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  • Injury Report

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    dhila
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    This injury report summarizes an incident involving an employee. It provides the employee's name, department, date of birth, and date of employment. The emergency contact name and phone number are also listed. The report describes the date, time, and location of the injury. It also lists any witnesses. Details of the injury are documented, along with possible contributory factors such as being struck by an object, machinery accident, or exposure to hazardous materials. Information is given about personal protective equipment used or not used. The treatment received is noted as either first aid, treatment at the factory clinic, or treatment at an outside clinic. The report concludes with signatures from medical and management staff.

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    This injury report summarizes an incident involving an employee. It provides the employee's name, department, date of birth, and date of employment. The emergency contact name and phone number are also listed. The report describes the date, time, and location of the injury. It also lists any witnesses. Details of the injury are documented, along with possible contributory factors such as being struck by an object, machinery accident, or exposure to hazardous materials. Information is given about personal protective equipment used or not used. The treatment received is noted as either first aid, treatment at the factory clinic, or treatment at an outside clinic. The report concludes with signatures from medical and management staff.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    7 views2 pages

    Injury Report

    Uploaded by

    dhila
    This injury report summarizes an incident involving an employee. It provides the employee's name, department, date of birth, and date of employment. The emergency contact name and phone number are also listed. The report describes the date, time, and location of the injury. It also lists any witnesses. Details of the injury are documented, along with possible contributory factors such as being struck by an object, machinery accident, or exposure to hazardous materials. Information is given about personal protective equipment used or not used. The treatment received is noted as either first aid, treatment at the factory clinic, or treatment at an outside clinic. The report concludes with signatures from medical and management staff.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 2

    Doc. No.

    CLIN-REP-003A
    xdcdkuf'%f&mwif^ycsuf Effective Date 27-Aug-14
    Injury Report Revised Date 0

    0efxrf;.ukd,fa&;tcsuftvuf ta&;ay:qufoG,f&efzkef;ESifhvdyfpm xdcdkuf'%f&m&@SdrSKta_ctae


    Information of Employee Emergency Contact Information of Injury
    trnf- tdrfzkef;eHygwf- ဒ%f&m&@SdonffhaehpJG-
    Name : Home Phone No. : Date of Injury :
    Xme- vdyfpm- ဒ%f&m&@Sdonfhae&m-
    Dept.: Address : Place of Injury :
    arG;ouU&mZf- ဒ%f&m&@Sdonfhtcsdef-
    Date of Birth : Time of Injury :
    tvkyf0ifonfhaeh- rsuf_rifoufaorsm;-
    Date of Witnesses :
    Employment :

    ဒ%f&m&SdrSKta_ctaeazmf_ycsuf Decription of Injury

    __________________________________________________________________________
    __________________________________________________________________________
    __________________________________________________________________________
    __________________________________________________________________________
    __________________________________________________________________________
    __________________________________________________________________________
    __________________________________________________________________________

    ဒ%f&m&apaomtcsufrsm; Contributive Factors

    wpfpkHwpf&mESifhwkdufrd^cif;
    _yKwfusvmaomypPnf;ESifhc nyf^cif;àydwfrd^cif; yGef;yJHh^cif;
    Struck by flying/thrown object Struck against object Caught in/under object Rubbed/abraded by object

    _yKwfus_cif;/
    acsmfvJ_cif; pufypPn;ffajumifh_zpfaom'%f& xyfwvJvJvSKyf&Sm;&_cif; "gwfvdkuf_cif;
    A fall Machinery/vehicle accident Repetitive motion Electric Shock
    tylcsdefvGefuJ_cif;
    Temperature extremes
    cE<mudk,f.wHkh_yefr+ aoG;/t_cm;t&nfESifhxdawGhrSK tqdyf&Sdaomt&mESifhxdawGt_cm;a&m*grsm;ulpufcH&_cif;
    Bodily reaction Blood/fluid exposure Toxic material exposure Other disease exposure
    vGefuJaomqlnHr+
    Noise extremes
    t_cm; Other

    cE<mudk,ftumtuG,f toHk;_yKrSK Use of Personal Protective Equipment


    a_caxmuftumtuG,f rsufESm/ rsufvHk;tumtuG,f touff&SLvrf;ajumif;tumtuG,f
    Foot protection Face/eye protection Respiratory protection

    vuftumtuG,f a&Shtum rwif&eftultnDay;onfhypPnf;


    Hand protection Apron/chaps Lifting assitance device

    t_cm; Other r&Sd/roHk; None

    ukorSK Medical Treatment


    a&S;OD;olem_yK puf&Hk&Sdaq;cef; _yifyaq;cef;
    First Aid Factory Clinic Outside Clinic
    ukorSK
    tajumif;t&m : __________________________________________________________________________________
    __________________________________________________________________________________
    Details : __________________________________________________________________________________

    vufrSwf Sign
    Doctor/Nurse HR Manager Factory Manager Director

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