Department/Center

Operator /

Last name

/

First name

/

I.D.

/ SEX / M / F
Position(1) / Degree (2) / Degree year(3)
Mailing Adress /

Telephone

Workplace in which the operator works(4) /

Address

/

Building No.

/

Floor

/ Room number
Responsible
/ Position / Last name / First name

N.B.READ THE NOTES CAREFULLY BEFORE FILLING IN THE FORM

Legislative Decree 81/08, TitleIII, USEOF WORKEQUIPMENTAND OF PERSONAL PROTECTIVE EQUIPMENT
WORK EQUIPMENT(5) / CE Marking /

Presenceof mobile elements(6)

/ Fixed/mobile protective guards(7) / User and maintenance manuals / Maintenance programme(8) / Protective clothing / Specific information and training(9) / Personal protective equipment(10)
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / NO
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / List of PPE:
Lab Coat
Safety glasses
Mask
Gloves
Sturdy footwear
Other:
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO
YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO / YES / NO
Date / / / / / Signature / Signature / Signatureand stamp of thestructure
Head of theDepartment/Center
Operator / Responsible
NOTESRisk Assessment Sheet –RISKS FROM MACHINERY

(1)Indicate one of the following positions:

-Professor

-Researcher

-Technician

-Administrative staff

-Thesis student, student taking post-graduate specialization, doctoral student, holder of a study grant, holder of a research bursary, graduate attendee.

(2)Thesis students only are required to indicate the name of the Degree Programme.

(3)Thesis students only are required to indicate the year of enrolment on the Degree Programme (for example, 4th).

(4)Reference must be made to the dataprovided by the"Servizio UniSGSL"(website: ). For example, Address: Milan – Via Celoria, 2; Building no: 3; Floor: Upper; Room number: R058.

(5)Any machine, equipment or utensil used in thelaboratory-workshop.

(6)For example: blades, drills, grinders.

(7)For example: to protect the operator from contact with rotating parts, from splashes ofcutting fluids, from worked metallic parts.

(8)Work equipmentmust be checked periodicallyto ensuresafety standards, and to maintain a good state ofrepairandefficiency.A record of maintenancemust be kept in a dedicated register.

(9) Place a cross in the “Yes” box if the Head of the laboratory-workshop has provided you with information about:

- safety and health risks related to the handling of work equipment and during foreseeable anomalous situations;

- real or potential health risks in each individual phase of processing;

- behaviours and precautions to be adopted to avoid exposure;

- hygiene measures;

- measures to be taken in the event of accidents or injuries, and how to prevent them;

- the use and maintenance of personal protective equipment.

(10)Personal Protective Equipment(PPE) mean any equipment designed to be worn and kept by the operator for the purpose of protecting him/her against one or more risks liable to threaten his/herhealth or safety when working, as well as all additions or accessories designed for the same purpose. Place a cross in the “Yes” box if personal protective equipmentis available in the workplace and isadequate in relation to the risks to be prevented (e.g. devices and clothing to protect eyes, face, airways, hands). In the space below indicate which devices are available in the workplace.

(11)Columnreservedfor university personneland equivalent persons whose work in other institutionsinvolves risk.According toLegislative Decree 81/08, art.3, comma 6, whenthe aforementioned personneland other personswork fornon-university administrations, the obligations set out in Legislative Decree 81/08 must be met by the host administration.

N.B. Send this form to the following address:

Ufficio del Servizio Prevenzione e Sicurezza sul Lavoro - Via Chiaravalle, 11 20122 Milano, Italy - Fax 02503.13486 - e-mail: