Form PW-HSE-08-07

PT. WASKITA KARYA (Persero), Tbk Rev. 02, June 2021

QHSE INSPECTION RESULT REPORT (NON-ROUTINE/WEEKLY)

Project Road Tono Noefefan Bridge to Inspected by, Putu G Harimurti
Oenuno Jannandrayuga Subadra (Sign)

Date Inspection 5 January 2023 Followed up by,

Inspection Type Non-Regular/Weekly Asyrof Sahli Awwali (Sign)

Basic Cause of Person Verification

Incompatibility Nonconformity Repair Suggestions & Responsible Follow-up Repair
No. (Appropriate/Not
(Photo/Description/Location) (HSE non-compliance only) Completion Target Time (Foreman / Sub / (Photo & Description)
Appropriate)
Waskita Personnel)

1. Unsafe Condition ➢ Segera dibuat proteksi SPLEM OK

➢ Target : 6 January 2023 QHSE

➢ Sudah dibuat proteksi dengan

pallet

➢ Penanganan limbah B3 belum di

proteksi dengan diberi alas agar tidak
langsung bersinggungan dengan
lantai
➢ Lokasi = Gudang Limbah B3
 Form PW-HSE-08-07
PT. WASKITA KARYA (Persero), Tbk Rev. 02, June 2021

QHSE INSPECTION RESULT REPORT (NON-ROUTINE/WEEKLY)

Project Road Tono Noefefan Bridge to Inspected by, Putu G Harimurti
Oenuno Jannandrayuga Subadra (Sign)

Date Inspection 12 January 2023 Followed up by,

Inspection Type Non-Regular/Weekly Asyrof Sahli Awwali (Sign)

Basic Cause of Person Verification

Incompatibility Nonconformity Repair Suggestions & Responsible Follow-up Repair
No. (Appropriate/Not
(Photo/Description/Location) (HSE non-compliance only) Completion Target Time (Foreman / Sub / (Photo & Description)
Appropriate)
Waskita Personnel)

1. Unsafe Condition ➢ Segera dibuat rambu- QHSEM OK

rambu untuk menghindari
kecelakaan
➢ Target : 12 Januari 2023

➢ Sudah dipasang rambu-rambu

keselamatan
➢ Belum terdapat rambu-rambu
keselamatan jalan di area tersebut
➢ Lokasi = Proyek STA. 1+450
 Form PW-HSE-08-07
PT. WASKITA KARYA (Persero), Tbk Rev. 02, June 2021

QHSE INSPECTION RESULT REPORT (NON-ROUTINE/WEEKLY)

Project Road Tono Noefefan Bridge to Inspected by, Putu G Harimurti
Oenuno Jannandrayuga Subadra (Sign)

Date Inspection 20 January 2023 Followed up by,

Inspection Type Non-Regular/Weekly Asyrof Sahli Awwali (Sign)

Basic Cause of Person Verification

Incompatibility Nonconformity Repair Suggestions & Responsible Follow-up Repair
No. (Appropriate/Not
(Photo/Description/Location) (HSE non-compliance only) Completion Target Time (Foreman / Sub / (Photo & Description)
Appropriate)
Waskita Personnel)

1. Unsafe Condition ➢ Segera dibuat proteksi QHSEM OK

untuk menghindari
kecelakaan
➢ Target : 20 Januari 2023

➢ Sudah dipasang proteksi

➢ Belum terdapat proteksi pada saluran

air yang beda elevasi dengan jalan
➢ Lokasi = Proyek STA. 5+500
 Form PW-HSE-08-07
PT. WASKITA KARYA (Persero), Tbk Rev. 02, June 2021

QHSE INSPECTION RESULT REPORT (NON-ROUTINE/WEEKLY)

Project Road Tono Noefefan Bridge to Inspected by, Putu G Harimurti
Oenuno Jannandrayuga Subadra (Sign)

Date Inspection 23 January 2023 Followed up by,

Inspection Type Non-Regular/Weekly Asyrof Sahli Awwali (Sign)

Basic Cause of Person Verification

Incompatibility Nonconformity Repair Suggestions & Responsible Follow-up Repair
No. (Appropriate/Not
(Photo/Description/Location) (HSE non-compliance only) Completion Target Time (Foreman / Sub / (Photo & Description)
Appropriate)
Waskita Personnel)

1. Unsafe Condition ➢ Segera dibuat proteksi SOM OK

untuk menghindari QHSE
kecelakaan
➢ Target : 24 January 2023

➢ Sudah dibuat proteksi

➢ Belum terdapat proteksi pada area pengaman
saluran air
➢ Lokasi = Proyek STA. 3+250