Tanggal : Lokasi : Id Badge Pengamat: Pengamatan:

X Positif Negatif
Thursday, April 18, 2024 KB 116 202207110

Apa yang anda lihat dan amati : Apa yang anda katakan dan lakukan :

Aktivitas :Radiography test

Melihat PPR/Safety team NDT membuat yellow line/baricade saat proses Radiography
berlangsung untuk menghindari paparan Radiasi yang di pancarkan terhadap orang di
sekitar

Memberikan apresiasi ke PPR tersebut karena sudah melakukan pekerjaan sesuai

prosedur

Perusahaan Orng Yang Diamati: Dept. orang yang Diamati:

PT. ADK MD NDT/Piping

FRM-106A-HSE-0016-Rev.1
At-Risk Observations Eyes on Task/Hand Personal Floating Device Hot Work Ascending-Descending
Body Position PPE Tools & Equipment Confined Space Entry Ventilation
PPE Head Selection & Use Communication Industrial Hygiene
Tools/Equipment Eye/Face Condition Barricade and Sign Lighting / Illumination
Work Condition Respiratory Protection Guard Permit to Work Emergency Procedure
Others Hearing Protection Restraint Device Others [At-Risk] Others
Body Positioning Hand Protection Work Condition Manual Handling
Line of Fire (Risk of Impact) Body Protection Housekeeping/Material Storage Pre-Use Inspection/Pre-Start Work Preparation
Pinch Point Foot Protection Walk/Work Surface Waste Management
Eyes on Path Fall Protection Energy Isolation X Smoking

Note: Silahkan di Checklist item yang di observasi.

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