酒店安全报告范本中英文对照.doc

安全报告员工口 登记客人□ 未登记客人□ 安全事件□酒店编号：TJBHS事件编号：D・ 年 月 口受伤/事故报告发牛-日期/ /初次发现H期/ /时间具体位酒店名称报告完成日期/ /星期itel:和关员工姓名出生日期Milk社保号码男女SAP#DOH职位部门在当前岗 位工作时 间FTPT体重员工在以前的雇用经历（非本酒店）或前受伤、病史 是否导致了事故/受伤的发生？事故发生前，当天 工作小时数爭故发牛时是否用过酒精或药物？□是□否有她行纱物则 试？□是□否受伤/事故信息受伤、事故描述（有必要可附额外说明材料）伤员是否同意急救？□是□否描述洒店提供的急救伤员冇否得到恰当的医疗？□是□否提供卜-列姓名、地址、医生、医院、门诊部目击者姓名 地址 1.2.3.财产损失描述遗失或损坏的财产价值警署警察件号滑倒地面类型列出造成滑倒的原因（例如：油脂、 绳索）？由于地而有水而 导致滑倒？□是□否物料运输任务当受伤/事故发生时，所持举的物体重量1-5磅口 16-30磅口 超过30磅口器械使用情况（例如卡车）受伤/爭故发生前物体携带或移动的水平距离使用楼梯或梯子（圈一个）楼梯 梯子阶梯数提交人员姓名（打印名）：职位：签字：日期：经理审核姓名（打印名）：职位:签名：日期:抄送： GM EAM CUL F/B FC HR SECFOENG HSKPSECURITY REPORTASSOCIATE □ REGISTERED □NON-REGISTERED GUEST □ SECURITY INCIDENT □HOTEL CODE: TJBHSIncident No.: D-Mo/Day/YearINJURY /INCIDENT REPORTDATE OF OCCURA NCE/ /DATE FIRST NOTIFIED/ /TIME OFDAYEXACT LOCATIO NOF WHERE LOSS OCCURR EDHOTEL NAMEADDRESSPHONE#SAP#DATE REPORT COMPLETED/ /DAY OF WEEKPARTY ORASSOCIATEINVOLVEDIF ASSOCIATENAMEPHONE NUMBERDATE OFBIRTHADDRESSSSNMALEFEMALEDOHOCCUPATIONDEPARTMENTLENGTH OF HOURS WORKED ON DAY OF INCIDENT (PRIOR TO INJURY)?FTPTWEIGHTPRIMARYLANGUAGEDID ASSOCIATEJ S PREVIOUS EMPLOYMENT, OFF-SITE ACTIVITIES, OR PRIOR INJURIES/ILLNESS CONTRIBUTE TO ACCIDENT/INJURIES?NUMBER OF HOURS WORKED ON DAY OFINCIDENT (PRIOR TO INJURY)?POSSIBLE ALCOHOL OR DRUG USE AT TIME OF INCIDENT?□ YES □ NODRUG TEST ADMINISTERED?□ YES □ NOINJURY/INCIDENTINFORMATIONDESCRIBE INJURY/INCIDENT (ATTACH ADDITIONAL PAGE IF NEEDED)DID INJURED PERSON AUTHOORIZE FIRST AID TREATMENT?□ YES □ NODESCRIBE FIRST AID TREATMENT ADMINISTERED BY HOTELDID INJURED PERSON RECEIVE OFF-PROPERTY MEDICAL TREATMENT?□ YES □ NOPROVIDE NAME AND ADDRESS OF DOCTOFVHOSPITAL/CLINICPHONE NUMBERWITNESSESNAME ADDRESS PHONE NUMBER1.2.3.PROPERTY DAMAGE/LOSSDESCRIBE MISSING OR DAMAGED PROPERTY VALUERESPONDING POLICE DEPT.RESPONDING POLICE OFFICERPHONE NUMBERCASE NUMBERSLIP AND FALLTYPE OF FLOOR SURFACELIST ANY OBJECTS OR SUBSTANCE THAT CONTRIBUTED TO THE FALL (i.e., grease, cords, etc.)DID FOOTWEAR CONTRBUTE TO THE ACCIDENT?□ YES □ NOMATERIALHANDINGTASKSWEIGHT OF OBJECT(S) BEING LIFTED/HANDLED WHEN INJURY/INCIDENT OCCURRED1 - 5 LBS □ 16-30 LBS □ OVER 30 LBS □IDENTIFY MECHANICALEQUIPMENT UTILIZED (i.e., cart)HORIZONTAL DISTANCE OBJECT CARRIED/MOVED PRIOR TO INJURY/INCIDENTSTAIRS OR LADDERS UTILIZED (CIRCLE ONE):STAIRS LADDERNUMBER OF STEPSCOMPLETED BYNAME (PRINT NAME):TITLESIGNATUREDATEVERIFIED BY MANAGERNAME (PRINT NAME):TITLESIGNATUREDATECC TO: GMEAM CUL F/B FC HR SEC FOENG HSKP。