Personal Accident & Health

• Document No.

• Conducted on

  Date

• Prepared by

Personnel Details :

• Name:

• Staff ID :

• NRIC :

• Address :

• Tel. No :

• Department :

• Section

  Select Ramp

  • Ramp

• Shift :

  Shift A

  Shift B

  Shift C

  Shift D

• Designation

  Ramp Agent

  Ramp Team Leader

• Date of Employment :

• Diseases/Injury :

• Fist Treatment :

• Second Treatment :

• Admitted Date :

• Discharge Date :

• MC form :

• MC Until :

Accident Detail :

• Date of Accident :

• Time of Accident :

• Place of Accident :

• Describe briefly how it happened :

• Describe briefly the injuries sustained :

• Name of person who witnessed the accident (in any) :

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• Name of Claimants :

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