No Form CM-EAI-02

Revision
IDENTIFICATION ENVIRONMENT IMPACTS ASPECTS Identification Date
00
10-Jan-22

Tim Penyusun Process Environment Impact

1 Juni Anggreni S SC Soil Contamination WK Worker Health Problem DL Lack of Disposal Location
2 Ruth Murni OFFICE WC Water Contamination OZ Ozone Destruction EC Increased Environmental Costs
3 AP Air Pollution NR Natural Resource Reduction

EVALUATION SCORES
ADDITIONAL CONTROL
Environmental
No. Activity/Product/Service Location Aspect
Impact
EXISTING CONTROL PROGRAM
LGL CON POS LOS VALUE I / NI
EL SUB EC ADM PPE

AP 1. Service Schedule
Vehicle Operation / 2 1 3 1 7 NI Routine repair or service
1
Mobilization
Field / Offsite Exhaust gas emissions X 2. Regularly Emision Testing
NR 1 1 3 1 6 NI Vehicle Usage Schedule X 1. Fuel saving program
AP 1. Service Schedule
2 1 3 1 7 NI Routine repair or service
2 Riding Motorcycle Field / Offsite Exhaust gas emissions X 2. Regularly Emision Testing
NR 1 1 3 1 6 NI Vehicle Usage Schedule X 1. Fuel saving program
NR 1 1 1 1 4 NI Two-sided paper use (recycle) X 1. Paper saving program
Office administrative
3 Workspace Paper Usage Provision of paper recycle storage
activities using paper DL 1 1 1 1 4 NI
boxes X 1. Recycling Program
4 Replacement printer ink SC 1 1 1 1 4 NI Provision of special waste bin X 1. Provision of hazardous waste bin
Disposal of used printer ink
Office
cartridges (Hazardous waste) WC 2 1 1 1 5 NI Provision of special waste bin X 1. Provision of hazardous waste bin
NR 1 1 1 1 4 NI Adequate usage X 1. Saving energy program
Electricity usage
WK 1 1 1 1 4 NI Adequate usage X 1. Saving energy program
NR 1 1 1 1 4 NI Two-sided paper use (recycle) X 1. Paper saving program
Paper Usage Provision of paper recycle storage
Operation of electrical DL 1 1 1 1 4 NI
boxes X 1. Recycling Program
equipment (Printers, Fax
5
Machines, Communicators,
Office NR 2 1 1 1 5 NI Regularly Inspection X 1. AC Maintenance
AC, etc.) CFC release into the air 1. FF Triaining 2. Fire Prevention
AP 2 1 1 1 5 NI Regularly Inspection
X Socialization
Temperature / cold excessive
WK 1 1 1 1 4 NI Adequate usage
in the workspace.
X 1. Hazard Socialization
AP 1 1 1 1 4 NI Provision of smoking area X 1. No Smoking Signage
Cigarette smoke Installation of dangerous smoking
WK 2 1 1 1 5 NI
6 Worker& visitor Activity Office signage X 1. Hazard Socialization
DL
Garbage Disposal 1 1 1 1 4 NI Provision of domestic garbage bins
X 1. Provision of garbage bins

CM-FM-HSE-01-02
 EVALUATION CRITERIA

LGL : LEGAL
1 No rules are exist
2 Rules are exist

CON : CONSEQUENCE
1 No significant consequences for the environment (spill <20 liter)
2 Considerable impact on the environment (Spill 20 - 100 liter)
3 Big impact on the environment (Spill >100 liter)

POS : POSSIBILITY
1 Occurs in an emergency
2 Occurs in abnormal conditions
3 Occurs in normal conditions

LOS : LOSS
1 Can be controlled
2 Difficult to control
3 Can not be controlled

VALUE TOTAL LGL + CON + POS + LOS

I If Score ≥ 8
NI If Score < 8

Annex-CM-PR-HSE-01-02