Fillable FORM 2B: EMPLOYEES COMPENSATION ORDINANCE (CAP. 282) SECTION (QBE)

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FORM 2B: EMPLOYEES COMPENSATION ORDINANCE (CAP. 282) SECTION (QBE)

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Country of origin: AUSTRALIA
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FORM 2B
EMPLOYEES’ COMPENSATION ORDINANCE
(CAP. 282)
SECTION 15(1A)(b)
NOTICE BY EMPLOYER OF AN ACCIDENT TO AN EMPLOYEE
RESULTING IN INCAPACITY FOR A PERIOD
NOT EXCEEDING 3 DAYS
To the Commissioner for Labour
I declare that the information given in this form is, to the best of my knowledge, true and accurate.
Name (in block letters) : __________________________________
Position : Sole proprietor Partner Manager Officer
Signature : _______________________________ Date : ___________________ ___________________
(for and on behalf of the employer) Chop of Company
A. Particulars of employee
Name of employee (Surname first) Identity Card/Passport No.
Tel. No. Address
B. Particulars of employer
Name of employing company/person Business Registration Certificate No.
Tel. No. Address Industry
Fax No.
C. Particulars of accident
Date of accident
_______/_______/_______
day / month / year
Address of the place of accident
Total number of days of temporary incapacity : day(s)
________
D. Particulars of compensation
Monthly earnings of the injured employee
for the purpose of calculating compensation : $_________________________
Amount of compensation : $ ____________________ paid
to be paid on ______/______/______
day/month/year
LD 478(s)
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EMPLOYEES’ COMPENSATION ORDINANCE
(CAP. 282)
SECTION 15(1A)(b)
NOTICE BY EMPLOYER OF AN ACCIDENT TO AN EMPLOYEE
RESULTING IN INCAPACITY FOR A PERIOD
NOT EXCEEDING 3 DAYS
FORM 2B
Important Notes
(1) This form shall be completed and returned in DUPLICATE to the Commissioner for Labour within 14 days of
the accident, irrespective of whether the accident gives rise to any liability to pay compensation, which results
in incapacity to an employee for a period not exceeding 3 days.
(2) If the period of incapacity in respect of the employee extends beyond 3 days after submitting this form, the
employer shall report the accident again in the prescribed form (Form 2) under S. 15(1A)(a) of the Employees’
Compensation Ordinance.
(3) An employer who fails to give notice as required or who gives any false or misleading information to the
Commissioner for Labour may be prosecuted.
(4) Please ‘ü’ in the appropriate box.
(5) For the purpose of calculating compensation to the injured employee, the monthly earnings shall be taken as the
earnings of the employee for the month immediately preceding the date of the accident, or the average monthly
earnings for the previous 12 months of employment (or any lesser period if the employee has not been so long
employed), whichever calculation is more favourable to the employee.
Earnings include :
(a) cash wages;
(b) the value of any privilege or benefit which can be estimated in cash, e.g. food, fuel or quarters supplied to
the employee if, as a result of the accident, he is deprived of any of them;
(c) overtime or other special remuneration for work done, whether in the form of bonus, allowance or
otherwise, if it is of a constant nature; and
(d) customary tips.
But remuneration for intermittent overtime, casual payments of a non-recurrent nature, the value of travelling
allowances or concession and the employer’s contributions to provident funds are not included.
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FORM 2B: EMPLOYEES COMPENSATION ORDINANCE (CAP. 282) SECTION (QBE)

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Completed 10 June 2021

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