________________________________________________________________________________________________________
11,4. Tashxis__________________________________________________________
(dastlabki, oxirgi)
12. Baxtsiz hodisa sabablarini bartaraf etish tadbirlari.
№
Tadbir nomi
Bajarilish muddati
Bajaruvchi
Bajarilishi haqida belgi.
13. Mehnat to’g’risidagi qonunchilik mehnatni muhofaza qilish qoidalari va me’yorlar buzilishiga yo’l qo’ygan shaxslar.
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