SEARCH
Philippine Government Forms All in One Location
Tweet
Share
B-309 EC Accident/Sickness Report
SSS report form used for accident or sickness
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: REPUBLIC OF THE PHILIPPINES
SOCIAL SECURITY SYSTEM
IMPORTANT
ACCIDENT/SICKNESS REPORT
IF VEHICULAR ACCIDENT
ATTACH COPY OF POLICE REPORT
SS NUMBER
SSS FORM B-309 (Revised 06/88) eeg
NAME OF EMPLOYEE (Last, First, Middle)
NAME OF EMPLOYER
SS I.D. NUMBER
ADDRESS
JOB DESCRIPTION OR OCCUPATION
DATE OF ACCIDENT/SICKNESS
EXACT TIME
PLACE
(Check applicable box)
REGULAR WORKING HOURS
From
To
DATE LAST REPORTED FOR WORK
OVERTIME
From
To
DATE RETURNED TO WORK
BRIEF DESCRIPTION OF ACCIDENT/SICKNESS
SIGNATURE OF IMMEDIATE SUPERVISOR
DATE
SIGNATURE OF PERSONNEL MANAGER
(Signature above printed name)
Internet Edition (7/2000)
DATE
