【法规名称】
【法规编号】 79975 什么是编号？
【正 文】
第2页 CAP 282A EMPLOYEES' COMPENSATION REGULATIONS
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[接上页] (Chapter 282) NOTICE BY OR ON BEHALF OF EMPLOYEE OF INCAPACITY OR DEATH DUE TO OCCUPATIONAL DISEASE To: (1) ............................................ ............................................ ............................................ Notice is hereby given that (2) .......................................................................................... ............................................................................................................................................. on the (3) ...................... day of ........................... 19 ......... was found to be suffering from the following occupational disease ................................................................................................ .............................................................. believed to be due to his employment by you upon the following work (4) ................................................................................................................... resulting in the death/partial/total incapacity of a permanent/temporary nature (5) of the employee. And notice is hereby further given that in consequence thereof compensation is claimed from you. Dated this ................... day of ..................... 19 ..... (6) ...............................................______________________________________________________________________ (1) Name and address of the employer or principal contractor. (2) Full name and address of the employee. (3) Date upon which disease is said to have been discovered. (4) State nature of the work which is said to have caused the occupational disease. (5) Delete whichever is inapplicable. (6) Signature, name and address of person giving the notice. ___________ FORM 2 [regulation 4] EMPLOYEES' COMPENSATION ORDINANCE (CAP 282) SECTION 15 NOTICE BY EMPLOYER OF THE DEATH OF AN EMPLOYEE OR OF AN ACCIDENT TO AN EMPLOYEE RESULTING IN DEATH OR INCAPACITY Important Notes (1) To be completed and returned in DUPLICATE to the Commissioner for Labour- (a) WITHIN 7 DAYS of the accident in the case of death; or (b) WITHIN 14 DAYS of the accident in the case of injury; or (c) WITHIN such period of time as required by the Commissioner for Labour. (2) An employer who fails to give notice as required or who gives any false or misleading information to the Commissioner for Labour may be prosecuted. (3) Part I must be completed for each employee. Part II is to be completed only if the accident occurred on a construction site. (4) If more than one employee was injured or died as a result of an accident, please complete a separate form in duplicate for each employee. (5) Please "P" in the appropriate box. (6) Please read the instructions carefully before completing this Form. ____________ FORM 2 EMPLOYEES' COMPENSATION ORDINANCE (CAP 282) SECTION 15 NOTICE BY EMPLOYER OF THE DEATH OF AN EMPLOYEE OR OF AN ACCIDENT TO AN EMPLOYEE RESULTING IN DEATH OR INCAPACITY To the Commissioner for Labour I declare that the information given in this form is, to the best of my knowledge, true and accurate. Signature: ________________________________________ (for and on behalf of the employer) Name (in block letters): ._____________________________________ Position: □ Sole proprietor □ Partner □ Manager □ Officer Date: ______________________________ ______________________________ Chop of Company (Note 1) -Part I- A. Particulars of the employee Name of employee (Surname first) Identity Card/Passport No. Telephone No. Fax No. Address Date of birth _____/_____/____ Day/Month/Year Sex □ Male □ Female Occupation An apprentice □ Yes □ No B. Particulars of employer Name of employing company/person Business Registration Certificate No. (Note 2) Telephone No. Address Trade Fax No. C. Particulars of principal contractor/holding company (Note 3) Name of principal contractor/holding company Business Registration Certificate No. Telephone No. Address Trade Fax No. D. Description of accident Describe how the accident happened and state what the employee was doing at the time (Note 4) State whether the accident occurred in the course of work □ Yes □ No Date of accident _____/_____/____ Day/Month/Year Time of accident ___________ a.m./p.m. Result of accident □ Death □ Injury Address of the place of accident Name of hospital/clinic where the employee received treatment E. Details of insurance (Note 5) Name and address of insurance company at the time of accident (Please refer to the insurance policy) Policy No. F. Details of earnings of the employee Average number of working days per month □ 22 □ 24 □ 26 □ 30 □ Others ________________ (please specify) Rest day is (a) □ not paid □ paid (b) □ not fixed □ fixed on _____________________ (Day of week) Details of earnings per month for the month immediately preceding the date of accident: (Note 6) |
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