賣場超市百貨運營門店管理 OP-003_事故報告和調(diào)查作業(yè)規(guī)范

1、HYMALL STANDARD OPERATING PROCEDURE樂購商業(yè)流通集團事故報告和調(diào)查作業(yè)規(guī)范-文件類別： 營運作業(yè)規(guī)范 文件編號： 撰寫單位： 總公司營運管理部 版 本： 第 一 版發(fā)行日期： 2005/機密等級： 機密 一般合計頁數(shù)： 共 33頁核 準(zhǔn)審 核制 定文件名稱事故報告和調(diào)查修改日期修改頁次修改頁序/版本更改內(nèi)容提要/文件修正履歷表樂購標(biāo)準(zhǔn)作業(yè)規(guī)范SOP NAME 名稱ACCIDENT REPORTING AND INVESTIGATION PROCEDURE事故報告和調(diào)查 SOP NUMBER & DATE OF ISSUE版本及日期122/4/2005AREA

2、/ DEPARTMENT COVERED適用區(qū)域或部門全店各區(qū)域之重要工作傷害,應(yīng)報告疾病,危險事故事件PURPOSE目的了解并減少顧客及員工之意外事故，合理處置現(xiàn)場，追蹤后續(xù)步驟，減少公司損失Supporting material輔助材料無WHO NEEDS TO BE TRAINED & ON WHAT? 哪些人需要做何種訓(xùn)練？所有店值班經(jīng)理，營業(yè)及客服部門值班、防損課組長、人資主管、店公關(guān)接受全部訓(xùn)練what the sm has to do店總要做什么研讀并了解文件內(nèi)容，并知道事故減少為公司重要管理指標(biāo)。5月10日前完成所有訓(xùn)練。要求所有參與店值班經(jīng)理及部門值班人員、防損主管(組長以上

3、)、人資主管、店公關(guān)研讀此規(guī)范并測試他們。要求所有上述人員了解表格之填寫，及RACI(權(quán)責(zé)劃分)表上各自份內(nèi)工作范圍所有記錄之原件存檔店總室，存檔期限三年，人資備份一份。讓所有受訓(xùn)人員了解，店值班是本規(guī)范執(zhí)行之主要責(zé)任人，各部門值班要接受其任務(wù)指派，協(xié)助事件、事故之調(diào)查。FAILURE TO ADHERE TO THE ABOVE POLICIES COULD RESULT IN DISCIPLINARY ACTION BEING TAKEN未依要求執(zhí)行者，將可能做紀(jì)律處分Joe Lin _ _COO Hymall 樂購營運總長 Accident Reporting / Investigati

4、on事故報告/調(diào)查 TLT 510Issue 1 Feb. 2005 PAGE 4Accident Reporting / Investigation事故報告/調(diào)查 TLT 510Issue 1 Feb. 2005 事故事件報告/調(diào)查及執(zhí)法部門訪店RACI權(quán)責(zé)劃分表項次項目內(nèi)容職務(wù)身份別時間 RACI1“事故事件記錄”TLT015a5天內(nèi)店值班店總TLT、區(qū)人資、區(qū)客服TLT、區(qū)防損、區(qū)人資2“事故事件記錄”TLT015b5天內(nèi)店值班店總TLT、區(qū)人資、區(qū)客服TLT、區(qū)防損、區(qū)人資3“每月事故統(tǒng)計報告表”TLT018上報每月2日前店人資店總TLT、區(qū)人資TLT、區(qū)防損、區(qū)人資、營運長4事故報告

5、總結(jié)表TLT019(每季)上報季初首月2日前店人資店總TLT、區(qū)人資TLT、區(qū)防損、區(qū)人資、營運長5事故調(diào)查(應(yīng)報告的事故/事件)TLT0205天內(nèi)店值班店總TLT、區(qū)人資TLT、區(qū)防損、區(qū)人資、營運長6事故/事件調(diào)查及通知相關(guān)主管24小時內(nèi)店值班店總TLT、區(qū)人資店內(nèi)有關(guān)部門、區(qū)人資、營運長、TLT7向TLT報告事故及事件5天內(nèi)店人資店總TLT、區(qū)人資TLT8聯(lián)系保險理賠事宜48小時內(nèi)店人資店總TLT、區(qū)人資、區(qū)財務(wù)區(qū)人資、財務(wù)、營運長9顧客慰問，后續(xù)處理視情況店客服店總區(qū)客服區(qū)人資10非顧客之后續(xù)處理視情況店人資店總區(qū)人資區(qū)人資11現(xiàn)場急救處理指揮視情況店值班店總TLT、區(qū)防損、區(qū)人資區(qū)人

6、資、區(qū)防損、營運長12每月查核記錄之歸檔與后續(xù)步驟執(zhí)行每月10日前店總區(qū)人資營運長、TLT13每季查核記錄之歸檔與后續(xù)步驟執(zhí)行每季首月20日前區(qū)人資營運長TLT ACCIDENT REPORTINGAND INVESTIGATIONPROCEDURE事故報告和調(diào)查程序Accident Reporting and Investigation Process事故報告和調(diào)查過程 XE Reporting Process XE Reporting Process XE Reporting Process In the event of an accident to a customer, employ

7、ee or contractor a First Aider must be called. Duty manager must also be informed - Communicate this to all staff. 當(dāng)任何相關(guān)顧客，員工或是合同商（專柜,商店街,保潔等）的事故發(fā)生時，必須及時進行救援。同時通知值班經(jīng)理將此向所有員工傳達。Duty Manager to undertake the initial investigation. 值班經(jīng)理應(yīng)進行最初的調(diào)查。WRITE names of ALL persons in the area記錄該區(qū)所有人員的姓名WRITE det

8、ails of the accident scene, include any significant observations regarding the scene or the injured person記錄事故現(xiàn)場詳情，包括任何相關(guān)現(xiàn)場和傷者的重要觀察CHECK CCTV footage of the area檢查該區(qū)的錄像記錄ASK - if anyone saw, heard or smelt anything; when and where did it happen; how did the accident occur?詢問任何看到，聽到或是聞到任何情況的人員，詢問事故發(fā)生

9、的事件以及事故是如何發(fā)生的。TAKE photographs/sketches of the scene, equipment and record on Investigation Form對現(xiàn)場、設(shè)備進行拍照畫草圖，記錄于調(diào)查表上ENSURE - equipment is taken out of service and examined by a maintenance確保設(shè)備停止使用，并由維護人員檢查過。INTERVIEW - all witnesses to the accident (record the date of the interview, the witnesses n

10、ame, occupation, address and contact number面談與事故所有的目擊者面談（記錄面談的日期，目擊者的姓名，職業(yè)，地址和聯(lián)系方式）Duty Manager to pass accident details to the Personnel Manager for consideration as to whether accident is reportable to Trading Law & Technical 值班經(jīng)理將事故的詳情傳達給人資，以考慮是否要將該事故報告給TLT（貿(mào)易法律與技術(shù)指導(dǎo)（安全與健康）部）.If Personnel Manager

11、 is absent, allocated someone in the store to take responsibility whilst Personnel Manager is off.如人資缺席，則應(yīng)安排門店相關(guān)人員在人資放假時承擔(dān)責(zé)任。Duty Manager to pass all details over to relevant Section Manager in order to undertake a full investigation and action any measures as necessary.值班經(jīng)理應(yīng)向相關(guān)的部門主管報告所有的細節(jié)，以便采取全面的調(diào)

12、查和必要的措施。Complete the TLT015a/TLT015b at time of accident and back page the back page is for employee accidents only this is for all accidents/incidents于事故發(fā)生時，填寫TLT015a,(適用于任何事故事件),TLT015b,(只用于員工事故報告）If the accident is reportable to Trading Law & Technical, complete TLT020 and send through to TLT dep

13、artment. 如事故屬于應(yīng)該向TLT報告的范圍，填寫TLT020 表格并將該表格送至TLT部。Determine whether the injury/incident is major reportable refer to Appendix 1請參照附錄一決定該傷害事件是否屬于應(yīng)重要報告的事件If major reportable, then contact TLT by phone within 24 hours of the incident and send the report off within 5 days. 如是重要應(yīng)報告的，請在事件發(fā)生的24小時內(nèi)電話聯(lián)系TLT部，并

14、請在5天之內(nèi)交上報告。All other reportables must be sent through within 5 days. 所有其他應(yīng)報告的事件應(yīng)在5天內(nèi)進行報告。If unsure, please contact TLT for further advice on 021 52942249 - 343如不確定，請撥打電話021 52942249 - 343聯(lián)系TLT，尋求更多建議。Contact insurance department for assistance with any claims聯(lián)系保險部門對相關(guān)索償進行協(xié)助Every month, accident stat

15、istics must be submitted to Trading Law & Technical and to the Regional Office using TLT018 必須每月通過TLT018表向TLT部和地區(qū)總部遞交事故數(shù)據(jù)報告。Every quarter an accident summary must be submitted to Trading Law & Technical and to the Regional Office using TLT019必須每三個月通過TLT019表向TLT部和地區(qū)總部遞交季度事故小結(jié)。See Appendix 4 for examp

16、le of completed Accident Investigate from參見附件4 意外事件調(diào)查報告樣本Reportable Accident Procedure應(yīng)報告事故程序APPENDIX 1附錄一Definition of Reportable Injuries, Diseases and Dangerous Occurrences應(yīng)報告的傷害，疾病和危險事件的定義Reportable Injuries, Diseases and Dangerous Occurrences應(yīng)報告的傷害，疾病和危險事故Definition定義When someone dies or suffer

17、s a major injury in a accident connected with the business (see definition of major injury below)與企業(yè)有關(guān)的事故導(dǎo)致人員死亡或受重傷（參照以下主要傷害的定義）An employee is injured which results in immediate hospital admission for more than 24 hours員工受傷而導(dǎo)致住院24小時以上A customer is taken directly to hospital from the store following

18、an accident related with the business與企業(yè)有關(guān)的事故發(fā)生后，顧客直接從門店被送至醫(yī)院There is over a three day injury (see definition below)受傷時間三天(大于三天)以上（參照以下定義）There is a dangerous occurrence (see definition below)危險事件發(fā)生（參照以下定義）Definition of Reportable Major Injuries應(yīng)報告的重要傷害定義Work related fatality因工作導(dǎo)致的致命傷害Fracture other

19、 than to fingers, thumbs or toes手指，拇指和腳趾以外的骨折Amputation切斷手術(shù)Dislocation of shoulder, hip, knee or spine肩膀、臀部，膝蓋或脊椎脫臼Loss of sight (temporary or permanent)失明（暫時或永久的）Chemical or hot metal burn to the eye or any penetrating injury to the eye眼部受到化學(xué)物或熱金屬的燒傷，或是眼部受到的任何尖銳的傷害Injury resulting from an electric

20、shock or electrical burn leading to unconsciousness or requiring resuscitation or admittance to hospital for more than 24 hours因電擊或是電燒傷而導(dǎo)致昏迷的傷害或任何需要住院24小時以上的傷害。Unconsciousness caused by asphyxia or exposure to harmful substance or biological agent因暈厥導(dǎo)致的不省人事，或是受到有害物體或生物試劑侵害而導(dǎo)致意識不清Accident Reporting /

21、 Investigation事故報告/調(diào)查 TLT510Issue 1 Feb. 2005 PAGE 7Acute illness requiring medical treatment, or loss of consciousness arising from absorption of any substance by inhalation, ingestion or through the skin任何需要醫(yī)療的急性疾病，或是因通過吸入，攝入或皮膚滲透物品而導(dǎo)致的意識喪失Acute illness requiring medical treatment where there is r

22、eason to believe that this resulted from exposure to a biological agent or its toxins or infected material需要醫(yī)療的急性疾病，并有理由相信該疾病是受到生物試劑或受其毒性或感染物品的侵害而導(dǎo)致的。Over Three Day Injury三天以上傷害Over 3 day injuries to staff must be reported when a member of staff is incapacitated for work for more than three consecut

23、ive days, not counting the day of the accident but including any days which would not have been working days. The expression more than three consecutive days means, in practice, at least four days. For example, if a person who normally works Monday to Friday is injured on Friday and returns to work

24、the following Wednesday, the Saturday and Sunday would have to be included when counting the days of incapacity. The total period of incapacity would be four days and the injury must be reported.如有員工無法工作連續(xù)三天(不含)以上，不包括事故發(fā)生的當(dāng)天，但包括任何非工作日，就應(yīng)該將該員工三天以上傷害這一事件進行報告?！斑B續(xù)三天以上”這個概念事實上就指的是至少有四天。比如，一位周一至周五正常工作的員工，

25、于周五受傷，并于下個周三返回工作，當(dāng)計算無法工作的天數(shù)時候應(yīng)將周六和周日包含在內(nèi)。這個無法工作的期間有四天，則這一傷害事件必須給于報告。Definition of Reportable Dangerous Occurrences“應(yīng)報告的危險事件”的定義Collapse, overturning or failure of load-bearing parts of lifts and lifting equipment任何載重的升降機或升降設(shè)備崩潰，倒塌或發(fā)生故障Explosion, collapse or bursting of any closed vessel or associate

26、d pipework任何封閉的容器或相關(guān)的管道發(fā)生的爆炸，崩潰或爆裂Plant or equipment coming into contact with overhead power lines任何設(shè)備與天花板電線發(fā)生碰撞Electrical short circuit or overload causing fire or explosion因短路或超負荷工作而導(dǎo)致的火災(zāi)或爆炸Any unintentional explosion, misfire, failure of demolition to cause the intended collapse, projection of ma

27、terial beyond a site boundary, injury caused by an explosion任何非故意的爆炸，熄火或引爆失敗導(dǎo)致場所外圍的坍塌或物體射出，從而引爆炸引起傷害Accidental release of a biological agent likely to cause severe human illness生物藥劑的可能會導(dǎo)致嚴(yán)重疾病的意外外泄Malfunction of breathing apparatus while in use or during testing immediately before use使用中或是在測試階段即將使用的呼

28、吸設(shè)備發(fā)生故障Collapse or partial collapse of a scaffold over five metres high, or erected near water where there could be a risk of drowning after a fall五米以上的腳手架的倒塌或部分倒塌，或腳手架建在水邊，可能會有下跌后被水淹沒的危險Unintended collapse of; any building or structure under construction, alteration or demolition where over 5 tonne

29、s of material falls; a wall or floor in a place of work; any false-work.任何建筑或正在建造的建筑的非人為倒塌，或任何改建或拆毀處的超過五噸以上的物品下跌，或作業(yè)處的墻或地面的非人為倒塌，或是任何腳手架的非人為倒塌。Explosion or fire causing suspension of normal work for over 24 hours因爆炸或火災(zāi)而延誤正常工作長達24小時以上的Sudden, uncontrolled release in a building of: 100kg or more of fl

30、ammable liquid; 10kg of flammable liquid above its boiling point; 10kg or more of flammable gas; or of 500kg of these substances if the release is in the open air.建筑中發(fā)生以下突然的，未控制的釋放：100公斤或以上的可燃液體；10公斤高于沸點的可燃液體；或更多的可燃氣體；或是500公斤以上物體在戶外釋放。Accidental release of any substance which may damage health任何可能危害

31、健康的物體的意外釋放Definition of Reportable Diseases應(yīng)報告的疾病的定義Poisonings中毒Cramp of the hand or forearm due to repetitive movements. Traumatic inflammation of the tendons of the hand or forearm or of the associated tendon sheaths.因重復(fù)活動造成的手或前臂抽筋。手或前臂腱關(guān)節(jié)或是相關(guān)的腱鞘外部發(fā)炎。Some skin diseases such as occupational dermati

32、tis.一些皮膚疾病，比如職業(yè)性皮炎 Lung diseases including; occupational asthma, pneumoconiosis, asbestosis, mesotherlioma;肺部疾病包括：職業(yè)性哮喘，肺炎，石棉沉滯癥和間皮瘤。Infections such as; leptospirosis; hepatitis; tuberculosis; anthrax; legionellosis and tetanus;傳染病比如：細螺旋體病，肝炎，肺結(jié)核，炭疽熱，軍團病和破傷風(fēng)。Other conditions such as: occupational ca

33、ncer, certain musculoskeletal disorders and hand arm vibration sysndrome其他情況比如: 職業(yè)的癌癥，肌骨胳類紊亂病和手臂振動癥。Diseases are only reportable if diagnosed in writing by a Doctor, and the persons job involves the appropriate work activity. Should you have any queries regarding complaints of occupationally related

34、 illnesses contact TLT.只有在影響傷者的工作相關(guān)強度并且具有醫(yī)生的書面處方的前提下，這些疾病才是應(yīng)報告的。如果對于相關(guān)職業(yè)的疾病有任何疑問，請聯(lián)系TLT。Accident Reporting / Investigation事故報告/調(diào)查 TLT510 Issue 1 Feb. 2005 PAGE 9APPENDIX 2TLT018附錄二Monthly Accident StatisticsReport Form每月事故統(tǒng)計報告表每月事故統(tǒng)計報告表TLT-018年月日Store name 門店名稱Jan一月Feb二月Mar 三月Apr 四月May五月Jun六月Jul七月Au

35、g 八月Sep九月Oct十月Nov十一月Dec十二月ATotal Number of Employee Accidents員工事故總數(shù)BTotal Number of Employee Reportable Accidents員工應(yīng)報告事故總數(shù)CTotal Number of Employees員工總數(shù)DTotal Number of Customer Accidents顧客事故總數(shù)ETotal Number of Customer Reportable Accidents顧客應(yīng)報告事故總數(shù)FTotal Number of Customers顧客總數(shù)Total Employee Acciden

36、t Rate（A/C） X1000總的員工事故比率Accident Rate for Employee Reportable 應(yīng)報告的員工事故比率(B/C) X 1000Total Customer Accident Rate 顧客事故比率(D/F) X 10000Accident Rate for Customer Reportable 應(yīng)報告的顧客事故比率(E/ F) X 10000 = Customer, Visitors, Contractors=顧客，參觀者，合同商Store Manager 店總 name 主辦人Accident Reporting / Investigation事

37、故報告/調(diào)查 TLT510 Issue 1 Feb. 2 PAGE 11Accident Summary Sheet TLT019事故報告總結(jié)表TLT019Store Name:Date:門店名稱： 日期：年月日SUMMARY OF TLT015a/b EMPLOYEE DETAILSTLT015a/b員工詳情概括Where did the accident happen?事故發(fā)生地點Total總數(shù)Accident type事故種類Total總數(shù)Sales floor 賣場Slip / trip 滑倒/絆倒Warehouse 倉庫Struck by fixed object 被固定裝置擊傷Ch

38、eckouts 收銀臺Struck by moving object 被移動裝置擊傷Car park 停車處Fall from height 從高處跌落Backyard 后場Lifting / handling 舉傷/抬傷Catering 就餐處Assault 人身攻擊Counters 柜臺Burn / scald 燒傷/燙傷Bakery 烘焙間Cut 割傷Other 其它Other 其它 Agent Involved相關(guān)媒介TOTAL總數(shù)Outcome后果Total總數(shù)Door 門Minor Employee Accidents (S) TLT015a/b輕微的員工事故(S) TLT015a

39、/bOil / fat 油/脂肪Reportable employee accident (T) TLT020應(yīng)報告的員工事故(T) TLT020Ice 冰Days absent following reportable accident應(yīng)報告事故發(fā)生后缺勤的天數(shù)Shelving / fixture 貨架Total number of employees (U)員工數(shù)目的總數(shù)Stock / products 貨物/商品Total Employee Accident Rate員工事故率的總數(shù)Trolley 手推車(S divided by U) X 1000S/U X 1000Pallet Tr

40、uck 拖板車Employee Accident Rate for Reportable應(yīng)報告員工事故比率Wet floor / spillage 濕地面/滲水(T divided by U) X 1000T/U X 1000Other 其它TOTAL NUMBER OF ACCIDENTS 事故總數(shù)目SUMMARY OF TLT015a/b CUSTOMER DETAILSTLT015a/b顧客詳情概括Where did the accident happen?事故發(fā)生地點Total總數(shù)Accident type事故類型Total總數(shù)Sales floor 賣場Slip / trip 滑倒/

41、絆倒Toilets 衛(wèi)生間Struck by fixed object 被固定裝置擊傷Produce 農(nóng)產(chǎn)品Struck by moving object 被移動裝置擊傷Store entrance 門店入口Fall from height 從高處跌落Catering 就餐處Lifting / handling 舉傷/抬傷Checkouts 收銀處Assault 人身攻擊Car park 停車處Burn / scald 燒傷/燙傷Other 其它Cut 割傷Agent Involved相關(guān)的媒介Total總數(shù)Outcome后果Total總數(shù)Basket 籃子Minor Customer Acc

42、idents (V) TLT015a輕微的顧客事故(V) TLT015aDoor 門Reportable customer accident (W) TLT020應(yīng)報告的顧客事故(W) TLT020顧客數(shù)日總數(shù)（Y）Ice 冰Wet floor / spillage 濕地面/滲水Shelving / fixture 貨架/裝置Total Customer Accident Rate 總的顧客事故率POS 收銀處(V divided by Y) X 10000(V/Y) X 10000Trolley 手推車Customer Accident Rate for Reportable應(yīng)報告的顧客事故

43、率Pallet Truck 拖板車(W divided by Y) X 10000W/Y X 10000Other 其它 = Customer, visitor and contractor =顧客，來訪者和合同商TOTAL NUMBER OF ACCIDENTS 事故總數(shù)Store Manager 店總 name 主辦人 2-2Accident Reporting / Investigation事故報告/調(diào)查 TLT510 Issue 1 Feb. 2 PAGE 24Accident Reporting / Investigation事故報告/調(diào)查 TLT510 APPENDIX 3附錄三A

44、ccident Investigation TLT020事故調(diào)查 TLT020Forms for Reportable Accidents/Incidents Only表格 只用于應(yīng)報告的事故/事件ACCIDENT/INCIDENTREPORT/INVESTIGATION FORM事故/事件報告/調(diào)查表格Section 1 - Location & Time of Accident第一部分 事故的時間和地點Store Name 門店名稱Day ofAccident星期幾Date ofAccident事故發(fā)生日期Time ofAccident事故發(fā)生時間Reportable應(yīng)報告的Over 3

45、day absence 三天以上缺勤 Major Injury 重大傷害 Damage Only 僅受損害 Near Miss 差一點就肇事 Road Traffic Accident 道路交通事故 Section 2 Personal Details第二部分- 個人信息Name: 姓名：_Male/Female (Delete as appropriate) Employee No (if applicable) Position 男 / 女 員工號碼（若有）_職位 _Employment Status: Permanent / Temporary / Agency / Contractor

46、 / Visitor / Customer (ring as applicable)雇傭情況：長期 / 臨時 / 中介代理商 / 合同商 / 訪客 / 顧客（請圈出）Home Address: 家庭地址：Post Code: Tel No: D.O.B:郵編：_ 電話號碼：_ _ 出生日期: _ _ _ Section 3 - Employment Details (If applicable if not go to Section 4)第三部分-雇傭情況（如沒有請直接填寫第4部分） Start Date (if applicable):開始工作日期（若有）：_Hymall Y/N Conc

47、ession Y/N and Company Name 樂購 是/否 專柜 是/否 ,公司名字:Other其它_Department Sect Mgr 部門 _ 課長_Departmental Mgr:部門經(jīng)理：_Normal Work Activity: Activity When Injured日常工作業(yè)務(wù)：_ 傷害出現(xiàn)時在做何事_Time Shift Started: Time Shift Finished (actual): 輪班開始時間：_ 輪班結(jié)束時間（實際）：_Time Shift Finished (planned):輪班結(jié)束時間（預(yù)定）：_(Complete as appro

48、priate insert N/A for not applicable)（按實際填寫 如不適用請寫N/A）Section 4 Injury Details第四部分 傷害情況Part of body injured受傷害的部位: _Description of injury傷害的描述: _Date of injury: Time of injury:受傷日期：_ 受傷時間：_am/pm TLT015a Completed Y/N TLT015a 完成 是/否TLT015b Completed (Employee Accident only) Y/NTLT015b完成 （僅適用于員工事故） 是/

49、否Section 5 Accident Causation第五部分- 事故原因Tick boxes most applicable:在最適用的格子內(nèi)打勾：Slip/Trip/Fall滑倒 / 絆倒 / 跌下Ground/stairs/other working surface(ring as applicable)地面/樓梯/其它工作表面_（在適用處畫圈）Fall from height高處墜落Height fallen墜落高度_米 Structure fell from從何處墜落_（Unit Ref No if applicable單位的編號，若適用_）Hit by moving vehic

50、le被行進的車輛撞擊Fork lift truck/ stacker/delivery vehicle/other電動叉車/堆高機/送貨車輛/其它（Unit Ref No if applicable單位的編號，若適用_）Handling/Lifting/Carrying操作 / 舉貨 / 搬運Weight lifted kg Dimensions 舉起的重量_公斤 尺寸_Trapped by something collapsing/Overturning被倒塌物品 / 翻出物品擊中Object was物品為：Hit by moving, flying or falling object被移動

51、，飛行 或 跌落的物品擊中Object was物品為：Hit something fixed or stationary被固定物體擊中Object was物品為：Contact with electricity觸電Portable appliance /fixed appliance/wiring /sockets(ring as applicable)便攜設(shè)備 / 固定設(shè)備 / 電線 / 插座（圈出適用的）Exposed to/contact withharmful substance受到有害物體侵害 / 接觸有害物體Substance was物品為：Exposure to fire 暴露于

52、火中Source of fire was火源是Contact with moving machinery與行進機械碰撞Machinery was機械是Drowned or asphyxiated淹沒或窒息Injury by animal由動物導(dǎo)致的傷害Animal was動物是Physically assaulted by person被他人傷害身體Assaulted by侵害人是Others其它Description解釋Section 6 - Authorisation 第六部分-授權(quán)Was person authorised to be in the area of the acciden

53、t?該人員是否有權(quán)在事故現(xiàn)場？Was person authorised to use the equipment?該人員是否有權(quán)使用該設(shè)備？ Was the person adequately trained?該人員是否接受足夠的培訓(xùn)？Section 7 Equipment Details第七部分 設(shè)備情況Description of item involved/damaged Unit Ref No:相關(guān)/受損物件的情況 單位編號:How did damage occur?損壞是如何發(fā)生的？Has repair or inspection been ordered/carried out?

54、 Yes/No If No why?是否已經(jīng)要求/實行修理或檢查？ 是 / 否 如果否，為什么？ Section 8 - Witness Details第八部分 目擊者情況Name: Employee No: Position:姓名： 員工號： 職務(wù)：Employment Status: Permanent/Temporary/Agency/Contractor/Visitor/Customer(ring as applicable)雇用狀況：長期 / 臨時 / 代理人 / 合同商 / 來訪者/顧客（請畫圈）Contact Address：聯(lián)系地址： Post Code: Tel No: 郵編

55、： 電話號碼：Witness Statement attached? Yes/No (delete)是否附有目擊者證詞？ 是/否If more than one witness provide above information on separate sheet如果有一個以上目擊者，請按照以上格式，設(shè)立單獨表格，記錄信息。Section 9 - Accident Details第九部分 事故情況Description of Accident/Incident意外事故/意外事件描述Section 10 - Investigation Summary第十部分調(diào)查概況Summary & Findi

56、ngs of Investigation調(diào)查結(jié)果概況Next steps to be applied locally. 門店應(yīng)該采取的后續(xù)步驟。Action行動Who何人When何時Recheck復(fù)檢Section 10 - Document Checklist (where applicable)第十部分 文件清單 （適用處）Please tick documents which have been collected:請在已收集的文件前打勾Relevant pages from log book:Photographs/Sketches(if applicable) 圖片/草圖日志中的相關(guān)

57、頁(若適用)：Housekeeping RoutinesWitness / Injured Party Statements(most recent)(Including Duty manager and First Aider)例行清潔程序 目擊者/受傷者陳述證明(最近的) （包括值班經(jīng)理和急救提供者）Maintenance / Inspection Records of Training Records Equipment/Engineering Report 培訓(xùn)記錄設(shè)備 / 工程的維修 / 檢查記錄報告Copy of Pre-Op Check CCTV available and re

58、tained預(yù)檢表單副本 被監(jiān)控電視記錄，并保留有錄象帶Training Material Available Yes/No Managers Summary Section 11 - Sign Off第十一部分- 簽名Investigation Undertaken By: Date調(diào)查人：_ 日期：_ACCIDENT INVESTIGATION事故調(diào)查Injured party傷者姓名:Date日期Employee Number(if applicable)員工號碼（若有）Time時間Job Title職務(wù)名稱:Interviewer面談人:The following statement

59、is made in connection with an accident involving 以下聲明是就_事故作出的。on _ the contents of which are true and honest to the best of my belief.時間是_ 。本人就所了解的事實作出了誠實的陳述如下:SIGNED:(INJURED PARTY)SIGNED:(INTERVIEWER)Page of INJURED PARTY STATEMENT傷者聲明表Injured party傷者姓名:Date日期Employee Number(if applicable)員工號碼（若有）

60、Time時間Job Title職務(wù)名稱Interviewer面談人The following statement is made in connection with an accident involving 以下聲明是就_事故作出的。on _ the contents of which are true and honest to the best of my belief.時間是_ 。本人就所了解的事實作出了誠實的陳述如下:SIGNED:(WITNESS)SIGNED:(INTERVIEWER)Page of ACCIDENT INVESTIGATION事故調(diào)查WITNESS STATE