1

| Specifi cas |
|
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1
Inspection type
HEALTH, OCCUPATIONAL SAFETY, ENVIRONMENT AND QUALITY REPORT

ified plan
Informal

General
Total
SOMAC

APPLICANT COMPANY: TRES CRUCES CONSORTIUM

-
REPORT TYPE MONTH 07-01-16 to 07-31-16 WEEKS 05
PREPARATOR BY: Eng. Christian Gregorio Vera Zavala APPROVED BY: Eng. Ronal Raul Reguera Chavez
ual
C.I.P. 186516 C.I.P. 127078

Number of Inspections
I) STATISTICS
to
the
WEEKS A month OBSERVATION
Number of workers in N in in 5 21
Man hours worked 5
Trivial Accidents 5 0
Disabling Accidents 5 0
Fatal Accidents 5 0
Number of days lost 5 0
FREQUENCY INDEX 5 0
Number of recommendations

SEVERITY index 5 0
ACCIDENT RATE 5 0
tea
Accident with property damage 5 0
05 N - N -
Reported incidents 5 1 Very mild character
Incident investigation 5 0
Substandard Acts 5 0
Substandard Conditions 5 0
OPT 2 5
Inspections 5 2 Visit of Representative of the
Entity
% Compliance % Pending 1

Man Hours Trained 5 5

%oo L 1

%oo L 1
%0011

%0011

HR training index 5 97

Q EVENTS (ACCIDENTS, INCIDENTS)

II. BRIEF DESCRIPTION OF IMPORTANT
r 0% I
r 0%

Date: Incident Type: Hour:

Work, level, others: Zone:
1%0

ion

Name of Accident: Occupation:

Description: All incidents have been reported as minor.

Doctor's Diagnosis:
Corrective and preventive measures Responsible % compliance
 HEALTH, OCCUPATIONAL SAFETY, ENVIRONMENT AND QUALITY REPORT
SOMAC

Specific Inspections Insp No. Obs. Lev. No. % Compliance

Implements 5 complete
Wheelbarrows 5 operational
Multipurpose 5 operational
Backhoe 5 operational
Roller 5 operational
Winches 0 Not Used
Truck Railing 0 operational
Tippers 5 operational
Bombs 5 operational
Information Board 5 Improve 1 100%
Tools 5 good condition
Roads 5 good condition
Stretchers 5 complete
Sustenance 5 complete
Powder magazines 0 Not Used
Harness 5 complete
Grills 5 operational
Total

Inspection by supervisors
No. From Observation Amount Pending
Supervisor Insp. Item ID Observed Task amount
% compliance
No. Raised
By Supervisor
Eng. Christian Vera Zavala 1 02.03.02.03 Formwork and Stripping 0 0 100%
Eng. Christian Vera Zavala 1 02.03.03.03 Steel Fy=4200kg/cm2 0 0 100%
Eng. Christian Vera Zavala 1 02.01.03.01 Concrete f'c =140kg/cm2 0 0 100%
Eng. Christian Vera Zavala 1 02.01.04.01 Concrete f'c=210kg/cm2 0 0 100%

Total
 HEALTH, OCCUPATIONAL SAFETY, ENVIRONMENT AND QUALITY REPORT
SOMAC
V. PLANNED TASK OBSERVATION.

Task
Supervisor Departure Observed Task Number Obs. Worker

Eng. Christian Vera Zavala 02.04.01.02 Trace and Repla. lasts.the 0

Eng. Christian Vera Zavala 02.02.02.03 Filling withproc.
own material 1 Operator Assistant
Eng. Christian Vera Zavala 02.03.02.03 Formwork and Stripping 0
Eng. Christian Vera Zavala 02.03.03.03 Steel Fy=4200kg/cm2 0
Eng. Christian Vera Zavala 02.01.04.01 Concrete f'c=210kg/cm2 1 Operator Assistant

Total

Personnel with dangerous behavior

Employee's name Date work Offense committed Corrective action

VI TRAINING AND TRAINING OF STAFF

Number of Number of Exposure

Supervisor Instruction topic Hours Men
topics participants Time Hours

Eng. Christian Vera Zavala Environmental Mitigation 1 21 0.5 10.5

Eng. Christian Vera Zavala Hygiene and Health on Site 1 20 0.5 10

Total Average 20.5 5 20.5

Training Index = Total Training Hours/Number of Workers
 HEALTH, OCCUPATIONAL SAFETY, ENVIRONMENT AND QUALITY REPORT
SOMAC

VII CONTROL OF HIGH RISK WORK

TYPE OF JOB AMOUNT RESULTS OBSERVATIONS
Height 0 0 0
Confined space 1 1 0
hot work 0 0 0
Surface Blasting 0 0 0
Excavation work 1 1 0
Works w/Machinery 1 1 0
Task change 0 0 0
Management of Toxic 0 0 0
Additives
VIII COMPLIANCE WITH THE MONTHLY SECURITY PROGRAM
Number of Scheduled Number of Activities % COMPLIANCE
Activities Executed
5 5 100%

IX RECOMMENDATIONS
RECOMMENDATIONS RESPONSIBLE

Improvement in Signage Eng. Christian Vera Zavala

Increase Security Areas Eng. Christian Vera Zavala
Promote increased cleanliness and order at the Work Site Eng. Christian Vera Zavala

x. CONCLUSIONS OF THE MONTHLY MANAGEMENT

1 Correct safety signage has been implemented
2 Safety talks are promoted as an effective prevention measure
3 Correct use of staff PPE
4 Correct use and operation of Materials and Equipment.
5 The implementation of security has improved the quality of personnel in the performance of their jobs.
 HEALTH, OCCUPATIONAL SAFETY, ENVIRONMENT AND QUALITY REPORT
SOMAC
XI CONTROLS TO MINIMIZE THE RISKS OF THE NEXT MONTH
POTENTIAL HAZARDS RECOMMENDATIONS RESPONSIBLE
Elemen formwork. Vertical Control of Work Areas Eng. Christian Vera Zavala
Emptying of Element. Vertic. Keep work areas clean Eng. Christian Vera Zavala
Construction Steel Proper use of tools and PPE Eng. Christian Vera Zavala

XII WEEKLY OCCUPATIONAL HEALTH SAFETY PROGRAM ENVIRONMENT AND QUALITY

ACTIVITY RESPONSIBLE
Elimination of Waste to control the Work Environment Eng. Christian Vera Zavala
Environmental awareness Eng. Christian Vera Zavala
Safety in a Storm Eng. Christian Vera Zavala

Head of Security Program Construction

Resident

Security Supervisor
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| First aid and health

| Facilities
| Team reports
| Security Management Tools
| Material handling
Electrical elements (Cables, connections, others)

Analysis of accidents and incidents

Blasting
| Ventilation
| Environment and Personal Health
| Tools
| Signaling
| Drilling
Operations

| Obligations and rights of the worker

|New personal induction
| Order and Cleanliness
| Others
| Motivation and behavior of the worker
| Handling of explosives
| Security Principles

| Management and care of equipment

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01 PROVISIONAL WORKS
01.01 WORK POSTER
01.02 STORAGE AND/OR GUARDIAN HOUSE
01.03 MOBILIZATION AND DEMOBILIZATION OF EQUIPMENT
01.04 MAINTENANCE OF ACCESS ROADS
01.05 WORK SAFETY AND HEALTH PLAN (PSST)
01.06 INDIVIDUAL PROTECTIVE EQUIPMENT (PPE)
01.07 COLLECTIVE PROTECTION TEAM (EPC)
02 RESERVOIR
02.01 DESANDER (01 UNIT)
02.01.01 PRELIMINARY WORK
02.01.01.01 LAYOUT LEVELS AND PRELIMINARY LAYOUT
02.01.01.02 I DRAW LEVELS AND LAYOUT DURING THE PROCESS
02.01.02 EARTH MOVEMENTS
02.01.02.01 MANUAL EXCAVATION IN LOOSE ROCK
02.01.02.02 REFINE, PROFILED AND COMPACTED
02.01.02.03 FILLED WITH OWN MATERIAL
02.01.02.04 REMOVAL OF SURPLUS MATERIAL C/ MINI LOADER EQUIPMENT
02.01.03 SIMPLE CONCRETE WORKS
02.01.03.01 CONCRETE F'C=140 KG/CM2 FOR SLOORING AND/OR SUBBASE E=4''
02.01.03.02 CONCRETE F'C=210 KG/CM2 IN FLOORS AND WALLS
02.01.03.03 FORMWORK AND REMOVAL
02.01.03.04 CURING OF STRUCTURES
02.01.04 REINFORCED CONCRETE WORKS
02.01.04.01 CONCRETE F'C=210 KG/CM2 IN FLOORS AND WALLS
02.01.04.02 FORMWORK AND REMOVAL
02.01.04.03 GRADE 60 CORRUGATED STEEL IN SLAB
02.01.05 METAL CARPENTRY
02.01.05.01 SIDE METAL GATE OF 0.5 X 0.40 M
02.01.05.02 SIDE METAL GATE OF 0.5 X 0.60 M
02.01.06 BOARDS AND OTHERS
02.01.06.01 JOINTS WITH SEALING ADDITIVE OF 1.2X2.4 CM
02.02 RESERVOIR C°A° 27X25M X 2.5 ML (V=1700M3)
02.02.01 PRELIMINARY WORK
02.02.01.01 LAYOUT LEVELS AND PRELIMINARY LAYOUT
02.02.01.02 I DRAW LEVELS AND LAYOUT DURING THE PROCESS
02.02.02 EARTH MOVEMENTS
02.02.02.01 EXCAVATION IN COMPACT GROUND WITH MACHINERY IN RESERVOIR
02.02.02.02 PROFILE AND COMPACTION REFINE
02.02.02.03 FILLED WITH OWN MATERIAL
02.02.02.04 REMOVAL OF SURPLUS MATERIAL C/ MINI LOADER EQUIPMENT
02.02.03 SIMPLE CONCRETE
02.02.03.01 CONCRETE F'C=140 KG/CM2 FOR SLOORING AND/OR SUBBASE E=4''
02.02.04 REINFORCED CONCRETE
02.02.04.01 CONCRETE FC=210 KG/CM2 IN FOOTINGS
02.02.04.02 CONCRETE F'C=210 KG/CM2 IN WALLS
02.02.04.03 CONCRETE FC=210 KG/CM2 IN SLAB
02.02.04.04 CORRUGATED STEEL FY= 4200 kg/cm2 GRADE 60
02.02.04.05 CARAVISTA FORMWORK AND REMOVAL OF RESERVOIR WALL
02.02.04.06 CURING OF STRUCTURES
02.02.05 METAL CARPENTRY
02.02.05.01 CHROME CAT TYPE LADDER
02.02.05.02 FENCE WITH BARBED WIRE FOR RESERVOIRS
02.02.06 BOARDS AND OTHERS
02.02.06.01 CONSTRUCTION JOINTS WITH WATER STOP 6" IN RESERVOIR
02.02.06.02 JOINTS WITH SEALING ADDITIVE OF 1.2X2.4 CM
02.03 COLLECTION BOXES AND VALVES
02.03.01 EARTH MOVEMENTS
02.03.01.01 MANUAL EXCAVATION IN LOOSE ROCK
02.03.01.02 PROFILE AND COMPACTION FOR FLOORS
02.03.01.03 FILLED WITH OWN MATERIAL
02.03.01.04 REMOVAL OF SURPLUS MATERIAL C/ MINI LOADER EQUIPMENT
02.03.02 SIMPLE CONCRETE WORKS
02.03.02.01 CONCRETE F'C=140 KG/CM2 FOR SLOORING AND/OR SUBBASE E=4''
02.03.02.02 STONE MASONRY WALL UNDER OVERFLOW CANAL
02.03.03 REINFORCED CONCRETE WORKS
02.03.03.01 CONCRETE FC=210 KG/CM2 IN BOX
02.03.03.02 CARAVISTA FORMWORK AND REMOVAL
02.03.03.03 CORRUGATED STEEL FY= 4200 kg/cm2 GRADE 60
02.03.03.04 CURING OF STRUCTURES
02.03.04 ACCESSORIES
02.03.04.01 INSPECTION COVER
02.03.04.02 VALVE AND ACCESSORIES RESERVOIR COLLECTION BOX
02.04 CHANNEL BY PASS
02.04.01 PRELIMINARY WORK
02.04.01.01 LAYOUT LEVELS AND PRELIMINARY LAYOUT
02.04.01.02 I DRAW LEVELS AND LAYOUT DURING THE PROCESS
02.04.02 EARTH MOVEMENTS
02.04.02.01 MANUAL EXCAVATION IN LOOSE ROCK
02.04.02.02 REFINE PROFILE AND COMPACTION
02.04.02.03 FILLED WITH OWN MATERIAL
02.04.02.04 REMOVAL OF SURPLUS MATERIAL C/ MINI LOADER EQUIPMENT
02.04.03 SIMPLE CONCRETE WORKS
02.04.03.01 CONCRETE f'c=175 kg/cm2 FOR CHANNELS
02.04.03.02 CARAVISTA FORMWORK AND REMOVAL
02.04.04 BOARDS AND OTHERS
02.04.04.01 GASKET WITH SEALING ADDITIVE OF 1.2 X 2.4 CM
02.04.04.02 CURING OF STRUCTURES
02.05 INPUT CHANNEL
02.05.01 PRELIMINARY WORK
02.05.01.01 LAYOUT LEVELS AND PRELIMINARY LAYOUT
02.05.01.02 I DRAW LEVELS AND LAYOUT DURING THE PROCESS
02.05.02 EARTH MOVEMENTS
02.05.02.01 MANUAL EXCAVATION IN LOOSE ROCK
02.05.02.02 REFINE PROFILE AND COMPACTION
02.05.02.03 FILLED WITH OWN MATERIAL
02.05.02.04 REMOVAL OF SURPLUS MATERIAL C/ MINI LOADER EQUIPMENT
02.05.03 SIMPLE CONCRETE WORKS
02.05.03.01 CONCRETE f'c=175 kg/cm2 FOR CHANNELS
02.05.03.02 CARAVISTA FORMWORK AND REMOVAL
02.05.04 BOARDS AND OTHERS
02.05.04.01 JOINTS WITH SEALING ADDITIVE OF 1.2X2.4 CM
02.05.04.02 CURING OF STRUCTURES
02.06 OUTPUT CHANNEL
02.06.01 PRELIMINARY WORK
02.06.01.01 LAYOUT LEVELS AND PRELIMINARY LAYOUT
02.06.01.02 I DRAW LEVELS AND LAYOUT DURING THE PROCESS
02.06.02 EARTH MOVEMENTS
02.06.02.01 MANUAL EXCAVATION IN LOOSE ROCK
02.06.02.02 REFINE PROFILE AND COMPACTION
02.06.02.03 FILLED WITH OWN MATERIAL
02.06.02.04 REMOVAL OF SURPLUS MATERIAL C/ MINI LOADER EQUIPMENT
02.06.03 SIMPLE CONCRETE WORKS
02.06.03.01 CONCRETE f'c=175 kg/cm2 FOR CHANNELS
02.06.03.02 CARAVISTA FORMWORK AND REMOVAL
02.06.04 BOARDS AND OTHERS
02.06.04.01 GASKET WITH SEALING ADDITIVE OF 1.2 X 2.4 CM
02.06.04.02 CURING OF STRUCTURES
03 SEVERAL
03.01 QA
03.01.01 MIX DESIGN TEST
03.01.02 CONCRETE STRENGTH TEST
03.01.03 CONSTRUCTION CONTROL SETTLEMENT, SLUMP
03.02 LAND FREIGHT
03.02.01 LAND FREIGHT TACNA - ROAD POINT 1
03.02.02 LAND FREIGHT ROAD POINT - WORK 1
03.03 ENVIRONMENTAL IMPACT MITIGATION
03.03.01 RECOMPOSITION OF QUARRY
03.03.02 PERMANENT CLEANING OF WORK
03.03.03 PERMANENT IRRIGATION OF WORK
03.04 DEVELOPMENT OF PRODUCTIVE CAPABILITIES
03.04.01 DEVELOPMENT OF PRODUCTIVE CAPABILITIES