Cek list Penilaian Pelaksanaan PRE-JOB SAFETY MEETING (PJSM)

Secara efisien dan efektif

Checklist of How to Conduct STARRT efficient and effectively
Penilai / Assessor : _________________________ ________ Tanda Tangan Penilai (Assessor's sign): ____________________________
Tanggal PJSM / Date of PJSM : ____________________ Jam mulai/Time start: ___________ Jam akhir / Time end: ____________

Nilai dalam
angka Keterangan/
No. Hal yang Perlu Dinilai / Items required to be assessed (Score in
figure) Remarks
(0 - 100)

1 Pemeriksaan APD lengkap (PPE Check-complete - by Lead)

2 Supervisor memimpin PJSM (Supervisor leads PJSM)
3 Jumlah Peserta (Total of attendees}
4 Formasi peserta (Form of attendees)
5 Suara cukup dan didengar (Adequate voice and can be heard)
6 Komunikasi 2 arah (2 way communication)
7 Tersedia PTW oleh Supervisor / Lead (PTW Available by Supv./Lead)
Tersedia JSA / TRA dibacakan dipedomani Supv. / Lead
8 (JSA/TRA available and referred by Supv./Lead)
Peragaan atau demonstarsikan cara kerja yang selamat
9 (Showing or demonstration how to work safely)
10 Peserta memahami pembahasan (Attendees understood)
11 Ada tanya jawab terkait (related question and answer)
12 Peserta bersemangat (Attendees with full spirit)
13 Berdoa (Praying to God Almighty)
14 Yel-yel (Yelling)
15 Total waktu dipakai / durasi (Time comsumed / duration) in minutes)

Uraian / Description (dinilai / Assessed) Nilai / Score

Sempurna (Perfect) 100
Sangat Baik (Very good) >80 - 99
Baik (Good) >75 - 80
Cukup (Fair) >60 - 75
Kurang (Poor) >45 - 60
Jelek (Very poor) <= 45

Diperiksa oleh, Dketahui oleh

Checked by, Aknowledged by,
HSSE Manager Construction Manager

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