Contoh Formulir Evaluasi Aspek Dapak Lingkungan

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Environmental Aspect and Impact Evaluation

Department : Production
Rev : 0
Tgl : 1 July 2010
Impact Criteria Score

Sensitivity
Extended
Recovery

Handling
Impact
Total Significan

Social
Level
Likely

Cost
N, Regulation :
Activity Aspect No. Aspect Impact Impact t Impact : Related Regulation
AB, E Available
Score Yes / No

Tumpahan A B C D E
Menimbang Raw Material prd-001 Raw
asap/ uap N Pencemaran Tanah Yes 3 1 1 1 1 7 YES PP no 18 Jo PP No 85 th 1999
Prd-002 material
Raw
Kemasan N Pencemaran udara Yes 10 1 1 1 1 14 YES MENAKER NO.01 MEN/1997
prd-003 material
Raw N Pencemaran Tanah Yes 10 5 1 1 1 18 YES PP no 18 Jo PP No 85 th 1999
prd-004 material
listrik N pemborosan SDA No 10 5 1 1 1 18 YES
DLL

Approved by Reviewed by Prepared by

Contoh Formulir Evaluasi Aspek Dapak Lingkungan

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Form No.GMCI.01.01