HSOR - Weekly Safety Performance

Week 25, 2024

 Scene Management Incident Investigation Corrective Action Effectiveness
Management Checks & Closeout
Immediately not exceeding 4 Within 12 Hours Within 24 Hours Within 30 Days Post 30 Days
hours
N1 – Fatality or Life Changed
Event Occurs P1 – Significant releases, fires, explosions, structural failures, dam failures, community evacuations, etc.
N5,P3,MA3, MA1 – Significant impacts to natural environment (long term effects, regional impact, fines or business interruption)
H3,C3 N2 – Recordable injury with high potential severity
Serious Injuries - Life Threatening Injuries requiring immediate life-preserving action, OR Life Changing Injuries, i.e.,
amputations
N3 –High potential severity with no Injury
N1, N2,H1, P1, MA1, C1 Doubt? C1 – Community incident with actual severity critical dan very critical
Serious Injuries N3,N4,P2,MA2, Yes Sensitive Event – Event that can be affecting company reputation or personal reputation
H2,C2
Sensitive Event Area related Conduct Share
Yes publish on Internal Investigation
incident Investigation Report to All
management** and deploy PTVI Area
Event Owner action Plan Close Event in
Initiates Consult with the
Safety Reps for SAP-IM
Notification via
Phone classification before
publish to Incident
Management Group
Appoint
Investigation Lead
(MIC) Investigation Drafted
(if >30 days Assign Individual
Mgr Safety
Safety approval is Actions & Update
Mgr Key statements assigns Action
Coordinator required from COO in SAP-IM with
HSER and scene data Coordinator
Comms Wide Formal approved actions
gathered
Mgr. Safety Communication
Initial event
information only*
Investigation Actions Review
Review Meeting Meeting (Lead Monitor
(Lead Investigator, Actions
Investigator,
Mgr Safety, Area (EHS Coord &
COO, PTVI Snr
Leadership Area)
Leadership)

Applicability Analysis
Area Leader

PTVI Sr Base Metals Event Owner

COO Registers in SAP- Process to another
Leadership HSE Post Action
IM including department Implementatio
Immediate n
Actions Effectiveness
Comms Wide
Formal Checks
Level 1 Events
Communication
Key learnings &
wide actions
Webcast
(N1 only) Note: If classification of event changes at any point, a review
Vale & Mind ID

meeting must be held with Safety System prior to updating in SAP-IM

BM Safety Snr
CEO
Leadership
BOD PTVI * ONLY Category N1, P1, MA1, C1, Serious Injury
** Information that published on Incident management:
Mind ID Safety Senior
Photo (if any), General information (What – general,
Leadership
when, who involved) – Please coordinate with your
safety coordinator before blast on
INCIDENT MANAGEMENT REPORTING THRU WHATSAPP
Objectives:
Menginformasikan kejadian incident dan accident (Personal, nearmiss, material, environmental, community) untuk meningkatkan awareness dan bukan untuk mencari root
cause/penyebab kejadian.
How:
- Laporkan setiap incident yang terjadi di area kerja masing-masing
- Laporan yang diberikan adalah general informasi (mandatory) sehingga tdk menimbulkan multitafsir.
- Jika ada keraguan dalam menentukan status atau mendeskripsikan mengenai kejadian, silakan dikomunikasikan ke safety coordinator area masing-masing
- Setelah dilaprokan lewat Whatsapp, maka owner incident berkewajiban untuk mendapatkan detail informasi dan membuatkan pelaporan incident secara tertulis melalui PPT
dan register di system (SAP)

Preliminary Incident Report

Photo : <Gambar Foto dari incident scene yang bersifat General yang bisa mendeskripsikan kejadian, tidak diperlukan menampilkan foto korban atau foto yang bersifat sensitive>
Event : <Apa incident/deviasi yang terjadi>
Date/Time : <Jam dan tanggal kejadian>
Location : <Tempat/lokasi kejadian>

Description:<Berisi informasi mengenai kejadian yang dilaporkan, jika masih ragu mengenai sequence atau detail kejadian, bisa hanya menginformasikan secara umum, Memberikan
informasi apakah ada korban/kerusakan yang diakibatkan oleh kejadian tersebut>

Misal: Salah satu unit LV xxxx terperosok di jalan (1), tidak ada korban dan kerusakan dari kejadian ini (2) untuk detail kejadian masih didalami dan akan diinformasikan kemudian (3)

1,2 – Mandatory untuk disampaikan

3 – Jika ada informasi lebih detail akan lebih baik, tetapi jika informasi belum clear maka silakan memberikan gambaran umum terkait kejadian

Immediate Action:<Berisi Langkah-langkah langsung yang dilakukan>:

Misal, <bisa action yang berbeda yang dilakukan langsung setelah kejadian>
➢ Melakukan Drug test/alcohol test
➢ Melakukan evakuasi terhadap unit
➢ Mengumpulkan data-data lapangan
➢ Dll action langsung yang dilakukan.

Fordetailinformationpleasecallyourrespectivesafetycoordinators 3
HSOR - Weekly Safety Performance
Safety Share
 Action Plan Status All incident 2024
In Process,
24, 10%
(All)

192

Action Control Category

28 15 7

Administrative Engineering Controls Substitution Elimination

Contros
Closed, 223, 90%

Severity Potential -
Severity Potential - Critical Severity Potential - Moderate Severity Potential - Low
Significant
 Action Plan Status All Incident (Department) 2024
Supply Chain Environment &
Mines Process Plant People & Culture
Management Permit

EXPLORATION
Energy and Logistic HSOR OPG EPC GEOSCIENCE & STUDY
Health Safety & Operational Risk (HSOR) Dept.
DATE : May 24th, 2024
SUBJECT : HSE Update Week 25 (end week Jun 21st, 2024)

0224 0893
Current LWC Free Current RWC Free
Last LWC : Last RWC :
• Truss #4 conveyor 215 dropped down around 30 cm and hit the • One of contractor’s employee got open wound in the right feet
employee on the right hand, March 18th, 2023 during dismantle the access platform at furnace area to the east
• An employee fallen when hung both on wood block of the canopy (skimming area), Dec 30th, 2021
and his right knee was dislocated, May 30th , 2023
• A mechanic was fell down from the work platform when he
stepped backwards, Sept 14th, 2023
• An employee of PT. GAH, when walked along the side of the road,
her left foot felt into the hole

Note: refers to incidents in controlled activities (uncontrolled are excluded).

 OPSE in 2024 YTD

1
1

3
1

36 1 2

OPSE Category Type Total

Related to dangerous energy release 14 9 23
(Demand on Safety System) (Flame/Fire/Explosion)
Related to dangerous material release 10 (+1) 3 3 (+1) 1
(Combustible (Hot Calcine) (Molten Metal) (Slope Failure) 17 (+2)
Liquid)
Week 25 Incidents
Suspected
Date Title of incident OPSE Rel MUE HiPo
Control Failure
6/18/2024 Kiln 5 HSD Leak P3 - - TBD

6/20/2024 Matte Spill due to Broken HMC3 P1 310-17 - TBD

3 1

HiPo: Event that could have resulted in a life changed or in one or multiple
21 16 1 fatalities, given a slight change in time, position or performance of controls
(+1) (+1) OPSE: Event caused by failures in controls in process, which could generate
unplanned/uncontrolled release of dangerous material/energy
Related to MUE: Event/initiating event which has the potential to (i) result
in multiple fatalities or (ii) extensive and irreversible environmental impact
off-site or loss of operating license
 Events related to MUE
Explosive
Quary PROCESS PLANT AREA Total Events

Explosion Material
Storage Coal System
8
10
MINING AREA 1 (+1)

Kiln
Dry Ore Stock Pile
Wet Ore Stock Pile Dryer
Disposal Ore Screening
Mining Station
1 (+1)
Hydro Generator - Turbine
3 2
Converter Furnace

Tank Farm Plant Site +

Gasoline tank

Thermal Generator - Boiler 1

Transport Bus
Pomalaa Camp

Tank Farm Mangkasa Point

1 Logistic
Port
Oil Tanker
48 KM Fuel Pipeline
Off-road personal
transport
(week 24)
 (week 25)

(-2) (-2)

(+2) (+2)
Top 10 Critical Risk CCV (week 24)
Position Risk Critical Control
1 (1) Vehicle Collision or Rollover - CAR 02 & 03 Road Design and Maintenance (85)
(598)
2 (2) Vehicle Impact on Person - CAR 02 & 03 Vehicle Preoperational Inspection (134)
(526)
3 (3) Fall from Height - CAR 01 (330) Fall Protection System (90)
4 (5) Contact with Electricity - CAR 10 (255) Electrical Isolation and Lockout (58)
5 (6) Falling Objects - CAR 01 (250) Barriers and Segregation (61)

6 (4) Uncontrolled Release of Energy - CAR 04 Isolation and Lockout (81)

(233)
7 (9) Lifting Operations - CAR 05 (179) Barriers and Segregation (49)
8 (NEW) Confined Space - CAR 06 (129) Isolation and Lockout (30)
9 (8) Slope Failure - CAR 08 (108) Geotechnical Inspection, Rock Fall
Management (31)
10 (10) Surface Fire and Explosion (81) Execution of Hot Work (19)

*numbers in bracket are position last week

Top 10 Critical Risk CCV (week 25)
Position Risk Critical Control
1 (2) Vehicle Impact on Person - CAR 02 & 03 Vehicle Preoperational Inspection (122)
(491)
2 (1) Vehicle Collision or Rollover - CAR 02 & 03 Road Design and Maintenance (71)
(429)
3 (5) Falling Objects - CAR 01 (240) Barriers and Segregation (59)
4 (3) Fall from Height - CAR 01 (225) Fall Protection System (53)
5 (6) Uncontrolled Release of Energy - CAR 04 Isolation and Lockout (77)
(210)
6 (4) Contact with Electricity - CAR 10 (170) Electrical Isolation and Lockout (42)
7 (7) Lifting Operations - CAR 05 (122) Mechanical Integrity of Lifting Equipment
(38)
8 (NEW) Contact with Molten Metal (CAR 11) (90) Molten Material Exposure Protection (19)
9 (8) Confined Space - CAR 06 (61) Entry Permit Execution (17)
10 (9) Slope Failure - CAR 08 (59) Excavation Design and Execution (17)

*numbers in bracket are position last week

OPSE Distribution (2024 YTD) P2 P3

Explosion Material
Quary Explosive Storage

0 5
Coal System 1 7
(+1)
MINING AREA 1 0
Kiln
Dry Ore Stock Pile
Wet Ore Stock Pile Dryer
Disposal Ore Screening
Station
0 14
Mining

0 0 Hydro Power Plant 1 1 5

Converter Furnace
(+1)

0 2

Tank Farm Plant Site +

0 1 Gasoline tank

Thermal Generator - Boiler

0 1
Tank Farm Mangkasa Point

Total OPSE 2024 YTD Logistic

Port

1 3 35 Oil Tanker
48 KM Fuel Pipeline

0 1
 (Overdue
LIF Achievement and Quality Action)
MTD June 2024

Average of JuneLIF% Average of Finding JuneLIF%

0% 20% 40% 60% 80% 100% 120% 0% 20% 40% 60% 80% 100% 120%

D052-ENERGY & LOGISTICS 100% D007-EXECUTIVE 100%

D045-SUPPLY CHAIN MGMT. 99%
DD483-OPERATIONAL RISK & SUSTAIN 100%
DD331-HEALTH, SAFETY & OPS RISK 91%
D023-MINES 91% DD523-TOTAL REWARD MGMT & HR OPS 100%
DD487-OPERATION 90% DD303-IGP 90%
DD498-EXPLORATION GEOSCIENCE & STUDY 89%
D027-PROCESS PLANT 84% DD487-OPERATION 52%
DD312-OPERATIONAL PLANNING & GEOTECH 84% D052-ENERGY & LOGISTICS 48%
DD359-PROJECT POMALAA 81%
DD507-SECURITY SERVICES 75% DD312-OPERATIONAL PLANNING & GEOTECH 46%
DD343-ENG PLANNING & CAPITAL 75% DD331-HEALTH, SAFETY & OPS RISK 45%
D040-TECHNICAL 75%
DD308-MINE PROJ PLANNING & GEOLOGY DD308-MINE PROJ PLANNING & GEOLOGY 41%
73%
DD438-ENVIRONMENT & PERMIT MGMT 63% DD359-PROJECT POMALAA 38%
D012-PEOPLE & CULTURE 45%
DD311-PROJECT BAHODOPI 31%
DD311-PROJECT BAHODOPI 43%
DD515-DEPUTY HEAD MINE PROJECT 40% D023-MINES 29%
DD377-PROJECT CONTROL 35% D027-PROCESS PLANT 25%
D010-EXT. REL & CORP AFFAIRS 29%
DD303-IGP 21% DD498-EXPLORATION GEOSCIENCE & STUDY 25%
DD483-OPERATIONAL RISK & SUSTAIN 17%
DD519-PROCUREMENT PROJECT 9% 70.88% DD377-PROJECT CONTROL 24%
30.35%
D007-EXECUTIVE 4% DD343-ENG PLANNING & CAPITAL 22%
DD523-TOTAL REWARD MGMT & HR OPS 3% D040-TECHNICAL 21%
D009-FINANCE 0%
D047-FINANCE & CONTROL DD438-ENVIRONMENT & PERMIT MGMT 18%
0%
DD310-CORP AFFAIRS & GEN ADMIN 0% D012-PEOPLE & CULTURE 17%
DD332-LEGAL 0%
DD433-EXT. AFFAIR & COMMUNICATIONS
DD467-STRATEGIC PERMIT & GA
0%
37.29%
D045-SUPPLY CHAIN MGMT.
DD507-SECURITY SERVICES
17%
15.45%
0% 13%
DD490-BNSI CORPORATE AFFAIRS & GA 0% DD515-DEPUTY HEAD MINE PROJECT 13%
DD491-BNSI FINANCE 0%
DD500-IA, COMPLIANCE & WB 0% D010-EXT. REL & CORP AFFAIRS 0%
DD516-BUSINESS DEVELOPMENT 0% D047-FINANCE & CONTROL 0%
DD518-PEOPLE 0%
DD521-INTEGRATION JV 0% DD519-PROCUREMENT PROJECT 0%

Achievement is counted personally

 (Overdue
CCV Achievement and Quality MTDAction)
June 2024

Average of JuneCCV% Average of Finding JuneCCV%

0% 20% 40% 60% 80% 100% 120% 0% 20% 40% 60% 80% 100% 120%
D052-ENERGY & LOGISTICS 100%
D045-SUPPLY CHAIN MGMT. D007-EXECUTIVE 100%
99%
DD343-ENG PLANNING & CAPITAL 91% DD523-TOTAL REWARD MGMT & HR OPS 100%
D023-MINES 90%
DD487-OPERATION 89% DD303-IGP 86%
DD331-HEALTH, SAFETY & OPS RISK 88% DD515-DEPUTY HEAD MINE PROJECT 70%
DD498-EXPLORATION GEOSCIENCE & STUDY 86%
DD312-OPERATIONAL PLANNING & GEOTECH 80% DD359-PROJECT POMALAA 63%
DD359-PROJECT POMALAA 80% DD487-OPERATION 63%
D027-PROCESS PLANT 79%
DD507-SECURITY SERVICES 71% DD308-MINE PROJ PLANNING & GEOLOGY 58%
D040-TECHNICAL 65%
DD377-PROJECT CONTROL 56%
DD438-ENVIRONMENT & PERMIT MGMT 62%
DD308-MINE PROJ PLANNING & GEOLOGY 61% DD312-OPERATIONAL PLANNING &… 54%
DD377-PROJECT CONTROL 55%
DD311-PROJECT BAHODOPI
DD331-HEALTH, SAFETY & OPS RISK 53%
42%
DD515-DEPUTY HEAD MINE PROJECT 38% D052-ENERGY & LOGISTICS 53%
D012-PEOPLE & CULTURE 34%
DD303-IGP 33% DD311-PROJECT BAHODOPI 48%
D010-EXT. REL & CORP AFFAIRS 32% DD498-EXPLORATION GEOSCIENCE &… 47%
DD519-PROCUREMENT PROJECT 8%
D007-EXECUTIVE 5% D023-MINES 46%
DD523-TOTAL REWARD MGMT & HR OPS 5% D040-TECHNICAL 35%
D009-FINANCE
D047-FINANCE & CONTROL
0% 73.47% D045-SUPPLY CHAIN MGMT. 32%
37.77%
0%
DD310-CORP AFFAIRS & GEN ADMIN 0% DD343-ENG PLANNING & CAPITAL 30%
DD332-LEGAL 0%
DD433-EXT. AFFAIR & COMMUNICATIONS 0% D012-PEOPLE & CULTURE 26%
DD467-STRATEGIC PERMIT & GA 0%
DD507-SECURITY SERVICES 26%
DD483-OPERATIONAL RISK & SUSTAIN 0%
DD490-BNSI CORPORATE AFFAIRS & GA
DD491-BNSI FINANCE
0%
0% 30.59% DD438-ENVIRONMENT & PERMIT MGMT 24% 12.14%
DD500-IA, COMPLIANCE & WB D027-PROCESS PLANT 15%
0%
DD516-BUSINESS DEVELOPMENT 0% D010-EXT. REL & CORP AFFAIRS 5%
DD518-PEOPLE 0%
DD521-INTEGRATION JV 0% DD519-PROCUREMENT PROJECT 0%

Achievement is counted personally

 (Overdue Action)
Update Week #25

CRM 2023_Overdue Action CRM 2024_Overdue Action

0 5 10 15 20 25 30 35 40 45 0 10 20 30 40 50 60

39 D023-MINES 53
D012-PEOPLE & CULTURE 51
39
D052-ENERGY & LOGISTICS 42
D052-ENERGY & LOGISTICS 31 42
31 39
DD343-ENG PLANNING & CAPITAL 41
DD498-EXPLORATION GEOSCIENCE & STUDY 9
9 D012-PEOPLE & CULTURE 28
28
D010-EXT. REL & CORP AFFAIRS 5 13
5 D045-SUPPLY CHAIN MGMT. 13
4 DD498-EXPLORATION GEOSCIENCE & STUDY 9
D027-PROCESS PLANT 9
4
DD331-HEALTH, SAFETY & OPS RISK 6
D045-SUPPLY CHAIN MGMT. 4 7
4 6
DD303-IGP 6
3
DD310-CORP AFFAIRS & GEN ADMIN
3 105 Action DD507-SECURITY SERVICES 4
4
220 Action
DD303-IGP 2 3
2 D027-PROCESS PLANT 3
2 DD438-ENVIRONMENT & PERMIT MGMT 3
DD311-PROJECT BAHODOPI 3
2
D040-TECHNICAL 2
DD507-SECURITY SERVICES 2 2
2 104 Action 3

DD523-TOTAL REWARD MGMT & HR OPS 2

DD312-OPERATIONAL PLANNING &… 2 214 Action
2 DD487-OPERATION 2
2
D040-TECHNICAL 1 1
1 D010-EXT. REL & CORP AFFAIRS 1

W24 W25 W24 W25

List akan dikirimkan ke Safety Improvement Area untuk dilakukan monitoring Follow-Up
Personal Injury Pyramid
Fatalities and Life Changed (N1)

Lost Time, Restricted Work and Medical Lost Time, Restricted Work and Medical
Treatment cases resulting from non high Treatment cases resulting from high potential
potential events (N4) events (N2)

Tier 3
First Aid cases and other non high First Aid cases and other potential
potential events (N5) events (N3)
Environment Event Pyramid

MA1 : Actual severity critical and very critical

MA4 : Actual serious with potential MA2 : Actual serious with potential
serious critical or very critical

Tier 3 MA3 : Actual moderate (or lower)

MA5 : Actual moderate (or lower)
with potential critical or very
with potential serious (or lower)
critical
Community Event Pyramid
C4 : Actual severity severe or moderate
with potential severity severe or
moderate
C5 : Actual severity no
consequence, very low or low with
potential severity very low, low,
moderate or severe
C1 : Actual severity critical and very critical
C2 : Actual severity severe or moderate
with potential severity critical or very
critical
Tier 3 C3 : Actual severity no
consequence, very low or low with
potential severity critical or very
critical
HSOR - Weekly Safety Information
Week 25, 2024
WEEKLY INCIDENT REPORT [WEEK 25]
PROCESS PLANT / Converter shift C / SUPV : Hamsin Tuncu

TYPE OF INCIDENT: PERSONAL INCIDENT ENVIRONMENTAL INCIDENT X MATERIAL / VEHICLE INCIDENT NEAR MISS ILLNESS NWR

CATEGORY: N1 N2 N3 N4 X N5 X P1 P2 P3 P4
CATEGORY: N1 N2 N3 N4 X N5 P1 P2 P3 P4
MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5

SAP-IM NUMBER: 20180960

DATE: Jun 20th, 2024, TIME: 05:24 AM
LOCATION: M.Aisle (Skiming Converer#4)
CLASSIFICATION OF ACTIVITY: Controlled
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS : RAC 11 – Molten Material
COMPANY INVOLVED: PTVI
DESCRIPTION / DESKRIPSI: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE
During the matte transfer process from Cv#3 to CV#4, during the process of pouring
the filled ladle into Cv#4, the Main Hoist HMC#3 sags and causes the north hock to ACTUAL No consequence No consequence Low
come off and the transfer matte to spill to the front of Cv#4.
Saat proses transfer matte dari Cv#3 ke Cv#4, saat penuangan ladle berisi ke Cv#4, POTENTIAL Moderate No consequence Low
main hoist HMC#3 melorot dan menyebabkan hook utara lepas dan matte transfer
No. Action Plan When Who Status
tumpah ke depan CV#4
Melakukan pengechekan kondisi break
1 Week 26 Jufri Emar kalalo In progress
POSSIBLE DIRECT CAUSE / KEMUNGKINAN PENYEBAB LANGSUNG: Main Hoist HMC#3
Main Hoist HMC#3 Sags / Main Hoist HMC#3 Melorot
Melaporkan segera ke safety HSOR jika
2 Week 26 Hamsin Done
ada kejadian tidak standar
IMMEDIATE ACTION / TINDAK LANJUT SEGERA:
• Secure the ladle that is still raised and park the HMC3./ Secure ladle yang masih No Lesson Learned
terangkat dan parkir HMC3
• Check and repaire main bale/ Check dan repair main bale 1, Buatkan schedule penggantian trustor HMC terutama trustor main joist dan aux hoist
• Internal investigation./ Investigasi internal
WEEKLY INCIDENT REPORT [WEEK 25]
PP / ORE PREPARATION / SUPERVISOR : ASWAT

TYPE OF INCIDENT: PERSONAL INCIDENT X ENVIRONMENTAL INCIDENT X MATERIAL / VEHICLE INCIDENT NEAR MISS ILLNESS NWR

CATEGORY: N1 N2 N3 N4 X N5 P1 P2 X P3 P4

MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5

SAP-IM NUMBER: # 20142427

DATE: June 18, 2024, TIME: 10.20 AM
LOCATION: HSD Supply Pipe to CM and Dryer # 3
CLASSIFICATION OF ACTIVITY: Not Controlled
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS : Not applicable
COMPANY INVOLVED: PTVI
DETAILED DESCRIPTION: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE
At around 10:20 it was found that the HSD pipe south of Kiln # 5 which leads to the
CM HSD tank and Dryer # 3 was leaking, no HSD had yet spilled onto the ground ACTUAL No consequence No consequence Low
because the HSD was still seeping into the pipe and structure / Sekitar jam 10:20 POTENTIAL No consequence Low Low
ditemukan pipa HSD di Selatan Kiln # 5 yang mengarah ke CM HSD tank dan Dryer #3
bocor, belum ada HSD yang tumpah ke atas tanah karena HSD masih merembes di No. Action Plan After Investigation When Who Status
pipa dan structure
Membuat Notifikasi Plan penggantian
IMMEDIATE CAUSE ANALYSIS 1 Week 25 I Wayan Sarjana Done
pipa HSD
Kebocoran disebabkan karena pipa HSD yang sudah keropos / The leak was caused
by the HSD pipe being porous No. Lesson Learnt

IMMEDIATE ACTION: Inspeksi rutin kondisi pipa yang dialiri bahan bakar atau mudah terbakar / Routine inspection
1
• Menutup valve supply HSD / Close the HSD supply valve of fuel or flammable pipes
• Menghubungi tim maintenance untuk pemasangan scaffolding dan perbaikan pipa
/ Contacting the maintenance team for scaffolding installation and pipe repairs
• Membuat laporan di IRIS / Make an IRIS report
WEEKLY INCIDENT REPORT [WEEK 25]
MINES / MP SOR / SUPV : SAHARUDDIN

TYPE OF INCIDENT: PERSONAL INCIDENT ENVIRONMENTAL INCIDENT X MATERIAL ACCIDENT NEAR MISS ILLNESS FIRE INCIDENT

CATEGORY: N1 N2 N3 N4 X N5 P1 P2 P3 P4
X
MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5

SAP-IM NUMBER: 20135955

DATE: June 15th, 2024, TIME: 06.50 AM
LOCATION: PTVI_SOR_MIN_FACE_Lembo East Hill
CLASSIFICATION OF ACTIVITY: Controlled
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS : RAC 03 - Mobile Equipment Operation
COMPANY INVOLVED : PTVI
DETAILED DESCRIPTION: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE
When the operator checked the unit at the start of the shift, it was found that the hose
accumulator Adapter on the HE 5012 under carriage was damaged./ Ketika operator ACTUAL No consequence No consequence Low
memeriksa unit di awal shift, ditemukan bahwa hose accumulator adapter pada HE POTENTIAL Low No consequence Low
5012 di bawah carriage rusak.
No. Action Plan After Investigation When Who Status
IMMEDIATE CAUSE ANALYSIS:
Hose exposed to material when traveling out of loading point./ Selang terpapar 1. Create IRIS report W25 Enos Done
material saat keluar dari loading point. 2. Conduct INS003 to Operator W25 Sadaruddin Done
IMMEDIATE ACTION: No. Lesson Learnt
• Park the unit in a safe place / Memarkir unit ditempat aman
• Report to the PTVI Supervisor to contact the Mechanic / Melapor ke Pengawas PTVI 1
untuk menghubungi Mekanik
• Hold SIMPER Operator/ Menahan simper operator
• INS OO3
• Report to IRIS / Report Ke IRIS
WEEKLY INCIDENT REPORT [WEEK 25]
MINES / MINE PRODUCTION PETEA / SUPV. Antonius Mangando

TYPE OF INCIDENT: PERSONAL INCIDENT ENVIRONMENTAL INCIDENT X MATERIAL / VEHICLE INCIDENT NEAR MISS ILLNESS NWR

CATEGORY: N1 N2 N3 N4 X N5 P1 P2 P3 P4
CATEGORY: N1 N2 N3 N4 N5 P1 P2 P3 P4
MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5

SAP-IM NUMBER: 20174425

DATE: June 21st, 2024, TIME: 01.45 PM
LOCATION: Mahalona
CLASSIFICATION OF ACTIVITY: N/A
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS : RAC 03 - Mobile Equipment Operation
COMPANY INVOLVED: PTVI
DESCRIPTION / DESKRIPSI: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE
At 01.45 PM, When HE3007 was cleaning up and side casting OB material, there was
material that fell from bucket and splashed it to bottom glass of HE3007/ Pada saat HE3007 ACTUAL No consequence No consequence Low
sedang melakukan membersihkan ore dan membuang material, ada material yang jatuh
dari bucket dan terlempar mengenai kaca bawah HE3007. POTENTIAL Low No consequence Low
No Action Plan When Who Status
POSSIBLE DIRECT CAUSE / KEMUNGKINAN PENYEBAB LANGSUNG:
Splash material from its bucket/ Lemparan material dari bucket HE3007 1 Park HE3007 on safe place W-25 Antonius M Done

IMMEDIATE ACTION / TINDAK LANJUT SEGERA: 2 Report to maintenance W-25 Antonius M Done
• Park HE3007 on safe place/ Parkir unit di tempat aman
• Report to maintenance/ Melaporkan ke Maintenance.. 3 Report to IRIS W-25 Antonius M Done
• Report to IRIS / Melaporkan ke IRIS. 4 Do INS003 and Disciplinary sanction W-25 Antonius M Done
• Do INS003 and Disciplinary sanction/ Melakukan INS003.
• Hold operator SIMPER and sent to Mine Training for re-assessment for a month/ Hold operator SIMPER and sent to Mine
5 W-25 Ebenheiser P In Progress
Menahan SIMPER dan melakukan assessment ulang dengan Mine Training selama satu Training for re-assessment for a month
bulan.
No Lesson Learned
WEEKLY INCIDENT REPORT [WEEK 25]
MINES / MP SOR / SUPV : EBENHEISER P

TYPE OF INCIDENT: PERSONAL INCIDENT ENVIRONMENTAL INCIDENT MATERIAL ACCIDENT X NEAR MISS ILLNESS FIRE INCIDENT

CATEGORY: N1 N2 N3 N4 X N5 P1 P2 P3 P4
CATEGORY: N1 N2 N3 N4 X N5 P1 P2 P3
MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5

SAP-IM NUMBER: TBA

DATE: Junr 18th, 2024, TIME: 09.30 AM
LOCATION: PTVI_SOR_Harapan Office
CLASSIFICATION OF ACTIVITY: Controlled
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS :
COMPANY INVOLVED : PTVI
DETAILED DESCRIPTION: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE
At around 09:30, the tree behind the security post at the gate of hope fell. There
were no injuries in this incident
ACTUAL No consequence No consequence No consequence
Sekitar jam 09:30, pohon yang berada di belakang pos security gate harapan rebah. POTENTIAL Low No consequence Low
Tidak ada cidera pada kejadian ini
No. Action Plan After Investigation When Who Status
IMMEDIATE CAUSE ANALYSIS:
1. Create IRIS report W25 EBENHEISER In Progress
Rotten tree./ Batang pohon lapuk
2. Clear the area W25 EBENHEISER Done
IMMEDIATE ACTION:
• Call GFS team./ Panggil tim GFS
• Move the tree from the yard./ Pindahkan pohon dari halaman
• Report to IRIS./ Laporkan ke IRIS
WEEKLY INCIDENT REPORT [WEEK #25] Commuting Incident – Non-Occupational injury
(not included in the safety pyramid)
EE & LOGISTIC-THERMAL PLANT MAINTENANCE/ SUPV : Nashir Achmad
TYPE OF INCIDENT: X PERSONAL INCIDENT ENVIRONMENTAL INCIDENT MATERIAL / VEHICLE INCIDENT NEAR MISS ILLNESS NWR

CATEGORY: N1 N2 N3 N4 X N5 P1 P2 P3 P4
X
MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5
C5

SAP-ID NUMBER:
DATE: Juni 20th, 2024, TIME: 5:50 AM
LOCATION: Between Karebbe dan Wasuponda
CLASSIFICATION OF ACTIVITY: Un Controlled
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS : N/A
COMPANY INVOLVED: PT. Qirani Tridaya Karya
DETAIL DESCRIPTION/ DESKRIPSI KEJADIAN: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE
There was a single motorcycle accident at the Karebbe-Wasuponda border, the victim was
an employee of PT Qirani Tridaya Karya. The accident victim was wearing work clothes and ACTUAL No consequence No consequence Very Low
a brief explanation of going to work../ terjadi kecelakaan lalulintas Tunggal pemotor di
perbatasan karebbe-wasuponda, korban merupakah karyawan PT Qirani Tridaya Karya. POTENTIAL Moderate No consequence Low
Korban kecelakaan menggunakan baju kerja dan penjelasan singkat akan berangkat ke
tempat kerja No. Action Plan After Investigation When Who Status
PTVI/Qirani Tridaya
1 Conduct internal investigation Week 25 Open
POSSIBLE DIRECT CAUSE / KEMUNGKINAN PENYEBAB LANGSUNG: Karya
Vehicle brakes are not functioning properly. PTVI/Qirani
Rem kendaraan tidak berfungsi dengan baik 2 Conduct safety Standdown Week 25 Done
tridaya karya
IMMEDIATE ACTION / TINDAK LANJUT SEGERA: No. Me
1. brought the victim to Wasuponda Health Center, then referred to Wotu Hospital.2.
conduct safety standdown / segera membawa korban ke puskesmas Wotu, kemudian di Ensure that each employee is healthy and prepares time properly for work and uses the
rujuk ke rumah sakit wotu BUS to the workplace that has been prepared by the Company.. Meyakinkan setiap
1
2. Conduct safety standdown / melakukan safety standdown karyawan ssehat dan prepare waktu dengan baik untuk bekerja dan menggunakan BUS
ketempat kerja yang telah di siapkan oleh Perusahaan.
WEEKLY INCIDENT REPORT [WEEK 25]
MINES / MINE PRODUCTION PETEA / SUPV : Arifuddin TP.

TYPE OF INCIDENT: PERSONAL INCIDENT ENVIRONMENTAL INCIDENT MATERIAL / VEHICLE INCIDENT NEAR MISS X ILLNESS X NWR

CATEGORY: N1 N2 N3 N4 N5 P1 P2 P3 P4
CATEGORY: N1 N2 N3 N4 X N5 M1 M2 M3 M4 M5
MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5

SAP-IM NUMBER: TBA

DATE: Jun 17th , 2024, TIME: 5:25 PM
LOCATION: PTVI_PET_MIN
CLASSIFICATION OF ACTIVITY: Controlled
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS : Not applicable
COMPANY INVOLVED: PTVI
DESCRIPTION / DESKRIPSI: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE
At 05.25 PM, operator felt stomachache, then he got cold and headache. The
operator contacted the supervisor dan told his condition. Supervisor took him to ACTUAL Low No consequence No consequence
first aid, a few moments later the operator was brought to hospital for further POTENTIAL Low No consequence No consequence
observation. /
Seorang karyawan Vale merasakan sakit pada bagian perut, kemudian berlanjut No. Action Plan When Who Status
panas dingin dan sakit kepala. Karyawan yg sakit kemudian menghubungi
pengawas d lokasi dan menyampaikan kondisinya. Pengawas langsung mengantar 1 Took the operator to First aid W-25 Arifuddin TP Done
karyawan yg bersangkutan ke first aid Petea untuk dilakukan observasi oleh tim
medik, tidak lama kemudian langsung dibawa ke Rumah Sakit Sorowako
menggunakan ambulance. 2 Made preliminary report W-25 Antonius M. Done

POSSIBLE DIRECT CAUSE / PENYEBAB LANGSUNG: No Lesson Learned

Operator got stomachache and felt cold/ Demam
1
IMMEDIATE ACTION / TINDAK LANJUT SEGERA:
Took to First Aid./ Bawa ke First Aid.
WEEKLY INCIDENT REPORT [WEEK #25]
PP / RKCTS / REDUCTION KILN

TYPE OF INCIDENT: PERSONAL INCIDENT ENVIRONMENTAL INCIDENT MATERIAL / VEHICLE INCIDENT NEAR MISS X ILLNESS X NWR

CATEGORY: N1 N2 N3 N4 N5 P1 P2 P3 P4
CATEGORY: N1 N2 N3 N4 N5 M1 M2 M3 M4 M5
MA1 MA2 MA3 MA4 MA5 C1 C2 C3 C4 C5

SAP-IM NUMBER: 20169081

DATE: 20th June 2024, TIME: / 07:50 AM
LOCATION: Kiln1 Feed pipe area
CLASSIFICATION OF ACTIVITY: Controlled
WAS THERE IMPACT FOR THE COMMUNITY? No
ASSOCIATED RAC / MHS : N/A
COMPANY INVOLVED: PTVI

DESCRIPTION / DESKRIPSI: SEVERITY HEALTH & SAFETY ENVIRONMENT FINANCE

A Vale employee Abd Syukur (BN6247) is cleaning the chute feed pipe on the catwalk of
ACTUAL Low No consequence No consequence
Kiln#1. After finishing the work, the employee felt pain in the lower left side of his waist. The
employee walks to the kiln lunchroom and then he reported to the supervisor to contact the POTENTIAL Low No consequence No consequence
FES ambulance so they can come to pick up the employee and bring him to the clinic.
Seorang karyawan Vale Abd Syukur (BN6247) sedang bertugas membersihkan chute feed pipe
No. Action Plan When Who Status
di catwalk Kiln#1. Setelah selesai melakukan pekerjaan, karyawan tersebut merasakan sakit
pada pinggang bagian bawah kiri. Karyawan berjalan ke lunchroom kiln dan melapor ke
pengawas untuk menghubungi ambulance FES agar dapat datang menjemput karyawan 1 First Aid treatment W25 Plant Clinic Done
bersangkutan menuju klinik.

POSSIBLE DIRECT CAUSE / KEMUNGKINAN PENYEBAB LANGSUNG:

Waiting for Doctor diagnose / Masih menunggu hasil diagnosa dokter

IMMEDIATE ACTION / TINDAK LANJUT SEGERA:

- Contact FES to provide first aid / Menghubungi FES untuk memberikan pertolongan
pertama
- Bring the employee to First Aid - Plant Site Clinic / Membawa karyawan ke First Aid - Klinik
Plant Site
- Clinic Observation / Observasi di klinik
HSOR - Weekly Safety Information
Week 25, 2024
PHONE AND SMOKING DETECTION 2024

Total case: 60 3
Closed: 12 ENERGY & LOGISTIC 1 3

In Progress: 25 ENG. PLANING & CAPITAL 2 6

(Waiting investigation report & INS-003 from the area/company)
ENVIRO PERMIT MGMT 4 1
Wait Decision: 23
(Waiting Warning Letter from CMT/HR) EXPLORATION 1

IGP POMALAA 14 2
No L3 No Unit Company Pelanggaran Date Status Case
INFORMATION TECHNOLOGY 1
Phone 01-May- Closed
1 MINES MAINTENANCE LV2263 PTVI In Progress
Detection 24
MINE PROJECT POMALAA 2 In Progress
Phone 06-May-
2 ENVIRO PERMIT MGMT CT.11456 PT. Taruna Mandiri Utama In Progress Wait Decion
Detection 24
3 MINES MAINTENANCE CT.11132 PT. Mastratech
Phone 16-May-
In Progress
MINES MAINTENANCE 2 2
Detection 24
MINE PROJECT Smoking 03-Jun-
4 CT.70096 PT. Wahyu Anggi Selaras In Progress MINES OPERATION 6 6
POMALAA Detection 24
MINE PROJECT DT 8177 Phone 04-Jun-
5 PT. Satria Jaya Sentosa In Progress
POMALAA EB Detection 24 OPR. PLAN & GEOTECH 1
Smoking 04-Jun-
6 ENVIRO PERMIT MGMT CT.11623 PT. Kembar Cipta Raya In Progress
Detection 24
DD 8779 Phone 12-Jun- PEOPLE & CULTURE 1
7 ENERGY & LOGISTIC PT. Ale Luwu Raya In Progress
XX Detection 24
ENG. PLANING & Phone 15-Jun- PROCESS PLANT 4
8 CT.11664 PT. Tri Machmud Jaya In Progress
CAPITAL Detection 24
ENG. PLANING & Phone 22-Jun-
9 CT.11420 PT. Welani Jaya Sorowako In Progress
CAPITAL Detection 24 SUPPY CHAIN MGMT 1
PT. Indra Pratama Smoking 19-Jun-
10 ENVIRO PERMIT MGMT CT.10420 In Progress
Wasuponda Detection 24
DP 1374 PT. Indra Pratama Phone 18-Jun-
11 ENVIRO PERMIT MGMT In Progress
GN Wasuponda Detection 24
For detail information pleasecall your respective safetycoordinators 35
INS-003 STATUS 2024

ENERGY & LOGISTIC 8

Incident Action
No L3 Date Judul Insiden
ENG. PLAN CAPITAL 1 6 Number Status
ENVIRO & PERMIT MGMT 2
ENG. PLAN QAC_N5_Dump truck CT.6450 fell into a
1 20057658 5-Jun-24 in progress
EXPLORATION 2 CAPITAL ditch

HSOR 2 2 IGP BAHODOPI 19938663 22-May-24 VAC_N5_CT. 40198 hit safety berm in progress

IGP BAHODOPI 11 in progress ACM_N5_material fell from bucket and

3 MINES 20174425 21-Jun-24 in progress
Done splashed it to bottom glass of HE3007
MINES 2 21
ACM_N5_the hose accumulator adapter
OPERATIONAL PLAN & GEO 1 4 MINES 20135955 15-Jun-24 on the HE 5012 under carriage was in progress
damaged
PEOPLE & CULTURE 4

PROCESS PLANT 27

SECURITY SERVICE 3

SUPPLY CHAIN MGMT 2

Fordetailinformationpleasecallyourrespectivesafetycoordinators 37
SUMMARY OVER SPEED 2024

15
14 14
13
11 11
10 10 10 10 10 10

1 1 1 1 1 1 1 1 1 1 1 1
Count of Vehicle ID.

PT. VALE INDONESIA

PT. TRI MACHMUD JAYA
PT. ANEKA JASA

PT. ALE LUWU RAYA

PT. CAPRA KARYA

PT. PUTRA MAHALONA

PT. PUTRA MAHALONA

PT. CAPRA KARYA

PT. PANCARAN DARAT

PT. PANCARAN DARAT

PT. NUSA KONSTRUKSI

PT. NUSA KONSTRUKSI

Average of Defiasi Over Speed (Km/H)
SOROWAKO
TRANSPORT

TRANSPORT
ENJINERING

ENJINERING
Week05 Week06 Week07 Week11 Week12 Week16 Week20 Week21 Week22 Week23

Defiasi Over Speed

No Vehicle ID. Start Time Company Week Tahun Status Case
(Km/H)

2 DD 8386 UB (ALR) 16-Apr-24 PT. ALE LUWU RAYA 15 Week16 2024 In Progress

39