Doc.

Number 26071-JO-HSE-F-002
Subcontractor
Logo Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT ABC Total Working Days : 200 Prepared By Approved By

Scope of Work : Civil Work Package 21 Safe Working Days : 200
PO No. / Subcontractor No. : 26071-100-xxx Total Manhour YTD : 1,000
Starting Date 01-Sep-19 Total Safe Manhour : 1,000
Reported Date 19-Mar-20 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 28-Feb-20
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - 07:00 - 08:00 sunny 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - 08:00 - 09:00 sunny 19.00 - 20.00
Restricted Work Case Number of Case - 09:00 - 10:00 sunny …..
Medical Treatment Case Number of Case - 10:00 - 11:00 sunny
Incident impact to environmental pollution Number of Case - 11:00 - 12:00 sunny
Incident impact to fire / asset damage Number of Case - 12:00 - 13:00 rainy
Environmental Damage Number of Case - 13:00 - 14:00 sunny
First Aid Case Number of Case - 14:00 - 15:00 sunny
Nearmiss Number of Case - 2 15:00 - 16:00 sunny
Emergency Evacuation Number of Case - 2 16:00 - 17:00 sunny
17:00 - 18:00 sunny
LTIFR 0.00
LTISR 0.00
TRIR 0.00

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1 Toolbox meeting
Day Shift 2 Premob Inspection Crane 50 T
POB Direct person 20
POB Indirect person 30
POB Total person 50
Working Hour hour 10
MH day shift 500
Extended Work
POB Extended Work person 5
Working Hour hour 2
MH Extended Work 10
Total MH Day Shift 510
POB Night Shift
POB Direct person -
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number 5 10
Heavy Vehicle Number 2 2
Crane Number 2 2
Heavy Equipment Number 2 2
Electrical Tools Number 5 5
Genset Number 3 3
Total KM Driven KM 10,000 9,475,473
Total HM Run hour 6,000 647,236
ID Badge
ID Badge Issued Number 10 100
ID Badge Out Number 2
OTHER
PTW Number 3
e-COP Number 2
HSE Periodic Inspections conducted Object number 6
Premob Inspection conducted Object number 1
Random Alcohol Test Person 1
Submit MCU Record Person 13
General HSE Talk Number 1
Toolbox Meeting Number 2

ACTIVITY (Picture & Caption)

diisi dengan foto kegiatan, caption sesuai dengan kolom "HSE Activity"
 Doc. Number 26071-JO-HSE-039
Effective Date 29-Oct-21
Subcontractor Daily HSE Statistics Report No. of Revision 001
Page 1/1

Subcontractor Name PT.PRATAMA WIDYA,Tbk Total Working Days : 851 Prepared By Approved By
PILE WORK (BROWN AREA) PKG-004 Safe Working Days : 851
PO No. / Subcontractor No. RDMP-P-SC-PIL-004 Total Manhour YTD : 563,241
Starting Date 10-Dec-20 : 563,241 Oryza Regina B.S. Adri M.Taher
Total Safe Manhour Without LTI
Reported Date 01-Jul-23 HSE Officer HSE Coordinator

Cummulative
Item UOM 15-Jan-22
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - 07:00 - 08:00 Sunny
Lost Time Injury (LTI) Number of Case - 08:00 - 09:00 Sunny
Restricted Work Case Number of Case - 09:00 - 10:00 Sunny
Medical Treatment Case Number of Case - - 10:00 - 11:00 Sunny
Incident impact to environmental pollution Number of Case - 11:00 - 12:00 Sunny
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Sunny
Environmental Damage Number of Case - 13:00 - 14:00 Sunny
First Aid Case Number of Case - 1 14:00 - 15:00 Sunny
Nearmiss Number of Case - - 15:00 - 16:00 Sunny
Emergency Evacuation Number of Case - 16:00 - 17:00 Sunny
17:00 - 18:00 Night
LTIFR 0 0.00 18:00 - 19:00 Night
LTISR 0 0.00 19:00 - 20:00 Night
TRIR 0 0.00 20:00 - 21:00 Night

POB & Manhour HSE Activity

No. of Total HSE Personnel person 10 11 1 Toolbox Meeting
Safety Coordinator person 1 1 2 Gas Test
Safety Officer/Safety Spv / Safetyman person 6 7 3 PJSM
Paramedic person 3 3 4 DCU
First Aider person - - 5 P2H Alat
Day Shift 6 Pengecekan SIKA dan PTW
POB Direct person 42 76 7 Gas Test Ulang
POB Indirect person 54 77 8 Perapihan dan Pengecekan Safety sign dan Safety line
POB Total person 96 9 HOUSEKEEPING
Working Hour hour 10 10
MH day shift 960 563,241
Extended Work Next Activity
POB Extended Work person 15 1
Working Hour hour 4 2
MH Extended Work 60 3
Total MH Day Shift 1,020 4
POB Night Shift 5
POB Direct person - - 6
POB Indirect person - - 7
POB Total - -
Working Hour hour - -
MH NIght shift - -
No. of Register Equipment
Light Vehicle Number 7 5
Heavy Vehicle Number 1 6
Crane Number 1 1
Heavy Equipment Number 12 14
Electrical Tools Number 12 15
Genset Number 5 4
Total KM Driven KM 125 100,800
Total HM Run hour 280 97,687
ID Badge
ID Badge Issued Number 92
ID Badge Out Number 3
OTHER
PTW Number - 1077
e-COP Number 4 1,722
HSE Periodic Inspections conducted Object number 13 1568
Premob Inspection conducted Object number - 47
Random Alcohol Test Person - 2
Submit MCU Record Person - 412
General HSE Talk Number - 311
Toolbox Meeting Number 4 1,822
Updated Job Safety Analysis Number - -
Domestic Waste M3 - -
Construction Waste M3 - -
Hazardous Waste M3 -
ACTIVITY (Picture & Caption)

TBM DCU EYE WASH INSPECTION GAS TEST

Monitoring Emergency Box PJSM Pemasangan Safety Line di Area Kerja Premob Inspection HOUSEKEEPING
 Doc. Number 26071-JO-HSE-039
Effective Date 29-Oct-21
Subcontractor Daily HSE Statistics Report No. of Revision 001
Page 1/1

Subcontractor Name PT.PRATAMA WIDYA,Tbk Total Working Days : 852 Prepared By Approved By
PILE WORK (BROWN AREA) PKG-004 Safe Working Days : 852
PO No. / Subcontractor No. RDMP-P-SC-PIL-004 Total Manhour YTD : 563,241
Starting Date 10-Dec-20 : 563,241 Oryza Regina B.S. Adri M.Taher
Total Safe Manhour Without LTI
Reported Date 02-Jul-23 HSE Officer HSE Coordinator

Cummulative
Item UOM 15-Jan-22
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - 07:00 - 08:00
Lost Time Injury (LTI) Number of Case - 08:00 - 09:00
Restricted Work Case Number of Case - 09:00 - 10:00
Medical Treatment Case Number of Case - - 10:00 - 11:00
Incident impact to environmental pollution Number of Case - 11:00 - 12:00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00
Environmental Damage Number of Case - 13:00 - 14:00
First Aid Case Number of Case - 1 14:00 - 15:00
Nearmiss Number of Case - - 15:00 - 16:00
Emergency Evacuation Number of Case - 16:00 - 17:00

LTIFR 0 0.00
LTISR 0 0.00
TRIR 0 0.00

POB & Manhour HSE Activity

No. of Total HSE Personnel person - 11 1
Safety Coordinator person - 1 2
Safety Officer/Safety Spv / Safetyman person - 7 3
Paramedic person - 3 4
First Aider person - - 5
Day Shift 6
POB Direct person - 76 7
POB Indirect person - 77 8
POB Total person - 9
Working Hour hour - 10
MH day shift - 563,241
Extended Work Next Activity
POB Extended Work person - 1 Toolbox Meeting
Working Hour hour - 2 Gas Test
MH Extended Work - 3 PJSM
Total MH Day Shift - 4 DCU
POB Night Shift 5 P2H Alat
POB Direct person - - 6 Pengecekan SIKA dan PTW
POB Indirect person - - 7 Gas Test Ulang
POB Total - - 8 Perapihan dan Pengecekan Safety sign dan Safety line
Working Hour hour - - 9 HOUSEKEEPING
MH NIght shift - - 10 Heavy Equipment Inspection
No. of Register Equipment
Light Vehicle Number 7 5
Heavy Vehicle Number 1 6
Crane Number 1 1
Heavy Equipment Number 12 14
Electrical Tools Number 12 15
Genset Number 5 4
Total KM Driven KM 125 100,925
Total HM Run hour 280 97,967
ID Badge
ID Badge Issued Number 92
ID Badge Out Number 3
OTHER
PTW Number - 1077
e-COP Number 4 1,722
HSE Periodic Inspections conducted Object number 13 1568
Premob Inspection conducted Object number - 47
Random Alcohol Test Person - 2
Submit MCU Record Person - 412
General HSE Talk Number - 311
Toolbox Meeting Number 4 1,822
Updated Job Safety Analysis Number - -
Domestic Waste M3 - -
Construction Waste M3 - -
Hazardous Waste M3 -
ACTIVITY (Picture & Caption)

NO ACTIVITY
TBM DCU EYE WASH INSPECTION GAS TEST

Monitoring Emergency Box

NO ACTIVITY PJSM Pemasangan Safety Line di Area Kerja Premob Inspection HOUSEKEEPING
 Doc. Number 26071-JO-HSE-039
Effective Date 29-Oct-21
Subcontractor Daily HSE Statistics Report No. of Revision 001
Page 1/1

Subcontractor Name PT.PRATAMA WIDYA,Tbk Total Working Days : 853 Prepared By Approved By
PILE WORK (BROWN AREA) PKG-004 Safe Working Days : 853
PO No. / Subcontractor No. RDMP-P-SC-PIL-004 Total Manhour YTD : 564,161
Starting Date 10-Dec-20 : 564,161 Oryza Regina B.S. Adri M.Taher
Total Safe Manhour Without LTI
Reported Date 03-Jul-23 HSE Officer HSE Coordinator

Cummulative
Item UOM 15-Jan-22
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - 07:00 - 08:00 Rainy
Lost Time Injury (LTI) Number of Case - 08:00 - 09:00 Rainy
Restricted Work Case Number of Case - 09:00 - 10:00 Rainy
Medical Treatment Case Number of Case - - 10:00 - 11:00 Rainy
Incident impact to environmental pollution Number of Case - 11:00 - 12:00 Rainy
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Rainy
Environmental Damage Number of Case - 13:00 - 14:00 Rainy
First Aid Case Number of Case - 1 14:00 - 15:00 Rainy
Nearmiss Number of Case - - 15:00 - 16:00 Rainy
Emergency Evacuation Number of Case - 16:00 - 17:00 Rainy

LTIFR 0 0.00
LTISR 0 0.00
TRIR 0 0.00

POB & Manhour HSE Activity

No. of Total HSE Personnel person 10 11 1 Toolbox Meeting
Safety Coordinator person 1 1 2 Gas Test
Safety Officer/Safety Spv / Safetyman person 6 7 3 PJSM
Paramedic person 3 3 4 DCU
First Aider person - - 5 P2H Alat
Day Shift 6 Pengecekan SIKA dan PTW
POB Direct person 37 76 7 Gas Test Ulang
POB Indirect person 55 77 8 Perapihan dan Pengecekan Safety sign dan Safety line
POB Total person 92 9 HOUSEKEEPING
Working Hour hour 10 10 Heavy Equipment Inspection
MH day shift 920 564,161
Extended Work Next Activity
POB Extended Work person - 1 Toolbox Meeting
Working Hour hour - 2 Gas Test
MH Extended Work - 3 PJSM
Total MH Day Shift 920 4 DCU
POB Night Shift 5 P2H Alat
POB Direct person - - 6 Pengecekan SIKA dan PTW
POB Indirect person - - 7 Gas Test Ulang
POB Total - - 8 Perapihan dan Pengecekan Safety sign dan Safety line
Working Hour hour - - 9 HOUSEKEEPING
MH NIght shift - -
No. of Register Equipment
Light Vehicle Number 7 5
Heavy Vehicle Number 1 6
Crane Number 1 1
Heavy Equipment Number 12 14
Electrical Tools Number 12 15
Genset Number 5 4
Total KM Driven KM 125 101,050
Total HM Run hour 280 98,247
ID Badge
ID Badge Issued Number 92
ID Badge Out Number 3
OTHER
PTW Number - 1077
e-COP Number 4 1,726
HSE Periodic Inspections conducted Object number 13 1581
Premob Inspection conducted Object number - 47
Random Alcohol Test Person - 2
Submit MCU Record Person - 412
General HSE Talk Number - 311
Toolbox Meeting Number 4 1,826
Updated Job Safety Analysis Number - -
Domestic Waste M3 - -
Construction Waste M3 - -
Hazardous Waste M3 -
ACTIVITY (Picture & Caption)

TBM DCU EYE WASH INSPECTION GAS TEST

Monitoring Emergency Box PJSM Pemasangan Safety Line di Area Kerja Premob Inspection HOUSEKEEPING
 Doc. Number 26071-JO-HSE-039
Effective Date 29-Oct-21
Subcontractor Daily HSE Statistics Report No. of Revision 001
Page 1/1

Subcontractor Name PT.PRATAMA WIDYA,Tbk Total Working Days : 854 Prepared By Approved By
PILE WORK (BROWN AREA) PKG-004 Safe Working Days : 854
PO No. / Subcontractor No. RDMP-P-SC-PIL-004 Total Manhour YTD : 564,971
Starting Date 10-Dec-20 : 564,971 Oryza Regina B.S. Adri M.Taher
Total Safe Manhour Without LTI
Reported Date 04-Jul-23 HSE Officer HSE Coordinator

Cummulative
Item UOM 15-Jan-22
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - 07:00 - 08:00 Cloudy
Lost Time Injury (LTI) Number of Case - 08:00 - 09:00 Cloudy
Restricted Work Case Number of Case - 09:00 - 10:00 Cloudy
Medical Treatment Case Number of Case - - 10:00 - 11:00 Cloudy
Incident impact to environmental pollution Number of Case - 11:00 - 12:00 Cloudy
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Cloudy
Environmental Damage Number of Case - 13:00 - 14:00 Cloudy
First Aid Case Number of Case - 1 14:00 - 15:00 Cloudy
Nearmiss Number of Case - - 15:00 - 16:00 Cloudy
Emergency Evacuation Number of Case - 16:00 - 17:00 Cloudy
17:00-18:00 Night
LTIFR 0 0.00 18:00-19:00 Night
LTISR 0 0.00 19:00-20:00 Night
TRIR 0 0.00 20:00-21:00 Night

POB & Manhour HSE Activity

No. of Total HSE Personnel person 10 11 1 Toolbox Meeting
Safety Coordinator person 1 1 2 Gas Test
Safety Officer/Safety Spv / Safetyman person 6 7 3 PJSM
Paramedic person 3 3 4 DCU
First Aider person - - 5 P2H Alat
Day Shift 6 Pengecekan SIKA dan PTW
POB Direct person 34 76 7 Gas Test Ulang
POB Indirect person 47 77 8 Perapihan dan Pengecekan Safety sign dan Safety line
POB Total person 81 9 HOUSEKEEPING
Working Hour hour 10 10
MH day shift 810 564,971
Extended Work Next Activity
POB Extended Work person 18 1 Toolbox Meeting
Working Hour hour 4 2 Gas Test
MH Extended Work 72 3 PJSM
Total MH Day Shift 882 4 DCU
POB Night Shift 5 P2H Alat
POB Direct person - - 6 Pengecekan SIKA dan PTW
POB Indirect person - - 7 Gas Test Ulang
POB Total - - 8 Perapihan dan Pengecekan Safety sign dan Safety line
Working Hour hour - - 9 HOUSEKEEPING
MH NIght shift - -
No. of Register Equipment
Light Vehicle Number 7 5
Heavy Vehicle Number 1 6
Crane Number 1 1
Heavy Equipment Number 12 14
Electrical Tools Number 12 15
Genset Number 5 4
Total KM Driven KM 125 101,175
Total HM Run hour 280 98,527
ID Badge
ID Badge Issued Number 92
ID Badge Out Number 3
OTHER
PTW Number - 1077
e-COP Number 4 1,730
HSE Periodic Inspections conducted Object number 13 1594
Premob Inspection conducted Object number - 47
Random Alcohol Test Person - 2
Submit MCU Record Person - 412
General HSE Talk Number - 311
Toolbox Meeting Number 4 1,830
Updated Job Safety Analysis Number - -
Domestic Waste M3 - -
Construction Waste M3 - -
Hazardous Waste M3 -
ACTIVITY (Picture & Caption)

TBM DCU EYE WASH INSPECTION GAS TEST

Monitoring Emergency Box PJSM Pemasangan Safety Line di Area Kerja Premob Inspection HOUSEKEEPING
 Doc. Number 26071-JO-HSE-039
Effective Date 29-Oct-21
Subcontractor Daily HSE Statistics Report No. of Revision 001
Page 1/1

Subcontractor Name PT.PRATAMA WIDYA,Tbk Total Working Days : 855 Prepared By Approved By
PILE WORK (BROWN AREA) PKG-004 Safe Working Days : 855
PO No. / Subcontractor No. RDMP-P-SC-PIL-004 Total Manhour YTD : 565,881
Starting Date 10-Dec-20 : 565,881 Oryza Regina B.S. Adri M.Taher
Total Safe Manhour Without LTI
Reported Date 05-Jul-23 HSE Officer HSE Coordinator

Cummulative
Item UOM 15-Jan-22
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - 07:00 - 08:00 Cloudy
Lost Time Injury (LTI) Number of Case - 08:00 - 09:00 Cloudy
Restricted Work Case Number of Case - 09:00 - 10:00 Cloudy
Medical Treatment Case Number of Case - - 10:00 - 11:00 Rainy
Incident impact to environmental pollution Number of Case - 11:00 - 12:00 Rainy
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Sunny
Environmental Damage Number of Case - 13:00 - 14:00 Sunny
First Aid Case Number of Case - 1 14:00 - 15:00 Sunny
Nearmiss Number of Case - - 15:00 - 16:00 Sunny
Emergency Evacuation Number of Case - 16:00 - 17:00 Sunny

LTIFR 0 0.00
LTISR 0 0.00
TRIR 0 0.00

POB & Manhour HSE Activity

No. of Total HSE Personnel person 10 11 1 Toolbox Meeting
Safety Coordinator person 1 1 2 Gas Test
Safety Officer/Safety Spv / Safetyman person 6 7 3 PJSM
Paramedic person 3 3 4 DCU
First Aider person - - 5 P2H Alat
Day Shift 6 Pengecekan SIKA dan PTW
POB Direct person 39 76 7 Gas Test Ulang
POB Indirect person 52 77 8 Perapihan dan Pengecekan Safety sign dan Safety line
POB Total person 91 9 HOUSEKEEPING
Working Hour hour 10 10
MH day shift 910 565,881
Extended Work Next Activity
POB Extended Work person - 1 Toolbox Meeting
Working Hour hour - 2 Gas Test
MH Extended Work - 3 PJSM
Total MH Day Shift 910 4 DCU
POB Night Shift 5 P2H Alat
POB Direct person - - 6 Pengecekan SIKA dan PTW
POB Indirect person - - 7 Gas Test Ulang
POB Total - - 8 Perapihan dan Pengecekan Safety sign dan Safety line
Working Hour hour - - 9 HOUSEKEEPING
MH NIght shift - - 10 Vehicle Inspection
No. of Register Equipment
Light Vehicle Number 7 5
Heavy Vehicle Number 1 6
Crane Number 1 1
Heavy Equipment Number 12 14
Electrical Tools Number 12 15
Genset Number 5 4
Total KM Driven KM 125 101,300
Total HM Run hour 280 98,807
ID Badge
ID Badge Issued Number 92
ID Badge Out Number 3
OTHER
PTW Number - 1077
e-COP Number 4 1,734
HSE Periodic Inspections conducted Object number 13 1607
Premob Inspection conducted Object number - 47
Random Alcohol Test Person - 2
Submit MCU Record Person - 412
General HSE Talk Number - 311
Toolbox Meeting Number 4 1,834
Updated Job Safety Analysis Number - -
Domestic Waste M3 - -
Construction Waste M3 - -
Hazardous Waste M3 -
ACTIVITY (Picture & Caption)

TBM DCU EYE WASH INSPECTION GAS TEST

Monitoring Emergency Box PJSM Pemasangan Safety Line di Area Kerja Premob Inspection HOUSEKEEPING
 Doc. Number 26071-JO-HSE-039
Effective Date 29-Oct-21
Subcontractor Daily HSE Statistics Report No. of Revision 001
Page 1/1

Subcontractor Name PT.PRATAMA WIDYA,Tbk Total Working Days : 856 Prepared By Approved By
PILE WORK (BROWN AREA) PKG-004 Safe Working Days : 856
PO No. / Subcontractor No. RDMP-P-SC-PIL-004 Total Manhour YTD : 566,841
Starting Date 10-Dec-20 : 566,841 Oryza Regina B.S. Adri M.Taher
Total Safe Manhour Without LTI
Reported Date 06-Jul-23 HSE Officer HSE Coordinator

Cummulative
Item UOM 15-Jan-22
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - 07:00 - 08:00 Cloudy
Lost Time Injury (LTI) Number of Case - 08:00 - 09:00 Sunny
Restricted Work Case Number of Case - 09:00 - 10:00 Sunny
Medical Treatment Case Number of Case - - 10:00 - 11:00 Sunny
Incident impact to environmental pollution Number of Case - 11:00 - 12:00 Sunny
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Sunny
Environmental Damage Number of Case - 13:00 - 14:00 Sunny
First Aid Case Number of Case - 1 14:00 - 15:00 Sunny
Nearmiss Number of Case - - 15:00 - 16:00 Sunny
Emergency Evacuation Number of Case - 16:00 - 17:00 Sunny

LTIFR 0 0.00
LTISR 0 0.00
TRIR 0 0.00

POB & Manhour HSE Activity

No. of Total HSE Personnel person 11 11 1 Toolbox Meeting
Safety Coordinator person 1 1 2 Gas Test
Safety Officer/Safety Spv / Safetyman person 7 7 3 PJSM
Paramedic person 3 3 4 DCU
First Aider person - - 5 P2H Alat
Day Shift 6 Pengecekan SIKA dan PTW
POB Direct person 38 76 7 Gas Test Ulang
POB Indirect person 58 77 8 Perapihan dan Pengecekan Safety sign dan Safety line
POB Total person 96 9 HOUSEKEEPING
Working Hour hour 10 10 Vehicle Inspection
MH day shift 960 566,841
Extended Work Next Activity
POB Extended Work person - 1 Toolbox Meeting
Working Hour hour - 2 Gas Test
MH Extended Work - 3 PJSM
Total MH Day Shift 960 4 DCU
POB Night Shift 5 P2H Alat
POB Direct person - - 6 Pengecekan SIKA dan PTW
POB Indirect person - - 7 Gas Test Ulang
POB Total - - 8 Perapihan dan Pengecekan Safety sign dan Safety line
Working Hour hour - - 9 HOUSEKEEPING
MH NIght shift - - 10
No. of Register Equipment
Light Vehicle Number 7 5
Heavy Vehicle Number 1 6
Crane Number 1 1
Heavy Equipment Number 12 14
Electrical Tools Number 12 15
Genset Number 5 4
Total KM Driven KM 125 101,425
Total HM Run hour 280 99,087
ID Badge
ID Badge Issued Number 92
ID Badge Out Number 3
OTHER
PTW Number - 1077
e-COP Number 4 1,738
HSE Periodic Inspections conducted Object number 13 1620
Premob Inspection conducted Object number - 47
Random Alcohol Test Person - 2
Submit MCU Record Person - 412
General HSE Talk Number - 311
Toolbox Meeting Number 4 1,838
Updated Job Safety Analysis Number - -
Domestic Waste M3 - -
Construction Waste M3 - -
Hazardous Waste M3 -
ACTIVITY (Picture & Caption)

TBM DCU EYE WASH INSPECTION GAS TEST

Monitoring Emergency Box PJSM Pemasangan Safety Line di Area Kerja Premob Inspection HOUSEKEEPING
MONTHLY REPORT
Month :
Subcontractor Name :
Scope of Work :

MAN POWER STRENGTH

POB (MTD) Man #REF!
MAN HOURS (MTD) Hour #REF!
HSE PERFORMANCE & STATISTIC
INJURY Fatality Case #REF!
Lost Time Injury (LTI) Case #REF!
Restricted Work Case Case #REF!
Medical Treatment Case Case #REF!
Incident impact to environmental pollution Case #REF!
Incident impact to fire / asset damage Case #REF!
Environmental Damage Case #REF!
First Aid Case Case #REF!
Nearmiss Case #REF!
Emergency Evacuation Case #REF!
Total Recordable Injury Rate #REF!
OTHER Light Vehicle Unit #REF!
Heavy Vehicle Unit #REF!
Crane Unit #REF!
Heavy Equipment Unit #REF!
Electrical tools Unit #REF!
Genset Unit #REF!
Total KM Driven KM #REF!
Total HM Run Hour #REF!

PTW Number #REF!

e-COP Number #REF!
HSE Periodic Inspections conducted Unit #REF!
Premob Inspection conducted Unit #REF!
Random Alcohol Test Person #REF!
Submit MCU Record Person #REF!
General HSE Talk Number #REF!
Toolbox Meeting Number #REF!
Updated Job Safety Analysis Number #REF!
WASTE RECORD Domestic Waste M3 #REF!
Construction Waste M3 #REF!
Hazardous Waste M3 #REF!