X# Mdunqn

l2AlS/2013
Version 2.0
PHIEU OANTT GIA TAY NGHE LAO DONG MAY
rudr crAN ngc NcuE/THU' vrpc: tir................ tl6n

Ngdy ki6m tra: ... ...1......12021 I

I-
TOn Lao clQng may: Md s0: Chuy€n:

I . Ngud'i tra: ki€m ..........Chric vu : ..

2. Nguoi ki6m tra: ..........Chric vu : ..

NQI DUNG KIfM TRA

Thd'i gian Thd'i gian
Stt NQi dung Chdt luqngD rnh gi6Xdc nt n
thuc t€ chu6n
I C6ng tto4n ki6m tra:

2 C6ng do4n kitim tra

::::::i:T:::
DANH GIA cHUNG SAU KHI KIEM TRA
,,
a. A.
Kdt qu6 sau khi ki€m tra:

b. Ki6m tra su dpng m6y: ..........

Drinh gi6 cira tru6'ng BQ phpn/ Chuy6n tru6ng:

n Eat, dC nghi kf he'p cl6ng Lao clQng tir ngdy: . ....1 .....2021

[-lfnOng clat, dd nghithanh ly Ho. p ctOng tirngiy: .....1....12021

LAO DQNG MAy CHrrytN TRT'ONG QUAN Li XY THUaT GIAM DOC NHA MAY
(I(y vd ghi rd hq t6n) (Ky vA ghi 16 he t6n) (Kf vd ghi rd h9 t6n) (Kf vA gbi 16 ho t6n)

Lwu it: Trinh kj' affi ckfr kj,vd trd BP Nhdn sqr trudc