Professional Documents
Culture Documents
100000
95006
90000 92074
85926
80000
70000
60000
JKKP
50000
PERKESO
40000
30000
20000
10000
1814 1262 3394
0
1999 2000 2001
JKKP 1814 1262 3394
PERKESO 92074 95006 85926
Part I – Preliminary
Part II – Notification of Accident, Dangerous
Occurrence, Occupational Poisoning and
Occupational Disease
Part III – No Interference at Accident or Dangerous
Occurrence Scene
Part IV – Maintenance of All Records of Accident,
Dangerous Occurrence, Occupational
Poisoning and Occupational Disease
Part V – Miscellaneous
RECORDABLE
REPORTABLE
Notify nearest DOSH by the
quickest means
Occurrence
Immediate
Death
Related
Serious
bodily injury
Work
MC > 4 days
Death
within 1 year
Injury, MC
4 days or less
Nama Nama
Orang yang boleh dihubungi (Jika lain dari atas) Tempat Kejadian
JUST OUTSIDE THE WAREHOUSE WHERE THE PLASTIC ROLLS ARE
KEPT
28/05/05;
No.Telefon Tarikh dan Masa Kejadian 4:30 PM
Kod Klasifikasi Industri (Jadual 3) Tarikh Mula Lapor kepada JKKP 29/05/05
Sila huraikan apa yang berlaku sebelum, semasa dan selepas kejadian.
THE ACCIDENT VICTIM WAS AN ASSISTANT TO THE TRUCK DRIVER
THE VICTIM WAS OPENING THE SIDE GATE OF THE TRUCK.
THE ROLLS WHICH WERE NOT TIED DOWN PROPERLY, CAME TUMBLING DOWN, CRUSHING THE VICTIM
THE FORKLIFT DRIVER CALLED FOR HELP AND THE VICTIM WAS REMOVED FROM THE SCENE AND SENT TO
HOSPITAL. HE WAS PRONOUNCED DEAD ON ARRIVAL.
CAUSES OF ACCIDENT :
CORRECTIVE ACTIONS :
Employee
Report
Suffers or EMPLOYER
likely to suffer
OP/OD
Report in 7 days
ort
p
Re
Registered
Medical
Practitioner/
Rep
Officer ort in 7
day
s
Self Employed
Person
Report in 7 day
s DOSH
Copyright © NIOSH 2011 28 / 49
O S H L E JKKP
G I 7S - LPEMBERITAHUAN
A T I O N MENGENAI KERACUNAN PEKERJAAN/PENYAKIT PEKERJAAN
Jawatan Jawatan
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Copyright © NIOSH 2011
O S H L E G I S L A T I O N
Huraian pekerjaan yang membawa kepada keracunan pekerjaan/penyakit pekerjaan (Sila huraikan sebarang
kerja yang dibuat oleh orang yang terlibat yang mungkin telah membawa kepada penyakit. Jika penyakit
mungkin disebabkan oleh pendedahan kepada sebarang agen semasa kerja, contoh kimia yang spesifik - sila
nyatakan agen berkenaan)
Tandatangan Pemberitahu
Tarikh
Penafian
Mengisi borang ini tidak menjadikan pengakuan ke atas sebarang lialibiliti oleh orang yang mengisi borang.
JKKP 8 record
JKKP 8 record
Copyright © NIOSH 2011 33 / 49
O S H L E G I S L A T I O N
ADOPOD
arising out of or in connection with the work
of your undertaking which is covered by the Act and involves:
One of your employees or a self- Dangerous Any other person who is not an employee at work but
employed person working in Occurrence who was either in premises under your control at the
your premises resulting in: listed in Table 6 time or was otherwise involved in the accident
resulting in :
Other injury Occupational Fatal or Other injury Fatal or other serious Other injury
causing poisoning / serious causing bodily injury or injury
incapacity diseases as bodily incapacity > 4 causing incapacity for
for 4 days or listed in injury calendar > 4 calendar days No action
less Table 16 days Other injury causing required
incapacity for > 4
calendar days
NOTIFY DOSH STATE OFFICE
IMMEDIATELY
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O S H L E G I S L A T I O N
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O S H L E G I S L A T I O N
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O S H L E G I S L A T I O N
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O S H L E G I S L A T I O N
FATALITY RATE :
FATALITY (Number of Fatalities / thousand employees)
Total No of Fatalities x 1,000
= ------------------------------------- P 8
K
JK
Annual Average Number of Employees
INCIDENT RATE :
INCIDENT (Number of Accidents / thousand employees)
Total No of Accidents x 1,000
= ------------------------------------
Annual Average Number of Employees
FREQUENCY RATE:
FREQUENCY RATE (Number of Accidents (TRC) / million man-
man-hours worked)
Total No of Accidents x 1,000,000
= -----------------------------------------
Total No of man-
man-hours worked
SEVERITY RATE :
SEVERITY (Average No of days lost (LTI) / million man-
man-hours worked)
Total No of days lost x 1,000,000
= ----------------------------------------
Total No of man-
man-hours worked
Copyright
Copyright ©
© NIOSH 2010
NIOSH 2011 4242 / 49
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O S H L E G I S L A T I O N