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Total productive maintenance (tpm) to mitigate accidents and occupational diseases

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The following bibliographic review will present and support the mitigation and reduction of the risk of occupational accidents or illnesses to acceptable levels, supported from the tools of TPM (total productive maintenance), 5 s, autonomous maintenance, predictive maintenance, training and training. This review supports the mechanisms to achieve zero accidents for a prolonged time, without ignoring the condition of the human being as a direct protagonist in achieving safe environments and a culture of self-care seen from different perspectives of the TPM.

tpm-to-mitigate-accidents-and-work-illnesses

Keywords: Industrial safety, TPM and occupational health and safety, Training, Safe work, reduction of work accidents.

Abstract

The following bibliographic review will present and support the mitigation and reduction of the risk of occurrence of work accidents or acceptable diseases, supported by the tools of TPM (total productive maintenance), 5 s, autonomous maintenance, predictive maintenance, training and training. This review supports the mechanisms to achieve zero accidents during a protracted period, without knowing the condition of the human being as a direct protagonist in the achievement of safe means and the culture of self-care seen from different perspectives of the TPM.

Introduction

In the development of the work environment there are certain relationships between the human being and the environment, within it are the working conditions that are directly related to the organization, the work content, social relations and the participation of workers, These activities can be dangerous, and thus generate risk conditions that can deteriorate the mental, physical and social well-being of people, for this the implementation of TPM (Total Productive Maintenance) as support for the development of the industry, allows to have production equipment always ready to sustain production levels in addition to guaranteeing the total and continuous operation of the equipment and facilities, improving relationships between people and the equipment used. (Castro Montero,Loss Reduction In Manufacturing By, & Leandra Mansilla Del Valle, nd, 2011, p. 11), (García & González, 2012, p. 2). Its methodology, based on different management techniques, where it establishes optimal strategies for the continuous increase of productivity, thus achieving success, competitiveness and effectiveness, which means meeting quality, time and production cost specifications, when implemented industrial maintenance strategies on health and safety issues. (Oliveiro García, 2004, p. 1). It is here where the objective of the system is oriented to achieve zero accidents, zero failures and zero defects.where it establishes optimal strategies for the continuous increase of productivity, thus achieving success, competitiveness and effectiveness, which means complying with specifications of quality, time and cost of production, when implementing industrial maintenance strategies on health and safety issues. (Oliveiro García, 2004, p. 1). It is here where the objective of the system is oriented to achieve zero accidents, zero failures and zero defects.where it establishes optimal strategies for the continuous increase of productivity, thus achieving success, competitiveness and effectiveness, which means complying with specifications of quality, time and cost of production, when implementing industrial maintenance strategies on health and safety issues. (Oliveiro García, 2004, p. 1). It is here where the objective of the system is oriented to achieve zero accidents, zero failures and zero defects.zero faults and zero defects.zero faults and zero defects.

There are many methods in companies dedicated to the mitigation of accidents or occupational diseases (Takeda, Pereira, gonzales and monterrosa 2017 p. 1.), but additionally, it is possible to implement productive tools adapted to the programs of "Health and Safety in the work ”of the organizations. Today there are many companies and countries that do not perceive the costs associated with work accidents; just to take an example and have a vision, 50% of work accidents can incur a disability that exceeds 11 days (Takeda, Pereira, gonzales and monterrosa 2017 p. 1.); the downtime of an employee who suffers a work accident has direct costs due to the reduction of the production that the employee contributes and indirect costs such as benefits expenses,absenteeism employee compensation without taking into account the costs of medical care assumed by the health system of each country and the burden on state coffers for increasingly poor families (International Labor Office, 2003 p.23. to p.25.); In addition to this, the possible implications for satisfaction due to non-compliance with the delivery times agreed with customers; In most organizations, the defined strategies are focused on expanding profit margins and being competitive in the market (Dominguez, 1997 p. 2). Therefore, the importance of implementing tools and strategies that help reduce the occupational risks to which workers are exposed; and increase productivity with the efficient use of all the resources available for production. (García Palencia, 2008.p. 2 P. 4).

This bibliographic review will analyze some pillars and management tools related to Total Productive Maintenance that can serve as support to companies in the strategies for reducing accidents and occupational diseases in organizations. And from prevention, good maintenance practices and good production practices. To have greater profitability in companies with mentally and physically healthy workers.

The objective of Total Productive Maintenance (TPM) is: zero losses, zero defects, minimizing machine stoppages, zero contamination and zero accidents (Fernanda & Restrepo, 2007 p. 2). This bibliographic review deepens the reduction of work accidents and occupational diseases with total productive maintenance, supported and sustained from, autonomous maintenance as a tool for identifying sources and risks for employees, preventive maintenance as helps to prevent stoppages of machines and workers' disabilities due to uncorrected risk factors, corrective and timely maintenance as a fundamental tool for continuous improvement and definitive correction; 5S as a waste eliminator to achieve clean and safe work environments (Reyes, Hern, & Pi, 2017.p. 4 to p. 5). And the pillar of education and training for error elimination.

TPM and Security and Environment Management.

(Tokutarö Suzuki, 1995 p. 223 to p 325). The certainty of the team, avoiding human errors, and eliminating accidents and pollution are some of the basic pillars of the TPM. Managing security and environment is one of the main activities in TPM.

The correct use of the TPM improves security in multiple ways, for example:

  • Defective equipment is the main reason for a common risk, so the implementation of campaigns for zero breakdowns and defects progressively improves safety The correct application of the 5S principles (as part of autonomous maintenance) helps to eliminate leaks and spills, turning workplaces clean, polished, and well organized Autonomous maintenance and targeted improvements help eliminate unsafe areas Operators trained in the use of TPM ensure the proper functioning of their equipment, thus developing skills to detect abnormalities and thus be able to resolve them quickly Equipment, machines, tools and processes are not operated by unqualified personnel Operators are responsible for their own health and safety.

5S as a tool to reduce work accidents and occupational diseases.

Many organizations implement Total Productive Maintenance (TPM) focused on increasing productivity, but they do not make an analysis or evaluation of the possible negative effects that they bring with them and that affect employees, (Reyes et al., 2017 p.12 a la p. 13) being relevant to understand that morally, mentally and physically healthy workers are more productive and add value to the processes and final product.

According to the ILO (International Labor Organization) approximately 2.3 million men and women die each year in accidents or occupational diseases (Anaya-Velasco, ndp1.), But a judicious and conscientious assessment has not been made of what percentage is It is caused by the absence of order and cleanliness in the transit areas and jobs in the companies, although these figures do not really show the panorama of economic losses and the physical and emotional suffering of workers, this raises the importance of the implementation of comprehensive management models in health and safety in the industrial field. (Isabel Riaño-Casallas, Hoyos Navarrete, & Valero Pacheco, 2016, p. 69.). In this sense, as a strategy for the prevention of occupational risks, standardized management systems arise,such as the OHSAS 18001 standard, aimed particularly at the management of health and safety at work. In this way, the companies that have adopted and applied these systems with the purpose of continuous improvement in the field of occupational health guarantee a safe work environment, preventing the number of occupational accidents.

Therefore, these Occupational Health and Safety Management Systems (SGSST) are a tool for the development of preventive activities in the organization, providing means for the management of safety and health in an organized way, (Anaya- Velasco, 2017, p. 2.) explains that the objectives of applying these management systems are: to identify, manage and reduce the effects of non-conforming products (zero losses), reduce environmental effects (Pollution) and the dangers of activities (zero accidents). TPM practice creates job security.

To maintain order and cleanliness in a constant way, a change must be made in the way of thinking and internalizing the formula, that order and discipline equals excellence, the Japanese begin at an early age in their homes and schools to live the philosophy of the 5s as a powerful tool (Cura, 2003 p. 1). The 5s in the work environment seeks to improve the quality of employees and involve them as protagonists of change and improvement; By explaining the above statement, it can be deduced that employees with greater work well-being, and safe environments have better physical and mental health (Cura, 2003 p. 1), which for the benefit of employers or business owners translates into fewer costs due to disability or damage caused as a result of an accident,and more productivity and competitiveness in the market (International Labor Office, 2003 p.25.).

The 5s tool consists of simple steps, some authors include an "s" corresponding to job safety and have proposed the 6s tool.

1s: Select or classify between what is really necessary in workplaces, offices, corridors and the entire company.

2s: Order in the jobs and things really necessary, these must have a place or location.

3s: Clean each work area and tools.

4s: Standardize the first 3 "s" to define them as policies to follow and maintain. 5s: Self-discipline or sustaining and including the previous 4s in a philosophy of life, and as part of natural acting (Reyes et al., 2017. p.7.).

To start the application of the 5s, a classification of the objects is made, marking with red cards those that are not necessary, the cards can be divided into two parts to write what it is, and what is the risk that it has (Cura, 2003 p 5 to p.6) and what consequence it can bring in the case of an accident or work incident, it is also relevant to define the state of the objects, those that are inoperative are removed from the areas or work station considering them useless and possible cause of accident at work due to bad location (Tomás Piqué-Ardanuy, 1997 p.2 to p.3.). In addition to returning late materials or products in process to the responsible department or initial location. The delimitation of jobs,Critical processes and risk areas are included in the "s" of the order and prevent work accidents (Manzano Ramírez, María and Gisbert Soler, 2016 p.8.) due to approaching dangerous areas or personnel unrelated to critical processes or who require specialized personnel.

The 5s suggest cleaning the entire work environment of dirt such as tools, workstations and corridors of the company (Tomás Piqué Ardanuy, 1997 p. 1.), having visually clean and orderly environments that motivate employees and favors productivity (Cura, 2003 p.8.), In this first step it is concluded that only order and cleanliness generates well-being and mental health to the worker (Manzano Ramírez, María and Gisbert Soler, 2016 p.5. A to p. 6.), (Manzano Ramírez, María and Gisbert Soler, 2016 p.9.). By eliminating harmful substances, factors or agents from jobs, the risk of an occupational accident or occupational disease acquired by the company's activities is reduced to acceptable levels (Robert, 2000 p.2. To p. 4.), (Carneromoya, Marín, Carnero-moya, Marín, & Vaillant, 2013 p.3.).

Setting the conditions of order and cleanliness within organizations is one of the most complex tasks due to the lack of internalization of the philosophy of order and cleanliness in employees running the risk of returning to the initial conditions, it is the responsibility of senior management to support the continuous improvement processes and, for that matter, establish procedures that can be fully complied with (Cura, 2003 p.8.) without the tasks of order and cleanliness putting the integrity of the workers at risk (Tomás Piqué Ardanuy, 1997 p.1) The loss of time and work accidents are losses for which final consumers are not willing to pay (Manzano Ramírez, María and Gisbert Soler, 2016). Employees are motivated when they have an indicator or references such as photographs, manuals, billboards,drawings or demarcations that show them where to locate tools (Cura, 2003 p.7.), work items or any item within the company (Manzano Ramírez, María and Gisbert Soler, 2016 p.9.). When employees easily locate the items they require, they reduce the risk of shock from unnecessary movement and misplaced objects. (Tomás Piqué-Ardanuy, 1997 p.2.). A cleaning policy should also be defined periodically, for example, before and at the end of working hours as one more responsibility, typical of their position (Tomás Piqué-Ardanuy, 1997 p.3 to p.4.). And more than an imposition, it is a culture and respect for the rules of cleaning and self-care, (Mendoza Haro, 2011 p. 2).work items or any item within the company (Manzano Ramírez, María and Gisbert Soler, 2016 p.9.). When employees easily locate the items they require, they reduce the risk of shock from unnecessary movement and misplaced objects. (Tomás Piqué-Ardanuy, 1997 p.2.). A cleaning policy should also be defined periodically, for example, before and at the end of working hours as one more responsibility, typical of their position (Tomás Piqué-Ardanuy, 1997 p.3 to p.4.). And more than an imposition, it is a culture and respect for the rules of cleaning and self-care, (Mendoza Haro, 2011 p. 2).work items or any item within the company (Manzano Ramírez, María and Gisbert Soler, 2016 p.9.). When employees easily locate the items they require, they reduce the risk of shock from unnecessary movement and misplaced objects. (Tomás Piqué-Ardanuy, 1997 p.2.). A cleaning policy should also be defined periodically, for example, before and at the end of working hours as one more responsibility, typical of their position (Tomás Piqué-Ardanuy, 1997 p.3 to p.4.). And more than an imposition, it is a culture and respect for the rules of cleaning and self-care, (Mendoza Haro, 2011 p. 2).reduce the risk of blows from unnecessary movements and misplaced objects. (Tomás Piqué-Ardanuy, 1997 p.2.). A cleaning policy should also be defined periodically, for example, before and at the end of working hours as one more responsibility, typical of their position (Tomás Piqué-Ardanuy, 1997 p.3 to p.4.). And more than an imposition, it is a culture and respect for the rules of cleaning and self-care, (Mendoza Haro, 2011 p. 2).reduce the risk of blows from unnecessary movements and misplaced objects. (Tomás Piqué-Ardanuy, 1997 p.2.). A cleaning policy should also be defined periodically, for example, before and at the end of working hours as one more responsibility, typical of their position (Tomás Piqué-Ardanuy, 1997 p.3 to p.4.). And more than an imposition, it is a culture and respect for the rules of cleaning and self-care, (Mendoza Haro, 2011 p. 2).

Autonomous maintenance as the first phase in the identification or correction of risk factors or latent dangers that may affect the health of workers or even the occurrence of an occupational accident.

Autonomous maintenance is one of the 8 most important pillars within the total productive maintenance due to the direct participation of the operators, it is in this pillar where each collaborator easily identifies possible unsafe conditions in the equipment (Garcia and Vallejo, 2014 p.7.) and (Paredes, 2009 p.1 to p.4), mismatches in the machines, dirt, leaks of flammable liquids or substances that can affect the health of employees (Paredes, 2009 p.1.). It is an individual responsibility to keep their tools and workstations in optimal conditions, favoring a safe and pleasant workplace;Many companies have a checklist with some simple checks that must be completed before and after operating the machines or work tools and although the main objective is to identify and anticipate anomalies, it can also be aimed at identifying latent dangers in the machines (Méndez, ndp1. to p.4), tools and jobs; Employees are people who know their work tools in detail, with simple training they could correct the failures they identify in the cleaning they do to their equipment (Méndez, ndp3 al p.4.), It is not just a matter of cleaning and dust off,In addition, the responsibility is acquired to make the reports on time and in a timely manner so that they are corrected by specialists or trained personnel of more technical and detailed repairs (Garcia and Vallejo, 2014 p.4.), according to the above it can be concluded that timely reporting to those responsible for the most specialized corrections is a management tool that mitigates occupational accidents and is known as corrective maintenance.

When the work areas are ordered, it is easier to identify any risk factor and you can think about the goal of zero accidents, then a graph is related to have a clearer vision or interpretation (Méndez, ndp4.)

Autonomous maintenance is composed of 7 steps (Paredes, 2009 p. 2), for this bibliographic review only the first 4 steps will be mentioned that directly contribute to the reduction of occupational accidents or outbreaks that may affect the health or integrity of workers.

Step 1. Initial cleaning.

The first thing to do to implement autonomous maintenance is to clean, but Talking about initial cleaning of equipment, machines and tools can be quite simple or not accepted by employees as it is associated more with the domestic and non-business environment; Without a doubt, clean environments in companies reduce the danger zones and therefore the level of risk of workplace accidents reaches acceptable levels (Telles & López-espinoza, 2013 p.1 to p.2.).

Step 2. Eliminate accumulators of contamination that may affect the health of operators and places inaccessible for cleaning or inspection without putting workers at risk.

After the initial cleaning is done, the machines, equipment and work tools must be kept clean, in step 2 strategies are created to prevent them from getting dirty again or in the case of residues from the use of the machines or Equipment these can be cleaned easily, periodically and without any obstacle that puts people's integrity at risk. For this, a distribution of equipment must be made so that operators can clean and inspect the equipment 360 degrees (Moyano, Piza, Zaruma, & Guadalupe, ndp3.a p.4), (Reyes et al., 2017 p. 14 to p. 15).

Step 3. Cleaning standardization.

The above steps mark the path to achieving safe and orderly work environments. The next step is to keep machines and spaces safe, the periodicity of cleaning and inspections must be defined, and a guide must be clearly described or a guide must be generated on the places, elements to be used and the amount of lubricants or detergents (Méndez, ndp6).

Step 3 seeks to systematize and create the culture of order, cleanliness and classification. Maintaining the safety and motivation of the staff. (Telles & López-espinoza, 2013 p.1 to p.2.).

Step 4. Inspection of equipment and spaces.

In this step, you must have an inspection and training guide (Méndez, ndp7.), Both for the review and for the correction of minor flaws that could stop the machine or any risk that could cause a work accident. It is necessary to inform and train operators to act in the workplace with the correction or report to the more technical maintenance areas and greater knowledge (Reyes et al., 2017 p. 14).

Contribution of keeping preventive Health and Safety at work

It was during the 50s that preventive maintenance was developed, a time during which functions for the prevention of failures or the prevention of maintenance and improvement in the execution of corrective, preventive and predictive maintenance were established with a tendency towards productive maintenance and improvement of maintainability. (Castro Montero, Reduction of Losses in Manufacturing, & Leandra Mansilla Del Valle, nd, 2011, p. 3.).

In a health and safety management system within a company, the concept of maintenance must be closely related to the inspection which shows the possible failure, in order to carry out the timely intervention ensuring human well-being or possible serious consequences. The basic sense of maintenance is to achieve the optimum degree of efficiency of the equipment or process. The time and quality of the operation carried out will be the result of availability and reliability in order to comply with all safety and environmental regulations, at a lower cost. (Gracia G; Gonzale S; Cortés M, 2009).

Preventive maintenance can be defined as a planned preservation, in order to know the status of the machines and equipment, at the most opportune moments and with the least impact, (Alavedra, C.; Gastelu, Y.; Méndez, G.; Minaya, C.; Pineda, B.; Prieto, k.; Ríos, k.;

Moreno, 2016, p.12) Preventive Maintenance or also called “planned maintenance”, has its origin before a failure or breakdown occurs and is carried out under controlled conditions avoiding any error in the system.

It is carried out under the experience of the personnel in charge (Salvador, 2013, p.20) therefore applying a correct occupational health and safety management system (SGSST), it is avoided to wait for the equipment to fail to carry out a repair, Rather, the appropriate spare parts are scheduled with enough time to eliminate failures and thus provide reliability and safety to the worker, assigning a series of preventive activities at certain times, especially at times that are not occurring to find and correct different problems that may generate failures and thus ensure that the quality of the service continues within the established limits, in this way there will be the confidence that it is operating in safe conditions since it is certain of the state of its operation (Alavedra, C.; Gastelu, AND.; Méndez, G.; Minaya, C.; Pineda, B.; Prieto, k.; Ríos, k.; Moreno, 2016, p.12), This definition explains that all conservation work that is carried out with the company's available means, while still offering a quality of service expected. This type of maintenance can be traced in different procedures, such as predictive, periodic, analytical, progressive and technical maintenance according to its reliability (Gaytan, 2000, p.3).progressive and technical according to its reliability (Gaytan, 2000. p.3).progressive and technical according to its reliability (Gaytan, 2000. p.3).

Within an occupational health and safety management system (SGSST), preventive or planned maintenance which encompasses different processes for its execution within a TPM framework as explained (Gaytan, 2000. p.5 to p. 10) helps preventive protection of people and their resources, maximizes the effectiveness of the equipment and its conservation, reduces costs and obtains statistical data that helps to optimize the system, specifically in this framework of (SGSST) Maintenance Preventive or planned achieves two objectives to maintain the equipment and the process in optimal conditions and to achieve effectiveness and cost efficiency, in a TPM development plan, planned maintenance is structured to meet these objectives (Tokutaro Suzuki, 1995, p. 145).

In the application of TPM, as an occupational health and safety management system, planned maintenance focuses on two pillars: the autonomous maintenance of the production area and the specialized maintenance area. In this planned maintenance system, the personnel carry out activities that improve or optimize the equipment and activities to improve the maintenance capacity technology (Tokutaro Suzuki, 1995, p. 148). Planned maintenance is one of the most important pillars in benefit of an industrial organization, the intention of this pillar consists in the need to gradually achieve the goal of “zero breakdowns” (Montoya I, Parra R, 2010, p. 25 a to p. 26). It is very common that companies carry out maintenance management externally,Therefore, when an occupational health and safety management system (SGSST) is implemented or the TPM is introduced, it is necessary to train and carry out inductions on accident prevention, so planned maintenance presents numerous limitations within a company, as the scant information collected to carry out preventive actions, are based on criteria or unsubstantiated recommendations by manufacturers or technicians without the pertinent information that validates the proper use of an occupational health and safety management system (SGSST) (Montoya I; Parra C, 2010, p. 25 to p. 26), since planned maintenance involves a series of dangerous activities during its implementation, related to the handling or introduction of new equipment,maintenance with stops or non-routine activities, for this it is necessary to design comprehensive safety programs and establish preliminary bases in the identification of faults or possible breakdowns (Tokutaro Suzuki, 1995, p. 331 to p. 332)

Training and education pillar in TPM as a mitigator of work accidents due to misinformation or lack of training for employees.

The training of personnel for the company must be essential before the workers are exposed to the functions or activities that they are going to develop and after the experience of the employees in the position there must be continuous maintenance or updating training (Muñoz Sanchez, 2010, p. 2.). Initial and continuous training create a culture of safe environments and safe environments that result in the reduction of accidents and occupational diseases (Ruiz & Ana, 2013, p.1).

It is common for companies to focus their efforts on the training of the functions and activities of the main operation of the company, from the top it is necessary to think and focus the efforts on a comprehensive training that develops the skills and abilities of the collaborators counting With qualified employees, the more prepared they are, the lower the probability that they may suffer an occupational accident, in addition to the information on protection at work that they must receive, according to the above it can be concluded that when the training is comprehensive and / or multipurpose it is a great contribution to the reduction of figures regarding work accidents (Ruiz & Ana, 2013, p.4).

From the training we can mitigate work accidents due to errors, here it must be emphasized that it is an error and that it is a violation, focusing the review on the error (Hecker S, 1973 p. 22).

The error referring to training is any unfavorable event due to incomplete training or not updated to reality, concluding that it is not attributable to the employee. And workplace accidents due to violations of procedures and processes are all those where the employee is aware but still proceeds in an insecure way without measuring the consequences (Hecker S, 1973 p. 22). Also called an unsafe act.

Many of the accidents at work are caused or we can attribute them to the lack of capacity or inability to carry out a job, as a consequence of having the minimum training or induction, the health of the collaborators must be promoted from the promotion of self-care that help to make the best and timely decisions about their health, preventing the probability of an event that puts their integrity at risk (Escobar, Mauricio, Franco, & María, 2017, p. 3 to p. 4). The most appropriate way to train people is first to explain how it should be done, second to show and operate the equipment, third to let the person start operating the equipment under supervision, then for the employee to do it alone and lastly evaluate the performance of the employee.In the event that the person does not reach the competition, the training must be started and repeated. Even so, the possibility of an accident at work is still very high (Encina, 2003, p. 2 to p. 3) because the human factor (Ruiz & Ana, 2013 p. 6) that it may have cannot be ignored. passive failures due to stress, exhaustion, lack of sleep or loss of situational awareness.

The participation of employees in groups or collaborative is fundamental within the training process (Hecker S, 1973 p. 11), as lessons learned, and formalization of manuals and procedures based on the experience acquired by workers since they are the ones who intervene directly (Ruiz & Ana, 2013 p. 7) and they know the risks or the best way to operate or do some activity.

The learning spaces must be free of danger so that workers feel comfortable and can internalize knowledge, without neglecting the continuous reinforcement of health and safety and the objectives to be achieved. In addition to this, there must be a pedagogical strategy with activities and exercises that achieve adherence to knowledge and remembrance and acquire tools that allow them to be and generate healthy and safe environments, strengthening the culture of self-care and industrial safety (Salazar, María, Santiago, Fabiola, & Ruiz, 2015) and (AB García, 2012 p. 2 to p. 4).

Finally, there must be continuous evaluation, monitoring and observation that guarantees that people are applying what they have learned and that there is no risk or probability of occurrence of a work accident due to violation of the procedures established for the functions for which the employees were trained. collaborators, in addition that the results in the evaluations help to reorient the objective or route that was outlined (AB García, 2012 p. 2 to p. 10 to p. 11).

Conclusions.

  • The philosophy of the 5S as a daily culture creates safe environments helping to prevent occupational risks, based on 5 essential steps: classify, order, clean, standardize and personal self-discipline The timely identification and correction of breakdowns, sources of contamination, Equipment failures and anomalies, help to mitigate accidents and incidents in order to preventively protect people and preserve machines, by promoting and applying an occupational health and safety management system, accidents are mitigated, failures or breakdowns in the work centers, generating reliability, efficiency and as such a reduction in costs not associated with operation.The proper training or induction given provides the necessary tools for self-care and decision-making in the face of unsafe acts that may put the integrity of the personnel at risk, thus generating optimal working conditions.

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