No. Doc. Tgl.

Terbit
F-030 01.01.20
DAILY SAFETY REPORT Rev. Halaman
06 1 dari 5

Rig Name : : Rig PDSI#51.2/PD550-M Project : PHR WK Rokan

Date : : 08/01/2022 Well : Bangko P-15

I. KEY PERSONNEL ON DUTY

Day Gifinando Almuttaqin Company Day Ivon
HSE Officer Rig Supt. Syafrimel
Night Raffi Uddin Man Night Roy Wicaksono

II. HSE PERFORMANCE/STATISTIC (Reff. F-059) YTD INCIDENT RECORD

Daily manhours 672 INCIDENT RATE FATAL 0 PD 0
Monthly manhours 5,340 LTIFR 0.00 LTA 0 MVA 0
YTD manhours 99,694 LTISR 0.00 RWDC 0 OIL SPILL 0
Safe manhours 5,340 TRIR 0.00 MTC 0 Near Miss 0
YTD Safe Manhours 99,694 MVAR 0.00 FAC 0 Lost Day 0
MTD KM Traveled 1,185
Daily Incident Highlight

III. HSE MEETING & CONTROL OF WORK (Reff. F-065, F-066, & F-067)
Tail Gate Meeting Weekly Meeting Pre Job Safety Meeting Safety Stand Down Meeting JSA PTW
Frequency 2 0 0 0 1 1
Participan 58 0 17 17 17 17
Durasi 60 0 10 10

IV. EQUIPMENT CERTIFICATION COMPLIANCE (%) (Reff. F-062)

SKPI RIG 100.00% MGD Callibration 100.00% PSV 0.00% Total Compliance
SKPP CRANE 100.00% Pressure Vessel 100.00% BOP 100.00%
88.89%
SKPP FORKLIFT 100.00% Lifting Gear 100.00% Weight Indicator 100.00%
Remarks

V. PEOPLE CERTIFICATION, DOCUMENT, & TRAINING COMPLIANCE (%) (Reff. F-060, F-061)
MIGAS Certification 100.00% HSE Passport Training 100.00%
Total Compliance 100.00%
Well Control Cert. 100.00% HSE Passport Reception 100.00%
Medical Check Up 100.00%
Remarks

- LTA : Lost Time Accident - TGM : Tail Gate Meeting

- RWDC : Restricted Workday Case - PJSM : Pre Job Safety Meeting
- MTC : Medical Treatment Case - SSD : Safety Stand Down
- FAC : First Aid Case - JSA : Job Safety Analysis
- PD : Property Damage - PTW : Permit To Work
- MVA : Motor-Vehicle Accident
 No. Doc. Tgl. Terbit
F-030 20.10.16
DAILY SAFETY REPORT Rev. Halaman
05 2 dari 5

VI. HSE & RIG ACTIVITY SUMMARY

HSE ACTIVITY RIG ACTIVITY
DAY SHIFT DAY SHIFT
- Mengkoordinir TGM, SSD, PJSM, Update POB,DSR, PEKA, HDR Program Kerja
- Safety Patrol dan Monitoring aktifitas pekerjaan crew - Loading Unloading Equipment
- Rekap Invetory - Dress Up Lokasi
- Houskeeping gudang - OST Training
- Maintenaince dan houskeeping

NIGHT SHIFT NIGHT SHIFT

- Mengkoordinir TGM, PJSM, Update POB,DSR, SWA Record, HES Daily Report Program Kerja:
- Safety Patrol - Loading Unloading Equipment
- Housekeeping - On Site Training
- Set Peralatan
- Maintenaince dan houskeeping

PERSONEL ON BOARD
No. Company Total POB SPECIAL EVENT / ISSUE
1 PT. PHR/ PT. PDC (DSM/ COMPANYMAN) 4 1. Tidak Tersedia Oil Spill Kit
2 PT. PDSI 2 2. Butuh Penambahan SCBA
3 PT.PDC (CREW) 38 3. Butuh pengadaan SRL untuk di subtruktur
4 PT. PDC (HSEO) 2 4. Stok apron welder kurang
5 PT.PDSI (HTE) 4 5. Perlu penambahan stok safety glass
6 PDC CATRING 4 6. Stock Coverall Kurang
7 PDSI ANGKUTAN 4 7. Pengadaan Untuk Closing Finding RnC
8 PT. HALIBURTON (DD SPERRY) 0
9 PT. SOLSTICE (MUD ENG) 0
10 PT. PRAKARSA (GEOLOGIST) 0
11 PT. BAKER HUGHES 0
12 RS. AWAL BROSS (MEDIC) 4
13 PT. SCHLUMBERGER (WIRELINE-CBL) 0
14 PT. PDSI (Top Drive) 2
15 PT. Benvours (Casing Slip) 0
16 PT. Schlumberger (BIT Runner) 0
17
18
19
20
21
TOTAL POB 64
 No. Doc. Tgl. Terbit
F-030 20.10.16
DAILY SAFETY REPORT Rev. Halaman
05 3 dari 5

VII. HSE OBSERVATION PROGRAM (PENGAMATANKESELAMATAN KERJA) (Reff. F-068)

Daily Current Month Year To Date
Safe Action 10 52.63% Safe Action 77 42.78% Safe Action 77 42.78%
Safe Condition 5 26.32% Safe Condition 76 42.22% Safe Condition 76 42.22%
Unsafe Action 2 10.53% Unsafe Action 14 7.78% Unsafe Action 14 7.78%
Unsafe Condition 2 10.53% Unsafe Condition 13 7.22% Unsafe Condition 13 7.22%
Nearmiss 0 0.00% Nearmiss 0 0.00% Nearmiss 0 0.00%
TOTAL 19 100.00% TOTAL 180 100.00% TOTAL 180 100.00%
Participation (Daily) % Participation (Monthly) % Monthly Closing Status
PDSI Employee 0 0.00% PDSI Employee 0 0.00% Open 0 #DIV/0!
PDSI Contractor 8 100.00% PDSI Contractor 67 100.00% Close 0 #DIV/0!
Client's Personnel 0 0.00% Client's Personnel 0 0.00% Year to Date Closing Status
Services company 0 0.00% Services company 0 0.00% Open 0 0.00%
TOTAL 8 100.00% TOTAL 67 100.00% Close 180 100.00%
Current Month PEKA Reported
Daily PEKA Reported
42.78% 42.22%
52.63% 80 40.00%
15 60.00%
10 26.32% 40.00% 40 7.78% 7.22% 20.00%
77 76 14 13 0.00%
0
5 10.53% 10.53% 20.00% 0 0.00%
10 5 2 2 0.00%
0

Nearmiss
Safe Action

Safe Condition

Unsafe Action

Unsafe Condition
0 0.00%
Nearmiss
Safe Action

Safe Condition

Unsafe Action

Unsafe Condition

Year to Date PEKA Reported PEKA Participation (Monthly)

100 42.78% 42.22% 50.00% 80 120.00%
70 100.00%
80 40.00% 100.00%
60 30.00% 60
50 80.00%
40 20.00%
7.78% 7.22% 40 60.00%
20 77 76 14 13 0.00%
0 10.00%
0 0.00% 30 40.00%
Nearmiss
Safe Condition

Unsafe Action

Condition
Safe Action

20
20.00%
Unsafe

10 0.00%
0 67 0.00%
0 0.00%
0
0 0.00%
PDSI Employee PDSI Client's Services
Contractor Personnel company

Year to date Closing Status Monthly Closing Status

180

Remarks
 No. Doc. Tgl. Terbit
F-030 20.10.16
DAILY SAFETY REPORT Rev. Halaman
05 4 dari 5

VIII. HSE PROGRAM IMPLEMENTATION (Reff. F-063)

Frequency
No. Activity REMARKS
Plan Daily MTD Coeff. %
1 Weekly HSE Meeting 4 0.00 0.00%
2 Fire Extinguisher inspection 1 0.00 0.00%
3 Fire Pump Inspection 4 0.00 0.00%
4 Eyewash & shower station inspection 4 1 1 0.25 25.00%
5 PPE Inspection 4 1 1 0.25 25.00%
6 HSE General Inspection 1 0.00 0.00%
7 Welding unit inspection 4 1 1 0.25 25.00%
8 Fall Arresting Equipment 1 0.00 0.00%
9 Camp & Hygiene inspection 4 1 1 0.25 25.00%
10 SCBA Inspection 1 0.00 0.00%
11 Light Vehicle Inspection 5 1 1 0.20 20.00%
12 Heavy Vehicle Inspection 2 0.00 0.00%
13 Drop Object Inspection 4 0.00 0.00%
14 Spill kit inspection 4 0.00 0.00% Tidak tersedia Oil Spill Kit
15 Hand & Finger injury inspection 4 1 1 0.25 25.00%
16 Noise measurement/mapping 1 0.00 0.00%
17 Lighting measurement 1 0.00 0.00%
18 Fire Drill 1 0.00 0.00%
19 Kick Drill 1 0.00 0.00%
20 Abandon Drill 1 0.00 0.00%
21 Medevac Drill 1 0.00 0.00%
TOTAL 53 6 6

HSE PROGRAM COMPLIANCE 6.90%

Remarks

Legend
: greater than 80%
: between 70% and 80%
: less than 70%
MTD : Month to Date
 No. Doc. Tgl. Terbit
F-030 20.10.16
DAILY SAFETY REPORT Rev. Halaman
05 5 dari 5

IX. HSE ACTION TRACKING MONITORING SYSTEM (Reff. F-064)

Current Month Finding / Recommendation Year to Date
Finding /
Recommendation Open Close In Progress Overdue Total % Close Open Close In Progress Overdue Total % Close

Government Inspection 0 0 0 0 0 0.00% 0 0 0 0 0 0.00%

Inspection Report 0 0 0 0 0 0.00% 0 0 0 0 0 0.00%

HSE Inspection & Internal
Audit 0 0 0 0 0 0.00% 0 0 0 0 0 0.00%

Management Walkthrough 1 1 0 0 2 50.00% 0 0 0 0 0 0.00%

External Audit
(ISO,OHSAS,ISRS) 0 0 0 0 0 0.00% 0 0 0 0 0 0.00%
Accident Investigation 0 0 0 0 0 0.00% 0 0 0 0 0 0.00%
Client's Audit 0 0 0 0 0 0.00% 0 0 0 0 0 0.00%
Others finding 0 0 0 0 0 0.00% 0 0 0 0 0 0.00%

HSE ACTION TRACKING COMPLIANCE #DIV/0!

60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Government Inspection HSE Inspection Management External Audit Accident Client's Audit Others finding
Inspection Report & Internal Audit Walkthrough (ISO,OHSAS,ISRS Investigation
)

Current Month
Year to Date

Remarks

MONTHLY RECAPITULATION OPERATION STATUS (DAY)

Operation 0 Rig Up 0 Idle 4
Rig Move 4 Rig Down 0
Prepared By Reviewed By Approved By
HSE Officer Sign Rig Superintendent Sign Company Man Sign

GIVINANDO A Syafrimel IVON

0 ROY WICAKSONO
Rafi Uddin
 No. Doc. Tgl. Terbit
MONTHLY RIG MAN HOUR & INCIDENT STATISTICS F-059 31.01.15
MONITORING SHEET Rev. Halaman
0 1 dari 1

Rig Name : Rig PDSI#51.2/PD550-M Project : PHR

Period : 08/01/2022

Personnel Date
Classification 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PDSI Employee 24 24 24 24 24 24 24 24
PDSI Contractor 636 636 636 648 648 648 648 648
TOTAL 660 660 660 672 672 672 672 672 0 0 0 0 0 0 0 0
Personnel Date
Classification 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PDSI Employee
PDSI Contractor
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Personnel Total Monthly Manhours Total Manhours Worked Year to Date Total Total Monthly Total Safe Manhours Until Total Year To Date Safe
Classification Worked Until Last Month Manhours Safe Manhours Last Month Manhour
PDSI Employee 192 3,972 4,164 192 3,972 4,164
PDSI Contractor 5,148 90,382 95,530 5,148 90,382 95,530
TOTAL 5,340 94,354 99,694 5,340 94,354 99,694

Monthly Until Last Month Year To Date

Incident Category Freq. Incident Category Freq. Incident Category Freq. Incident Category Freq. Incident Category Freq. Incident Category Freq.
FATALITY 0 PD 0 FATALITY 0 PD 0 FATALITY 0 PD 0
LTA 0 MVA 0 LTA 0 MVA 0 LTA 0 MVA 0
RWDC 0 OIL SPILL 0 RWDC 0 OIL SPILL 0 RWDC 0 OIL SPILL 0
MTC 0 NEARMISS 0 MTC 0 NEARMISS 0 MTC 0 NEARMISS 0
FAC 0 LOST DAY 0 FAC 0 LOST DAY 0 FAC 0 LOST DAY 0
Notes:
- Safe Manhour will be reset to zero if Accident classified as LTA & Fatality occurred
 No. Doc. Tgl. Terbit
F-061 31.01.15
PERSONNEL CERTIFICATE MONITORING SHEET Rev. Halaman
0 1 dari 4
12/30/2000 1/14/2022
Rig :RIG PDSI#51.2/PD550-M Project : PHR
Period : 08/01/2022

WELL CONTROL CERTIFICATE

No Name Position Type of Certificate Certificate Number Certificate Release Certificate Expiracy Remarks
1 Syafrimel Rig Supt. IADC 00001092 20-Jan-20 20-Jan-22
2 Rig Supt.
3 Toolpusher
4 Toolpusher
5 Ali Syamsir Lubis Toolpusher IADC 00001088 1/25/2021 25-Jan-23
6 Driller
7 Driller
8 Driller
MIGAS CERTIFICATE
No Name Position Type of Certificate Certificate Number Certificate Release Certificate Expiracy Remarks
1 Syafrimel Rig Supt. APB III 2.096474.20 30-Jan-20 30-Jan-24
2 Arif Anwar Rig Supt. APB III 2.04180.96 9-Aug-18 9-Aug-22
3 David Toolpusher APPS 1300079612020 14-Nov-20 14-Nov-24
4 Zulmahendra Toolpusher APB III 24.658895.20 21-Feb-20 21-Feb-24
5 Ali Syamsir Lubis Toolpusher APPS 238 01039 2019 16-Aug-19 16-Aug-22
6 Solah Driller APPS 34.002967.19 19-Sep-19 19-Sep-23
7 Amrizal Driller APB 1300126062021 29-Oct-21 29-Oct-25
8 Cahyadi Driller JB III 23.040783.18 12-Jul-18 12-Jul-22
9 Asst. Driller
10 Asst. Driller
11 Asst. Driller
12 Rahmat Mustakim Derrickman OMPS 1300048292020 26-Sep-20 26-Sep-24
13 Anggiat Derrickman OMPS 102.007520 2019 18-Dec-19 18-Dec-22
14 Okta Piandes Derrickman OMPS 3.096947.19 12-Dec-19 12-Dec-23
15 Derrickman
16 Derrickman
17 Derrickman
18 Ariansyah Floorman
 No. Doc. Tgl. Terbit
F-061 31.01.15
PERSONNEL CERTIFICATE MONITORING SHEET Rev. Halaman
0 1 dari 4

No Name Position Type of Certificate Certificate Number Certificate Release Certificate Expiracy Remarks
19 Riansyah Floorman
20 Fajri Ardi Floorman OLB 1300062512021 31-Jul-21 31-Jul-25
21 Hendri Saputra Floorman OMB 22.013231.18 8-Mar-18 8-Mar-24
22 Saparudin Floorman OMB 22.013023.18 29-Sep-18 29-Sep-22
23 Arif Sobirin Floorman OLPS 3.095727.18 10-Oct-18 10-Oct-22
24 Teddy Ervansyah Floorman OLPS 3.096857.19 23-Oct-19 23-Nov-23
25 Ramdon Rizal Floorman OLPS 1300037902021 29-Apr-21 29-Apr-25
26 Mario Pratama Floorman OLPS 1300048062020 26-Sep-20 26-Sep-24
27 Floorman
28 Floorman
29 Floorman
30 Gifianando A HSE Officer AK3 Operator Migas 7.096134.18 1-Nov-18 1-Nov-22
31 Raffi Udin HSE Officer AK3 Operator Migas 7.097978.19 10-Aug-19 10-Aug-23
32 Firmansyah HSE Officer AK3 Operator Migas 7.015720.18 1-Mar-18 1-Mar-22
33 Badi Uzzaman Welder SMAW 6G 05003/AL/DMTS/201 29-Aug-19 29-Aug-22
34 Eko S Welder SMAW 6G 181.001764.18 25-Oct-18 25-Oct-21 Sudah perpanjang menunggu hasil
35 Hartansyah Welder SMAW 6G 1300096232020 9-Dec-20 9-Dec-24
36 Bagas Rifael Crane Operator CRAWLER CRANE C 1300056072021 16-Jun-21 16-Jun-25
37 Arif Budiman Crane Operator MOBILE CRANE C 52.094629.18 25-Oct-18 25-Oct-22
38 Windi Sugianto Crane Operator MOBILE CRANE C 53.114928.19 2-Nov-19 2-Nov-23
39 Khoiry Rahmad Rigger RIGGER 78000 5169 000763 1-Jul-19 1-Jul-23
40 Rigger
41 Rigger
42 Forklift Operator
43 Forklift Operator
44 Forklift Operator
 SUMMARY
WELL CONTROL CERTIFICATE MIGAS CERTIFICATE
Description Freq. % Description Freq. %
Total Certificate Expired 0 #DIV/0! Total Certificate Expired 0 0%
Total Certificate Expired in the Next 3 months 0 #DIV/0! Total Certificate Expired in the Next 3 months 0 0%
Valid Certificate 0 #DIV/0! Valid Certificate 27 100%
 No. Doc. Tgl. Terbit
F-060 31.01.15
PERSONNEL MEDICAL CHECK UP MONITORING SHEET Rev. Halaman
0 1 dari 4
30-Dec-00 1/14/2022
Rig : Rig PDSI#51.2/PD550-M Project : PHR
Period : 08/01/2022

No Name Position Company Join Date MCU Date MCU Expiracy Status Keterangan
1 Syafrimel Rig Superintendent PT. PDC 30 Desember 1900 fit
2 PT.PDC 30 Desember 1900 fit
3 Zulmahendra Toolpusher PT. PDC 30 Desember 1900 fit
4 Ali Syamsir Lubis Toolpusher PT.PDSI 30 Desember 1900 fit
5 Heri Susanto Toolpusher PT. PDC 30 Desember 1900 fit
6 Solah Driller PT. PDSI 30 Desember 1900 fit
7 Ibrahim Driller PT. PDC 30 Desember 1900 fit
8 Driller PT. PDC 30 Desember 1900 fit
9 Rahmat Mustakim Derrickman PT. PDC 30 Desember 1900 fit
10 Rio Aprisa Derrickman PT. PDC 30 Desember 1900 fit
11 Derrickman PT. PDC 30 Desember 1900 fit
12 Riansah Floorman PT. PDC 30 Desember 1900 fit
13 Ariansyah Floorman PT. PDC 30 Desember 1900 fit
14 Aris Sobirin Floorman PT. PDC 30 Desember 1900 fit
15 Saparudin Floorman PT. PDC 30 Desember 1900 fit
16 Oktapiandes Floorman PT. PDC 30 Desember 1900 fit
17 Firdaus Floorman PT. PDC 30 Desember 1900 fit
18 Floorman PT. PDC 30 Desember 1900 fit
19 Floorman PT. PDC 30 Desember 1900 fit
20 Floorman PT. PDC 30 Desember 1900 fit
21 M. Al Asri Roustabout PT. PDC 30 Desember 1900 fit
22 Rizki Bayuna Roustabout PT. PDC 30 Desember 1900 fit
23 Hendra R Roustabout PT. PDC 30 Desember 1900 fit
24 Wan Padli Roustabout PT. PDC 30 Desember 1900 fit
25 M. Iryawan Basuni Mudboy PT. PDC 30 Desember 1900 fit
26 Sugiharto Mudboy PT. PDC 30 Desember 1900 fit
27 Mudboy PT. PDC 30 Desember 1900 fit
28 Chief Mekanik PT. PDC 30 Desember 1900 fit
29 Irfan Mekanik PT. PDC 30 Desember 1900 fit
30 Achmad Yuni Mekanik PT. PDC 30 Desember 1900 fit
31 Mekanik PT. PDC 30 Desember 1900 fit
32 Nofriadi Elektrik PT. PDC 30 Desember 1900 fit
33 Muhammad Ilham Elektrik PT. PDC 30 Desember 1900 fit
34 Elektrik PT. PDC 30 Desember 1900 fit
35 Sulaiman Motoris PT. PDC 30 Desember 1900 fit
36 Oscar Aldi Pratama Motoris PT. PDC 30 Desember 1900 fit
37 Motoris PT. PDC 30 Desember 1900 fit
38 Badi Uzzaman Welder PT. PDC 30 Desember 1900 fit
39 Hartansyah Welder PT. PDC 30 Desember 1900 fit
40 Eko Welder PT. PDC 30 Desember 1900 fit
41 Ferly Ramadhan Rig Clerk PT. PDC 30 Desember 1900 fit
42 Topo Storekeeper PT. PDC 30 Desember 1900 fit
43 ADM/Store PT. PDC 30 Desember 1900 fit
44 Driver PT.PMS 30 Desember 1900 fit
45 Driver PT.PMS 30 Desember 1900 fit
46 Driver PT.PMS 30 Desember 1900 fit
 No. Doc. Tgl. Terbit
F-060 31.01.15
PERSONNEL MEDICAL CHECK UP MONITORING SHEET Rev. Halaman
0 2 dari 4

No Name Position Company Join Date MCU Date MCU Expiracy Status Keterangan
47 Driver PT. PDC 30-Dec-00 fit
48 Driver PT. PDC 30-Dec-00 fit
49 Driver PT. PDC 30-Dec-00 fit
50 Biyoga Ananto HSE Officer PT. PDC 30-Dec-00 fit
51 Dimas Okta HSE Officer PT. PDC 30-Dec-00 fit
52 HSE Officer PT. PDC 30-Dec-00 fit
53 Opt. Crane PT. PDC 30-Dec-00 fit
54 Opt. Crane PT. PDC 30-Dec-00 fit
55 Rigger PT. PDC 30-Dec-00 fit
56 Rigger PT. PDC 30-Dec-00 fit
57 30-Dec-00 fit
58 30-Dec-00 fit
59 30-Dec-00 fit
60 30-Dec-00 fit
61 30-Dec-00 fit
62 30-Dec-00 fit
63 30-Dec-00 fit
64 30-Dec-00 fit
65 30-Dec-00 fit
66 30-Dec-00 fit
67 30-Dec-00 fit
68 30-Dec-00 fit
69 30-Dec-00 fit
70 30-Dec-00 fit
71 30-Dec-00 fit
72 30-Dec-00 fit
73 30-Dec-00 fit
74 30-Dec-00 fit
75 30-Dec-00 fit
76 30-Dec-00 fit
77 30-Dec-00 fit
78 30-Dec-00 fit
79 30-Dec-00 fit
80 30-Dec-00 fit
81 30-Dec-00 Fit 2
82 30-Dec-00 fit
83 30-Dec-00 Fit
84 30-Dec-00 fit
85 30-Dec-00 fit
86 30-Dec-00 fit
87 30-Dec-00 Fit 2
88 30-Dec-00 Fit 2
89 30-Dec-00 fit
90 30-Dec-00 fit
91 30-Dec-00 fit
92 30-Dec-00 fit
93 30-Dec-00 fit
94 30-Dec-00 fit
95 30-Dec-00 fit
96 30-Dec-00
97 30-Dec-00
98 30-Dec-00
No. Doc. Tgl. Terbit
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PERSONNEL MEDICAL CHECK UP MONITORING SHEET Rev. Halaman
0 3 dari 4
No Name Position Company MCU Date MCU Expiracy Status Keterangan
96 30-Dec-00
97 30-Dec-00
98 30-Dec-00
99 30-Dec-00
100 30-Dec-00
101 30-Dec-00
102 30-Dec-00
103 30-Dec-00
104 30-Dec-00
105 30-Dec-00
106 30-Dec-00
107 30-Dec-00
108 30-Dec-00
109 30-Dec-00
110 30-Dec-00
111 30-Dec-00
112 30-Dec-00
113 30-Dec-00
114 30-Dec-00
115 30-Dec-00
116 30-Dec-00
117 30-Dec-00
118 30-Dec-00
119 30-Dec-00
120 30-Dec-00
121 30-Dec-00
122 30-Dec-00
123 30-Dec-00
124 30-Dec-00
125 30-Dec-00
126 30-Dec-00
127 30-Dec-00
128 30-Dec-00
129 30-Dec-00
130 30-Dec-00
131 30-Dec-00
132 30-Dec-00
133 30-Dec-00
134 30-Dec-00
135 30-Dec-00
136 30-Dec-00
137 30-Dec-00
138 30-Dec-00
139 30-Dec-00
140 30-Dec-00
141 30-Dec-00
142 30-Dec-00
143 30-Dec-00
144 30-Dec-00
 No. Doc. Tgl. Terbit
F-060 31.01.15
PERSONNEL MEDICAL CHECK UP MONITORING SHEET Rev. Halaman
0 4 dari 4

No Name Position Company MCU Date MCU Expiracy Status Keterangan

145 30-Dec-00
146 30-Dec-00
147 30-Dec-00
148 30-Dec-00
149 30-Dec-00
150 30-Dec-00
151 30-Dec-00
152 30-Dec-00
153 30-Dec-00
154 30-Dec-00
155 30-Dec-00
156 30-Dec-00
157 30-Dec-00
158 30-Dec-00
159 30-Dec-00
160 30-Dec-00
161 30-Dec-00
162 30-Dec-00
163 30-Dec-00
164 30-Dec-00
165 30-Dec-00
166 30-Dec-00
167 30-Dec-00
168 30-Dec-00
169 30-Dec-00
170 30-Dec-00
171 30-Dec-00
172 30-Dec-00
173 30-Dec-00
174 30-Dec-00
175 30-Dec-00
176 30-Dec-00
177 30-Dec-00
178 30-Dec-00
179 30-Dec-00
180 30-Dec-00
SUMMARY
Description Freq. % Description Freq. %
Total MCU Expired 0 0.00% Total Fit Personnel 91 100.00%
Total MCU Expired in the next 3 months 0 0.00% Total Unfit Personnel 0 0.00%
Total Valid MCU 91 100.00%
Remarks
 No. Doc. Tgl. Terbit
F-062 31.01.15
EQUIPMENT CERTIFICATE MONITORING SHEET Rev. Halaman
0 1 dari 2
12/30/2000 1/14/2022
Rig #REF! Project #REF!
Period #REF!

No Name of Equipment Brand Type Serial Number Certificate Number

Certificate Release Certificate Expiracy
1 Rig Petro Drill 515/55-879/PLO/DMT/2021 27-Jul-21 17-Jun-25
2 Crane
3 Crane
4 Overhead Crane
5 Overhead Crane
6 Forklift
7 Multi Gas Detector BW Technologies MAX XT II MA221-016821 30-Jul-21 29-Jan-22
8 Multi Gas Detector BW Technologies MAX XT II MA221-016830 30-Jul-21 29-Jan-22
9 Multi Gas Detector
10 Mesh Guard LEL
11 Mesh Guard LEL
12 Pressure Vessel
13 Pressure Vessel
14 Pressure Vessel
15 Pressure Vessel
16 Safety Valve (PSV)
17 Safety Valve (PSV)
18 Safety Valve (PSV)
19 Safety Valve (PSV)
20 Safety Valve (PSV)
21 Sound Level Meter LUTRON SL-4012 I.455904 S.NK2105-37 27-May-21 27-Nov-21
22 Lux Meter LUTRON LX-1102 S.035836 S.NK2105-043 27-May-21 27-Nov-21
23 Earth Tester Meter
24 BOP - Diverter
25 BOP - Annular
26 BOP - Single Ram
27 BOP - Annular 13-5/8" SK21023
28 BOP - Double Ram 13-5/8" SK21039
29 BOP - Annular 11" SK21018
30 BOP - Double Ram 11" SK21043
31 BOP - Single Ram
No. Doc. Tgl. Terbit
F-062 31.01.15
EQUIPMENT CERTIFICATE MONITORING SHEET Rev. Halaman
0 2 dari 2

No Name of Equipment Brand Type Serial Number Certificate Number Certificate Release Certificate Expiracy
32 Weight Indicator X20215
33 RPM Meter
34 SPM Meter
35 SPM Meter
36 PG - MP 2
37 PG - MP 1
38 PG - Stand Pipe
39 PG - Accumulator
40 PG - Accumulator
41 PG - Accumulator
42 PG - Drilling Console
43 PG - Remote Acc
44 PG - Remote Acc
45 PG - Remote Acc
46 PG - Remote Acc
47 Pressure Gauge
48 Pressure Tong Line Pul
49 PG - Super Choke
50 Top Drive
51 Fire Pump
52 Accumulator 20-47
53
54
55
56
 SAF

No. RIG SUMBER TANGGAL

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Sumber
1 = Government Inspection
2 = Inspection Report
3 = HSE Inspection & Internal Audit
4 = Management Walkthrough
5 = External Audit (ISO,OHSAS,ISRS)
6 = Accident Investigation
7 = Client's Audit
8 = Others finding
9=
SAFETY ACTION ITEM LIST (SAIL)

TEMUAN REKOMENDASI KATEGORI CLSR

RIG
PDSI #01.2/N80B-M Tools & Equipment
PDSI #02.2/IE900-E Safe Zone Position
PDSI #03.1/CWKM200-M Permit To Work
PDSI #04.3/N110-M Isolation
PDSI #05.2/OW760-M Confined Space
PDSI #06.2/N80UE Lifting Operation
PDSI #07.1/H30FD-M Fit To Work
PDSI #08.1/H40D-M Working At Height
PDSI #09.2/N80UE Personal Floatation Device
PDSI #10.2/D700-M System Override
PDSI #11.2/N80B-M Asset Integrity
PDSI #12.3/N110-M Driving Safety
PDSI #13.1/H40D-M Others
PDSI #14.4/MSH2000-M
PDSI #15.3/N110-M
PDSI #16.2/NT45-M
PDSI #17.2/NT45-M
PDSI #18.2/LTO650-M
PDSI #19.1/LTO350-M
PDSI #20.2/EMSCOD2-M
PDSI #21.2/OW700-M
PDSI #22.2/OW700-M
PDSI #23.1/CWKT210-M
PDSI #24.1/CWKT210-M
PDSI #25.2/LTO750-M
PDSI #26.1/H25CD-M
PDSI #27.1/KB-150-M
PDSI #28.2/D1000-E
PDSI #29.3/D1500-E
PDSI #30.2/D1000-E
PDSI #31.3/D1500-E
PDSI #32.2/N80UE
PDSI #33.1/IDECO-H35-M
PDSI #34.1/IDECO-H35-M
PDSI #35.1/IDECO-H35-M
PDSI #36.1/SKYTOP650-M
PDSI #37.3/F200-E
PDSI #38.2/D1000-E
PDSI #39.3/D1500-E
PDSI #40.4/LDW2000-E
PDSI #41.3/N110UE-E
PDSI #42.3/N1500-E
PDSI #43.3/AB1500-E
N55XC
APS 1502
APS 2001
 No. Doc. Tgl. Terbit
F-064 20.03.20
Rev. Halaman
1 1 dari 2

PIC TINDAK LANJUT DUE DATE STATUS

Status
Open
Close
In Progress
Overdue
Nama Form : SAIL (Safety Action Item List)
Latar Belakang : Masih banyaknya temuan-temuan yang tidak termonitor
Fungsi Form : Untuk memonitor temuan-temuan
Sumber Temuan :
- Goverment Inspection
- Inspection Report
- HSE Inspection & Internal Audit
- Management Walkthrough
- External Audit (ISRS, ISO & OHSAS)
- Accident Investigation
- Client's Audit
- Others Finding
Cara Kerja Form :
- Apabila ada temuan dari sumber tersebut di atas, harap di register (Di input) di halaman
ini, nantinya semua temuan akan di monitor per masing-masing Rig
 No. Doc. Tgl. Terbit
HSE PROGRAM IMPLEMENTATION F-063 31.01.15
MONITORING SHEET Rev. Halaman
0 1 dari 2
30-Dec-00 1/14/2022
Rig : Rig PDSI#51.2/PD550-M Project : PHR WK Rokan
Period : 08/01/2022

No. Activity Implementation Date HSE Officer In Charge Remarks

1 Weekly HSE Meeting 02 Januari 2022 Gifianando/Raffi Uddin
2 Weekly HSE Meeting
3 Weekly HSE Meeting
4 Weekly HSE Meeting
5 Fire Extinguisher Inspection
6 Fire Pump Inspection 07 Januari 2022 Gifianando/Raffi Uddin
7 Fire Pump Inspection
8 Fire Pump Inspection
9 Fire Pump Inspection
10 Eyewash & Shower Station Insp. 03 Januari 2022 Gifianando/Raffi Uddin
11 Eyewash & Shower Station Insp.
12 Eyewash & Shower Station Insp.
13 Eyewash & Shower Station Insp.
14 PPE Inspection 03 Januari 2022 Gifianando/Raffi Uddin
15 PPE Inspection
16 PPE Inspection
17 PPE Inspection
18 Welding unit inspection 03 Januari 2022
19 Welding unit inspection
20 Welding unit inspection
21 Welding unit inspection
22 Fall Arresting Equipment
23 Camp & Hygiene Inspection
24 Camp & Hygiene Inspection
25 Camp & Hygiene Inspection
26 Camp & Hygiene Inspection 07 Januari 2022 Gifianando/Raffi Uddin
27 SCBA Inspection
28 Light Vehicle Inspection 03 Januari 2022 Gifianando/Raffi Uddin
29 Light Vehicle Inspection
30 Light Vehicle Inspection
31 Light Vehicle Inspection
32 Light Vehicle Inspection
33 Heavy Vehicle Inspection
34 Heavy Vehicle Inspection
35 Drop Object Inspection 03 Januari 2022
36 Drop Object Inspection
37 Drop Object Inspection
38 Drop Object Inspection
39 Spill Kit Inspection N/A
40 Spill Kit Inspection N/A
41 Spill Kit Inspection N/A
42 Spill Kit Inspection N/A
43 Hand & Finger Injury Inspection 03 Januari 2022 Gifianando/Raffi Uddin
44 Hand & Finger Injury Inspection
 No. Doc. Tgl. Terbit
HSE PROGRAM IMPLEMENTATION F-063 31.01.15
MONITORING SHEET Rev. Halaman
0 2 dari 2

No. Activity Implementation Date HSE Officer In Charge Remarks

45 Hand & Finger Injury Inspection
46 Hand & Finger Injury Inspection
47 Noise Measurement/Mapping
48 Light Measurement
49 Fire Drill
50 Kick Drill
51 Abandon Drill
52 Medivac Drill
53 HSE General inspection
54
55
56
57
58
59
60
 HSE MEETING RECA

No. Tanggal Jenis Meeting

1 01/01/2022 Tail Gate Meeting

07.00 Wib

2 01/01/2022 Tail Gate Meeting

19.00 Wib

3 02/01/2022 Tail Gate Meeting

07.00 Wib
4 02/01/2022 Tail Gate Meeting

07.00 Wib

5 03/01/2022 Tail Gate Meeting

07.00 Wib

6 03/01/2022 Tail Gate Meeting

19.00 Wib
7 04/01/2022 Tail Gate Meeting

07.00 Wib

8 04/01/2022 Tail Gate Meeting

19.00 Wib

9 05/01/2022 Tail Gate Meeting

07.00 Wib
10 05/01/2022 Tail Gate Meeting

19.00 Wib

11 06/01/2022 Tail Gate Meeting

07.00 Wib

12 06/01/2022 Tail Gate Meeting

19.00 Wib
13 07/01/2022 Tail Gate Meeting

07.00 Wib

14 07/01/2022 Tail Gate Meeting

19.00 Wib

15 08/01/2022 Tail Gate Meeting

07.00 Wib
16 08/01/2022 Tail Gate Meeting

19.00 Wib

17
18
19
20
21
22

23
24
25

26
27

28

29
30
31

32

33
34

35
36
37
39
40
41
42
43
44
45

46
47
48
49
50
51
52

53
54
55
56

57
58
59
60

61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
 93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
Jenis Meeting
Tail Gate Meeting
Weekly Meeting
Pre Job Safety Meeting
Safety Stand Down Meeting
 HSE MEETING RECAPITULATION FORM

Topik Meeting
Program Kerja::
- Packing peralatan dan persiapan moving
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan
Program Kerja::
- Packing peralatan dan persiapan moving
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Onsute Training APAR
- Review POA
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan
Program Kerja::
- Packing peralatan dan persiapan moving
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Moving ke lokasi baru
- Loading Equipment
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan
Program Kerja::
- Packing peralatan dan persiapan moving
- Install Durrabase
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Loading Unloading Equipment
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Loading Unloading Equipment
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan
Program Kerja::
- Packing peralatan dan persiapan moving
- Loading Unloading Equipment
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Loading Unloading Equipment
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan

Program Kerja::
- Packing peralatan dan persiapan moving
- Loading Unloading Equipment
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan
Program Kerja::
- Packing peralatan dan persiapan moving
- Loading Unloading Equipment
- Maintenaince dan houskeeping

'Aspek HSE
- Terapkan protocol covid-19
- Buat dan sosialisasikan SIKA dan JSA kepada semua personil yang terlibat pekerjaan
- Pastikan CLSR di pahami dan di sosialisaikan
- Gunakan PPE dengan lengkap
- Jauhi line of firer
- Onsite Training
- Hindari posisi jari pada pitch point
- Gunakan double tagline saat pengangkatan
 No. Tgl. Terbit
F-065 01.07.15
Rev Halaman
0

Pembicara Participan Durasi

Companyman, Rig Supt, 22 30
Toolpusher & HSE Officer

Companyman, Rig Supt, 22 30

Toolpusher & HSE Officer

Companyman, Rig Supt, 22 30

Toolpusher & HSE Officer
Companyman, Rig Supt, 22 30
Toolpusher & HSE Officer

Companyman, Rig Supt, 22 30

Toolpusher & HSE Officer

Companyman, Rig Supt, 22 30

Toolpusher & HSE Officer
Companyman, Rig Supt, 22 30
Toolpusher & HSE Officer

Companyman, Rig Supt, 22 30

Toolpusher & HSE Officer

Companyman, Rig Supt, 22 30

Toolpusher & HSE Officer
Companyman, Rig Supt, 22 60
Toolpusher & HSE Officer

Companyman, Rig Supt, 22 60

Toolpusher & HSE Officer

Companyman, Rig Supt, 22 60

Toolpusher & HSE Officer
Companyman, Rig Supt, 22 45
Toolpusher & HSE Officer

Companyman, Rig Supt, 22 45

Toolpusher & HSE Officer

Companyman, Rig Supt, 22 45

Toolpusher & HSE Officer
Companyman, Rig Supt, 22 45
Toolpusher & HSE Officer
membantu agar DP kembali keposisi semula.
 JSA RECAPITULAT

Rig :RIG PDSI#51.2/PD550-M

Project PHR

Sumur / Lokasi
No. Tanggal
Rig
1 1-Jan-22 Bangko P-15
2 1-Jan-22 Bangko P-15
3 1-Jan-22 Bangko P-15
4 2-Jan-22 Bangko P-15
5 2-Jan-22 Bangko P-15
6 2-Jan-22 Bangko P-15
7 3-Jan-22 Bangko P-15
8 3-Jan-22 Bangko P-15
9 3-Jan-22 Bangko P-15
10 4-Jan-22 Bangko P-15
11 5-Jan-22 Bangko P-15
12 5-Jan-22 Bangko P-15
13 5-Jan-22 Bangko P-15
14 6-Jan-22 Bangko P-15
15 7-Jan-22 Bangko P-15
16 8-Jan-22 Bangko P.18
17 8-Jan-22 Bangko P.18
18 30-Dec-99 30-Dec-99
19 30-Dec-99 30-Dec-99
20 30-Dec-99 30-Dec-99
21 30-Dec-99 30-Dec-99
22 30-Dec-99 30-Dec-99
23 30-Dec-99 30-Dec-99
24 30-Dec-99 30-Dec-99
25 30-Dec-99 30-Dec-99
26 30-Dec-99 30-Dec-99
27 30-Dec-99 30-Dec-99
28 30-Dec-99 30-Dec-99
29 30-Dec-99 30-Dec-99
30 30-Dec-99 30-Dec-99
31 30-Dec-99 30-Dec-99
32 30-Dec-99 30-Dec-99
33 30-Dec-99 30-Dec-99
34 30-Dec-99 30-Dec-99
35 30-Dec-99 30-Dec-99
36 30-Dec-99 30-Dec-99
37 30-Dec-99 30-Dec-99
38 30-Dec-99 30-Dec-99
39 30-Dec-99 30-Dec-99
40 30-Dec-99 30-Dec-99
41 30-Dec-99 30-Dec-99
42 30-Dec-99 30-Dec-99
43 30-Dec-99 30-Dec-99
44 30-Dec-99 30-Dec-99
45 30-Dec-99 30-Dec-99
46 30-Dec-99 30-Dec-99
47 30-Dec-99 30-Dec-99
48 30-Dec-99 30-Dec-99
49 30-Dec-99 30-Dec-99
50 30-Dec-99 30-Dec-99
51 30-Dec-99 30-Dec-99
52 30-Dec-99 30-Dec-99
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
 91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
 JSA RECAPITULATION FORM

Pekerjaan Lokasi Pekerjaan

Pembuatan tempat APAB RIG SITE
Pengecatan pompa tanki solar RIG SITE
Reparasi IBOP RIG SITE
Housekeeping peralatan RIG SITE
Pengecatan peralatan RIG SITE
Pemberisihan Trip Tank RIG SITE
Pengelasan Pad eye Rotary table RIG SITE
Housekeeping and Maintanance RIG SITE
Pengelasan Stand POB RIG SITE
Safety Patrol RIG SITE
Moving Rig Equipment RIG SITE
Loading Equipment RIG SITE
Install Durrabase di Lokasi BNK P-18 RIG SITE
Loading Unloading RIG Equipment RIG SITE
Dress Up Lokasi RIG SITE
Set Mud tank RIG SITE
Install Lightening Rig Site RIG SITE
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
 No.
F-066
Rev
0

Period Jan-22

Pengawas Pekerjaan Rig Supt. In Charge

Ali Syamsir Lubis Syafrimel
Ali Syamsir Lubis Syafrimel
David Palendra Syafrimel
Ali Syamsir Lubis Syafrimel
Ali Syamsir Lubis Syafrimel
Ali Syamsir Lubis Syafrimel
Ali Syamsir Lubis Syafrimel
David Palendra Syafrimel
David Palendra Syafrimel
David Palendra Syafrimel
Zulmahendra Syafrimel
Panas Syafrimel
Ali Syamsir Lubis Syafrimel
Zulmahendra Syafrimel
Zulmahendra Syafrimel
Zulmahendra Syafrimel
Ali Syamsir Lubis Syafrimel
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
30-Dec-99 30-Dec-99
 Tgl. Terbit
01.07.15
Halaman
-

HSE Officer in Charge

RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
RAFI/NANDO
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
30-Dec-99
 No. Tgl. Terbit
F-067 01.07.15
PERMIT TO WORK REGISTER
Rev Halaman
0 -

Rig :RIG PDSI#51.2/PD550-M Period Jan-22

Project PHR

Sumur /
No. Tanggal Lokasi Rig Nomor PTW No Isolasi Jenis PTW Pekerjaan Lokasi Pekerjaan PTW Coordinator Performing Authority Site Authority Area Authority
1 1-Jan-22 Bangko P-15 001/PDSI/P-015/I/22 Panas Pembuatan tempat APAB RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Ivon
2 1-Jan-22 Bangko P-15 002/PDSI/P-015/I/22 Dingin Pengecatan pompa tanki solar RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Ivon
3 1-Jan-22 Bangko P-15 003/PDSI/P-015/I/22 Dingin Reparasi IBOP RIG SITE RAFI/NANDO David Palendra Syafrimel Roy Wicaksono
4 2-Jan-22 Bangko P-15 004/PDSI/P-015/I/22 Dingin Housekeeping peralatan RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Ivon
5 2-Jan-22 Bangko P-15 005/PDSI/P-015/I/22 Dingin Pengecatan peralatan RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Ivon
6 2-Jan-22 Bangko P-15 006/PDSI/P-015/I/22 Ruang Terbatas Pemberisihan Trip Tank RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Ivon
7 3-Jan-22 Bangko P-15 007/PDSI/P-015/I/22 Panas Pengelasan Pad eye Rotary table RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Ivon
8 3-Jan-22 Bangko P-15 008/PDSI/P-015/I/22 Dingin Housekeeping and Maintanance RIG SITE RAFI/NANDO David Palendra Syafrimel Roy Wicaksono
9 3-Jan-22 Bangko P-15 009/PDSI/P-015/I/22 Panas Pengelasan Stand POB RIG SITE RAFI/NANDO David Palendra Syafrimel Roy Wicaksono
10 4-Jan-22 Bangko P-15 010/PDSI/P-015/I/22 Dingin Safety Patrol RIG SITE RAFI/NANDO David Palendra Syafrimel Roy Wicaksono
11 5-Jan-22 Bangko P-15 011/PDSI/P-015/I/22 Dingin Moving Rig Equipment RIG SITE RAFI/NANDO Zulmahendra Syafrimel Ivon
12 5-Jan-22 Bangko P-15 012/PDSI/P-015/I/22 Dingin Loading Equipment RIG SITE RAFI/NANDO Zulmahendra Syafrimel Ivon
13 5-Jan-22 Bangko P-15 013/PDSI/P-015/I/22 Dingin Install Durrabase di Lokasi BNK P-18 RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Roy Wicaksono
14 6-Jan-22 Bangko P-15 014/PDSI/P-015/I/22 Dingin Loading Unloading RIG Equipment RIG SITE RAFI/NANDO Zulmahendra Syafrimel Ivon
15 7-Jan-22 Bangko P-15 015/PDSI/P-015/I/22 Dingin Dress Up Lokasi RIG SITE RAFI/NANDO Zulmahendra Syafrimel Ivon
16 8-Jan-22 Bangko P.18 016/PDSI/P-018/I/22 Dingin Set Mud tank RIG SITE RAFI/NANDO Zulmahendra Syafrimel Ivon
17 8-Jan-22 Bangko P.18 017/PDSI/P-018/I/22 Dingin Install Lightening Rig Site RIG SITE RAFI/NANDO Ali Syamsir Lubis Syafrimel Roy Wicaksono
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85 -
86 -
87 -
88 -
89 -
90 -
91 -
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
 No. Doc. Tgl. Terbit
MONTHLY PENGAMATAN KESELAMATAN KERJA (PEKA) F-068 20.03.20
MONITORING SHEET Rev. Halaman
3 1 dari 3

Rig Name :RIG PDSI#51.2/PD550-M Project : PHR

Period 1-Jan-22

PENGAMATAN KESELAMATAN KERJA (PEKA) REPORTED

Date
Category
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Safe Action 10 11 12 8 9 8 9 10
Safe Condition 17 13 14 6 8 7 6 5
Unsafe Action 2 2 0 1 2 3 2 2
Unsafe Condition 2 3 1 1 2 1 1 2
Nearmiss 0 0 0 0 0 0 0 0
TOTAL 31 29 27 16 21 19 18 19 0 0 0 0 0 0 0 0

Date
Category
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Safe Action
Safe Condition
Unsafe Action
Unsafe Condition
Nearmiss
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

YEARLY MONITORING
MONTH Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Safe Action 77
Safe Condition 76
Unsafe Action 14
Unsafe Condition 13
Nearmiss 0
TOTAL 180 0 0 0 0 0 0 0 0 0 0 0
 No. Doc. Tgl. Terbit
MONTHLY PENGAMATAN KESELAMATAN KERJA (PEKA) F-068 20.03.20
MONITORING SHEET Rev. Halaman
3 2 dari 3

PENGAMATAN KESELAMATAN KERJA (PEKA) PARTICIPATION

Personnel Date
Classification 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PDSI Employees 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PDSI Contractor 9 11 9 5 8 9 8 8 0 0 0 0 0 0 0 0
Client's Personnel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Services Company 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Personnel Date
Classification 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PDSI Employees
PDSI Contractor
Client's Personnel
Services Company

PEKA CLOSING STATUS MONITORING

JAN FEB MAR APR MAY JUN JUL AUG
STATUS
Qty. % Close Qty. % Close Qty. % Close Qty. % Close Qty. % Close Qty. % Close Qty. % Close Qty. % Close
OPEN 0 0 0 0 0 0 0 0
CLOSE 180 100.00% 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
TOTAL 180 0 0 0 0 0 0 0
SEPT OKT NOV DES YTD CLOSING STATUS
STATUS
Qty. % Close Qty. % Close Qty. % Close Qty. % Close STATUS QTY % CLOSE
OPEN 0 0 0 0 OPEN 0
CLOSE
TOTAL
0
0
#DIV/0! 0
0
#DIV/0! 0
0
#DIV/0! 0
0
#DIV/0! CLOSE
TOTAL
180
180
100.00%
 No. Doc. Tgl. Terbit
MONTHLY PENGAMATAN KESELAMATAN KERJA (PEKA) F-068 20.03.20
MONITORING SHEET Rev. Halaman
3 3 dari 3

YEARLY MONITORING - CLSR

MONTH Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Tools & Equipment - UA 0
Tools & Equipment - UC 0
Safe Zone Position - UA 0
Safe Zone Position - UC 0
Permit To Work - UA 0
Permit To Work - UC 0
Isolation - UA 0
Isolation - UC 0
Confined Space - UA 0
Confined Space - UC 0
Lifting Operation - UA 0
Lifting Operation - UC 0
Fit To Work - UA 0
Fit To Work - UC 0
Working At Height - UA 0
Working At Height - UC 0
Personal Floatation Device - UA 0
Personal Floatation Device - UC 0
System Override - UA 0
System Override - UC 0
Asset Integrity - UA 0
Asset Integrity - UC 0
Driving Safety - UA 76
Driving Safety - UC 76
Others - UA 76
Others - UC 76
TOTAL 304 0 0 0 0 0 0 0 0 0 0 0
 No. Doc. Tgl. Terbit
F-070 29.01.16
KM TRAVELED MONITORING SHEET Rev. Halaman
0 1 dari 1

Rig Name :RIG PDSI#51.2/PD550-M Project : PHR

Period 1-Jan-22

MONTHLY MONITORING
Date
Classification
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Light Vehicle 234 112 132 123 120 118 96 101
Heavy Vehicle 0 0 0 0 56 28 32 33
TOTAL 234 112 132 123 176 146 128 134 0 0 0 0 0 0 0 0
Personnel Date
TOTAL
Classification 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Light Vehicle 1036
Heavy Vehicle 149
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1185

YEARLY MONITORING
Month
Classification
JAN FEB MAR APR MAY JUN JUL
Light Vehicle 1036
Heavy Vehicle 149
TOTAL 1185 0 0 0 0 0 0
Month
Classification TOTAL
AUG SEP OCT NOP DES
Light Vehicle 1185
Heavy Vehicle 1185
TOTAL 0 0 0 0 0
 MONTHLY RIG STATUS MONITORING SHEET

Rig Name :RIG PDSI#51.2/PD550-M Project : PHR

Period 1-Jan-22

DAILY MONITORING
Date
Classification
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Operation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rig Move 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0
Rig Up 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rig Down 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Idle 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0

Date
Classification
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Operation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rig Move 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rig Up 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rig Down 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Idle 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

MONTHLY RECAPITULATION
Classification Summary (Day)

Operation 0
Rig Move 4
Rig Up 0 0
Rig Down 0 0
Idle 4 4
TOTAL 8
 No. Doc. Tgl. Terbit

PERSONNEL TRAINING MONITORING SHEET Rev. Halaman

12/30/2000 1/14/2022
Rig :RIG PDSI#51.2/PD550-M
Period Jan-22

Training
No Name Position Jumlah Modul Certificate Release Certificate Expiracy Remarks
1 ARIF ANWAR RIG SUPT 21 Materi 27-Nov-21 18-Nov-22
2 SYAFRIMEL RIGSUPT 22 Materi 27-Nov-21 18-Nov-22
3 GIFIANANDO ALMUTTAQIN HSE 16 Materi 27-Nov-21 18-Nov-22
4 RAFI UDDIN HSE 16 Materi 27-Nov-21 18-Nov-22
5 FIRMANSYAH A HSE 16 Materi 27-Nov-21 18-Nov-22
6 M. ARIF EKA PUTRA CLERK 21 Materi 27-Nov-21 18-Nov-22
7 FERLY RAMADHAN CLERK 21 Materi 27-Nov-21 18-Nov-22
8 NOVIAR STOREKEEPER 21 Materi 27-Nov-21 18-Nov-22
9 DAVID PALENDRA TOOL PUSHER 21 Materi 27-Nov-21 18-Nov-22
10 IMAM DRILLER 21 Materi 27-Nov-21 18-Nov-22
11 ANGGIAT PUTAR PUTAR DERRICKMAN 21 Materi 27-Nov-21 18-Nov-22
12 RAMDON RIZAL FLOORMAN 21 Materi 27-Nov-21 18-Nov-22
13 FAJRI A FLOORMAN 21 Materi 27-Nov-21 18-Nov-22
14 MARIO PRATAMA FLOORMAN 21 Materi 27-Nov-21 18-Nov-22
15 HENDRI SAPUTRA FLOORMAN 21 Materi 27-Nov-21 18-Nov-22
16 EDDY JUNAIDI CHIEF MEKANIK 21 Materi 27-Nov-21 18-Nov-22
17 MULKIES MEKANIK 21 Materi 27-Nov-21 18-Nov-22
18 RAHMAT RIDWAN ELECTRIC 21 Materi 27-Nov-21 18-Nov-22
19 RANDY HIDAYAT MUD BOY 21 Materi 27-Nov-21 18-Nov-22
20 SUPRIADI MOTORIST 21 Materi 27-Nov-21 18-Nov-22
21 SUHENDRA ROUSTABOT 21 Materi 27-Nov-21 18-Nov-22
22 JHONNY KURNIAWAN ROUSTABOT 21 Materi 27-Nov-21 18-Nov-22
23 HANTARSYAH WELDER 21 Materi 27-Nov-21 18-Nov-22
24 ZULMAHENDRA TOOLPUSHER 21 Materi 27-Nov-21 18-Nov-22
25 SOLAH DRILLER 21 Materi 27-Nov-21 18-Nov-22
26 RAHMAT MUSTAKIN DERRIKMAN 21 Materi 27-Nov-21 18-Nov-22
27 RIDHO SILABAN FLOORMAN 21 Materi 27-Nov-21 18-Nov-22
28 RIDHO ALDINO FLOORMAN 21 Materi 27-Nov-21 18-Nov-22
 No. Doc. Tgl. Terbit
F-061 31.01.15
PERSONNEL CERTIFICATE MONITORING SHEET Rev. Halaman
0 1 dari 4

No Name Position Type of Certificate Certificate Release Certificate Expiracy Remarks

29 EMIL T.R FLOORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
30 RIANSYAH FLOORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
31 ARIANSYAH FLOORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
32 SUGIHARTO MUD BOY HSE Online Trainng 27-Nov-21 18-Nov-22
33 IRFAN MEKANIK HSE Online Trainng 27-Nov-21 18-Nov-22
34 SULAIMAN MOTORIST HSE Online Trainng 27-Nov-21 18-Nov-22
35 NOFRIADI ELEKTRIK HSE Online Trainng 27-Nov-21 18-Nov-22
36 EKO SUHARMONO WELDER HSE Online Trainng 27-Nov-21 18-Nov-22
37 M. Al ASARI Rostabout HSE Online Trainng 27-Nov-21 18-Nov-22
38 WAN PADLI Rostabout HSE Online Trainng 27-Nov-21 18-Nov-22
39 ALI SYAMSIR LUBIS TOOLPUSHER HSE Online Trainng 27-Nov-21 18-Nov-22
40 AMRIZAL DRILLER HSE Online Trainng 27-Nov-21 18-Nov-22
41 OKTA PIANDES DERRIKMAN HSE Online Trainng 27-Nov-21 18-Nov-22
42 TEDDY ERVANSYAH FLOORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
43 SAPARUDIN FLOORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
44 ARIF SOBIRIN FLOORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
45 RIDHO SILABAN FLOORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
46 AHMAD YUNI MEKANIK HSE Online Trainng 27-Nov-21 18-Nov-22
47 MUHAMMAD ILHAM ELEKTRIK HSE Online Trainng 27-Nov-21 18-Nov-22
48 OSCAR ALDI PRATAMA MOTORMAN HSE Online Trainng 27-Nov-21 18-Nov-22
49 HENDRA R ROUSTABOT HSE Online Trainng 27-Nov-21 18-Nov-22
50 RIZKI BAYUNA ROUSTABOT HSE Online Trainng 27-Nov-21 18-Nov-22
51 M. IRYAWAN BASYUNI MUD BOY HSE Online Trainng 27-Nov-21 18-Nov-22
52 BADI UZZAMAN WELDER HSE Online Trainng 27-Nov-21 18-Nov-22
53 AULIL AMRI DRIVER HSE Online Trainng 27-Nov-21 18-Nov-22
54 AZRIL SYAKIRMAN DRIVER HSE Online Trainng 27-Nov-21 18-Nov-22
55 ADE DRIVER HSE Online Trainng 27-Nov-21 18-Nov-22
56 MOH ABDULLAH DRIVER HSE Online Trainng 27-Nov-21 18-Nov-22
57
58
59
60
 61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
SUMMARY
WELL CONTROL CERTIFICATE
Description Freq. % Freq. %
Total Certificate Expired 26 32.50% 0 #DIV/0!
Total Certificate Expired in the Next 3 months 0 0.00% 0 #DIV/0!
Valid Certificate 54 67.50% 0 #DIV/0!
Rig Name :RIG PDSI#51.2/PD550-M
Period 1-Jan-22

TANGGAL JAM TINGKAT

NO RIG LOKASI PROJECT
KEJADIAN KEJADIAN KEPARAHAN

1 01 Januari 2020 Ringan

2 01 Januari 2020 Sedang
3 01 Januari 2020 Berat
4 01 Januari 2020 Berat
5 01 Januari 2020 Berat
6 01 Januari 2020 Berat
 Project : PHR

HSE
KATEGORI KLASIFIKASI RIG SUPT. TOOLPUSHER KRONOLOGIS
OFFICER
INSIDEN KECELAKAAN INCHARGE INCHARGE KEJADIAN NAMA
INCHARGE
KORBAN
PD Non Tambang
FAC Non Tambang
MTC Non Tambang
RWC Tambang
LTI / DAFW Tambang
FAT Tambang
 MONTHLY INCIDENT MONITORING S

KASUS KECELAKAAN BERAKIBAT CEDERA (INJURY)

ANGGOTA
PENGALAM TUBUH DESKRIPSI PENYEBAB PENANGANAN
USIA JABATAN
AN YANG CEDERA CEDERA CEDERA
CEDERA
DENT MONITORING SHEET

KASUS KECELAKAAN YANG MENGAKIBATKAN KERUSAKAN HARTA BENDA

(PROPERTY DAMAGE)
BIAYA JENIS PERBAIKAN
HARI KERJA DESKRIPSI PENYEBAB BIAYA
PENGOBAT PROPERTY YANG
HILANG KERUSAKAN KERUSAKAN PERBAIKAN
AN YANG RUSAK DILAKUKAN
 PENYEBAB TERJADINYA KECELAKAAN TINDAKAN PERBAIKAN (CORRECTIVE ACTION)

UNSAFE UNSAFE PERSONAL ROOT REKOMENDASI PERBAIKAN YANG

JOB FACTOR
ACTION CONDITION FACTOR CAUSE PERBAIKAN DILAKUKAN
 No. Doc. Tgl. Terbit

Rev. Halaman

(CORRECTIVE ACTION)
INVESTIGATION LEARNING
INVESTIGATION
PRESENTATION FROM EVENT
REPORT STATUS
STATUS STATUS STATUS
Tingkat Keparahan Kategori Klasifikasi Status

Ringan PD Tambang Open

Sedang FAC Non Tambang Closed
Berat MTC In Progress
RWC Overdue
LTI / DAFW
FAT

Note : PD Property Damage

FAC First Aid Case
MTC Medical Treatment Case
RWC Restricted Work Case
LTI / DAFW Lost Time Incident / Days Away
FAT From Work
Fatality
Rig Name :RIG PDSI#51.2/PD550-M
Period 1-Jan-22

TANGGAL
NO JAM KEJADIAN RIG LOKASI PROJECT
KEJADIAN

1
2
3
4
 MONTHLY NEARMISS MONITORING SHE

Project

POTENSI
KEPARAHAN JIKA
KRONOLOGIS KEJADIAN PENYEBAB LANGSUNG
TERJADI
KECELAKAAN
Unsafe Action
S MONITORING SHEET

: PHR

ANALISA PENYEBAB

PENYEBAB LANGSUNG PENYEBAB DASAR

Unsafe Condition JOB FACTOR PERSONAL FACTOR

 No. Doc. Tgl. Terbit

Rev. Halaman

TINDAKAN PERBAIKAN (CORRECTIVE ACTION)

STATUS

PERBAIKAN YANG
REKOMENDASI PERBAIKAN
DILAKUKAN
Tingkat Keparahan Status

Ringan Open
Sedang Closed
Berat In Progress
Overdue
Rig Name :RIG PDSI#51.2/PD550-M
Period 1-Jan-22

Category Kode Barang

APD APD-001
APD APD-002
APD APD-003
APD APD-004
APD APD-005
APD APD-006
APD APD-007
APD APD-008
APD APD-009
APD APD-010
APD APD-011
APD APD-012
APD APD-013
APD APD-014
APD APD-015
APD APD-016
APD APD-017
APD APD-018
APD APD-019
APD APD-020
APD APD-021
APD APD-022
APD APD-023
APD APD-024
APD APD-025
APD APD-026
APD APD-027
APD APD-028
APD APD-029
APD APD-030
APD APD-031
APD APD-032
APD APD-033
APD APD-034
APD APD-035
APD APD-036
APD APD-037
APD APD-038
APD APD-039
APD APD-040
APD APD-041
APD APD-042
APD APD-043
APD APD-044
APD APD-045
APD APD-046
APD APD-047
APD APD-048
APD APD-049
APD APD-050
APD APD-051
APD APD-052
APD APD-053
APD APD-054
APD APD-055
APD APD-056
APD APD-057
APD APD-058
APD APD-059
APD APD-060
APD APD-061
APD APD-062
APD APD-063
APD APD-064
APD APD-065
APD APD-066
APD APD-067
APD APD-068
APD APD-069
APD APD-070
APD APD-071
APD APD-072
APD APD-073
APD APD-074
APD APD-075
APD APD-076
APD APD-077
APD APD-078
APD APD-079
APD APD-080
APD APD-081
APD APD-082
APD APD-083
APD APD-084
APD APD-085
APD APD-086
APD APD-087
APD APD-088
APD APD-089
APD APD-090
APD APD-091
 APD APD-092
APD APD-093
APD APD-094
APD APD-095
APD APD-096
APD APD-097
APD APD-098
APD APD-099
APD APD-100
APD APD-101
APD APD-102
APD APD-103
APD APD-104
APD APD-105
APD APD-106
APD APD-107
APD APD-108
APD APD-109
APD APD-110
APD APD-111
APD APD-112
APD APD-113
APD APD-114
APD APD-115
APD APD-116
APD APD-117
APD APD-118
APD APD-119
APD APD-120
APD APD-121
APD APD-122
APD APD-123
APD APD-124
APD APD-125
APD APD-126
APD APD-127
APD APD-128
APD APD-129
Dokumen HSE-001
Dokumen HSE-002
Dokumen HSE-003
Dokumen HSE-004
Dokumen HSE-005
Dokumen HSE-006
Dokumen HSE-007
Dokumen HSE-008
Dokumen HSE-009
Safety Sign HSE-010
Safety Sign HSE-011
Safety Sign HSE-012
 Safety Sign HSE-013
Safety Sign HSE-014
Safety Sign HSE-015
Safety Sign HSE-016
Safety Sign HSE-017
Safety Sign HSE-018
Safety Sign HSE-019
Safety Sign HSE-020
Safety Sign HSE-021
Safety Sign HSE-022
Safety Sign HSE-023
Safety Sign HSE-024
Safety Sign HSE-025
Safety Sign HSE-026
Safety Sign HSE-027
Safety Sign HSE-028
Safety Sign HSE-029
Safety Sign HSE-030
Safety Sign HSE-031
Safety Sign HSE-032
Safety Sign HSE-033
Safety Sign HSE-034
Safety Sign HSE-035
Safety Sign HSE-036
Safety Sign HSE-037
Safety Sign HSE-038
Safety Sign HSE-039
Safety Sign HSE-040
Safety Sign HSE-041
Safety Sign HSE-042
Safety Sign HSE-043
Safety Sign HSE-044
Safety Sign HSE-045
Safety Sign HSE-046
Safety Sign HSE-047
Bendera HSE-048
Bendera HSE-049
Bendera HSE-050
Bendera HSE-051
Detector HSE-052
Detector HSE-053
Detector HSE-054
Detector HSE-055
Detector HSE-056
Detector HSE-057
Detector HSE-058
Detector HSE-059
Detector HSE-060
Detector HSE-061
Emergency Kit HSE-062
Emergency Kit HSE-063
Emergency Kit HSE-064
Emergency Kit HSE-065
Emergency Kit HSE-066
Emergency Kit HSE-067
Emergency Kit HSE-068
Emergency Kit HSE-069
Emergency Kit HSE-070
Emergency Kit HSE-071
Emergency Kit HSE-072
Emergency Kit HSE-073
Emergency Kit HSE-074
Confined Space HSE-075
Confined Space HSE-076
Confined Space HSE-077
Environment HSE-078
Environment HSE-079
Environment HSE-080
Environment HSE-081
Environment HSE-082
Fire Fighting HSE-083
Fire Fighting HSE-084
Fire Fighting HSE-085
Fire Fighting HSE-086
Fire Fighting HSE-087
Fire Fighting HSE-088
Fire Fighting HSE-089
Fire Fighting HSE-090
Fire Fighting HSE-091
Fire Fighting HSE-092
Fire Fighting HSE-093
Fire Fighting HSE-094
Fire Fighting HSE-095
Fire Fighting HSE-096
LOTO HSE-097
LOTO HSE-098
Lifting HSE-099
Lifting HSE-100
Lifting HSE-101
Lifting HSE-102
Lifting HSE-103
Lifting HSE-104
Lifting HSE-105
Lifting HSE-106
Lifting HSE-107
Work at Height HSE-108
Work at Height HSE-109
Work at Height HSE-110
Work at Height HSE-111
Work at Height HSE-112
Work at Height HSE-113
Additional HSE-114
Additional HSE-115
Additional HSE-116
 DAILY STOCK PERSONAL PROTECTION EQUIPMENT MONITORIN

Project

Nama Barang Satuan Stok Awal

Safety Helmet (Merah) Pcs 0
Safety Helmet (Putih) Pcs 0
Safety Helmet (Orange) Pcs 0
Safety Helmet (Hijau) Pcs kotak
Safety Helmet (Kuning) Pcs 0
Safety Helmet (Biru) Pcs 0
Chin Strap Pcs 150
Safety Glasess (Clear) Pcs 25
Safety Glasess (Black) Pcs 0
Safety Glasess (Anti Fog) Pcs 0
Safety Goggles Pcs 0
Welding Glasess Pcs 0
Topeng Las Pcs 0
Face Shields Pcs 0
Mask (Dust) Pcs 20
Mask (Half) Pcs 5
Mask (Catridge) Pcs 18
Mask (Canister) Pcs 0
Mask (Filter) Pcs 0
Mask (Gas) Pcs 0
Mask (BTX) Box 0
Ear Plug (Disposable) Box 0
Ear Plug (Personal) Pcs 0
Ear Muff Pcs 0
Coverall (Cotton) - Size S Pcs 0
Coverall (Cotton) - Size M Pcs 0
Coverall (Cotton) - Size L Pcs 0
Coverall (Cotton) - Size XL Pcs 0
Coverall (Cotton) - Size XXL Pcs 0
Coverall (Cotton) - Size XXXL Pcs 0
Coverall (Cotton) - Size 4XL Pcs 0
Coverall (Cotton) - Size 5XL Pcs 0
Coverall (Cotton) - Size 8XL Pcs 0
Coverall (FRC) - Size S Pcs 0
Coverall (FRC) - Size M Pcs 0
Coverall (FRC) - Size L Pcs 0
Coverall (FRC) - Size XL Pcs 0
Coverall (FRC) - Size XXL Pcs 0
Coverall (FRC) - Size XXXL Pcs 0
Coverall (FRC) - Size 4XL Pcs 0
Coverall (FRC) - Size 5XL Pcs 0
Coverall (FRC) - Size 8XL Pcs 0
Coverall (Disposable) - Size S Pcs 0
Coverall (Disposable) - Size M Pcs 0
Coverall (Disposable) - Size L Pcs 0
Coverall (Disposable) - Size XL Pcs 0
Coverall (Disposable) - Size XXL Pcs 0
Coverall (Disposable) - Size XXXL Pcs 0
Coverall (Disposable) - Size 4XL Pcs 0
Coverall (Disposable) - Size 5XL Pcs 0
Coverall (Disposable) - Size 8XL Pcs 0
Coverall (Paritan) - Size S Pcs 0
Coverall (Paritan) - Size M Pcs 0
Coverall (Paritan) - Size L Pcs 0
Coverall (Paritan) - Size XL Pcs 0
Coverall (Paritan) - Size XXL Pcs 0
Coverall (Paritan) - Size XXXL Pcs 0
Coverall (Paritan) - Size 4XL Pcs 0
Coverall (Paritan) - Size 5XL Pcs 0
Coverall (Paritan) - Size 8XL Pcs 0
Coverall (Visitor) - Size S Pcs 0
Coverall (Visitor) - Size M Pcs 0
Coverall (Visitor) - Size L Pcs 0
Coverall (Visitor) - Size XL Pcs 0
Coverall (Visitor) - Size XXL Pcs 0
Coverall (Visitor) - Size XXXL Pcs 0
Coverall (Visitor) - Size 4XL Pcs 0
Coverall (Visitor) - Size 5XL Pcs 0
Coverall (Visitor) - Size 8XL Pcs 0
Rain Coat - Size S Pcs 0
Rain Coat - Size M Pcs 0
Rain Coat - Size L Pcs 0
Rain Coat - Size XL Pcs 0
Rain Coat - Size XXL Pcs 0
Rain Coat - Size XXXL Pcs 0
Rain Coat - Size 4XL Pcs 0
Rain Coat - Size 5XL Pcs 0
Rain Coat - Size 8XL Pcs 0
Apron (Welder) Pcs 0
Apron (Chemical) Pcs 24
Jaket Hangat - Size S Pcs 0
Jaket Hangat - Size M Pcs 0
Jaket Hangat - Size L Pcs 0
Jaket Hangat - Size 2L Pcs 0
Jaket Hangat - Size 3L Pcs 0
Jaket Hangat - Size 4L Pcs 0
Jaket Hangat - Size 5L Pcs 0
Jaket Hangat - Size 8L Pcs 0
Rompi (HSE Marshal) Pcs 0
Rompi (Rigger) Pcs 0
Harness (Derrickman) Pcs 0
Harness (Full Body) Pcs 6
Harness (Man Ridding) Pcs 0
Double Landyard (With Absorband) Pcs 3
Double Landyard Pcs 0
Welding Sleeves Psg 0
Welding Gloves Psg 0
Hand Gloves (Polkadot) Lusin 0
Hand Gloves (Rubber - Electrical) Psg 0
Hand Gloves (Rubber - Chemical) Psg 0
Hand Gloves (Mechanic) Psg 0
High Impact Gloves - Size S Psg 2
High Impact Gloves - Size M Psg 22
High Impact Gloves - Size L Psg 8
High Impact Gloves - Size XL Psg 4
Safety Shoes (Rubber) - Size 3/37 Psg 0
Safety Shoes (Rubber) - Size 4/38 Psg 0
Safety Shoes (Rubber) - Size 5/39 Psg 0
Safety Shoes (Rubber) - Size 6/40 Psg 0
Safety Shoes (Rubber) - Size 7/41 Psg 0
Safety Shoes (Rubber) - Size 8/42 Psg 0
Safety Shoes (Rubber) - Size 9/43 Psg 0
Safety Shoes (Rubber) - Size 10/44 Psg 0
Safety Shoes (Rubber) - Size 11/45 Psg 0
Safety Shoes (Rubber) - Size 12/46 Psg 0
Safety Shoes (Leather) - Size 3/37 Psg 0
Safety Shoes (Leather) - Size 4/38 Psg 0
Safety Shoes (Leather) - Size 5/39 Psg 0
Safety Shoes (Leather) - Size 6/40 Psg 0
Safety Shoes (Leather) - Size 7/41 Psg 0
Safety Shoes (Leather) - Size 8/42 Psg 0
Safety Shoes (Leather) - Size 9/43 Psg 0
Safety Shoes (Leather) - Size 10/44 Psg 0
Safety Shoes (Leather) - Size 11/45 Psg 0
Safety Shoes (Leather) - Size 12/46 Psg 0
Fire Suits - Helmet Pcs 2
Fire Suits - Gloves Psg 2
Fire Suits - Suits Pcs 2
Fire Suits - Boots Psg 2
Kartu PEKA Lembar 0
Buku Izin Kerja - Panas (Merah) Buku 0
Buku Izin Kerja - Dingin (Biru) Buku 0
Buku Izin Kerja - Ruang Terbatas (Hijau) Buku 0
Buku Izin Kerja - Isolasi (Kuning) Buku 0
Plastik - Izin Kerja Pcs 0
Plastik - Learning From Event (LFE) Pcs 0
Calendar - Learning From Event (LFE) Pcs 0
Leaflet - Program HSE Lembar 0
Poster - Kebijakan QHSSE Pcs 0
Poster - Komitmen Program QHSSE Pcs 0
Poster - Program QHSSE Pcs 0
Poster - Untuk Rig Pcs 0
Poster - Untuk Kantor Pcs 0
Poster - Untuk Workshop Pcs 0
Poster - Untuk Gudang Pcs 0
Safety Sign - Kondisi Lokasi Pcs 0
Safety Sign - Gunakan APD Pcs 0
Safety Sign - Selamat datang di Rig Pcs 0
Safety Sign - Tmu Harap Lapor Pcs 0
Safety Sign - Parkir Mundur Pcs 0
Safety Sign - Laporkan Setiap Insiden Pcs 0
Safety Sign - Dilarang Merokok Pcs 0
Safety Sign - Dilarang Masuk Pcs 0
Safety Sign - Authorized Personel Pcs 0
Safety Sign - Waspada saat memanjat Pcs 0
Safety Sign - Bahaya Ayunan Crane Pcs 0
Safety Sign - Area Kebisingan Pcs 0
Safety Sign - Kabel bawah tanah Pcs 0
Safety Sign - Perhatikan langkah anda Pcs 0
Safety Sign - Bahaya Gas Beracun Pcs 0
Safety Sign - Listrik tegangan tinggi Pcs 0
Safety Sign - Gunakan Full Body Harness Pcs 0
Safety Sign - Pipa Tekanan Tinggi Pcs 0
Safety Sign - Pekerjaan Panas Pcs 0
Safety Sign - Area Pengelasan Pcs 0
Safety Sign - Area Penyimpanan Tabung Bertekanan Pcs 0
Safety Sign - Muster Point Pcs 0
Safety Sign - Safety Performance Board Pcs 0
Safety Sign - APAR Pcs 0
Safety Sign - Eyewash Pcs 0
Safety Sign - Shower Pcs 0
Safety Sign - Exit Kanan Pcs 0
Safety Sign - Exit Kiri Pcs 0
Safety Sign - Bahaya Pinch Point Pcs 0
Safety Sign - Bahaya Pekerjaan di ketinggian Pcs 0
Safety Sign - Drop Object Pcs 0
Bendera - Merah Putih Pcs 1
Bendera - K3 Pcs 1
Bendera - Tali Labrang Pcs 0
Bendera - Kondisi sumur Pcs 3
Gas Detector (Portable) Pcs 2
Gas Detector (Personal) Pcs 0
Gas Detector (Fix - Monitor) Pcs 1
Gas Detector (Fix - Sensor) Pcs 2
Digital Light meter (Lux Meter) Pcs 1
Digital Earth tester Meter Pcs 1
Sound Level Meter Pcs 1
Noise Dose Meter Pcs 0
BTX personal dose meter (optional) Pcs 0
Windshock Pcs 2
LHR’s electrical rescue kit Set 0
Stretcher (Scoop) Pcs 0
Stretcher (Basket) - Heavy Duty for lifitng evacuation Pcs 0
Adjustable lifting bridle (4 legs web sling) Set 0
First Aid (Kit) Set 0
First Aid (Responder Bag) Set 0
Working at height rescue equipment Set 0
Station (Eye Wash) Pcs 2
Station (Shower) Pcs 0
Station (Shower) - c/w Eyewash Pcs 0
SCBA Set 4
EEBA Set 1
Compressore Set 1
Confined space Kit (Blower) Pcs 1
Confined space Kit (Portable aluminum tripod) Pcs 1
Confined space Kit (Emergency lamp) Pcs 1
Spill Kits (95 gallon) Set 0
Spill Kits (Reffill absorbant) Set 0
Spill Kits (Drum Stacker containment) Set 0
Takakura composter Set 1
Tempat Sampah (3 Jenis) Set 1
Apar (Multi Purpose Dry Chemical 50 Kg) Pcs 0
Apar (Dry Powder, 9 Kg) Pcs 0
Apar (Foam-900, 9 Ltr) Pcs 0
Apar (Carbon Dioxide/CO2, 5 Kg) Pcs 0
Apar (Carbon Dioxide/CO2, 25 Kg) Pcs 0
Cover Apar Pcs 0
Fire Blanket Pcs 2
Flash Light (Senter) c/w charger Pcs 0
Fire Axe (Kapak) Pcs 0
Fire Pump 350 GPM Pcs 1
Fire Pump 500 GPM Pcs 0
Fire Pump Accessories Set 0
Mobile Foam Unit (c/w. Foam inductor, hose, foam nozzle) Set 0
Foam Concentrate (19-25 Liter) Drum 0
LOTO Kits Station (c/w Tag and Lock) Pcs 0
LOTO Kits Combined (c/w Valve Lock, circuit breaker, dll) Set 0
Lifting Accessories (Spreader Bar - Type bar) Pcs 0
Lifting Accessories (Bottom Lifting Lugs - 4 ea) Pcs 0
Lifting Accessories (Corner Protector) Pcs 0
Lifting Accessories (4 Parts Shackle - 8 Ton) Pcs 0
Lifting Accessories (4 Parts Shackle - 12 Ton) Pcs 0
Lifting Accessories (4 Parts Shackle - 18 Ton) Pcs 0
Lifting Accessories (Master Link) Pcs 0
Webbing Sling Pcs 4
Drum Lifter Pcs 0
SRL (Self Retracting Line - Fall Arrestor) Set 0
Vertical Life Line (Ladder Safe / Cable Block) Set 0
Horizontal Life Line Set 0
Scaffolding Set 0
Kursi Lari (Geronimo Type) Set 0
Kursi Lari (Descender) Set 1
Laptop Unit 1
Printer Unit 1
Kamera Unit 1
 No. Doc. Tgl. Terbit

NT MONITORING SHEET Rev. Halaman

: SBT

Stok Masuk Stok Keluar Stok Akhir Keterangan

0 0 0
0 0 0
0 0 0
0 0 #VALUE!
0 0 0
0 0 0
0 0 150
0 0 25
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 20
0 0 5
0 0 18
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
16 8 8
30 11 19
34 18 16
16 6 10
4 4 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 24
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 6
0 0 0
0 0 3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 2
0 0 22
0 0 8
0 0 4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 0 10
30 0 30
30 0 30
8 0 8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 2
0 0 2
0 0 2
0 0 2
0 0 0
0 0 0
0 0 0 Stock Habis
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 1
0 0 1
0 0 0
0 0 3
0 0 2
0 0 0
0 0 1
0 0 2
0 0 1
0 0 1
0 0 1
0 0 0
0 0 0
0 0 2 1 ea kondisi sudah pudar
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 2
0 0 0
0 0 0
0 0 4 1 Unit rusak pada main valve
0 0 1
0 0 1
0 0 1
0 0 1
0 0 1
0 0 0
0 0 0
0 0 0
0 0 1
0 0 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 2 1 ea dalam kondisi rusak
0 0 0
0 0 0
0 0 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 4 2 PCS 5T dan 2 PCS 2T
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 1
0 0 1
0 0 0 Printer Rusak
0 0 1