PRIMA NIRBHAYA MSE 3.

02
Form

PT DARMA HENWA
INCIDENT NOTIFICATION
(Preliminary Information)
Tanggal / Date: Kamis, 07 Desember 2023
Jam / Time: 08:40 WITA
Lokasi / Location: Laydown RL80
Perusahaan /
PT. Darma Henwa
Company:
Department/
Contract Mining Contract Bengalon
Custodian:
Penjelasan Singkat Crane Truck CT 1099 (Mercy Actros, Crane Tadano SWL 10T) mengangkat main block
Kejadian / Incident crawler crane dari tanah ke low boy. Saat main block yang diangkat sudah berada pada
Brief Description: posisi sekitar 25 cm dari lantai low boy, sling CT 1099 putus sehingga rantai angkat
terjatuh bersama dengan main block CT 1099. Hook rantai angkat mengenai helm safety
sebelah kanan sehingga korban terjatuh
Crane Truck CT 1099 (Mercy Actros, Crane Tadano SWL 10T) lifts the main block of
the crawler crane from the ground to the low boy. When the main block being lifted was
about 25 cm from the floor of the low boy, the sling CT 1099 broke so the lifting chain
fell along with the main block CT 1099. The hook of the lifting chain hit the right safety
helmet so the victim fell.
Akibat Kecelakaan Alat / Equipment: :-
/ Accident
Consequences Orang / People : - Dalam pemerikaan dokter
Lingkungan / Environment :-

Lihat foto-foto kejadian di bawah ini/ See the incident pictures below
Foto 1 | Picture 1 Foto 2 | Picture 2

Posisi Crane Truck dan Lowboy | Crane truck and Kondisi Rantai Angkat | Lift Chain
Lowboy position Condition

Document Title Approved By Effective Date Uncontrolled Document

Notifikasi Insiden / Incident Notification GM CMD 21 Apr 2019 When Printed or Out of HSE Info

Doc Registration No. Version Next Review Due

Page 1 of 1
HSE_KPC_KPC_MSE3.02_DOC_FRMb_002 1.2 20 Apr 2024