List of workplaces for the special assessment of working conditions

Employer / organization​

No. Document number​ dated Date the document was prepared. Facilities: Facilities and addresses​. Schedule and grounds for the assessment: Grounds for the assessment and approved schedule​. Approved by the commission for the special assessment of working conditions: minutes Number and date of the approval minutes​, order establishing commission membership Order establishing commission membership​. Chair: Selected employee’s full name​, Selected employee’s position​. Commission members: Commission members and representation​. The list must be approved before work on the special assessment of working conditions begins, in accordance with part 5 of Article 9 of Federal Law No. 426-FZ.

List of workplaces​ No similar workplaces are identified in the list; each listed workplace is considered individually.

Workplaces / categories not included in this list and substantiated grounds: Excluded categories and grounds​. Mere omission from the table does not exempt a workplace from the special assessment of working conditions; the grounds must be checked against current legislation. Send the approved list to the organization conducting the assessment and take account of actual changes before assessment. The list is not an assessment report and does not establish a working-condition class. Approving person / chair ______________ / Selected employee’s full name​ /, date Date the document was prepared. Commission members’ signatures:

Commission members’ signatures​