12-工伤事故报告表

12-工伤事故报告 ASSOCIATE INJURY REPORT FORM 工伤事故报告表 (Please complete this within 24hrs after injury请在受伤后24小时内完成此表) Name姓名:_______霍敏_______________________ Associate No.员工编号:____________________ ____ Division/Department总部门/分部:_餐饮部/点心部__ Position职位:_______单尾主管________________ Start Date入职日期:____2013-5-8________________ Sex性别:_______女___________________________ Date of Injury受伤日期:___2013-10-29_____________ Time of Injury受伤时间:_晚上19点________________ Specify work area where accident occurred事故发生的具体地点:______中厨点心部蒸炉________________________ Extent of Injury受伤程度:___________________________________________________________________________ Body Part Injury受伤的具体部位:_______左手腕________________________________________________________ The injured are receiving care(send to hospital)伤者接受何种护理(是否送至医院):到医院进行包扎。_________________________________________________________________________________________________ __________________________________________________________________________________________________ Describe how accident occurred详细描述事情发生经过: _10月29日晚上19点在酒店点心房蒸包子的过程中蒸笼盖损坏脱落导致蒸汽上升烫伤左手手腕。__________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Witness of Accident工伤见证人签字: Division部门: Position职位: ________________________ ________________________________ Associate’s Signature/Date Manager on duty Signature/Date 员工签字/日期 值班经理签字/日期 What other additional corrections would prevent reoccurrence? (Completed by Department. ) 采取什么措施可以防止相类似的事故发生,(由所在部门填写) ___提醒员工在工作当中要注意，做事情要集中精神，按部就班。 __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _____________________________ _________________________________ _____________________________ Department Head’s Signature/Date HR Manager/Director’s Signature/Date General Manager’s Signature/Date 部门经理/总监签字/日期 人力资源部经理/总监签字/日期 总经理签字/日期 白联(White)-人力资源部(HR) 粉联(Pink)-财务部(Finance) 蓝联(Blue)-部门(Department)