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Programa Institucional para la Gestión de Residuos ... - swisscontact

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11.2. Ficha <strong>de</strong> Acci<strong>de</strong>ntes<br />

I.- Datos Generales:<br />

S w i s s c o n t a c t | C o m i t é m a n e j o d e r e s i d u o s s ó l i d o s h o s p i t a l m a t e r n o i n f a n t i l “ G e r m á n U r q u i d i ”<br />

FICHA DE ACCIDENTES<br />

PINCHAZOS/ LESIONES/ SALPICADURAS<br />

Nombre y apellido ………………………………………………………………………………………………………………………………………..<br />

Edad ………………………………………Ocupación …………………………………………………………………………………………………….<br />

Fecha ……………………………………...hora …………………………………Servicio ……………………………………………………………...<br />

Descripción <strong>de</strong>l acci<strong>de</strong>nte ……………………………………………………………………………………………….…………………………..<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

Tipo <strong>de</strong> lesión …………………………………………………………………………………………………………………………………………………<br />

Parte afectada …………………………………………………………………………………………………………………………………………………<br />

Informante ……………………………………………………………………………………………………………………………………………………...<br />

II.- INVESTIGACIONDEL PACIENTE<br />

Como ocurrió ………………………………………………………………………………………………………………………………………………...<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

…………………………………………………………………………………………………………………………………………………………………………….<br />

A N E XO S<br />

33

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