FRM.02.004 İş Kazasi Tutanaği

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FRM.02.004 İŞ KAZASI TUTANAĞI

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FRM.02.004 İş Kazasi Tutanaği

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Hanife Hava

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İŞ KAZASI TUTANAĞI- RAPORU

Bu form kazaya ramak kala ,ilk yardım,iş günü kaybı,çoklu yaralanma ile sonuçlanan kazalarda ve risk tespiti yapılan durumlarda kullanılmaktadır
Kaza tarihi Kaza Tanımı
Ramak Kala İlk Yardım İş Günü Kaybı Çoklu Yaralanma
.. / .. / ….
Kazalının / Tehlikeyi Atlatanın Yaralanan Bölge Kaza Sebebi
Adı soyadı / Bölümü

Tehlikeyi Tanımlayınız (Kazalıya /Tehlikeyi Atlatana Göre)

............................................................................................................................................................................................
…………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………..

Tanıklara Göre
…………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………..

Sonuç Olarak
…………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………..

Kök Nedenler

Tamamlama
Durum
Önleyici Faaliyetler Sorumlu Kişi Tarihi

Kazalıya Yapılan İşlem

TANIK TANIK

Raporu Hazırlayan Tarih Bölüm Şefi Bölüm Müdürü

(Ad Soyad ve imza) İmza İmza
…../…./……

FRM.02.004/00 Dağıtım:Personel (kaza durumunda) , Kalite (risk durumunda)

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