Official :: Vidyut Suraksha Nideshalay

FORMAT FOR TRANSMITTING A REPORT OF ELECTRICAL ACCIDENT (SEE RULE-44-I)

1- Date of accident and time

2- Place of accident (village / city, tehsil / police station, district and state)

3- Methodology of distribution and voltage (whether EHBH / HB line / sub station production is central / consumer / repatriation / service line / other performance)

4- The name of the load seeker of the payer, whose jurisdiction had taken place in the accident.

5- The name of the owner / owner of the energy whose accident took place in the premises.

6- Details of the sufferer (s): -

(A) Human

S No.

Name

Father's Name

Gender(M/F)

Complete Address

Age

Fatal/Nonfatal

(B) Animals

S No.

Description of Animal(s)

Number

Owner(s) Name

Owner(s) Address(s)

Fatal/Nonfatal

7- If the victim is the employee / employee of the supplier:

The designation of such person (s)
Enlightened description of the work done, if any
Was such persons / persons allowed to do that work?

8- If the victim is an employee / employee of an approved contractor:

What was the supervisor's competency certificate issued by the injured person / persons under electrical worker license or rule-45? If so, give the number and the date of issue of it and the name of the issuing authority.
Name of the person whose name is the victim

9- If the accident occurred in the provider's system, then what was the permission to do the work (PTVW)?

10- (a) Nature and extension of damage, for example, describe the disability (permanent or temporary) or burning / other damages of any part of the body / body.

(b) If a fatal accident happened, what was the autopsy?

11- Detailed reason Accident (details to be given on a separate sheet attachment with this form)

12- Immediately after the occurrence of rash, proceedings (giving details) regarding first aid, medical care etc?

13- What has been reported to the concerned District Magistrate and the police station about Accident? If yes, give details?

14- It is possible to where went to what action to maintain the evidence relating to Accident extent?

15- Name and post name of the person (those persons) who were assisted or supervised by filling or damaged persons (individuals)?

16- Is the person who was screwed / was given security equipment and was used by them? (For example, rubber gloves, rubber mats, safety sticks and stairs etc.)?

17- Was the self-employed switches and other disciplinary tips employed to deactivate the sections to work on them?

18- Whether the work on electrified lines was done by authorized persons / individuals? If yes, names and designations of such person / persons should be given?

19- Did such persons / persons who had suffered from electrical accidents / were given / were given artificial rehabilitation treatment, if so, how long had he been given prior to his / her abandonment?

20- The name and post name of the person who was present at the time of the accident?

Any other information / comments

place: ---------------
Name: --------------
Post name: ---------------

Time: ---------------
Signature:: ---------------
Date: ---------------
Reporting person's address: ---------------
(Sense 0 EB0305 / 21 / N X XIII-85)
B M Reddy
Secretary, (CBET)