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  • ReportenaccidentesnAI 365ec2a8edd1860

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    ReportenaccidentesnAI 365ec2a8edd1860

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    lSTEVENl

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    © All Rights Reserved
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    REPORTE DE INCIDENTES, ACCIDENTES Y ENFERMEDADES LABORALES

    EVENTO: INCIDENTE LABORAL

    FECHA DEL EVENTO: ____________________________________________________________


    NOMBRE DEL TRABAJADOR: _____________________________________________________
    OCUPACION: ___________________________________________________________________
    AREA DE TRABAJO: _____________________________________________________________
    SITIO EXACTO DEL EVENTO: _____________________________________________________

    DESCRIPCION DETALLADA DEL EVENTO:

    ANALISIS DE CAUSAS:
    CONDICIONES NO SEGURAS:

    1.________________________________________________________________________
    2. _______________________________________________________________________
    3. ________________________________________________________________________

    COMPORTAMIENTOS NO SEGUROS:

    1._________________________________________________________________________
    2. ________________________________________________________________________
    3. ________________________________________________________________________

    MEDIDAS PREVENTIVAS RECOMENDADAS:


    1. _____________________________________________________________________
    2. _____________________________________________________________________
    3. _____________________________________________________________________
    4. _____________________________________________________________________
    5. _____________________________________________________________________
    REPORTE DE INCIDENTES, ACCIDENTES Y ENFERMEDADES LABORALES
    EVENTO: ACCIDENTE LABORAL

    FECHA DEL EVENTO: ____________________________________________________________


    NOMBRE DEL TRABAJADOR: _____________________________________________________
    OCUPACION: ___________________________________________________________________
    AREA DE TRABAJO: _____________________________________________________________
    SITIO EXACTO DEL EVENTO: _____________________________________________________

    DESCRIPCION DETALLADA DEL EVENTO:

    ANALISIS DE CAUSAS:
    CONDICIONES NO SEGURAS:

    1.________________________________________________________________________
    2. _______________________________________________________________________
    3. ________________________________________________________________________

    COMPORTAMIENTOS NO SEGUROS:

    1._________________________________________________________________________
    2. ________________________________________________________________________
    3. ________________________________________________________________________

    MEDIDAS PREVENTIVAS RECOMENDADAS:


    1. _____________________________________________________________________
    2. _____________________________________________________________________
    3. _____________________________________________________________________
    4. _____________________________________________________________________
    5. _____________________________________________________________________
    REPORTE DE INCIDENTES, ACCIDENTES Y ENFERMEDADES LABORALES
    EVENTO: PRESUNTA ENFERMEDAD LABORAL

    FECHA DEL EVENTO: ____________________________________________________________


    NOMBRE DEL TRABAJADOR: _____________________________________________________
    OCUPACION: ___________________________________________________________________
    AREA DE TRABAJO: _____________________________________________________________
    SITIO EXACTO DEL EVENTO: _____________________________________________________

    DESCRIPCION DETALLADA DEL EVENTO:

    ANALISIS DE CAUSAS:
    CONDICIONES NO SEGURAS:

    1.________________________________________________________________________
    2. _______________________________________________________________________
    3. ________________________________________________________________________

    COMPORTAMIENTOS NO SEGUROS:

    1._________________________________________________________________________
    2. ________________________________________________________________________
    3. ________________________________________________________________________

    MEDIDAS PREVENTIVAS RECOMENDADAS:


    1. _____________________________________________________________________
    2. _____________________________________________________________________
    3. _____________________________________________________________________
    4. _____________________________________________________________________
    5. _____________________________________________________________________

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