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DATE :
NOM : Prénom :
ENTREPRISE :
DATE D'EMBAUCHE : DATE DE SORTIE : DUREE D'EXPOSITION :
ACTIVITES

Evaluation : 0 = néant 1 = occasionnel 2 = fréquent 3 = permanent
  Evaluation   Evaluation
Décharge le camion   Range les colis dans un roll  
Transporte les palettes en zone de préparation   Filme la palette  
Descend les palettes stockées sur racks   Etiquette la palette  
Dépote les palettes   Entre sa commande en informatique  
Prépare les commandes en prenant le nombre de colis sur plusieurs palettes   Transporte la palette en zone d'expédition  
Prépare sa commande en prenant les articles directement dans les racks en se faisant élever à leur niveau (picking)   Charge le camion  
Met les articles dans un carton   Range les palettes vides  
Range les colis sur palettes   Nettoie le poste de travail  
CONDITIONS DE TRAVAIL

Entourer l'item adéquat
Horaires Journée  Nuit  Alternés : 2X8  3X8  Autres
Contraintes organisationnelles et relationnelles Horaires modulables  Rythme imposé
Relations collègues  Relations hiérarchie
Ambiance thermique Intempéries  Chambre frigorifique
Chambre surgélation-congélation  Chaleur
Travail en air et espace contrôlé Climatisation  Espace confiné
Contrainte visuelle Ecran  Appareils optiques  Soudure
Travail de précision
Conduite Engins  Chariot automoteur  Transpalette autoporté  VL  PL
Aides à la manutention Transpalette manuel  Transpalette électrique  Diable
RISQUES LIES AUX ACTIVITES

Evaluation : 0 = néant 1 = occasionnel 2 = fréquent 3 = permanent 4 = surveillance médicale renforcée
Liés à une maladie professionnelle et/ou SMR Evaluation MPI Risques autres Evaluation
Travail en chambre frigorifique (<4°)     Electriques (mise en charge)  
Travail de nuit - Equipes alternantes     Acide batterie  
Affections périarticulaires   57 Collisions entre engins  
Lésions eczématiformes (artichaut, alliacés)   65 Interaction engins-piétons  
Rhinite et asthme (soja...)   66 Fumées d'échappement : diesel  
Pneumopathie d'hypersensibilité   66 bis Charge mentale  
Onyxis et périonyxis (fruits sucrés)   77    
Aff. rachis vibrations   97    
Aff. rachis charges lourdes   98    
         
PROTECTIONS INDIVIDUELLES ET COLLECTIVES

Fréquence d'utilisation : 1 = occasionnellement 2 = fréquemment 3 = en permanence
  Type Disponible Utilisé Fréquence d'utilisation
Vêtements de travail        
Gants        
Chaussures de sécurité        
Autres        
SURVEILLANCE MEDICALE LIEE AUX RISQUES
Examens complémentaires Réglementaire = R
Conseillé = C
Oui Fréquence
Analyse d'urine C    
Audiogramme C    
Examen de la vision C    
Enzymes hépatiques C    
Glycémie C    
Dépistage alcool et drogues C    
Tests psychotechniques C    
Vaccinations
Tétanos C    
ACTIVITES DE TIERS TEMPS
Sonométrie : Ambiance lumineuse :
Prélèvements atmosphériques : Autres :
AUTEURS : Catherine Vollet (médecin du travail), Béatrice Muller (médecin du travail), Dominica Feron (médecin du travail) (Médecine du travail Durance Luberon) (84)
DATE DE CREATION : Juillet 2003
DERNIERE MISE A JOUR : Septembre 2003

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