Vous êtes sur la page 1sur 2

HATALETRO SDN BHD

REPORT KEMALANGAN

Tarikh kemalangan: ___________________Masa: __________________________

Tarikh di laporkan: ___________________Masa: __________________________

Tempat/ Daerah : _______________ ❏ Staff❏ Ibu bapa ❏ Lain: _____________________

Nama :______________________________________________________________________

Lokasi kemalangan:____________________________________________________________________

Terangkan secara terperinci tentang kemalangan:


_____________________________________________________________________________________
_____________________________________________________________________________________
Punca Kemalangan:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Aadakah kemalangan berlaku ketika kerja sedang berjalan? ❑ Yes ❑ No

Komen:
__________________________________________________________________________________________
__________________________________________________________________________________________
___________________________________________________________________________
Maklumat Saksi Kemalangan

Saksi

Nama:__________________________________________________________________________

Alamat:______________________________________________________________________________

Telefon Rumah:__________________Cell phone: _____________________Tempat Kerja:____________

Others
Nama:________________________________________________________________________________

Alamat:______________________________________________________________________________

Telefon Rumah: ______________Cell phone: _________________________Tempat Kerja: ___________

Vous aimerez peut-être aussi