RESUME DATA HSE UNIT BISNIS : INFRA 1 (Minggu 2)

NO DIVISI NAMA PROYEK

Non JO
1 Infra 1 Bendungan Tigadihaji OKU
2 Infra 1 Bendungan Rukoh Aceh
3 Infra 1 Irigasi Batang Asai Paket I
4 Infra 1 Bendungan Tugu Trenggalek (100%)
5 Infra 1 DI Rentang
6 Infra 1 Bendungan Napun Gete
7 Infra 1 Bendungan Bringin Sila Paket 2
8 Infra 1 Pekerjaan Pengendalian Banjir Tukad Unda
9 Infra 1 Bendung Kuwil - Minahasa Sulut
10 Infra 1 Pembangunan Bendungan Pammukulu 2 Takalar
11 Infra 1 Bendungan Karalloe Thp II

JO
12 Infra 1 Irigasi Doplang Cilacap (NK70% - KSSA 30%)
13 Infra 1 Bendungan Sadawarna (NK 60% - ADHI 40%)
14 Infra 1 Pemb. Bendungan Bendo (JO WIKA 36%, HK 32%, NK 32%)
Bendungan Meninting (Paket II) Lombok Barat (NK 73% - PT
15 Infra 1 Sacna Nusantara 27%)

16 Infra 1 Bendungan Tiu Suntuk (NK 65% - Bahagia Bangun Nusa 35%)

17 Infra 1 Saluran Irigasi Bintang Bano III (JO 70%)

18 Infra 1 SPAM Kali Dendeng (JO 70%)
Pembangunan Bendungan DI Bomberay (JO NK 70% - Wakita
19 Infra 1
Jaya Purnama 30%)

TOTAL
KLASIFIKASI Pekerja April 2021
TOTAL
RISIKO
JKO
AWAL M1 M2 M3 M4
(1-8) (9-15) (16-22) (23-30)

EXTREME 326 266 592

EXTREME 109 37 146
EXTREME 185 184 369
EXTREME 175 119 294
MEDIUM 126 103 229
HIGH 0
HIGH 216 177 393
HIGH 215 89 305
EXTREME 92 91 184
EXTREME 159 130 289
EXTREME 417 419 836

MEDIUM 147 58 205

EXTREME 156 142 298
EXTREME 336 312 648

EXTREME 277 276 553

HIGH 603 451 1,054

HIGH 110 110

HIGH 57 158 215

HIGH 77 52 129

3,782 3,064 0 6,846

 JKO April 2021 UNSAFE ACTION MINGGU-2
TOTAL
JKO
M1 M2 M3 M4
IHH IHM
(1-8) (9-15) (16-22) (23-30)

20,627 14,920 35,547 1 0

6,976 2,344 9,320 2 0
10,644 9,300 19,944 0 0
8,700 6,416 15,116 5 0
7,972 5,392 13,364 7 0
0
13,092 9,493 22,585 7 0
10,888 4,292 15,180 1 0
5,480 4,768 10,248 9 0
8,691 7,082 15,773 7 0
23,144 20,072 43,216 9 0

9,408 3,232 12,640 8 0

9,984 7,952 17,936 0 0
14,834 11,936 26,770 0 0

13,944 13,916 27,860 6 0

27,372 21,656 49,028 4 0

6,848 6,848
3,033 7,098 10,131 2 0

2,916 2,424 5,340 3 0

204,553 152,293 0 356,846 71 0

47
SAFE ACTION MINGGU-2 April 2021 UNSAFE CONDITION MINGGU-2 April 2021

Total IHH UA
IHMP LSB TOTAL IHH IHM IHMP LSB TOTAL
dan UC

0 0 1 22 0 0 0 22 23
0 0 2 3 0 0 7 10 5
0 0 0 35 0 0 50 85 35
0 2 7 25 0 0 11 36 30
0 9 16 18 3 0 15 36 25
0 0 0
0 0 7 11 0 3 4 18 18
0 0 1 13 0 2 3 18 14
0 1 10 17 0 0 12 29 26
0 3 10 28 0 0 37 65 35
0 6 15 18 0 0 14 32 27

0 15 23 9 0 0 0 9 17
0 1 1 35 0 0 46 81 35
0 7 7 7 0 0 0 7 7

1 10 17 29 0 2 13 44 35

2 13 19 26 0 6 47 79 30

0 0 0
0 0 2 31 0 0 0 31 33

0 3 6 28 0 1 6 35 31

3 70 144 355 3 14 265 637

 TBT (%) TBM (%)

Pekerja Pelaksana SOM HSE PM SEM

60% 86% 71% 86% 0% 0%

16% 0% 17% 33% 0% 100%
94% 100% 100% 100% 100% 100%
99% 100% 75% 100% 100% 100%
98% 100% 100% 100% 100% 100%

65% 70% 20% 93% 100% 0%

57% 0% 29% 71% 0% 0%
90% 97% 100% 100% 100% 100%
88% 100% N/A 100% 0% 0%
89% 98% 100% 100% 0% 0%

0% 100% 29% 100% 100% 100%

85% 75% 100% 100% 100% 100%
27% 67% N/A 100% 100% 0%

67% 51% 14% 100% 100% 0%

67% 86% 86% 86% 100% 100%

36% 76% 71% 76% 0% 0%

91% N/A 100% 100% 100% 100%

 Housekeeping Pengukuran
TBM (%)
Massal Lingkungan

SOM SAM Pekerja Staf Hari Hari NEARMISS

0% 0% 70% 55% - - -
0% 0% 32% 15% - - -
100% 100% 93% 90% - - -
100% 100% 100% 100% - - -
100% 0% 100% 100% - - -

100% 0% 64% 82% - - -

0% 0% 100% 60% - - -
100% 100% 100% 0% - - 1
N/A 100% 86% 70% - - 1
0% 0% 0% 0% 6 - -

100% 100% 0% 80% - - -

100% 100% 96% 91% 1 - -
0% 0% 24% 25% - - -

100% 0% 38% 38% - - -

100% 100% 92% 92% 1 1 -

-
0% 0% 0% 0% - 1 -

N/A 100% 90% 82% 1 - -

2
 DATA KECELAKAAN 2021
(MINGGUAN)

FAC MTC RWC LTI FAT PD ED

- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -

- - - - - - -
1 - - - - - -
1 - - - - - -
- - - - - - -
- - - - - - -

- - - - - - -
- - - - - - -
- - - - - - -

- - - - - - -

- - - - - - -

- - - - - - -
- - - - - - -

- - - - - - -

2 - - - - - -
 NAMA HSE PERSONIL 2021

LWC HSE OFFICER HSE INSPECTOR / ADMIN

- Sopian Dwi Syahputra

- Edy Elfian Afdhal
- Sandi okta M. Rizky Fardhillah
- Yossi Jefri
- Dicky Ragil Farkhan (Uut)
Eka
- Mardani Jhon
- Maulana Parwanto
- Hendri Ferdian Emen Didin
- Ervin Agustrianto Rahayu Utami
- Juhidden Jaingot Samosir Andi Rahbil Fadly

- Afrizal Apri
- Dhani Agung Mubarok
- Rizaldy

- Fanani Dilla

- Rahmat Mustari Rahmat Mappe

- Hasan Hadi Utomo

- Thadeus Ihsan

- Brian Klopfleisch

-
AMA HSE PERSONIL 2021

HSE INSPECTOR / ADMIN HSE INSPECTOR / ADMIN

Silvi Julianti

Veni Mantevani
Prapto

Aji

Faisal

Maemuna

Fahri Dhanee

Maya
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PROYEK BENDUNGAN TIGA DIHAJI Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date
AVERAGE
Day APRIL 2021 TOTAL MAN HOUR
MAN POWER
A WEEK
Date 9 10 11 12 13 14 15 A WEEK

STAFF
Karyawan NK Man Power 46 46 46 46 0 44 44
Jam Kerja 8 8 8 8 0 8 8
Man Hour 368 368 368 368 0 352 352
Karyawan JO Man Power 0 0 0 0 0 0 0
39 2,176
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 46 46 46 46 0 44 44
TOTAL MAN HOUR STAFF 368 368 368 368 0 352 352
Harian
Pekerja Harian Man Power 13 13 13 13 0 13 13
Jam Kerja 8 8 8 8 0 8 8 11 624
Man Hour 104 104 104 104 0 104 104
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 260 260 221 258 0 258 258
Jam Kerja 8 8 8 8 0 8 8 216 12,120
Man Hour 2080 2080 1768 2064 0 2064 2064
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN HOUR (NORMAL) 2552 2552 2240 2536 0 2520 2520 266 14,920

OVER TIME
Description Date
Day APRIL 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
Karyawan JO Man Power 0 0 0 0 0 0 0
0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 0 0 0 0 0 0 0
TOTAL MAN HOUR STAFF 0 0 0 0 0 0 0
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 0 0 0 0 0 0 0 0 0

TOTAL KESELURUHUAN MAN HOUR

2552 2552 2240 2536 0 2520 2520 266 14,920
(NORMAL + OVER TIME)

THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : Hari
s/d saat ini

Total Man Hour dari

: 231,136 Jam
awal tahun s/d saat ini

Total Man hour dari

: Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Sopian Darmawan Setyohadi

HSE Officer Project manager

PT NINDYA KARYA (PERSERO)

DIVISI INFRA 1
PROYEK BENDUNGAN TIGA DIHAJI
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT Diisi jumlah temuannya khusus untuk

IHH
Description Date
Day APRIL 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) : 5 5 2 2 0 2 4 Kriteria Khusus IHH Jumlah Temuan
Unsafe Action 0 0 0 1 0 0 0 1 APD 1
IHH
Unsafe Condition 5 5 2 1 0 5 4 22 Rambu 6
Inspeksi HSE Management (IHM) : Alat Angkat & Angkut
Unsafe Action 0 0 0 0 0 0 0 0 Alat Produksi
Unsafe Condition 0 0 0 0 0 0 0 0 Alat Berat 1
Inspeksi HSE Management Proyek (IHMP) : 0 0 Hand Tools
Unsafe Action 0 0 0 0 0 0 0 0 Operasi Pengangkatan
Unsafe Condition 0 0 0 0 0 0 0 0 Pekerjaan di Ketinggian
Laporan Sumber Bahaya (LSB) : 0 0 0 0 0 0 0 Pekerjaan Galian 8
Unsafe Action 0 0 0 0 0 0 0 0 Pekerjaan Panas
Unsafe Condition 0 0 0 0 0 0 0 0 Listrik 3
Kategori Kejadian : Scaffolding
Near Miss 0 0 0 0 0 0 0 0 Gudang & Pengelolaan Material
First Aid Case 0 0 0 0 0 0 0 0 Housekeeping
MTC 0 0 0 0 0 0 0 0 Pengelolaan Limbah & Lingkungan
RWC 0 0 0 0 0 0 0 0 Lain-lain 1
LTI 0 0 0 0 0 0 0 0 Total 20
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0 Total IHH (L124) 20
Property Damage 0 0 0 0 0 0 0 0 selisih - (harus nol)
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day APRIL 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 5 2 2 0 2 4 20
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 0 0 0 0 0 0 0 0
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 16 0 2 0 18
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 180 180 165 176 0 184 180

Pekerja Total pekerja di hari tersebut 260 260 221 258 0 258 258 60%
% 69% 69% 75% 68% 0% 71% 70%
Hadir TBT 2 2 2 2 0 2 2

Pelaksana Total pelaksana di hari tersebut 2 2 2 2 0 2 2 86%

% 100% 100% 100% 100% 0% 100% 100%

Hadir TBT 1 1 1 1 0 1 0

SOM JUMLAH SOM 1 1 1 1 1 1 1 71%

% 100% 100% 100% 100% 0% 100% 0%

Hadir TBT 2 2 2 2 0 2 3

HSE Total HSE di hari tersebut 2 2 2 2 2 2 3 86%

% 100% 100% 100% 100% 0% 100% 100%

TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 0 0%
SEM Hadir TBM 0 0 0 0 0 0 0 0%
SOM Hadir TBM 0 0 0 0 0 0 0 0%
SAM Hadir TBM 0 0 0 0 0 0 0 0%
Hadir TBM 0 0 0 0 0 0 180
Pekerja 70%
Total pekerja di hari tersebut 0 0 0 0 0 0 258
Hadir TBM 0 0 0 0 0 0 24
STAFF 55%
Total staff di hari tersebut 0 0 0 0 0 0 44

Reported By : Acknowledge By :

Sopian Darmawan Setyohadi

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PROYEK BENDUNGAN RUKOH Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 16 April 2021

Description Date AVERAGE

Day April 2021 MAN TOTAL MAN
POWER A HOUR A WEEK
Date 9 10 11 12 13 14 15 16 WEEK
STAFF
Karyawan NK Man Power 7 44 0 0 0 48 49 0
Jam Kerja 8 8 8 8 8 8 8 0
Man Hour 56 352 0 0 0 384 392 0
Karyawan JO Man Power 0 0 0 0 0 0 0 0
19 1,184
Jam Kerja 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 7 44 0 0 0 48 49 0
TOTAL MAN HOUR STAFF 56 352 0 0 0 384 392 0
Harian
Pekerja Harian Man Power 0 2 0 0 0 2 4 0
Jam Kerja 8 8 8 8 8 8 8 0 1 64
Man Hour 0 16 0 0 0 16 32 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 22 22 0 0 0 22 22 0
Jam Kerja 8 8 8 8 8 8 8 0 11 704
Man Hour 176 176 0 0 0 176 176 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 49 0 0 0 0 0 0
Jam Kerja 8 8 8 8 8 8 8 0 6 392
Man Hour 0 392 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
TOTAL MAN HOUR (NORMAL) 232 936 0 0 0 576 600 0 37 2,344

OVER TIME
Description Date
Day April 2021
Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15 16
STAFF
Karyawan NK Man Power 0 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
Karyawan JO Man Power 0 0 0 0 0 0 0 0
0 0
Jam Kerja 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 0 0 0 0 0 0 0 0
TOTAL MAN HOUR STAFF 0 0 0 0 0 0 0 0
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 0 0 0 0 0 0 0 0 0 0
TOTAL KESELURUHUAN MAN HOUR
232 936 0 0 0 576 600 0 37 2,344
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 770 Hari
s/d saat ini

Total Man Hour dari

: 66,242 Jam
awal tahun s/d saat ini

Total Man hour dari

: 546,609 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

EDY ELFIAN ERMA JULIADI

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PROYEK BENDUNGAN RUKOH
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15 16
Inspeksi Harian HSE (IHH) :
Unsafe Action 0 0 0 0 0 2 0 0 2 IHH
Unsafe Condition 0 2 0 0 0 0 1 0 3
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 0 0 0 0 0 0 0
Unsafe Condition 0 3 0 0 0 2 2 0 7
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15 16
Jumlah Temuan Inspeksi Harian HSE (IHH) 0 2 0 0 0 2 1 0 5
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 0 3 0 0 0 2 2 0 7
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 16 % A WEEK
Hadir TBT 18 0 0 0 15 0

Pekerja Total pekerja di hari tersebut 71 0 0 0 22 0 16%

% 25% 0% 0% 0% 68% 0%
Hadir TBT 0 0 0 0 0 0
Total pelaksana di hari
Pelaksana 4 4 4 4 4 4 0%
tersebut
% 0% 0% 0% 0% 0% 0%
Hadir TBT 1 0 0 0 0 0

SOM JUMLAH SOM 1 1 1 1 1 1 17%

% 100% 0% 0% 0% 0% 0%
Hadir TBT 2 0 0 0 3 0

HSE Total HSE di hari tersebut 2 2 2 2 3 2 33%

% 100% 0% 0% 0% 100% 0%
 TBM ( 15/04/2021L; Pembagian Extra Fooding & Reward )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 0 0 0%
SEM Hadir TBM 0 0 0 0 0 0 1 0 100%
SOM Hadir TBM 0 0 0 0 0 0 0 0 0%
SAM Hadir TBM 0 0 0 0 0 0 0 0 0%
Hadir TBM 0 0 0 0 0 0 7 0
Pekerja 32%
Total pekerja di hari tersebut 0 0 0 0 0 0 22 0
Hadir TBM 0 0 0 0 0 0 8 0
STAFF 15%
Total staff di hari tersebut 0 0 0 0 0 0 52 0

Reported By : Acknowledge By :

EDY ELFIAN ERMA JULIADI

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
-PROYEK JARINGAN IRIGASI BATANG ASAI PAKET 1- Month : April 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day April 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 63 63 63 63 63 63 63
Jam Kerja 8 8 8 8 8 8 8
Man Hour 504 504 504 504 504 504 504
Karyawan JO Man Power 0 0 0 0 0 0 0
63 3,528
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 63 63 63 63 63 63 63
TOTAL MAN HOUR STAFF 504 504 504 504 504 504 504
Harian
Pekerja Harian Man Power 5 5 5 5 5 5 5
Jam Kerja 8 8 8 8 8 8 8 5 280
Man Hour 40 40 40 40 40 40 40
PEKERJA + MANDOR
Pekerja Mandor Man Power 45 45 45 45 45 45 45
Jam Kerja 8 8 8 8 8 8 8 45 2,520
Man Hour 360 360 360 360 360 360 360
SUBCONTRACTOR
Pekerja Subcontractor Man Power 25 25 25 25 25 25 25
Jam Kerja 8 8 8 8 8 8 8 25 1,400
Man Hour 200 200 200 200 200 200 200
OPERATOR
Operator Man Power 10 10 10 10 10 10 10
Jam Kerja 8 8 8 8 8 8 8 10 560
Man Hour 80 80 80 80 80 80 80
TOTAL MAN HOUR (NORMAL) 1184 1184 1184 1184 1184 1184 1184 148 8,288

OVER TIME
Description Date
Day April 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 5 15 15 15 10 10 10
Jam Kerja 4 4 4 4 4 4 4
Man Hour 20 60 60 60 40 40 40
Karyawan JO Man Power 0 0 0 0 0 0 0
11 320
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 5 15 15 15 10 10 10
TOTAL MAN HOUR STAFF 20 60 60 60 40 40 40
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 20 15 15 18 25 25 25
Jam Kerja 4 4 4 4 4 4 4 20 572
Man Hour 80 60 60 72 100 100 100
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0
Jam Kerja 4 4 4 4 4 4 4 0 0
Man Hour 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 5 5 5 5 5 5
Jam Kerja 4 4 4 4 4 4 4 4 120
Man Hour 0 20 20 20 20 20 20
TOTAL OVER TIME MAN HOUR 100 140 140 152 160 160 160 36 1,012
TOTAL KESELURUHUAN MAN HOUR
1284 1324 1324 1336 1344 1344 1344 184 9,300
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 416 Hari
s/d saat ini

Total Man Hour dari

: 168,741 Jam
awal tahun s/d saat ini

Total Man hour dari

: 884,835 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

SANDI OKTA PRAYOGA ERWAN FATRIANSYAH

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PROYEK JARINGAN IRIGASI BATANG ASAI PAKET 1 -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 0 0 0 0 0 0 0 0 IHH
Unsafe Condition 5 5 5 5 5 5 5 35
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 10 10 10 5 5 5 5 50
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 5 5 5 5 5 5 35
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 10 10 10 5 5 5 5 50
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 40 43 43 40 43 43 43

Pekerja Total pekerja di hari tersebut 45 45 45 45 45 45 45 94%

% 89% 96% 96% 89% 96% 96% 96%

Hadir TBT 2 2 2 2 2 2 2
Total pelaksana di hari
Pelaksana 2 2 2 2 2 2 2 100%
tersebut
% 100% 100% 100% 100% 100% 100% 100%
Hadir TBT 1 1 1 1 1 1 1

SOM JUMLAH SOM 1 1 1 1 1 1 1 100%

% 100% 100% 100% 100% 100% 100% 100%

Hadir TBT 3 3 3 3 3 3 3

HSE Total HSE di hari tersebut 3 3 3 3 3 3 3 100%

% 100% 100% 100% 100% 100% 100% 100%

 TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 1 100%
SEM Hadir TBM 0 0 0 0 0 0 1 100%
SOM Hadir TBM 0 0 0 0 0 0 1 100%
SAM Hadir TBM 0 0 0 0 0 0 1 100%
Hadir TBM 0 0 0 0 0 0 42
Pekerja 93%
Total pekerja di hari tersebut 0 0 0 0 0 0 45
Hadir TBM 0 0 0 0 0 0 57
STAFF 90%
Total staff di hari tersebut 0 0 0 0 0 0 63

Reported By : Acknowledge By :

SANDI OKTA PRAYOGA ERWAN FATRIANSYAH

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- NAMA PROYEK - Month : MARET 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day Maret 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 49 49 49 49 0 49 49
Jam Kerja 8 8 8 8 0 8 8
Man Hour 392 392 392 392 0 392 392
Karyawan JO Man Power 0 0 0 0 0 0 0
42 2,352
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 49 49 49 49 0 49 49
TOTAL MAN HOUR STAFF 392 392 392 392 0 392 392
Harian
Pekerja Harian Man Power 18 18 17 18 0 0 18
Jam Kerja 8 8 8 8 0 0 8 13 712
Man Hour 144 144 136 144 0 0 144
PEKERJA + MANDOR
Pekerja Mandor Man Power 25 30 12 29 0 27 27
Jam Kerja 8 8 8 8 0 8 8 21 1,200
Man Hour 200 240 96 232 0 216 216
SUBCONTRACTOR
Pekerja Subcontractor Man Power 38 35 23 30 0 30 31
Jam Kerja 8 8 8 8 0 8 8 27 1,496
Man Hour 304 280 184 240 0 240 248
OPERATOR
Operator Man Power 10 10 5 5 0 10 10
Jam Kerja 8 8 8 8 0 8 8 7 400
Man Hour 80 80 40 40 0 80 80
TOTAL MAN HOUR (NORMAL) 1120 1136 848 1048 0 928 1080 110 6,160

OVER TIME
Description Date
Day Maret 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 7 5 10 7 0 20 7
Jam Kerja 4 4 4 4 0 4 4
Man Hour 28 20 40 28 0 80 28
Karyawan JO Man Power 0 0 0 0 0 0 0
8 224
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 7 5 10 7 0 20 7
TOTAL MAN HOUR STAFF 28 20 40 28 0 80 28
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 6 0
Jam Kerja 0 0 0 0 0 4 0 1 24
Man Hour 0 0 0 0 0 24 0
OPERATOR
Operator Man Power 0 0 0 0 0 2 0
Jam Kerja 0 0 0 0 0 4 0 0 8
Man Hour 0 0 0 0 0 8 0
TOTAL OVER TIME MAN HOUR 28 20 40 28 0 112 28 9 256
TOTAL KESELURUHUAN MAN HOUR
1148 1156 888 1076 0 1040 1108 119 6,416
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 835 Hari
s/d saat ini

Total Man Hour dari

: 125,346 Jam
awal tahun s/d saat ini

Total Man hour dari

: 851,384 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

YOSSI DWI ARYONO BANGUN ARIFANTO

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- NAMA PROYEK -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 1 1 0 1 0 2 0 5 IHH
Unsafe Condition 4 4 5 4 0 3 5 25
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 0 1 0 1 0 2
Unsafe Condition 1 2 3 2 0 1 2 11
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 5 5 5 0 5 5 30
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 1 2 3 3 0 2 2 13
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 0 24 23 24 0 0 24

Pekerja Total pekerja di hari tersebut 0 24 24 24 0 0 24 99%

% 0% 100% 96% 100% 0% 0% 100%

Hadir TBT 0 6 6 6 0 0 6
Total pelaksana di hari
Pelaksana 0 6 6 6 0 0 6 100%
tersebut
% 0% 100% 100% 100% 0% 0% 100%
Hadir TBT 0 1 0 1 0 0 1

SOM JUMLAH SOM 0 1 0 1 0 0 1 75%

% 0% 100% 0% 100% 0% 0% 100%

Hadir TBT 0 6 6 6 0 0 6

HSE Total HSE di hari tersebut 0 6 6 6 0 0 6 100%

% 0% 100% 100% 100% 0% 0% 100%

 TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 1 0 0 0 0 0 0 100%
SEM Hadir TBM 1 0 0 0 0 0 0 100%
SOM Hadir TBM 1 0 0 0 0 0 0 100%
SAM Hadir TBM 1 0 0 0 0 0 0 100%
Hadir TBM 18 0 0 0 0 0 0
Pekerja 100%
Total pekerja di hari tersebut 18 0 0 0 0 0 0
Hadir TBM 49 0 0 0 0 0 0
STAFF 100%
Total staff di hari tersebut 49 0 0 0 0 0 0

Reported By : Acknowledge By :

YOSSI DWI ARYONO BANGUN ARIFANTO

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- IRIGASI RENTANG - Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day APRIL 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 47 48 25 47 47 51 52
Jam Kerja 8 8 8 8 0 8 8
Man Hour 376 384 200 376 0 408 416
Karyawan JO Man Power 0 0 0 0 0 0 0
45 2,160
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 47 48 25 47 47 51 52
TOTAL MAN HOUR STAFF 376 384 200 376 0 408 416
Harian
Pekerja Harian Man Power 14 15 11 8 0 14 12
Jam Kerja 8 8 8 8 0 8 8 11 592
Man Hour 112 120 88 64 0 112 96
PEKERJA + MANDOR
Pekerja Mandor Man Power 49 50 50 42 0 44 41
Jam Kerja 8 8 8 8 0 8 8 39 2,208
Man Hour 392 400 400 336 0 352 328
SUBCONTRACTOR
Pekerja Subcontractor Man Power 5 5 5 5 0 5 5
Jam Kerja 8 8 8 8 0 8 8 4 240
Man Hour 40 40 40 40 0 40 40
OPERATOR
Operator Man Power 4 4 4 4 0 4 4
Jam Kerja 8 8 8 8 8 8 8 3 192
Man Hour 32 32 32 32 0 32 32
TOTAL MAN HOUR (NORMAL) 952 976 760 848 0 944 103 5,392

OVER TIME
Description Date
Day APRIL 2021
Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
Karyawan JO Man Power 0 0 0 0 0 0
0 0
Jam Kerja 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 0 0 0 0 0 0 0
TOTAL MAN HOUR STAFF 0 0 0 0 0 0 0
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 0 0 0 0 0 0 0 0 0
TOTAL KESELURUHUAN MAN HOUR
952 976 760 848 0 944 103 5,392
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 241 Hari
s/d saat ini

Total Man Hour dari

: 91119 Jam
awal tahun s/d saat ini

Total Man hour dari

: 228946 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Dicky Ragil PADI

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
-IRIGASI RENTANG -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day APRIL 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 1 0 3 2 0 1 0 7 IHH
Unsafe Condition 3 5 1 2 0 3 4 18
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 3 0 0 0 3
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 3 2 0 2 1 0 1 9
Unsafe Condition 1 2 4 2 3 0 3 15
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day APRIL 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 4 5 4 4 0 4 4 25
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 3 0 0 0 3
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 4 4 4 4 4 0 4 24
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 63 60 60 50 57 53

Pekerja Total pekerja di hari tersebut 63 65 61 50 58 53 98%

% 100% 92% 98% 100% 98% 100%

Hadir TBT 3 3 3 3 3 3
Total pelaksana di hari
Pelaksana 3 3 3 3 3 3 100%
tersebut
% 100% 100% 100% 100% 100% 100%
Hadir TBT 1 1 1 1 1 1

SOM JUMLAH SOM 1 1 1 1 1 1 100%

% 100% 100% 100% 100% 100% 100%

Hadir TBT 3 3 3 3 3 3

HSE Total HSE di hari tersebut 3 3 3 3 3 3 100%

% 100% 100% 100% 100% 100% 100%

 TBM ( 15 April 2021)
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 1 100%
SEM Hadir TBM 0 0 0 0 0 0 1 100%
SOM Hadir TBM 0 0 0 0 0 0 1 100%
SAM Hadir TBM 0 0 0 0 0 0 0%
Hadir TBM 0 0 0 0 0 0 53
Pekerja 100%
Total pekerja di hari tersebut 0 0 0 0 0 0 53
Hadir TBM 0 0 0 0 0 0 52
STAFF 100%
Total staff di hari tersebut 0 0 0 0 0 0 52

Reported By : Acknowledge By :

Dicky Ragil PADI

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
BENDUNGAN BERINGIN SILA PAKET-2 Month : April 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day April 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 3 3 3 2 0 2 3
Jam Kerja 8 8 8 8 0 8 8
Man Hour 24 24 24 16 0 16 24
Karyawan JO Man Power 58 58 55 50 5 55 58
51 2,840
Jam Kerja 8 8 8 8 8 8 8
Man Hour 464 464 440 400 40 440 464
TOTAL MAN POWER STAFF 61 61 58 52 5 57 61
TOTAL MAN HOUR STAFF 488 488 464 416 40 456 488
Harian
Pekerja Harian Man Power 19 20 16 15 0 15 21
Jam Kerja 8 8 8 8 0 8 8 15 848
Man Hour 152 160 128 120 0 120 168
PEKERJA + MANDOR
Pekerja Mandor Man Power 69 70 68 25 0 68 68
Jam Kerja 8 8 8 8 0 8 8 53 2,944
Man Hour 552 560 544 200 0 544 544
SUBCONTRACTOR
Pekerja Subcontractor Man Power 50 50 42 20 0 50 50
Jam Kerja 8 8 8 8 0 8 8 37 2,096
Man Hour 400 400 336 160 0 400 400
OPERATOR
Operator Man Power 9 9 6 4 0 6 9
Jam Kerja 8 8 8 8 0 8 8 6 344
Man Hour 72 72 48 32 0 48 72
TOTAL MAN HOUR (NORMAL) 1664 1680 1520 928 40 1568 1672 162 9,072

OVER TIME
Description Date
Day April 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
Karyawan JO Man Power 4 5 4 4 3 5 5
4 120
Jam Kerja 4 4 4 4 4 4 4
Man Hour 16 20 16 16 12 20 20
TOTAL MAN POWER STAFF 4 5 4 4 3 5 5
TOTAL MAN HOUR STAFF 16 20 16 16 12 20 20
Harian
Pekerja Harian Man Power 3 3 3 0 0 0 3
Jam Kerja 4 4 4 0 0 0 4 2 48
Man Hour 12 12 12 0 0 0 12
PEKERJA + MANDOR
Pekerja Mandor Man Power 5 5 5 0 0 4 5
Jam Kerja 4 4 5 0 0 4 4 3 101
Man Hour 20 20 25 0 0 16 20
SUBCONTRACTOR
Pekerja Subcontractor Man Power 7 6 4 0 0 4 4
Jam Kerja 4 4 4 0 0 4 4 4 100
Man Hour 28 24 16 0 0 16 16
OPERATOR
Operator Man Power 4 3 2 0 0 2 2
Jam Kerja 4 4 4 0 0 4 4 2 52
Man Hour 16 12 8 0 0 8 8
TOTAL OVER TIME MAN HOUR 92 88 77 16 12 60 76 15 421
TOTAL KESELURUHUAN MAN HOUR
1756 1768 1597 944 52 1628 1748 177 9,493
(NORMAL + OVER TIME)

THIS WEEK
31-Dec-18 25
Jumlah hari kerja dari
proyek mulai (SPMK) : 811 Hari
s/d saat ini
Total Man Hour dari
: 180831 Jam
awal tahun s/d saat ini

Total Man hour dari

: 1767071 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

MARDANI IKHSAN AHMAD DAIROBI

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
BENDUNGAN BERINGIN SILA PAKET-2
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 1 1 0 0 0 2 3 7 IHH
Unsafe Condition 4 2 0 0 0 3 2 11
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 3 3
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 1 3 0 0 0 0 0 4
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 3 0 0 0 5 5 18
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 3 3
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 1 3 0 0 0 0 0 4
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 % A WEEK
Hadir TBT 105 102 85 30 0 85

Pekerja Total pekerja di hari tersebut 147 149 132 64 0 139 65%

% 71% 68% 64% 47% #DIV/0! 61%

Hadir TBT 4 3 2 2 0 3
Total pelaksana di hari
Pelaksana 4 4 4 4 0 4 70%
tersebut
% 100% 75% 50% 50% #DIV/0! 75%
Hadir TBT 0 1 0 0 0 0

SOM JUMLAH SOM 1 1 1 1 0 1 20%

% 0% 100% 0% 0% #DIV/0! 0%
Hadir TBT 3 3 3 2 0 3

HSE Total HSE di hari tersebut 3 3 3 3 0 3 93%

% 100% 100% 100% 67% #DIV/0! 100%
TBM ( 25 Maret 2021; Tekanan darah terhadap pekerjaan diketinggian dan APAR)
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 1 100%
SEM Hadir TBM 0 0 0 0 0 0 0 0%
SOM Hadir TBM 0 0 0 0 0 0 1 100%
SAM Hadir TBM 0 0 0 0 0 0 0 0%
Hadir TBM 0 0 0 0 0 0 95
Pekerja 64%
Total pekerja di hari tersebut 0 0 0 0 0 0 148
Hadir TBM 0 0 0 0 0 0 50
STAFF 82%
Total staff di hari tersebut 0 0 0 0 0 0 61

Reported By : Acknowledge By :

MARDANI IKHSAN AHMAD DAIROBI

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PENGENDALIAN BANJIR TUKAD UNDA - Month : MARET 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day Maret 2021 MAN POWER
HOUR A WEEK
Date 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr A WEEK
STAFF
Karyawan NK Man Power 42 42 42 32 0 0 0
Jam Kerja 8 8 8 8 8 8 8
Man Hour 336 336 336 256 0 0 0
Karyawan JO Man Power 0 0 0 0 0 0 0
23 1,264
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 42 42 42 32 0 0 0
TOTAL MAN HOUR STAFF 336 336 336 256 0 0 0
Harian
Pekerja Harian Man Power 2 2 2 2 0 0 0
Jam Kerja 8 8 8 8 8 8 8 1 64
Man Hour 16 16 16 16 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 43 32 30 32 0 0 0
Jam Kerja 8 8 8 8 8 8 8 20 1,096
Man Hour 344 256 240 256 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 32 26 18 24 0 0 0
Jam Kerja 8 8 8 8 8 8 8 14 800
Man Hour 256 208 144 192 0 0 0
OPERATOR
Operator Man Power 12 13 11 10 0 0 0
Jam Kerja 8 8 8 8 8 8 8 7 368
Man Hour 96 104 88 80 0 0 0
TOTAL MAN HOUR (NORMAL) 1048 920 824 800 0 0 0 64 3,592

OVER TIME
Description Date
Day Maret 2021 Total
Average Mandays
Manpower
Date 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr
STAFF
Karyawan NK Man Power 42 42 42 32 0 0 0
Jam Kerja 4 4 4 4 4 4 4
Man Hour 168 168 168 128 0 0 0
Karyawan JO Man Power 0 0 0 0 0 0 0
23 632
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 42 42 42 32 0 0 0
TOTAL MAN HOUR STAFF 168 168 168 128 0 0 0
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 17 0 0 0 0 0 0
Jam Kerja 4 0 0 0 0 0 0 2 68
Man Hour 68 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 236 168 168 128 0 0 0 25 700
TOTAL KESELURUHUAN MAN HOUR
(NORMAL + OVER TIME)
1284 1088 992 928 0 0 0 89 4,292
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 190 Hari
s/d saat ini

Total Man Hour dari

: 157,136 Jam
awal tahun s/d saat ini

Total Man hour dari

: 256,700 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

A. Maulana I Made Sujana

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PENGENDALIAN BANJIR TUKAD UNDA -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day Maret 2021 TOTAL
Date 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr
Inspeksi Harian HSE (IHH) :
Unsafe Action 1 0 0 0 0 0 0 1 IHH
Unsafe Condition 3 3 4 3 0 0 0 13
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 1 0 1 0 0 0 0 2
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 1 1 0 1 0 0 0 3
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 1 0 0 0 0 0 0 1
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Maret 2021 TOTAL
Date 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr
Jumlah Temuan Inspeksi Harian HSE (IHH) 4 3 4 3 0 0 0 14
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
1 0 1 0 0 0 0 2
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 1 1 0 1 0 0 0 3
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr % A WEEK
Hadir TBT 43 32 30 32 0 0 0

Pekerja Total pekerja di hari tersebut 43 32 30 32 0 0 0 57%

% 100% 100% 100% 100% 0% 0% 0%

Hadir TBT 0 0 0 0 0 0 0
Total pelaksana di hari
Pelaksana 0 0 0 0 0 0 0 0%
tersebut
% 0% 0% 0% 0% 0% 0% 0%
Hadir TBT 1 0 1 0 0 0 0

SOM JUMLAH SOM 1 1 1 1 1 1 1 29%

% 100% 0% 100% 0% 0% 0% 0%
Hadir TBT 3 3 2 2 2 0 2

HSE Total HSE di hari tersebut 3 3 2 2 2 0 2 71%

% 100% 100% 100% 100% 100% 0% 0%

 TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 0 0%
SEM Hadir TBM 0 0 0 0 0 0 0 0%
SOM Hadir TBM 0 0 0 0 0 0 0 0%
SAM Hadir TBM 0 0 0 0 0 0 0 0%
Hadir TBM 0 32 0 0 0 0 0
Pekerja 100%
Total pekerja di hari tersebut 0 32 0 0 0 0 0
Hadir TBM 0 25 0 0 0 0 0
STAFF 60%
Total staff di hari tersebut 0 42 0 0 0 0 0

Reported By : Acknowledge By :

A. Maulana I Made Sujana

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PROYEK BENDUNGAN KUWIL KAWANGKOAN PAKET 2 - Month : MARET 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day April 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 43 43 43 43 43 43 43
Jam Kerja 8 8 8 8 8 8 8
Man Hour 344 344 344 344 344 344 344
Karyawan JO Man Power 0 0 0 0 0 0 0
43 2,408
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0
TOTAL MAN POWER STAFF 43 43 43 43 43 43
TOTAL MAN HOUR STAFF 344 344 344 344 344 344 344
Harian
Pekerja Harian Man Power 2 2 2 2 2 2 2
Jam Kerja 8 8 8 8 8 8 8 2 112
Man Hour 16 16 16 16 16 16 16
PEKERJA + MANDOR
Pekerja Mandor Man Power 17 17 17 17 17 17 17
Jam Kerja 8 8 8 8 8 8 8 17 952
Man Hour 136 136 136 136 136 136 136
SUBCONTRACTOR
Pekerja Subcontractor Man Power 14 14 14 14 14 14 14
Jam Kerja 8 8 8 8 8 8 8 14 784
Man Hour 112 112 112 112 112 112 112
OPERATOR
Operator Man Power 3 3 3 3 3 3 3
Jam Kerja 8 8 8 8 8 8 8 3 168
Man Hour 24 24 24 24 24 24 24
TOTAL MAN HOUR (NORMAL) 632 632 632 632 632 632 79 4,424

OVER TIME
Description Date
Day April 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 4 5 6 0 2 4 2
Jam Kerja 4 4 4 4 4 4 4
Man Hour 16 20 24 0 8 16 8
Karyawan JO Man Power 0 0 0 0 0 0 0
3 92
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 4 5 6 0 2 4 2
TOTAL MAN HOUR STAFF 16 20 24 0 8 16 8
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 7 7 7 7 7 7 7
Jam Kerja 4 4 4 4 4 4 4 7 196
Man Hour 28 28 28 28 28 28 28
OPERATOR
Operator Man Power 2 2 2 2 2 2 2
Jam Kerja 4 4 4 4 4 4 4 2 56
Man Hour 8 8 8 8 8 8 8
TOTAL OVER TIME MAN HOUR 52 56 60 36 44 52 44 12 344
TOTAL KESELURUHUAN MAN HOUR
684 688 692 668 676 684 44 91 4,768
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 1699 Hari
s/d saat ini

Total Man Hour dari

: 79106 Jam
awal tahun s/d saat ini

Total Man hour dari 1,614,413

: Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

HENDRI FERDIAN AM RADITYO ARDHIAN PRATAMA

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PROYEK BENDUNGAN KUWIL KAWANGKOAN PAKET 2 -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 1 1 1 1 0 2 3 9
Unsafe Condition 2 3 3 3 3 2 1 17
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 0 1 0 0 0 1
Unsafe Condition 2 2 2 1 2 1 2 12
Kategori Kejadian :
Near Miss 0 1 0 0 0 0 0 1
First Aid Case 0 0 0 1 0 0 0 1
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 3 4 4 4 3 4 4 26
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 2 2 2 2 2 1 2 13
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 35 41 38 37 39 40 40

Pekerja Total pekerja di hari tersebut 43 43 43 43 43 43 43 90%

% 81% 95% 88% 86% 91% 93% 93%

Hadir TBT 5 5 5 4 5 5 5

Pelaksana Total pelaksana di hari tersebut 5 5 5 5 5 5 5 97%

% 100% 100% 100% 80% 100% 100% 100%

Hadir TBT 1 1 1 1 1 1 1

SOM JUMLAH SOM 1 1 1 1 1 1 1 100%

% 100% 100% 100% 100% 100% 100% 100%

Hadir TBT 5 5 5 5 5 5 5

HSE Total HSE di hari tersebut 5 5 5 5 5 5 5 100%

% 100% 100% 100% 100% 100% 100% 100%

TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 1 0 0 100%
SEM Hadir TBM 0 0 0 0 1 0 0 100%
 SOM Hadir TBM 0 0 0 0 1 0 0 100%
SAM Hadir TBM 0 0 0 0 1 0 0 100%
Hadir TBM 0 0 0 0 37 0 0
Pekerja 86%
Total pekerja di hari tersebut 0 0 0 0 43 0 0
Hadir TBM 0 0 0 0 32 0 0
STAFF 76%
Total staff di hari tersebut 0 0 0 0 42 0 0

Reported By : Acknowledge By :

HENDRI FERDIAN AM RADITYO ARDHIAN PRATAMA

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PEMBANGUNAN BENDUNGAN PAMUKKULU PAKET 2 KAB.TAKALAR - Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 9/4/2021

MANPOWER AND MANHOURS Up To : 15/04/2021

Description Date AVERAGE

TOTAL MAN
Day Maret 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 39 39 41 42 0 42 43
Jam Kerja 8 8 8 8 0 8 8
Man Hour 312 312 328 336 0 336 344
Karyawan JO Man Power 0 0 0 0 0 0 0
35 1,968
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 39 39 41 42 0 42 43
TOTAL MAN HOUR STAFF 312 312 328 336 0 336 344
Harian
Pekerja Harian Pelaksana Man Power 7 3 3 3 0 3 3
Jam Kerja 8 8 8 8 8 8 8 3 176
Man Hour 56 24 24 24 0 24 24
Safetyman Man Power 2 2 2 2 0 2 2
Jam Kerja 8 8 8 8 8 8 8 2 96
Man Hour 16 16 16 16 0 16 16
Pekerja Harian Survey Man Power 6 6 6 6 0 6 6
Jam Kerja 8 8 8 8 8 8 8 5 288
Man Hour 48 48 48 48 0 48 48
PEKERJA + MANDOR
Pekerja Mandor Mekarsari Man Power 18 3 0 3 0 3 10
Jam Kerja 8 8 8 8 8 8 8 5 296
Man Hour 144 24 0 24 0 24 80
Pekerja Mandor Hasan Man Power 8 8 8 8 0 8 8
Jam Kerja 8 8 8 8 8 8 8 7 384
Man Hour 64 64 64 64 0 64 64
SUBCONTRACTOR
Pekerja Subcontractor Dahana Man Power 10 10 10 10 0 10 10
Jam Kerja 8 8 8 8 8 8 8 9 480
Man Hour 80 80 80 80 0 80 80
Pekerja Subcontractor Shadit Man Power 21 21 21 21 0 21 21
Jam Kerja 8 8 8 8 8 8 8 18 1,008
Man Hour 168 168 168 168 0 168 168
OPERATOR
Pekerja Subcon CDS Man Power 10 10 10 10 0 10 10
Jam Kerja 8 8 8 8 8 8 8 9 480
Man Hour 80 80 80 80 0 80 80
PKL Man Power 7 7 7 7 0 7 7
Jam Kerja 8 8 8 8 8 8 8 6 336
Man Hour 56 56 56 56 0 56 56
TOTAL MAN HOUR (NORMAL) 1024 872 864 896 0 896 960 98 5,512

OVER TIME
Description Date
Day Maret 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 15 15 15 15 0 15 20
Jam Kerja 6 6 6 6 0 6 6
Man Hour 90 90 90 90 0 90 120
Karyawan JO Man Power 0 0 0 0 0 0 0
14 570
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 15 15 15 15 0 15 20
TOTAL MAN HOUR STAFF 90 90 90 90 0 90 120
Harian
Pekerja Harian Man Power 3 3 3 4 0 3 3
Jam Kerja 8 8 8 8 8 8 8 3 152
Man Hour 24 24 24 32 0 24 24
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 16 10 10 10 20 20 20
Jam Kerja 8 8 8 8 8 8 8 15 848
Man Hour 128 80 80 80 160 160 160
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 242 194 194 202 160 274 304 31 1,570
TOTAL KESELURUHUAN MAN HOUR
1266 1066 1058 1098 160 1170 1264 130 7,082
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari proyek

: 1242 Hari
mulai (SPMK) s/d saat ini

Total Man Hour dari awal tahun

: 66863 Jam
s/d saat ini

Total Man hour dari awal proyek

: 532019 Jam
s/d saat ini

Reported By : Acknowledge By :

Rahayu Utami Djirzise Abd Hakim F

Inspector 2 Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PEMBANGUNAN BENDUNGAN PAMUKKULU PAKET 2 KAB.TAKALAR -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 0 2 0 1 3 1 0 7 IHH
Unsafe Condition 5 11 0 1 4 4 3 28
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 2 0 0 0 1 3
Unsafe Condition 7 6 4 7 0 7 6 37
Kategori Kejadian :
Near Miss 0 0 0 0 0 1 0 1
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 1 0 1
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 13 0 2 7 5 3 35
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek (IHMP) 0 0 0 0 0 0 0 0
Jumlah Temuan Laporan Sumber Bahaya (LSB) 7 6 6 7 0 7 7 40
Jumlah Rapat HSE (Internal plus External) 1 0 0 0 0 0 0 1
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 6 0 6
Jumlah induksi eksternal 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 35 35 34 34 40 34 40

Pekerja Total pekerja di hari tersebut 36 36 36 44 53 34 54 88%

% 97% 97% 94% 77% 75% 100% 74%

Hadir TBT 3 3 3 3 3 3 3
Total pelaksana di hari
Pelaksana 3 3 3 3 3 3 3 100%
tersebut
% 100% 100% 100% 100% 100% 100% 100%
Hadir TBT 0 0 0 0 0 0 0

SOM JUMLAH SOM 0 0 0 0 0 0 0 N/A

% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Hadir TBT 3 3 3 3 3 3 3

HSE Total HSE di hari tersebut 3 3 3 3 3 3 3 100%

% 100% 100% 100% 100% 100% 100% 100%

TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 0 0%
SEM Hadir TBM 0 0 0 0 0 0 0 0%
SOM Hadir TBM 0 0 0 0 0 0 0 0%
SAM Hadir TBM 0 0 0 1 0 0 0 100%
Hadir TBM 0 0 0 24 0 0 0
Pekerja 86%
Total pekerja di hari tersebut 0 0 0 28 0 0 0
Hadir TBM 0 0 0 28 0 0 0
STAFF 70%
Total staff di hari tersebut 0 0 0 40 0 0 0
Reported By : Acknowledge By :

Rahayu Utami Djirzise Abd Hakim F

Inspector 2 Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PEMBANGUNAN BENDUNGAN KARALLOE Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day Maret 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 70 70 70 70 70 70 70
Jam Kerja 8 8 8 8 0 8 8
Man Hour 560 560 560 560 0 560 560
Karyawan JO Man Power 0 0 0 0 0 0 0
70 3,360
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 70 70 70 70 70 70 70
TOTAL MAN HOUR STAFF 560 560 560 560 0 560 560
Harian
Pekerja Harian Man Power 95 95 95 95 95 96 96
Jam Kerja 8 8 8 8 0 8 8 95 4,576
Man Hour 760 760 760 760 0 768 768
PEKERJA + MANDOR
Pekerja Mandor Man Power 75 75 75 75 75 75 80
Jam Kerja 8 8 8 8 0 8 8 76 3,640
Man Hour 600 600 600 600 0 600 640
SUBCONTRACTOR
Pekerja Subcontractor Man Power 121 121 121 121 121 121 121
Jam Kerja 8 8 8 8 0 8 8 121 5,808
Man Hour 968 968 968 968 0 968 968
OPERATOR
Operator Man Power 17 17 17 17 17 17 17
Jam Kerja 8 8 8 8 0 8 8 17 816
Man Hour 136 136 136 136 0 136 136
TOTAL MAN HOUR (NORMAL) 3024 3024 3024 3024 0 3032 3072 379 18,200

OVER TIME
Description Date
Day Maret 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 22 22 22 22 22 22 22
Jam Kerja 8 8 8 8 0 8 8
Man Hour 176 176 176 176 0 176 176
Karyawan JO Man Power 0 0 0 0 0 0 0
19 1,056
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 22 22 22 22 0 22 22
TOTAL MAN HOUR STAFF 176 176 176 176 0 176 176
Harian
Pekerja Harian Man Power 5 5 5 5 5 5 5
Jam Kerja 8 8 8 8 0 8 8 5 240
Man Hour 40 40 40 40 0 40 40
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 10 10 10 10 10 10 10
Jam Kerja 6 6 6 6 0 6 6 10 360
Man Hour 60 60 60 60 0 60 60
OPERATOR
Operator Man Power 6 6 6 6 6 6 6
Jam Kerja 6 6 6 6 0 6 6 6 216
Man Hour 36 36 36 36 0 36 36
TOTAL OVER TIME MAN HOUR 312 312 312 312 0 312 312 40 1,872
TOTAL KESELURUHUAN MAN HOUR
3336 3336 3336 3336 0 3344 3384 419 20,072
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 1045 Hari
s/d saat ini

Total Man Hour dari

: 322779 Jam
awal tahun s/d saat ini

Total Man hour dari

: 2769336 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Juhidden J Samosir Bagus P Ririh

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- NAMA PROYEK -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 3 0 0 2 0 2 2 9 IHH
Unsafe Condition 2 2 5 3 0 3 3 18
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 2 0 0 1 0 1 2 6
Unsafe Condition 1 2 4 2 0 3 2 14
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 2 5 5 0 5 5 27
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 3 2 4 3 0 4 4 20
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 1 0 0 0 0 0 1 2
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 1 1 1 1 0 1 1 6
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 260 258 258 250 0 255 257

Pekerja Total pekerja di hari tersebut 286 286 286 286 286 286 290 89%

% 91% 90% 90% 87% 0% 89% 89%

Hadir TBT 7 7 6 6 0 6 6
Total pelaksana di hari
Pelaksana 7 7 7 6 7 6 6 98%
tersebut
% 100% 100% 86% 100% 0% 100% 100%
Hadir TBT 1 1 1 1 0 1 1

SOM JUMLAH SOM 1 1 1 1 1 1 1 100%

% 100% 100% 100% 100% 0% 100% 100%

Hadir TBT 7 7 7 7 0 7 7

HSE Total HSE di hari tersebut 7 7 7 7 7 7 7 100%

% 100% 100% 100% 100% 0% 100% 100%

 TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 0 0%
SEM Hadir TBM 0 0 0 0 0 0 0 0%
SOM Hadir TBM 0 0 0 0 0 0 0 0%
SAM Hadir TBM 0 0 0 0 0 0 0 0%
Hadir TBM 0 0 0 0 0 0 0
Pekerja #DIV/0!
Total pekerja di hari tersebut 0 0 0 0 0 0 0
Hadir TBM 0 0 0 0 0 0 0
STAFF #DIV/0!
Total staff di hari tersebut 0 0 0 0 0 0 0
Tanggal 13 OFF

Reported By : Acknowledge By :

Juhidden J Samosir Bagus P Ririh

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PROYEK IRIGASI SERAYU DOPLANG - CILACAP - Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 16 April 2021

Description Date AVERAGE

TOTAL MAN
Day April 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 40 40 40 40 40 40 40
Jam Kerja 8 8 8 8 8 8 8
Man Hour 320 320 320 320 320 320 320
Karyawan JO Man Power 0 0 0 0 0 0 0
40 2,240
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 40 40 40 40 40 40 40
TOTAL MAN HOUR STAFF 320 320 320 320 320 320 320
Harian
Pekerja Harian Man Power 17 17 17 17 17 17 17
Jam Kerja 8 8 8 8 8 8 8 17 952
Man Hour 136 136 136 136 136 136 136
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 5 0 0 0
Jam Kerja 0 0 0 8 0 0 0 1 40
Man Hour 0 0 0 40 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN HOUR (NORMAL) 456 456 456 496 456 456 456 58 3,232

OVER TIME
Description Date
Day April 2021 Total Average
Manpower Mandays
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
Karyawan JO Man Power 0 0 0 0 0 0 0
0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 0 0 0 0 0 0 0
TOTAL MAN HOUR STAFF 0 0 0 0 0 0 0
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 0 0 0 0 0 0 0 0 0
TOTAL KESELURUHUAN MAN HOUR
456 456 456 496 456 456 456 58 3,232
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 1,041 Hari
s/d saat ini

Total Man Hour dari

: 143,768 Jam
awal tahun s/d saat ini

Total Man hour dari

: 2,647,708 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Afrizal Adi N Agus Setya R

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- PROYEK IRIGASI SERAYU DOPLANG - CILACAP -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 3 3 0 0 0 0 2 8 IHH
Unsafe Condition 0 0 3 2 2 2 0 9
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 2 2 2 2 3 2 2 15
Unsafe Condition 0 0 0 0 0 0 0 0
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 6 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 3 3 3 2 2 2 2 17
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 2 2 2 2 3 2 2 15
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 6 15 % A WEEK
Hadir TBT 0 0 0 5 0 0 0

Pekerja Total pekerja di hari tersebut 0 0 0 0 0 0 0 0%

% 0% 0% 0% 0% 0% 0% 0%
Hadir TBT 2 2 2 2 2 2 2

Pelaksana Total pelaksana di hari tersebut 2 2 2 2 2 2 2 100%

% 100% 100% 100% 100% 100% 100% 100%

Hadir TBT 0 1 0 1 0 0 0

SOM JUMLAH SOM 1 1 1 1 1 1 1 29%

% 0% 100% 0% 100% 0% 0% 0%
Hadir TBT 2 2 2 2 2 2 2

HSE Total HSE di hari tersebut 2 2 2 2 2 2 2 100%

% 100% 100% 100% 100% 100% 100% 100%

TBM ( -03-2021 )
*nb: isi di hari yang % A WEEK
TBM saja
PM Hadir TBM 0 0 0 0 0 0 1 100%
SEM Hadir TBM 0 0 0 0 0 0 1 100%
SOM Hadir TBM 0 0 0 0 0 0 1 100%
SAM Hadir TBM 0 0 0 0 0 0 1 100%
Hadir TBM 0 0 0 0 0 0 0
Pekerja #DIV/0!
Total pekerja di hari tersebut 0 0 0 0 0 0 0
Hadir TBM 0 0 0 0 0 0 32
STAFF 80%
Total staff di hari tersebut 0 0 0 0 0 0 40

Reported By : Acknowledge By :

Afrizal Adi N Agus Setya R

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- BENDUNGAN SADAWARNA PAKET II - Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day Maret 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 22 20 19 19 20 21 21
Jam Kerja 8 8 8 8 8 8 8
Man Hour 176 160 152 152 160 168 168
Karyawan JO Man Power 47 47 45 52 47 48 48
68 3,808
Jam Kerja 8 8 8 8 8 8 8
Man Hour 376 376 360 416 376 384 384
TOTAL MAN POWER STAFF 69 67 64 71 67 69 69
TOTAL MAN HOUR STAFF 552 536 512 568 536 552 552
Harian
Pekerja Harian Man Power 17 18 17 18 0 18 18
Jam Kerja 8 8 8 8 8 8 8 15 848
Man Hour 136 144 136 144 0 144 144
PEKERJA + MANDOR
Pekerja Mandor Man Power 52 57 40 40 0 55 52
Jam Kerja 8 8 8 8 8 8 8 42 2,368
Man Hour 416 456 320 320 0 440 416
SUBCONTRACTOR
Pekerja Subcontractor Man Power 15 13 13 14 0 12 14
Jam Kerja 8 8 8 8 8 8 8 12 648
Man Hour 120 104 104 112 0 96 112
OPERATOR
Operator Man Power 5 5 5 5 5 5 5
Jam Kerja 8 8 8 8 8 8 8 5 280
Man Hour 40 40 40 40 40 40 40
TOTAL MAN HOUR (NORMAL) 1264 1280 1112 1184 576 1272 1264 142 7,952

OVER TIME
Description Date
Day Maret 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
Karyawan JO Man Power 0 0 0 0 0 0 0
0 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 0 0 0 0 0 0 0
TOTAL MAN HOUR STAFF 0 0 0 0 0 0 0
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 0 0 0 0 0 0 0 0 0
TOTAL KESELURUHUAN MAN HOUR
1264 1280 1112 1184 576 1272 1264 142 7,952
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 837 Hari
s/d saat ini

Total Man Hour dari

: 104,992 Jam
awal tahun s/d saat ini

Total Man hour dari

: 680,636 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Dhani Setyobudi M.Faizal

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- BENDUNGAN SADAWARNA PAKET II -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 0 0 0 0 0 0 0 0 IHH
Unsafe Condition 5 5 5 5 5 5 5 35
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 1 0 0 0 0 0 1
Unsafe Condition 7 7 6 4 10 6 6 46
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 5 5 5 5 5 5 35
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 7 8 6 4 10 6 6 47
Jumlah Rapat HSE (Internal plus External) 1 1 1 1 0 1 1 6
Jumlah induksi karyawan/pekerja baru 0 6 0 0 0 9 0 15
Jumlah induksi eksternal 0 0 0 0 1 0 0 1
Housekeeping Massal (diisi 1 bila melakukan) 0 0 1 0 0 0 0 1
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 73 77 62 72 74 75

Pekerja Total pekerja di hari tersebut 89 93 75 77 90 89 85%

% 82% 83% 83% 94% 82% 84%

Hadir TBT 2 2 1 1 1 2
Total pelaksana di hari
Pelaksana 2 2 2 2 2 2 75%
tersebut
% 100% 100% 50% 50% 50% 100%
Hadir TBT 1 1 1

SOM JUMLAH SOM 1 1 1 100%

% 100% 100%
Hadir TBT 2 2 2 2 2 2

HSE Total HSE di hari tersebut 2 2 2 2 2 2 100%

% 100% 100% 100% 100% 100% 100%

 TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 1 100%
SEM Hadir TBM 1 100%
SOM Hadir TBM 1 100%
SAM Hadir TBM 1 100%
Hadir TBM 65
Pekerja 96%
Total pekerja di hari tersebut 68
Hadir TBM 72
STAFF 91%
Total staff di hari tersebut 79

Reported By : Acknowledge By :

Dhani Setyobudi M.Faizal

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
- BENDUNGAN BENDO (LANJUTAN) - Month : MARET 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day April 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 15 13 11 15 10 15 15
Jam Kerja 8 8 8 8 8 8 8
Man Hour 120 104 88 120 80 120 120
Karyawan JO Man Power 71 68 60 71 45 71 71
79 4,408
Jam Kerja 8 8 8 8 8 8 8
Man Hour 568 544 480 568 360 568 568
TOTAL MAN POWER STAFF 86 81 71 86 55 86 86
TOTAL MAN HOUR STAFF 688 648 568 688 440 688 688
Harian
Pekerja Harian Man Power 4 4 4 4 5 4 6
Jam Kerja 8 8 8 8 8 8 8 4 248
Man Hour 32 32 32 32 40 32 48
PEKERJA + MANDOR
Pekerja Mandor Man Power 6 6 6 6 0 6 6
Jam Kerja 8 8 8 8 8 8 8 5 288
Man Hour 48 48 48 48 0 48 48
SUBCONTRACTOR
Pekerja Subcontractor Man Power 65 65 65 65 10 65 65
Jam Kerja 8 8 8 8 8 8 8 57 3,200
Man Hour 520 520 520 520 80 520 520
OPERATOR
Operator Man Power 12 12 12 12 0 12 12
Jam Kerja 8 8 8 8 8 8 8 10 576
Man Hour 96 96 96 96 0 96 96
TOTAL MAN HOUR (NORMAL) 1384 1344 1264 1384 560 1384 1400 156 8,720

OVER TIME
Description Date
Day April 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 15 13 11 15 10 15 15
Jam Kerja 2 2 2 2 2 2 2
Man Hour 30 26 22 30 20 30 30
Karyawan JO Man Power 71 68 67 69 45 71 71
79 1,112
Jam Kerja 2 2 2 2 2 2 2
Man Hour 142 136 134 138 90 142 142
TOTAL MAN POWER STAFF 86 81 78 84 55 86 86
TOTAL MAN HOUR STAFF 172 162 156 168 110 172 172
Harian
Pekerja Harian Man Power 4 4 4 4 5 4 6
Jam Kerja 0 0 0 0 0 0 0 4 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 6 6 6 6 0 6 6
Jam Kerja 6 6 6 6 6 6 6 5 216
Man Hour 36 36 36 36 0 36 36
SUBCONTRACTOR
Pekerja Subcontractor Man Power 65 65 65 65 10 65 65
Jam Kerja 4 4 4 4 4 4 4 57 1,600
Man Hour 260 260 260 260 40 260 260
OPERATOR
Operator Man Power 12 12 12 12 0 12 12
Jam Kerja 4 4 4 4 4 4 4 10 288
Man Hour 48 48 48 48 0 48 48
TOTAL OVER TIME MAN HOUR 516 506 500 512 150 516 516 156 3,216
TOTAL KESELURUHUAN MAN HOUR
1900 1850 1764 1896 710 1900 1916 312 11,936
(NORMAL + OVER TIME)

THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 460 Hari
s/d saat ini

Total Man Hour dari

: 185804 Jam
awal tahun s/d saat ini
Total Man hour dari
: 1.210.558 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Rizaldy S Adimas
HSE Officer Project manager

PT NINDYA KARYA (PERSERO)

DIVISI INFRA 1
- BENDUNGAN BENDO (LANJUTAN) -
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT Diisi jumlah temuannya

Description Date khusus untuk IHH
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) : Kriteria Khusus IHH Jumlah Temuan
Unsafe Action 0 0 0 0 0 0 0 0 IHH Rambu 5
Unsafe Condition 1 1 1 1 1 1 1 7 Alat Angkat & Angkut
Inspeksi HSE Management (IHM) : Alat Produksi
Unsafe Action 0 0 0 0 0 0 0 0 Alat Berat
Unsafe Condition 0 0 0 0 0 0 0 0 Hand Tools
Inspeksi HSE Management Proyek (IHMP) : Operasi Pengangkatan
Unsafe Action 0 0 0 0 0 0 0 0 Pekerjaan di Ketinggian
Unsafe Condition 0 0 0 0 0 0 0 0 Pekerjaan Galian 1
Laporan Sumber Bahaya (LSB) : Pekerjaan Panas
Unsafe Action 1 1 1 1 1 1 1 7 Listrik
Unsafe Condition 0 0 0 0 0 0 0 0 Scaffolding
Kategori Kejadian : Gudang & Pengelolaan Material
Near Miss 0 0 0 0 0 0 0 0 Housekeeping 1
First Aid Case 0 0 0 0 0 0 0 0 Pengelolaan Limbah & Lingkungan
MTC 0 0 0 0 0 0 0 0 Lain-lain
RWC 0 0 0 0 0 0 0 0 Total 7
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0 total L97 + L98 7
Fatality 0 0 0 0 0 0 0 0 selisih - (harus nol)
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 1 1 1 1 1 1 1 7
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 1 1 1 1 1 1 1 7
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 1 0 1
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 20 20 20 20 20 20 20
Pekerja Total pekerja di hari tersebut 75 75 75 75 75 75 75 27%
% 27% 27% 27% 27% 27% 27% 27%
Hadir TBT 4 4 4 4 4 4 4
Total pelaksana di hari
Pelaksana 6 6 6 6 6 6 6 67%
tersebut
% 67% 67% 67% 67% 67% 67% 67%
Hadir TBT 0 0 0 0 0 0 0

SOM JUMLAH SOM 0 NA NA NA NA NA NA N/A

% #DIV/0! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!

Hadir TBT 6 6 6 6 6 6 6
HSE Total HSE di hari tersebut 6 6 6 6 6 6 6 100%
% 100% 100% 100% 100% 100% 100% 100%
TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 1 0 0 0 0 0 0 100%
SEM Hadir TBM 0 0 0 0 0 0 0 0%
SOM Hadir TBM NA 0 0 0 0 0 0 0%
SAM Hadir TBM NA 0 0 0 0 0 0 0%
Hadir TBM 20 0 0 0 0 0 0
Pekerja 24%
Total pekerja di hari tersebut 84 0 0 0 0 0 0
Hadir TBM 20 0 0 0 0 0 0
STAFF 25%
Total staff di hari tersebut 81 0 0 0 0 0 0

Reported By : Acknowledge By :

Rizaldy S Adimas
HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PROYEK BENDUNGAN MENINTING PAKET 2 Month : Friday, April 9, 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE MAN

TOTAL MAN HOUR A
Day Apr-21 POWER A
WEEK
Date 9 10 11 12 13 14 15 WEEK
STAFF
Karyawan NK Man Power 57 57 57 57 57 57 57
Jam Kerja 8 8 8 8 8 8 8
Man Hour 456 456 456 456 456 456 456
Karyawan JO Man Power 4 4 4 4 4 4 4
61 3,416
Jam Kerja 8 8 8 8 8 8 8
Man Hour 32 32 32 32 32 32 32
TOTAL MAN POWER STAFF 61 61 61 61 61 61 61
TOTAL MAN HOUR STAFF 488 488 488 488 488 488 488
Harian
Pekerja Harian Man Power 10 10 10 10 10 10 10
Jam Kerja 8 8 8 8 8 8 8 10 560
Man Hour 80 80 80 80 80 80 80
PEKERJA + MANDOR
Pekerja Mandor Man Power 53 53 53 53 53 53 53
Jam Kerja 8 8 8 8 8 8 8 53 2,968
Man Hour 424 424 424 424 424 424 424
SUBCONTRACTOR
Pekerja Subcontractor Man Power 77 77 77 77 77 77 77
Jam Kerja 8 8 8 8 8 8 8 77 4,312
Man Hour 616 616 616 616 616 616 616
OPERATOR
Operator Man Power 24 24 24 24 24 24 24
Jam Kerja 8 8 8 8 8 8 8 24 1,344
Man Hour 192 192 192 192 192 192 192
TOTAL MAN HOUR (NORMAL) 1800 1800 1800 1800 1800 1800 1800 225 12,600

OVER TIME
Description Date
Day Apr-21 Total Manpower Average Mandays
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 3 3 3 3 3 3 3
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
Karyawan JO Man Power 1 1 1 1 1 1 1
4 0
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 4 4 4 4 4 4 4
TOTAL MAN HOUR STAFF 0 0 0 0 0 0 0
Harian
Pekerja Harian Man Power 4 4 4 4 4 4 4
Jam Kerja 4 4 4 4 4 4 4 4 112
Man Hour 16 16 16 16 16 16 16
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 40 40 40 40 40 40 40
Jam Kerja 4 4 4 4 4 4 4 40 1,120
Man Hour 160 160 160 160 160 160 160
OPERATOR
Operator Man Power 3 3 3 3 3 3 3
Jam Kerja 4 4 4 4 4 4 4 3 84
Man Hour 12 12 12 12 12 12 12
TOTAL OVER TIME MAN HOUR 188 188 188 188 188 188 188 51 1,316
TOTAL KESELURUHUAN MAN HOUR
1988 1988 1988 1988 1988 1988 1988 276 13,916
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 586 Hari
s/d saat ini

Total Man Hour dari

: 148240 Jam
awal tahun s/d saat ini

Total Man hour dari

: 788476 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

AKHMAD FANANI ANDIKO IRHASH PUTRA, ST

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PROYEK BENDUNGAN MENINTING PAKET 2
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT Diisi jumlah temuannya khusus

untuk IHH
Description Date
Day Apr/21 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) : Kriteria Khusus IHH Jumlah Temuan
Unsafe Action 3 0 0 2 1 0 0 6 IHH Rambu 6
Unsafe Condition 2 5 5 3 4 5 5 29 Alat Angkat & Angkut 4
Inspeksi HSE Management (IHM) : Alat Produksi
Unsafe Action 0 0 0 0 0 0 0 0 Alat Berat 3
Unsafe Condition 0 0 0 0 0 0 0 0 Alat Pelindung Diri (APD) 3
Inspeksi HSE Management Proyek (IHMP) : Hand Tools
Unsafe Action 1 0 0 0 0 0 0 1 Operasi Pengangkatan
Unsafe Condition 0 1 1 0 0 0 0 2 Pekerjaan di Ketinggian
Laporan Sumber Bahaya (LSB) : Pekerjaan Galian 0
Unsafe Action 1 0 2 2 1 2 2 10 Pekerjaan Panas
Unsafe Condition 2 3 1 1 2 1 3 13 Listrik 3
Kategori Kejadian : Scaffolding
Near Miss 0 0 0 0 0 0 0 0 Gudang & Pengelolaan Material 2
First Aid Case 0 0 0 0 0 0 0 0 Housekeeping 5
MTC 0 0 0 0 0 0 0 0 Pengelolaan Limbah & Lingkungan 1
RWC 0 0 0 0 0 0 0 0 Lain-lain 8
LTI 0 0 0 0 0 0 0 0 Total 35
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0 total L97 + L98 35
Property Damage 0 0 0 0 0 0 0 0 selisih -
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Apr/21 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 5 5 5 5 5 5 35
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
1 1 0 0 1 0 0 3
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 3 3 3 3 3 3 5 23
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 55 40 54 60 60 55 55

Pekerja Total pekerja di hari tersebut 83 83 83 83 83 83 83 67%

% 66% 48% 65% 72% 72% 66% 79%

Hadir TBT 3 3 4 3 3 4 3
Total pelaksana di hari
Pelaksana 7 7 7 7 7 7 7 51%
tersebut
% 43% 43% 57% 43% 43% 57% 71%
Hadir TBT 0 0 0 0 0 0 1

SOM JUMLAH SOM 1 1 1 1 1 1 1 14%

% 0% 0% 0% 0% 0% 0% 100%
Hadir TBT 4 4 4 4 4 4 4

HSE Total HSE di hari tersebut 4 4 4 4 4 4 4 100%

% 100% 100% 100% 100% 100% 100% 100%

TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 0 0 1 100%
DPM Hadir TBM 0 0 0 0 0 0 1 100%
SEM Hadir TBM 0 0 0 0 0 0 0 0%
SOM Hadir TBM 0 0 0 0 0 0 1 100%
SAM Hadir TBM 0 0 0 0 0 0 0 0%
Hadir TBM 0 0 0 0 0 0 30
Pekerja 38%
Total pekerja di hari tersebut 0 0 0 0 0 0 80
Hadir TBM 0 0 0 0 0 0 40
STAFF 73%
Total staff di hari tersebut 0 0 0 0 0 0 55

Reported By : Acknowledge By :

AKHMAD FANANI ANDIKO IRHASH PUTRA, ST

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PROYEK PEMBANGUNAN BENDUNGAN TIU SUNTUK (PAKET 1) Month : MARET 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day Maret 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 45 45 45 45 0 45 45
Jam Kerja 8 8 8 8 0 8 8
Man Hour 360 360 360 360 0 360 360
Karyawan JO Man Power 4 4 4 4 0 4 4
42 2,352
Jam Kerja 8 8 8 8 0 8 8
Man Hour 32 32 32 32 0 32 32
TOTAL MAN POWER STAFF 49 49 49 49 0 49 49
TOTAL MAN HOUR STAFF 392 392 392 392 0 392 392
Harian
Pekerja Harian Man Power 55 55 55 55 0 55 55
Jam Kerja 8 8 8 8 0 8 8 47 2,640
Man Hour 440 440 440 440 0 440 440
PEKERJA + MANDOR
Pekerja Mandor Man Power 92 92 92 92 0 92 92
Jam Kerja 8 8 8 8 0 8 8 79 4,416
Man Hour 736 736 736 736 0 736 736
SUBCONTRACTOR
Pekerja Subcontractor Man Power 151 151 151 151 0 151 151
8 8 8 8 0 8 8 129 7,248
Man Hour 1208 1208 1208 1208 0 1208 1208
OPERATOR
Operator Man Power 29 29 29 29 0 29 29
Jam Kerja 8 8 8 8 0 8 8 25 1,392
Man Hour 232 232 232 232 0 232 232
TOTAL MAN HOUR (NORMAL) 3008 3008 3008 3008 0 3008 3008 322 18,048

OVER TIME
Description Date
Day Maret 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 23 20 22 10 0 0 0
Jam Kerja 4 4 4 4 0 0 0
Man Hour 92 80 88 40 0 0 0
Karyawan JO Man Power 1 1 2 1 0 0 0
11 320
Jam Kerja 4 4 4 4 0 0 0
Man Hour 4 4 8 4 0 0 0
TOTAL MAN POWER STAFF 24 21 24 11 0 0 0
TOTAL MAN HOUR STAFF 96 84 96 44 0 0 0
Harian
Pekerja Harian Man Power 35 40 42 44 0 0 0
Jam Kerja 4 4 4 4 0 0 0 23 644
Man Hour 140 160 168 176 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 92 92 92 92 0 0 0
Jam Kerja 4 4 4 4 0 0 0 53 1,472
Man Hour 368 368 368 368 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 52 57 55 67 0 0 0
Jam Kerja 4 4 4 4 0 0 0 33 924
Man Hour 208 228 220 268 0 0 0
OPERATOR
Operator Man Power 13 13 19 17 0 0 0
Jam Kerja 4 4 4 4 0 0 0 9 248
Man Hour 52 52 76 68 0 0 0
TOTAL OVER TIME MAN HOUR 864 892 928 924 0 0 0 129 3,608
TOTAL KESELURUHUAN MAN HOUR
3872 3900 3936 3932 0 3008 3008 451 21,656
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 450 Hari
s/d saat ini

Total Man Hour dari

: 322,660 Jam
awal tahun s/d saat ini

Total Man hour dari

: 778,586 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Muh. Rahmat Mustari Edden Umaga Dinata

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PROYEK PEMBANGUNAN BENDUNGAN TIU SUNTUK (PAKET 1)
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 0 1 0 1 0 1 1 4 IHH
Unsafe Condition 5 4 5 4 0 4 4 26
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 1 1 0 0 0 2
Unsafe Condition 1 1 0 1 0 2 1 6
Laporan Sumber Bahaya (LSB) :
Unsafe Action 3 1 2 1 0 3 3 13
Unsafe Condition 7 9 8 9 0 7 7 47
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 5 5 5 0 5 5 30
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
1 1 1 2 0 2 1 8
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 10 10 10 10 0 10 10 60
Jumlah Rapat HSE (Internal plus External) 9 8 10 18 0 11 9 65
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 18 18
Jumlah induksi eksternal 3 0 0 0 0 0 0 3
Housekeeping Massal (diisi 1 bila melakukan) 1 0 0 0 0 0 0 1
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 1 1

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 289 276 269 297 0 288 276

Pekerja Total pekerja di hari tersebut 364 364 364 364 0 364 364 67%

% 79% 76% 74% 82% 0% 79% 76%

Hadir TBT 2 2 2 2 0 2 2
Total pelaksana di hari
Pelaksana 2 2 2 2 0 2 2 86%
tersebut
% 100% 100% 100% 100% 0% 100% 100%
Hadir TBT 1 1 1 1 0 1 1

SOM JUMLAH SOM 1 1 1 1 0 1 1 86%

% 100% 100% 100% 100% 0% 100% 100%

Hadir TBT 9 9 9 9 0 9 9

HSE Total HSE di hari tersebut 9 9 9 9 0 9 9 86%

% 100% 100% 100% 100% 0% 100% 100%

 TBM ( TULISKAN TANGGAL; KEGIATAN TBM )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 1 0 0 0 0 0 100%
SEM Hadir TBM 0 1 0 0 0 0 0 100%
OE Hadir TBM 0 1 0 0 0 0 0 100%
SOM Hadir TBM 0 1 0 0 0 0 0 100%
SAM Hadir TBM 0 1 0 0 0 0 0 100%
Hadir TBM 0 293 0 0 0 0 0
Pekerja 92%
Total pekerja di hari tersebut 0 320 0 0 0 0 0
Hadir TBM 0 40 0 0 0 0 43
STAFF 100%
Total staff di hari tersebut 0 40 0 0 0 0 43

Reported By : Acknowledge By :

Muh. Rahmat Mustari Edden Umaga Dinata

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PEMBANGUNAN SPAM KALI DENDENG KAPASITAS 150L/DET
Month : APRIL 2021
KOTA KUPANG
WEEKLY SAFETY REPORT Period : 09 April 2021
MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN
Day April 2021 MAN POWER
HOUR A WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 2 2 2 2 2 2 2
Jam Kerja 8 8 8 8 8 8 8
Man Hour 16 16 16 16 16 16 16
Karyawan JO Man Power 32 32 32 32 33 33 33
34 1,928
Jam Kerja 8 8 8 8 8 8 8
Man Hour 256 256 256 256 264 264 264
TOTAL MAN POWER STAFF 34 34 34 34 35 35 35
TOTAL MAN HOUR STAFF 272 272 272 272 280 280 280
Harian
Pekerja Harian Man Power 20 27 14 30 30 29 30
Jam Kerja 8 8 8 8 8 8 8 26 1,440
Man Hour 160 216 112 240 240 232 240
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 46 47 18 48 46 40 47
Jam Kerja 8 8 8 8 8 8 8 42 2,336
Man Hour 368 376 144 384 368 320 376
OPERATOR
Operator Man Power 12 12 0 8 8 8 8
Jam Kerja 8 8 8 8 8 8 8 8 448
Man Hour 96 96 0 64 64 64 64
TOTAL MAN HOUR (NORMAL) 896 960 528 960 952 896 960 110 6,152

OVER TIME
Description Date
Day April 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 2 2 2 2 2 2 2
Jam Kerja 2 2 1 2 2 2 2
Man Hour 4 4 2 4 4 4 4
Karyawan JO (Kantor) Man Power 7 7 5 7 7 7 7
Jam Kerja 2 2 1 2 2 2 2
Man Hour 14 14 5 14 14 14 14 16 268
Karyawan JO (Lapangan) Man Power 8 8 0 9 9 8 9
Jam Kerja 3 3 0 3 3 3 3
Man Hour 24 24 0 27 27 24 27
TOTAL MAN POWER STAFF 17 17 7 18 18 17 18
TOTAL MAN HOUR STAFF 42 42 7 45 45 42 45
Harian
Pekerja Harian Man Power 5 5 0 6 6 6 6
Jam Kerja 3 3 0 3 3 3 3 5 102
Man Hour 15 15 0 18 18 18 18
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 27 15 0 34 26 39 35
Jam Kerja 3 3 0 3 3 3 3 25 528
Man Hour 81 45 0 102 78 117 105
OPERATOR
Operator Man Power 0 0 0 4 4 4 4
Jam Kerja 0 0 0 3 3 3 3 2 48
Man Hour 0 0 0 12 12 12 12
TOTAL OVER TIME MAN HOUR 138 102 7 177 153 189 180 48 946
TOTAL KESELURUHUAN MAN HOUR
1034 1062 535 1137 1105 1085 1140 158 7,098
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) s/d : 165 Hari
saat ini

Total Man Hour dari awal

: 88,238 Jam
tahun s/d saat ini

Total Man hour dari awal

: 99,918 Jam
proyek s/d saat ini

Reported By : Acknowledge By :

Tadeus Satria Ragel Seno Susanto

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
PEMBANGUNAN SPAM KALI DENDENG KAPASITAS 150L/DET
KOTA KUPANG
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 1 0 1 0 0 0 0 2 IHH
Unsafe Condition 2 2 2 7 7 3 8 31
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Laporan Sumber Bahaya (LSB) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day April 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 3 2 3 7 7 3 8 33
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 0 0
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 0 0 0 0 0 0 0 0
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 0 0 0 0
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 1 0 0 1

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 17 16 10 14 13 15 13

Pekerja Total pekerja di hari tersebut 46 47 18 48 46 40 47 36%

% 37% 34% 56% 29% 28% 38% 28%

Hadir TBT 3 3 2 2 1 2 3
Total pelaksana di hari
Pelaksana 3 3 3 3 3 3 3 76%
tersebut
% 100% 100% 67% 67% 33% 67% 100%
Hadir TBT 1 0 1 1 0 1 1

SOM JUMLAH SOM 1 1 1 1 1 1 1 71%

% 100% 0% 100% 100% 0% 100% 100%

Hadir TBT 3 2 2 2 2 2 3

HSE Total HSE di hari tersebut 3 3 3 3 3 3 3 76%

% 100% 67% 67% 67% 67% 67% 100%

TBM
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM
SEM Hadir TBM
SOM Hadir TBM
SAM Hadir TBM
Hadir TBM
Pekerja
Total pekerja di hari tersebut
Hadir TBM
STAFF
Total staff di hari tersebut

Reported By : Acknowledge By :
Tadeus Satria Ragel Seno Susanto
HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
BENDUNG D.I BOMBERAY Month : APRIL 2021

WEEKLY SAFETY REPORT Period : 09 April 2021

MANPOWER AND MANHOURS Up To : 15 April 2021

Description Date AVERAGE

TOTAL MAN HOUR A
Day Maret 2021 MAN POWER
WEEK
Date 9 10 11 12 13 14 15 A WEEK
STAFF
Karyawan NK Man Power 13 13 13 13 13 13 13
Jam Kerja 0 8 8 8 8 8 8
Man Hour 0 104 104 104 104 104 104
Karyawan JO Man Power 0 0 0 0 0 0 0
13 624
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 13 13 13 13 13 13 13
TOTAL MAN HOUR STAFF 0 104 104 104 104 104 104
Harian
Pekerja Harian Man Power 6 6 6 6 8 6 7
Jam Kerja 8 8 8 8 4 8 8 7 328
Man Hour 48 48 48 48 32 48 56
PEKERJA + MANDOR
Pekerja Mandor Man Power 38 36 29 34 8 6 9
Jam Kerja 8 8 8 8 8 8 8 20 976
Man Hour 304 288 232 272 64 48 72
SUBCONTRACTOR
Pekerja Subcontractor Man Power 2 2 2 2 2 2 2
Jam Kerja 8 8 8 8 8 8 8 2 96
Man Hour 16 16 16 16 16 16 0
OPERATOR
Operator Man Power 6 6 6 6 6 6 6
Jam Kerja 8 8 8 8 8 8 8 6 288
Man Hour 48 48 48 48 48 48
TOTAL MAN HOUR (NORMAL) 416 504 448 488 264 264 48 2,312

OVER TIME
Description Date
Day Maret 2021 Total
Average Mandays
Manpower
Date 9 10 11 12 13 14 15
STAFF
Karyawan NK Man Power 4 4 4 4 4 4 4
Jam Kerja 4 4 4 4 4 4 4
Man Hour 16 16 16 16 16 16 16
Karyawan JO Man Power 0 0 0 0 0 0 0
4 112
Jam Kerja 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL MAN POWER STAFF 4 4 4 4 4 4 4
TOTAL MAN HOUR STAFF 16 16 16 16 16 16 16
Harian
Pekerja Harian Man Power 0 0 0 0 0 0 0
Jam Kerja 4 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
PEKERJA + MANDOR
Pekerja Mandor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
SUBCONTRACTOR
Pekerja Subcontractor Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
OPERATOR
Operator Man Power 0 0 0 0 0 0 0
Jam Kerja 0 0 0 0 0 0 0 0 0
Man Hour 0 0 0 0 0 0 0
TOTAL OVER TIME MAN HOUR 16 16 16 16 16 16 16 4 112
TOTAL KESELURUHUAN MAN HOUR
432 520 464 504 280 280 16 52 2,424
(NORMAL + OVER TIME)
THIS WEEK

Jumlah hari kerja dari

proyek mulai (SPMK) : 846 Hari
s/d saat ini

Total Man Hour dari

: 71,665 Jam
awal tahun s/d saat ini

Total Man hour dari

: 558,951 Jam
awal proyek s/d saat ini

Reported By : Acknowledge By :

Brian Klopfleisch Sumardiana

HSE Officer Project manager
 PT NINDYA KARYA (PERSERO)
DIVISI INFRA 1
Bendung D.I Bomberay
WEEKLY SAFETY PERFORMANCE REPORT

INCIDENT
Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Inspeksi Harian HSE (IHH) :
Unsafe Action 1 0 1 0 1 0 0 3 IHH
Unsafe Condition 4 3 3 5 4 5 4 28
Inspeksi HSE Management (IHM) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 0 0
Inspeksi HSE Management Proyek (IHMP) :
Unsafe Action 0 0 0 0 0 0 0 0
Unsafe Condition 0 0 0 0 0 0 1 1
Laporan Sumber Bahaya (LSB) :
Unsafe Action 1 1 0 0 0 1 0 3
Unsafe Condition 1 0 1 1 1 0 2 6
Kategori Kejadian :
Near Miss 0 0 0 0 0 0 0 0
First Aid Case 0 0 0 0 0 0 0 0
MTC 0 0 0 0 0 0 0 0
RWC 0 0 0 0 0 0 0 0
LTI 0 0 0 0 0 0 0 0
LWC 0 0 0 0 0 0 0 0
Fatality 0 0 0 0 0 0 0 0
Property Damage 0 0 0 0 0 0 0 0
Environmental Damage 0 0 0 0 0 0 0 0
*nb: melampirkan FM-RIHH, dan Laporan awal & akhir kecelakaan (jika ada)

Health, Safety and Environmental Management

Description Date
Day Maret 2021 TOTAL
Date 9 10 11 12 13 14 15
Jumlah Temuan Inspeksi Harian HSE (IHH) 5 3 4 5 5 5 4 31
Jumlah Temuan Inspeksi HSE Management (IHM) 0 0 0 0 0 0 0 0
Jumlah Temuan Inspeksi HSE Management Proyek
0 0 0 0 0 0 1 1
(IHMP)
Jumlah Temuan Laporan Sumber Bahaya (LSB) 2 1 1 1 1 1 2 9
Jumlah Rapat HSE (Internal plus External) 0 0 0 0 0 0 0 0
Jumlah induksi karyawan/pekerja baru 0 0 0 0 2 0 0 2
Jumlah induksi eksternal 0 0 0 0 0 0 0 0
Housekeeping Massal (diisi 1 bila melakukan) 1 0 0 0 0 0 0 1
Pengukuran Lingkungan (diisi 1 bila melakukan) 0 0 0 0 0 0 0 0

PERSENTASE TBT DAN TBM

TBT (SETIAP HARI) 9 10 11 12 13 14 15 % A WEEK
Hadir TBT 40 38 36 39 19 16 19

Pekerja Total pekerja di hari tersebut 44 42 39 44 21 18 20 91%

% 91% 90% 92% 89% 90% 89% 95%

Hadir TBT NA NA NA NA NA NA NA
Total pelaksana di hari
Pelaksana NA NA NA NA NA NA NA N/A
tersebut
% N/A N/A N/A N/A N/A N/A N/A
Hadir TBT 1 1 1 1 1 1 1

SOM JUMLAH SOM 1 1 1 1 1 1 1 100%

% 100% 100% 100% 100% 100% 100% 100%

Hadir TBT 1 1 1 1 1 1 1

HSE Total HSE di hari tersebut 1 1 1 1 1 1 1 100%

% 100% 100% 100% 100% 100% 100% 100%

 TBM ( Kamis,31 Maret 2021 )
% A WEEK
*nb: isi di hari yang TBM saja
PM Hadir TBM 0 0 0 0 1 0 0 100%
SEM Hadir TBM 0 0 0 0 1 0 0 100%
SOM Hadir TBM 0 0 0 0 0 0 0 0%
SAM Hadir TBM 0 0 0 0 1 0 0 100%
Hadir TBM 0 0 0 0 19 0 0
Pekerja 90%
Total pekerja di hari tersebut 0 0 0 0 21 0 0
Hadir TBM 0 0 0 0 9 0 0
STAFF 82%
Total staff di hari tersebut 0 0 0 0 11 0 0

Reported By : Acknowledge By :

Brian Klopfleisch Sumardiana

HSE Officer Project manager