SAFE WORK ANALYSIS (SWA) VERSION 00001/2023

STAGEI
BACKGROUND OF THE WORK
NOMBRE DE LA EMPRESA: FECHA: / /
TASK DESCRIPTION: HORA DE INICIO: TIME OF TERMINATION:

SPECIFIC PLACE: WORK AREA:

NOMBRE DE SUPERVISOR RESPONSABLE DEL TRABAJO: SIGNATURE

1. FROM THE WORKERS: ANSWER EACH QUESTION YES NO

1 Am I in the physical and psychological condition to perform the task?
Am I trained and do I know the preventive measures that my employer has defined to carry out my work or task?
correct and safe way?
3 Do the environmental conditions correspond to those evaluated in the task planning? (example; lighting, terrain, order,
railings, gratings, platforms, climatic conditions, etc.
4 Do I have all the specific personal protective equipment for the task?
5 Do I have the appropriate equipment and tools for the task, in good condition and with up-to-date inspection?
6 Do I know how to act and react in an emergency?
7 Does the prior analysis, described in the step-by-step process, cover all the necessary control measures for the task?

A NO to any of the questions means not to start the task and to notify your supervision to define the measures.
Necessary ones that allow the task to be carried out safely, which must be additionally written in the
STEP BY STEP ANALYSIS.

2. Verify if one or more Control Strategy (EdC) applies by selecting the checkbox:
EdC Security (S) Yes No Occupational Health (OH) Yes No
EdC No. EdC No. EdC No. EdC No. EdC No. EdC No. EdC No. EdC No.
[Link] NO N/A [Link] NO N/A [Link] NO N/A [Link] NO N/A C.C.SÍ NO N/A [Link] NO N/A [Link] NO N/A C.C.SÍ NO N/A

IF THEY ARE NOT THERE

CONTROLS
CRITICS
DO NOT START THE TASK AND
GIVE A WARNING TO YOUR
SUPERVISOR

EdC No. EdC No. EdC No EdC No. EdC No. EdC No. EdC No. EdC No.
C.C.SÍ NO N/A [Link] NO N/A [Link] NO N/A [Link] NO N/A [Link] NO N/A [Link] NO N/A [Link] NO N/A [Link] NO N/A

RESPOND TO THE CHECKLIST OF CRITICAL CONTROLS CORRESPONDING TO THE EDCs THAT APPLY, WHICH ARE NOT CONSIDERED
INSIDE THE STEP BY STEP.

3. "IS THERE INTERACTION WITH OTHERS

Yes No

A YES TO THIS QUESTION MEANS TO ALSO PERFORM STEP 6 'CROSS WORK VERIFICATION'.

Do I need a special work permit? Please specify which one. YES NO

Access Permit to the Area Floor Retro License (granted or smooth) and railings
Hot Work Permit Work at Height Permit and SPDC Verification
Work Permit in Confined Spaces Work Permit for Aerial Electric Lines
Isolation and Lockout Permit Work Permit with Radioactive Equipment
Work Permit to Intervene on Energized Equipment Other Permissions
Lifting Permit (for critical lifts) Indicate which one
 SAFE WORK ANALYSIS (SWA) VERSION 00001/2023
Rev. November 5, 2021

5. INITIAL ENVIRONMENT ASSESSMENT. MARK YES OR NO IF THE CONDITION APPLIES. IN CASE OF A YES,
INCLUDE STEP BY STEP, IN STAGE II (ATTACHED SHEET)

1. Towers 2. Channeling APPLIES 7. Structures

3. Substances Excavations 5.
APPLICATION
6. Transfer
A
APPLY andlines APPLY subterranean APPLY residues andditches Surfaces APLICA
download and APPLY obstructing
electrical electricand dangerous irregulars teamsonroutes accesses
hydric in the area

[Link] APLIC [Link]

ig APPLY 10. Equipment APPLICATION
Risk for APPLICATIONOTHER:d(eb
csrief)ainohterenrvoinmenatlcon
on
id
[Link]
il
of A
deficient in
A A
contagious by
material movement COVID-19
UV radiation

6. VERIFICATION OF CROSS JOBS YES NO

Do I have the owner's authorization to segregate my workplace from the others?
Did I coordinate my actions and inform the preventive controls with the other jobs present in the area?
I verified the effectiveness of 360° segregation including the upper and lower levels that I could.
affect? Consider the '3 A's Above; Below; Around.
I reviewed the risk analysis of the cross jobs and it is possible to carry out the task in safe conditions while interacting with
other tasks in the area?

IN CASE OF A NO, STOP AND REQUEST ASSISTANCE FROM THE SUPERVISOR IN CHARGE OF THE AREA.
Once the process is completed, all workers in the team or work crew must sign the sheet to validate that the hazard identification process,
Risk assessment and control measures established herein are mandatory and non-compliance may lead to the application of the sanctions established in the
RECSS, RIOHS, Management of Critical Behaviors and Guide for the Management of Consequences and Recognition.

TAKING KNOWLEDGE CROSS ANALYSIS

NOMBRE EMPRESA: NOMBRE SUPERVISOR:

SUPERVISOR SIGNATURE

NOMBRE EMPRESA: NOMBRE SUPERVISOR:

SUPERVISOR SIGNATURE

WORKERS / SIGN AT THE BEGINNING OF WORK WORKERS / SIGN AT THE END OF THE WORK
Each worker subscribed in the list signs and declares to terminate their activity,
work or task without injuries or incidents and must leave the area clean
ordered.
NAME SIGNATURE NAME FIRM

REMEMBER THAT IF THE CONDITIONS OF THE TASK, WORKING HOURS, ENVIRONMENT, EQUIPMENT OR CHANGE OF INITIAL MEMBERS CHANGE, THE NECESSARY STEPS MUST BE ADDED TO THE
ART.
 SAFE WORK ANALYSIS (ATS) VERSION 00001/2023

STEP-BY-STEP RISK ANALYSIS PREVIOUSLY PLANNED AND MANDATORY FOR EACH TASK

TASK DESCRIPTION: CHANGE OF PLUGS

NAME OF SUPERVISOR WHO VALIDATED STEP BY STEP
FROM THE TASK: FIRM:

VERIFICATION OF
COMPLIANCE (of the
UNWANTED EVENT/INCIDENT CONTROLS at the point of
SEQUENCE OF WORK CONTROLS
(which leads to death, illness, injury, work)
(Step by step how the Task will be carried out) What should I do to avoid having an accident?
damage or other loss
YES NO
1.1.1 Be attentive to the conditions of the
1.1. Same level fall/Twist of environment
1. Access to the workspace
ankles due to irregular floors.
1.1.2 Travel through authorized places
2.1.1 Be attentive to the conditions of the
2. Verification of the environment 2.1. Fall at the same level/Sprain ofenvironment
ankles on uneven floors.
2.1.2 Transit through authorized places

3.1.1 Be aware of the conditions of the

3.1. Same level fall/Sprain of environment
3. Work Point Segregation ankles due to uneven floors.
3.1.2 Transit through authorized places

4.1.1. Be aware of the conditions of

environment

4.1.2. Do not use distracting elements

4.1. Hit by materials and/or during the workday
tools
4.1.3. Use PPE (helmet, impact-resistant gloves,
safety glasses, geologist, Shoes of
4.- Transfer of materials and tools security
to the ground
4.2.1. To know the associated risks with
manual handling of loads.

4.2. Overexertion 4.2.2. Use all the muscles of the body

for the lifting and lowering of a load
and bend the knees, keep the back straight
and the head raised to perform a load
 SAFE WORK ANALYSIS (SWA) VERSION 00001/2023

VERIFICATION OF
COMPLIANCE (of the
WORK SEQUENCE UNWANTED EVENT/INCIDENT CONTROLS CONTROLS at the point of
Step by step on how the task will be performed (which leads to death, illness, injury, What should I do to avoid having an accident? work)
damage or other loss
YES NO
6.1.1. Monitoring of symptoms of the staff to
start of the day
6.- Health and COVID-19 contagion 6.1 Contagion by Covid-19
6.1.2. Frequent hand washing and/or use of
alcohol gel on the ground
In case that in a control identified in the step by step it is identified that 'Does Not Comply', a 'I say No' must be managed and reported to the supervisor to
implement the controls and/or safety measures for the execution of the work. These controls and/or measures must be incorporated in the step-by-step (stage II)