□;个人□)申报单位全称:_______________________________________________单位地址:_____________________________________________________联系电话:_______________________手机、小灵通__________________申报时间:__________年_______月_______日申报内容:受伤者姓名:______________性别:______年龄:______工种:_______受伤者单位全称:_______________________________________________受伤日期:________年_______月_______日、身份证号码:_______________________________________________伤害类别:生产□;交通□;意外□具体伤害部位:_______________________伤害经过:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________接报登记:1.申报单位(盖章)2.接报人(签名)年月日年月日本登记表一式三联,一联存档、两联交申请人(一联于申请工伤认定时提交,一联于申请待遇时提交)。特别提醒:本表请务必在员工发生事故之日起30日内填写并申报登记!
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