FORMAT Code: SSO-F-13

Version: 01
SAFE WORK ANALYSIS (SWA)
Page: 01

EXECUTING COMPANY: LOS PORTALES S.A. FECHA: HORA INICIO: FINAL HOUR:

PROYECTO/OBRA: SUN OF THE ALAMEDA REAL - II STAGE AUTHORIZATIONS:

WORKPLACE: Lambayeque CARGO: LAST NAME AND FIRST NAME: COMPANY

GROUP LEADER/ FOREMAN:

WORK TO BE DONE:
RESIDENT/SUPERVISOR OF WORK: HERNÁN CHICCHÓN ALDEA

V°B° SSOMA/PDR OF WORK: YACORI RIVERO BURGOS

Note: The undersigned, in their capacity as direct responsible parties, certify that the security measures required in this format have been personally verified on-site, for which we grant authorization for the commencement of work and commit to ensuring the safety of the personnel.

REQUIREMENT FOR THE EXECUTION OF WORKS AND/OR ACTIVITY AS APPLICABLE (MARK WITH X OR APPROVED)

Additional work permit Specific procedure Specific training Gas monitoring Noise monitoring MSDS sheets

PERSONAL PROTECTIVE EQUIPMENT (PPE):

Boots with steel toe x Hearing protection Leather gloves Harness 2 LV c/shock abs. Leather jacket Oxygen therapist lenses

Dielectric boots Dust respirator Dielectric gloves 2 LV harness with steel cable Leather apron grinder wheel

Rubber Boots Smoke respirator Neoprene gloves Harness 1 LV Leather sleeves Knee pads

Safety helmet Gas mask Rubber gloves Reflective vest Long cuff gloves Others 1:

Chin strap Safety glasses Carpenter gloves Whistle Welder's helmet Others 2:

COLLECTIVE PROTECTION EQUIPMENT:

Rigid railings Cintas Signs Vertical brake Fire extinguisher Fall protection net

Cones Orange net Lifeline Bloqueo retráctil First Aid Kit and Stretcher Stop/Go Signs

Gates Lighting Light beacons Lookouts/Rigger Lockout and tagging Hoods

LIST THE ACTIVITIES / TASKS TO PERFORM THE WORK DANGERS RISKS CONTROL MEASURE

OBSERVATIONS / SUGGESTIONS:
The AST must consider not only the hazards of the work area but also those of its surroundings: energized lines, ground elevation changes, wind speed, low lighting, temperature, etc.
● Before starting a job, follow these steps: (1) What do I have to do? (2) How am I going to do it? (3) What do I need to do it? (4) How could I get injured? and (5) What will I do to avoid it?
 OBLIGATIONS OF THE WORKER GENERAL RULES OF SSOMA
I will comply with ALL the directives given to me by my Employer to avoid getting injured. 1. Do not allow the start of any work without the Daily Briefing and the AST, with the participation of the entire crew. In case of
I will not perform any work: High Risk work verify that the additional Work Permits are being complied with.
-Without having first elaborated the specific AST of the work. Every worker must perform tasks if they have been trained for those jobs.
If I do not have a specific order from my immediate Supervisor. 3. Keep the work area organized, marked and clean. Separate waste accordingly, avoid spills.
In tasks and positions of a higher category than stipulated in my contract. 4. Once the risk areas are defined, it is not allowed to stay beneath places where objects may fall or along a path of a
If I do not have ALL the required PPE. load (tools, parts in the assembly process, etc.).
If I am not competent: That is, I do not have experience, I have not been instructed and/or trained in 5. Do not use equipment outside of its design criteria or manufacturer's specifications.
said work. 6. Scaffolding and/or equipment that has not been authorized for use will not be used.
If this job is HIGH RISK and I do not have the REQUIRED PERMITS. 7. Block and tag lines with energy (electric, hydraulic, mechanical, etc.) before working on them.
I will use my PPE appropriately at all times, I will not alter or replace them. 8. Do not drive, operate, or intervene with mobile equipment without authorization. Do not talk on the cell phone while operating or driving this equipment.
In case of an accident, I MUST STOP MY WORK AND REPORT immediately. 9. Do not remove or eliminate systems, devices, and/or protection or security measures. Use the authorized PPE safely and keep them.
done to my immediate supervisor. in good condition.
Do not remove and/or eliminate systems, devices, and/or measures of protection or security. 10. Report accidents and incidents immediately.
Comply with the 'General SSOMA Standards'. 11. Do not enter the work area under the influence of alcohol or unauthorized drugs, nor bring such products in, including to the camps.
Comply with the Internal Regulations on Occupational Safety and Health - RISST. 12. I think and then I act, if I observe a risky act I give feedback to my partner. I tell him that he can get hurt if he doesn't do
correctly the task.
Every worker has the right to refuse to work if the conditions for performing the task could lead to serious injuries.
14. Prepare yourself physically and mentally for each task. Comply with medical provisions, take care of your health.

Occurrence
No. Full name Company
(No news or describe the injury)
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IMPORTANT NOTES TO CONSIDER:
1. TO INCORPORATE NEW PERSONNEL INTO THE CREW, THE CREW LEADER AND/OR SUPERVISOR SHALL COMMUNICATE TO THIS NEW PERSONNEL THE RISKS ASSOCIATED WITH EACH TASK AND/OR ACTIVITY. IF GREATER
SPACE, AN ADDITIONAL FORMAT MUST BE ATTACHED.
No work can be carried out without an ast.
3. THE AST CONSTITUTES A SPECIFIC WRITTEN ORDER. THEREFORE, FAILURE TO COMPLY WITH THE AST THAT RESULTS IN INJURIES TO THE WORKER DOES NOT CONSTITUTE A WORK ACCIDENT IN ACCORDANCE WITH D.S. 003-98-SA - STANDARDS.
TECHNIQUES OF COMPLEMENTARY RISK WORK INSURANCE, ART. 2, SECTION 2.3, LITERAL C.