«tasdiqlayman» Rahbar Imzo, yozuvni kengaytmasi 2023y. Korxona pechati

«TASDIQLAYMAN» Rahbar __________________________ Imzo, yozuvni kengaytmasi «______»__________________2023y. Korxona pechati

Izoh№1 Forma N-1 Bir nusxadan jo‘natiladi - Jarohatlanuvchiga (oilada o‘lim sodir bo‘lganda) - mehnatni muhofaza xizmati rahbari (muhandis , mutaxasis) - mehnat bo‘yicha davlat bosh texnik inspektoriga

AKT №______
Ishlab chiqarishda baxtsiz hodisalar
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)
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 tuzilgan _____________________
( sana, oy, yil)
Komissiya raisi ________________________
(FISH, imzo)
Komissiya a’zosi _______________________
(FISH, imzo)