事故调查报告 副本.docVIP

Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness. (Optional: Use to investigate a minor injury or near miss that could have resulted in a serious injury or illness.) 说明：发生事故后应立即填写该报告（该报告也适用于调查可能引起较大伤害或者疾病的轻伤和虚惊事故） Number编号：_________ This is a report of a该事故属于: □ Death死亡 □Lost Time 损失工时 □Dr. Visit Only厂外就医 □First Aid Only 急救护理 □Near Miss虚惊 Date of incident事故日期: This report is made by报告填写人为: □Employee员工 □Supervisor主管 □EHS □Other其他_________ Step 1: Injured employee (complete this part for each injured empl