HSE Performance Report

PT LEVINE LATERSIA BARATAM
MONTHLY HSE PER
SITE TTD Month:

Prepared by (sign) By:
EFENDI GINTING
Approved by (sign)
Company Contractor
Performance Indicators
Total Man Hours Worked Onsite Rantau Onsite

Total Man Hours 30940 0
Occupational Safety
Major Overdue Action Items 0 0
Minor Overdue Action Items 0 0
- MINOR INJURY 0 0
- MAYOR INJURY 0 0
NEAR MISS 4 0
FATALITY / DEAD 0 0
LOST TIME INJURY 0 0
Occupational Safety
Fatality 0 0 0
Fatal Accident Rate (FAR) 0 0 0
Permanent Partial Dissability (PPD) 0 0 0
Permanent Total Disability (PTD) 0 0 0
Lost Work Day Case (LWC) 0 0 0
Lost Time Injury (LTI) 0 0 0
Lost Time Injury Frequency (LTIF) 0 0 0
Restricted Work Day Case (RWC) 0 0 0
Medical Treatment Injury (MTI) 2 0 0
Total Reportable Case (TRC) 0 0 0
Total Reportable Case Frequency (TRCF) 0 0 0
First Aid Case (FAC) 0 0 0
Major Property Damage 0 0 0
Minor Property Damage 2 0 0
Major Fire/Explosion 0 0 0
Minor Fire/Explosion 0 0 0
High Potential Incident 0 0 0
Near Miss 0 0 0
Land Transport Safety
Total Distance Driven (km) 0 0 0
Total Number of Fatal Vehicles Accidents 0 0 0
Internal
Fatal Vehicle Accident Rate (FVAR) 0 0 0
Total Number of Serious Vehicle Accidents 0 0 0
Serious Vehicle Accident Rate (SVAR) 0 0 0
Total Number of Vehicle Accidents 2 0 0
Total Vehicle Accident Rate (TVAR) 2 0 0
Internal
PT LEVINE LATERSIA BARATAMA- ATS RANTAU PROJECT
MONTHLY HSE PERFORMANCE
MARET 2022
EFENDI GINTING HSE Performance, HSE Dept.
Contractor Total Current FY 2022 Remarks

Month
Onsite
0 30940 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Internal
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Internal
30,940
Internal
TeLiTi Register Document Revision : 04
Period: July-2021 Date Rev 13/8/2018

Document Number : Page 1/4
Department / Project : Bukit Tua Phase 2B

Lokasi / Location : AWB. PTM2
1 TOTAL Cards
Number of Observation Cards 531
2 Type of Action
Observation 501
Stop Work 30
3 Observation
Safe Condition 284
Unsafe Condition 247
Total Observation 531
4 Category Observation
Unsafe
Variable Safe Observation
Observation
No of Safe No of Unsafe
Kesehatan / Health
Observation Observation
- Kondisi sehat / siap kerja - Fit for work 18 5
- Bahan berbahaya bagi tubuh - Hazardous substance 2 2
- Ergonomi / posisi tubuh - Ergonomic / posture 0 1
- Kondisi psikologi - Psychological condition 0 0 101
- Kebersihan & kesehatan - Hygiene & sanitation 56 17 101
Lingkungan / Environment
- Kerapian & kebersihan - House keeping 53 52
- Berpotensi pencemaran - Potentially of spill / emission 7 1
- Paparan gas beracun - Toxic gas exposure 0 0
- Pemberian simbol-simbol standar - Standard labeling 8 1
- Penggunaan Energi - Energy Use 0 0 122
- MSDS - Material Safety Data Sheets 0 0 122
Prosedur / Procedure
- Dokumen ijin kerja - Permit To Work (PTW) 2 0
- Penilaian Resiko Pekerjaan - HIRA / JSA /JRA 7 6
- Petunjuk kerja - SOP / Guideline / Working instruction 79 68
- Siap tanggap darurat - Emergency preparedness 0 3
- Sertifikasi operasi / Peralatan - Certificates 0 0 184
- Pengawasan - Supervisor 5 14 184
Perkakas & Peralatan / Tools & Equipment
- Alat pelindung diri - PPE 36 49
- Alat portable - Hand / portable tools 2 8
- Listrik - Electircal / electronic 0 3
- Mekanis - Mechanical 5 4 112
- Kendaraan / alat berat - Vehicular / heavy equipment 4 1 112
Kebakaran / Fire
- Berpotensi kecelakaan - Potentially accident 0 4
- Berpotensi kebakaran / meledak - Potentially fire / explode 0 8 12
TOTAL OBSERVATION 284 247 949
Number Of Observation Kartu TeLiTi Kartu TeLiTi Unsafe Observation index
Safe Condition Unsafe Condition 12

25
91 Health
54 Fire & Safety
247
284 Environment
65 Tools & Equipment
Document / Procedure
Health (Unsafe observation) Fire & Safety (Unsafe Observation)
5 - Kondisi sehat / siap kerja - Fit

for work
- Bahan berbahaya bagi tubuh 4 - Berpotensi kecelakaan - Po-
2 - Hazardous substance tentially accident
1 - Ergonomi / posisi tubuh - Variable Unsafe Observasi
17 Ergonomic / posture 8
- Kondisi psikologi - Psycho- Health 25 /
- Berpotensi kebakaran
logical condition meledak - Potentially fire /
Fire & Safety explode 12
- Kebersihan & kesehatan -
Hygiene & sanitation Environment 54
Tools & Equipment 65
Document / Procedure 91
Environment (Unsafe Observation) Tool & Equipment ( Unsafe Observation)
Variable safe Observasi
- Alat pelindung diri - PPE
- Kerapian & kebersihan - House
1
11
keeping 3 4
- Alat portable - Hand / portable
- Berpotensi pencemaran - Po- Health 8 tools 76
tentially of spill / emission
Fire & Safety 0
- Listrik - Electircal / electronic
- Paparan gas beracun - Toxic gas Environment - Mekanis - Mechanical68
exposure 49
- Kendaraan / alat berat - Vehicular /
- Pemberian simbol-simbol standar - heavy equipment
52 Standard labeling
- Penggunaan Energi - Energy Use
- MSDS - Material Safety Data Sheets
Document / Procedure (Unsafe Observation)
14 6
3 - Dokumen ijin kerja - Permit To Work (PTW)
- Penilaian Resiko Pekerjaan - HIRA / JSA /JRA
- Petunjuk kerja - SOP / Guideline / Working instruction
- Siap tanggap darurat - Emergency preparedness

68
- Sertifikasi operasi / Peralatan - Certificates
- Pengawasan - Supervisor
Number Of Observation Kartu TeLiTi Kartu TeLiTi Safe Observation index
S a fe Condition U ns a fe Condition
68
93
247 H ealth Fi re & Safety En vi ro n men t To o l s & Eq u i p men t Do cu men t / P ro ced u re
284
76
47
Health (Safe observation) Fire & Safety (Safe Observation)
18
- K o n d i si seh at / si ap kerj a - Fi t fo r wo rk - B ah an b erb ah aya b agi tu b u h - Hazard o u s su b stan ce
56
- Ergo n o mi / p o sisi tu b u h - Ergo n o mi c / p o stu re - K o n d isi p si ko lo gi - P sych o l o gi cal co n d i ti o n
- B erp o ten si kecelakaan - P o ten ti al l y accid en t - B erp o ten si keb akaran / mel ed ak - P o ten ti al ly fi re / exp lo d e
- K eb ersi h an & keseh atan - Hygi en e & san i tati o n
Environment (Safe Observation) Tool & Equipment (Safe Observation)
8
7 - K erap i an & keb ersih an - H o u se keep i n g - B erp o ten si p en cemaran - P o ten ti all y o f sp il l / emissi o n
4
5
2
53 - P ap aran gas b eracu n - To xi c gas exp o su re - P emb eri an simb o l -si mb o l stan d ar - Stan d ard l ab eli n g
- A l at p el in d u n g d iri - P P E - A l at p o rtab l e - Han d / p o rtab l e to o l s - Listri k - El ecti rcal / electro n i c
36
- P en ggu n aan En ergi - En ergy U se - M SDS - M ateri al Safety Data Sh eets
- M ekan i s - M ech an i cal - K en d araan / alat b erat - V eh i cu l ar / h eavy eq u i p men t
Document / Procedure (Safe Observation)
5 2 7
- Do ku men i ji n kerja - P ermi t To W o rk (P TW ) - P en i l ai an R esi ko P ekerj aan - HI R A / JSA /JR A - P etu n j u k kerj a - SO P / Gu id el in e / W o rki n g i n stru cti o n - Si ap tan ggap d aru rat - Emergen cy p rep ared n ess - Serti fi kasi o p erasi / P eralatan - C erti fi cates
- P en gawasan - Su p ervi so r
79
Safe Observation Analysis
2.5
1.5
Axis Title
0.5
0
Kesehatan / Health Lingkungan / En- Perkakas & Perala- Prosedur / Pro- Kebakaran / Fire
vironment tan / Tools & cedure
Equipment
Unsafe Observation Analysis

40
35
30
25
20
15
10
5
0
Equipment
Action Analysis Act of Observer Analysis
17
29%
P enc e gahan/ Prev e ntiv e Ac t Perbaik an/ Corre c tiv e Ac t
O bs erv ation S top W ork
71%
66
Period: May-21 Date Rev 25-Aug-21

Document Number : 33011-REG-TeLiTi-019 Page 1/4

Lokasi / Location : AWB EP.300
1 TOTAL Cards
2 Type of Action
Observation 435
Stop Work 0
3 Observation
Safe Condition 136
Unsafe Condition 299
Variable
Kesehatan / Health
- Kondisi psikologi - Psychological condition 0 3
- Kebersihan & kesehatan - Hygiene & sanitation 6 12
- Penggunaan Energi - Energy Use 0 0
- MSDS - Material Safety Data Sheets 0 0
- Sertifikasi operasi / Peralatan - Certificates 0 0
- Pengawasan - Supervisor 12 6
- Mekanis - Mechanical 0 1
- Kendaraan / alat berat - Vehicular / heavy equipment 0 0
Kebakaran / Fire
- Berpotensi kebakaran / meledak - Potentially fire / explode 0 0
TOTAL OBSERVATION 136 299
S afe Condition U ns afe Condition
31
131 68
136
Heal th Fi re & Safety En viro n men t To o ls & Eq u ip men t Do cu men t / P ro ced u re
299 69
12 - K o n d i si seh at / siap kerja - Fit fo r wo rk - B ah an b erb ah aya b agi tu b u h - Hazard o u s su b stan ce
12 - Ergo n o mi / p o sisi tu b u h - Ergo n o mi c / p o stu re - K o n d isi p si ko lo gi - P sych o lo gi cal co n d i ti o n

Variable Unsafe Observasi
- B erp o ten si kecelakaan - P o ten ti al l y accid en t - B erp o ten si keb akaran / meled ak - P o ten ti all y fi re / exp l o d e
3 Health 31
Fire & Safety 0

Environment 68
4 10 1
Health 14
- A lat p el i n d u n g d i ri - P P E - A l at p o rtab le - Han d / p o rtab l e to o l s - Listri k - El ecti rcal / electro n i c
- K erap ian & keb ersi h an - Ho u se keep i n g - B erp o ten si p en cemaran - P o ten ti all y o f sp il l / emissio n
28
Fire & Safety 0
Environment 19
30
- M ekan is - M ech an i cal - K en d araan / alat b erat - V eh i cu l ar / h eavy eq u ip men t
- P ap aran gas b eracu n - To xic gas exp o su re - P emb eri an simb o l -si mb o l stan d ar - Stan d ard l ab eli n g
64
- P en ggu n aan En ergi - En ergy Use - M SDS - M ateri al Safety D ata Sh eets
61
44
- D o ku men ij in kerj a - P ermit To W o rk (P TW ) - P en i laian R esiko P ekerjaan - HI R A / JSA /JR A - P etu n j u k kerj a - SOP / Gu i d eli n e / W o rki n g in stru cti o n - Siap tan ggap d aru rat - Emergen cy p rep ared n ess - Serti fi kasi o p erasi / P eral atan - C erti fi cates
116 - P en gawasan - Su p erviso r

S a fe Condition U ns afe Condition
19
136 14
16 87
Health Fi re & Safety En vi ro n men t To o ls & Eq u i p men t Do cu men t / P ro ced u re
299
4
6 - K o n d i si seh at / si ap kerj a - Fi t fo r wo rk - B ah an b erb ah aya b agi tu b u h - Hazard o u s su b stan ce
2 - Ergo n o mi / p o sisi tu b u h - Ergo n o mi c / p o stu re - K o n d isi p si ko lo gi - P sych o l o gical co n d i ti o n

- B erp o ten si kecelakaan - P o ten ti al ly accid en t - B erp o ten si keb akaran / meled ak - P o ten ti all y fi re / exp l o d e
2
- K erap i an & keb ersih an - Ho u se keep in g - B erp o ten si p en cemaran - P o ten ti all y o f sp il l / emi ssi o n
2
1
- P ap aran gas b eracu n - To xi c gas exp o su re - P emb erian simb o l-simb o l stan d ar - Stan d ard l ab el i n g
- A l at p eli n d u n g d i ri - P P E - A lat p o rtab l e - Han d / p o rtab le to o ls - Li stri k - El ecti rcal / el ectro n i c
19
13
- P en ggu n aan En ergi - En ergy Use - M SDS - M ateri al Safety Data Sh eets
- M ekan i s - M ech an ical - K en d araan / alat b erat - V eh i cu lar / h eavy eq u i p men t
12 2
- D o ku men ij in kerj a - P ermit To W o rk (P TW ) - P en i lai an R esiko P ekerjaan - HI R A / JSA /JR A - P etu n j u k kerj a - SOP / G u id el in e / W o rki n g i n stru cti o n - Siap tan ggap d aru rat - Emergen cy p rep ared n ess - Serti fi kasi o p erasi / P eral atan - C erti fi cates
26 47 - P en gawasan - Su p erviso r
2.5
1.5
Axis Title
0.5
0
Kesehatan / Lingkungan / Perkakas & Prosedur / Kebakaran / Fire
Health Environment Peralatan / Procedure
Tools & Equip-
ment

40
35
30
25
20
15
10
5
0
Equipment
17
29%
P enc e gaha n/ Prev e ntiv e Ac t Perbaik a n/ Corre c tiv e Ac t
O bs e rv ation S top W ork
71%
66
Period: Aug-21 Date Rev 13/8/2018

Document Number : 33011-REG-TeLiTi-019 Page 1/4

Lokasi / Location : Lamongan Clear Area
1 TOTAL Cards
2 Type of Action
Observation 173
Stop Work 0
3 Observation
Safe Condition 94
Unsafe Condition 79
Variable
Kesehatan / Health
Kebakaran / Fire
Safe Condition Unsafe Condition

Safe C o n d itio n Un safe C o n d i tio n
8
8
Health
32
Fire & Safety
79
94
Health
Environment Fir e&Saf et y Envir onment Tools &Equipment Document/ Pr ocedur e
31
Tools & Equipment
1 - Kondisi sehat / siap kerja - Fit

for work
- Bahan berbahaya bagi tubuh
- Kondis isehat / siapker ja- Fit f or wor k - Bahanberbahayabagit ubuh- Hazar dous subst ance - Er gonom i/posis it ubuh- Er gonomic/ post ur e - Kondis ipsikologi- Psychologic alcondition
- Berpotensi kecelakaan - Po-

2 - Hazardous substance tentially accident
5 - Ergonomi / posisi tubuh - Variable Unsafe Observasi
Ergonomic / posture
- Ber potensikecelakaan- Pot entiallyaccident - Ber pot ensikebakar an/ meledak- Pot entiallyfire/explode
- Kondisi psikologi - Psycho-

- Keber sihan&kesehat an- Hygiene&sanit ation
Health 8 /
logical condition meledak - Potentially fire /
Fire & Safety explode 0
- Alat pelindung diri - PPE
keeping Tools & Equipment
6 - Alat portable - Hand / portable
31
1
- Berpotensi pencemaran - Po- Health tools 4
Fire & 3Safety 15
- Kerapian&keber sihan- Housekeeping - Ber potensipencem ar an- Pot entiallyof spil/emis sion - Paparangasberacun- Toxic gas exposure - Pember iansimbol- simbolstandar - St andar dlabeling
0
- Alat pelindungdiri- PPE - Alat por table- Hand/ por t ablet ools - List r ik- Electir cal/ elect ronic - Mekanis - Mechanical - Kendar aan/alatberat - Vehic ular /heavyequipment
- Paparan gas beracun - Toxic gas Environment - Mekanis - Mechanical11

exposure
7
- Kendaraan / alat berat - Vehicular /
- Pemberian simbol-simbol standar - heavy equipment
7 Standard labeling
- PenggunaanEnergi- EnergyUse - MSDS- Mat erialSaf et yDat aSheets
- MSDS - Material Safety Data Sheets
2 2
3
- Dokumen ijin kerja - Permit To Work (PTW)

- Dokumenijnkerja- Permit ToWor k(PTW) - PenilaianResikoPekerjaan- HI RA/ J SA/JRA - Pet unjukker ja- SOP/Guideline/ Workinginstr uction - Siaptanggapdar ur at- Emergencypr eparedness - Ser tifikasioperasi/Per alatan- Cer tific ates - Pengawasan- Super vis or

25
S a fe Condition U ns a fe Condition
Safe C o n d iti o n Un safe C o n d i tio n
4 11
79 48
Health Fir e&Safet y Envir onment Tools &Equipment Document /Pr ocedur e
H ealth Fi re & Safety En vi ro n men t To o l s & Eq u i p men t Do cu men t / P ro ced u re
94 31
2 2
- Kondisisehat/ siapker ja- Fitf orwor k - Bahanber bahayabagit ubuh- Hazardous subst ance - Er gonom i/posis it ubuh- Er gonomic/ post ur e - Kondis ipsikologi- Psychologic alcondition
- Ber pot ensikecelakaan- Pot entiallyaccident - Ber pot ensikebakar an/ meledak- Pot entiallyfire/ explode
- Ergo n o mi / p o sisi tu b u h - Ergo n o mi c / p o stu re - K o n d isi p si ko lo gi - P sych o l o gi cal co n d i ti o n

- B erp o ten si kecelakaan - P o ten ti al l y accid en t - B erp o ten si keb akaran / mel ed ak - P o ten ti al ly fi re / exp lo d e
- Kebersihan&kesehat an- Hygiene&sanit ation
2
- K erap i an & keb ersih an - H o u se keep i n g
- Kerapian&keber sihan- Housekeeping - Berpotensipencem ar an- Pot entiallyof spil/ emis sion
- B erp o ten si p en cemaran - P o ten ti all y o f sp il l / emissi o n
- Paparangasberacun- Toxic gas exposure - Pember iansimbol- simbolst andar - St andar dlabeling
3
- P ap aran gas b eracu n - To xi c gas exp o su re - P emb eri an simb o l -si mb o l stan d ar - Stan d ard l ab eli n g
- A l at p el in d u n g d iri - P P E - A l at p o rtab l e - Han d / p o rtab l e to o l s - Listri k - El ecti rcal / electro n i c
11
26
- Alatpelindungdir i- PPE - Alatport able- Hand/ port abletools - Lis tr ik- Electircal/elect ronic - Mekanis - Mechanic al - Kendar aan/alatber at- Vehicular/ heavyequipment
- PenggunaanEnergi- Ener gyUse - MSDS- Mat er ialSaf et yDataSheets
- P en ggu n aan En ergi - En ergy U se - M SDS - M ateri al Safety Data Sh eets

- M ekan i s - M ech an i cal - K en d araan / alat b erat - V eh i cu l ar / h eavy eq u i p men t
1 3
- Do ku men i ji n kerja - P ermi t To W o rk (P TW ) - P en i l ai an R esi ko P ekerj aan - HI R A / JSA /JR A - P etu n j u k kerj a - SO P / Gu id el in e / W o rki n g i n stru cti o n - Si ap tan ggap d aru rat - Emergen cy p rep ared n ess - Serti fi kasi o p erasi / P eralatan - C erti fi cates
- Dokumenijnker ja- Per mit ToWor k(PTW) - PenilaianResikoPeker jaan- HI RA/J SA/J RA - Pet unjukkerja- SOP/ Guideline/ Wor kinginst r uction - Siaptanggapdarurat - Emer gencypr epar edness - Sertifikasioperasi/ Per alat an- Cer tificat es - Pengawasan- Supervis or
19
25 - P en gawasan - Su p ervi so r
2.5
60
50
2
40
1.5
30
Title
Axis Title
1
Axis
20
0.5
10
0
Equipment

40
35
35
30
30
25
25
20
20
15
15
10
10
5
5
0
Equipment
17
29%
83 90
P enecegah
P enc an / P reve
gahan/ n tieventiv
Prev A ct e Ac t PPerbaik
erb aikan /an/
C o rrective
CorreAc cttiv e Ac t
Ob servatio n Sto p W o rk
O bs erv ation S top W ork
71%
66
100%
Period: July-2021 Date Rev 13/8/2018

Document Number : Page 1/4

Lokasi / Location : DSV - CO 1
1 TOTAL Cards
2 Type of Action
Observation 85
Stop Work 0
3 Observation
Safe Condition 49
Unsafe Condition 36
Unsafe
Variable Safe Observation
Observation
Kesehatan / Health
Kebakaran / Fire
Safe Condition Unsafe Condition

10
Health
18 Fire & Safety
36
3 Environment
49
5
Tools & Equipment
- Kondisi sehat / siap kerja -

3 Fit for work
4 - Bahan berbahaya bagi
tubuh - Hazardous - Berpotensi kecelakaan - Po-
substance tentially accident
Variable Unsafe Observasi
- Ergonomi / posisi tubuh -
Ergonomic / posture Health 10 /
3 - Kondisi psikologi - Psycho-
meledak - Potentially fire /
logical condition Fire & Safety explode 0
Tools & Equipment 5
Document / Procedure - Alat pelindung diri - 22
PPE
keeping Tools & Equipment 1
1 - Alat portable - Hand / portable
- Berpotensi pencemaran - Po- Health tools 16
Fire & Safety 1
- Paparan gas beracun - Toxic gas 1 3
exposure Environment - Mekanis - Mechanical 9
- Pemberian simbol-simbol standar - Kendaraan / alat berat - Vehicular /

- Standard labeling heavy equipment
3
- MSDS - Material Safety Data

Sheets
1
2 5
- Dokumen ijin kerja - Permit To Work (PTW)

10
S a fe Condition U ns afe Condition
9
1
22
36
Health Fi re & Safety En vi ro n men t To o ls & Eq u i p men t Do cu men t / P ro ced u re
49 16
5
8
- Ergo n o mi / p o sisi tu b u h - Ergo n o mi c / p o stu re - K o n d isi p si ko lo gi - P sych o l o gical co n d i ti o n
- B erp o ten si kecelakaan - P o ten ti al ly accid en t - B erp o ten si keb akaran / meled ak - P o ten ti all y fi re / exp l o d e
3 1
- K erap i an & keb ersih an - Ho u se keep in g - B erp o ten si p en cemaran - P o ten ti all y o f sp il l / emi ssi o n
- P ap aran gas b eracu n - To xi c gas exp o su re - P emb erian simb o l-simb o l stan d ar - Stan d ard l ab el i n g
- A l at p eli n d u n g d i ri - P P E - A lat p o rtab l e - Han d / p o rtab le to o ls - Li stri k - El ecti rcal / el ectro n i c
9
1
- P en ggu n aan En ergi - En ergy Use - M SDS - M ateri al Safety Data Sh eets
- M ekan i s - M ech an ical - K en d araan / alat b erat - V eh i cu lar / h eavy eq u i p men t
2
1 4 - D o ku men ij in kerj a - P ermit To W o rk (P TW ) - P en i lai an R esiko P ekerjaan - HI R A / JSA /JR A - P etu n j u k kerj a - SOP / G u id el in e / W o rki n g i n stru cti o n - Siap tan ggap d aru rat - Emergen cy p rep ared n ess - Serti fi kasi o p erasi / P eral atan - C erti fi cates
5 - P en gawasan - Su p erviso r
10
2.5
1.5
Axis Title
0.5
0
Kesehatan / Lingkungan / Perkakas & Prosedur / Kebakaran / Fire
Health Environment Peralatan / Procedure
Tools & Equip-
ment

40
35
30
25
20
15
10
5
0
Equipment
17
29%
P enc e gaha n/ Prev e ntiv e Ac t Perbaik a n/ Corre c tiv e Ac t
O bs e rv ation S top W ork
71%
66
LOSS TIME INJURY
COMPANY/ LTI
No. SITE Date Time (hrs) Brief Description Activity Root Causes Recommendations
CONTRACTORS
Fatality Permanent Partial Disability (PPD) Lost Workday Case (LWC)
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Internal
Medical Treatment Injury
COMPANY/ Type of Incident

NO SITE DATE TIME Brief Description Activity
CONTRACTORS
LTI MTI RWC
DEC
ATS RANTAU
Internal
FIRE/EXPLOTION
Estimate direct
COMPANY/ Process/Non- cost of
NO SITE DATE TIME Brief Description Major/Minor Fire/Explosion Root Causes Recommendations
CONTRACTORS Process Fire/Explosion
(usd)
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Internal
HIPO NEAR MISS
COMPANY/
No. SITE DATE TIME Brief Description Basic Risk Factor
CONTRACTORS
Internal
Major & Minor Overdue Action Items
No. Site Major/Minor Assurance Brief Description
DEC
1
DEC
Internal
STOP WORK
No Date Project
Internal
STOP WORK
Location Description
Internal
Activity Action Taken
Internal
U
No. of UAUC Monthly Submission 196
Monthly Manhours 13,510
Ratio 69
No. of UAUC YTD 2019 Submission 3,109

YTD 2019 Manhours 184,756
YTD 2019 Ratio 59
Categories Code Total (Monthly) Total (YTD 2019)
Unsafe Act UA 28 353

Unsafe Condition UC 124 1454
Safe Observation SO 44 1302
GRAND TOTAL 196 3109
Item Unsafe Act Total (Monthly) Total (YTD 2019)
UA1 Carrying over passengers 0 0
UA2 Others 19
0
UA3 Parking at non designated area 0

0
UA4 Parking wrong direction 0

0
UA5 Seat belt 0 0
UA6 Speeding 0 0
UA7 Non Ergonomic Behavior 5 29
UA8 Arms and hands. 0 27 7
UA9 Ears. 0 9
6
UA10 Eyes and face. 3 29
5
UA11 Full body harness. 1 7
4
UA12 Head (Helmet). 0 13
UA13 Improper storage of PPE 3
0 3
UA14 Legs and feet. 1 6 2
UA15 Not worn properly. 1 17 1

UA16 Respiratory system 0 0
1 4 0
1 2
UA17 Torn or damage clothing 0 0 UA UA U
Internal
1
0 0
0
1 2
UA UA U
UA18 Trunk 0 0
UA19 Wrong clothing for the job 0 0
UA20 Bypassing safety devices 0 0
UA21 Procedure not followed 4 32
UA22 Procedure not know / understood 0 3
UA23 Procedures inadequate 0 0
UA24 Unsafe operational acts 2 14
UA25 Working on moving parts / equipment 0 2
UA26 Adjusting personal protective equipment 0 2 60
UA27 Changing position 0 15
UA28 Equipment earthing 50
0 0
UA29 Failure to secure or warn 6 49
40
UA30 Horse play 1 1
UA31 Improper use of hands 0 28 30
UA32 Performing lockouts 0 0
19
UA33 Procedure ignorance 0 13 20
UA34 Rearranging job 1 8

10
UA35 Stopping job 0 0
UA36 Using phone while working 0
0 0 0
1 2
UA37 Defective tools or equipment 0 5 UA UA
UA38 Uncertified tools or equipment 0 0
UA39 Used incorrectly 1 15
UA40 Wrong for the job 1 3
Grand Total 28 353
Item Unsafe Condition Total (Monthly) Total (YTD 2019)
UC1 Stray animals 0 0
UC2 Venomous Insect/Animals 17

1
UC3 Harmful to environment 7

3
UC4 Inadequate PPE/ Personnel Attire 2

1
UC5 Poor housekeeping 42 474
UC6 Awkward exposure / static posture 0 0
UC7 Being struck by object 34 45
3
40
UC8 Caught in, on or between objects 3 50
35
UC9 Contacting electric current 0 3 30
UC10 Contacting hazardous substance 0 3 25
20
15
Internal
10
40
35
30
25
UC11 Contacting temperature extremes 0 2 20
UC12 Overexertion 6 7 15
UC13 Repetitive motion 10

0 1
5
UC14 Striking against object 3 15 0 1
0
UC15 Unstable footing 0 7 UC1 UC
UC16 Damage Power Cord 1 7

UC17 Faulty Electrical Equipment 0 16
UC18 Improper Storage of Flammable Materials 0 1
UC19 Overloading Power Socket 1 10
UC20 Smoking at non designated area 0 2
UC21 Chemical handling 0 5
UC22 Health detrimental 5 27
UC23 House keping 11 402
UC24 Inadequate Procedure 2 35
UC25 Non Compliance to Permit to Work Procedure 0 0
UC26 Unauthorized Vehicle Entrance 0 0
UC27 Equipment dislodge 3 22
UC28 Equipment Malfunction 22 84
UC29 Heavily Corroded 1 53
UC30 Loose/No Grating Clip 2 25
UC31 No/Due for Inspection 0 36
UC32 Poor/Due for Maintenance 6 87
UC33 Used beyond specification 8 20
Grand Total 124 1454
BEST CARD UAUC ANALYSIS (based o

No BEST UAUC FINDING HIGHLIGHT
Observed someone did manual lift of big shakcle Non ergonomic behaviour Lack of ergonomic awar
by himself, nobody help him
1
Observed someone installed only 1 tagline while Procedure ignorance Lack of lifting awareness
2 lifting of gangway
Found someone used unsecured ladder for Failure to secure/warn Lack of riskawareness
working at height
3
Internal
SAFETY TALK PERIODE MARET 2022
NO DETAILS OF ACTIVITIES
Title: SAFETY TALK
Date: 28-Feb-22
Venue: PARKIRAN UNIT PT LEVINE LATERSIA BARATAMA SITE ATS

1
PROJECT MANAGER, SUPERINTENDENT MINING, SAFETY OFFICER,
Participants: SUPERVISOR PRODUCTION, FOREMAN PRODUCTION, ALL DRIVER AND ALL
OPERATOR, MECHANIC
Objectives: MENGANALISA POTENSI BAHAYA DITEMPAT KERJA
Title: GENERAL SAFETY TALK
Date: 9-Mar-22
Venue: PARKIRAN UNIT PT LEVINE LATERSIA BARATAMA SITE ATS

2
KOMISARIS, PROJECT MANAGER, SUPERINTENDENT MINING, SAFETY
Participants OFFICER, SUPERVISOR PRODUCTION, FOREMAN PRODUCTION, ALL DRIVER
AND ALL OPERATOR, MECHANIC DAN PT KAMI
Objectives: GIAT BEKERJA DENGAN MENERAPKAN K3

Title:
GENERAL SAFETY TALK
Date:
29-Mar-22
Venue:
PARKIRAN UNIT PT LEVINE LATERSIA BARATAMA SITE ATS
3
KOMISARIS, PROJECT MANAGER, SUPERINTENDENT MINING, SAFETY
Participants: OFFICER, SUPERVISOR PRODUCTION, FOREMAN PRODUCTION, HRGA, HRD
ALL DRIVER AND ALL OPERATOR, MECHANIC DAN PT KAMI
Objectives:
TIPS MENJALANKAN PUASA DENGAN SELAMAT DAN SEHAT
Title:
Date:
Venue:
4
Participants:
Objectives:
Internal
IODE MARET 2022
PICTURE
Picture
TY OFFICER,
ALL DRIVER AND ALL
Picture
INING, SAFETY
UCTION, ALL DRIVER
Picture
ATS
INING, SAFETY
UCTION, HRGA, HRD
AMI
EHAT
Picture
Internal
Internal
Internal
Internal
Internal
Internal
Internal
HSE ACTION
NO DETAILS OF ACTIVITIES
Title: Pembuatan baliho
Date: 13-Mar-22
Venue: area workshop, pos security, depan musola, simpang 4 pit heri.
1
Potensi Bahaya: Mengabaikan keselamatan dan kesehatan kerja
Total: 5 buah baliho
Fungsi mengingatkan kembali pentingnya K3
Title: Pemasangan nomor lambung unit exca
Date: 18-Mar-22
Venue: All Unit exca
Potensi Bahaya: apabila tidak terdapat nomor lambung pada unit kesulitan untuk
berkomunikasi dan akan menyebabkan insiden kecelakaan.
2
Total: 27 lembar nomor lambung
Objectives: Agar unit memiliki identitas dan mengurangi resiko kecelakaan.
Title: Pemasangan Desilinator area Gorong-gorong disposal
Date: 18-Mar-22
Venue: jalan Gorong-gorong disposal
Potensi Bahayanya apabila tidak terdapat rambu Desilinator akan

3 Potensi Bahaya:
berpotensi unit yang melintas akan tergelincir ke gorong-gorong
Total: 6 buah
Dengan dipasangnya rambu Desilinator ini disisi kiri dan kanan jalan
Objectives: Gorong-gorong disposal akan mengurangi potensi bahaya salah jalur dan
tergelincir
Title: Rambu Prioritas Muatan
Internal
Date: 19-Mar-22
Venue: jalan dari arah disposal ke arah Gorong-gorong.
Potensi Bahaya: miss komunikaksi, kecelakan unit, dan tergelincir

4
Total: 1 tempat
agar unit kosongan yang akan melewati gorong-gorong dapat berhati hati
Objectives: dan memberikan pioritas apabila terdapat unit bermuatan yang akan
melintasi gorong-gorong arah front ke disposal mendapat pioritas.
Title: RAINFALL
Date: Setiap pagi hari
Venue:
5 Potensi Bahaya: terkontaminasinya air lingkungan dan banjir.
Total:
Objectives: agar volume air hujan dapat diketahui
Title: PENANGANAN LIMBAH B3
Date: Setiap penampungan limbah B3 yang sudah penuh
Venue: 25-Mar-22
6 Potensi Bahaya: Tercemarnya lingkungan jika tidak ditanggulangi limbah B3
Total: 11.5 Drum
Internal
6
Objectives: Agar tidak tercemarnya lingkungan
Internal
PICTURE
Picture
Picture
Picture
Picture
Internal
Picture
Picture
Internal
Internal
MONITORING ISSUED RADI
NAMA JABATAN MERK DAN TYPE RADIO
MUHAMMAD ABDI MUNIB SURVEYOR ICOM-V86
DENY YUDHO PRASETYO INSTRUMENT ICOM-V86
MUHAMMAD IKHSAN SUTIYONO STICKMAN ICOM-V86
HASYIM STICKMAN ICOM-V80
PARLIN FOREMAN PRODUKSI ICOM-V80
SUWARYADI SUPERVISOR PRODUKSI ICOM-V80
HENDRA WIJAYA FOREMAN PRODUKSI ICOM-V80
HASAN SUHUT PIT ENGGINER ICOM-V86
SUWAJI FOREMAN PRODUKSI ICOM-V86
SUWAJI PROJECT MANAGER ICOM-V80
ILOVAN VIRGIANO SAFETY OFFICER ICOM-V80
EDO / HENDRA CHECKER SHIFT SIANG ICOM-V80
SUNARDI ELECTRIC FOREMAN ICOM-V86
CHALILUL RAHMAN CHECKER SHIFT MALAM ICOM-V80
EFENDI A.S GINTING SAFETY OFFICER ICOM-V86
SUKIMIN SPV MINING ICOM-V80
SYAHREL YANI STICKMAN ICOM-V80
ING ISSUED RADIO
SN RADIO TANGGAL DITERIMA TANGGAL PENGEMBALIAN
11029816-6 SEJAK DARI SITE KINTAP
60276966-1 SEJAK DARI SITE PENGARON
11029819-7 3/24/2022
11028361-4 12/10/2021
60270990-1 12/11/2021
60319669-0 12/18/2021
11029815-9 12/16/2021
60235512-1 12/19/2021
11025967-7 SEJAK DARI SITE PCN
60276960-1 SEJAK DARI SITE SANGA SANGA
60296618-6 SEJAK DARI SITE SANGA SANGA
Safe Days Rating (SDR) SITE PT ATS
Year to Date and Year to Project 31 MARET 2022
Minggu Senin Selasa Rabu Kamis Jum'at Sabtu
27 28 1 2 3 4 5
SAFE
6 7 8 9 10 11 12
SAFE SAFE UNSAFE SAFE SAFE SAFE SAFE
13 14 15 16 17 18 19
SAFE SAFE SAFE SAFE UNSAFE SAFE SAFE
20 21 22 23 24 25 26
UNSAFE SAFE SAFE SAFE SAFE SAFE SAFE
27 28 29 30 31 1 2
SAFE SAFE NM NM SAFE
Legend
SAFE Safe Day
NM Near Miss / Hampir Celaka
FAI First Aid Injury
MTI Medical Treatment Injuri
LTI Lost Time Injury
ENV Environmental
PD maj Property Damage with cost ≥1000 USD
PD min Property Damage with cost <1000 USD
AS Accident Subcontractor
PT LEVINE LATERSIA BARATAMA
SITE PT ATS RANTAU
PERIODE : J Mar-22
DURASI HUJAN (JAM)
VOLUME PENGECEKAN RAIN I RAIN II
TANGGAL
AIR (MM) (WITA)
START FINISH START FINISH
1 4.0 8:00 1:00 1:42 0:00 1:00
2 8:00 1:42 2:30 0:00 0:00
3 9.4 8:00 21:12 0:00 4:30 6:00
4 5.5 8:00 6:00 8:12 0:00 0:00
5 9.0 8:00 7:48 8:12 0:00 0:00
6 8:00 8:36 12:00 0:00 6:00
7 40.0 8:00 8:48 12:00 2:30 0:00
8 10.0 8:00 6:00 8:12 0:00 0:00
9 0.6 8:00 18:00 0:00
10 24.9 8:00 0:00 0:00
11 8:00 16:24 18:00
12 8.5 8:00 18:00 0:00 0:00 0:00
13 47.0 8:00 15:00 18:00 13:00 18:00
14 38.0 8:00 16:00 18:00 1:00 3:18
15 202.5 8:00 6:00 9:00 0:00 0:00
16 5.5 8:00 6:00 14:00 0:00 0:00
17 8:00 1:00 6:00
18 43.5 8:00 13:18 18:00 0:00 0:00
19 1.5 8:00 0:00 0:00
20 30.5 8:00 0:00 0:00
21 41.0 8:00 19:00 0:00 0:00 0:00
22 8:00 6:00 9:30 0:00 0:00
23 8:00 18:30 18:54 0:00 0:00
24 8:00 1:18 6:00 0:00 0:00
25 8:00 0:00 0:00 0:00 0:00
26 8:00 0:00 0:00 0:00 0:00
27 8:00 0:00 0:00 0:00 0:00
28 8:00 15:00 18:00 22:54 0:00
29 8:00 0:00 0:00 0:00 0:00
30 8:00 0:00 0:00 0:00 0:00
31 8:00 17:12 18:00 18:00 23:18
521.4 SUMMARY TOTAL
KOORDINAT: X: 302469,870 Y: 9672303,622
DURASI HUJAN (JAM)
TOTAL JAM HUJAN
RAIN III RAIN IV INTENSITY
TOTAL JAM (MM/Hour)
START FINISH START FINISH TOTAL HUJAN
0:00 0:00 0:00 0:00 1:42 1.70 2.35
0:00 0:00 0:00 0:00 0:48 0.80 0.00
0:00 0:00 0:00 0:00 4:18 4.30 2.19
0:00 0:00 0:00 0:00 2:12 2.20 2.50
0:00 0:00 0:00 0:00 0:24 0.40 22.50
0:00 0:00 0:00 0:00 9:24 9.40 0.00
0:00 6:00 0:00 0:00 6:42 6.70 5.97
0:00 0:00 0:00 0:00 2:12 2.20 4.55
0:00 1:00 0:00 0:00 7:00 7.00 0.09
0:00 0:00 0:00 0:00 0:00
21:00 0:00 0:00 0:00 4:36 4.60 0.00
0:00 0:00 0:00 0:00 6:00 6.00 1.42
18:30 0:00 0:00 0:00 13:30 13.50 3.48
0:00 0:00 0:00 0:00 4:18 4.30 8.84
0:00 0:00 0:00 0:00 3:00 3.00 67.50
0:00 0:00 0:00 0:00 8:00 8.00 0.69
0:00 0:00 0:00 0:00 5:00 5.00 0.00
0:00 0:00 0:00 0:00 4:42 4.70 9.26
0:00 0:00 0:00 0:00 0:00
0:00 0:00 0:00 0:00 0:00
0:00 0:00 0:00 0:00 5:00 5.00 8.20
0:00 0:00 0:00 0:00 3:30 3.50 0.00
0:00 0:00 0:00 0:00 0:24 0.40 0.00
0:00 0:00 0:00 0:00 4:42 4.70 0.00
0:00 0:00 0:00 0:00 0:00
0:00 0:00 0:00 0:00 0:00
0:00 0:00 0:00 0:00 0:00
1:54 4:48 0:00 0:00 7:00 7.00 0.00
0:00 0:00 0:00 0:00 0:00
0:00 0:00 0:00 0:00 0:00
0:00 0:00 0:00 0:00 6:06 6.10 0.00
ARY TOTAL 14:30 110.50 139.52
TOTAL RAIN DAY 23 Day
TOTAL VOLUME 521.4 mm
RATES VOLUME / RAIN DAY 16.82 mm/ Day
RATES VOLUME / RAIN HOUR 0.95 mm / Hour
RATES HOUR / RAIN DAY 3.56 Hour / Day
INTENSITY (MM/Hour)
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
INTENSITY (MM/Hour)
This chart isn't available in your version of Excel.
Editing this shape or saving this workbook into a different file format will
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PT LEVINE LATERSIA BARATAMA
SITE ATS RANTAU, KALSEL
NO NO DOCUMENT DISCRIPTION POTENSI BAHAYA
Terdapat potensi bahaya terjatuhnya pohon diatas

1 001/HR/HSE/2022 tebing depan pit hery, apabila tidak dilakukan clearing
akan berpotensi pohon terjatuh dan mengenai unit/
manusia dibawahnya
Terdapat potensi tercemarnya lingkungan akibat

2 002/HR/HSE/2022 batubara tercampur dengan top soil dilokasi timbunan
top soil
Terdapat Potensi bahaya pada unit hauler terutama

3 003/HR/HSE/2022 ketika shift malam karena terdapat beberapa unit yang
DT tata yang belum terdapat lampu belakangnya dan
juga beberapa unit lampu belakangnya rusak
Terdapat potensi pencemaran lingkungan pada area

4 004/HR/HSE/2022 sekitar tempat penampungan limbah B3 sementara
akibat solar dan oli yang tercecer
karena sudah terdapat Pompa untuk membuang Air

Asam Tambang maka sebelum dialirkan ke masyarakat,
5 005/HR/HSE/2022 perlu adanya pembuatan Settling Pond atau kolam
pengendapan untuk pengontrolan kadar air yang akan
dialirkan ke masyarakat
Pengadaan Water Truck dan Tower Lamp untuk

6 006/HR/HSE/2022
kebutuhan mining dept terutama ketika shift malam
7 007/HR/HSE/2022 Pembuatan gudang Limbah B3
8 008/HR/HSE/2022 Pengadaan Rambu rambu pada pompa
9 009/HR/HSE/2022 Pengadaan Nomer lambung pada unit LV

10 010/HR/HSE/2022 Penanggulangan longsor Low wall pit 1 Yuli
11 011/HR/HSE/2022 Terdapat patahan retakan pada disposal atas
12 012/HR/HSE/2022 Belum adanya lokasi dampingan untuk Top Soil
13
PIC TANGGAL TEMUAN TANGGAL ACTION STATUS TINDAKAN PERBA
MINING DEPT 1/7/2022 OPEN
ENGINEERING DEPT 1/7/2022 OPEN
PLANT DEPT 1/8/2022 OPEN
Area yang terdapat ceceran

PLANT DEPT 1/18/2022 1/19/2022 CLOSE telah ditampung kembali ke
bekas dan disimpan ke tem
sementara
ENGINEERING DEPT 1/24/2022 OPEN
MINING DEPT &

1/27/2022 OPEN
ENGINEERING DEPT
ENGINEERING DEPT &

1/27/2022 OPEN
PLANT DEPT
HSE DEPT 1/27/2022 OPEN
HSE DEPT 1/27/2022 3/1/2022 CLOSE

ENGGINERING DEPT 1/1/2022 OPEN

TINDAKAN PERBAIKAN SUMMARY (HARI)
Area yang terdapat ceceran oli dan solar

telah ditampung kembali ke dalam drum 1
bekas dan disimpan ke tempat limbah B3
sementara
I. MONTHLY REPORT SAFETY SECTION
1.1. STATISTIK KECELAKAAN PT. LEVINE LATERSIA BARATAMA SITE RANTAU
LLB RANTAU SUBCON LLB

DESCRIPTION
THIS MONTH LAST MONTH YTD THIS MONTH LAST MONTH YTD
TOTAL MAN POWER 130 130 0 0
TOTAL MAN HOURS 33,800 33,800 0 0
TOTAL JUMLAH KECELAKAAN 2 2 0 0
FATALITY 0 0 0 0
RWDI 0 0 0 0
CACAT TETAP 0 0 0 0
LTI 0 0 0 0
MTI 0 0 0 0
FAI 0 0 0 0
ACCIDENT PD MINOR ( ≤ $ 1000 ) 0 0 0 0
ACCIDENT PD MAYOR ( > $ 1000 ) 0 0 0 0
INCIDENT 0 0 0 0
NEAR MISS 4 4 0 0
LINGKUNGAN 4 4 0 0
LOST DAY 0 0 0 0
FREQUENCY RATE ( FR ) 0 59 0 #DIV/0!
SAVERITY RATE ( SR ) 0 0 0 #DIV/0!
TOTAL MAN POWER TOTAL MAN HOURS TOTAL JUMLAH KECELAKAAN

3
40000
35000 33,800 33,800
30000 2
25000
20000
15000 1
10000
5000 130 130 0 0 0 0
0 0
THIS LAST YTD THIS LAST YTD THIS LAST YTD THIS LAST YTD
MONTH MONTH MONTH MONTH MONTH MONTH MONTH MONTH
LLB RANTAU SUBCON LLB LLB RANTAU SUBCON LLB
FATALITY RWDI CACAT TETAP LTI MTI FAI ACCIDENT PD MINOR ( ≤ $ 1000 ) ACCIDENT PD MAYOR ( > $ 1000 )
1 1
1 1
0 0 0 0 0 0 0 0
0 0
THIS LAST YTD THIS LAST YTD THIS LAST YTD THIS LAST YTD
MONTH MONTH MONTH MONTH MONTH MONTH MONTH MONTH
LLB RANTAU SUBCON LLB LLB RANTAU SUBCON LLB

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PT LEVINE LATERSIA BARATAM

MONTHLY HSE PER

SITE TTD Month:

Total Man Hours Worked Onsite Rantau Onsite

EFENDI GINTING HSE Performance, HSE Dept.

Contractor Total Current FY 2022 Remarks

Period: July-2021 Date Rev 13/8/2018

Department / Project : Bukit Tua Phase 2B

Number of Observation Cards 531

Safe Condition Unsafe Condition 12

Health (Unsafe observation) Fire & Safety (Unsafe Observation)

5 - Kondisi sehat / siap kerja - Fit

- Penggunaan Energi - Energy Use

- MSDS - Material Safety Data Sheets

Document / Procedure (Unsafe Observation)

3 - Dokumen ijin kerja - Permit To Work (PTW)

- Penilaian Resiko Pekerjaan - HIRA / JSA /JRA

- Petunjuk kerja - SOP / Guideline / Working instruction

- Siap tanggap darurat - Emergency preparedness

247 H ealth Fi re & Safety En vi ro n men t To o l s & Eq u i p men t Do cu men t / P ro ced u re

Health (Safe observation) Fire & Safety (Safe Observation)

- K eb ersi h an & keseh atan - Hygi en e & san i tati o n

Environment (Safe Observation) Tool & Equipment (Safe Observation)

Document / Procedure (Safe Observation)

Unsafe Observation Analysis

Action Analysis Act of Observer Analysis

O bs erv ation S top W ork

Period: May-21 Date Rev 25-Aug-21

Department / Project : Bukit Tua Phase 2B

Number of Observation Cards 435

S afe Condition U ns afe Condition

Health (Unsafe observation) Fire & Safety (Unsafe Observation)

12 - K o n d i si seh at / siap kerja - Fit fo r wo rk - B ah an b erb ah aya b agi tu b u h - Hazard o u s su b stan ce

12 - Ergo n o mi / p o sisi tu b u h - Ergo n o mi c / p o stu re - K o n d isi p si ko lo gi - P sych o lo gi cal co n d i ti o n

Fire & Safety 0

Document / Procedure (Unsafe Observation)

116 - P en gawasan - Su p erviso r

Health (Safe observation) Fire & Safety (Safe Observation)

2 - Ergo n o mi / p o sisi tu b u h - Ergo n o mi c / p o stu re - K o n d isi p si ko lo gi - P sych o l o gical co n d i ti o n

Environment (Safe Observation) Tool & Equipment (Safe Observation)

Document / Procedure (Safe Observation)

Unsafe Observation Analysis

Action Analysis Act of Observer Analysis

O bs e rv ation S top W ork

Period: Aug-21 Date Rev 13/8/2018

Department / Project : Bukit Tua Phase 2B

Number of Observation Cards 173

Safe Condition Unsafe Condition

Environment Fir e&Saf et y Envir onment Tools &Equipment Document/ Pr ocedur e

Health (Unsafe observation) Fire & Safety (Unsafe Observation)

1 - Kondisi sehat / siap kerja - Fit

- Berpotensi kecelakaan - Po-

- Kondisi psikologi - Psycho-

- Paparan gas beracun - Toxic gas Environment - Mekanis - Mechanical11

- Penggunaan Energi - Energy Use

- MSDS - Material Safety Data Sheets

Document / Procedure (Unsafe Observation)

- Penilaian Resiko Pekerjaan - HIRA / JSA /JRA