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Fecha de entrega: ..................................
CONSTANCIA DE ENTREGA Y COMPROMISO DE CUMPLIMIENTO DEL REGLAMENTO
INTERNO DE SEGURIDAD Y SALUD EN EL TRABAJO DE PROVIAS NACIONAL
Yo ....................................................................................................…… … identificado con DNI

(Nombres y Apellidos)
N°: ............................................................ ……………………….…trabajador de la Organización
.......................................................................................... Me comprometo a cumplir el presente
Reglamento, firmando este documento, reconozco que voy a leer y cumplir mis
Responsabilidades en Seguridad y Salud en el Trabajo.
PUESTO DE TRABAJO: ............................................................................................ ………
UNIDAD GERENCIAL/AREA DE TRABAJO: ......................................................... ………
LUGAR DE TRABAJO: SEDE CENTRAL ……………………………………….
UNIDAD ZONAL ……………………………………….
UNIDAD DE PEAJE ….……………………………………..
OTRO………………………………………………………………
FIRMA DEL TRABAJADOR: .......... ……………………..
NOMBRE Y APELLIDO DE LA PERSONA QUE ENTREGA EL REGLAMENTO:
…………………………………………………………………………………………………………………
Reglamento Interno de Seguridad y Salud en el Trabajo para el personal de PROVIAS NACIONAL 42 de 43
Noviembre 2013

Anexo 03 - Reglamento Interno de Seguridad y Salud1

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Fecha de entrega: ..................................

Yo ....................................................................................................…… … identificado con DNI

N°: ............................................................ ……………………….…trabajador de la Organización

.......................................................................................... Me comprometo a cumplir el presente

PUESTO DE TRABAJO: ............................................................................................ ………

UNIDAD GERENCIAL/AREA DE TRABAJO: ......................................................... ………

LUGAR DE TRABAJO: SEDE CENTRAL ……………………………………….

UNIDAD ZONAL ……………………………………….

UNIDAD DE PEAJE ….……………………………………..

FIRMA DEL TRABAJADOR: .......... ……………………..

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Anexo 03 - Reglamento Interno de Seguridad y Salud1

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Anexo 03 - Reglamento Interno de Seguridad y Salud1

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Fecha de entrega: ..................................

Yo ....................................................................................................…… … identificado con DNI

N°: ............................................................ ……………………….…trabajador de la Organización

.......................................................................................... Me comprometo a cumplir el presente

PUESTO DE TRABAJO: ............................................................................................ ………

UNIDAD GERENCIAL/AREA DE TRABAJO: ......................................................... ………

LUGAR DE TRABAJO: SEDE CENTRAL ……………………………………….

UNIDAD ZONAL ……………………………………….

UNIDAD DE PEAJE ….……………………………………..

FIRMA DEL TRABAJADOR: .......... ……………………..

Vous aimerez peut-être aussi

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