HSE WORKPLACE CONDITION INSPECTION (WCI)

HAZARD / NON-CONFORMANCE FORM

Department: A. Project Development Area: Basalt Quarry-ReCyn Site

1. Record the details of all Hazards / Non-conformances identified during the WCI on this form.
Instructions to Area
2. Record the details of the Corrective Actions required to rectify each identified Hazard / Non-conformance, individually or as a group.
Representative:
3. Provide a copy of this form to the OHS Department.

Ref Location Hazards / Non-conformances Immediate Corrective Actions Responsibility Due Date

P.6 Basalt Quary Found a large amount of general rubbish that Remove the rubbish to the landfill. Alfian 2/10/2019
indicates that rubbish is not thrown into landfills Make sure the rubbish is disposed of regularly every day to
every day. the landfills.

P.2 ReCyn Waste bin with a special label for B3 waste are Segregate the waste according to the types. Steve 9/10/2019
Project used to dispose of general waste. Re-socialization to all employee about waste segregation Thistlethwaite/
as the types. Dede

P a g e | 1 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
O.2 ReCyn 1. No B3 labels for each chemical packaging. Steve 9/10/2019
O.4 Project 2. No B3 symbols for each chemical Thistlethwaite/
O.5 packaging according to the B3 Dede
Closed
characteristic.
3. No MSDS provide in the area. 10/10/2019
4. No spill kit provide for the area.
5. No eyewash provide near to the area.

1. Installation label in oil can

2. Installation sign characteristic chemical in oil can
3. Installation msds in wall hazardous
4. Installation reinforcement on hazardous wall
5. Installation eyewash and spill kit

P a g e | 2 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
N.1 ReCyn The bund-wall for the chemical storage is not Steve 9/10/2019
N.2 Project properly. There is not standard and does not Thistlethwaite/
Closed
N.3 function to prevent leaks from overflowing to the Dede
ground, no valve and less of control. 5/10/2019

heightens the bund wall and provides cover to the bund

wall so that rain water cannot enter

P a g e | 3 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
A.4 ReCyn Water tank (tandone) is placed on top working This is unacceptable condition, Barricade the Area ASAP. Steve 9/10/2019
Project platform of scaffolding. Done Thistlethwaite/
Dismantling the scaffold and provide the proper water Dede
tanks stand.

Closed
6/10/2019

Water tank already moved down and dismantled the tank

stand (scaffold materials). No more water tank used and
water supplies to the office is connected to the main line
from process plant
B.2 Basalt Access in office too narrow because of many stuff Provide the safe walkway, especially when in emergency Srira/Bogy 9/10/2019
Quary inside office. situation.

Closed
4/10/2019

B.5 Basalt Identified stove and LPG in the work area Remove stove and LPG from the work area 9/10/2019

P a g e | 4 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
 Quary
Closed
5/10/2019

F.2 ReCyn No hard barricade around the hole Install hard barricade around the hole Steve 6/10/2019
Thistlethwaite/
Project
Dede

Closed
4/10/2019

H.2 Basalt No updated tagging for some of electrical Check all the electrical equipment and tag by authorized Citra/Braily 9/10/2019
Quary equipment. person.

P a g e | 5 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
H.2 ReCyn No electrical tagging on some electrical finish tag with electrical PT AR Steve 9/10/2019
Project/IMN equipment. Thistlethwaite/ Closed
Dede 7/10/2019
Office

P a g e | 6 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
J.5 Basalt No "out of service" tagging on broken chain block Attached out of service tagging on the broken chain block Alfian/Braily 9/10/2019
Quary and store in the separate place.
Closed
5/10/2019

P a g e | 7 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
K.6 Basalt Fire extinguisher not hanging properly Hang the fire extinguisher, at list 15 cm base FE from Srira/Braily 9/10/2019
Quary surface, and equipped with the signs (125 cm from
surface).

K.9 Basalt No smoke detector attached in some of office Install smoke detector in office room Alfian/Srira/ 9/10/2019
Quary room Braily

M.7 ReCyn No support for plumbing piping. installation Support the plumbing pipes Steve 9/10/2019
P a g e | 8 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019
Project Thistlethwaite/
Dede
Closed
8/10/2019

Ben Griffiths 30/09/2019

Name of Area Superintendent Signature Date of Inspection

P a g e | 9 of 9
HSE-DOC-FRM-00574-EN WORKPLACE CONDITION INSPECTION HAZARD / NON-CONFORMANCE REGISTER FORM Version 1.3
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 24 October 2019