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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
Accueille et installe les patients Sert les repas, débarrasse
Accueille les familles Fait la vaisselle
Fait le ménage Participe à la gestion des produits d'entretien et alimentaires
Désinfecte les chambres Participe aux soins : sonnettes, téléphone, aide aux toilettes, brancardage, accompagnement dans un autre service
Fait les lits Encadre les stagiaires
Prévoit les menus en liaison avec cuisine Recueille et transmets les informations et les consignes
Prépare et met en plat les repas Manipule le linge sale
CONDITIONS DE TRAVAIL

Entourer l'item adéquat
Horaires Journée  Nuit  Alternés : 2 X 8 3 x 8   Week-end   Jours fériés
Contraintes organisationnelles et relationnelles Pluralité des tâches avec gestion des priorités
Relations collègues  Relations hiérarchie  Relations malades
Respect du secret médical, des consignes, des circuits  Dépassement d'horaires  Charge de travail variable
Ambiance thermique Chaleur
Travail en air et espace contrôlé Climatisation
Autres Odeurs : urine, désinfectant
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
Rayonnements ionisants 6 Souffrance mentale, risque de dépression
Manutention manuelle Travail debout avec déplacement ou piétinement selon les tâches
Risque biologique Agressions physiques ou verbales
Travail de nuit Contraintes posturales (réfection lits)
Bacille tuberculeux 40 Ethers de glycol
Aldéhyde formique 43 Produits irritants cutanés ou des voies aériennes supérieures
Hépatites 45 Produits corrosifs
Aff. Cut. Amines aliphatiques 49 Chutes, coupures, contusions
Aff. Resp. amines aliphatiques 49 bis Accident par exposition au sang
Poliomyélite 54 Rachialgies
Amibes 55
Affections périarticulaires 57
Lésions eczématiformes 65
Rhinite et asthmes 66
Maladies infectieuses hospitalières 76
Kératoconjonctivites virales 80
Solvants 84
Latex 95
Hantavirus 96
Affections 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 d'hygiène
Vêtements de travail : blouse, chaussures, sur chaussures
Lunettes
Gants
Procédure AES
Autres
SURVEILLANCE MEDICALE LIEE AUX RISQUES
Examens complémentaires Réglementaire = R
Conseillé = C
Oui Fréquence
Radiographie pulmonaire C
Spirométrie C
Audiométrie C
IDR à 10 UI R
Dosage anticorps anti HBs R si vaccination après 25 ans
Contrôle sérologique rubéole, toxoplasmose, cytomégalovirus C Femmes en âge de procréer
NFS (si rayonnements ionisants) R
Dosimétrie (si rayonnements ionisants) R
Vaccinations
BCG R
DTPolio R 10 ans
Hépatite B R Titrage Ac inf. 10 UI/l
Hépatite A C
Typhoïde C
Rougeole, oreillons rubéole C Femme en âge de procréer
ACTIVITES DE TIERS TEMPS
Formation gestes et postures : Autres :
AUTEURS : Catherine Vollet (médecin du travail), Béatrice Muller (médecin du travail), Dominica Feron (médecin du travail) (Médecine du travail Durance Luberon) (84)
D'APRES LA fiche d'activité professionnelle Bossons Futé n°88 : Agent de service hospitalier qualifié
DATE DE CREATION : Décembre 2003
DERNIERE MISE A JOUR : Février 2004

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