OBSERVACION DE COMPORTAMIENTO SEGURO EN EL TRABAJO

Empresa: _______________________________________________________________
rea de Trabajo: _________________________________________________________
Persona Observada: ______________________________________________________
Fecha de Observacin: ____________________________________________________
Observador(a):___________________________________________________________
Actos Inseguros en la ejecucin de las tareas:

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________________________________________________________

Mejoras Acordadas:

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________________________________________________________

_______________________________________

Firma del Trabajador

C.C