N-1 shaklli dalolatnoma nusxasi

10. Baxtsiz hodisa yuz bergan sana va vaqt. ____________________________
(kun,oy,yil)
11.Baxtsiz hodisa holati.________________________________________________
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11.1.Baxtsiz hodisa sabablari_____________________________________________
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11.2 Jarohat etkazilishga sabab bo’lgan asbob-uskuna_______________________________________________________________________________________________________________________________
11.3 Jabrlanuvchining xushyorligi (alkogol va narkotiklar ta’siridagi)__________ (Tibbiy xulosaga binoan)
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11,4. Tashxis__________________________________________________________
(dastlabki, oxirgi)
12. Baxtsiz hodisa sabablarini bartaraf etish tadbirlari.

№	Tadbir nomi	Bajarilish muddati	Bajaruvchi	Bajarilishi haqida belgi.

13. Mehnat to’g’risidagi qonunchilik mehnatni muhofaza qilish qoidalari va me’yorlar buzilishiga yo’l qo’ygan shaxslar.
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