HSE WEEKLY REPORT

Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di

Kab. Pasuruhan & Kab. Probolinggo (8.000 SR)
Tahun Anggaran 2019

Nomor Kontrak : 026.PK/Cons/PPK/Gen-JRG6/IV/2019 Minggu Ke : 01

Lokasi Proyek : Kabupaten Probolinggo Periode : Mei 2019

No Report : JRG6-KPD-3513-HS-RW-001 Tanggal : 02 Mei s/d 08 Mei 2019

A. HSE Performance

Last Weekly This Weekly Total Cumulative

No. Description of Incidents
Office Site Office Site Office Site
1 Total Manpower 0 0 7 0 7 0

2 Manhours 0 0 392 0 392 0

3 Safe Man Hours 0 0 392 0 392 0

4 Near Misses 0 0 0 0 0 0
5 First Aid Cases 0 0 0 0 0 0

6 Medical Treatment Case (MTC) 0 0 0 0 0 0

7 Fire/Explosions 0 0 0 0 0 0
8 Traffic Cases/Vehicle Cases 0 0 0 0 0 0

9 Property Damage 0 0 0 0 0 0
10 Environmental Spill/Losses 0 0 0 0 0 0

TOTAL SAFE MANHOURS 392

B. Pro-Active Measures:

Description of Participation, Communication & Last Weekly This Weekly Total Cumulative
No.
Consultation Office Site Office Site Office Site

1 Communication & Training

a. Induction 0 0 0 1 0 1

b. Toolbox Talk 0 0 0 4 0 4

c. Pembuatan JSA 0 0 0 1 0 1

d. Permit Keluar 0 0 0 1 0 1
e. Inspeksi K3L 0 0 0 0 0 0

f. Laporan Anomaly 0 0 0 0 0 0

g. Investigasi 0 0 0 0 0 0

h. Lain-lain 0 0 0 0 0 0

C. Notes :

Dibuat Oleh, Diperiksa Oleh, Menyetujui,

Ahmad Sirojuddin Sarmidi Hidayat

KSO Pratiwi - Dhamma PMC - KSO Amythas - Virama CAS - PT. PGN
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 01

Lokasi Proyek : Kabupaten Probolinggo Periode : Maret 2021

No Report : JRG18-PPS-3513-HS-RW-001 Tanggal : 15 Maret s/d 23 Maret 2021

A. HSE Performance

Last Weekly This Weekly Total Cumulative

No. Description of Incidents
Office Site Office Site Office Site
1 Total Manpower 0 0 3 11 3 11

2 Manhours 0 0 168 616 168 616

3 Safe Man Hours 0 0 168 616 168 616

4 Near Misses 0 0 0 0 0 0
5 First Aid Cases 0 0 0 0 0 0

6 Medical Treatment Case (MTC) 0 0 0 0 0 0

7 Fire/Explosions 0 0 0 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0 0 0 0

9 Property Damage 0 0 0 0 0 0

10 Environmental Spill/Losses 0 0 0 0 0 0

TOTAL SAFE MANHOURS 696

B. Pro-Active Measures:

Description of Participation, Communication

No. Last Weekly This Weekly Total Cumulative
& Consultation

1 Communication & Training

a. Induction 0 0 0

b. Toolbox Talk 0 3 3

c. Pembuatan JSA 0 0 0
d. Permit Keluar 0 0 0

e. Inspeksi K3L 0 0 0

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat Oleh, Diperiksa Oleh, Menyetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 02

Lokasi Proyek : Kabupaten Probolinggo Periode : Maret 2021

No Report : JRG18-PPS-3513-HS-RW-002 Tanggal : 24 Maret s/d 30 Maret 2021

A. HSE Performance

Last Weekly This Weekly Total Cumulative

No. Description of Incidents
Office Site Office Site Office Site
1 Total Manpower 3 11 7 16 7 14

2 Manhours 168 616 304 896 472 1512

3 Safe Man Hours 168 616 304 896 472 1512

4 Near Misses 0 0 0 0 0 0
5 First Aid Cases 0 0 0 0 0 0

6 Medical Treatment Case (MTC) 0 0 0 0 0 0

7 Fire/Explosions 0 0 0 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0 0 0 0

9 Property Damage 0 0 0 0 0 0

10 Environmental Spill/Losses 0 0 0 0 0 0

TOTAL SAFE MANHOURS 1984

B. Pro-Active Measures:

Description of Participation, Communication

No. Last Weekly This Weekly Total Cumulative
& Consultation

1 Communication & Training

a. Induction 0 0 0

b. Toolbox Talk 3 7 10

c. Pembuatan JSA 0 0 0
d. Permit Keluar 0 0 0

e. Inspeksi K3L 0 0 0

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat Oleh, Diperiksa Oleh, Menyetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 03

Lokasi Proyek : Kabupaten Probolinggo Periode : Maret - April 2021

No Report : JRG18-PPS-3513-HS-RW-003 Tanggal : 31 Maret s/d 06 April 2021

A. HSE Performance

Last Weekly This Weekly Total Cumulative

No. Description of Incidents
Office Site Office Site Office Site
1 Total Manpower 7 14 12 15 12 15

2 Manhours 472 1512 704 784 1176 2296

3 Safe Man Hours 472 1512 704 784 1176 2296

4 Near Misses 0 0 0 0 0 0
5 First Aid Cases 0 0 0 0 0 0

6 Medical Treatment Case (MTC) 0 0 0 0 0 0

7 Fire/Explosions 0 0 0 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0 0 0 0

9 Property Damage 0 0 0 0 0 0

10 Environmental Spill/Losses 0 0 0 0 0 0

TOTAL SAFE MANHOURS 3472

B. Pro-Active Measures:

Description of Participation, Communication

No. Last Weekly This Weekly Total Cumulative
& Consultation

1 Communication & Training

a. Induction 0 25 25

b. Toolbox Talk 10 7 17

c. Pembuatan JSA 0 0 0
d. Permit Keluar 0 0 0

e. Inspeksi K3L 0 0 0

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat Oleh, Diperiksa Oleh, Menyetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 04

Lokasi Proyek : Kabupaten Probolinggo Periode : April 2021

No Report : JRG18-PPS-3513-HS-RW-004 Tanggal : 07 April 2021 s/d 13 April 2021

A. HSE Performance

No. Description of Incidents Last Weekly This Weekly Total Cumulative

1 Total Manpower 27 154 154

2 Manhours 3472 6648 10120

3 Safe Man Hours 3472 6648 10120

4 Near Misses 0 0 0
5 First Aid Cases 0 0 0

6 Medical Treatment Case (MTC) 0 0 0

7 Fire/Explosions 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0

9 Property Damage 0 0 0

10 Environmental Spill/Losses 0 0 0

TOTAL SAFE MANHOURS 10120

B. Pro-Active Measures:

Description of Participation, Communication &

No. Last Weekly This Weekly Total Cumulative
Consultation

1 Communication & Training

a. Induction 25 116 141

b. Toolbox Talk 17 7 24

c. Pembuatan JSA 0 9 9
d. Permit Keluar 0 8 8

e. Inspeksi K3L 0 0 0

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat, Diperiksa dan Disetujui, Diperiksa dan Disetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 05

Lokasi Proyek : Kabupaten Probolinggo Periode : April 2021

No Report : JRG18-PPS-3513-HS-RW-005 Tanggal : 14 April 2021 s/d 20 April 2021

A. HSE Performance

No. Description of Incidents Last Weekly This Weekly Total Cumulative

1 Total Manpower 154 163 163

2 Manhours 10120 8696 18816

3 Safe Man Hours 10120 8696 18816

4 Near Misses 0 0 0
5 First Aid Cases 0 0 0

6 Medical Treatment Case (MTC) 0 0 0

7 Fire/Explosions 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0

9 Property Damage 0 0 0

10 Environmental Spill/Losses 0 0 0

TOTAL SAFE MANHOURS 18816

B. Pro-Active Measures:

Description of Participation, Communication &

No. Last Weekly This Weekly Total Cumulative
Consultation

1 Communication & Training

a. Induction 141 23 164

b. Toolbox Talk 24 7 31

c. Pembuatan JSA 9 9 18
d. Permit Keluar 8 9 17

e. Inspeksi K3L 24 0 24

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat, Diperiksa dan Disetujui, Diperiksa dan Disetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS Kab. Probolinggo
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 06

Lokasi Proyek : Kabupaten Probolinggo Periode : April 2021

No Report : JRG18-PPS-3513-HS-RW-006 Tanggal : 21 April 2021 s/d 27 April 2021

A. HSE Performance

No. Description of Incidents Last Weekly This Weekly Total Cumulative

1 Total Manpower 163 165 165

2 Manhours 18816 9224 28040

3 Safe Man Hours 18816 9224 28040

4 Near Misses 0 0 0
5 First Aid Cases 0 0 0

6 Medical Treatment Case (MTC) 0 0 0

7 Fire/Explosions 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0

9 Property Damage 0 0 0

10 Environmental Spill/Losses 0 0 0

TOTAL SAFE MANHOURS 28040

B. Pro-Active Measures:

Description of Participation, Communication &

No. Last Weekly This Weekly Total Cumulative
Consultation

1 Communication & Training

a. Induction 164 0 164

b. Toolbox Talk 31 7 38

c. Pembuatan JSA 18 9 27
d. Permit Keluar 17 9 26

e. Inspeksi K3L 24 1 25

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat, Diperiksa dan Disetujui, Diperiksa dan Disetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS Kab. Probolinggo
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 07

Lokasi Proyek : Kabupaten Probolinggo Periode : April - Mei 2021

No Report : JRG18-PPS-3513-HS-RW-007 Tanggal : 28 April 2021 s/d 04 Mei 2021

A. HSE Performance

No. Description of Incidents Last Weekly This Weekly Total Cumulative

1 Total Manpower 165 43 43

2 Manhours 28040 6632 34672

3 Safe Man Hours 28040 6632 34672

4 Near Misses 0 0 0
5 First Aid Cases 0 0 0

6 Medical Treatment Case (MTC) 0 0 0

7 Fire/Explosions 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0

9 Property Damage 0 0 0

10 Environmental Spill/Losses 0 0 0

TOTAL SAFE MANHOURS 34672

B. Pro-Active Measures:

Description of Participation, Communication &

No. Last Weekly This Weekly Total Cumulative
Consultation

1 Communication & Training

a. Induction 164 1 165

b. Toolbox Talk 38 7 45

c. Pembuatan JSA 27 1 28
d. Permit Keluar 26 7 33

e. Inspeksi K3L 25 0 25

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat, Diperiksa dan Disetujui, Diperiksa dan Disetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS Kab. Probolinggo
 HSE WEEKLY REPORT
Pembangunan Jaringan Gas Bumi Untuk Rumah Tangga di
Kab. Probolinggo & Kota Probolinggo (10.817 SR)
Tahun Anggaran 2021

Nomor Kontrak : 01600.SP/PPK-EPC/JRG18/2021 Minggu Ke : 08

Lokasi Proyek : Kabupaten Probolinggo Periode : Mei 2021

No Report : JRG18-PPS-3513-HS-RW-008 Tanggal : 05 Mei 2021 s/d 11 Mei 2021

A. HSE Performance

No. Description of Incidents Last Weekly This Weekly Total Cumulative

1 Total Manpower 43 4 4

2 Manhours 34672 896 35568

3 Safe Man Hours 34672 896 35568

4 Near Misses 0 0 0
5 First Aid Cases 0 0 0

6 Medical Treatment Case (MTC) 0 0 0

7 Fire/Explosions 0 0 0

8 Traffic Cases/Vehicle Cases 0 0 0

9 Property Damage 0 0 0

10 Environmental Spill/Losses 0 0 0

TOTAL SAFE MANHOURS 35568

B. Pro-Active Measures:

Description of Participation, Communication &

No. Last Weekly This Weekly Total Cumulative
Consultation

1 Communication & Training

a. Induction 165 0 165

b. Toolbox Talk 45 7 52

c. Pembuatan JSA 28 0 28
d. Permit Keluar 33 0 33

e. Inspeksi K3L 25 0 25

f. Laporan Anomaly 0 0 0

g. Investigasi 0 0 0
h. Lain-lain 0 0 0

C. Notes :

Dibuat, Diperiksa dan Disetujui, Diperiksa dan Disetujui,

Ahmad Sirojuddin Bachtiar Arfan Agung Nugroho

HSE PPS HSE PMC CAS Kab. Probolinggo