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(Name of the enterprise, company/ korxona, kompaniya nomi)
IDENTIFICATION/GUVOHNOMA № ____
Issued / Berilgan sana ______________________________________________
that you have completed __________________________________ instructions on safe working methods for your profession (position)/Kasbingiz (lavozim) uchun xavfsiz ishlash usullari bo'yicha _______________________________________________________________
i n (on) / ichida (yoqilgan) ____________________________________________
(workshop, site, installation, team/
( ustaxona , uchastka, montaj, jamoa )
Chairman of the commission /Komissiya raisi __________________________________________________
(signature/imzo)
__________________________________________________
(last name/ism, familiya)
M.P./M.O`.
Date of issue/Berilgan sana: «___» __________ 20 ______
Information about passing medical examinations
Tibbiy ko'rikdan o'tish haqida ma'lumot
Information about transfers / Transferlar haqida ma'lumot
Date
Sana
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Where transferred to which workshop
Qayerda, qaysi ustaxonaga o'tkazilgan
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Profession (position)
Kasb (lavozim)
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Signature of the workshop manager
Ish boshqaruv-chining imzosi
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1. Checking knowledge of rules and instructions for safe working methods/ Qoidalar va ko'rsatmalar haqidagi bilimlarni tekshirish xavfsiz ishlash usullari
Date
Sana
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Protocol number
Protokol raqami
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Evaluation conclusion
Baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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2. Checking knowledge of the rules for the installation and safe operation of pressure vessels/ Bosimli idishlarni o'rnatish va xavfsiz ishlash qoidalari bo'yicha bilimlarni tekshirish
Date
Sana
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Protocol number
Protokol raqami
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Evaluation conclusion
Baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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3. Checking knowledge of safety rules in the gas industry/
Gaz sanoatida xavfsizlik qoidalari bo'yicha bilimlarni tekshirish
Date
Sana
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Protocol number
Protokol raqami
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Evaluation conclusion
Baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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4. Checking knowledge of the rules for the installation and safe operation of lifting cranes/ Yuk ko'taruvchi kranlarni o'rnatish va xavfsiz ishlatish qoidalari bo'yicha bilimlarni tekshirish
Date
Sana
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Protocol number
Protokol raqami
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Evaluation conclusion
Baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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5. Checking knowledge of the rules for the installation and safe opera-tion of steam and hot water boilers/ Bug 'va issiq suv qozonlarini o'rnatish va xavfsiz ishlatish qoidalari bo'yicha bilimlarni tekshirish
Date
Sana
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Protocol number
Protokol raqami
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Evaluation conclusion
Baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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6. Checking knowledge of electrical installations of consumers and electrical safety during the operation of electrical installations of consumers / Iste'molchilarning elektr qurilmalari va iste'molchilarning elektr inshootlarini ishlatish paytida elektr xavfsizligi bo'yicha bilimlarni tekshirish
Date
Sana
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Record number in the journal /Jurnaldagi raqamni yozib oling
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Qualification group assessment conclusion
Malakaviy guruh baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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7. Checking knowledge of fountain safety rules /
Favvoralar xavfsizligi qoidalari haqidagi bilimlarni tekshirish
Date
Sana
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Protocol number
Protokol raqami
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Evaluation conclusion
Baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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8. Training at courses / Kurslarda o'qitish
Date
Sana
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Course name
Kurs nomi
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Number of hours
Soatlar soni
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Signature of the person responsible for technical training / Texnik tayyorgarlik uchun mas'ul shaxsning imzosi
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9. Checking knowledge of industrial safety rules /
Sanoat xavfsizligi qoidalari bo'yicha bilimlarni tekshirish
Date
Sana
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Protocol number
Protokol raqami
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Evaluation conclusion
Baholash xulosasi
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Commission chairman's signature/Komissiya raisining imzosi
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Control sheet/Nazorat taloni №1
Full name _________________________________
I.F.Sh. to`liq _______________________________
__________________________________________
Workplace _________________________________
Ish joyi ____________________________________
Position (profession) _________________________
Lavozimi (kasbi) ____________________________
___________________________________________
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Control sheet/Nazorat taloni №1
Full name ___________________________________
I.F.Sh. to`liq _________________________________
___________________________________________
Workplace ___________________________________
Ish joyi ______________________________________
Position (profession) _________________________
Lavozimi (kasbi) ____________________________
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Type of violations, labor protection rules
Huquqbuzarliklar turi, mehnatni muhofaza qilish qoidalari
_________________________________________ _________________________________________
Full name, position, and signature of the person who took the ticket/Talonni olgan shaxsning to'liq ismi, lavozimi va imzosi _________________________________________
_________________________________________
"_____"____________20 ___ y/y.
Offender's signature _________________
Huquqbuzarning imzosi
"_____"____________20 ___ y/y.
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