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THE PETROLEUM PROJECTS & TECHNICAL ‫ﺷﺮﻛﺔ ﺍﻟﻤﺸﺮﻭﻋﺎﺕ ﺍﻟﺒﺘﺮﻭﻟﻴﺔ ﻭ ﺍﻹﺳﺘﺸﺎﺭﺍﺕ ﺍﻟﻔﻨﻴﺔ‬

CONSULTATIONS CO. ‫ﺍﻹﺩﺍﺭﺓ ﺍﻟﻌﺎﻣﺔ ﻟﻠﺴﻼﻣﺔ ﻭﺍﻟﺼﺤﺔ ﺍﻟﻤﻬﻨﻴﺔ‬


HSE General Department ‫ﻭﺣﻤﺎﻳﺔ ﺍﻟﺒﻴﺌﺔ‬
‫ﺑﺗـــﺭﻭﺟــــــﺕ‬
First Aid
Injured Name :-……………… ……………… …………… ……….. Day/Month/Year :-…………………………. ………….………….

Financial No.:-………………… …………Age :-………………………….………………………….

Job :- ……………………Place :- …………………………… Time And Date :-………….………………….


How Happened In Details :-
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Injury Tool:-

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Diagnosis :-

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Safety And Occupation Hygiene Department Recommendation :-

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Root Causes:
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Corrective Action:
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Doctor :- ………………………

Name :- ………………………

Signature :- ………………………

Date :- ………………………

Issue No. (3) Issue Date: March2014 Revision No. (1) PJ-HSEMSF-4.5.3.1- 03

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