HSE.F-76 Rev.

00

INSPECTION RECORD
PT. China Comservice Indonesia

Page 1 of 5

Name of Inspector/Auditor :
Date : 24 May 2024
Gilang Tryadi
Location & Project Code :
422EG33E_LTE SIDEMPUAN BATANG JALA RELOC Company : PT China Comservice Indonesia

Company to be Inspected : Name of other persons participating:

PT.CCSI Zulfan Harahap& Muhammad Aldy Harahap

Note : All evidence/ Photo must have timestamp

Fill Remark with : If appropriate If Not Available If Found Any Violation/ NC

INSPECTED ITEMS REMARK COMMENT / EVIDANCE

Name of Work :
1. Use of Personal Protective Equipment ( PPE) OK

Photo 1. (Manpower using PPE)

2. Condition of Tools and PPE Tools and PPE being used :
OK a. Safety Helmet
b. Full Body Harness (double/ single lanyard)
c. Safety Shoes
d. Medical mask

Figure 2. (PPE and tools Photo)

 HSE.F-76 Rev.00

INSPECTION RECORD
PT. China Comservice Indonesia

Page 2 of 5

3. All team WAH License, FA, Electrical Certificate,

Driving Licence, STNK OK

Figure 3. Photo of certificate and licenses

4. Availability of Fire Extinguisher

OK

5. Condition of Fire Extinguisher

Expired date: 29/ 12/ 2024

(check once a month))

6. Hospitality: General Condition Onsite OK

 HSE.F-76 Rev.00

INSPECTION RECORD
PT. China Comservice Indonesia

Page 3 of 5

Figure 3. Photo of Clean Area Onsite

7. Availability of First Aid Kit

OK

Figure. Photo of First Aid Box Opened

8. Medicines Condition and Expired Date OK

9. Safety Line and Safety Banner

OK
 HSE.F-76 Rev.00

INSPECTION RECORD
PT. China Comservice Indonesia

Page 4 of 5

Figure 5. Photo of Safety Line and Safety Banner

10. Sanitary rooms: General condition

11. Sanitary rooms: Other

INSPECTED BY CHECKED BY APPROVED BY

( Gilang Tryadi ) ( ___________________ ) ( ___________________ )

QC/ Regional QHSE Officer QHSE Manager