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SINALIZAO
MAQUINAS/EQUIPAMENTOS..............................................................................NR 18.22......................
USO DE EPIS........................................................................................................NR 6..............................
REA DE TRABALHO...........................................................................................NR 18.27.......................
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EQUIPAMENTOS DE PROTEO
CAPACETE...........................................................................................................NR.6.3..........................
CALADOS ..........................................................................................................NR.6.3...........................
CINTO DE SEGURANA.... .................................................................................NR 6.3...........................
LUVAS...................................................................................................................NR 6..............................
CULOS ...............................................................................................................NR 6.2 L. C...................
MASCARAS ..........................................................................................................NR 6..............................
PROTETOR AURICULAR.....................................................................................NR 6..............................
AVENTAL...............................................................................................................NR 6.3..........................
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GUARDA CORPOS
PERIFERIAS..........................................................................................................NR18.13.4...................
SACADAS .... ........................................................................................................NR18.13.4...................
POOS DE ELEVADORES...................................................................................NR18.13.2...................
ESCADAS..............................................................................................................NR18.12......................
RAMPAS ...............................................................................................................NR18.12.6...................
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CHOQUE ELETRICO
REDE ELTRICA: PRXIMA, PROTEGIDA......................................................................NR18.15.4.......
ISOLAMENTO DA FIAO.................................................................................................NR18.21.4.1....
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INSTALAES SANITRIAS
LAVATRIOS ......................................................................................................................NR18.4.2.5.....
MICTRIOS .........................................................................................................................NR18.4.2.7.....
CHUVEIROS.........................................................................................................................NR18.4.2.8.....
VESTIRIOS ........................................................................................................................NR18.4.2.9.....
ALOJAMENTO................................. .....................................................................................NR18.4.2.9.....
AQUECEDOR DE REFEIO.. ..........................................................................................NR18.4.2.11.3.
LOCAL PARA REFEIES ..................................................................................................NR18.4.2.11...
PAPEL HIGIENICO................................................................................................................NR18.4.2.6.1...
GUA POTVEL....................................................................................................................NR18.4.2.11.4.
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OUTROS:_____________________________________________________________________________________________________________
RECEBIDO
Em ______/_____/______
_____________________________
Carimbo e/ou assinatura da empresa
LEGENDA
Pssimo - 0 a 20%
Ruim - 20,1 a 40%
Regular - 40,1 a 60%
Bom - 60,1 a 80%
ANEXO 1
RELAO DE TRABALHADORES ENCONTRADOS NA EMPRESA
NOME DA EMPRESA ______________________________________________________________________________________________________________________________________________________
NOME DO PROPRIETRIO:_________________________________________________________________________________________________________________________________________________
ENDEREO DA OBRA:__________________________________________________N_____________BAIRRO____________________________________CIDADE____________________ESTADO______
CNPJ / CPF: __________________________FONE/FAX:__________________________ENG. RESPONSVEL__________________________N CREA______________N ART EXECUO______________
ENCARREGADO: ____________________________________________TIPO DA OBRA: ( ) SOBRADO
Nome do Trabalhador
Escolaridade
Funo
( ) OBRAS PBLICAS
( ) MISTA
Data de Admisso