Scribd Logo
Upload

Welcome to Scribd!

  • 7 views

    Injury Report

    Uploaded by

    bicu

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Injury Report

    Uploaded by

    bicu
    7 views2 pages

    Original Title

    INJURY REPORT

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views2 pages

    Injury Report

    Uploaded by

    bicu

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    ffirl"In-,

    f,liF''li'7
    - :--+ *.v
    qo 'rc 3. E
    t,:riq /, e. [. E:
    I-r_ .I;

    fE ?rsT &rnoi/nAe*ical BeSrae'tnte*t

    ffifql* * ela HTq Hr t{i}t


    H*;*ry R*g:$a"'fi *;{ Eretp?*-t *e
    E trEl qigot € o
    Accident Case 11o.......

    iii

    ,Et
    i'
    te-ci"r/f,rt({.t.ii ?o-1

    :I ,,..,,,,.,.StetionlSh.op,,.,..........,.....,...........pay....,,,,,.
    -*
    &i
    =-{4;lT
    E\^+^
    * ertti, qqq att.qm
    time and'plece af Accident-.."i,rr.r.r..r.,...! ,{'.,.i€ri,.r,.r

    n, si'q fI errrc, *-e? elit iqm


    Llate, tinre and piace ci Hxarrrination....,.....,.,.... ,,r*..,'r!,.!.r '. ".".,
    $" trdi F.rt Er'l'<*i,l.rr )T?IILT rist fi u' qiq rrfrq

    V; *a: w gqE;*iiiqril j ,rruiir l.{Taa i f+m* qqnT f{

    ,"i
    :r.i'

    ij
    s-i:i ,t"t qi.i -<;:*-t qiut- eli q;r-?eTf{.ri +;i:lri"+f.t &;tii q:fr S, s*4" iri'Il', clEis, E={ItEl
    lJt W'r"t ei' i; iet'fq;r
    i'l*me, design*ti-:ti-i, -{'iitsrrlGnt oi staif wha is *utharis*ci t* r;i:tify cas+ in!ured oir duty,.".,..15,ie3.r.,*--....rri....

    0. -rrc; i}-ti ggtrfis-x" 6*qtti'sT qqTq


    +xri qiq f*-s' il+"f{ erir, qq* qrt it ': . ..',
    in,;uied Smplaye*'s Statement cf cause an* ma-aner of s*siai*ing injutie,r..,;,;j,;;l;rirtiiiii-;i.i-ir;..iriir..:'..:ir;:'i{i..,".r*t';.....

    .; o '"""""'Frtr ffile'6TSffil?ft,-qf rliATEih gtitr'<f':iq65:ia1$"."'""'9rni""""'r'1e'r"'i"'!r'


    ;i ,il; ir'i,JiE tt<-r1a+ai+r< qr R{I'
    -i-

    lli,...- ;,i iltiiin'rtiii ir'nde lby.........,.,..,,;r.;;;r'rli;:,r,i,;:r:rii:.iritl.-..'iiii;i}i'Fi1,",,r.,.,,"..fli,d acce.bredJi$futga by j. e injure#


    +
    +::iifiC1leC.,.. rrrrrii'rarirFi.'iaiaertrj;i'tiJt*i!.lr"iiirrilri.,...recr:...rrr"!'..{

    iZ <i,ii' "i;T ittorrtrlDisposal of patient,...,,*


    ..a,"E#!..s3ts$:i:,'l.i.,-.gta,,,,..'t,,.rrlr.lrrrrrrri.i|1i;!!,trl'i!!;$tr-rtr:r.rliii.1ijiiriir1.ilrr'.r1ii.i

    -.p,!q1fi
    i:t. n q€T.rrlerq'er$ w Frwre
    . ll;i;ii";i:.:ieii-.T.1. *f tl-re

    u
    -3

    EEIIi:;FlKClisi-

    .,
    ;r-
    ,i *i
    ..-i ;'.

    "J -
    i.', .l

    a
    aB
    B _-,s-4
    --l

    €*
    .wE.
    i-,-t
    =5a n

    -::i d

    /'J?4---:-
    ! dr'- r;
    ?-/-/tF*/r
    \

    i;.

    {
    ! \
    J €'
    { +-
    't a -."- -*.4--.M+
    =

    as
    0
    ti* €
    \I
    .E:
    .t

    You might also like