CASA DE CARNES SERRADÃO.

RELATÓRIO DE INVESTIGAÇÃO
E O ANALISE DE ACIDENTES

NUMERO:

ACIDENTADO
Nome:_______________________________________________________________
Setor:________________________________________________________________
Função:______________________________________________________________

ACIDENTE
Data do acidente:______________
Horário de entrada:_____________ Horário do acidente:____________________
Local do acidente:_____________________________________________________

CARACTERÍSTICA DO ACIDENTE

TÍPICO SEM AFASTAMENTO: TÍPICO COM AFASTAMENTO:

TRAJETO SEM AFASTAMENTO: TRAJETO COM AFASTAMENTO:

DESCRIÇÃO DO ACIDENTE
Que trabalho era feito? Com qual objetivo?
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Descrição do acidente:
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Quais foram ás consequências e a parte do corpo atingida?

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INVESTIÇÃO DO ACIDENTE:

Causas que contribuíram diretamente para ocorrência:

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AÇÕES A SEREM IMPLANTADAS PARA EVITAR ACIDENTES SEMELHANTES E

PRAZO.
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GERENTE: ___________________________________________________________

TESTEMUNHA: ________________________________________________________

ACIDENTADO:_________________________________________________________

SESMT:______________________________________________________________

DATA: ___/___/___