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  • SHE Incident Investigation

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    hsetraining040
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    This document is an incident investigation report detailing a workplace incident. It provides information on the date and time of incident, location, weather conditions, those involved including victim, witnesses and management. It identifies the direct causes such as not wearing protective equipment and tripping hazards. It also examines the root causes such as lack of training. Finally it outlines a hierarchy of corrective actions and planned improvements like creating sanctions for not wearing PPE, scheduling training and controlling hazards.

    Original Description:

    SAWCV QAFAWRCGZDAWEVFDGAWESFDZEWF

    Original Title

    SHE Incident Investigation (1)

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    This document is an incident investigation report detailing a workplace incident. It provides information on the date and time of incident, location, weather conditions, those involved including victim, witnesses and management. It identifies the direct causes such as not wearing protective equipment and tripping hazards. It also examines the root causes such as lack of training. Finally it outlines a hierarchy of corrective actions and planned improvements like creating sanctions for not wearing PPE, scheduling training and controlling hazards.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    7 views3 pages

    SHE Incident Investigation

    Uploaded by

    hsetraining040
    This document is an incident investigation report detailing a workplace incident. It provides information on the date and time of incident, location, weather conditions, those involved including victim, witnesses and management. It identifies the direct causes such as not wearing protective equipment and tripping hazards. It also examines the root causes such as lack of training. Finally it outlines a hierarchy of corrective actions and planned improvements like creating sanctions for not wearing PPE, scheduling training and controlling hazards.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 3

    SHE INCIDENT INVESTIGATION REPORT

    DETAIL INCIDENT & RINGKASAN:


    Tanggal Jam
    Tanggal Insiden: Jam Insiden:
    Pelaporan: Pelaporan:

    Shift: I II III

    Kondisi Cuaca:

    Lokasi Insiden:
    Proses / Pekerjaan pada
    saat terjadi insiden:

    Kronologis Insiden
    (Rangkum secara singkat seluruh
    fakta di lapangan)

    Gambar / Sketsa / Foto

    Korban/Pelaku Saksi Atasan SHE Management

    (……………………………………) (………………………) (………………………) (……………………..…) (………..…………………)


    SHE INCIDENT INVESTIGATION REPORT
    PENJELASAN FAKTOR-FAKTOR YANG DIIDENTIFIKASI
    Berikan penjelasan untuk setiap faktor yang diidentifikasi.

    PENYEBAB LANGSUNG
    Tindakan tidak aman (klausal SCAT) Penjelasan Penyebab
    1.1 Violation by individual Tidak menggunakan APD (safety harness) Ribet menggunakan APD

    Kondisi tidak aman (klausal SCAT) Penjelasan Penyebab


    8.4. Ceceran oli …………………………………………
    8…… Lokasi kerja berantakan

    PENYEBAB DASAR
    Faktor Pribadi (klausal SCAT) Penjelasan Penyebab
    Belum pernah training tidak tahu cara
    6……… Ribet menggunakan APD
    menggunakan APD

    Faktor Organisasi/Pekerjaan
    Penjelasan Penyebab
    (klausal SCAT)

    HIRARKI PERBAIKAN PENYEBAB KECELAKAAN


    Berikan penjelasan bagaimana rencana perbaikan dari penyebab yang teridentifikasi.
    PENYEBAB TERIDENTIFIKASI HIRARKI PERBAIKAN LANGKAH PERBAIKAN
    Eliminasi/Substitusi Penyebab
    Pengendalian melalui perancangan
    Membuat aturan sanksi perusahaan
    Ribet tidak mau pakai APD Kontrol administrasi
    penggunaan APD
    Pelatihan
    Alat Pelindung diri
    Eliminasi/Substitusi Penyebab
    Pengendalian melalui perancangan
    Kontrol administrasi
    Pelatihan
    Alat Pelindung diri
    Eliminasi/Substitusi Penyebab
    Pengendalian melalui perancangan
    Belum pernah training tidak tahu cara
    Kontrol administrasi
    menggunakan APD
    Pelatihan Membuat jadwal pelatihan untuk kryawan
    Alat Pelindung diri
    Eliminasi/Substitusi Penyebab
    Pengendalian melalui perancangan
    SHE INCIDENT INVESTIGATION REPORT
    Kontrol administrasi
    Pelatihan
    Alat Pelindung diri
    Eliminasi/Substitusi Penyebab
    Pengendalian melalui perancangan
    Kontrol administrasi
    Pelatihan
    Alat Pelindung diri

    RENCANA TINDAKAN PERBAIKAN

    Buat pernyataan tindakan perbaikan yang akan diambil untuk mencegah pengulangan insiden.
    (Faktor Absen/Ketiadaan/ Kegagalan Sistem Pelindung & Faktor Organisasi wajib ditindaklanjuti dengan tindakan)
    Hard Soft
    Tenggat
    Rencana Tindakan Perbaikan Control Control Oleh Prioritas
    Waktu
    () ()
    SHE,
    1. Membuat aturan sanksi perusahaan penggunaan APD V Manage 1 Juli 2021
    ment
    2.
    3.
    4.
    5.
    6.
    7.
    8.
    9.
    10.

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