TP ON IN LC VIT NAM

CNG TY
THY IN I NINH

CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc
, ngy thng ..nm ..

BIN BN KHO ST HIN TRNG

Vo lc .................., ti ............................... chng ti gm:
1. i din n v lm cng vic:
1.1. ng ........................................... Chc v: .............. .......... ......................
1.2. ng ........................................... Chc v: .............. ......... ......................
2. i din (cc) n v qun l vn hnh:
2.1. ng ........................................... Chc v: .............. n v ......................
2.2. ng ........................................... Chc v: .............. n v ......................
2.3. ng ........................................... Chc v: .............. n v ......................
3. i din..........................................................................................................
Cng nhau kho st thc t, trao i v thng nht phn cng trch nhim
thc hin nhng ni dung m bo an ton v in cho n v cng tc khi tin
hnh cng vic, c th nh sau:
4. a im (hoc thit b) thc hin cng vic: ................................................
5. Ni dung cng vic: .......................................................................................
6. Phm vi lm vic: ...........................................................................................
7. Thi gian tin hnh cng vic: .......................................................................
8. Trch nhim ca cc n v lin quan:
a/ i vi (cc) n v qun l vn hnh:
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b/ i vi n v lm cng vic:
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c/ i vi (cc) n v iu (nu c):
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d/ Nhng ni dung khc c lin quan n cng vic:
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Bin bn ny c lp thnh ..... bn v c tt c mi ngi d hp ca cc
n v c lin quan n cng vic u thng nht lm c s tin hnh cng vic
sau ny (nu khng thay i v nhng ni dung chnh) v k tn di y.
I DIN N V
LM CNG VIC

I DIN (CC) N
V QUN L VH

I DIN (CC) N
V IU