Article 1 of the model report on individual work-related injury application:
Leaders:
Hello!
? Unit? Man, are you there? Year? Month? During working hours in the morning, due to? Month? Sunday night? Does the unit work overtime? Point? At eight o'clock the next morning (Monday), I continued to sort out materials and attend classes at school. Due to overwork and exhaustion. ? Point? About that time? What are people doing because the unit is in urgent need of information? Where do people come from? Send information to? Unit, in the unit? Place, accidentally fell, resulting in a broken left foot. The unit is confirmed as a work-related injury. After several months of treatment and aftercare, I have improved and can basically go back to work. In the meantime, because? Is the unit busy? People-related diseases and causes are reported to our unit, and we hereby apply.
After hospitalization, the unit approved the application because it was unable to go to work normally. People's sick leave applications. So, I hope the leadership will approve it? Man-made work-related injuries, welcome relevant leaders to visit our unit before making a decision. I hope the leader will consider the application made by our unit as a thank you. I am here to convey
Salute!
Unit:
Time:
Article 2 of the model personal injury application report:
Applicant: Chen Daoying, male,1April 1966 1 1, ethnic group: Han nationality, Yeshan Village, Si Qian Town, Panshun County, Zhejiang Province.
Request the labor department to legally identify the applicant as a work-related injury on August 24, xx, and identify the facts and reasons.
The applicant is Hangzhou Tongda Group Co., Ltd., who was recruited into the woodworking team in April of xx, and worked as a carpenter in the second standard woodworking class of Shaoxing Binjiang Golden Home.
On August 24, xx, at about 6: 00 in the morning, he accidentally fell off the shelf while making molds, causing serious injuries to the applicant. After being injured, the applicant was immediately taken to the First Affiliated Hospital of Shaoxing People's Hospital.
According to the Regulations on Industrial Injury Insurance, I hereby apply to the labor department for investigation and verification of the applicant's injury, and my injury is legally recognized as a work-related injury.
I am here to convey
I am here to convey
Shaoxing social security department
Applicant (signature)
Article 3 of the model report of individual work-related injury application:
Applicant: xxx, male, born in xx, xx, X family, living in xxxxxxxxxxxxxxxxxxxxx, ID number: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX, telephone number: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.
Application: Request to confirm that the applicant suffered work-related injuries on the way to work on xx, xx, xxxx.
Damage process:
On the evening of xx, xx, xxxx, I got off work and took a taxi home to the intersection of xxxx and xxxx. When the taxi was waiting normally according to the traffic rules, it was rear-ended by the rear vehicle, resulting in the applicant's head being knocked unconscious. He was taken to the hospital by an ambulance on 120 and was diagnosed as XXXX (concussion).
According to the provisions of "Industrial Injury Insurance Road", anyone who is injured by a traffic accident that is not his responsibility on his way to and from work shall be recognized as an industrial injury.
Hereby apply
Applicant: