O-24-Anexo1_Alt3 Distribuio e Controlo dos Equipamentos de Proteco Individual (EPI's)Nome trabalhador:Funo:N da Obra / Designao da Obra (se Aplicvel):EPIQTDCapacete de proteco 11,2,3,4,9,10,11Protectores auriculares 16Tampes auriculares116Sapato anti-derrapante c/ palmilha e biqueira de ao12, 4,5,6,7,12Botim de borracha c/ palmilha e biqueira de ao 4,5,6,7,12,17Sapato de borracha s/ palmilha e s/ biqueira de ao 13culos de proteco18,11,18Mscara ou capacete para soldador 8,11,14,15,18Luvas de proteco mecnica15, 10, 12,14Luvas de proteco qumica 5, 10, 12, 14Luvas de borracha isolante 13Colete Reflector120Arns de Segurana1 **1Avental 8, 14Fato de Trabalho18, 11, 14Fato Oleado de Trabalho1 **17Mscara filtrante antigs 19Mscara filtrante anti poeiras118__________________________________________________________________________________________(1) ndicar cdigos de acordo com a tabela abaixo(2) Rbrica do Trabalhador e data de recepo (apenas quando h mais do que uma fase de entrega de EP's)(3) Rbrica de quem recebe a devoluo (quando h lugar a devoluo)RIC! " PR!TE#ER1 - Quedas em altura 9 - Pancadas na cabea 17 - ntempries2 - Quedas do mesmo nvel 10 - Cortes 18 - Poeiras / Particulas em suspenso3 - Quedas de objectos 11 - Estilhaos 19 - Gases / Vapores4 - Quedas por escorregamento 12 - Entalamento 20 - nvisibilidade do Trabalhador5 - Objectos Pontiagudos ou Cortantes 13 - Electrocusso 21 - Biolgicos6 - Esmagamento do p 14 - Queimaduras 22 - _____________7 - Toro do p 15 - Radiaes Luminosas 23 - _____________8 - Projeco de metais em fuso 16 - Rudo 24 -_____________Trabalhador Responsvel Armazm/Ferramentaria (se aplicvel)_______________________ ___________________________ _____ / _____ / ________ _____ / _____ / ________ DataVerificaes de nspeco aos EP's: Rbrica RS ou SST Rbrica RS ou SST Verificaes de nspeco aos EP's: _____ / _____ / ________ ________________ ____________________ / _____ / ________ _____ / _____ / ________ ________________ ____________________ / _____ / ________ _____ / _____ / ________ ________________ ____________________ / _____ / ________($) ($$)Riscos a Prote%er (&)Recepo (') (R(brica)Data)Devoluo (*) (R(brica)Data)ATENO: A no utilizao dos EP's prescritos e o no cumprimento das regras de segurana do respectivo posto de trabalho motivo para instaurao de um processo disciplinar.Ao assinar este registo, o trabalhador declara que recebeu ($) e tem sua disposio na ferramentaria ($$), sem custos, os Equipamentos de Proteco ndividual acima indicados, comprometendo-se a utiliz-los correctamente de acordo com as instrues recebidas e apenas para os fins a que os mesmos foram previstos, a conserv-los e a mant-los em bom estado, e a participar todas as avarias ou deficincias de que tenha conhecimento ou o seu desaparecimento.Responsvel Mximo em Obra, RMO ouResponsvelSegurana em Obra, RS ouresponsvel SST da Empresa, SSTO-24-Anexo1_Alt3O-24-Anexo1_English Version_Alt3Worker's Name:Function:Job Number / Job Designation (if Applicable):PPEQTDProtective Helmet 11,2,3,4,9,10,11Hearing protectors 16Ear Pluggs116Shoe anti-slip with insole and steel toe12, 4,5,6,7,12Loot rubber with insole and steel toe 4,5,6,7,12,17Rubber shoe without insole and without steel toe 13Safety Glasses18,11,18Welders Face Shild ou Helmet 8,11,14,15,18Gloves of Mechanical Protection15, 10, 12,14Gloves of Chemical Protection 5, 10, 12, 14nsulating Rubber Gloves 13High Visibility Vest120Safety Harness1 **1Apron 8, 14Working Clothes18, 11, 14Waterproof Working Clothes1 **17Anti Gas filter Mask 19Anti Dust filter Mask118__________________________________________________________________________________________(1) Enter codes in accordance with the table below(2) Worker Signature and reception date (only when there is more than a delivery phase of PPE)(3) Signature of the person receiving the return (when there is a return)Ris+s to Protect01 - Falls from height 09 - Blows to the head 17 - Storms02 - Falls from same level 10 - Cuts 18 - Dust / Particles in suspension03 - Falling Objects 11 - Fragments 19 - Gases / vapors04 - Falls due to slipping 12 - Entrapment 20 - Worker nvisibility05 - Sharp Objects 13 - Electrocution 21 - Biological06 - Crushing leg 14 - Burns 22 - _____________07 - Foot Twist 15 - Luminous Radiation23 - _____________08 - Molten Metal Projection 16 - Noise 24 -_____________WorkerWarehouse / Toolhouse Responsible (if applicable)_______________________ ___________________________ Nome _____ / _____ / ________ _____ / _____ / ________ DataPPE nspection Checks: RS or SST Signature RS or SST Signature PPE nspection Checks: _____ / _____ / ________ ________________ ____________________ / _____ / ________ _____ / _____ / ________ ________________ ____________________ / _____ / ________Distribution and Control o, Personal Protective Equipment (PPE) (English Version)Company Deploy:($) ($$)Ris+s to Protect (&)Reception (') (i%nature)Date)Returns (*) (i%nature)Date)WARNNG: Failure to use the prescripted PPE and non-compliance with safety rules executing the job is cause for prosecution proceedings.By signing this registration, the worker states that has received (*) and has available in the tooling house (**), free of charge, the Personal Protective Equipment above mentioned, pledging to use them correctly according to the received instructions and only for the purposes for which they were provided and retain them and keep them in good condition, and report all the faults or weaknesses that have knowledge or its disappearance.Maximum Responsible at Site, RMO orHealth and Safety Responsible at site, RS orCompany Health &Safety Responsible, STTO-24-Anexo1_English Version_Alt3 _____ / _____ / ________ ________________ ____________________ / _____ / ________O-24-Anexo1_Version_francaise_Alt3Nom:Fonction:N Cuvre (Si applicable):PPEQTDCasque11,2,3,4,9,10,11Casque antibruit 16Bouchon d'oreilles116Chaussures/Bottes de scurit12, 4,5,6,7,12Bottes de scurit - mpermable 4,5,6,7,12,17Chaussures de Scurit - solation 13Lunettes de scurit18,11,18cran/masque soudure 8,11,14,15,18Gants - Protection Mcanique15, 10, 12,14Gants - Protection Chimique 5, 10, 12, 14Gants - solation 13Gilet haute visibilit 20 Harnais de scurit 1Tablier Cuir 8, 14Vtements de Protections18, 11, 14Vtements de Travail - ntempries 17Masque de Protection - gaz 19Masque de Protection - Poussire118__________________________________________________________________________________________(1) Entres les codes en accords avec la description ci-dessous(2) Signature du Travailleur et date de rception (Seulement s'il y a lieu a plus d'une rception)(3) Signature de qui reoit les quipements a substituerRisques a prot-%er01 - Chutes de hauteur (> 2m) 09 - Coups la tte 17 - ntempries02 - Chutes de mmes niveau 10 - Coupures 18 - Poussires / Particules en suspension03 - Chute d'objets 11 - Fragments 19 - Gazes / vapeurs04 - Chute/Glissade 12 - Pincements 20 - Visibilit05 - Objets coupants 13 - lectrocution 21 - Biologique06 - Broyage du pied 14 - Brlures 22 - _____________07 - Foulure 15 - Radiation Lumineuses 23 - _____________08 - Projection mtal en fusion 16 - Bruit 24 -_____________TravailleurResponsable Maison d'outillage (si applicable) Responsable Scurit sur Site, RSS_______________________ ___________________________ Nombre _____ / _____ / ________ _____ / _____ / ________ DateRegistre d'inspection EP: Signature RS/RSS Signature RS/RSS Registre d'inspection EP: _____ / _____ / ________ ________________ ____________________ / _____ / ________ _____ / _____ / ________ ________________ ____________________ / _____ / ________ Distribution et Contr.le des /quipements de Protections Individuelles (Version Franaise)($) ($$)Risque 0 prot-%er (&)R-ception (') (i%nature)Date)D-volution (*) (i%nature)Date)AVERTSSEMENT: Ne pas utiliser le s quipements de protections prescris et le non-respect des rgles de scurit d'excution du travail est une cause pour l'instauration d'un procs disciplinairesEn signant ce document, le travailleur atteste qu'il a reu (*) et dispose dans la maison d'outillage (**), gratuitement, l'quipement de protection individuelle mentionne ci-dessus, en s'engageant les utiliser correctement selon les instructions reues, seulement pour les fins pour lesquelles ils ont t fournis, de les conserver et maintenir en bon tat, et de signaler tous les dfauts dont ilsont une connaissance ou leu disparitionResponsable sur Site, RSResponsable Scurit EntrepriseO-24-Anexo1_Version_francaise_Alt3 _____ / _____ / ________ ________________ ____________________ / _____ / ________