3
20
111102285636164230
北京市密云区人力资源和社会保障局
工伤认定申请
1111022856361642303002014007004
0
2e0ab262-2fd2-4184-8744-b0b42b357962
a3bf6444-a9fb-4141-8a43-22bd0d15dbae
3
20
密云区人力资源社会保障局
110118000000
北京市密云区人力资源和社会保障局
密云区人力资源和社会保障局:法定工作日: 上午: 08:30 - 11:30; 下午: 13:00 - 17:00;
密云区人力资源和社会保障局:北京市密云区康宝路15号劳动能力鉴定管理中心
1.职工发生事故伤害或者按照职业病防治法规定被诊断、鉴定为职业病，所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向用人单位登记地的区社会保险行政部门提出工伤认定申请。遇有特殊情况，经报社会保险行政部门同意，申请时限可以适当延长。用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位登记地的区社会保险行政部门提出工伤认定申请。（来源:《工伤保险条例》2003年4月27日中华人民共和国国务院令第375号公布，根据2010年12月20日《国务院关于修改〈工伤保险条例〉的决定》修订 第十七条） 2.申报材料齐全，填写完整，符合要求。 3.在上述规定时限内提出申请。
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《工伤保险条例》第十四条第（一）在工作时间和工作场所内，因工作原因受到事故伤害的\n\t6.10 职工死亡的\n\t6.2 符合《工伤保险条例》第十四条第（二）项工作时间前后在工作场所内，从事与工作有关的预备性或者收尾性工作受到事故伤害的\n\t\t6.2.1 是否涉及“加班加点”\n\t\t\t6.2.1.1 是\n\t\t\t6.2.1.2 否\n\t6.3 符合《工伤保险条例》第十四条第（三）在工作时间和工作场所内，因履行工作职责受到暴力等意外伤害的\n\t6.4 符合《工伤保险条例》第十四条第（四）患职业病的\n\t6.5 符合《工伤保险条例》第十四条第（五）因工外出期间，由于工作原因受到伤害或者发生事故下落不明的\n\t\t6.5.1 是否涉及用人单位组织或指派参加活动\n\t\t\t6.5.1.1 是\n\t\t\t6.5.1.2 否\n\t\t6.5.2 是否涉及因工外出\n\t\t\t6.5.2.1 是\n\t\t\t6.5.2.2 否\n\t6.6 符合《工伤保险条例》第十四条第（六）在上下班途中，受到非本人主要责任的交通事故或者城市轨道交通、客运轮渡、火车事故伤害的\n\t\t6.6.1 是否涉及上下班交通事故\n\t\t\t6.6.1.1 是\n\t\t\t6.6.1.2 否\n\t6.7 符合《工伤保险条例》第十五条第（一）在工作时间和工作岗位，突发疾病死亡或者在48小时之内经抢救无效死亡的\n\t6.8 符合《工伤保险条例》第十五条第（二）在抢险救灾等维护国家利益、公共利益活动中受到伤害的\n\t6.9 符合《工伤保险条例》第十五条第（三）职工原在军队服役，因战、因公负伤致残，已取得革命伤残军人证，到用人单位后旧伤复发的","CD_TIME":"Jul 28, 2025 2:43:08 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实施主体 北京市密云区人力资源和社会保障局 服务对象 自然人、企业法人、事业法人、社会组织法人、非法人企业、行政机关、其他组织
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受理条件 1.职工发生事故伤害或者按照职业病防治法规定被诊断、鉴定为职业病，所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向用人单位登记地的区社会保险行政部门提出工伤认定申请。遇有特殊情况，经报社会保险行政部门同意，申请时限可以适当延长。用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位登记地的区社会保险行政部门提出工伤认定申请。（来源:《工伤保险条例》2003年4月27日中华人民共和国国务院令第375号公布，根据2010年12月20日《国务院关于修改〈工伤保险条例〉的决定》修订 第十七条） 2.申报材料齐全，填写完整，符合要求。 3.在上述规定时限内提出申请。
办理时间 密云区人力资源和社会保障局:法定工作日: 上午: 08:30 - 11:30; 下午: 13:00 - 17:00; 查看详情
办理地点 密云区人力资源和社会保障局:北京市密云区康宝路15号劳动能力鉴定管理中心 查看详情
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序号 材料名称 材料来源 材料
必要性		 数量要求 介质要求 表格及样例
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序号 材料名称 材料来源 材料
必要性		 数量要求 介质要求 表格及样例
下载		 受理标准 提供材料
依据		 其他要求
一工伤认定申请表申请人自备必要原件2份表格类；纸质样表下载空表下载1.用钢笔或签字笔填写，字体工整清楚。 2.申请人为用人单位的，在首页申请人处加盖单位公章。 3.受伤害部位一栏填写受伤害的具体部位。 4.诊断时间一栏，职业病者，按职业病确诊时间填写；受伤或死亡的，按初诊时间填写。 5.受伤害经过简述，应写明事故发生的时间、地点，当时所从事的工作，受伤害的原因以及伤害部位和程度。职业病患者应写明在何单位从事何种有害作业，起止时间，确诊结果。 6.申请事项栏，受伤害职工或者其近亲属、工会组织应写 明提出认定或者视同为工伤的申请并签字。用人单位申请的，应 注明【展开】国务院关于修改《工伤保险条例》的决定【展开】按照《工伤认定申请表》填表说明要求填写【展开】
受伤害职工一寸免冠照片申请人自备必要原件1份其他；纸质样例下载无【展开】工伤证【展开】正面，彩色，原件1张【展开】
二、劳动关系材料
（一）劳动关系材料申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载劳动合同经用人单位与劳动者在劳动合同文本上签字或者盖章生效；被聘用人员在聘用合同上签字或者盖章生效；人事证明真实有效。【展开】北京市实施《工伤保险条例》若干规定【展开】劳动、聘用合同文本或者与用人单位存在劳动关系（包括事实劳动关系）、人事关系的其他材料【展开】
一次性趸缴工伤保险费的建设项目申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载用人单位提供受伤害职工的材料真实、有效且清晰。【展开】关于做好北京市建筑业工伤保险工作的通知【展开】关于代缴建设项目职工工伤保险费的协议、分包合同【展开】
三受伤后医疗诊断证明中介机构或法定机构产生来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载诊断证明书、就诊病历、职业病诊断证明书或者职业病诊断鉴定书应当符合本市规定的格式和要求。【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
或职业病诊断材料中介机构或法定机构产生来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载职业病诊断证明书或者职业病诊断鉴定书应当符合本市规定的格式和要求。【展开】国务院关于修改《工伤保险条例》的决定【展开】如职业病诊断证明书、职业病诊断鉴定书【展开】
四、用人单位作为申请人申请工伤认定的
（一）营业执照（副本）政府部门核发来源说明>必要正本原件1份；副本复印件1份结果文书类；纸质样例下载用人单位提供职工受到事故伤害或患职业病的材料真实、有效、清晰，能够证明事故发生的全部过程。【展开】国务院关于修改《工伤保险条例》的决定【展开】或事业单位法人证书、民间非营利组织登记证书、统一社会信用代码证书等【展开】
授权委托书申请人自备必要原件1份文本类；纸质样例下载用人单位提供职工受到事故伤害或患职业病的材料真实、有效、清晰，授权委托书要素齐全。【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
受委托人的中华人民共和国居民身份证政府部门核发来源说明>必要原件1份（原件仅供查验)；复印件1份结果文书类；纸质样例下载符合公安部门制定身份证的有关要求，材料真实、有效、清晰。【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
受伤害职工的中华人民共和国居民身份证政府部门核发来源说明>必要原件1份（原件仅供查验)；复印件1份结果文书类；纸质样例下载符合公安部门制定身份证的有关要求，材料真实、有效、清晰。【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
事故报告申请人自备必要原件1份文本类；纸质样例下载所提供的材料真实有效【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
受伤害职工的相应病历中介机构或法定机构产生来源说明>必要原件1份；复印件1份文本类；纸质样例下载所提供的材料真实有效【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
五、受伤害职工本人申请工伤认定的
（一）受伤害职工的中华人民共和国居民身份证政府部门核发来源说明>必要原件1份（原件仅供查验)；复印件1份结果文书类；纸质样例下载所提供的材料真实有效【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
受伤害职工的相应病历中介机构或法定机构产生来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载所提供的材料真实有效【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
六、工伤职工近亲属、工会组织申请工伤认定的提交
（一）、工伤职工近亲属申报的
1职工与其近亲属关系材料申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载所提供的材料真实有效【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
（二）、工会组织申报的
1单位情况说明材料申请人自备必要原件1份文本类；纸质样例下载所提供的材料真实有效【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
（三）授权委托书申请人自备必要原件1份文本类；纸质样例下载所提供的材料真实有效【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
受委托人的中华人民共和国居民身份证政府部门核发来源说明>必要原件1份（原件仅供查验)；复印件1份结果文书类；纸质样例下载中华人民共和国居民身份证的材料真实有效。【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
受伤害职工的中华人民共和国居民身份证政府部门核发来源说明>必要原件1份（原件仅供查验)；复印件1份结果文书类；纸质样例下载中华人民共和国居民身份证的材料真实有效。【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
受伤害职工的相应病历中介机构或法定机构产生来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载工会组织申报的，所提供的病历材料齐全、真实有效。【展开】国务院关于修改《工伤保险条例》的决定【展开】【展开】
七、符合《工伤保险条例》第十四条第一款第（一）项“在工作时间和工作场所内，因工作原因受到事故伤害的”
（一）伤害事故文书申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载受伤害事故材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
八、符合《工伤保险条例》第十四条第一款第（二）项“工作时间前后在工作场所内，从事与工作有关的预备性或者收尾性工作受到事故伤害的”提交
（一）伤害事故文书申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载受伤害事故材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
（二）、涉及“加班加点”的另需
1由于生产经营需要延长工作时间的材料申请人自备必要原件1份文本类；纸质样例下载受伤害事故材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
九、符合《工伤保险条例》第十四条第一款第（三）项“在工作时间和工作场所内，因履行工作职责受到暴力等意外伤害的”
（一）意外伤害文书申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载受伤害事故材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
或司法机关出具的法律文书政府部门核发来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载受伤害事故材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
十、符合《工伤保险条例》第十四条第一款第（四）项“患职业病的”
（一）职业病诊断材料（如职业病诊断证明书、职业病诊断鉴定书）中介机构或法定机构产生来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载职业病诊断证明书或者职业病诊断鉴定书应当符合本市规定的格式和要求。【展开】《工伤保险条例》第十九条【展开】【展开】
十一、符合《工伤保险条例》第十四条第一款第（五）项“因工外出期间，由于工作原因受到伤害或者发生事故下落不明的”提交
（一）伤害事故文书申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载受伤害事故材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
或下落不明的事故文书申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载申请材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
（二）、涉及用人单位组织或指派参加活动的
1相应活动材料（如活动方案、通知通告、日程安排）申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载申请材料真实有效【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
（三）、涉及因工外出的
1外出材料（如单位领导批示、邀请函、差旅报销、接待单位出具的材料）申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载申请材料真实有效【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
十二、符合《工伤保险条例》第十四条第一款第（六）项“在上下班途中，受到非本人主要责任的交通事故或者城市轨道交通、客运轮渡、火车事故伤害的”提交
（一）责任认定的法律文书政府部门核发来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质、电子样例下载司法机关、公安机关交通管理、交通运输、铁道等部门或者法律、行政法规授权组织出具的相关法律文书真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】司法机关、公安机关交通管理、交通运输、铁道等部门或者法律、行政法规授权组织出具的【展开】
（二）、涉及上下班交通事故的
1出行合理时间和合理路线的情况材料申请人自备必要原件1份文本类；纸质样例下载真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】如单位考勤制度、出行路线、居住地信息【展开】
十三、符合《工伤保险条例》第十五条第一款第（一）项“在工作时间和工作岗位，突发疾病死亡或者在48小时之内经抢救无效死亡的”
（一）医疗机构抢救记录申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载医院抢救记录和诊断材料真实有效，符合国家规定的格式和要求。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
十四、符合《工伤保险条例》第十五条第一款第（二）项“在抢险救灾等维护国家利益、公共利益活动中受到伤害的”
（一）相关单位出具的材料申请人自备必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载抢险救灾和维护国家利益、公共利益活动证明材料真实有效。【展开】北京市实施《工伤保险条例》若干规定（北京市人民政府令第242号）【展开】【展开】
十五、符合《工伤保险条例》第十五条第一款第（三）项“职工原在军队服役，因战、因公负伤致残，已取得革命伤残军人证，到用人单位后旧伤复发的”
（一）中华人民共和国残疾军人证政府部门核发来源说明>必要原件1份（原件仅供查验)；复印件1份结果文书类；纸质样例下载革命伤残军人证真实有效。【展开】《工伤保险条例》【展开】【展开】
旧伤复发诊断材料中介机构或法定机构产生来源说明>必要原件1份（原件仅供查验）；复印件1份文本类；纸质样例下载申请材料齐全、规范、真实、可行、有效【展开】《工伤保险条例》【展开】【展开】
十六、职工死亡的
（一）死亡证明中介机构或法定机构产生来源说明>必要原件1份；复印件1份文本类；纸质样例下载职工死亡的，医疗机构、公安部门出具的死亡证明材料真实有效。【展开】《工伤保险条例》【展开】【展开】
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  • 申请与受理1

    办理步骤办理时限办理人员办理结果
    申报/收件0个工作日申请人/

    审查标准

    1.职工发生事故伤害或者按照职业病防治法规定被诊断、鉴定为职业病，所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向用人单位登记地的区社会保险行政部门提出工伤认定申请。遇有特殊情况，经报社会保险行政部门同意，申请时限可以适当延长。用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位登记地的区社会保险行政部门提出工伤认定申请。（来源:《工伤保险条例》2003年4月27日中华人民共和国国务院令第375号公布，根据2010年12月20日《国务院关于修改〈工伤保险条例〉的决定》修订 第十七条）
    2.申报材料齐全，填写完整，符合要求。
    3.在上述规定时限内提出申请。    【展开】
    办理步骤办理时限办理人员办理结果
    受理0个工作日综窗人员材料完整，通过初审；材料不完整，通知补正。

    审查标准

    1.职工发生事故伤害或者按照职业病防治法规定被诊断、鉴定为职业病，所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向用人单位登记地的区社会保险行政部门提出工伤认定申请。遇有特殊情况，经报社会保险行政部门同意，申请时限可以适当延长。用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位登记地的区社会保险行政部门提出工伤认定申请。（来源:《工伤保险条例》2003年4月27日中华人民共和国国务院令第375号公布，根据2010年12月20日《国务院关于修改〈工伤保险条例〉的决定》修订 第十七条）
    2.申报材料齐全，填写完整，符合要求。
    3.在上述规定时限内提出申请。    【展开】
  • 审查与决定2

    办理步骤办理时限办理人员办理结果
    决定5个工作日首席代表或部门负责人予以受理出具《工伤认定申请受理决定书》，不予受理出具《工伤认定申请不予受理决定书》

    审查标准

    1.职工发生事故伤害或者按照职业病防治法规定被诊断、鉴定为职业病，所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向用人单位登记地的区社会保险行政部门提出工伤认定申请。遇有特殊情况，经报社会保险行政部门同意，申请时限可以适当延长。用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位登记地的区社会保险行政部门提出工伤认定申请。（来源:《工伤保险条例》2003年4月27日中华人民共和国国务院令第375号公布，根据2010年12月20日《国务院关于修改〈工伤保险条例〉的决定》修订 第十七条）
    2.申报材料齐全，填写完整，符合要求。
    3.在上述规定时限内提出申请。    【展开】
  • 颁证与送达3

    办理步骤办理时限办理人员结果名称
    发证0个工作日综窗人员

    1、工伤认定申请受理决定书

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工伤认定申请受理决定书
结果名称工伤认定申请受理决定书
结果文书类型其他
结果样本《工伤认定申请受理决定书》结果样本.docx
有效时间无时限
工伤认定申请不予受理决定书
结果名称工伤认定申请不予受理决定书
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结果样本《工伤认定申请不予受理决定书》结果样本.docx
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【行政法规】工伤保险条例
制定机关中华人民共和国国务院
依据名称工伤保险条例
发布号令（文号）中华人民共和国国务院令第586号
法条（具体规定）内容第十七条：职工发生事故伤害或者按照职业病防治法规定被诊断 、鉴定为职业病，所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向统筹地区社会保险行政部门提出工伤认定申请。遇有特殊情况，经报社会保险行政部门同意，申请时限可以适当延长。用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位所在地统筹地区社会保险行政部门提出工伤认定申请。
【展开】

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