PIANO OPERATIVO
di SICUREZZA
coi contenuti minimi previsti dal D.P.R. 222/2003
DITTA ____________________________________________________________
INDIRIZZO CANTIERE ______________________________________________
OPERE DA REALIZZARE ____________________________________________
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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1) ANAGRAFE DELL’IMPRESA ESECUTRICE
Ditta _______________________________________________________________________________
Sede legale _________________________________________________________________________
Città ________________________________________ ( ____ )
Tel. ______________________ Fax _______________________ Cell. ______________________
Rappresentante legale _______________________________________________________________
nato a _______________________________________________ ( ____ ) il ___________________
residente in ________________________________________________________________________
Responsabile del Servizio di Prevenzione e Protezione (RSPP) _________________________________
interno, mansione __________________________________________________________
esterno
Rappresentante dei Lavoratori aziendale (RLS) ______________________________________________
(se eletto o designato)
Rappresentante dei Lavoratori territoriale (RLST) ____________________________________________
(se eletto o designato)
Addetto/i antincendio/evacuazione ________________________________________________________
Addetto/i gestione emergenze ___________________________________________________________
Addetto/i al Pronto Soccorso ____________________________________________________________
Medico Competente ___________________________________________________________________
(se previsto)
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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2) ANAGRAFE DEL CANTIERE
Indirizzo del cantiere __________________________________________________________________
Capo cantiere ________________________________________________________________________
Direttore tecnico di cantiere _____________________________________________________________
Preposto presente in cantiere ___________________________________________________________
Recapito telefonico di cantiere __________________________________________________________
Elenco nominativo dei lavoratori dipendenti della ditta esecutrice presenti in cantiere
Nome e cognome
Qualifica
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Elenco lavoratori autonomi subaffidatari operanti in cantiere per conto della ditta esecutrice
Nome e cognome
Qualifica
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I sottoelencati addetti sono presenti in cantiere durante l’orario di lavoro
Antincendio/evacuazione ______________________________________________________________
Gestione emergenze _________________________________________________________________
Pronto Soccorso ____________________________________________________________________
Data presunta inizio lavori __________________
Data presunta fine lavori ________________
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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3) DESCRIZIONE DEL CANTIERE
3 a - Turni di lavoro
Giorni settimanali _____________________________
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Orario
_____________________________
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3 b - Elenco servizi igienico-assistenziali
Baracca spogliatoio
si
no alternativa _________________________________________
Locale mensa/refettorio
si
no alternativa _________________________________________
Servizi igienici
si
no alternativa _________________________________________
3 c - Elenco di: ponteggi, ponti su ruote a torre, altre opere provvisionali, gru, argani, betoniere, macchine
movimento terra, macchine piegaferri, seghe circolari, impianti di terra e di protezione contro le scariche
atmosferiche, attrezzature portatili, ecc.
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Si rammenta che:
-
il ponteggio deve essere provvisto di autorizzazione ministeriale, libretto d’uso e manutenzione, disegno
esecutivo (per altezza fino a 20 metri), progetto (per ponteggi di altezza superiore a 20 metri o con
caratteristiche di notevole complessità in rapporto alle dimensioni ed ai sovraccarichi nonché i casi
previsti dalle Circolari del M.L.P.S. 46/2000 e 20/2003);
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deve essere redatto il Pi.M.U.S. per i vari tipi di ponteggio (rif. Circolari del M.L.P.S. 25/2006 e 30/2006);
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tutte le macchine presenti in cantiere (betoniera, sega circolare, gru, ecc.) marcate CE devono essere
dotate di libretto d’uso e manutenzione.
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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3 d - Dislocazione dei servizi di cui al punto 3 b) e delle attrezzature di cui al punto 3 c)
(in alternativa allegare piantina)
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3 e - Attività di cantiere: tipologia di lavoro svolta dai lavoratori autonomi operanti in cantiere per conto della
ditta esecutrice
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Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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3 f - Attività di cantiere: tipologia di lavoro svolta dall’impresa, eventualmente divisa per fasi / sottofasi
(cronoprogramma dei lavori), con descrizione delle modalità di attuazione sia organizzative che procedurali, le
attrezzature impiegate e le misure preventive e protettive adottate in relazione ai rischi
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Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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3 g - Elenco delle sostanze e preparati pericolosi utilizzati nel cantiere (allegare le schede di sicurezza)
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3 h - Elenco dei Dispositivi di Protezione Individuali (DPI) forniti ai lavoratori occupati in cantiere
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3 i - L’esito del rapporto di valutazione del rumore
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Si rammenta che a seguito del recepimento delle direttive europee 2003/10/CE (rumore) e 2002/44/CE
(vibrazioni) l’impresa deve effettuare, oltre alla valutazione del rischio derivante dal rumore, anche quella
derivante da vibrazioni meccaniche.
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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3 l - Documentazione in merito a:
Informazione (descrivere modalità e contenuti)
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Formazione (descrivere modalità e contenuti)
o Responsabile del Servizio di Prevenzione e Protezione (RSPP)
corso svolto presso ______________________________________________ il ____________
o Rappresentante dei Lavoratori per la Sicurezza (RLS)
corso svolto presso ______________________________________________ il ____________
o Addetto/i antincendio/gestione emergenze
corso svolto presso ______________________________________________ il ____________
o Addetto/i al Pronto Soccorso
corso svolto presso ______________________________________________ il ____________
o Lavoratori
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Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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3 m - Misure preventive e protettive, integrative rispetto a quelle contenute nel PSC, quando previsto, da
adottare in relazione ai rischi connessi alle proprie lavorazioni in cantiere
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Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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3 n - Procedure complementari e di dettaglio richieste dal PSC, quando previsto
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_____________________
(data)
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(titolare dell’impresa)
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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FOGLI DI
INFORMAZIONE DA
STACCARE E
AFFIGGERE IN
CANTIERE IN POSIZIONE
BEN VISIBILE
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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NUMERI TELEFONICI DI UTILITA’
CARABINIERI
POLIZIA
VIGILI DEL FUOCO
PRONTO SOCCORSO
112
113
115
118
POLIZIA MUNICIPALE
__________ _______________________________
PUBBLICA ASSISTENZA LOCALE
__________ _______________________________
RECAPITO TELEFONICO DATORE DI LAVORO
______________________________________________
GESTORI LOCALI RETI : TELEFONIA ______________
GAS _________ ACQUA __________ LUCE __________
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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ORARIO DI LAVORO
ENTRATA
ALLE ORE
RIPOSO
DALLE
ALLE
USCITA
ALLE ORE
SABATO
DATORE DI LAVORO
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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Responsabile del Servizio di Prevenzione e Protezione
(RSPP)____________________________________________________________________________
Rappresentante dei Lavoratori per la sicurezza (RLS)
(se eletto o designato)
_______________________________________________________________________________________
Rappresentante dei Lavoratori territoriale (RLST)
(se eletto o designato)
_______________________________________________________________________________________
Addetto/i antincendio
_______________________________________________________________________________________
Addetto/i gestione emergenze
_______________________________________________________________________________________
Addetto/i al Pronto Soccorso
_______________________________________________________________________________________
Medico Competente
(se previsto)
_______________________________________________________________________________________
Modulistica redatta da ASL 4 “Chiavarese” Struttura Complessa Prevenzione Sicurezza Ambiente di Lavoro - Rev 2007
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