Code: SIG-UMY-F-005

SAFETY IS: ... QUALITY PRODUCTION

Versión: 001

Fecha: 15/01/2021
OPT FORMAT (PLANNED TASK OBSERVATION) Page: 1/1

TASK TO OBSERVE: PET NAME PETS CODE AREA OR DEPARTMENT

ZONE: NV: LABOR: BODY: MINA: SECTION: FECHA: HOUR: GUARDIA:

CARGO - SIGNATURE
PERFORMANCE OF
NAME OF THE OBSERVED EXPERIENCE IN THE POSITION RISK LEVEL
PETS

GOOD HIGH

REGULAR MEDIUM

BAD LOW

TYPE OF OPT (Check as appropriate)

EXPOSURE TO RISK Persona Team Process Weekly Monthly Quarterly

ROUTINE OBSERVATIONS

ICAS Incident Act S. Condition S. Yes No

ACCIDENT PRECEDENTS

OBSERVATION OF THE WORK

EVALUATION YES / NO COMMENTS

Correct use of PPE YES NO

Ordered and clean jobs YES NO

Safe and logical steps taken (PETS) YES NO

Recognized IPERC and applied controls YES NO

Correct use of equipment and tools YES NO

Workplace according to the standard YES NO

Could any of the practices or conditions
observed resulting in property damage or injury to YES NO
the person?
FROM THE TASK STEP SEQUENCE (PETS), IDENTIFY WHICH ONE IS CARRIED OUT IN SUCH A WAY THAT IT COULD CAUSE INJURIES OR LOSSES TO PEOPLE.
ENVIRONMENT OR EQUIPMENT.

STEP N° DESCRIPTION OF THE STEP OBSERVATION RISK LEVEL CORRECTION

DATE OF
RECOMMENDATIONS OF THE OBSERVER RESPONSIBLE
EXECUTION

Update / Implement PETS

Change of Tool

Lack of
Training

Should an observation be made of

follow-up on this worker in the future?

Have you properly congratulated and/or returned?

instruct the worker?

Changing jobs
Another area
Another Work
Another area
N/A

SUPERVISOR / OBSERVER Area Chief