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. Statut, Manoeuvre ou ouvrier non qualifié = 1 ; Ouvrier qualifié = 2

. Si and . Le, s)quel(s) et pour quelle(s) maladie(s) 49, Maladie, vol.3

S. Oui, disposez-vous de moyens de protections ? (Cocher si oui) Hottes d'aspiration Gants Masques à cartouches Blouse

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S. Oui, quelles étaient les circonstances de survenue ? (Cocher si oui) Chute de plain-pied Chute de hauteur Manutention de charges lourdes Manipulation d'outils tranchants ou coupants Conduite de véhicule Effondrement d'objets Projection de produits Electrisation Autres

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