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    Accident Book: Employees' State Insurance Corporation

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    nasir ahmed
    This document appears to be an accident report form used by the Employees' State Insurance Corporation of India to document workplace injuries. The form includes fields to record the date and time of injury, details of the injured employee such as name, age, occupation, and insurance number, and details of the accident including cause, nature of injury, location, and a description of what the employee was doing at the time. Witness information and signatures are also collected.

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    Accident Book: Employees' State Insurance Corporation

    Uploaded by

    nasir ahmed
    30 views1 page
    This document appears to be an accident report form used by the Employees' State Insurance Corporation of India to document workplace injuries. The form includes fields to record the date and time of injury, details of the injured employee such as name, age, occupation, and insurance number, and details of the accident including cause, nature of injury, location, and a description of what the employee was doing at the time. Witness information and signatures are also collected.

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    esic-new-form11

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    This document appears to be an accident report form used by the Employees' State Insurance Corporation of India to document workplace injuries. The form includes fields to record the date and time of injury, details of the injured employee such as name, age, occupation, and insurance number, and details of the accident including cause, nature of injury, location, and a description of what the employee was doing at the time. Witness information and signatures are also collected.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    30 views1 page

    Accident Book: Employees' State Insurance Corporation

    Uploaded by

    nasir ahmed
    This document appears to be an accident report form used by the Employees' State Insurance Corporation of India to document workplace injuries. The form includes fields to record the date and time of injury, details of the injured employee such as name, age, occupation, and insurance number, and details of the accident including cause, nature of injury, location, and a description of what the employee was doing at the time. Witness information and signatures are also collected.

    Copyright:

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    of 1

    www.esicoimbatore.

    org

    EMPLOYEES’ STATE INSURANCE CORPORATION


    REG. FORM 11

    ACCIDENT BOOK
    (Regulation 66)

    Sl. Date Time of Name & Address of Injured Sex Age Insurance No. Shift, department & Details of Injury
    No. of Notice Person Occupation of the employee
    Cause Nature Date Time Place
    Notice

    1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

    What exactly was the injured Name, Occupation address & signature or the Signature and designation of the Name, address & Occupation of two Remarks, if any
    person doing at the time of thumb impression of the person(s) giving person who makes the entry in witnesses.
    accident. notice. the Accident Book
    14. 15. 16. 17. 18.

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