DISTRIBUTION FORM MEECAMW-HS-FTP-002-REV0

Personal Protective Equipment Date: 20/03/2017

Cost Centre -

Name of worker
Nr. of worker Category:
Mota-Engil Subcontractor:

Size
PPE or Color Risks Authoriz. Return PPE Risks Authoriz. Return

4,5,6,
Safety Boots 7,8 14

4,5,6,
Gumboots 8,9,17 Filter mask 17

Hard hat w/ chinstrap 11 Face shield 12,13

Worksuit 16,17 Face shield dark 12,13

Rain suit 9 Safety glasses 12,13

Reflective vest 16 Disposable worksuit 17

T-shirts 20 Ear plugs 3

Blue shirts 20 Ear muffs 3

Orange Jacket 16,17 Snake Gaters 2

Nitrile Gloves 12,13 Leg-Guards 10

Leather gloves 12,13 Welding gloves 13,18

13,18,
Maxiflex Gloves 12,13 Welding mask 19

13,18,
Rubber gloves 15,17 Welding goggles 19

Life-Line 1 Welding apron 13,18

Retractable Life-Line 1
Safety Harness + 1
Double Lanyard

RISKS
1- Fall from heights 8- Impact at ankle/foot level
2- Snake Bites 9- Adverse weather conditions
3- Exposure to excessive noise 10- Impact at lower leg level
4- Falls caused by slipping 11- Impacts to the head
5- Pointed or sharp-edged objects 12- Cuts
6- Crushing of the foot 13- Projection of particles
7- Twisting of the ankle 14- Exposure to dust
15- Electrocution
16- Hit by equipment / vehicles
17- Contact with chemical products
18- Extreme temperatures
19- Extreme lighting
20- Others

DECLARATION
I declare that I have received the Individual Protective Equipment mentioned above and I undertake to use it correctly
in compliance with the instructions received, and to keep it in good condition, reporting all deterioration or defects that I become aware of.

Worker's Signature: Date:

OBSERVATIONS: