Protokół nr ........ / SBZ/131/2005

z kontroli stanu bezpieczeństwa i higieny pracy przeprowadzonej w …………………………

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.( miejsce kontroli)

w dniu……………………….. przez …………………………………...………………………

( imię i nazwisko, stanowisko służbowe).

Kontrolę przeprowadzono w obecności…………………………………………………………

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( imię i nazwisko, stanowisko służbowe).

1. Przedmiotem kontroli były następujące zagadnienia:

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2. Informacja o wykonaniu zaleceń z poprzednich kontroli, ( jeżeli takie miały miejsce).

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3. W wyniku kontroli stwierdzono:

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….............................................................................................................……………………[Author ID1: at Tue Jul 19 09:33:00 2005 ]

[Author ID1: at Tue Jul 19 09:34:00 2005 ][Author ID1: at Tue Jul 19 09:34:00 2005 ]

[Author ID1: at Tue Jul 19 09:34:00 2005 ]

4. Zalecenia pokontrolne:

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