Number : E.DM.

HSE-FS021

Logo Perusahaan WEEKLY OHS INSPECTION FORM Date : februari, 1st 2023

Revision : 01

PT. ECOOILS JAYA INDONESIA ( DUMAI )

PERUSAHAAN :
AKTIVITAS PROJECT :
MONTH : YEAR :

Hazard Classification Documentation Status

No Date Findings Potential Hazard Location Action Plan PIC Regulation Close Date
(Open/Close)
L M H E Before After

Hazard Classification : Reported Date :

L Low Risk Resiko Kecil Reported By Known By,

M Medium Risk Resiko Menengah
H High Risk Resiko Besar
E Extream Risk Resiko Sangat Besar
*/ Based on Risk Matriks on Hazard Identicitaion and Risk Asessment
Nama Nama Dabrin Syahputra
HSSE PT…...... SPV / MANAGER PT…...... HSSE Executive PT. EcoOils