PERTANNA

SAFETY OBSERVATION CARD RDMP

KARTU OBSERVASI KESELAMATAN

Date & Time/Tanggal &Waktu

:01 203
Location/ Lokasi
|Name & Position/ Nama & Posisi
:Ama
Company/ Perusahaan :-SA
Type of Observation (Please Thick One)
Jenis Pengamatan (Centang Salah Satu)

SAFETY GOLDEN RULES Violation?

Pelanggaron Terhadap SAFETY GOLDEN RULES?
Yes No

UNSAFE ACT/CONDITION
Kondisi/ Prilaku Tidak Aman

SAFE BEHAVIOUR/GOOD PRACTICE

Perilaku /Praktik Kerja Aman
SUGGESTION
Saran

JELASKAN APA YANG ANDA LIHAT

Describe what did you see

TINDAKAN APA YANG ANDALAKUKAN ATAU KESEPAKATAN YANG ANDA

BUAT?
What Action Did You Do or Agreement Made?
|(Berikansaran positifatou menghentikon perilaku/kondisi tidak amnon)
|(Give Positive Suggestionor Stop the Unsafe Action/ Condition)

TINDAKAN REKOMENDASI/ Recommendation Action

 SAFETY OBSERVATION CARD RDMPO
KARTU OBSERVASI KESELAMATAN

Dete & Te/Tangga & Waktu

:07-7- 203
Locotiony Lokzsi
Nce & ostior/ Nam & Posisi
Compony/ Perusahaan
Ë
PrgarrOton (Centang Salah Satu)

SAFETY GOLDEN RULES Violation?

Peianggoran Terhodap SAFETY GOLDEN RULES?
Yes No
UNSAFE ACT/CONDITION
Kondisi Prilaku Tidak Aman
SAFE BEHAVIOUR/GOOD PRACTICE
Perilaku/Praktik Kerja Aman
SUGGESTION
Saran

JELASKAN APA YANG ANDA LIHAT

Describe what did you see

TINDAKAN APA YANG ANDA LAKUKANATAU KESEPAKATAN YANG ANDA

BUAT?
Whot Action Did You Do or Agreement Made?
(Berikon saran positif atau menghentikon peraku/kondisi tdok on
(Give Positive Suggestion or Stop the Unsafe Action/ Condition)

TINDAKAN REKOMENDASI /Recommendation Action

 NTAMINA
ote SAFETY OBSERVATION CARD RDMP
oca KARTU OBSERVASI KESELAMATAN
an Date & Tine/ Tanggal & Waktu
Locotion/ Lokasi
:1-0- 20y
Name & POsition/ Nama & Posisi
wDnnPerISnaan
Type of Observation (Please Thick One)
jenis Pengamatan (Centang Salah Satu)

SAFETY GOLDEN RULES Violation ?

Pelonggaran Terhadap SAFETY GOLDEN RULES?
Yes No
UNSAFE ACT/CONDITION
Kondisi /Prilaku Tidak Aman
SAFE BEHAVIOUR/GOOD PRACTICE
Perilaku/ Praktik Kerja Aman
SUGGESTION
Saran
JELASKAN APA YANG ANDAUHAT
Describe what did yousee

TINDAKAN APAYANG ANDA LAKUKANATAU KESEPAKATAN VANG ANDA

BUAT?
What Action Did You Do or Agreement Made?
|(Berikan saran posiif utou menghentikon perilaku/konisi tdok omon)
(Give Positive Suggestionor Stop theUnsefe Action/ Condition)

Satan a
TINDAKAN REKOMENDASI/ Recommendation Actíon
 PenAMIA
SAFErY OBSERVATION CARD
KARTU OBSIRVASKESELAAATAN
loate A TIme/ TangglR Waktu

Location/ Lokasl :ALCn As

Name & Position/ Nama & Posisl : 3OTaM
Company/ Perusahaan : S
Type of Observation (Plcase Thick One)
Jenis Pengamatan (Centang Salah Satu)

SAFETY GOLDEN RULES Violation?

Pelanggaran Terhadap SAFETY GOLDEN RULES?
Yes No
UNSAFE ACT/CONDITION
Kondisi /Prilaku Tidak Aman

SAFE BEHAVIOUR/GOOD PRACTICE

Perilaku / Praktik Kerja Aman

SUGGESTION
Saran

JELASKAN APA YANG ANDA IHAT

Describe what did you see

Pe
TINDAKAN APA YANG ANDA LAKUKANATAU KESEPAKA TAN VANG ANDA
BUAT?
What Action Did You Do or Agreement Made?
(Berikan saran positifatau menghentikan perilaku/kondisi tidak aman)
(Give Positive Suggestion or Stop the Unsafe Action/ Condition)

TINDAKAN REKOMENDASI / Recomnendation Action