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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
Garnissage du four avec du bois Contrôle qualité
Préparation de la pâte Congélation du produit cuit
Préparation du garnissage Emballage
Etalement de la pâte Palettisation
Garnissage de la pizza Préparation des commandes
Cuisson au four (enfourne contrôle, défourne) Chargement du camion
Service à table Nettoyage du poste de travail, des ustensiles
Livraison à domicile
Vente au comptoir
CONDITIONS DE TRAVAIL

Entourer l'item adéquat
Horaires Journée  Nuit  Alternés : 2X8  3X8  Autres
Déplacements hors entreprise Locaux
Contraintes organisationnelles et relationnelles Dépassements d'horaire  Rythme imposé
Relations collègues  Relations hiérarchie
Contact public  Charge mentale
Bruit Oui  Non
Ambiance thermique Intempéries  Chambre frigorifique  Chaleur
Travail en air et espace contrôlé Climatisation  Espace confiné  Chambre de pousse
Contrainte visuelle Lumière artificielle  Contrôle qualité
Conduite Chariot automoteur
Transpalette autoporté  VL  Scooter
Autres
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 de nuit Manutention répétitive (pâton, ingrédients de garnissage, palettisation)
Cancérogènes (HAP) Coupures (ouverture des boîtes, des emballages)
Travail effectué en chambre frigorifique Station debout, piétinement
Bruit 42 Glissade, chute
Hépatites 45 Brûlures
Affections périarticulaires 57 Alternance chaud-froid : risque ORL
Oxyde de carbone 64 Risque routier
Lésions eczématiformes 65 Agression
Rhinite et asthmes 66 Allergie au bois de chêne
Pneumopathie d'hypersensibilité 66 bis
Vibrations et chocs 69
Chlorure de sodium 78
Rouget du porc 88
Latex 95
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
Masque
Vêtements de travail
Gants/Manchons
Crème barrière
Protection auditive
Chaussures de sécurité
Autres
SURVEILLANCE MEDICALE LIEE AUX RISQUES
Examens complémentaires Réglementaire = R
Conseillé = C
Oui Fréquence
Radiographie pulmonaire C
Spirométrie C
Audiogramme C
Examen de la vision C
Tests allergologiques C
Vaccinations
BCG C
Tétanos C
Hépatite A C
ACTIVITES DE TIERS TEMPS
Sonométrie : Ambiance lumineuse :
Prélèvements atmosphériques : dosage CO
et HAP
Autres :
AUTEURS : Catherine Vollet (médecin du travail), Béatrice Muller (médecin du travail), Dominica Feron (médecin du travail) (Médecine du travail Durance Luberon) (84)
VOIR la fiche d'activité professionnelle Bossons Futé n°113 : Pizzaiolo
DATE DE CREATION : Juillet 2003
DERNIERE MISE A JOUR : Février 2004

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