CHECK LIST DE SEGURANA

INSPEO GERAL DE SEGURANA

DATA: _ _ _ / _ _ _ / _ _ _ /

COMPRESSOR ELTRICO:_________________________ TC. SEGURANA: ______________________________________

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ACOMPANHANTE: ______________________________________
PREFIXO: _________________________________________ ________________________________________________________
EMPRESA: ________________________________________

N NORMAL
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21

CABO DE LIGAO
ATERRAMENTO DA CARCAA
VLVULAS DE SEGURANA
MANGUEIRAS E ACESSRIOS
PROTEO DAS PARTES MVEIS
EXTINTOR

RESPONSVEL MANUTENO: __________________________

PONTOS AVALIADOS
R - REGULAR
N R D

D - DEFICIENTE
N

22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42

OBS. DEFEITOS: ITENS ___________________________________________________________________________

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TC. SEGURANA: _ _ _ _ _ _ _ _ _ _ VISTO MANUTENO: _ _ _ _ _ _ _ _ _ VISTO RESPONSVEL: _ _ _ _ _ _ _ _ _ _

DATA:
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