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EMPRESA :____________________________
SETOR : _______________________________________________
FONTE : ___________________________________________________________________
DOSE : ___________
ALTERNATIVAS DE CORREÇÃO :
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4 - Enclausuramento da Fonte de Ruído : __________________________________________
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II - CALOR :
SETOR : _______________________________________________
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ALTERNATIVAS DE CORREÇÃO :
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( ) INVIÁVEL ( ) VIÁVEL prazo : ____________________________
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SETOR : _______________________________________________
FONTE : __________________________________
ALTERNATIVAS DE CORREÇÃO :
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SETOR : _______________________________________________
FONTE :
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ALTERNATIVAS DE CORREÇÃO :
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( ) INVIÁVEL ( ) VIÁVEL prazo : ____________________________
2 - Redução da utilização do equipamento em cada jornada : ___________________________
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V - VIBRAÇÕES :
SETOR : _______________________________________________
FONTE : ___________________________________________________________________
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DOSE : ___________
ALTERNATIVAS DE CORREÇÃO :
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VI - FRIO :
SETOR : _______________________________________________
FONTE : ___________________________________________________________________
ALTERNATIVAS DE CORREÇÃO :
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VII - UMIDADE :
SETOR : _______________________________________________
ALTERNATIVAS DE CORREÇÃO :
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( ) INVIÁVEL ( ) VIÁVEL prazo : ____________________________
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SETOR : _______________________________________________
ALTERNATIVAS DE CORREÇÃO :
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IX - POEIRAS MINERAIS :
SETOR : _______________________________________________
ALTERNATIVAS DE CORREÇÃO :
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( ) INVIÁVEL ( ) VIÁVEL prazo : ____________________________
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X - AGENTES BIOLÓGICOS :
SETOR : _______________________________________________
FONTE : ________________________________
ALTERNATIVAS DE CORREÇÃO :
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XI - AGENTES ERGONÔMICOS :
Em cumprimento ao disposto nos itens da Norma Regulamentadora n.º 17 da
Portaria 3214/78.
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XII. ATIVIDADES E OPERAÇÕES PERIGOSAS :
A - EXPLOSIVOS :
Restringir o número de trabalhadores expostos ao essencial em cada turno, proibindo a
exposição dos demais através de Ordem de Serviço de Segurança e Saúde no Trabalho.
B - INFLAMÁVEIS :
Restringir o número de trabalhadores expostos ao essencial em cada turno, proibindo a
exposição dos demais através de Ordem de Serviço de Segurança e Saúde no Trabalho.
C - RADIAÇÃO IONIZANTE :
Restringir o número de trabalhadores expostos ao essencial em cada turno, proibindo a
exposição dos demais através de Ordem de Serviço de Segurança e Saúde no Trabalho.
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D - ELETRICIDADE :
Restringir o número de trabalhadores expostos ao essencial em cada turno, proibindo a
exposição dos demais através de Ordem de Serviço de Segurança e Saúde no Trabalho.
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XIV. EDIFICAÇÕES :
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XV. INSTALAÇÕES ELÉTRICAS :
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XVII. PROTEÇÕES DE MÁQUINAS E EQUIPAMENTOS :
XIX. FORNOS :
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XXI. PROTEÇÃO CONTRA INCÊNDIOS :
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SETOR POSTO DE CORREÇÕES PROPOSTAS PRAZOS
TRABALHO
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XXVI. Com relação a Produtos Químicos no trabalho rural :
RESPONSÁVEL TÉCNICO
NOME:__________________________________________________
CRM / CREA ________________ RG MTb-SSMT ____._________
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