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CHECK LIST PARA ELABORAO DE PPRA

EMPRESA:
NOME:______________________________________________________________________
RUA/AV._______________________________________________BAIRRO:_______________________
QUANTIFICAO DE EMPREGADOS EXPOSTOS: ______________________

RECONHECIMENTO DOS RISCOS AMBIENTAIS


1 - RUDO CONTNUO/ INTERMITENTE

SETOR/FUNO

no h rudo no ambiente.

dB(A)

TEMP.
EXPOSIO
/HORAS

HABITUAL/
PERMANENTE

EVENTUAL

3 CALOR
Tipos de exposio:

Habitual e Permanente

ventual

Tempo de exposio ao calor _______Horas

Temperatura: TBN____________C
TG ____________
TBS____________

7 VIBRAES
(

) no h fontes produtoras de vibraes.

) h fontes produtoras de vibraes :

Local/ Atividade
________________________________________________________________________________

9 UMIDADE
(

) No h reas encharcadas, permanentemente molhadas ou lquidos em condies


continuadas de asperso.

) H umidade excessiva no(s) posto(s) de trabalho :


Funo___________________________________________________________
Funo___________________________________________________________

10 - AGENTES QUMICOS
(

) no h exposio aos agentes relacionados.

) h exposio aos seguintes agentes relacionados :


Posto de trabalho
1________________________________

Agente
_________________________________

2________________________________

_________________________________

3________________________________

_________________________________

4________________________________

_________________________________

5________________________________

_________________________________

6________________________________

_________________________________

7________________________________

_________________________________

8________________________________

_________________________________

9________________________________

_________________________________

10_______________________________

_________________________________

11- POEIRAS MINERAIS (Anexo n 12 da NR-15 da Portaria 3214/78)


(

) no h exposio aos agentes relacionados.

) h exposio aos seguintes agentes relacionados :


Posto de trabalho

Agente

1________________________________

_________________________________

2________________________________

_________________________________

12- AGENTES BIOLGICOS (Anexo n 14 da NR-15 da Portaria 3214/78)


(

) no h exposio nas formas previstas no Anexo n. 14 da NR-15.

) h exposio aos seguintes agentes relacionados :


Posto de trabalho
1________________________________

Contato direto com


_________________________________

2________________________________

_________________________________

3________________________________

_________________________________

13. ATIVIDADES E OPERAES PERIGOSAS (NR-16 da Portaria 3214/78)


A - EXPLOSIVOS:
(

) no h reas de risco para esses agentes.

) h reas de risco :
Posto de trabalho

Agente

1________________________________

_________________________________

2________________________________

_________________________________

B - INFLAMVEIS
(

) no h reas de risco para esses agentes.

) h reas de risco :
Posto de trabalho

Agente

1________________________________

_________________________________

2________________________________

_________________________________

C - ELETRICIDADE
(

) no h reas de risco para esses agentes.

) h reas de risco :
Posto de trabalho

Agente

1________________________________

_________________________________

2________________________________

_________________________________

D - RADIAO IONIZANTE
(

) no h reas de risco para esses agentes.

) h reas de risco :
Posto de trabalho

Agente

1________________________________

_________________________________

2________________________________

_________________________________

14. Ergonomia (NR-17 da Portaria 3214/78)


A - LEVANTAMENTO E TRANSPORTE DE MATERIAIS
(

) no h.

) h
Posto de trabalho

Tipo de esforo

1________________________________

_________________________________

2________________________________

_________________________________

3________________________________

_________________________________

B - MOBILIRIO
Posto de trabalho

Mesa / bancada

Assentos

Comandos

1___________________

_____________

_________________

___________

2___________________

_____________

_________________

___________

3___________________

_____________

_________________

___________

4___________________

_____________

_________________

___________

5___________________

_____________

_________________

___________

C - EQUIPAMENTOS DE TRABALHO
Posto de trabalho

Equipamento

Postura

Esforo fsico

1___________________

_____________

_________________

___________

2___________________

_____________

_________________

___________

3___________________

_____________

_________________

___________

4___________________

_____________

_________________

___________

5___________________

_____________

_________________

___________

D - VENTILAO
[ ver item calor ]

) ambiente agradvel.

E - ILUMINAO
Aparentemente

(
(

) satisfatrio

Portas/janelas/aberturas/telhas

) abafado
(

) insuficiente
rea

1________________________________

_________________________________

2________________________________

_________________________________

3________________________________

_________________________________

4________________________________

_________________________________

5________________________________

_________________________________

F - RUDO

[ ver item rudo ]

) confortvel

) desconfortvel

G - ORGANIZAO DO TRABALHO
- normas de produo : ________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
- o modo operatrio : __________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
- a exigncia de tempo : _______________________________________________________
____________________________________________________________________________
____________________________________________________________________________
- a determinao do contedo de tempo : ___________________________________________
____________________________________________________________________________
____________________________________________________________________________
- o ritmo de trabalho : __________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
- o contedo das tarefas : _______________________________________________________
____________________________________________________________________________
____________________________________________________________________________
- o sistema de avaliao : _______________________________________________________
____________________________________________________________________________
____________________________________________________________________________

15. EDIFICAES (NR-8 da Portaria 3214/78)


(

) alvenaria

) outro _______________________________________________

P direito : __________metros

Pisos : __________________________________________

Cobertura : Estrutura : __________________________Telhas : _______________________


Laje/forro : ___________________________

Cor do teto : __________________________

Aberturas de iluminao/ventilao : ______________________________________________


Revestimento das paredes : interno : ______________________ externo : _______________
Pintura interna : Tipo : __________________________ cor : ________________________
Divises Internas : Material : ______________________ altura : ______________________
Escadas / rampas/ passagens / mezaninos / canaletas :_______________________________
___________________________________________________________________________
____________________________________________________________________________

16. INSTALAES ELTRICAS (NR-10 da Portaria 3214/78)


(

) h Laudo Tcnico de Regularidade das Instalaes Eltricas [ item 10.3.2.7.1 da NR-10 ]

( ) Fiao toda embutida em eletrodutos, com quadros de distribuio protegidos com tampas,
caixas individuais de chave geral para cada mquina com disjuntor magntico individual, com
protees contra contatos acidentais, devidamente sinalizadas, com tomadas de fora de
dimensionamento e nmero adequados, destinadas uma para cada equipamento.
(
) Se no, descrio :
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Mquinas / equipamentos eltricos
Aterramento : _________________________________________________________________
Manuteno Eltrica : __________________________________________________________
____________________________________________________________________________

17. MQUINAS E EQUIPAMENTOS (NR-12 da Portaria 3214/78)


Distanciamento : entre mquinas : _______________________________________________
Mquina / parede : ______________________________________________
reas de circulao : ____________________________________________
Vias de circulao : ____________________________________________
Dispositivos de Acionamento e chaves gerais individuais : __________________________

____________________________________________________________________________
Protees de partes mveis e transmisses : _____________________________________
____________________________________________________________________________
Protees contra rupturas e partculas : __________________________________________
____________________________________________________________________________
Motosserras / Cilindros de Massa : ______________________________________________
____________________________________________________________________________

18. CALDEIRAS (NR-13 da Portaria 3214/78)


(

) no h.

) h

Pronturio :
Projeto Mecnico: __________________________________________________
Projeto Civil da Casa de Caldeira : _____________________________________
Projeto de Instalao : _______________________________________________
Relatrio Anual de Inspeo : ( ultimo ) -

____ / _____ / _____

Teste Hidrosttico :

____ / _____ / _____

( ultimo ) -

Caldeira :
Placa de Identificao : _____________________________________________
Indicao de Categoria : _____________________________________________
Manual de Operao :

_____________________________________________

Controle de Qualidade da gua : ______________________________________


Iluminao de Emergncia : __________________________________________
Registro de Segurana : ultima anotao :
Operadores :

_______________________________________

ultima assinatura : ________________________________________


numero : _________ qualificao : ________________________________

____________________________________________________________________________

19. VASOS DE PRESSO (NR-13 da Portaria 3214/78)


(

) no h.

) h

Pronturio :
Projeto Mecnico: __________________________________________________
Projeto de Instalao : _______________________________________________
Relatrio Anual de Inspeo : ( ultimo ) -

____ / _____ / _____

Teste Hidrosttico :

____ / _____ / _____

( ultimo ) -

Caldeira :
Placa de Identificao : _____________________________________________
Indicao de Categoria : _____________________________________________
Manual de Operao :

_____________________________________________

Controle de Qualidade da gua : ______________________________________


Iluminao de Emergncia : __________________________________________
Registro de Segurana : ultima anotao :
Operadores :

_______________________________________

ultima assinatura : ________________________________________


numero : _________ qualificao : ________________________________

____________________________________________________________________________

20. FORNOS (NR-14 da Portaria 3214/78)


(

) no h.

) h

Modelo / Marca : _____________________________________________________________


Combustvel : _____________________________

Tem projeto ? __________________

Instalaes Eltricas / GLP / leo : _______________________________________________


____________________________________________________________________________
____________________________________________________________________________

21. TRABALHOS A CU ABERTO (NR-21 da Portaria 3214/78)


(

) no h.

) h

Abrigos contra intempries : ____________________________________________________


____________________________________________________________________________
gua Potvel : _______________________________________________________________
Sanitrios : __________________________________________________________________
Local Alimentao : ___________________________________________________________
EPI especficos : ______________________________________________________________

22. PROTEO CONTRA INCNDIOS (NR-23 da Portaria 3214/78)


Brigada de Incndio : _________________________________________________________
Extintores :
Quantidade e tipo disponveis :
Espuma : ________________

gua - Gs :

PQS

gua Pressurizada : _______________________

: _________________

__________________________

Gs Carbnico : _________________________
Sinalizao : ____________________________________________________________
______________________________________________________________________
Distncia :______________________________________________________________
Etiquetas de Identificao : _______________________________________________
_______________________________________________________________________
Fichas de Controle de Inspeo : ____________________________________________
_______________________________________________________________________
Hidrantes : __________________________________________________________________

23. CONDIES SANITRIAS (NR-24 da Portaria 3214/78)


conjuntos sanitrios :
masculino
nmero de gabinetes :

___________________

nmero de lavatrios :

___________________

rea

___________________

feminino
_______________
_______________
_______________

paredes

___________________

_______________

pisos

___________________

_______________

limpeza

___________________

_______________

banheiros :
masculino

feminino

nmero de chuveiros :

_____________________

________________

rea

_____________________

________________

paredes

_____________________

________________

pisos

_____________________

________________

limpeza

_____________________

________________

vestirios :
masculino

feminino

nmero

_________________________

________________

rea

_________________________

________________

paredes

_________________________

________________

pisos

_________________________

________________

nmero de armrios :

_________________________

________________

limpeza

_________________________

________________

locais de refeio :
Local de Instalao :

___________________________________________________

Mesas e Assentos

___________________________________________________

Pisos

___________________________________________________

Iluminao

___________________________________________________

Ventilao

___________________________________________________

Lavatrios

___________________________________________________

Pias

____________________________________________________

gua Potvel

___________________________________________________

Aquecimento de refeies :

______________________________________________

cozinha : ___________________________________________________________________

____________________________________________________________________________

alojamentos :

______________________________________________________________

____________________________________________________________________________

gua potvel :
____________________________________________________________________________
____________________________________________________________________________

rea de lazer :

____________________________________________________________

____________________________________________________________________________

24. RESDUOS INDUSTRIAIS (NR-25 da Portaria 3214/78)


Slidos : ___________________________________________________________________

____________________________________________________________________________
Lquidos : __________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

25. SINALIZAO DE SEGURANA (NR-26 da Portaria 3214/78)


Cores :

____________________________________________________________________

____________________________________________________________________________
____________________________________________________________________________
Rotulagem Preventiva : ______________________________________________________
____________________________________________________________________________

____________________________________________________________________________

26. COMISSO INTERNA DE PREVENO DE ACIDENTES CIPA


( NR-5 da Portaria 3214/78)
(

Regularmente constituda e operante.

) Irregular.

Cipeiro indicado pelo empregador, com curso de Preveno de Acidentes do Trabalho.

27. SERVIO ESPECIALIZADO EM ENGENHARIA DE SEGURANA E


MEDICINA DO TRABALHO SESMT (NR-4 da Portaria 3214/78)
(

) No exigida para o grau de risco e nmero de empregados.

) Regularmente constitudo e Registrado no MTb

) Irregular.

28. ACIDENTES E AFASTAMENTOS NOS LTIMOS DOIS ANOS


Data

Iniciais

Descrio

1-

___ / ___ /___

_______

___________________________________________

2-

___ / ___ /___

_______

___________________________________________

3-

___ / ___ /___

_______

___________________________________________

4-

___ / ___ /___

_______

___________________________________________

5-

___ / ___ /___

_______

___________________________________________

6-

___ / ___ /___

_______

___________________________________________

7-

___ / ___ /___

_______

___________________________________________

8-

___ / ___ /___

_______

___________________________________________

9-

___ / ___ /___

_______

___________________________________________

10 -

___ / ___ /___ *

_______ *

___________________________________________

11 -

___ / ___ /___ *

_______ *

___________________________________________

12 -

___ / ___ /___ *

_______ *

___________________________________________

13 -

___ / ___ /___ *

_______ *

___________________________________________

14 -

___ / ___ /___ *

_______ *

___________________________________________

15 -

___ / ___ /___ *

_______ *

___________________________________________

16 -

___ / ___ /___ *

_______ *

___________________________________________

17 -

___ / ___ /___ *

_______ *

___________________________________________

18 -

___ / ___ /___ *

_______ *

___________________________________________

19 -

___ / ___ /___ *

_______ *

___________________________________________

20 -

___ / ___ /___ *

_______ *

___________________________________________

22 -

___ / ___ /___ *

_______ *

___________________________________________

23 -

___ / ___ /___ *

_______ *

___________________________________________

24 -

___ / ___ /___ *

_______ *

___________________________________________

25 -

___ / ___ /___ *

_______ *

___________________________________________

26 -

___ / ___ /___ *

_______ *

___________________________________________

29.

MEDIDAS DE CONTROLE J EXISTENTES


Agente

Medida

1 - _______________________

___________________________________________

2 - _______________________

___________________________________________

3 - _______________________

___________________________________________

4 - _______________________

___________________________________________

5 - _______________________

___________________________________________

6 - _______________________

___________________________________________

7 - _______________________

__________________________________________

8 - _______________________

___________________________________________

9 - _______________________

___________________________________________

10 - _______________________

___________________________________________

30. EQUIPAMENTOS DE PROTEO INDIVIDUAL (EPI) EM USO


(NR-6 da Portaria 3214/78)
_________________________________________________________________
_________________________________________________________________

_________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

ESTABELECIMENTO DE PRIORIDADES
E METAS DE AVALIAO E CONTROLE
PROVIDNCIA
SETOR
12345678910-

Mantidos, em carter provisrio, os uso dos seguintes EPIs encontrados


e/ou
introduzidos, enquanto conclui-se a avaliao tcnica dos riscos e exposies dos
trabalhadores :
POSTO DE TRABALHO

EPI

CA

RESPONSVEL TCNICO
NOME:__________________________________________________
CRM / CREA ________________ RG MTb-SSMT ____._________