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  • 4. Biên Bản Tường Trình Tai Nạn

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    9 views1 page

    4. Biên Bản Tường Trình Tai Nạn

    Uploaded by

    me2 koreancosmetic

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BIÊN BẢN TAI NẠN

    ACCIDENT REPORT

    Họ và tên nạn nhân (Name of victim):.................................................................Tuổi (Age):.............


    Địa chỉ thừơng trú (Address):.............................................................................................................
    ...............................................................................................................................................................
    Nghề nghiệp (Job):...............................................................................................................................
    Tên đơn vị (Company’s name):...........................................................................................................
    Địa chỉ đơn vị (Company’s address):..................................................................................................
    ...............................................................................................................................................................
    Tai nạn xảy ra hồi (Accident): .........giờ (hour) ...........Phút (Minute), ngày (Date) ..........................
    Diễn biến ra tai nạn (Accident happening):........................................................................................
    ...............................................................................................................................................................
    ...............................................................................................................................................................
    ...............................................................................................................................................................
    ...............................................................................................................................................................

    Nguyên nhân xảy ra tai nạn (Aftermath of accident): .......................................................................


    ...............................................................................................................................................................
    ...............................................................................................................................................................
    Hậu quả tai nạn (Consequence of accident): ...................................................................................
    ...............................................................................................................................................................
    ...............................................................................................................................................................
    ...............................................................................................................................................................
    ...............................................................................................................................................................

    Xác nhận của đơn vị / người làm chứng ……………., ngày ..............tháng ....... năm 20........
    ……………., Date .....................................................

    Người khai
    (Ký ghi rõ họ tên)

    1
    Claim form | Jan.2018

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