Comprobante de visita

• Empresa

• Fecha de visita

  Date

• Dependencia

• Direccion
  Address

• Observación

Workplace

• Housekeeping

  Yes

  No

  N/A

• Workspace

  Yes

  No

  N/A

• Prevention and protection measures

  Yes

  No

  N/A

• Is hazards and requirements information available?

  Yes

  No

  N/A

Ergonomy

• Push and pull

  Yes

  No

  N/A

• Lifting and lowering

  Yes

  No

  N/A

• Torsion

  Yes

  No

  N/A

• Crouch/snuggle

  Yes

  No

  N/A

• Overwork

  Yes

  No

  N/A

• Repetitive actions

  Yes

  No

  N/A

Procedures

• Are the procedures known?

  Yes

  No

  N/A

• Are the procedures followed correctly?

  Yes

  No

  N/A

• Are safety standards satisfied?

  Yes

  No

  N/A

Working equipement

• Is working equipement in good state?

  Yes

  No

  N/A

• Is working equipement correctly used?

  Yes

  No

  N/A

PPE

• Hands

  Yes

  No

  N/A

• Head

  Yes

  No

  N/A

• Eyes and face

  Yes

  No

  N/A

• Ears

  Yes

  No

  N/A

• Nose and mouth

  Yes

  No

  N/A

• Feet

  Yes

  No

  N/A

• Body

  Yes

  No

  N/A

Personal evaluation

• Is the worker aware of the risks due the activities he's doing and to' the place where those activities take place? Does he prevent them?

  Yes

  No

  N/A

Recomanded actions

• undefined

Signatures of participants

• Worker observed

  Sign

• Person involved

  Sign

• Observer

  Sign