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Área de SSOMA

Código: FDP-SSM-SIG -RG-019 Declaración de Testigos


Elaborado por: Raúl Arellano
Revisado por: Alfredo Moyano
Aprobado por: Alfredo Moyano
Modificación: Ver.01
Fecha: 07.08.2017

DECLARACION
LESIONADO TESTIGO

1. Describa brevemente lo que sucedió o pudo presenciar


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Nombres y Apellidos del Declarante: ______________________________________________________

Cargo: ________________ Firma: ________________ Huella digital:

DNI: __________________ Fecha: ________________

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