(ATS) SAFE WORK ANALYSIS

NAME THE TASK: AREA:

AREA SUPERVISOR: COMPANY: PLACE:

JOB RESPONSIBLE: SIGNATURE: DATE: HOUR:

EQUIPMENT: HERRAMIENTAS MANUALES, ELECTRICAS: MATERIALS, CHEMICAL PRODUCTS:

Risk Risk
STEPS OF THE ASSIGNMENT / WORK DANGERS RISKS Preventive Measures / Control Measures
Actual Residual
BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA

BMA BMA
BMA BMA
Observations:

B Low Risk, if an accident were to occur the person would not suffer significant injuries at most First Aid.
Moderate Risk; If an accident were to occur, the staff would suffer moderate injuries such as cuts, stitches, mild traumatic brain injury, contusions, or medical treatments.
A High Risk; If the consequence of an accident occurs, resulting in Restricted work or lost time or fatality, material damage greater than $10,000.
 I understand that I am responsible for complying with what is stated in the safe work analysis conducted for this activity.
First and Last Names Cargo Code Company
1
2
3
4
5
6
7
8
9
10
11
12
Hand Care. Work area PETER EPP Tools and Equipment Order and Cleanliness

Yes No If No Yes No If No Yes No Yes No

Hot surfaces Fire extinguisher Height Helmet Standardized Free passages
Sharp surfaces First Aid Kit Esp. Confined Safety glasses In perfect condition Trash cans
Cutting Surfaces Signaling Excavation Ear plug Inspection tape Clean area
Pinch points Delimitation Izaje Respirator Suitable Tools in their place
Entanglement points Meeting point Radioactive sources Work clothes Well-placed equipment
Chemical products Eye wash Blasting Gloves
Electric energy Water box Explosives Harness
Cart
Safety shoe
Scaffolding Load outputs Chemical substances Stairs Vehicle management Emergencies
If No Yes No Yes No If No Yes No
Communications Center
Standardized Lifting plan MSDS Sheets Good steps Rested conductor
Control
Horizontalism Certified rigger Spill trays Suitable ladder Check List Phone: ........................
Verticality Slings NFPA 704 Code. use of harness Operational beacon
Cell phone: ……………………………..
Operation card Shackles spill kit Staircase with inspection Operational loss
Check List Crane Check List Ventilation Good support Fire extinguisher
Say "this call is a
Baseboards Nearby fire extinguishers correct inclination First aid kit
emergency" and identify yourself.
Tied tools Seat belt
Indicate the type of emergency
Internal permission
Indicate your location.

POS SAFE TASK ASSIGNMENT

SUPERVISOR CLOSE OF ATS:
CLOSING DATE AND TIME OF ATS: SUPERVISOR'S SIGNATURE:
1. Did anyone get injured or were there any material damages during today's task or was there an unforeseen incident? If ... No ... (if it is Yes, explain)

2. ¿Se reporto al área de HSE del cliente? Si……… No …….. NA………

3. Was there any problem with the assigned task?

4. What can we do for tomorrow to improve the task?

5. Other precautions:

I AM RESPONSIBLE FOR MY SAFETY AND THAT OF MY COLLEAGUES