Doc. no.

FORM_GR-GROUP-HSE-005-E

HSE TRAINING Rev. 01 Date 18/12/2018

REGISTRATION FORM Page 1 of 4

Ref. Doc. no. STD_GR-GROUP-HSE-002-E

TRAINING TITLE AND CODE: Saipem LSR (Life Saving Rules) 2020 Edition Cascade PEOPLE LEARNING CODE:
TRAINING DELIVERY LANGUAGE: ESPAÑOL COUNTRY: MEXICO
DATE (DAY/MONTH/YEAR of courses delivery) : 09/07/2020 TRAINING LOCATION: HEAD OFFICE (SMARTWORKING)
PROJECT: HEAD OFFICE NAME OF TRAINING CENTRE (if applicable): N/A
DURATION (hours): 1 HR CLIENT: N/A
TRAINING METHODS:
Verbal explanation DELPHI Power Point presentation Practice Other (specify):
Video Other Power Point presentation Simulation
COURSE CONTENTS (if other than DELPHI contents):
1 VIDEO INTRODUCTORIO AHMED
2 REGLAS PARA SALVAR VIDAS – LANZAMIENTO 2015
3 LSR- PROYECTO DE ACTUALIZACION 2019
4 NUEVAS REGLAS PARA SALVAR VIDAS DE IOGP / EDICION 2020
5 POSTER / STOP WORK AUTHORITY / VIDEO LSR ORIGINAL
6 MANAGEMENT WALK ABOUT TOOL
7 LSR ELEARNING
ASSESSMENT METHODS:
Informal during training Written test Product evidence
Verbal questions Practical exercise Other (specify)
Trainers Name:

Internal External Name of Organization (if external):

 Doc. no. FORM_GR-GROUP-HSE-005-E

HSE TRAINING Rev. 01 Date 18/12/2018

REGISTRATION FORM Page 2 of 4

Ref. Doc. no. STD_GR-GROUP-HSE-002-E

SAIPEM PERSONNEL

BADGE NUMBER WORKSITE JOB

NAME SURNAME (if applicable, fill in (current workplace SIGNATURE KNOWLEDGE ASSESSMENT
Company Employee ID) assignment)
POSITION

1 EDGAR ALVIRDE 167914 Home office Process Engineer Edgar Alvirde Digitally signed by Edgar Alvirde
Date: 2020.07.09 11:54:59 -05'00' … Achieved … Not Yet Achieved

Mexico city Process Engineer

2 LEONARDO APARICIO 174790 office Alvaro Digitally signed by Alvaro
Date: 2020.07.09 12:08:29 -05'00' … Achieved … Not Yet Achieved

3 EDUARDO ARTEAGA Process Engineer E.Arteaga Digitally signed by E.Arteaga

Date: 2020.07.09 12:22:54 -05'00' … Achieved … Not Yet Achieved

4 MARIA ATENCO 511 Mexico city Maria Atenco Digitally signed by Maria Atenco
Date: 2020.07.09 12:33:56 -05'00' … Achieved … Not Yet Achieved

5 GIOVANNI BELTRAN … Achieved … Not Yet Achieved

6 JOSE CAMARGO José Guadalupe Digitally signed by José

224 Mexico city Process Engineer Camargo Durán
Guadalupe Camargo Durán
Date: 2020.07.09 16:30:55 -05'00'
… Achieved … Not Yet Achieved

Armando Cedillo
Process Engineer
Digitally signed by Armando
7 ARMANDO CEDILLO 167748 Castillo
Cedillo Castillo
Date: 2020.07.09 16:46:48 -05'00'
… Achieved … Not Yet Achieved

8 CRISTIANO COPELLI … Achieved … Not Yet Achieved

Daniel Cornejo Digitally signed by Daniel Cornejo

9 DANIEL CORNEJO 219 Mexico City Process Engineer Pérez
Pérez
Date: 2020.07.09 17:10:50 -05'00' … Achieved … Not Yet Achieved

10 EVELIN HERRERA 638 Mexico City HSE HERRERA MORENO Digitally signed by HERRERA
MORENO Evelin … Achieved … Not Yet Achieved
Evelin Date: 2020.07.09 17:18:34 -05'00'

José Filiberto Digitally signed by José Filiberto

11 JOSE GALINDO 1247 Mexico City Mexico City Galindo Lara
Galindo Lara
Date: 2020.07.09 17:59:31 -05'00' … Achieved … Not Yet Achieved

12 ADOLFO GARCIA 174791 Mexico City Process Engineer Adolfo.Garcia Digitally signed by Adolfo.Garcia
Date: 2020.07.09 18:12:04 -05'00' … Achieved … Not Yet Achieved

13 BERNARDO GARCIA
Digitally signed by Bernardo
171712 Mexico City Process Engineer Bernardo García García
Date: 2020.07.09 18:34:45 -05'00' … Achieved … Not Yet Achieved

14 SALVADOR HERNANDEZ … Achieved … Not Yet Achieved

15 JAIME NAVA … Achieved … Not Yet Achieved

16 JOSE RODRIGUEZ … Achieved … Not Yet Achieved

Digitally signed by Valeria L.
17 VALERIA MARQUEZ 60235 Mexico City Ing. Ambiental Valeria L. Marquez Marquez
Date: 2020.07.10 11:07:52 -05'00' … Achieved … Not Yet Achieved
 Doc. no. FORM_GR-GROUP-HSE-005-E

HSE TRAINING Rev. 01 Date 18/12/2018

REGISTRATION FORM Page 3 of 4

Ref. Doc. no. STD_GR-GROUP-HSE-002-E

SAIPEM PERSONNEL

BADGE NUMBER WORKSITE JOB

NAME SURNAME (if applicable, fill in (current workplace SIGNATURE KNOWLEDGE ASSESSMENT
Company Employee ID) assignment)
POSITION

18 IVAN MARTINEZ … Achieved … Not Yet Achieved

19 JOSE CARLOS MEDINA … Achieved … Not Yet Achieved

20 EDGAR OCAMPO … Achieved … Not Yet Achieved

21 SUSANA OCHOA … Achieved … Not Yet Achieved

22 VICTOR OLALDE … Achieved … Not Yet Achieved

23 TSAYURI PAZOL … Achieved … Not Yet Achieved

24 ANDRES RAMIREZ … Achieved … Not Yet Achieved

25 LEONEL RAMOS … Achieved … Not Yet Achieved

26 ALBERTO RIVERA … Achieved … Not Yet Achieved

27 MARIA ROJAS … Achieved … Not Yet Achieved

28 JORGE SALINAS … Achieved … Not Yet Achieved

29 JOSE ZUBILLAGA … Achieved … Not Yet Achieved

30 ZULEIRA TRANI … Achieved … Not Yet Achieved

31 … Achieved … Not Yet Achieved

32 … Achieved … Not Yet Achieved

 Doc. no. FORM_GR-GROUP-HSE-005-E

HSE TRAINING Rev. 01 Date 18/12/2018

REGISTRATION FORM Page 4 of 4

Ref. Doc. no. STD_GR-GROUP-HSE-002-E

(SUB) CONTRACTOR PERSONNEL / PARTNERS

WORKSITE JOB
NAME SURNAME COMPANY (current workplace SIGNATURE KNOWLEDGE ASSESSMENT
assignment) POSITION

1 … Achieved … Not Yet Achieved

2 … Achieved … Not Yet Achieved

Remedial actions taken for failure of knowledge assessment:

Training performed by:

NAME: BADGE NUMBER: TITLE: SIGNATURE:

LUIS FUENTES AMERICAS AREA HSE
COORDINATOR

Notes:
x Scan the signed form and send it to: corporate.hse.training@saipem.com x Fill in this form digitally in capital letters.
x Only signed participations are considered valid. x Mandatory: insert badge numbers for Saipem personnel.