Accident Investigation Report 事故调查报告范例.docVIP

事故调查报告 Accident Investigation Report 事故发生日期/Date: 2012年12 月 10日 EHS-38 1. 事故概况 Accident 事故地Accident Location 东车间中间通道 日期及时间 Date and Time 事故当事人资料 ata of accident party 所在部门Dept. 姓 名name 工 种 ob 工作经验 在本司工作时间 陈xx Chen Yahua 操作工 Operator 48个月 48 months 21个月12months （2011.3.11） 潘xx Pan Yuming 叉车工 Forklift driver 11天 11days （2012.11.30) 事件/事故类型:（只可选一种，在对应的表格划“√”）Incident/accident type: (only can choose one type and mark “√” in the column ) 伤亡casualties 财产损失property loss 环保事件nvironmental events 公众影响 未遂事件ttempted accident 其它 √ 人身的伤害: (在相对应的栏填写相应的数字，需要) Personal injuries: (fill the number in the corresponding column, industrial injury report is also needed) 急救处理mergent Treatment 医护处理 medical treatment 工时损失orking time lost 死亡 CT检查，休养及药物治疗。CT checking, having rest and medicine 事故损失 直接损失（元） 858 RMB（2012年12月10日医院费用 Hospital charge on 10 Dec. 12） 间接损失（元） 2. 事故描述（需报告所有相关人员、伤亡和治疗细节） 潘xx（男）42周岁，于2012年11月30日入职我公司，从事叉车作业一职。12月10日上午10:50前后从事叉车作业时，行经ACNT东车间中间过道时（由西向东行驶），由于通道右侧堆放2层原材料，视线受阻未注意到行人，加上车辆靠右侧行驶（距离边线约30cm）及未鸣笛，导致撞上突然从通道右侧原材料背后步行出来的员工。 Pan Yuming(male), 42 years old, entry Amann on 30,Nov. 12 as a forklift driver. About 10:50 on 10, Dec morning, he was driving forklift from west to east in ACNT eastern workshop, met the pass way. As there were two storey of raw material on the right side of the pass way which blocked the sight, he missed the walking people. Plus he drove on the right side ( 30cm to the border) but no whistle then caused it stroke the people walking out from the raw material on the right side suddenly. 陈xx（男）23周岁，于2011年3月11日入职我公司，从事生产操作工一职。12月10日上午10：50前后，取三卷原纱（一手一个，另一个夹在腋下），由于通道右侧堆放2层原材料，视线受阻未注意到通道上行驶的叉车，且转弯向西时未做停顿观察直接从通道右侧原材料背后步行出来，导致直接被叉车防护栏撞到。 Chen Yahua (male), 23 years old, entry Amann on 11-March-2011 as a operator. About 10:50 on 10, Dec morning, he was carry three spools of raw yarn (one in each hand and another one under the arm. As there were two storey