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PT xxxx yyyyyy zzzzzzzz FORM PENILAIAN RESIKO RISK ASSESSMENT

Working Unit Last Review Date Next Review Date Revision Status : : : :
Date : EHS Secretariat Division Head

Date :

1. Hazard Identification
No. Work Station/Process Description of Activity* Legal Aspect (Y/N)** Hazard ID No.*** Possible accident / ill health Person-at-risk

2. Risk Evaluation
Existing Risk Control Seve Likelih Risk rity ood Rating (S) (L) (SxL)

* : Please add remarks in the activity with (R) for routine, (NR) for non-routine, and (E) for emergency situation ** : If "Y", please add remarks with the number of legal, refer to OHS identification and evaluation of compliance (PLJ/EHS/006-FM-001) *** : Fill with working area code and number of hazard. Working area code for ID number refer to Table II. Process Owner Code System in SOP Control of Document page 11 Example : for IPA1, ID number will be 01-1, 01-02, 01-3, etc.

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