Introduction to work injury determination application form sample and instructions for filling out the form
Work-related injury determination is an administrative confirmation act performed by the labor administrative department in accordance with the authorization of the law to determine whether an employee's injury (or occupational disease) due to an accident is a work-related injury or is regarded as a work-related injury. A worker's personal injury is caused by improper operation or other reasons during work or deemed work, and the qualitative behavior of the process is carried out in order to identify the subject of the injury. According to the relevant regulations of our country, it is generally confirmed by the labor administrative department.
1. Fill in the form with a pen or marker pen, with neat and clear fonts.
2. If the applicant is an employer, the official seal of the employer shall be affixed to the applicant on the homepage.
3. Fill in the specific injured part in the injured part column.
4. In the column of diagnosis time, for occupational diseases, fill in according to the time of diagnosis of the occupational disease; for injuries or deaths, fill in according to the time of first diagnosis.
5. A brief description of the injury should indicate the time and place of the accident, the work performed at the time, the cause of the injury, and the location and extent of the injury. Occupational disease patients should indicate in which unit they are engaged in hazardous work, the start and end time, and the diagnosis result.
Work Injury Determination Application Form Sample Installation Steps
1. Click the link to download the sample work-related injury determination application form provided on this website
2. Download the sample work injury determination application form and right-click to unzip the file.
3. Double-click the unzipped Work Injury Determination Application Form Sample application to install it.
How to use the work injury determination application form sample
1. After decompressing the downloaded software package, double-click the document
2. Just fill in the actual information as required
Work Injury Determination Application Form Sample Software Comparison
Work Injury Determination Investigation Records
Different from the sample work-related injury determination application form, the work-related injury determination investigation transcript is suitable for the production, modification, printing, and uploading of daily inquiry transcripts by labor arbitration case handlers of the Bureau of Human Resources and Social Security. Realizing the office automation of labor arbitration work, this recording software has a template function, and all commonly used information can be freely added, deleted, and modified.
Sample letter of decision on acceptance of application for recognition of work-related injury
Sample decision letter for acceptance of application for work-related injury determination. This decision letter is made in triplicate, and each of the social insurance administrative department, the employee or his close relatives, and the employer shall keep one copy. The sample format of the work-related injury determination application acceptance decision is formal, safe and non-toxic, and everyone can use it with confidence!
Application for Arbitration of Work Injury and Labor Disputes
The application for arbitration of work-related injury and labor disputes is due to the respondent's failure to implement the claimant's work-related injury insurance benefits in accordance with relevant regulations, which has caused great harm to the claimant. In order to safeguard the legitimate rights and interests of the applicant, a complaint was filed with the Labor Arbitration Commission, requesting support for the applicant's request.
The above three software are closely related to work-related injuries, just like the work-related injury determination application form sample. If you need it, you can click to download and use it.
Work Injury Determination Application Form Sample Update Log
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Huajun editor recommends: The sample work injury determination application form provided on this site is in formal format and is welcome to download. In addition, this website also provides downloadable examples of decision letters not to recognize work-related injuries, notices from the Public Security Bureau not to grant bail pending trial, notices to rectify illegal land use, re-cultivation and greening, etc. |
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