ANALYSIS_x000D_Job
Safety Analysis Local Delivery
1 (54)
Job Safety Analysis Local Delivery
Nombre de la persona que realiza
Puesto
Fecha
Cliente
Nombre del Contratista
Nombre del Sitio (con ID)
Zona rural
Zona urbana
Actividad a realizar
Ubicacin geogrfica del sitio y hospital ms cercano:
Esquema o mapa del sitio de ejecucin del trabajo
Direccin / Localizacin
Telfonos:
Verificacin (Marcar con una "X")
SI
NO
N/A
SI
Buena condicin fsica y mental para realizar las
actividades designadas:
Se cuenta con plizas de seguros (Gastos mdicos,
automvil):
Buenas condiciones de la estructura para realizar
trabajos en alturas:
Botiqun de primeros auxilios en sitio:
Todas las personas en sitio cuentan con equipo de
proteccin personal:
El personal que trabajar en alturas est capacitado:
Equipo de Proteccin completo para la actividad de
trabajo:
El personal que trabajar en alturas es certificado:
Equipo de Proteccin en buenas condiciones para la
actividad de trabajo:
Procedimiento de "Trabajo Seguro en Alturas":
Herramientas de mano y energa completas:
NO
N/A
El personal que realiza trabajos elctricos es certificado:
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Herramientas de mano y energa en buenas condiciones:
Realizacin de charla de seguridad de 5 minutos:
Safety Analysis Local Delivery
2 (54)
El personal que realiza trabajos elctricos est
capacitado:
Procedimiento de "Trabajo seguro con corriente
elctrica":
"Los riesgos calificados como NO ACEPTABLES y que NO EXISTA ACCIN MITIGANTE deben ser canalizados de inmediato al Responsable de P
Ericsson".
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
3 (54)
Fotos de Equipo de Proteccin Personal, Plan de Emergencia, Botiqun y Extintor en sitio
Seleccin de peligros, Riesgos y acciones recomendadas (Marcar con una "X")
Probabilidad
SI
Conduccin (traslado al sitio)
Alta
Media
Baja
NO
Riesgos:
Colisin vehicular
Consecuencia
Inseguridad (robo, secuestro, amenazas)
Lesiones mltiples
Fatalidad
Otro (especificar):
Incapacidad permanente total
Incapacidad permanente parcial
Primeros auxilios
Afectacin del servicio
Afectacin a la marca Ericsson o Cliente
Otro (especificar):
SI
Acceso al sitio
Probabilidad
Alta
Media
Baja
NO
Riesgos:
Inseguridad (robo, secuestro, amenazas)
Agresiones vecinales
Consecuencia
Agresiones animales
Fatalidad
Maleza
Incapacidad permanente total
Mala condicin de iluminacin
Incapacidad permanente parcial
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Otro (especificar):
4 (54)
Primeros auxilios
Afectacin del servicio
Afectacin a la marca Ericsson o Cliente
Otro (especificar):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
5 (54)
Fotografas de riesgos de acceso al sitio:
Probabilidad
SI
Trabajo en Alturas
Alta
Media
Baja
NO
Riesgos:
Cada a ms de 2 metros de altura
Consecuencia
Amputaciones
Fracturas
Fatalidad
Daos en espalda
Incapacidad permanente total
Lneas areas elctricas
Incapacidad permanente parcial
Esguinces
Primeros auxilios
Golpes
Afectacin del servicio
Clima adverso (lluvia, viento fuerte, etc.)
Afectacin a la marca Ericsson o Cliente
Insolacin (golpe de calor)
Otro (especificar):
Hipotermia (bajas temperaturas)
Agresiones de animales
Pnico (trabajo en alturas)
Cada de equipos y/o herramientas
Mala condicin de iluminacin
Otro (especificar):
Trabajos en alturas superiores a los 2 metros en solitario estn prohibidas, se debe contar con un viga o
Fotografas de riesgos en trabajos en alturas:
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
6 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Probabilidad
SI
Trabajos con corriente elctrica
7 (54)
Alta
Media
Baja
NO
Riesgos:
Electrocucin
Consecuencia
Amputaciones
Quemaduras
Fatalidad
Incendio
Incapacidad permanente total
Paro cardiorrespiratorio
Incapacidad permanente parcial
Mala condicin de iluminacin
Primeros auxilios
Explosin
Afectacin del servicio
Otro (especificar):
Afectacin a la marca Ericsson o Cliente
Otro (especificar):
Trabajos con alta tensin estn prohibidos, trabajos con energa se debe contar con un viga o acompaante (ex
Baja tensin (LV) se refiere normalmente a la tensin que supera los niveles de tensin muy baja, pero sin llegar a superar 1.0
conductores, o 600 V de CA o 900 V de CC entre conductores o a tierra.
Fotografas de riesgos en trabajos con corriente elctrica:
SI
Trabajos en caliente
Probabilidad
Alta
Media
Baja
NO
Riesgos:
Quemaduras
Incendio
Consecuencia
Explosin
Fatalidad
Molde exotrmico en malas condiciones
Incapacidad permanente total
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Mala condicin de iluminacin
8 (54)
Incapacidad permanente parcial
Electrocucin
Primeros auxilios
Otro (especificar):
Afectacin del servicio
Afectacin a la marca Ericsson o Cliente
Otro (especificar):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Probabilidad
SI
Manipulacin Manual
9 (54)
Alta
Media
Baja
NO
Riesgos:
Daos a la espalda
Consecuencia
Lesiones mltiples
Atrapamiento
Fatalidad
Luxaciones
Incapacidad permanente total
Contusiones
Incapacidad permanente parcial
Mala condicin de iluminacin
Primeros auxilios
Otro (especificar):
Afectacin del servicio
Afectacin a la marca Ericsson o Cliente
Otro (especificar):
Fotografas de riesgos en trabajos en caliente y/o manipulacin manual:
Manejo de qumicos / Residuos peligrosos
SI
Probabilidad
Alta
Media
Baja
NO
Riesgos:
Intoxicacin
Derrames, fugas de qumicos
Consecuencia
Explosin
Fatalidad
Contaminacin del agua
Incapacidad permanente total
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Contaminacin del suelo
Incapacidad permanente parcial
Contaminacin del aire
Primeros auxilios
Afectacin de la flora
Afectacin del servicio
Afectacin de la fauna
Afectacin a la marca Ericsson o Cliente
Incendio
10 (54)
Otro (especificar):
Quemaduras
Otro (especificar):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
11 (54)
Fotografas de riesgos en trabajos con manejo de qumicos / residuos peligrosos:
Trabajo en "Espacios confinados"
Probabilidad
SI
Alta
Media
Baja
NO
Riesgos:
Daos a la espalda
Consecuencia
Lesiones mltiples
Atrapamiento
Fatalidad
Luxaciones
Incapacidad permanente total
Contusiones
Incapacidad permanente parcial
Mala condicin de iluminacin
Primeros auxilios
Cada a ms de 2 metros de altura
Afectacin del servicio
Cada de equipos y/o herramientas
Explosin
Afectacin a la marca Ericsson o Cliente
Otro (especificar):
Incendio
Otro (especificar):
Fotografas de riesgos en trabajos en espacios confinados:
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
12 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
13 (54)
Fotografas de otros riesgos identificados:
Ejecutor del anlisis y determinacin de controles:
Nombre y cargo
Firma
Nombre
Nombre y firmas de los integrantes de la cuadrilla:
Nombre
Nombre
Nombre
Nombre
Nombre
Nombre
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
14 (54)
Analysis Local Delivery
rea
Proyecto
Actividad a realizar
fica del sitio y hospital ms cercano:
a del sitio de ejecucin del trabajo
SI
NO
N/A
Plan de emergencia y nmeros de emergencia:
Equipo para realizar actividad de rescate:
Plan de rescate:
Extintor en sitio y automvil:
Procedimiento de "Trabajo seguro en Caliente":
Procedimiento de "Trabajo seguro con cargas pesadas":
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
15 (54)
Procedimiento de "Trabajo seguro con qumicos /
residuos peligrosos":
Procedimiento de "Trabajo seguro en espacios
confinados":
TE deben ser canalizados de inmediato al Responsable de Proyecto (IM Ericsson) con copia a contacto OHS
Ericsson".
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
16 (54)
Acciones recomendadas para prevenir el riesgo en
"Conduccin (traslado al sitio)"
Capacitacin en "Manejo seguro"
Uso de cinturn de seguridad
Contar con herramientas para el auto
Contar con llanta de refaccin
Contar con equipo de sealizacin
Otro (especificar):
Acciones recomendadas para prevenir el riesgo en "Acceso
al sitio"
Seguir recomendaciones de Security
Contar con repelente de insectos
Uso de equipo de iluminacin
Respaldo en Sitio de Personal de Seguridad
Otro (especificar):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
17 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
18 (54)
Acciones recomendadas para prevenir el riesgo en "Trabajos
en Alturas"
Capacitacin en "trabajos en altura"
Uso de equipo de proteccin anticaidas
Simular lnea de vida (horizontal / vertical)
Uso de bloqueador solar
Escaleras mviles en buenas condiciones
Contar con bolsa porta herramientas
Sealizacin / Delimitar rea de trabajo
Distancias de seguridad vs. arco elctrico
Uso de equipo de iluminacin
Hidratacin (agua para beber)
Uso de equipo para manipular cargas en alturas
Ropa para bajas temperaturas
Otro (especificar):
itario estn prohibidas, se debe contar con un viga o acompaante
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
19 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
20 (54)
Acciones recomendadas para prevenir el riesgo en "Trabajos
con corriente elctrica"
Capacitacin en "Riesgo elctrico"
Uso de EPP dielctrico
Uso de herramientas dielctricas
Uso de equipo de iluminacin
Bloqueo / Etiquetado
Uso de voltmetro para verificar electricidad
Otro (especificar):
energa se debe contar con un viga o acompaante (excepto bajo voltaje)
veles de tensin muy baja, pero sin llegar a superar 1.000 V de CA o 1.500 V de CC entre los
o 900 V de CC entre conductores o a tierra.
Acciones recomendadas para prevenir el riesgo en "Trabajos
en caliente"
Capacitacin en "Prevencin de incendios"
Uso de equipo de EPP
Uso de equipo de iluminacin
Otro (especificar):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
21 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
22 (54)
Acciones recomendadas para prevenir el riesgo en
"Manipulacin Manual"
Capacitacin en "Manejo de cargas"
Uso de equipo de EPP
Mantenimiento a la maquinaria pesada
Uso de equipo de iluminacin
Otro (especificar):
Acciones recomendadas para prevenir el riesgo en "Manejo
de qumicos / Residuos peligrosos"
Capacitacin en "Prevencin de incendios"
Capacitacin en "Gestin de Residuos"
Uso de equipo de EPP
Uso de kit para manejo de residuos
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
23 (54)
Uso de kit para derrames
Contar con MSDS / Hojas de seguridad
Otro (especificar):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
24 (54)
Acciones recomendadas para prevenir el riesgo en "Trabajos
confinados"
Capacitacin en "trabajos en altura"
Uso de equipo de EPP
Contar con bolsa porta herramientas
Uso de equipo de iluminacin
Delimitar rea de trabajo
Contar con viga o acompaante
Contar con un explosmetro
Otro (especificar):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
25 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
26 (54)
Revisado por:
Nombre y cargo
Firma
Firma
Firma
Firma
Firma
Firma
Firma
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(Spanish)
Public
ANALYSIS_x000D_Job
27 (54)
Safety Analysis Local Delivery
Inspeccin de Equipo de Proteccin
para Trabajos en Alturas
Empresa:
Proyecto:
Inspeccionado por:
Fecha:
El chequeo de equipo de protecin personal debe ser diario antes de cada uso
Elemento
Condicin / Falta a ser revisada
Cumplimiento
Arns de seguridad
Cdigo del arns
Fecha de Fabricacin
SI
NO
Cdigo de la
eslinga
Fecha de
Fabricacin
SI
NO
Cdigo de la
eslinga
Fecha de
Fabricacin
SI
NO
Cdigo de la
eslinga
Fecha de
Fabricacin
SI
NO
Cdigo de la
eslinga
Fecha de
Fabricacin
SI
NO
Fecha de
Fabricacin
Fecha de entrega
SI
NO
Se encuentra en buen estado (roturas, corte, desgarros, etc)
Cintas de Arns
Mosquetones
Hebillas
D - Rings
Costuras
Abrasin especialmente en zonas de contacto con accesorios
Estiramiento excesivo
Daos por contacto con calor, sustancias corrosivas o solventes
Se encuentran en perfecto estado (oxidados, rotos, dao por calor)
Desgaste en pivotes o seguros
Resortes rotos, desgastados o fuera de lugar
Libre de deformacin o dao fsico
Deterioro o dao fsico
Roturas o labios deformados
Lengetas deformadas
Falta de ajuste
Roturas, especialmente en la interseccin de la parte recta y curva
Se encuentran en perfecto estado (oxidados, rotos, dao por calor)
Libre de deformacin o dao fsico
Las argollas en D laterales presentan deformaciones o corrosin
Las argollas en D laterales cuentan con fisuras o agrietamiento.
La argolla en D dorsal presenta deformaciones o corrosin
La argolla en D dorsal cuenta con fisuras o agrietamiento.
La argolla en D frontal presenta deformaciones o corrosin.
La argolla en D frontal cuenta con fisuras o agrietamiento.
Costuras rotas, cortadas o desgastadas
Dao o debilitamiento de costuras debido a contacto con el calor, elementos corrosivos o enmohecimiento
Eslinga en "Y" con amortiguador de impacto
Cortes
Cintas de la Lnea de Abrasin o deshilachado
vida
Estiramiento
Deterioro por podredumbre, enmohecimiento o exposicin ultravioleta
Verificar indicaciones de sobrecargas
Amortiguador de
Protector del amortiguador de impactos en buen estado
impacto
El absorbedor de impacto se ve activado y/o est por fuera de su posicin inicial.
Mosquetones /
ganchos
Los mosquetones / ganchos presentan deformaciones, fisuras o corrosin.
Eslinga de Posicionamiento
Cortes
Cinta de la eslinga
Mosquetones /
ganchos
Abrasin o deshilachado
Estiramiento
Deterioro por podredumbre, enmohecimiento o exposicin ultravioleta
Los mosquetones / ganchos presentan deformaciones, fisuras o corrosin.
Arrestad
or de
Cadas
(carrito
para
lnea de
vida)
Seguros gastados
Excesivo desgaste de la seccin por uso
Freno anticaidas
para lnea de vida
Deterioro o dao fsico
Al arrestador le hace falta tornillos y/o pasadores.
El sistema se encuentra trabado y/o no funciona.
Conector de anclaje
El conector presenta rasgaduras, aplastamientos o deformacin en la cinta y/o elementos metlicos.
(Tie-off / Track plus)
Existe presencia de pinturas y/u componentes ajenos a la estructura bsica del anclaje
Las uniones y/o las costuras presentan hilos sueltos.
Otros
Casco
Guantes
Lentes
Botas
Casco sin visera (dielctrico clase E)
Soporte de la barbilla del barbiquejo esta roto o daado
Barbiquejo en buen estado, sin presentar hilos sueltos
Guantes adecuados para escalar, en buen estado y con buen ajuste
Lentes de proteccin en buen estado
Botas con puntera, dielctricas y en buen estado
EL EQUIPO PARA TRABAJO EN ALTURA CUENTA CON LA CERTIFICACION ANSI Z 359.1?
Luego de esta evaluacin se considera el equipo de proteccin personal:
Nombre y firma del Supervisor de obra:
FIRMA
OPERATIVO
Nombre y firma de persona con cargo del equipo de proteccin:
FIRMA
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved: TAM/O/N/M/A [Acela Juarez]Date: 2014-12-23
Sheet: Inspeccin de EPP (Spanish)
Public
No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
28 (54)
Job Safety Analysis Local Delivery
Name of the person doing the JSA
Position
Date
Customer
Supplier Name
Site Name (with ID)
Rural area
Urban area
Activity performed
Geographic location of the site and the nearest hospital:
Scheme or site map of execution of work
Address / Location
Phone:
Verification (Mark with an "X")
Yes
No
N/A
Yes
Good physical and mental condition to perform assigned
activities:
It has insurance policies (medical expenses, car):
Good condition of the structure for work at heights:
First aid kit on site:
All persons on site include personal protective
equipment:
Staff working at height are trained:
Team Full protection for the work activity:
Staff working at heights is certified:
Protective Equipment in good condition for the work
activity:
Procedure "Safe Work at Height":
Complete hand tools and energy:
Personnel performing electrical work is certified:
No
N/A
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Hand tools and power in good condition:
Personnel performing electrical work is qualified:
Performing safety briefing 5 minutes:
Procedure "Safe work with electricity":
29 (54)
"The risks qualified as UNACCEPTABLE and NO ACTION THERE MITIGATING, should be channeled immediately to the Project Manager (IM Er
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
30 (54)
Photos: Personal Protective Equipment, Emergency Plan, aid kit and fire extinguisher on site
Selection of hazards, risks and recommended actions (Mark with an "X")
Probability
Yes
Driving (transfer to the site)
No
High
Risks:
Medium
Vehicular collision
Low
Consequence
Insecurity (robbery, kidnapping, threats)
Multiple lesions
Fatality
Other (specify):
Permanent or total disability
Permanent partial disability
First aid
Affectation of service
Impact on the brand Ericsson or Client
Other (specify):
Yes
Site Access
Probability
No
High
Risks:
Medium
Insecurity (robbery, kidnapping, threats)
Low
Aggression of neighborhood
Consequence
Animal aggression
Fatality
Undergrowth
Permanent or total disability
Poor lighting conditions
Permanent partial disability
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Other (specify):
31 (54)
First aid
Affectation of service
Impact on the brand Ericsson or Client
Other (specify):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
32 (54)
Photos: Risks to access the site
Probability
Yes
Work at Height
No
High
Risks:
Medium
Fall more than 2 meters
Low
Consequence
Amputation
Fractures
Fatality
Damage to back
Permanent or total disability
Electrical overhead lines
Permanent partial disability
Sprain
First aid
Knocking
Affectation of service
Adverse weather (rain, strong wind, etc.)
Impact on the brand Ericsson or Client
Insolation (heat stroke)
Other (specify):
Hypothermia (low temperatures)
Animal aggression
Panic (working at heights)
Fall of equipment and / or tools
Poor lighting conditions
Other (specify):
Work in excess of 2 meters, alone, heights are prohibited; should have a vigia or companion
Photos: Risks work at heights
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
33 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Probability
Yes
Works with electricity
34 (54)
No
High
Risks:
Medium
Electrocution
Low
Consequence
Amputation
Burns
Fatality
Fire
Permanent or total disability
Cardiac arrest
Permanent partial disability
Poor lighting conditions
First aid
Explosion
Affectation of service
Other (specify):
Impact on the brand Ericsson or Client
Other (specify):
Works with high voltage are prohibited, works with energy must have a lookout or companion (except lo
"Low voltage (" LV ")" usually refers to the voltage exceeds low voltage levels, but without exceeding 1000 V AC or 1500 V DC betwe
between conductors or ground.
Photos: Risks works with electricity
Yes
Hot work
Probability
No
High
Risks:
Medium
Burns
Fire
Low
Consequence
Explosion
Fatality
Exothermic mold in poor condition
Permanent or total disability
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Poor lighting conditions
35 (54)
Permanent partial disability
Electrocution
First aid
Other (specify):
Affectation of service
Impact on the brand Ericsson or Client
Other (specify):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
Probability
Yes
Manual handling
36 (54)
No
High
Risks:
Medium
Damage to back
Low
Consequence
Multiple injuries
Entrapping
Fatality
Luxations
Permanent or total disability
Contusions
Permanent partial disability
Poor lighting conditions
First aid
Other (specify):
Affectation of service
Impact on the brand Ericsson or Client
Other (specify):
Photos: Risks hot work and / or manual handling
Handling chemicals / hazardous waste
Yes
Probability
No
High
Risks:
Medium
Intoxication
Spills, leaks of chemicals
Low
Consequence
Explosion
Fatality
Water Pollution
Permanent or total disability
Soil contamination
Permanent partial disability
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
37 (54)
Air Pollution
First aid
Affectation of flora
Affectation of service
Allocation of wildlife
Fire
Impact on the brand Ericsson or Client
Other (specify):
Burns
Other (specify):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
38 (54)
Photos: Risks works with chemical handling / hazardous waste
Probability
Yes
Working on "confined spaces"
No
High
Risks:
Medium
Damage to back
Low
Consequence
Multiple injuries
Entrapping
Fatality
Luxations
Permanent or total disability
Contusions
Permanent partial disability
Poor lighting conditions
First aid
Fall more than 2 meters
Affectation of service
Fall of equipment and / or tools
Impact on the brand Ericsson or Client
Explosion
Other (specify):
Fire
Other (specify):
Photos: Risks work in confined spaces
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
39 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
40 (54)
Photos: Other risks identified
Executing the analysis and determination of controls:
Name and position
Signature
Name an
Name and signature of the members of the crew:
Name
Name
Name
Name
Name
Name
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
41 (54)
Analysis Local Delivery
Area
Project
Activity performed
n of the site and the nearest hospital:
ite map of execution of work
Yes
No
N/A
Emergency plan and emergency numbers:
Equipment for rescue activity:
Rescue Plan:
Extinguisher on site and car:
Procedure "Safe Hot Work":
Procedure "Safe work with heavy loads":
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
42 (54)
Procedure "Safe work with chemicals / hazardous waste"
Procedure "Safe work in confined spaces":
uld be channeled immediately to the Project Manager (IM Ericsson) with a copy to contact OHS Ericsson".
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
43 (54)
Recommended actions to prevent the risk in "Driving
(transfer to the site)"
Training on "Safe driving"
Using Seatbelt
Have tools for automobile
Having spare tire
Having equip signaling
Other (specify):
Recommended actions to prevent risk "Site Access"
Seguir recomendaciones de Security
Have insect repellent
Using lighting equipment
Security personnel to access the site
Other (specify):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
44 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
45 (54)
Recommended actions to prevent the risk in "Working at
Height"
Training on "working at height"
Using Fall Protection Equipment
Simulate lifeline (horizontal / vertical)
Using sunscreen
Escalators in good condition
Having tool bag
Signaling / delimit workspace
Safety distances vs. electrical arc
Using lighting equipment
Hydration (drinking water)
Use of equipment to handle loads at height
Clothing for low temperatures
Other (specify):
ghts are prohibited; should have a vigia or companion
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
46 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
47 (54)
Recommended actions to prevent the risk in "Working with
electricity"
Training on "Electrical risk"
Dielectric PPE use
Use of insulated tools
Using lighting equipment
Lockout / Tagout
Use voltmeter to check electricity
Other (specify):
h energy must have a lookout or companion (except low voltage)
but without exceeding 1000 V AC or 1500 V DC between conductors, or 600 V AC or 900 V DC
conductors or ground.
Recommended actions to prevent risk "Hot work"
Training on "Fire Prevention"
Use of personal protective equipment
Using lighting equipment
Other (specify):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
48 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
49 (54)
Recommended actions to prevent the risk in "Manual
handling"
Training on "Manual Handling"
Use of personal protective equipment
Maintenance to heavy machinery
Using lighting equipment
Other (specify):
Recommended actions to prevent risk on "Management of
chemical / hazardous waste"
Training on "Fire Prevention"
Training on "Waste Management"
Use of personal protective equipment
Using waste management kit
Using spill kit
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
50 (54)
Having MSDS / Safety Data Sheets
Other (specify):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
51 (54)
Recommended actions to prevent risk "Confined Works"
Training on "working at height"
Use of personal protective equipment
Having tool bag
Using lighting equipment
Delimit workspace
Having vigia or companion
Having a explosimeter
Other (specify):
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
52 (54)
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
Safety Analysis Local Delivery
53 (54)
Reviewed by:
Name and position
Signature
Signature
Signature
Signature
Signature
Signature
Signature
Date: 2014-12-23
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved:
TAM/O/N/M/A
Juarez] No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
Sheet:
JSA RLAM [Acela
(English)
Public
ANALYSIS_x000D_Job
54 (54)
Safety Analysis Local Delivery
Personal Protective Equipment Inspection
to working at heights
Company:
Project:
Inspected by:
Date:
The personal protective equipment check up must be daily before use it
Element
Condition / Failure to be reviewed
Fulfillment
Safety harness
Harness straps
Harness code
Date of manufacture
YES
NO
Sling code
Date of manufacture
YES
NO
Sling code
Date of manufacture
YES
NO
Fall arrestor code
Date of manufacture
YES
NO
Sling code
Date of manufacture
YES
NO
Date of manufacture
Delivery date
YES
NO
Is in good condition (breakage , cutting, tearing, etc.)
Abrasion especially in areas of contact with accessories
Overstretching
Damage contact with heat, corrosive substances or solvents
They are in perfect condition (rusted , broken , heat damage)
Carabiners
Buckles
D - Rings
Sewing
Wear on pins or insurance
Broken springs , worn or out of place
Deformation or physical harm
Spoilage or physical harm
Breakage or deformation
Deformed beards
Unadjusted
Cracks, especially at the intersection of the straight portion and curved
They are in perfect condition (rusted , broken , heat damage)
Deformation or physical harm
The side D rings are deformed or presents corrosion
The side D rings have cracks or crazing
The dorsal D -ring presents deformation or corrosion
The dorsal D-ring has cracks or crazing
The front D ring has deformation or corrosion
The front D ring has cracks or crazing
Broken sewing , cut or worn
Damage or weakness seams due to contact with heat , corrosive or mildew
Sling "Y" with shock absorber
Lifeline straps
Absorber
Cuts
Abrasion or frayed
Overstretching
Deterioration by rotting, mold or ultraviolet exposure
Check overload indications
Protector of the shock absorber in good condition
The impact absorber is activated and / or is outside of its home position.
Carabiners / hooks Carabiners / hooks with deformations, cracks or corrosion.
Positioning Lanyard
Sling straps
Cuts
Abrasion or frayed
Overstretching
Deterioration by rotting, mold or ultraviolet exposure
Carabiners / hooks Carabiners / hooks with deformations, cracks or corrosion.
Fall arrestor (trolley for lifeline)
Insurance worn
Excessive wear and tear section
Fall arrestor (trolley
Deterioration or physical harm
for lifeline)
Arrestor is missing bolts / pins.
The system is locked and / or does not work.
Anchorage connector
The connector has tears, crushing or deformation on straps and / or metal elements
(Tie-off / Track plus) There presence of paint and / or outside of core components of the anchor structure
The joins and / or seams have loose threads.
Others
Helmet
Helmet without a visor (dielectric E class)
Support chinstrap is broken or damaged
Gloves
Chinstrap in good condition, without presenting loose threads
Gloves suitable for climbing, in good condition and good fit
Goggles
Safety boots
Goggles in good condition
Safety boots with toe cap, dielectric and in good condition
DOES WORK AT HEIGHT EQUIPMENT HAS THE ANSI Z 359.1 CERTIFICATION?
After this evaluation is considered personal protective equipment:
Name and signature of crew leader at work:
SIGNATURE
OPERATIONAL
Name and signature of person using protective equipment:
SIGNATURE
Prepared: TAM/O/N/M/A Acela Juarez_x000D_Approved: TAM/O/N/M/A [Acela
Date:
Juarez]
2014-12-23
Sheet: Inspection PPE (English)
Public
No: OPER/RLAM-14:004435 Uen_x000D_Rev: A
