FISADEINSTRUIRECOLECTIVA

In conformitate cu prevederile art. 82 din HG nr. 1.425 din 11 octombrie 2006 pentru aprobarea Normelor metodologice de aplicare a
prevederilor Legii securitatii si sanatatii in munca nr. 319/2006

Privindsecuritateasisanatateainmuncaintocmitaazi_________________________
Subsemnatul.................................................................,avandfunctiade...........................................................,amprocedatla
instruireaunuinumarde.....................persoanedela........................................................................conformtabeluluinominal,
indomeniulsecuritatiisisanatatiiinmunca,pentruvizitainintreprindere/unitateinzilele..............................................
Incadrulinstruiriisauprelucraturmatoarelemateriale;
............................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................
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Prezentafisadeinstructajsevapastrala
.............................................................................................................................................................................................
Verificat,Semnaturaceluicareaefectuatinstruirea

TABELNOMINAL
Cupersoaneleparticipantelainstruire,Subsemnatiiamfostinstruitisiamluatcunostintadematerialele
prelucratesiconsemnateinfisadeinstruirecolectivaprivindsecuritateasisanatateainmuncasineobligamsale
respectamintocmai.
NR
CRT

1
2
3
4
5
6
7
8
9
10
11
12
13

NUMEPRENUME

ACTDE
IDENTITATE/PASAPORT

SEMNATURA

DATAEXPIRARII

14

15
16
17
18
19
20
21
22
23
24
25
27
28

Numelesiprenumelepersoaneicareaprimitunexemplar________________________________________________________________________
SEMNATURA______________________________________________