Report of an accident at work (Completed form)

Accidents during work activities at manufacturing enterprises are by no means uncommon. The reason for their occurrence may be a gross violation of safety regulations, neglect of labor protection requirements and other circumstances. In accordance with Art. 228 of the Labor Code of the Russian Federation, the employer is obliged to conduct an investigation and draw up the relevant documents. How is an act of form N-1 drawn up, how many copies do you need to make? How long should a document be kept? The answers to these and other questions are in our material.

Act in form N-1

This document is drawn up by a special commission during the investigation of an industrial accident. The form of act N-1 for 2019 was approved by Resolution of the Ministry of Labor of Russia dated October 24, 2002 No. (as amended on November 14, 2016). The document must describe in detail the circumstances and causes of industrial injuries and indicate measures to prevent them in the future.

You can download the act form N-1 (form) below.

The information indicated in the act can be divided into three blocks:

  • information about the employer and the victim;
  • description of the incident;
  • description of measures to eliminate the causes that led to the accident.

The report in form N-1 is drawn up and signed by the commission that investigated the incident. It must also be signed by the manager. The document must be drawn up in accordance with the materials of the investigation. Additional papers are attached to the act: medical reports, expert opinions, extracts from briefing logs, etc. An example of an H-1 act can be taken as a basis if there is a need to draw up a similar document for your organization.

There should be no empty fields in the document form. All data must be written clearly and completely; abbreviations are not allowed. The accident report in Form N-1 should not contain any blots, cross-outs, or additional entries. If there is a need to make certain clarifications or correct any information, you can make a note about the corrections at the end of the text. It must be certified by all members of the commission. The document can be generated on a computer or filled out a ready-made form by hand.

Deadlines

According to Article 229 of the Labor Code, the investigation of an industrial accident is carried out within a time frame determined by the severity of the injury:

  1. When an incident at work only resulted in a minor injury to an employee, up to 3 days are given for an investigation.
  2. In case of serious injuries and deaths, the commission's investigation into the incident should last no more than 15 days.
  3. When the management did not immediately begin an investigation, and the result of the injury did not immediately appear in the victim, the investigation can be carried out within 1 month.

The period is counted from the moment the management issues a decree on creating a commission and carrying out work to study the circumstances of the accident.

ATTENTION! The victim may request an investigation into the circumstances of the accident that led to his injury at any time.

Number of copies of the act

How many copies of the act in form N-1 need to be drawn up? The document is drawn up in at least three copies:

  • one remains in storage in the organization;
  • the second is given to the injured employee or his representative;
  • the third is sent to the FSS.

In Art. 353 of the Labor Code of the Russian Federation states that government departments must monitor compliance with labor legislation. In practice, an act in form N-1 is drawn up at the enterprise and then submitted to the Federal Labor Inspectorate.

If representatives of another party or department were involved in the investigation, a report in form N-1 is also drawn up for them. When an incident is widespread, a separate report is drawn up for each employee. The employer is obliged to transfer one copy of the document to the affected person within three days from the date of its approval by the commission.

Each copy must be certified by all members of the commission. In the event of an occupational disease (poisoning), the report must be signed by a representative of the State Sanitary and Epidemiological Service. A sample of filling out the act (form N-1) will be presented below.

Rules for filling out an industrial accident report form N1 - instructions

The document must be drawn up in a special form established by the Ministry of Labor.

If you fill it out incorrectly or not in accordance with the H-1 form, then it will simply be considered invalid and will not be accepted by the insurance service or other inspection agency.

Follow these instructions when writing:

On the left, at the top, the initials of the employer or his representative are indicated

The date when the act was drawn up and the official seal of the enterprise are put.

Write the name of the document in the middle

Be sure to include the serial number of the case.

Indicate when, on what day and at what exact time the tragedy occurred

Enter information about the organization where the employee works

Where the structural unit is indicated, the department where the specialist is registered is entered

The following are the persons who conducted the investigation:

Their position, initials and place of work must be indicated.

Provide accurate information about the victim in paragraph 5

If internships, briefings, or training were conducted, then all information about them is indicated in paragraph 6

9.Try to describe in detail the place where the tragedy occurred in paragraph 7

Indicate what conditions at the site could have led to the accident.

Then list the circumstances of the incident

Please indicate what type of incident it is.

If there is a medical report, please indicate its number and diagnosis.

Don't forget about witnesses either.

List all the reasons why the tragedy could have occurred

Indicate the culprits and their actions that led to the accident.

Write down how to change the situation at the enterprise so that such incidents do not occur again

At the conclusion of the document, signatures must be placed - with a transcript - of those who participated in the commission

It is better to draw up the act by hand, printing out the form on a PC, or to draw up the act entirely on a PC - and then do not forget to let the members of the commission and management sign it.

When is it necessary to draw up a deed?

An N-1 form report is issued only if the incident is directly related to production. That is, the employee was injured during the production process and as a result he lost his ability to work. The list of situations that can be qualified as an industrial accident is given in Art. 227 Labor Code of the Russian Federation.

Some incidents are not related to production. However, they are also subject to investigation and recording. The only difference is in the documentation - such an act is drawn up in any form.

Rules for management actions

When an employee or several employees receive an injury or microtrauma at work, management is obliged to act according to the established instructions . This determines how quickly the victim receives medical care and how competent and legal the management’s actions will be:

  • If an accident occurs and an employee is injured, regardless of its severity, he must be taken to the hospital.
  • Care should be taken to ensure that other workers are not harmed due to this accident.
  • Measures are being taken to prevent such incidents in the future.
  • The location where the employee was injured should remain unchanged pending an investigation.
  • The incident is reported to regulatory authorities , including the State Commission, and a commission is created that conducts a thorough investigation into the circumstances of the incident. Such a commission can be headed by either the head of the enterprise or a person authorized by him for such work.

Features of filling out the document

The act in form N-1, a sample of which is available below, consists of a “head” and 11 points. The header of the document contains information about the organization, position and full name. manager and date of approval.

Filling out the act in form N-1 is carried out as follows:

  • The first paragraph indicates the date and exact time of the accident.
  • The second paragraph contains the full name of the enterprise, its legal address, and OKVED code.
  • The third paragraph of form N-1 (accident report) contains information about the organization that sent the injured employee to work. If it is absent, put a dash.
  • The fourth paragraph indicates the composition of the commission that investigated the incident.
  • In the fifth, they display detailed information about the injured employee (full name, date of birth, position held, length of service).
  • In the sixth paragraph of the N-1 accident investigation report, information about the instructions provided (or lack thereof) is indicated.
  • In the seventh paragraph, you need to provide a brief description of the place (object) where the accident occurred. If the injury was sustained as a result of working on equipment, indicate its name, type, brand, and year of manufacture.
  • The eighth paragraph of the form N-1 report shows the circumstances of the accident.
  • The ninth paragraph indicates the main and concomitant causes of the accident.
  • The tenth paragraph lists the officials who committed violations of labor protection requirements.
  • The eleventh paragraph lists the measures that were taken to eliminate the causes of the incident.

You can download the act in form N-1 below.

Procedure for conducting an accident investigation

When starting an investigation, the commission carries out various actions aimed at identifying all the details of the circumstance. Standard actions are:

  • interviewing the victim and possible witnesses;
  • a thorough inspection of the scene of the incident;
  • attracting third-party specialists with a narrow profile;
  • collection of information and documents related to labor protection.

Of course, other actions may be performed at the discretion of the inspectors. The main thing is that they are aimed at a high-quality and reliable investigation. After all the procedures have been completed, the members of the inspection team come to a common conclusion. Experts determine under what circumstances the incident occurred, who is at fault and what injuries the employee received, and how guilty the victim is of the incident.

All this information is included in the act. Its form is chosen depending on who the victim works. Thus, the standard form that is used when receiving a work injury is N-1. However, if a professional athlete is injured, the report is drawn up in the N-1PS form. Moreover, the document is issued only if the injury occurred during a competition or training.

( Video : “Accident at work. How to recover compensation for moral damage”)

Basic rules for filling out the act

As a rule, the document is drawn up in triplicate.
One is sent to the Social Insurance Fund, one remains with the employer and one is given to the employee. It happens that the case is further investigated by third-party specialists. In this case, the required number of copies is made for each side. There must be complete and reliable information about what happened. If several employees are injured, a separate document is drawn up for each of them. As for the commission, it must consist of at least three people. These can be both employees of the organization and third-party specialists. Often the composition of the review team determines the complexity of a particular case. Members of the commission must carefully understand what happened. They determine the degree of guilt of each employee and identify the circumstances that caused the dangerous situation to arise.

One of the main conditions for the correct execution of a document is the affixing of autographs by all members of the inspection team. Moreover, living signatures must appear on all copies.

Instructions for filling out an industrial accident report

The act in form N-1 consists of several pages.
There should be no difficulties in filling them out, because there are hints under the lines. Thus, the document must have a “header” that contains the name of the company, the position of the manager, his passport details, and the date of registration. Next comes the main part, consisting of eleven points. Each of them must be filled out very carefully. All information entered must be true. If there are any inaccuracies, the document may be invalidated. As a result, an injured employee may not receive the social benefits assigned to him in a timely manner. In this case, the employee has the right to demand compensation for moral damage from the employer. In addition to a detailed description of the accident and the actions of the company’s employees, the commission must draw conclusions. In fact, they determine the degree of guilt of a particular employee.

The final stage involves affixing signatures. If the members of the commission come to a consensus, the document is signed. There are situations when the opinions of the review team members differ. They cannot come to a common conclusion. Thus, a specialist who does not agree with the general opinion must indicate weighty arguments for his decision. Although such situations are extremely rare. Usually, the opinions of each member of the commission are taken into account, which allows us to come to a common conclusion. After the document is signed by the inspectors, it is handed over to the director of the enterprise, who must also sign his autograph here.

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