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[接上页] □ 10 Formwork erection □ 11 Brick laying □ 12 Caisson work □ 13 Trench work □ 14 Gas pipe fitting □ 15 Water pipe fitting □ 16 Electrical wiring □ 17 Material handling □ 18 Lift installation □ 19 Slope work □ 20 Others (please specify) ____________ Whereabouts on the site such work was performed O. Machinery involved, if any (tick one or more boxes) (Note 10) □ 01 Skip/material hoist □ 02 Passenger hoist/builders' lift □ 03 Tower crane □ 04 Mobile crane □ 05 Lorry-mounted crane □ 06 Hydraulic crane □ 07 Suspended working platform □ 08 Boatswain's chair □ 09 Pile driver □ 10 Boring jig □ 11 Bar bender □ 12 Concrete mixer □ 13 Air compressor/receiver □ 14 Others (please specify) P. Transporting or construction machinery involved, if any (tick one box) □ 01 Dump truck □ 02 Loader □ 03 Excavator □ 04 Bulldozer □ 05 Grader □ 06 Compacting roller □ 07 Others (please specify) _______________ -End of Part II- Explanatory Notes Note 1: The signature and company chop which appear in both copies of Form 2 submitted to the Commissioner for Labour should be in the original. Note 2: If the Business Registration Certificate No. is not available, the Identity Card No. of the employing person should be entered. Note 3: Section C on particulars of principal contractor/holding company should be completed only when the employer is either- (a) a subcontractor; or (b) a subsidiary of a holding company within the meaning of the Companies Ordinance (Cap 32) and which is covered by and specified in the insurance policy taken out by the group of companies to which it belongs. Note 4: Describe how the accident happened, state what the employee was doing at the time and give details of how the accident happened, e.g. what work was the injured doing, what factors (directly and indirectly) leading to the accident, and how he was injured, etc. Note 5: The name and address of the insurer as appeared on the insurance policy, instead of those of the broker or agent, should be entered here. Note 6: Earnings include- (a) cash wages; (b) the value of any privilege or benefit which can be estimated in cash, e.g. food, fuel or quarters supplied to the employee if, as a result of the accident, he is deprived of any of them; (c) overtime or other special remuneration for work done, whether in the form of bonus, allowance or otherwise, if it is of a constant nature; and (d) customary tips.But remuneration for intermittent overtime, casual payments of a non-recurrent nature, the value of travelling allowances or concession and the employer's contributions to provident funds are not included. Note 7: Construction Site Building worksite: site for building substructure, superstructure, etc. Civil worksite: site for building roads, bridges, etc. Renovation/repair of existing buildings: internal or external renovation, repairing, painting, or external wall cleaning, etc. (Note: Fitting-out in new buildings should be regarded as a building worksite.). Shipyard Floating vessel: ship building or repairing conducted on floating shipyard or floating vessel. Non-floating vessel: ship building or repairing conducted on slipway or shore. Maintenance workshop: maintenance workshop of the shipyard where parts of ships are machined, repaired or maintained. Manufactory Production area: production workshop or any location where actual production is being carried out. Maintenance workshop: maintenance workshop of the manufactory where machinery parts are machined, repaired or maintained. Loading/unloading area: location inside the manufactory assigned for loading and unloading activities including cargo handling. Storage area: location inside the manufactory used for storage purpose. Others Container yard: the location where container handling, stacking and maintenance work, etc. are being carried out. Note 8: Please briefly describe the main function of the workplace at the time of the accident. Note 9: Please give details on the injury sustained, e.g. while working on a working platform, an employee twisted his ankle and fell 3 m onto the ground. In the above example, the following boxes in sections J, K and L should be marked- In section J Nature of injury: Sprain & strain (box 14). In section J Part of body injured: Ankle (box 55). In section K Type of accident: Fall of person from 3 m (box 04). In section L Agents involved: Ladder or working at height (box 05). In the description of the agents indicated: A platform constructed of a plank which measured 5 m long by 2 m wide and by 5 mm thick.Note 10: If none of the machinery provided is suitable, please tick box 14 and specify the name of the machinery or briefly describe the type of machinery involved. (L.N. 469 of 1996) FORM 2A [regulation 4] EMPLOYEES' COMPENSATION ORDINANCE (CAP 282) SECTION 15 NOTICE BY EMPLOYER OF THE DEATH OR INCAPACITY OF AN EMPLOYEE DUE TO OCCUPATIONAL DISEASE |