Safety Walk & House Keeping Inspection Form

Inspectors: M. Barren [MGMT], Gigih S, Bagus W S, Department/Area : Location: Inspection (Date):

Agus Budiyono[MAINT], Roiyan MFA, Kurniawan, 500 Kv 500 Kv 22 Maret 2022
Edy S, Joni S [HSEC], Bayu FU, B. Kukuh, Iwan
Priyanto, Banaryanto [Prod], M. Rasyid [WME], Irfan,
Deny [Indopama], Samsul H[BWA], Nurbandi [Truba],
Subro [ISS], Yusran [MDG] M. Arif [Atalian]
Estimated
Item/No Hazard Corrective Person/Department Actual Completion Initials of person
Description of Conditions found Completion WO Needed
. Class Actions/Comment responsible Date completing
Date

Need to check all

1. area and remove the ISS
grass

Wild grass inside the 500 Kv area U8

Safety & Housekeeping Inspection Report Page 1

 Put it back to it
2 Truba
original place

Fire extinguisher was put on an

improper place after finish the job at
drum screen U7 area which is can see
from 500 Kv U8 area

Tidy up and stored at

3. BWA
proper original place

Metal plate not store on proper place

after finish the job to protect
dewatering hose oon intake area U8

Safety & Housekeeping Inspection Report Page 2

 Opportunity to
replace the cable
4. Truba
protector with the
proper one
Cable protector was broken by doing
its job to protect cable which is
crossing the intake road

Dispose the wooden

5 Indopama
scrap

Unsafe condition wooden scrap with

protruding corroded nail was stored on
the 500 Kv fence potentially contact
with worker

Safety & Housekeeping Inspection Report Page 3

 Segregate the waste
prior dispose and
6. Indopama
dispose it on the
proper bin

Mixed garbage waste on the 500 Kv

area

Closed by Indopama 22 Mar

2022

Safety & Housekeeping Inspection Report Page 4

 Install solid barricade
to prevent worker
7. Indopama
contact with sharp
object

Protruding corroded plate on a

drainage at 500 Kv area

Clean up, dispose the

8. waste to proper bin Indopama
and tidy the area

Empty paint container and empty jerry

can was untidy at 500 Kv area

Safety & Housekeeping Inspection Report Page 5

 Repair the concrete
9 need WO need WO
pedestal/ support

Broken concrete pedestal/ support an

500 Kv Area

Repair the stentphone

10 need WO need WO
panel box

Broken stentphone panel box

Repair the concrete

11 need WO need WO
pedestal/ support

Safety & Housekeeping Inspection Report Page 6

 Broken concrete pedestal/ support on
manhole CW pipe at 500 Kv area

Take down the

12 TBA
hanger if not used

Corroded wire ties at Insulator hanger

at 500 Kv U8 area potentially
collapses

Safety & Housekeeping Inspection Report Page 7

 13 Repair the pedestal need WO need WO

Broken concrete pedestal on floor

drainage at 500 Kv U8 area

Safety & Housekeeping Inspection Report Page 8

 Paint with yellow and
14 black mark on the need WO need WO
conrete

Different elevation can cause trip or

fall on the same level at 500 Kv U8
area

Safety & Housekeeping Inspection Report Page 9

 Need tightening the
15 need WO need WO
bordes

Floor bordes at 150 Kv transformer U8

was loose

Safety & Housekeeping Inspection Report Page 10

 Need to paint with
yellow and black
16 marking to provide need WO need WO
clear color of floor
obstacle

Floor obstruction pipe guther

potentially cause trip or fall on a same
level at 150 Kv U8 area
UC=16 UA=0

Safety & Housekeeping Inspection Report Page 11