TOKA TINDUNG PROJECT

PLAN TASK OBSERVATION (PTO) FORM

TT-OHS-FRO-xxxx

1. 2.
3. OBSERVER INX No.

Name : Shancha Agusta OBJECTIVES OF OBSERVATION

Job Title : Mechanical Engineer TO KNOW:
ID. Badge No :
1. The team's ability to do assignments
following work guidelines.
2. The adequacy of work guides becomes
Date & Time : 18 september 2023 guidance for carrying out tasks safely and
efficiently.

Observer Team
1. Name : Terry Lasapu ID No. : Job Title : OHS Inspector, OHS
OHS Advisor and HE
2. Name : Robinson Sulle ID No. : Job Title :
Assessor, OHS
3 Name : John Nainggolan ID No. : 4210882 Job Tittle : Mechanical Engineer

4. 5.
6. TASK BEING OBSERVED

Task Name : Fabrication Pipe Fire Line

Supervisor Area : Matius Durand
No. of Worker :
Location : Magazine Area 10

� � Follow Up
Type of Observation :
�New �
� � Full
Scope of Observation :
�Partial �
�JSEA/WI �
Job Guidance :
� � SOP or COP

Reason of Observation :
�Follow up Incident � Critical Task Audit
� �
�Follow up Training � Non Routine Task
� �
7. 8.
9. TYPES OF ACTIVITIES

Nama Dokumen Plan Task Observation (PTO) Form

Ditetapkan Oleh Kepala Teknik Tambang Tanggal Terbit xxx
No Dokumen TT-OHS-FRO-xxxx Tanggal Tinjau Ulang xxx
Halaman 1 dari
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 TOKA TINDUNG PROJECT
PLAN TASK OBSERVATION (PTO) FORM
TT-OHS-FRO-xxxx

� Working at height 󠇮 Isolation, Lock Out and Tag Out

󠇮 Working Near Hot Water

�
� �
Electrical Safety Working in Confined Space
󠇮 Working near TSF Mud

� �
� �
Operating vehicle & Mobile
Equipment
Blasting Activities
󠇮 Lifting & Supporting Load

� �
� �
Hazardous Substance Fatigue Management
󠇮 Work Permit

� �
� Other activities
:

�
10. OSERVATION CHECKLIST
Abilities of the Team Performing Task
No. ITEM YES NO N/A No. ITEM YES NO N/A
1. Step of the task in correct order 7. Equipment & tools being used:
2. All task steps are followed a. In good condition
a. Worker Qualification (job title
3. b. Used properly and appropriately
and level as per JSEA)
b. No. of worker as per JSEA 8. Communication among worker properly
c. Appropriate PPE as per JSEA 9. Adequate Supervision
4. Work permit completed 10. Sufficient time to work safely
Housekeeping maintained during
5. TAKE 5 properly conducted 11.
performing the task
Pre-job safety talk conducted
6. 12. Job conducted safely as plan
properly
Adequacy of Work Guidance
JSEA or Work Instruction (SWI)
No. Items YES NO N/A No. Items YES NO N/A
1. Still Valid, Not Expired 4. All hazards adequately controlled
2. Steps of the task in correct order 5. Align with referred SOP or COP
3. All hazards identified 6. Any other effective work method
Prosedur or COP
No. Items YES NO N/A No. Items YES NO N/A
1. Still valid, Not Expired 3. Adequately covered the JSEA
2. Specific and controlled 4. Still appropriate to current condition

Nama Dokumen Plan Task Observation (PTO) Form

Ditetapkan Oleh Kepala Teknik Tambang Tanggal Terbit xxx
No Dokumen TT-OHS-FRO-xxxx Tanggal Tinjau Ulang xxx
Halaman 2 dari
No Revisi 00 Dokumen terkendali dan valid hanya ada di sharepoint Archi Indonesia
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 TOKA TINDUNG PROJECT
PLAN TASK OBSERVATION (PTO) FORM
TT-OHS-FRO-xxxx

Feedback for improvement

Do Follow-up of observation on workers or duty needs to be followed up ? Yes No

11. DETAIL OF CORRECTIVE ACTIONS

Describe the actions that have been taken to effect this change, Note the actions below
No. Actions By Who Due Date
1
2
3
4
5

Signed Signed Signed Signed

Name: Name: Name: Name:

Nama Dokumen Plan Task Observation (PTO) Form

Ditetapkan Oleh Kepala Teknik Tambang Tanggal Terbit xxx
No Dokumen TT-OHS-FRO-xxxx Tanggal Tinjau Ulang xxx
Halaman 3 dari
No Revisi 00 Dokumen terkendali dan valid hanya ada di sharepoint Archi Indonesia
3