Äîêóìåíò âçÿò èç êýøà ïîèñêîâîé ìàøèíû. Àäðåñ îðèãèíàëüíîãî äîêóìåíòà : http://www.apo.nmsu.edu/Site/usersguide/SafetyPlan/wcnoa.pdf Äàòà èçìåíåíèÿ: Wed Feb 1 21:37:47 2006 Äàòà èíäåêñèðîâàíèÿ: Sun Apr 10 03:14:13 2016 Êîäèðîâêà:

NOTICE OF ACCIDENT/NOTIFICACION DE ACCIDENTE
In accordance with New Mexico law, Section 52-1-29, NMSA 1978 Conforme a la Ley de la CompensaciÑn de los Trabajadores, SecciÑn 52-1-29, NMSA 1978

I, ______________________________________________, was involved in an on-the-job accident me lastimÈ en un accidente en el trabajo Yo, (name of employee/nombre del empleado) at approximately __________________, on ________________, 20_____. aproximadamente (time/ a la(s) hora(s)) el (date/fecha) del 20______. What happened and where:_____________________________________________________________________ ¿QuÈ ocurriÑ y dÑnde ocurriÑ? ___________________________________________________________________________________________ ___________________________________________________________________________________________ Signed:_________________________________Signed:_________________________________ Firma: (employee/empleado) Firma: (employer or agent/empleador o agente) Employee's social security number_______________________ Date:__________________ NÇmero de seguro social del empleado: Fecha:
Employer/employee: Each keep one copy. Empleador/empleado: Retener una copia. For more information, call the Workers' Compensation Administration. Ask for an ombudsman. Para mÀs informaciÑn, pÑngase en contacto con el Programa de Asesores (Ombudsman Program) en la AdministraciÑn de la CompensaciÑn de los Trabajadores Albuquerque: 841-6000 - 1 (800) 255-7965 Farmington: 327-5467 -1 (800) 568-7310 Las Vegas: 454-9251 - 1 (800) 281-7889 Lovington: 396-3437 - 1 (800) 934-2450 Las Cruces: 524-6264 -1 (800) 870-6826 Form NOA-1 (5/97)