Rekap Daily Check Up MOR III

Lokasi DCU: Depot LPG Balongan

Tanggal Jam Tanggal Lahir NIK/No. KTP Nopek/No ID

No Nama PJP Jabatan/Jenis Pekerjaan Keluhan Nadi
DCU DCU Card
1 7/1/2019 06.30 Alif Akbar Satria N 4/17/1999
321215171499 0005754787 PERTAMINA Distribution Bottle (-) 84
2 7/1/2019 06.31 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 72
3 7/1/2019 06.32 Nevi Yandra PERTAMINA Spv Receiving & Storage (-) 82
4 7/1/2019 06.33 Aan Kharison 4/17/1979 93n113915 PT. PTC Security (-) 81
5 7/1/2019 06.34 Abdul Basit 7/10/1983 113908 PT. PTC Security (-) 79
6 7/1/2019 06.35 Afdilah 8/30/1981 27087 PT. Nurcahya Intan Teknik (-) 76
7 7/1/2019 06.36 Aryanto 5/4/1983
321214040583 0003
JR 027088 PT. Nurcahya Intan Teknik (-) 88
8 7/1/2019 06.37 Caskam PT. PTC Security (-) 88
9 7/1/2019 06.38 Deny Suryana 12/6/1980 752334 PERTAMINA SGA (-) 76
10 7/1/2019 06.39 Nevi Yandra PERTAMINA Spv Receiving & Storage (-) 80
11 7/1/2019 06.40 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-) 87
12 7/1/2019 06.41 Dicky Ortega 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 72
13 7/1/2019 06.42 Harry Ramadhan PT. Nurcahya Intan Adm. SGA (-) 78
14 7/1/2019 06.43 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-) 83
15 7/1/2019 06.44 Ismail PT. Nurcahya Intan HSE Operation Support (-) 78
16 7/1/2019 06.45 Kartisa PT.Alpha&Omega El Jireh Cleaning Services (-) 79
17 7/1/2019 06.46 M. Sulkhin PT. Alpha&Omega El Jireh Receiving&Storage (-) 75
18 7/1/2019 06.47 Kasdi 4/14/1984
32121414 0487 0001 PT. Nurcahya Intan Teknik (-) 84
19 7/1/2019 06.48 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-) 74
20 7/1/2019 06.49 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-) 82
21 7/1/2019 06.50 M. Solek PT. PTC Security (-) 71
22 7/1/2019 06.51 Rakhmanto 10/25/1979
321210251079 000127272 PT. Nurcahya Intan HSE (-) 78
23 7/1/2019 06.52 Khafid 8/3/1982 PT. Nurcahya Intan HSE (-) 78
24 7/1/2019 06.53 Khamir 10/10/1976
321214101076 0003 PT. Alpha & Omega El Jireh TKJP (-) 79
25 7/1/2019 06.54 sumarto 1/29/197332121529173 0001 PT. Alpha & Omega El Jireh Operator Loading (-) 83
26 7/1/2019 06.55 Supriyanto PT.Alpha&Omega El Jireh Handling 12 kg (-) 84
27 7/1/2019 06.56 Ahmad Taufik 8/17/1984 PT. Nurcahya Intan Gate Keeper (-) 71
28 7/1/2019 14.30 Hary Duwi S 9/25/1994
321214250994 0001
JE 036044 PT. Alpha & Omega El Jireh P2 (-) 75
29 7/1/2019 14.31 Toifudin 6/13/1984 93 11 38 96 PT. PTC Security (-) 75
30 7/1/2019 14.32 Sumarto 10/6/1984 JR 02768 PT. Nurcahya Intan HSE (-) 80
31 7/1/2019 14.33 M. Sulkhin PT. Alpha&Omega El Jireh Receiving&Storage (-) 72
32 7/1/2019 14.34 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-) 70
33 7/1/2019 14.35 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind (-) 79
34 7/1/2019 14.36 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan (-) 84
35 7/1/2019 14.37 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution(-) 92
36 7/1/2019 14.38 M. Thoriq R 750202 PERTAMINA Teknik (-) 78
37 7/1/2019 14.39 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG (-) 72
38 7/1/2019 14.40 Viki Dharma Alghozali PERTAMINA Tech. Maintenance (-) 82
39 7/1/2019 14.41 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading (-) 88
40 7/1/2019 14.42 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-) 71
41 7/1/2019 14.43 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS (-) 80
42 7/1/2019 14.44 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-) 80
43 7/1/2019 22.30 Wahyono PT.Nurcahya Intan HSE (-) 78
44 7/1/2019 22.31 Caskam PTC Security (-) 82
45 7/1/2019 22.32 Aan Kharison PTC Security (-) 80
46 7/1/2019 22.33 M.Solek PTC Security (-) 81

Total kunjungan Tanggal 01/07/2019 : 46 Orang

Total FIT : 46 Orang
Total UNFIT : 0 Orang
 Alcohol
Pernaf Kesadaran Reflek Tes Tes Tandem
TD Breath Kesimpulan
asan Cahaya Romberg Walking Tester
110/70 21 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 22 CM (-) (-) (-) (-) FIT
110/70 22 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
120/80 18 CM (-) (-) (-) (-) FIT
110/80 21 CM (-) (-) (-) (-) FIT
120/80 18 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/80 18 CM (-) (-) (-) (-) FIT
120/70 20 CM (-) (-) (-) (-) FIT
110/70 18 CM (-) (-) (-) (-) FIT
110/70 18 CM (-) (-) (-) (-) FIT
100/60 18 CM (-) (-) (-) (-) FIT
120/80 21 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
120/80 21 CM (-) (-) (-) (-) FIT
100/60 18 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
140/80 21 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
90/70 21 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
110/70 22 CM (-) (-) (-) (-) FIT
100/70 18 CM (-) (-) (-) (-) FIT
120/70 22 CM (-) (-) (-) (-) FIT
120/80 21 CM (-) (-) (-) (-) FIT
120/80 21 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
120/80 21 CM (-) (-) (-) (-) FIT
110/70 19 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
100/60 19 CM (-) (-) (-) (-) FIT
90/70 18 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
120/80 22 CM (-) (-) (-) (-) FIT
120/70 23 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/No Keluh

No Tanggal DCU DCU Nama PJP Jabatan/Jenis Pekerjaan
Lahir KTP ID Card an

1 7/2/2019 06.30 Alif Akbar Satria N 4/17/1999 321215171499 0005

754787 PERTAMINA Distribution Bottle (-)
2 7/2/2019 06.31 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-)
3 7/2/2019 Yaseer
06.32 Gary Rigel Hakim Khan PERTAMINA Adm Sales&General (-)
4 7/2/2019 06.33 Deny Suryana PERTAMINA Administrator Distribution Verification (-)
5 7/2/2019 06.34 Rakhmanto 10/25/1979
321210251079 0001
27272 PT. Nurcahya Intan HSE (-)
6 7/2/2019 06.35 Rudi Harno 1/29/1973
321215290173 0001 PT. Alpha & Omega El Jireh Operator Loading (-)
7 7/2/2019 06.36 Aryanto 5/4/1983
321214040583 0003
JR 027088 PT. Nurcahya Intan Teknik (-)
8 7/2/2019 06.37 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-)
9 7/2/2019 06.38 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-)
10 7/2/2019 06.39 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind (-)
11 7/2/2019 06.40 Rangga P 11/20/1975 PERTAMINA Spv HSSE (-)
12 7/2/2019 06.41 Runedi 7/17/1968 PT. Alpha & Omega El Jireh P2 (-)
13 7/2/2019 06.42 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-)
14 7/2/2019 06.43 Kasdi 4/14/1984
32121414 0487 0001 PT. Nurcahya Intan Teknik (-)
15 7/2/2019 06.44 Khamir 10/10/1976
321214101076 0003 PT. Alpha & Omega El Jireh TKJP (-)
16 7/2/2019 06.45 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan (-)
17 7/2/2019 06.46 sumarto 1/29/1973
32121529173 0001 PT. Alpha & Omega El Jireh Operator Loading (-)
18 7/2/2019 06.47 Supriyanto PT.Alpha&Omega El Jireh Handling 12 kg (-)
19 7/2/2019 06.48 Mustani PT.Alpha&Omega El Jireh Handling 12 kg (-)
20 7/2/2019 06.49 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-)
21 7/2/2019 06.50 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-)
22 7/2/2019 06.51 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-)
23 7/2/2019 06.52 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG (-)
24 7/2/2019 06.53 Warka'i 11/5/1981 28004 PT. Alpha & Omega El Jireh P2 (-)
25 7/2/2019 14.30 Aan Kharison 4/17/1979 93n113915 PT. PTC Security (-)
26 7/2/2019 14.31 Fery Eliswanto PT. Nurcahya Intan HSE Operation Support (-)
 27 7/2/2019 14.32 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-)
29 7/2/2019 14.33 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support (-)
30 7/2/2019 14.34 Toifudin 6/13/1984 93 11 38 96 PT. PTC Security (-)
31 7/2/2019 14.35 Hanikha Alamsyah 10/24/1997
321214241097 0001 (-)
32 7/2/2019 14.36 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2 (-)
33 7/2/2019 14.37 Abdul Basit 7/10/1983 113908 PT. PTC Security (-)
34 7/2/2019 22.30 Agus Santoso PTC Security (-)
35 7/2/2019 22.31 M.Solek PTC Security (-)
36 7/2/2019 22.32 Memet R.H PT.Nurcahya Intan HSE (-)

Total kunjungan Tanggal 02/07/2019 : 36 Orang

Total FIT : 36 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Reflek Tes
Nadi TD Pernafasan Kesadaran Cahaya Tandem Breath Kesimpulan
Romberg Walking Tester
84 110/70 21 CM (-) (-) (-) (-) FIT
72 120/80 20 CM (-) (-) (-) (-) FIT
82 110/70 19 CM (-) (-) (-) (-) FIT
74 120/80 20 CM (-) (-) (-) (-) FIT
74 100/60 20 CM (-) (-) (-) (-) FIT
84 120/80 26 CM (-) (-) (-) (-) FIT
88 120/80 19 CM (-) (-) (-) (-) FIT
87 110/80 20 CM (-) (-) (-) (-) FIT
80 130/80 20 CM (-) (-) (-) (-) FIT
79 110//70 21 CM (-) (-) (-) (-) FIT
85 90/60 20 CM (-) (-) (-) (-) FIT
84 120/80 20 CM (-) (-) (-) (-) FIT
83 100/60 20 CM (-) (-) (-) (-) FIT
84 110/70 21 CM (-) (-) (-) (-) FIT
79 110/60 21 CM (-) (-) (-) (-) FIT
84 110/80 21 CM (-) (-) (-) (-) FIT
83 110/70 20 CM (-) (-) (-) (-) FIT
84 130/80 20 CM (-) (-) (-) (-) FIT
71 90/70 21 CM (-) (-) (-) (-) FIT
71 100/60 19 CM (-) (-) (-) (-) FIT
70 120/80 20 CM (-) (-) (-) (-) FIT
70 120/70 22 CM (-) (-) (-) (-) FIT
72 100/70 19 CM (-) (-) (-) (-) FIT
99 100/70 20 CM (-) (-) (-) (-) FIT
81 130/80 20 CM (-) (-) (-) (-) FIT
70 110/70 20 CM (-) (-) (-) (-) FIT
71 120/80 20 CM (-) (-) (-) (-) FIT
62 120/80 20 CM (-) (-) (-) (-) FIT
73 120/80 20 CM (-) (-) (-) (-) FIT
64 100/60 22 CM (-) (-) (-) (-) FIT
80 110/70 22 CM (-) (-) (-) (-) FIT
79 120/80 22 CM (-) (-) (-) (-) FIT
80 120/90 20 CM (-) (-) (-) (-) FIT
82 110/80 18 CM (-) (-) (-) (-) FIT
78 110/70 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/N
No Tanggal DCU DCU Nama Tanggal Lahir NIK/No. KTP PJP Jabatan/Jenis Pekerjaan
o ID Card

1 7/3/2019 06.30 Sodikin PT. Alpha&Omega El Jireh Receiving&Storage

2 7/3/2019 06.31 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle
3 7/3/2019 06.32 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery
4 7/3/2019 06.33 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage
5 7/3/2019 06.34 Hanito Kusuma Harian PERTAMINA Spv Receiving, Storage & Distribution
6 7/3/2019 06.35 Rakhmanto 10/25/1979 321210251079 0001 JR 027272 PT. Nurcahya Intan HSE
7 7/3/2019 06.36 Rudi Harno 1/29/1973 321215290173 0001 PT. Alpha & Omega El Jireh Operator Loading
8 7/3/2019 06.37 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan Teknik
9 7/3/2019 06.38 Durma PT.Alpha&Omega El Jireh Cleaning Services
10 7/3/2019 06.39 Caskam PT. PTC Security
11 7/3/2019 06.40 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind
12 7/3/2019 06.41 Viki Dharma Alghozali PERTAMINA Tech. Maintenance
13 7/3/2019 06.42 Rangga P 11/20/1975 PERTAMINA Spv HSSE
14 7/3/2019 06.43 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver
15 7/3/2019 06.44 Syarifudin PT. Nurcahya Intan HSE Operation Support
16 7/3/2019 06.45 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS
17 7/3/2019 06.46 Khamir 10/10/1976 321214101076 0003 PT. Alpha & Omega El Jireh TKJP
18 7/3/2019 06.47 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan
19 7/3/2019 06.48 Zamroni 7/13/1989 PT. Prima Armada Raya Driver
20 7/3/2019 06.49 Waryudi PT.Alpha&Omega El Jireh Cleaning Services
21 7/3/2019 06.50 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS
22 7/3/2019 06.51 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic
23 7/3/2019 06.52 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services
24 7/3/2019 06.53 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind
25 7/3/2019 06.54 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
26 7/3/2019 06.55 Hanikha Alamsyah 10/24/1997 321214241097 0001
27 7/3/2019 06.56 Kasdi 4/14/1983 321214140483 0001 PT. Nurcahya Intan Teknik
28 7/3/2019 14.30 Abdul Cholik PT. Alpha&Omega El Jireh Operator Loading
29 7/3/2019 14.31 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2
30 7/3/2019 14.32 Hamdan Fauzi PT. Alpha&Omega El Jireh Operator Loading
31 7/3/2019 14.33 Khafid 8/3/1982 PT. Nurcahya Intan HSE
32 7/3/2019 14.34 Aan Kharison 4/17/1979 93n113915 PT. PTC Security
33 7/3/2019 14.35 Sumarto 10/6/1984 JR 02768 PT. Nurcahya Intan HSE
34 7/3/2019 14.36 Juandana PERTAMINA Spv Receiving & Storage
35 7/3/2019 22.30 Abdul Basit PTC Security
36 7/3/2019 22.31 Syarifudin PT.Nurcahya Intan HSE
37 7/3/2019 22.32 Syamsul Fuady PT.Nurcahya Intan HSE
38 7/3/2019 22.33 Warka'i Alpha O P2
39 7/3/2019 22.34 Tri Handoyo Organik P2

Total kunjungan Tanggal 03/07/2019 : 39 Orang

Total FIT : 39 Orang
Total UNFIT : 0 Orang
R III

Tes Alcohol
Reflek Tes
Keluhan Nadi TD Pernafasan Kesadaran Cahaya Tandem Breath Kesimpulan
Romberg Walking Tester
(-) 89 130/80 20 CM (-) (-) (-) (-) FIT
(-) 84 100/70 21 CM (-) (-) (-) (-) FIT
(-) 72 120/80 20 CM (-) (-) (-) (-) FIT
(-) 82 110/70 19 CM (-) (-) (-) (-) FIT
(-) 92 130/80 20 CM (-) (-) (-) (-) FIT
(-) 69 110/70 20 CM (-) (-) (-) (-) FIT
(-) 84 120/80 26 CM (-) (-) (-) (-) FIT
(-) 88 120/80 19 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 83 110/70 19 CM (-) (-) (-) (-) FIT
(-) 79 110//70 21 CM (-) (-) (-) (-) FIT
(-) 78 100/70 19 CM (-) (-) (-) (-) FIT
(-) 85 100/70 20 CM (-) (-) (-) (-) FIT
(-) 72 120/80 22 CM (-) (-) (-) (-) FIT
(-) 85 110/80 20 CM (-) (-) (-) (-) FIT
(-) 83 110/70 20 CM (-) (-) (-) (-) FIT
(-) 79 120/80 21 CM (-) (-) (-) (-) FIT
(-) 84 130/80 21 CM (-) (-) (-) (-) FIT
(-) 85 120/80 20 CM (-) (-) (-) (-) FIT
(-) 71 120/70 19 CM (-) (-) (-) (-) FIT
(-) 70 100/70 20 CM (-) (-) (-) (-) FIT
(-) 78 120/70 22 CM (-) (-) (-) (-) FIT
(-) 71 100/60 20 CM (-) (-) (-) (-) FIT
(-) 86 110/70 20 CM (-) (-) (-) (-) FIT
(-) 71 110/70 20 CM (-) (-) (-) (-) FIT
(-) 64 90/70 22 CM (-) (-) (-) (-) FIT
(-) 77 120/70 20 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 80 110/70 22 CM (-) (-) (-) (-) FIT
(-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 20 CM (-) (-) (-) (-) FIT
(-) 81 120/80 20 CM (-) (-) (-) (-) FIT
(-) 79 120/80 21 CM (-) (-) (-) (-) FIT
(-) 72 110/70 20 CM (-) (-) (-) (-) FIT
(-) 75 110/80 20 CM (-) (-) (-) (-) FIT
(-) 80 110/80 19 CM (-) (-) (-) (-) FIT
(-) 80 100/70 18 CM (-) (-) (-) (-) FIT
(-) 78 100/70 18 CM (-) (-) (-) (-) FIT
(-) 80 110/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal Nopek/N

No Tanggal DCU DCU Nama NIK/No. KTP PJP Jabatan/Jenis Pekerjaan
Lahir o ID Card

1 7/4/2019 06.30 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle
2 7/4/2019 06.31 Choliq Santoso 6/23/1976 JR 027275 PT. Nurcahya Intan Gate Keeper
3 7/4/2019 06.32 Harry R 4/4/1990 PT. Nurcahya Intan Adm
4 7/4/2019 06.33 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
5 7/4/2019 06.34 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh P1
6 7/4/2019 06.35 Rakhmanto 10/25/1979 321210251079 0001 JR 027272 PT. Nurcahya Intan HSE
7 7/4/2019 06.36 Mustahil PT.Alpha&Omega El Jireh Cleaning Services
8 7/4/2019 06.37 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan Teknik
9 7/4/2019 06.38 Durma PT.Alpha&Omega El Jireh Cleaning Services
10 7/4/2019 06.39 Caskam PT. PTC Security
11 7/4/2019 06.40 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver
12 7/4/2019 06.41 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS
13 7/4/2019 06.42 Deny Suryana PERTAMINA Administrator Distribution Verification
14 7/4/2019 06.43 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan
15 7/4/2019 06.44 Zamroni 7/13/1989 PT. Prima Armada Raya Driver
16 7/4/2019 06.45 Waryudi PT.Alpha&Omega El Jireh Cleaning Services
17 7/4/2019 06.46 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS
18 7/4/2019 06.47 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic
19 7/4/2019 06.48 Nevi Yandra PERTAMINA Spv Receiving & Storage
20 7/4/2019 06.49 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services
21 7/4/2019 06.50 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
22 7/4/2019 06.51 Hanikha Alamsyah 10/24/1997 321214241097 0001
23 7/4/2019 06.52 Kasdi 4/14/1983 321214140483 0001 PT. Nurcahya Intan Teknik
24 7/4/2019 06.53 Toifudin PT. PTC Security
25 7/4/2019 06.54 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support
26 7/4/2019 06.55 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG
27 7/4/2019 06.56 Syarifudin 2/15/1985 PT. Nurcahya Intan HSE
28 7/4/2019 14.30 Sumarto PT.Nurcahya Intan HSE
29 7/4/2019 14.31 Runedi PT. Alpha & Omega El Jireh P2
30 7/4/2019 14.32 Memet Rahmat Hidayat11/20/1975 JR 0270267 PT. Nurcahaya Intan HSE Operation Support
31 7/4/2019 14.33 Juandana 30/7/1982 744125 Organik P2
32 7/4/2019 14.34 Kadrawi
33 7/4/2019 22.30 Abdul Basit PTC Security
34 7/4/2019 22.31 Syarifudin PT.Nurcahya Intan HSE
35 7/4/2019 22.32 Syamsul Fuady PT.Nurcahya Intan HSE
36 7/4/2019 22.33 Warka'i Alpha O P2
37 7/4/2019 22.34 Tri Handoyo Organik P2

Total kunjungan Tanggal 04/07/2019 : 37 Orang

Total FIT : 37 Orang
Total UNFIT : 0 Orang
R III

Tes Alcohol Kesimpul

Reflek Tes
Keluhan Nadi TD Pernafasan Kesadaran Romberg Walking Breath
Tandem
Cahaya an
Tester
(-) 78 90/70 21 CM (-) (-) (-) (-) FIT
(-) 80 100/70 21 CM (-) (-) (-) (-) FIT
(-) 69 120/80 20 CM (-) (-) (-) (-) FIT
(-) 92 130/80 20 CM (-) (-) (-) (-) FIT
(-) 79 120/80 21 CM (-) (-) (-) (-) FIT
(-) 69 100/70 20 CM (-) (-) (-) (-) FIT
(-) 79 110/70 19 CM (-) (-) (-) (-) FIT
(-) 88 100/70 19 CM (-) (-) (-) (-) FIT
(-) 79 100/70 20 CM (-) (-) (-) (-) FIT
(-) 83 120/80 19 CM (-) (-) (-) (-) FIT
(-) 72 120/80 22 CM (-) (-) (-) (-) FIT
(-) 83 100/70 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 19 CM (-) (-) (-) (-) FIT
(-) 84 120/80 21 CM (-) (-) (-) (-) FIT
(-) 85 110/70 20 CM (-) (-) (-) (-) FIT
(-) 71 120/80 19 CM (-) (-) (-) (-) FIT
(-) 70 110/70 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 22 CM (-) (-) (-) (-) FIT
(-) 89 120/80 19 CM (-) (-) (-) (-) FIT
(-) 71 100/70 20 CM (-) (-) (-) (-) FIT
(-) 71 100/70 20 CM (-) (-) (-) (-) FIT
(-) 64 90/70 22 CM (-) (-) (-) (-) FIT
(-) 77 110/70 20 CM (-) (-) (-) (-) FIT
(-) 72 100/70 19 CM (-) (-) (-) (-) FIT
(-) 81 110/70 20 CM (-) (-) (-) (-) FIT
(-) 82 110/70 20 CM (-) (-) (-) (-) FIT
(-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 75 110/80 19 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 110/80 20 CM (-) (-) (-) (-) FIT
(-) 75 100/80 18 CM (-) (-) (-) (-) FIT
(-) 75 100/70 19 CM (-) (-) (-) (-) FIT
(-) 75 110/80 20 CM (-) (-) (-) (-) FIT
(-) 80 110/80 19 CM (-) (-) (-) (-) FIT
(-) 80 100/70 18 CM (-) (-) (-) (-) FIT
(-) 78 100/70 18 CM (-) (-) (-) (-) FIT
(-) 80 110/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/N

No Tanggal DCU DCU Nama PJP Jabatan/Jenis Pekerjaan Keluhan
Lahir KTP o ID Card

1 7/5/2019 06.30 Choliq Santoso 6/23/1976 JR 027275 PT. Nurcahya Intan Gate Keeper (-)
2 7/5/2019 06.31 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution (-)
3 7/5/2019 06.32 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh P1 (-)
4 7/5/2019 06.33 Rakhmanto 10/25/1979
321210251079 0001
JR 027272 PT. Nurcahya Intan HSE (-)
5 7/5/2019 06.34 Khafid PT. Nurcahya Intan HSE Operation Support (-)
6 7/5/2019 06.35 Aryanto 5/4/1983
321214040583 0003
JR 027088 PT. Nurcahya Intan Teknik (-)
7 7/5/2019 06.36 Durma PT.Alpha&Omega El Jireh Cleaning Services (-)
8 7/5/2019 06.37 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-)
9 7/5/2019 06.38 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-)
10 7/5/2019 Muhammad Thoriq Rusydian
06.39 Harian PERTAMINA Technician Engineering Planning (-)
11 7/5/2019 Yaseer Gary Rigel Hakim Khan
06.40 Harian PERTAMINA Adm Sales&General (-)
12 7/5/2019 06.41 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-)
13 7/5/2019 06.42 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-)
14 7/5/2019 06.43 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-)
15 7/5/2019 06.44 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-)
16 7/5/2019 06.45 Mustahil PT.Alpha&Omega El Jireh Cleaning Services (-)
17 7/5/2019 06.46 Nevi Yandra PERTAMINA Spv Receiving & Storage (-)
18 7/5/2019 06.47 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services (-)
19 7/5/2019 06.48 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-)
20 7/5/2019 06.49 Hanikha Alamsyah 10/24/1997 321214241097 0001 (-)
21 7/5/2019 06.50 Kasdi 4/14/1983
321214140483 0001 PT. Nurcahya Intan Teknik (-)
22 7/5/2019 06.51 Toifudin PT. PTC Security (-)
23 7/5/2019 06.52 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-)
24 7/5/2019 06.53 Rustamadji 8/15/1977 745012 PERTAMINA Ast. Environmental & Hygiene Ind (-)
25 7/5/2019 06.54 Rangga Pringga Yudha Harian PERTAMINA Supervisor HSSE (-)
26 7/5/2019 06.55 Ruswan PB 10/17/1990 730220 PERTAMINA Sales & General Adm (-)
27 7/5/2019 06.56 Sumarto 10/6/1984 JR 02768 PT. Nurcahya Intan HSE (-)
28 7/5/2019 14.30 M. Walid Noldi 5/18/1996
321214180596 0002
### PT. Alpha & Omega El Jireh P2 (-)
29 7/5/2019 14.31 Memet Rahmat Hidayat 11/20/1975 JR 0270267 PT. Nurcahaya Intan HSE Operation Support (-)
30 7/5/2019 14.32 Sumarto PT.Nurcahya Intan HSE (-)
31 7/5/2019 14.33 Dicky (-)
32 7/5/2019 14.34 Parjan (-)
33 7/5/2019 22.30 Hari Dwi.S Alpha O P2 (-)
34 7/5/2019 22.31 Syarifudin PT.Nurcahya Intan HSE (-)
35 7/5/2019 22.32 Syamsul Fuady PT.Nurcahya Intan HSE (-)
36 7/5/2019 22.33 Runedi Alpha O P2 (-)

Total kunjungan Tanggal 05/07/2019 : 36 Orang

Total FIT : 36 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Reflek Tes
Nadi TD Pernafasan Kesadaran Cahaya Romberg Walking Breath
Tandem Kesimpulan
Tester
80 100/70 21 CM (-) (-) (-) (-) FIT
92 120/80 20 CM (-) (-) (-) (-) FIT
79 110/80 21 CM (-) (-) (-) (-) FIT
69 100/70 20 CM (-) (-) (-) (-) FIT
89 120/80 19 CM (-) (-) (-) (-) FIT
88 110/80 19 CM (-) (-) (-) (-) FIT
79 110/80 20 CM (-) (-) (-) (-) FIT
72 120/80 22 CM (-) (-) (-) (-) FIT
83 120/80 20 CM (-) (-) (-) (-) FIT
91 130/80 20 CM (-) (-) (-) (-) FIT
78 100/70 19 CM (-) (-) (-) (-) FIT
85 110/80 20 CM (-) (-) (-) (-) FIT
71 110/70 19 CM (-) (-) (-) (-) FIT
70 120/80 20 CM (-) (-) (-) (-) FIT
78 110/80 22 CM (-) (-) (-) (-) FIT
86 110/70 20 CM (-) (-) (-) (-) FIT
89 110/80 19 CM (-) (-) (-) (-) FIT
71 100/70 20 CM (-) (-) (-) (-) FIT
71 110/70 20 CM (-) (-) (-) (-) FIT
64 100/70 22 CM (-) (-) (-) (-) FIT
77 120/80 20 CM (-) (-) (-) (-) FIT
72 100/70 19 CM (-) (-) (-) (-) FIT
87 90/70 20 CM (-) (-) (-) (-) FIT
84 120/80 20 CM (-) (-) (-) (-) FIT
78 110/70 20 CM (-) (-) (-) (-) FIT
71 110/70 20 CM (-) (-) (-) (-) FIT
79 120/80 21 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
76 110/80 20 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
75 100/70 19 CM (-) (-) (-) (-) FIT
80 130/80 20 CM (-) (-) (-) (-) FIT
78 110/80 19 CM (-) (-) (-) (-) FIT
72 120/80 20 CM (-) (-) (-) (-) FIT
80 90/70 18 CM (-) (-) (-) (-) FIT
80 120/80 18 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/No

No Tanggal DCU Nama PJP Jabatan/Jenis Pekerjaan
DCU Lahir KTP ID Card

1 7/6/2019 06.30 Syarifudin PT. Nurcahya Intan HSE Operation Support

2 7/6/2019 06.31 Tri Handoyo PERTAMINA Spv Receiving & Storage
3 7/6/2019 06.32 Viki Dharma Alghozali PERTAMINA Tech. Maintenance
4 7/6/2019 06.33 Abdul Basit 7/10/1983 12/17/1930 PT. PTC Security
5 7/6/2019 06.34 Abdul Cholik PT. Alpha&Omega El Jireh Operator Loading
6 7/6/2019 06.35 Ahmad Taufik PT. Nurcahya Intan Gate Keeper
7 7/6/2019 06.36 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support
8 7/6/2019 06.37 Dicky Ortega PT. Alpha&Omega El Jireh Operator Loading
9 7/6/2019 06.38 M. Walid Noldi PT. Alpha&Omega El Jireh Receiving&Storage
10 7/6/2019 06.39 Memet Rahmat Hidayat PT. Nurcahya Intan HSE Operation Support
11 7/6/2019 06.40 Nasion Tri Utomo PT. PTC Security
12 7/6/2019 06.41 Sodikin PT. Alpha&Omega El Jireh Receiving&Storage
13 7/6/2019 06.42 Brohim PT. Alpha&Omega El Jireh Receiving&Storage
14 7/6/2019 06.43 Sumarto PT. Nurcahya Intan HSE Operation Support
15 7/6/2019 06.44 Parjan PT. Alpha&Omega El Jireh Operator Loading
16 7/6/2019 06.45 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage
17 7/6/2019 06.46 Ismail 11/20/1969 HSE
18 7/6/2019 06.47 sumarto 1/29/1973
32121529173 0001 PT. Alpha & Omega El Jireh Operator Loading
19 7/6/2019 06.48 Denny Ryan P 8/6/1983 10/30/3959 PERTAMINA Administrator Dist. Verification
20 7/6/2019 06.49 Kasdi PT. Nurcahya Intan maintenece&Utilities
21 7/6/2019 06.50 Khafid PT. Nurcahya Intan HSE Operation Support
22 7/6/2019 06.51 Khamir PT.Alpha&Omega El Jireh Operator Loading
23 7/6/2019 06.52 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver
24 7/6/2019 06.53 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic
25 7/6/2019 14.30 Rustamadji 8/15/1977 745012 PERTAMINA Ast. Environmental & Hygiene Ind
26 7/6/2019 14.31 Toifudin PT. PTC Security
27 7/6/2019 14.32 Taka PT. Alpha&Omega El Jireh Operator Loading
28 7/6/2019 14.33 Wahidin PT. Alpha&Omega El Jireh Operator Loading
29 7/6/2019 14.34 Agus Santoso PT. PTC Security
30 7/6/2019 22.30 Syarifudin PT.Nurcahya Intan HSE
31 7/6/2019 22.31 Tri Handoyo Organik P2
32 7/6/2019 22.32 Abdul Basit PTC Security
33 7/6/2019 22.33 Hary Dwi.S Alpha O P2
34 7/6/2019 22.34 Sodikin Alpha O P2

Total kunjungan Tanggal 06/07/2019 : 34 Orang

Total FIT : 34 Orang
Total UNFIT : 0 Orang
R III

Tes Alcohol
Reflek Tes
Keluhan Nadi TD Pernafasan Kesadaran Romberg Walking Breath
Tandem Kesimpulan
Cahaya Tester
(-) 85 110/80 20 CM (-) (-) (-) (-) FIT
(-) 82 110/80 20 CM (-) (-) (-) (-) FIT
(-) 88 110/80 20 CM (-) (-) (-) (-) FIT
(-) 79 100/70 21 CM (-) (-) (-) (-) FIT
(-) 78 100/70 20 CM (-) (-) (-) (-) FIT
(-) 82 110/70 20 CM (-) (-) (-) (-) FIT
(-) 88 120/80 20 CM (-) (-) (-) (-) FIT
(-) 84 110/70 20 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 93 120/81 20 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 90/70 20 CM (-) (-) (-) (-) FIT
(-) 69 110/70 20 CM (-) (-) (-) (-) FIT
(-) 64 130/80 20 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 88 110/80 20 CM (-) (-) (-) (-) FIT
(-) 83 120/80 20 CM (-) (-) (-) (-) FIT
(-) 79 110/80 22 CM (-) (-) (-) (-) FIT
(-) 79 120/80 21 CM (-) (-) (-) (-) FIT
(-) 79 120/81 22 CM (-) (-) (-) (-) FIT
(-) 79 130/80 20 CM (-) (-) (-) (-) FIT
(-) 80 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 22 CM (-) (-) (-) (-) FIT
(-) 84 110/80 20 CM (-) (-) (-) (-) FIT
(-) 72 100/70 19 CM (-) (-) (-) (-) FIT
(-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 88 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 20 CM (-) (-) (-) (-) FIT
(-) 78 110/80 18 CM (-) (-) (-) (-) FIT
(-) 82 110/80 19 CM (-) (-) (-) (-) FIT
(-) 70 100/70 20 CM (-) (-) (-) (-) FIT
(-) 80 120/80 20 CM (-) (-) (-) (-) FIT
(-) 71 120/80 19 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/No

No Tanggal DCU DCU Nama PJP Jabatan/Jenis Pekerjaan Keluhan
Lahir KTP ID Card

1 7/7/2019 06.30 Khafid 8/3/1982 PT. Nurcahya Intan HSE (-)

2 7/7/2019 06.31 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification (-)
3 7/7/2019 06.32 Kasdi 4/14/1983
321214140483 0001 PT. Nurcahya Intan Teknik (-)
4 7/7/2019 06.33 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-)
5 7/7/2019 06.34 M. Walid N 5/18/1996
32121480596 0002
02 8003 PT. Alpha & Omega El Jireh P2 (-)
6 7/7/2019 06.35 Choliq Santoso 6/23/1976 JR 027275 PT. Nurcahya Intan Gate Keeper (-)
7 7/7/2019 06.36 Kadrawi PT.Alpha&Omega El Jireh Handling 12 kg (-)
8 7/7/2019 06.37 Dicky Ortega 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-)
9 7/7/2019 06.38 Rustamadji 10/9/3939 PERTAMINA Ast. Environmental & Hygiene Ind (-)
10 7/7/2019 06.39 Sumarto 10/6/1984 JR 02768 PT. Nurcahya Intan HSE (-)
11 7/7/2019 06.40 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2 (-)
12 7/7/2019 06.41 Aan Kharison 4/17/1979 93n113915 PT. PTC Security (-)
13 7/7/2019 06.42 Nasion Tri Utomo PT. PTC Security (-)
14 7/7/2019 14.30 Agus Santoso 8/21/1972 PT. PTC Security (-)
15 7/7/2019 14.31 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE (-)
16 7/7/2019 14.32 Ismail PT. Nurcahya Intan HSE (-)
17 7/7/2019 22.30 Syarifudin PT.Nurcahya Intan HSE (-)
18 7/7/2019 22.31 Nevi Yandra Organik P2 (-)
19 7/7/2019 22.32 Toifudin PTC Security (-)
20 7/7/2019 22.33 Hary Dwi.S Alpha O P2 (-)
21 7/7/2019 22.34 Khafid PT.Nurcahya Intan HSE (-)

Total kunjungan Tanggal 07/07/2019 : 21 Orang

Total FIT : 21 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Reflek Tes
Nadi TD Pernafasan Kesadaran Cahaya Romberg Walking Breath
Tandem Kesimpulan
Tester
78 120/80 20 CM (-) (-) (-) (-) FIT
76 100/70 20 CM (-) (-) (-) (-) FIT
77 120/70 20 CM (-) (-) (-) (-) FIT
78 120/70 22 CM (-) (-) (-) (-) FIT
84 110/70 20 CM (-) (-) (-) (-) FIT
80 100/70 21 CM (-) (-) (-) (-) FIT
82 120/80 20 CM (-) (-) (-) (-) FIT
72 110/80 20 CM (-) (-) (-) (-) FIT
79 110/70 20 CM (-) (-) (-) (-) FIT
79 110/80 21 CM (-) (-) (-) (-) FIT
80 110/70 21 CM (-) (-) (-) (-) FIT
88 130/80 20 CM (-) (-) (-) (-) FIT
84 100/70 20 CM (-) (-) (-) (-) FIT
88 110/80 20 CM (-) (-) (-) (-) FIT
80 110/70 21 CM (-) (-) (-) (-) FIT
89 100/70 22 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
80 120/80 22 CM (-) (-) (-) (-) FIT
82 110/80 22 CM (-) (-) (-) (-) FIT
85 120/80 22 CM (-) (-) (-) (-) FIT
80 100/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/N

No Tanggal DCU DCU Nama PJP Jabatan/Jenis Pekerjaan Kelu
han Nadi TD
Lahir KTP o ID Card

1 7/8/2019 06.30 Alif Akbar Satria N 4/17/1999

321215171499 0005
754787 PERTAMINA Distribution Bottle (-) 84 110/70
2 7/8/2019 06.31 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support (-) 77 120/80
3 7/8/2019 06.32 Aryanto 5/4/1983
321214040583 0003
JR 027088 PT. Nurcahya Intan Teknik (-) 88 120/80
4 7/8/2019 06.33 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-) 87 110/80
5 7/8/2019 06.34 M. Sulkhin PT. Alpha&Omega El Jireh Receiving&Storage (-) 75 110/70
6 7/8/2019 06.35 Kasdi 4/14/1984
32121414 0487 0001 PT. Nurcahya Intan Teknik (-) 84 110/70
7 7/8/2019 06.36 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-) 74 110/70
8 7/8/2019 06.37 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-) 82 110/70
9 7/8/2019 06.38 Rakhmanto 10/25/1979
321210251079 0001
27272 PT. Nurcahya Intan HSE (-) 78 120/80
10 7/8/2019 06.39 Khamir 10/10/1976
321214101076 0003 PT. Alpha & Omega El Jireh TKJP (-) 79 100/70
11 7/8/2019 06.40 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-) 70 100/70
12 7/8/2019 06.41 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan (-) 84 120/80
13 7/8/2019 06.42 M. Thoriq R 750202 PERTAMINA Teknik (-) 78 110/70
14 7/8/2019 06.43 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG (-) 72 110/70
15 7/8/2019 06.44 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading (-) 88 130/80
16 7/8/2019 06.45 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-) 71 120/80
17 7/8/2019 06.46 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS (-) 80 110/70
18 7/8/2019 06.47 Rudi Harno 1/29/1973
321215290173 0001 PT. Alpha & Omega El Jireh Operator Loading (-) 84 120/80
19 7/8/2019 06.48 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-) 71 100/70
20 7/8/2019 06.49 Wahidin PT. Alpha&Omega El Jireh Operator Loading (-) 82 120/80
21 7/8/2019 06.50 Febriyono PT.Alpha&Omega El Jireh Cleaning Services (-) 78 110/70
22 7/8/2019 06.51 Durma PT.Alpha&Omega El Jireh Cleaning Services (-) 79 120/80
23 7/8/2019 06.52 Memet Rahmat Hidayat PT. Nurcahya Intan HSE Operation Support (-) 82 110/80
24 7/8/2019 06.53 Wahyono PT. Nurcahya Intan HSE Operation Support (-) 79 110/70
25 7/8/2019 06.54 Hanikha Alamsyah 10/24/1997 321214241097 0001 (-) 64 90/70
26 7/8/2019 06.55 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-) 85 120/80
27 7/8/2019 06.56 Kadrawi PT.Alpha&Omega El Jireh Handling 12 kg (-) 80 110/70
 28 7/8/2019 06.57 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
(-) 92 130/80
29 7/8/2019 06.58 Yuyun Wahyuni PT. Nurcahya Intan Operator Administration (-) 81 100/70
30 7/8/2019 06.59 Viki Dharma Alghozali PERTAMINA Tech. Maintenance (-) 79 100/70
31 7/8/2019 14.30 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-) 80 120/80
32 7/8/2019 14.31 Ismail PT. Nurcahya Intan HSE Operation Support (-) 78 110/70
33 7/8/2019 14.32 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification(-) 76 100/60
34 7/8/2019 14.33 Syamsul Fuady PT. Nurcahya Intan HSE Operation Support (-) 82 110/70
35 7/8/2019 22.30 Syarifudin PT.Nurcahya Intan HSE (-) 80 110/70
36 7/8/2019 22.31 Deden A.R PATRA TRAIDING P2 (-) 85 120/80
37 7/8/2019 22.32 Toifudin PTC Security (-) 82 100/80
38 7/8/2019 22.33 Sodikin Alpha O P2 (-) 85 120/80

Total kunjungan Tanggal 08/07/2019 : 38 Orang

Total FIT : 38 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Reflek Tes
Pernafasan Kesadaran Cahaya Tandem Breath Kesimpulan
Romberg Walking Tester
21 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
19 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
18 CM (-) (-) (-) (-) FIT
21 CM (-) (-) (-) (-) FIT
21 CM (-) (-) (-) (-) FIT
21 CM (-) (-) (-) (-) FIT
21 CM (-) (-) (-) (-) FIT
21 CM (-) (-) (-) (-) FIT
22 CM (-) (-) (-) (-) FIT
21 CM (-) (-) (-) (-) FIT
21 CM (-) (-) (-) (-) FIT
19 CM (-) (-) (-) (-) FIT
19 CM (-) (-) (-) (-) FIT
19 CM (-) (-) (-) (-) FIT
18 CM (-) (-) (-) (-) FIT
26 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
22 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
18 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
20 CM (-) (-) (-) (-) FIT
22 CM (-) (-) (-) (-) FIT
18 CM (-) (-) (-) (-) FIT
22 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal Nopek/No

No Tanggal DCU Nama NIK/No. KTP PJP Jabatan/Jenis Pekerjaan
DCU Lahir ID Card

1 7/9/2019 06.30 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle
2 7/9/2019 06.31 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan Teknik
3 7/9/2019 06.32 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan Teknik
4 7/9/2019 06.33 Agus Santoso PT. PTC Security
5 7/9/2019 06.34 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS
6 7/9/2019 06.35 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS
7 7/9/2019 06.36 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE
8 7/9/2019 06.37 Khamir 10/10/1976 321214101076 0003 PT. Alpha & Omega El Jireh TKJP
9 7/9/2019 06.38 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic
10 7/9/2019 06.39 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan
11 7/9/2019 06.40 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG
12 7/9/2019 06.41 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading
13 7/9/2019 06.42 Waryudi PT.Alpha&Omega El Jireh Cleaning Services
14 7/9/2019 06.43 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS
15 7/9/2019 06.44 Rudi Harno 1/29/1973 321215290173 0001 PT. Alpha & Omega El Jireh Operator Loading
16 7/9/2019 06.45 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
17 7/9/2019 06.46 Durma PT.Alpha&Omega El Jireh Cleaning Services
18 7/9/2019 06.47 Memet Rahmat Hidayat PT. Nurcahya Intan HSE Operation Support
19 7/9/2019 06.48 Wahyono PT. Nurcahya Intan HSE Operation Support
20 7/9/2019 06.49 Zamroni 7/13/1989 PT. Prima Armada Raya Driver
21 7/9/2019 06.50 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
22 7/9/2019 06.51 Viki Dharma Alghozali PERTAMINA Tech. Maintenance
23 7/9/2019 06.52 Caskam PT. PTC Security
24 5 juli 2019 06.53 Hanikha Alamsyah 10/24/1997 321214241097 0001
25 7/9/2019 06.54 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services
26 7/9/2019 14.30 Syamsul Fuady PT. Nurcahya Intan HSE Operation Support
27 7/9/2019 14.31 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification
28 7/9/2019 14.32 Ismail PT. Nurcahya Intan HSE Operation Support
29 7/9/2019 14.33 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver
30 7/9/2019 22.30 Caskam PTC Security
31 7/9/2019 22.31 Toifudin PTC Security

Total kunjungan Tanggal 09/07/2019 : 31 Orang

Total FIT : 31 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Pernaf Kesadaran Reflek Tes
Keluhan Nadi TD Romberg Walking Breath
Tandem Kesimpulan
asan Cahaya Tester

(-) 84 100/70 21 CM (-) (-) (-) (-) FIT

(-) 88 110/70 19 CM (-) (-) (-) (-) FIT
(-) 84 120/80 21 CM (-) (-) (-) (-) FIT
(-) 94 130/80 20 CM (-) (-) (-) (-) FIT
(-) 74 110/70 21 CM (-) (-) (-) (-) FIT
(-) 82 120/80 21 CM (-) (-) (-) (-) FIT
(-) 78 110/70 21 CM (-) (-) (-) (-) FIT
(-) 79 120/80 21 CM (-) (-) (-) (-) FIT
(-) 70 110/70 22 CM (-) (-) (-) (-) FIT
(-) 84 120/80 21 CM (-) (-) (-) (-) FIT
(-) 72 100/70 19 CM (-) (-) (-) (-) FIT
(-) 88 110/70 19 CM (-) (-) (-) (-) FIT
(-) 71 110/70 19 CM (-) (-) (-) (-) FIT
(-) 80 120/80 18 CM (-) (-) (-) (-) FIT
(-) 84 140/90 26 CM (-) (-) (-) (-) FIT
(-) 71 110/70 20 CM (-) (-) (-) (-) FIT
(-) 79 110/80 20 CM (-) (-) (-) (-) FIT
(-) 82 110/70 20 CM (-) (-) (-) (-) FIT
(-) 79 100/70 20 CM (-) (-) (-) (-) FIT
(-) 85 110/70 20 CM (-) (-) (-) (-) FIT
(-) 92 130/80 20 CM (-) (-) (-) (-) FIT
(-) 79 120/80 20 CM (-) (-) (-) (-) FIT
(-) 83 110/80 19 CM (-) (-) (-) (-) FIT
(-) 64 100/70 22 CM (-) (-) (-) (-) FIT
(-) 71 110/70 20 CM (-) (-) (-) (-) FIT
(-) 82 110/70 20 CM (-) (-) (-) (-) FIT
(-) 76 100/60 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 18 CM (-) (-) (-) (-) FIT
(-) 80 120/80 20 CM (-) (-) (-) (-) FIT
(-) 80 130/90 19 CM (-) (-) (-) (-) FIT
(-) 78 120/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No ID
No Tanggal DCU DCU Nama Tanggal Lahir NIK/No. KTP PJP
Card

1 7/10/2019 06.30 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA
2 7/10/2019 06.31 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan
3 7/10/2019 06.32 Agus Santoso PT. PTC
4 7/10/2019 06.33 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh
5 7/10/2019 06.34 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan
6 7/10/2019 06.35 Susianudin 11/5/1971 200900 PT. Nurcahya Intan
7 7/10/2019 06.36 Frigalf Thedy Miha Leo PERTAMINA
8 7/10/2019 06.37 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh
9 7/10/2019 06.38 Durma PT.Alpha&Omega El Jireh
10 7/10/2019 06.39 Memet Rahmat Hidayat PT. Nurcahya Intan
11 7/10/2019 06.40 Wahyono PT. Nurcahya Intan
12 7/10/2019 06.41 Zamroni 7/13/1989 PT. Prima Armada Raya
13 7/10/2019 06.42 Hanito Kusuma PERTAMINA
14 7/10/2019 06.43 Hanikha Alamsyah 10/24/1997 321214241097 0001
15 7/10/2019 06.44 Alam Kurniawan PT.Alpha&Omega El Jireh
16 7/10/2019 06.45 Suradi 7/24/1974 20534 PT. Prima Armada Raya
17 7/10/2019 06.46 Choliq Santoso 6/23/1976 JR 027275 PT. Nurcahya Intan
18 7/10/2019 06.47 M. Walid Noldi 5/18/1996 321214180596 0002 PT. Alpha & Omega El Jireh
19 7/10/2019 06.48 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan
20 7/10/2019 06.49 Febriyono PT.Alpha&Omega El Jireh
21 7/10/2019 06.50 Suherman 11/29/1963 663555 PERTAMINA
22 7/10/2019 06.51 Akhmad Mubarok PT. Nurcahya Intan
23 7/10/2019 06.52 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh
24 7/10/2019 06.53 Ari Yunanto PERTAMINA
25 7/10/2019 06.54Yaseer Gary Rigel Hakim Khan PERTAMINA
26 7/10/2019 06.55 Rangga P 11/20/1975 PERTAMINA
27 7/10/2019 06.56 Harry R 4/4/1990 PT. Nurcahya Intan
28 7/10/2019 06.57 M. Solek PT. PTC
29 7/10/2019 06.58 Riksa Nian Lestari PT.Alpha&Omega El Jireh
30 7/10/2019 14.30 Warka'i PT.Alpha O
31 7/10/2019 14.31 Runedi PT. Alpha & Omega El Jireh
32 7/10/2019 14.32 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan
33 7/10/2019 14.33 Abdul Basit 7/10/1983 113908 PT. PTC
34 7/10/2019 14.34 Fery Eliswanto 8/29/1996 PT. Nurcahaya Intan
35 7/10/2019 14.35 Dicky Ortega 6/17/1992 36007 PT. Alpha & Omega El Jireh
36 7/10/2019 22.30 Deden A.R PATRA TRAIDING
37 7/10/2019 22.31 Juandana Organik
38 7/10/2019 22.32 Nasion Tri Utomo PTC
39 7/10/2019 22.33 Brohim Alpha O
40 7/10/2019 22.34 Aan Kharison PTC

Total kunjungan Tanggal 10/07/2019 : 40 Orang

Total FIT : 40 Orang
Total UNFIT : 0 Orang
ily Check Up MOR III

Tes Alcohol
Keluh Nadi Pernafa Kesadaran Reflek Tes
Jabatan/Jenis Pekerjaan TD Tandem Breath Kesimpulan
an san Cahaya Romberg Walking Tester
Distribution Bottle (-) 84 100/70 21 CM (-) (-) (-) (-) FIT
Teknik (-) 88 110/70 19 CM (-) (-) (-) (-) FIT
Security (-) 94 130/80 20 CM (-) (-) (-) (-) FIT
CS (-) 74 110/70 21 CM (-) (-) (-) (-) FIT
HSE (-) 78 90/70 21 CM (-) (-) (-) (-) FIT
Mecanic (-) 70 110/80 22 CM (-) (-) (-) (-) FIT
Jr Spv Distribution Bottle LPG (-) 72 100/70 19 CM (-) (-) (-) (-) FIT
CS (-) 80 110/70 18 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 79 100/70 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 82 100/70 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 79 110/70 20 CM (-) (-) (-) (-) FIT
Driver (-) 85 120/80 20 CM (-) (-) (-) (-) FIT
Spv Receiving, Storage & Distribution
(-) 92 130/80 20 CM (-) (-) (-) (-) FIT
(-) 64 90/70 22 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 71 100/70 20 CM (-) (-) (-) (-) FIT
Driver (-) 80 110/70 20 CM (-) (-) (-) (-) FIT
Gate Keeper (-) 80 110/70 21 CM (-) (-) (-) (-) FIT
P2 (-) 78 130/80 20 CM (-) (-) (-) (-) FIT
Teknik (-) 84 120/80 21 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 78 120/80 20 CM (-) (-) (-) (-) FIT
OH Depot LPG Balongan (-) 84 140/80 21 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 77 100/70 20 CM (-) (-) (-) (-) FIT
CS (-) 83 100/60 20 CM (-) (-) (-) (-) FIT
Spv Engineering Planning & Maintenance(-) 79 100/70 20 CM (-) (-) (-) (-) FIT
Adm Sales&General (-) 82 100/70 19 CM (-) (-) (-) (-) FIT
Spv HSSE (-) 85 110/70 20 CM (-) (-) (-) (-) FIT
Adm (-) 76 110/80 20 CM (-) (-) (-) (-) FIT
 Security (-) 81 110/80 20 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 88 120/90 20 CM (-) (-) (-) (-) FIT
P2 (-) 75 110/80 19 CM (-) (-) (-) (-) FIT
P2 (-) 76 110/80 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 78 120/80 19 CM (-) (-) (-) (-) FIT
Security (-) 74 100/80 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 76 110/80 20 CM (-) (-) (-) (-) FIT
P1 (-) 75 110/80 19 CM (-) (-) (-) (-) FIT
Security (-) 80 110/80 20 CM (-) (-) (-) (-) FIT
P2 (-) 85 90/70 22 CM (-) (-) (-) (-) FIT
Security (-) 82 110/70 22 CM (-) (-) (-) (-) FIT
P2 (-) 78 120/80 20 CM (-) (-) (-) (-) FIT
Security (-) 82 140/80 18 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No Jabatan/Jenis

No Tanggal DCU Nama Tanggal Lahir NIK/No. KTP PJP Keluhan Nadi
DCU ID Card Pekerjaan

1 7/11/2019 06.30 Alif Akbar Satria N 4/17/1999321215171499 0005754787 PERTAMINA Distribution Bottle (-) 84
2 7/11/2019 06.31 Aryanto 5/4/1983321214040583 0003
JR 027088 PT. Nurcahya Intan Teknik (-) 88
3 7/11/2019 06.32 Agus Santoso PT. PTC Security (-) 94
4 7/11/2019 06.33 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-) 74
5 7/11/2019 06.34 Rakhmanto 10/25/1979321210251079 0001 27272 PT. Nurcahya Intan HSE (-) 78
6 7/11/2019 06.35 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS (-) 80
7 7/11/2019 06.36 Durma PT.Alpha&Omega El Jireh Cleaning Services (-) 79
8 7/11/2019 06.37 Hanito Kusuma PERTAMINASpv Receiving, Storage & Distribution
(-) 92
9 7/11/2019 06.38 Hanikha Alamsyah 10/24/1997321214241097 0001 (-) 64
10 7/11/2019 06.39 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services (-) 71
11 7/11/2019 06.40 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-) 80
12 7/11/2019 06.41 Choliq Santoso 6/23/1976 JR 027275 PT. Nurcahya Intan Gate Keeper (-) 80
13 7/11/2019 06.42 M. Walid Noldi 5/18/1996321214180596 0002
8/31/1976 PT. Alpha & Omega El Jireh P2 (-) 78
14 7/11/2019 06.43 Kasdi 4/14/198432121414 0487 0001 PT. Nurcahya Intan Teknik (-) 84
15 7/11/2019 06.44 Febriyono PT.Alpha&Omega El Jireh Cleaning Services (-) 78
16 7/11/2019 06.45 Rangga P 11/20/1975 PERTAMINA Spv HSSE (-) 85
17 7/11/2019 06.46 Harry R 4/4/1990 PT. Nurcahya Intan Adm (-) 76
18 7/11/2019 06.47 M. Solek PT. PTC Security (-) 81
19 7/11/2019 06.48 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-) 71
20 7/11/2019 06.49 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE (-) 80
21 7/11/2019 06.50 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 72
22 7/11/2019 06.51 Akhmad Nurul Arofat PERTAMINA Spv Receiving & Storage (-) 85
23 7/11/2019 06.52 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-) 82
24 7/11/2019 06.53 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-) 71
25 7/11/2019 06.54 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support (-) 88
26 7/11/2019 06.55 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh P1 (-) 79
27 7/11/2019 06.56 Ismail 11/20/1969 HSE (-) 88
 28 7/11/2019 06.57 Yuyun Wahyuni PT. Nurcahya Intan Operator Administration (-) 79
29 7/11/2019 06.58 Ari Yunanto PERTAMINASpv Engineering Planning & Maintenance
(-) 79
30 7/11/2019 14.30 Rustamadji 8/15/1977 745012 PERTAMINA Ast. Environmental & Hygiene(-)Ind 84
31 7/11/2019 14.31 Toifudin PT. PTC Security (-) 72
32 7/11/2019 14.32 Taka PT. Alpha&Omega El Jireh Operator Loading (-) 82
33 7/11/2019 14.33 Wahidin PT. Alpha&Omega El Jireh Operator Loading (-) 88
34 7/11/2019 14.34 Agus Santoso PT. PTC Security (-) 78
35 7/11/2019 22.30 Sumarto PT.Nurcahya Intan HSE (-) 78
36 7/11/2019 22.31 Toifudin PTC Security (-) 80
37 7/11/2019 22.32 Nasion Tri Utomo PTC Security (-) 82
38 7/11/2019 22.33 Brohim Alpha O P2 (-) 85
39 7/11/2019 22.34 Caskam PTC Security (-) 80
40 7/11/2019 22.35 Aan Kharison PTC Security (-) 82

Total kunjungan Tanggal 11/07/2019 : 40 Orang

Total FIT : 40 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Reflek Tes
TD Pernafasan Kesadaran Tandem Breath Kesimpulan
Cahaya Romberg Walking Tester
100/70 21 CM (-) (-) (-) (-) FIT
110/70 19 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
100/70 21 CM (-) (-) (-) (-) FIT
110/70 18 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
90/70 22 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
90/70 21 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
100/60 19 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 21 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
 90/70 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
100/70 18 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/80 18 CM (-) (-) (-) (-) FIT
110/80 22 CM (-) (-) (-) (-) FIT
110/90 19 CM (-) (-) (-) (-) FIT
130/90 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal Nopek/No Jabatan/Jenis

No Tanggal DCU DCU Nama NIK/No. KTP PJP Keluhan
Lahir ID Card Pekerjaan

1 7/12/2019 06.30 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle (-)
2 7/12/2019 06.31 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan Teknik (-)
3 7/12/2019 06.32 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-)
4 7/12/2019 06.33 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE (-)
5 7/12/2019 06.34 Durma PT.Alpha&Omega El Jireh Cleaning Services (-)
6 7/12/2019 06.35 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution (-)
7 7/12/2019 06.36 Hanikha Alamsyah 10/24/1997 321214241097 0001 (-)
8 7/12/2019 06.37 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services (-)
9 7/12/2019 06.38 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-)
10 7/12/2019 06.39 Choliq Santoso 6/23/1976 JR 027275 PT. Nurcahya Intan Gate Keeper (-)
11 7/12/2019 06.40 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan Teknik (-)
12 7/12/2019 06.41 Rangga P 11/20/1975 PERTAMINA Spv HSSE (-)
13 7/12/2019 06.42 Harry R 4/4/1990 PT. Nurcahya Intan Adm (-)
14 7/12/2019 06.43 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-)
15 7/12/2019 06.44 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE (-)
16 7/12/2019 06.45 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-)
17 7/12/2019 06.46 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-)
18 7/12/2019 06.47 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-)
19 7/12/2019 06.48 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support (-)
20 7/12/2019 06.49 Ismail 11/20/1969 HSE (-)
21 7/12/2019 06.50 Yuyun Wahyuni PT. Nurcahya Intan Operator Administration (-)
22 7/12/2019 06.51 Warka'i 11/5/1981 28004 PT. Alpha & Omega El Jireh P2 (-)
23 7/12/2019 06.52 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-)
24 7/12/2019 06.53 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-)
25 7/12/2019 06.54 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG (-)
26 7/12/2019 06.55 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2 (-)
27 7/12/2019 06.56 Runedi PT. Alpha & Omega El Jireh P2 (-)
 28 7/12/2019 06.57 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind (-)
29 7/12/2019 06.58 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan (-)
30 7/12/2019 14.30 Sodikin PT. Alpha & Omega El Jireh P2 (-)
31 7/12/2019 14.31 M. Walid Noldi 5/18/1996 321214180596 0002 8/31/1976 PT. Alpha & Omega El Jireh P2 (-)
32 7/12/2019 14.32 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan HSE Operation Support (-)
33 7/12/2019 14.33 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage (-)
34 7/12/2019 14.34 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading (-)
35 7/12/2019 14.35 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading (-)
36 7/12/2019 14.36 Kamir 10/10/1976 321214101076 0003 77 PT. Alpha&Omega EL Jireh Operator Loading (-)
37 7/12/2019 14.37 Toifudin PTC Security (-)
38 7/12/2019 22.30 Memet R.H PT.Nurcahya Intan HSE (-)
39 7/12/2019 22.31 Wahyono PT.Nurcahya Intan HSE (-)
40 7/12/2019 22.32 Nasion Tri Utomo PTC Security (-)
41 7/12/2019 22.33 Aan Kharison PTC Security (-)

Total kunjungan Tanggal 12/07/2019 : 41 Orang

Total FIT : 41 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Reflek Tes
Nadi TD Pernafasan Kesadaran Cahaya Romberg Walking Breath
Tandem Kesimpulan
Tester
84 100/70 21 CM (-) (-) (-) (-) FIT
88 120/80 19 CM (-) (-) (-) (-) FIT
74 130/80 21 CM (-) (-) (-) (-) FIT
78 110/80 21 CM (-) (-) (-) (-) FIT
79 120/80 20 CM (-) (-) (-) (-) FIT
92 130/80 20 CM (-) (-) (-) (-) FIT
64 90/70 22 CM (-) (-) (-) (-) FIT
71 110/70 20 CM (-) (-) (-) (-) FIT
80 120/80 20 CM (-) (-) (-) (-) FIT
80 100/70 21 CM (-) (-) (-) (-) FIT
84 120/80 21 CM (-) (-) (-) (-) FIT
85 100/70 20 CM (-) (-) (-) (-) FIT
76 110/70 20 CM (-) (-) (-) (-) FIT
71 110/70 20 CM (-) (-) (-) (-) FIT
80 120/80 21 CM (-) (-) (-) (-) FIT
72 120/80 20 CM (-) (-) (-) (-) FIT
82 120/80 21 CM (-) (-) (-) (-) FIT
71 130/80 19 CM (-) (-) (-) (-) FIT
88 120/80 20 CM (-) (-) (-) (-) FIT
88 110/70 20 CM (-) (-) (-) (-) FIT
79 120/80 20 CM (-) (-) (-) (-) FIT
99 100/70 20 CM (-) (-) (-) (-) FIT
70 120/80 22 CM (-) (-) (-) (-) FIT
83 120/80 20 CM (-) (-) (-) (-) FIT
72 110/70 19 CM (-) (-) (-) (-) FIT
80 110/80 22 CM (-) (-) (-) (-) FIT
76 120/80 20 CM (-) (-) (-) (-) FIT
86 90/70 20 CM (-) (-) (-) (-) FIT
84 120/80 21 CM (-) (-) (-) (-) FIT
87 130/80 20 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
78 120/80 19 CM (-) (-) (-) (-) FIT
76 110/80 19 CM (-) (-) (-) (-) FIT
78 110/80 19 CM (-) (-) (-) (-) FIT
78 120/80 19 CM (-) (-) (-) (-) FIT
78 110/80 19 CM (-) (-) (-) (-) FIT
76 110/80 19 CM (-) (-) (-) (-) FIT
78 110/80 20 CM (-) (-) (-) (-) FIT
80 120/80 18 CM (-) (-) (-) (-) FIT
81 120/70 22 CM (-) (-) (-) (-) FIT
80 130/90 18 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No
No Tanggal DCU Nama Tanggal Lahir NIK/No. KTP PJP Jabatan/Jenis Pekerjaan
DCU ID Card

1 7/13/2019 06.30 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE
2 7/13/2019 06.31 Harry R 4/4/1990 PT. Nurcahya Intan Adm
3 7/13/2019 06.32 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
4 7/13/2019 06.33 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE
5 7/13/2019 06.34 Ismail 11/20/1969 HSE
6 7/13/2019 06.35 Runedi PT. Alpha & Omega El Jireh P2
7 7/13/2019 06.36 Warka'i 11/5/1981 28004 PT. Alpha & Omega El Jireh P2
8 7/13/2019 06.37 Zamroni 7/13/1989 PT. Prima Armada Raya Driver
9 7/13/2019 06.38 Tri Handoyo PERTAMINA Spv Receiving & Storage
10 7/13/2019 06.39 Parjan
11 7/13/2019 14.30 Sodikin PT. Alpha & Omega El Jireh P2
12 7/13/2019 14.31 Khafid 3/8/1982 PT.Nurcahya Intan HSE
13 7/13/2019 14.32 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage
14 7/13/2019 14.33 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading
15 7/13/2019 14.34 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading
16 7/13/2019 14.35 Kamir 10/10/1976 321214101076 0003 77 PT. Alpha&Omega EL Jireh Operator Loading
17 7/13/2019 14.36 Toifudin PTC Security
18 7/13/2019 14.37 Sumarto 10/6/1984 2768 PT. Nurcahya Intan HSE
19 7/13/2019 14.38 Caskam 15/6/1973 113910 PTC Security
20 7/13/2019 14.39 Ahmad Taufik 8/17/1984 PT.Nurcahya Intan Gate Keeper
21 7/13/2019 14.40 Heriyawan
22 7/13/2019 22.30 Memet R.H PT.Nurcahya Intan HSE
23 7/13/2019 22.31 Wahyono PT.Nurcahya Intan HSE
24 7/13/2019 22.32 Agus Santoso PTC Security
25 7/13/2019 22.33 M.Solek PTC Security
Total kunjungan Tanggal 13/07/2019 : 25 Orang
Total FIT : 25 Orang
Total UNFIT : 0 Orang
OR III

Tes Alcohol
Reflek Tes
Keluhan Nadi TD Pernafasan Kesadaran Cahaya Romberg Walking Breath
Tandem Kesimpulan
Tester
(-) 78 100/70 21 CM (-) (-) (-) (-) FIT
(-) 76 120/80 20 CM (-) (-) (-) (-) FIT
(-) 71 100/70 20 CM (-) (-) (-) (-) FIT
(-) 80 110/70 21 CM (-) (-) (-) (-) FIT
(-) 88 100/70 20 CM (-) (-) (-) (-) FIT
(-) 76 120/80 20 CM (-) (-) (-) (-) FIT
(-) 99 90/70 20 CM (-) (-) (-) (-) FIT
(-) 85 120/80 20 CM (-) (-) (-) (-) FIT
(-) 82 110/70 20 CM (-) (-) (-) (-) FIT
(-) 80 130/80 20 CM (-) (-) (-) (-) FIT
(-) 80 120/80 20 CM (-) (-) (-) (-) FIT
(-) 76 110/80 20 CM (-) (-) (-) (-) FIT
(-) 76 110/80 19 CM (-) (-) (-) (-) FIT
(-) 78 120/80 19 CM (-) (-) (-) (-) FIT
(-) 78 120/80 19 CM (-) (-) (-) (-) FIT
(-) 78 120/80 19 CM (-) (-) (-) (-) FIT
(-) 76 110/80 19 CM (-) (-) (-) (-) FIT
(-) 76 110/80 19 CM (-) (-) (-) (-) FIT
(-) 76 110/80 20 CM (-) (-) (-) (-) FIT
(-) 76 110/80 20 CM (-) (-) (-) (-) FIT
(-) 78 120/80 19 CM (-) (-) (-) (-) FIT
(-) 80 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 100/70 18 CM (-) (-) (-) (-) FIT
(-) 81 120/80 19 CM (-) (-) (-) (-) FIT
(-) 80 100/70 22 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No ID
No Tanggal DCU DCU Nama Tanggal Lahir NIK/No. KTP PJP Jabatan/Jenis Pekerjaan
Card

1 7/14/2019 06.30 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan Teknik
2 7/14/2019 06.34 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
3 7/14/2019 06.35 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support
4 7/14/2019 06.36 Runedi PT. Alpha & Omega El Jireh P2
5 7/14/2019 06.37 M. Walid Noldi 5/18/1996 321214180596 0002 8/31/1976 PT. Alpha & Omega El Jireh P2
6 7/14/2019 06.38 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan HSE Operation Support
7 7/14/2019 06.39 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading
8 7/14/2019 06.40 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading
9 7/14/2019 06.41 Warka'i 11/5/1981 28004 PT. Alpha & Omega El Jireh P2
10 7/14/2019 06.42 Khamir 10/10/1976 321214101076 0003 PT. Alpha & Omega El Jireh TKJP
11 7/14/2019 06.43 Heriyawan PT. Alpha&Omega El Jireh Operator Loading
12 7/14/2019 06.44 Abdul Basit 7/10/1983 113908 PT. PTC Security
13 7/14/2019 06.45 Ahmad Taufik PT. Nurcahya Intan Gate Keeper
14 7/14/2019 06.46 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading
15 7/14/2019 14.30 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification
16 7/14/2019 14.31 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver
17 7/14/2019 14.32 Ismail 11/20/1969 PT. Nurcahya Intan HSE
18 7/14/2019 14.33 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE
19 7/14/2019 22.30 Memet R.H PT.Nurcahya Intan HSE
20 7/14/2019 22.31 M.Walid Noldi Alpha O P2

Total kunjungan Tanggal 14/07/2019 : 20 Orang

Total FIT : 20 Orang
Total UNFIT : 0 Orang
III

Tes Alcohol
Pernaf Kesadara Reflek Tes
Keluhan Nadi TD Tandem Breath Kesimpulan
asan n Cahaya Romberg Walking Tester
(-) 88 120/80 19 CM (-) (-) (-) (-) FIT
(-) 71 100/70 20 CM (-) (-) (-) (-) FIT
(-) 88 120/80 20 CM (-) (-) (-) (-) FIT
(-) 76 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 100/70 19 CM (-) (-) (-) (-) FIT
(-) 78 120/80 19 CM (-) (-) (-) (-) FIT
(-) 78 100/70 19 CM (-) (-) (-) (-) FIT
(-) 99 90/70 20 CM (-) (-) (-) (-) FIT
(-) 79 130/80 21 CM (-) (-) (-) (-) FIT
(-) 82 110/80 20 CM (-) (-) (-) (-) FIT
(-) 74 110/80 20 CM (-) (-) (-) (-) FIT
(-) 82 100/70 20 CM (-) (-) (-) (-) FIT
(-) 88 110/70 19 CM (-) (-) (-) (-) FIT
(-) 76 100/70 20 CM (-) (-) (-) (-) FIT
(-) 80 120/80 20 CM (-) (-) (-) (-) FIT
(-) 88 110/70 20 CM (-) (-) (-) (-) FIT
(-) 80 110/70 21 CM (-) (-) (-) (-) FIT
(-) 80 110/80 20 CM (-) (-) (-) (-) FIT
(-) 82 120/80 22 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Tanggal Jam Nopek/No

No Nama Tanggal Lahir NIK/No. KTP PJP Jabatan/Jenis Pekerjaan Keluh
DCU DCU ID Card an Nadi

1 7/15/2019 06.30 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle (-) 84
2 7/15/2019 06.34 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan Teknik (-) 88
3 7/15/2019 06.35 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-) 74
4 7/15/2019 06.36 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE (-) 78
5 7/15/2019 06.37 Durma PT.Alpha&Omega El Jireh Cleaning Services (-) 72
6 7/15/2019 06.38 Hanikha Alamsyah 10/24/1997 321214241097 0001 (-) 64
7 7/15/2019 06.39 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services (-) 71
8 7/15/2019 06.40 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-) 71
9 7/15/2019 06.41 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 72
10 7/15/2019 06.42 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-) 79
11 7/15/2019 06.43 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-) 70
12 7/15/2019 06.44 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-) 78
13 7/15/2019 06.45 Sodikin PT. Alpha & Omega El Jireh P2 (-) 87
14 7/15/2019 06.46 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan HSE Operation Support (-) 78
15 7/15/2019 06.47 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage (-) 76
16 7/15/2019 06.48 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading (-) 89
17 7/15/2019 06.49 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading (-) 82
18 7/15/2019 06.50 Toifudin PTC Security (-) 76
19 7/15/2019 06.51 Khamir 10/10/1976 321214101076 0003 PT. Alpha & Omega El Jireh TKJP (-) 90
20 7/15/2019 06.52 Dicky Ortega 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 72
21 7/15/2019 06.53 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading (-) 78
22 7/15/2019 06.54 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-) 85
23 7/15/2019 06.55 Caskam 15/6/1973 113910 PTC Security (-) 73
24 7/15/2019 06.56 Brohim PT. Alpha&Omega El Jireh Receiving&Storage (-) 78
25 7/15/2019 06.57 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-) 87
26 7/15/2019 14.30 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh P1 (-) 79
27 7/15/2019 14.31 Khafid 3/8/1982 PT.Nurcahya Intan HSE (-) 76
28 7/15/2019 14.32 sumarto 1/29/1973 32121529173 0001 PT. Alpha & Omega El Jireh Operator Loading (-) 83
29 7/15/2019 14.33 M. Solek PT. PTC Security (-) 67
30 7/15/2019 14.34 Fery Eliswanto 8/29/1996 PT. Nurcahaya Intan HSE Operation Support (-) 69
31 7/15/2019 14.35 Nasion Tri Utomo PT. PTC Security (-) 84
32 7/15/2019 14.36 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification (-) 76
33 7/15/2019 14.37 Juandana 30/7/1982 744125 Organik P2 (-) 68
34 7/15/2019 14.38 Viki Dharma Alghozali PERTAMINA Tech. Maintenance (-) 79
35 7/15/2019 14.39 Choliq Santoso 6/23/1976 JR 027275 PT. Nurcahya Intan Gate Keeper (-) 74
36 7/15/2019 14.40 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2 (-) 68
37 7/15/2019 14.41 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind(-) 86
38 7/15/2019 14.42 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
(-) 92
39 7/15/2019 22.30 Syamsul Fuady PT.Nurcahya Intan HSE (-) 82
40 7/15/2019 22.31 Warka'i Alpha O P2 (-) 78
41 7/15/2019 22.32 Ismail PT.Nurcahya Intan HSE (-) 81
42 7/15/2019 22.33 Agus Santoso PTC Security (-) 85
43 7/15/2019 22.34 Runedi Alpha O P2 (-) 80
Total kunjungan Tanggal 15/07/2019 : 43 Orang
Total FIT : 43 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Reflek Tes
TD Pernafasan Kesadaran Tandem Breath Kesimpulan
Cahaya Romberg Walking Tester
100/70 21 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
110/80 21 CM (-) (-) (-) (-) FIT
100/60 20 CM (-) (-) (-) (-) FIT
100/70 22 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
110/80 22 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
130/80 19 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
130/90 21 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/60 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
110/80 21 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
90/60 20 CM (-) (-) (-) (-) FIT
90/60 20 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
90/70 18 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 21 CM (-) (-) (-) (-) FIT
90/60 22 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
140/90 20 CM (-) (-) (-) (-) FIT
110/80 18 CM (-) (-) (-) (-) FIT
100/80 20 CM (-) (-) (-) (-) FIT
120/80 18 CM (-) (-) (-) (-) FIT
130/90 22 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No Jabatan/Jenis

No Tanggal DCU DCU Nama Tanggal Lahir NIK/No. KTP PJP Keluhan
ID Card Pekerjaan

1 7/16/2019 06.30 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safety (-)
2 7/16/2019 06.31 Cholik Santoso 6/23/1976 27275 PT. Nurcahya Intan Gate Keeper (-)
3 7/16/2019 06.32 Panji Setyo W 3/24/1995 3.204282404E+15 PERTAMINA OJT HSSE (-)
4 7/16/2019 06.33 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-)
5 7/16/2019 06.34 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan Teknik (-)
6 7/16/2019 06.35 Akhmad Mubaroq PT. Nurcahya Intan HSE (-)
7 7/16/2019 06.36 Rustamadji 8/15/1977 745012 PERTAMINA HSSE (-)
8 7/16/2019 06.37 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage (-)
9 7/16/2019 06.38 Caskam 15/6/1973 113910 PTC Security (-)
10 7/16/2019 06.39 Sodikin PT. Alpha & Omega El Jireh P2 (-)
11 7/16/2019 06.40 Toifudin PTC Security (-)
12 7/16/2019 06.41 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG (-)
13 7/16/2019 06.42 Hanito Kusuma PERTAMINA Sr Spv Receiving, Storage & Distribution
(-)
14 7/16/2019 06.43 Aryanto PT. Nurcahya Intan Maintenance&Utilities (-)
15 7/16/2019 06.44 Susianudin PT. Nurcahya Intan Maintenance&Utilities (-)
16 7/16/2019 06.45 Alam PT.Alpha&Omega El Jireh Cleaning Services (-)
17 7/16/2019 06.46 nendi PT.Alpha&Omega El Jireh Cleaning Services (-)
18 7/16/2019 06.47 Mustahil PT.Alpha&Omega El Jireh Cleaning Services (-)
19 7/16/2019 06.48 Hamdan Fauzi PT. Alpha&Omega El Jireh Operator Loading (-)
20 7/16/2019 06.49 Muhamad Abdul Musa PT.Alpha&Omega El Jireh Cleaning Services (-)
21 7/16/2019 06.50 Rakhmanto PT. Nurcahya Intan HSE Operation Support (-)
22 7/16/2019 06.51 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-)
23 7/16/2019 06.52 Durma PT.Alpha&Omega El Jireh Cleaning Services (-)
24 7/16/2019 06.53 Ari Yunanto ### PERTAMINASpv Engineering Planning & Maintenance (-)
25 7/16/2019 06.54 Kartisa PT.Alpha&Omega El Jireh Cleaning Services (-)
26 7/16/2019 06.55 Rangga Pringga Yudha PERTAMINA Supervisor HSSE (-)
27 7/16/2019 14.30 Wahyono PT. Nurcahya Intan HSE Operation Support (-)
28 7/16/2019 14.31 M. Sulkhin PT. Alpha&Omega El Jireh Receiving&Storage (-)
29 7/16/2019 14.32 Khamir PT.Alpha&Omega El Jireh Operator Loading (-)
30 7/16/2019 14.33 Memet Rahmat Hidayat PT. Nurcahya Intan HSE Operation Support (-)
31 7/16/2019 14.34 Dicky Ortega PT. Alpha&Omega El Jireh Operator Loading (-)
32 7/16/2019 14.35 Adhita Adhitya Sudrajat PERTAMINA Jr Spv Distribution Bulk LPG (-)
33 7/16/2019 14.36 Fery Eliswanto PT. Nurcahya Intan HSE Operation Support (-)
34 7/16/2019 14.37 Nasion Tri Utomo PT. PTC Security (-)
35 7/16/2019 14.38 Juandana ### PERTAMINA Spv Receiving & Storage (-)
36 7/16/2019 14.39 Denny Ryan Putra PERTAMINA Administrator Distribution Verification
(-)
37 7/16/2019 14.40 Deny Suryana ### PERTAMINA Administrator Distribution Verification
(-)
38 7/16/2019 22.30 Syamsul Fuady PT.Nurcahya Intan HSE (-)
39 7/16/2019 22.31 Warka'i Alpha O P2 (-)
40 7/16/2019 22.32 Runedi Alpha O P2 (-)
41 7/16/2019 22.33 Tri Handoyo Organik P2 (-)

Total kunjungan Tanggal 16/07/2019 : 41 Orang

Total FIT : 41 Orang
Total UNFIT : 0 Orang
 Tes Alcohol Kesimpul
Pernafasan Kesadara Reflek Tes
Nadi TD Tandem Breath
n Cahaya Romberg Walking an
Tester
76 110/80 19 CM (-) (-) (-) (-) FIT
78 100/70 20 CM (-) (-) (-) (-) FIT
75 100/70 19 CM (-) (-) (-) (-) FIT
71 100/70 19 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
75 110/70 20 CM (-) (-) (-) (-) FIT
70 100/70 20 CM (-) (-) (-) (-) FIT
76 110/70 19 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
80 120/80 20 CM (-) (-) (-) (-) FIT
76 120/80 19 CM (-) (-) (-) (-) FIT
71 90/70 19 CM (-) (-) (-) (-) FIT
80 130/80 20 CM (-) (-) (-) (-) FIT
76 110/80 19 CM (-) (-) (-) (-) FIT
76 110/70 19 CM (-) (-) (-) (-) FIT
73 100/70 19 CM (-) (-) (-) (-) FIT
76 110/70 19 CM (-) (-) (-) (-) FIT
70 90/70 19 CM (-) (-) (-) (-) FIT
80 120/80 19 CM (-) (-) (-) (-) FIT
72 100/70 19 CM (-) (-) (-) (-) FIT
75 110/70 19 CM (-) (-) (-) (-) FIT
78 120/80 19 CM (-) (-) (-) (-) FIT
76 110/70 19 CM (-) (-) (-) (-) FIT
76 110/70 19 CM (-) (-) (-) (-) FIT
72 90/70 19 CM (-) (-) (-) (-) FIT
72 100/70 19 CM (-) (-) (-) (-) FIT
74 100/70 19 CM (-) (-) (-) (-) FIT
76 110/80 20 CM (-) (-) (-) (-) FIT
80 140/80 20 CM (-) (-) (-) (-) FIT
75 100/70 19 CM (-) (-) (-) (-) FIT
78 120/80 19 CM (-) (-) (-) (-) FIT
76 110/80 19 CM (-) (-) (-) (-) FIT
72 90/60 19 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
72 90/70 19 CM (-) (-) (-) (-) FIT
71 90/70 19 CM (-) (-) (-) (-) FIT
73 100/70 19 CM (-) (-) (-) (-) FIT
78 110/80 18 CM (-) (-) (-) (-) FIT
80 110/80 18 CM (-) (-) (-) (-) FIT
80 120/80 18 CM (-) (-) (-) (-) FIT
82 120/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No ID Jabatan/Jenis Keluh

No Tanggal DCU DCU Nama Tanggal Lahir NIK/No. KTP PJP
Card Pekerjaan an

1 17 juli 2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-)
2 17 juli 2019 06.31 Durma PT.Alpha&Omega El Jireh Cleaning Services (-)
3 17 juli 2019 06.32 Hanikha Alamsyah 10/24/1997321214241097 0001 (-)
4 17 juli 2019 06.33 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-)
5 17 juli 2019 06.34 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-)
6 17 juli 2019 06.35 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-)
7 17 juli 2019 06.36 Sodikin PT. Alpha & Omega El Jireh P2 (-)
8 17 juli 2019 06.37 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-)
9 17 juli 2019 06.38 Caskam 15/6/1973 113910 PTC Security (-)
10 17 juli 2019 06.39 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh P1 (-)
11 17 juli 2019 06.40 Khafid 3/8/1982 PT.Nurcahya Intan HSE (-)
12 17 juli 2019 06.41 Juandana 30/7/1982 744125 Organik P2 (-)
13 17 juli 2019 06.42 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
(-)
14 17 juli 2019 06.43 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-)
15 17 juli 2019 06.44 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-)
16 17 juli 2019 06.45 Ari Yunanto PERTAMINA Spv Engineering Planning & Maintenance
(-)
17 17 juli 2019 06.46 Ismail 11/20/1969 HSE (-)
18 17 juli 2019 14.30 Wahyono 1/24/1981 27271 PT. Nurcahya Intan HSE (-)
19 17 juli 2019 14.31 M. Walid Noldi 5/18/1996321214180596 00028/31/1976 PT. Alpha & Omega El Jireh P2 (-)
20 17 juli 2019 14.32 Memet Rahmat Hidayat 11/20/1975 JR 0270267 PT. Nurcahaya Intan HSE Operation Support (-)
21 17 juli 2019 14.33 Parjan (-)
22 17 juli 2019 14.34 Denny Ryan Putra 8/6/1983 752338 PERTAMINA SGA (-)
23 17 juli 2019 14.35 Agus Santoso PTC Security (-)
24 17 juli 2019 14.36 Moh.Solek 15/3/1980 113889 PTC Security (-)
25 17 juli 2019 22.30 Syamsul Fuady PT.Nurcahya Intan HSE (-)
26 17 juli 2019 22.31 Warka'i Alpha O P2 (-)
27 17 juli 2019 22.32 Runedi PTC Security (-)
28 17 juli 2019 22.33 Tri Handoyo Organik P2 (-)

Total kunjungan Tanggal 17/07/2019 : 28 Orang

Total FIT : 26 Orang
Total UNFIT : 2 Orang
Up MOR III

Tes Alcohol
Pernafas Kesada Reflek Tes
Nadi TD Tandem Breath Kesimpulan
an ran Cahaya Romberg Walking Tester

74 100/70 20 CM (-) (-) (-) (-) FIT

72 120/80 20 CM (-) (-) (-) (-) FIT
64 100/70 22 CM (-) (-) (-) (-) FIT
71 100/70 20 CM (-) (-) (-) (-) FIT
72 110/80 20 CM (-) (-) (-) (-) FIT
78 110/70 20 CM (-) (-) (-) (-) FIT
87 120/80 20 CM (-) (-) (-) (-) FIT
85 120/80 20 CM (-) (-) (-) (-) FIT
73 120/80 20 CM (-) (-) (-) (-) FIT
79 120/80 20 CM (-) (-) (-) (-) FIT
76 110/80 20 CM (-) (-) (-) (-) FIT
68 120/80 18 CM (-) (-) (-) (-) FIT
92 140/90 20 CM (-) (-) (-) (-) UN FIT
71 110/80 19 CM (-) (-) (-) (-) FIT
80 120/80 20 CM (-) (-) (-) (-) FIT
79 110/70 20 CM (-) (-) (-) (-) FIT
88 140/90 20 CM (-) (-) (-) (-) UNFIT
76 100/70 19 CM (-) (-) (-) (-) FIT
76 110/80 20 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
80 130/80 20 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
80 120/80 19 CM (-) (-) (-) (-) FIT
76 110/80 20 CM (-) (-) (-) (-) FIT
80 110/80 22 CM (-) (-) (-) (-) FIT
78 100/70 22 CM (-) (-) (-) (-) FIT
85 100/70 20 CM (-) (-) (-) (-) FIT
80 110/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Tanggal Jam
No Nama Tanggal Lahir NIK/No. KTP Nopek/No ID Card PJP Jabatan/Jenis Pekerjaan
DCU DCU

1 7/18/2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS
2 7/18/2019 06.31 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE
3 7/18/2019 06.32 Durma PT.Alpha&Omega El Jireh Cleaning Services
4 7/18/2019 06.33 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
5 7/18/2019 06.34 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver
6 7/18/2019 06.35 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
7 7/18/2019 06.36 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery
8 7/18/2019 06.37 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS
9 7/18/2019 06.38 Waryudi PT.Alpha&Omega El Jireh Cleaning Services
10 7/18/2019 06.39 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic
11 7/18/2019 06.40 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2
12 7/18/2019 06.41 Ari Yunanto PERTAMINA Spv Engineering Planning & Maintenance
13 7/18/2019 06.42 Juandana 30/7/1982 744125 Organik P2
14 7/18/2019 06.43 Abdul Basit 7/10/1983 12/17/1930 PT. PTC Security
15 7/18/2019 06.44 Fery Eliswanto PT. Nurcahya Intan HSE Operation Support
16 7/18/2019 06.45 Firmansyah PT. Nurcahya Intan Adm. HSE
17 7/18/2019 06.46 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage
18 7/18/2019 06.47 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS
19 7/18/2019 06.48 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan Teknik
20 7/18/2019 06.49 Khafid 3/8/1982 PT.Nurcahya Intan HSE
21 7/18/2019 06.50 Mustafid PT. Nurcahya Intan Gate Keeper
22 7/18/2019 06.51 Sumarto 10/6/1984 JR 02768 PT. Nurcahya Intan HSE
23 7/18/2019 14.30 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading
24 7/18/2019 14.31 Wahyono PT. Nurcahya Intan HSE Operation Support
25 7/18/2019 14.32 M. Walid Noldi 5/18/1996 321214180596 0002 8/31/1976 PT. Alpha & Omega El Jireh P2
26 7/18/2019 14.33 Ahmad Taufik PT. Nurcahya Intan Gate Keeper
27 7/18/2019 14.34 Agus Santoso PT. PTC Security
28 7/18/2019 14.35 Memet Rahmat Hidayat 11/20/1975 JR 0270267 PT. Nurcahaya Intan HSE Operation Support
29 7/18/2019 14.36 Moh.Solek 15/3/1980 113889 PTC Security
30 7/18/2019 14.37 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification
31 7/18/2019 14.38 Sodikin PT. Alpha & Omega El Jireh P2
32 7/18/2019 14.39 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading
33 7/18/2019 14.40 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading
34 7/18/2019 14.41 Heriyawan PT. Alpha&Omega El Jireh Operator Loading
35 7/18/2019 22.30 Fery Eliswanto PT.Nurcahya Intan HSE
36 7/18/2019 22.31 Hary Dwi.S Alpha O P2
37 7/18/2019 22.32 Abdul Basit PTC Security

Total kunjungan Tanggal 18/07/2019 : 34 Orang

Total FIT : 34 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Keluh Nadi Pernaf Kesada Reflek Tes
TD Tandem Breath Kesimpulan
an asan ran Cahaya Romberg Walking Tester

(-) 82 120/80 21 CM (-) (-) (-) (-) FIT

(-) 72 100/70 21 CM (-) (-) (-) (-) FIT
(-) 79 90/60 20 CM (-) (-) (-) (-) FIT
(-) 92 130/80 20 CM (-) (-) (-) (-) FIT
(-) 80 120/80 20 CM (-) (-) (-) (-) FIT
(-) 71 90/70 20 CM (-) (-) (-) (-) FIT
(-) 72 120/80 20 CM (-) (-) (-) (-) FIT
(-) 82 110/80 21 CM (-) (-) (-) (-) FIT
(-) 84 120/80 19 CM (-) (-) (-) (-) FIT
(-) 68 100/70 22 CM (-) (-) (-) (-) FIT
(-) 80 100/70 22 CM (-) (-) (-) (-) FIT
(-) 79 120/80 20 CM (-) (-) (-) (-) FIT
(-) 75 110/80 18 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 69 100/60 19 CM (-) (-) (-) (-) FIT
(-) 82 120/80 19 CM (-) (-) (-) (-) FIT
(-) 80 110/70 18 CM (-) (-) (-) (-) FIT
(-) 84 110/80 21 CM (-) (-) (-) (-) FIT
(-) 76 90/60 20 CM (-) (-) (-) (-) FIT
(-) 83 120/80 19 CM (-) (-) (-) (-) FIT
(-) 87 120/80 20 CM (-) (-) (-) (-) FIT
(-) 88 120/80 19 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 85 120/80 20 CM (-) (-) (-) (-) FIT
(-) 69 90/70 19 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 85 120/80 20 CM (-) (-) (-) (-) FIT
(-) 76 100/70 20 CM (-) (-) (-) (-) FIT
(-) 76 110/80 20 CM (-) (-) (-) (-) FIT
(-) 87 130/80 20 CM (-) (-) (-) (-) FIT
(-) 89 130/80 19 CM (-) (-) (-) (-) FIT
(-) 78 120/80 19 CM (-) (-) (-) (-) FIT
(-) 91 130/90 20 CM (-) (-) (-) (-) FIT
(-) 85 110/80 20 CM (-) (-) (-) (-) FIT
(-) 82 120/80 18 CM (-) (-) (-) (-) FIT
(-) 80 110/70 22 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/N Keluh Nadi

No Tanggal DCU DCU Nama PJP Jabatan/Jenis Pekerjaan
Lahir KTP o ID Card an

1 7/19/2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-) 74
2 7/19/2019 06.31 Rakhmanto 10/25/1979
321210251079 0001
27272 PT. Nurcahya Intan HSE (-) 78
3 7/19/2019 06.32 Durma PT.Alpha&Omega El Jireh Cleaning Services (-) 72
4 7/19/2019 06.33 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services (-) 71
5 7/19/2019 06.34 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-) 78
6 7/19/2019 06.35 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 79
7 7/19/2019 06.36 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-) 79
8 7/19/2019 06.37 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-) 86
9 7/19/2019 06.38 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-) 79
10 7/19/2019 06.39 Brohim PT. Alpha&Omega El Jireh Receiving&Storage (-) 78
11 7/19/2019 06.40 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-) 87
12 7/19/2019 06.41 Khafid 3/8/1982 PT.Nurcahya Intan HSE (-) 73
13 7/19/2019 06.42 sumarto 1/29/1973
32121529173 0001 PT. Alpha & Omega El Jireh Operator Loading (-) 83
14 7/19/2019 06.43 Juandana 30/7/1982 744125 Organik P2 (-) 68
15 7/19/2019 06.44 Viki Dharma Alghozali PERTAMINA Tech. Maintenance (-) 79
16 7/19/2019 06.45 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2 (-) 74
17 7/19/2019 06.46 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind (-) 86
18 7/19/2019 06.47 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution(-) 92
19 7/19/2019 06.48 Ari Yunanto PERTAMINA Spv Engineering Planning & Maintenance (-) 79
20 7/19/2019 06.49 Frigalf Thedy Miha Leo PERTAMINA Jr Spv Distribution Bottle LPG (-) 72
21 7/19/2019 06.50 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support (-) 88
22 7/19/2019 06.51 Harry R 4/4/1990 PT. Nurcahya Intan Adm (-) 89
23 7/19/2019 06.52 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS (-) 80
24 7/19/2019 06.53 Parjan (-) 80
25 7/19/2019 06.54 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-) 71
26 7/19/2019 06.55 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-) 80
27 7/19/2019 06.56 Rangga P 11/20/1975 PERTAMINA Spv HSSE (-) 72
28 7/19/2019 06.57Ruswan Purnasetia Binangkit PERTAMINA Jr Spv Sales & General Adm (-) 86
29 7/19/2019 06.58 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan (-) 80
30 7/19/2019 14.30 Wahidin 15/09/1973
321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading (-) 81
31 7/19/2019 14.31 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading (-) 71
32 7/19/2019 14.32 Febriyono Cleaning Services PT.Alpha&Omega El Jireh (-) 78
33 7/19/2019 14.33 M. Walid Noldi 5/18/1996
321214180596 0002
### PT. Alpha & Omega El Jireh P2 (-) 88
34 7/19/2019 14.34 Khamir PT.Alpha&Omega El Jireh Operator Loading (-) 81
35 7/19/2019 14.35 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE (-) 80
36 7/19/2019 14.36 Ahmad Taufik PT. Nurcahya Intan Gate Keeper (-) 71
37 7/19/2019 14.37 Rudi Harno 5/29/1973
321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading (-) 87
38 7/19/2019 14.38 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification (-) 76
39 7/19/2019 22.30 Sumarto PT.Nurcahya Intan HSE (-) 80
40 7/19/2019 22.31 Abdul Basit PTC Security (-) 80
41 7/19/2019 22.32 Sodikin Alpha O P2 (-) 78
42 7/19/2019 22.33 Caskam PTC Security (-) 80
43 7/19/2019 22.34 Hary Dwi.S Alpha O P2 (-) 82
44 7/19/2019 22.35 Fery Eliswanto PT.Nurcahya Intan HSE (-) 85
45 7/19/2019 22.36 Ismail PT.Nurcahya Intan HSE (-) 80

Total kunjungan Tanggal 19/07/2019 : 45 Orang

Total FIT : 45 Orang
Total UNFIT : 0 Orang
 Pern Tes Alcohol Kesimpul
afasa Kesada Reflek Tes
TD Tandem Breath
ran Cahaya Romberg Walking an
n Tester
110/70 21 CM (-) (-) (-) (-) FIT
110/80 21 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
120/80 22 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
90/60 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
100/70 18 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
110/70 22 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
130/90 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 18 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
100/60 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
110/70 19 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
110/70 19 CM (-) (-) (-) (-) FIT
130/80 19 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
120/80 18 CM (-) (-) (-) (-) FIT
120/80 22 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. KTP Nopek/No ID Kelu Nadi

No Tanggal DCU DCU Nama PJP Jabatan/Jenis Pekerjaan
Lahir Card han

1 7/20/2019 06.30 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 87
2 7/20/2019 06.31 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-) 86
3 7/20/2019 06.32 Brohim PT. Alpha&Omega El Jireh Receiving&Storage (-) 77
4 7/20/2019 06.33 Juandana 30/7/1982 744125 Organik P2 (-) 68
5 7/20/2019 06.34 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2 (-) 72
6 7/20/2019 06.35 Harry R 4/4/1990 PT. Nurcahya Intan Adm (-) 89
7 7/20/2019 06.36 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-) 80
8 7/20/2019 06.37 Khamir PT.Alpha&Omega El Jireh Operator Loading (-) 86
9 7/20/2019 06.38 Kasdi 4/14/198432121414 0487 0001 PT. Nurcahya Intan Teknik (-) 78
10 7/20/2019 06.39 Agus Santoso PT. PTC Security (-) 79
11 7/20/2019 06.40 Rudi Harno 5/29/1973321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading (-) 82
12 7/20/2019 06.41 Wahyono PT. Nurcahya Intan HSE Operation Support (-) 76
13 7/20/2019 06.42 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading (-) 88
14 7/20/2019 06.43 Nasion Tri Utomo PT. PTC Security (-) 84
15 7/20/2019 14.30 Hamdan Fauzi PT. Alpha&Omega El Jireh Operator Loading (-) 80
16 7/20/2019 14.31 Cholik Santoso 6/23/1976 27275 PT. Nurcahya Intan Gate Keeper (-) 67
17 7/20/2019 14.32 M. Walid Noldi 5/18/1996321214180596 00028/31/1976 PT. Alpha & Omega El Jireh P2 (-) 85
18 7/20/2019 14.33 Runedi PT. Alpha & Omega El Jireh P2 (-) 87
19 7/20/2019 14.34 Abdul Basit 7/10/1983 12/17/1930 PT. PTC Security (-) 79
20 7/20/2019 14.35 Ismail 11/20/1969 PT. Nurcahya Intan HSE (-) 88
21 7/20/2019 14.36 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification (-) 76
22 7/20/2019 22.30 Syarifudin PT.Nurcahya Intan HSE (-) 80
23 7/20/2019 22.31 Deden Arif.R Patra traiding Security (-) 82
24 7/20/2019 22.32 Sodikin Alpha O P2 (-) 85
25 7/20/2019 22.33 Caskam PTC Security (-) 80
26 7/20/2019 22.34 Hary Dwi.S Alpha O P2 (-) 82
27 7/20/2019 22.35 Fery Eliswanto PT.Nurcahya Intan HSE (-) 78
28 7/20/2019 22.36 Nevi Yandra Organik P2 (-) 80
29 7/20/2019 22.37 Juandana Organik P2 (-) 80

Total kunjungan Tanggal 20/07/2019 : 29 Orang

Total FIT : 29 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Pernaf Kesadaran Reflek Tes
TD Tandem Breath Kesimpulan
asan Cahaya Romberg Walking Tester
130/80 20 CM (-) (-) (-) (-) FIT
90/70 22 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
90/70 18 CM (-) (-) (-) (-) FIT
110/70 22 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
110/80 18 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
100/70 22 CM (-) (-) (-) (-) FIT
130/90 20 CM (-) (-) (-) (-) FIT
110/80 21 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
120/80 22 CM (-) (-) (-) (-) FIT
90/70 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal Nopek/No

No Tanggal DCU DCU Nama NIK/No. KTP PJP Jabatan/Jenis Pekerjaan
Lahir ID Card

1 7/21/2019 06.30 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery
2 7/21/2019 06.31 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic
3 7/21/2019 06.32 Heriyawan PT. Alpha&Omega El Jireh Operator Loading
4 7/21/2019 06.33 Khamir PT.Alpha&Omega El Jireh Operator Loading
5 7/21/2019 06.34 M. Walid Noldi 5/18/1996 321214180596 0002 8/31/1976 PT. Alpha & Omega El Jireh P2
6 7/21/2019 06.35 Agus Santoso PT. PTC Security
7 7/21/2019 06.36 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading
8 7/21/2019 06.37 Wahyono PT. Nurcahya Intan HSE Operation Support
9 7/21/2019 06.38 Moh.Solek 15/3/1980 113889 PTC Security
10 7/21/2019 06.39 Memet Rahmat Hidayat 11/20/1975 JR 0270267 PT. Nurcahaya Intan HSE Operation Support
11 7/21/2019 06.40 Ahmad Taufik PT. Nurcahya Intan Gate Keeper
12 7/21/2019 06.41 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading
13 7/21/2019 06.42 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan Teknik
14 7/21/2019 06.43 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification
15 7/21/2019 14.30 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE
16 7/21/2019 14.31 Abdul Basit 7/10/1983 12/17/1930 PT. PTC Security
17 7/21/2019 14.32 Runedi PT. Alpha & Omega El Jireh P2
18 7/21/2019 14.33 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage
19 7/21/2019 22.30 Sumarto PT.Nurcahya Intan HSE
20 7/21/2019 22.31 Deden Arif.R Patra traiding Security
21 7/21/2019 22.32 Brohim Alpha O P2
22 7/21/2019 22.33 Caskam PTC Security
23 7/21/2019 22.34 M.Sulkhin Alpha O P2
24 7/21/2019 22.35 Khafid PT.Nurcahya Intan HSE
25 7/21/2019 22.36 Nevi Yandra Organik P2
Total kunjungan Tanggal 21/07/2019 : 18 Orang
Total FIT : 18 Orang
Total UNFIT : 0 Orang
III

Tes Alcohol Kesimpula

Pernafasa Kesadaran Reflek Tes
Keluhan Nadi TD Tandem Breath
n Cahaya Romberg n
Walking Tester
(-) 79 120/80 20 CM (-) (-) (-) (-) FIT
(-) 76 110/70 22 CM (-) (-) (-) (-) FIT
(-) 91 130/90 20 CM (-) (-) (-) (-) FIT
(-) 86 120/80 20 CM (-) (-) (-) (-) FIT
(-) 85 120/80 20 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 78 110/80 19 CM (-) (-) (-) (-) FIT
(-) 76 110/70 20 CM (-) (-) (-) (-) FIT
(-) 71 90/70 20 CM (-) (-) (-) (-) FIT
(-) 75 110/70 20 CM (-) (-) (-) (-) FIT
(-) 69 90/70 19 CM (-) (-) (-) (-) FIT
(-) 88 110/70 19 CM (-) (-) (-) (-) FIT
(-) 84 120/80 20 CM (-) (-) (-) (-) FIT
(-) 76 100/70 20 CM (-) (-) (-) (-) FIT
(-) 68 90/70 21 CM (-) (-) (-) (-) FIT
(-) 69 100/70 20 CM (-) (-) (-) (-) FIT
(-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 110/80 19 CM (-) (-) (-) (-) FIT
tidak ada 80 110/80 20 CM (-) (-) (-) (-) FIT
tidak ada 78 110/80 19 CM (-) (-) (-) (-) FIT
tidak ada 85 120/80 18 CM (-) (-) (-) (-) FIT
tidak ada 80 130/90 20 CM (-) (-) (-) (-) FIT
tidak ada 82 100/70 18 CM (-) (-) (-) (-) FIT
tidak ada 78 100/70 20 CM (-) (-) (-) (-) FIT
tidak ada 80 110/80 22 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal Nopek/No ID

No Tanggal DCU DCU Nama NIK/No. KTP PJP
Lahir Card

1 7/22/2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh
2 7/22/2019 06.35 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan
3 7/22/2019 06.40 Durma PT.Alpha&Omega El Jireh
4 7/22/2019 06.45 Alam Kurniawan PT.Alpha&Omega El Jireh
5 7/22/2019 06.50 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan
6 7/22/2019 06.55 Bambang Winarto 12/21/1964 748515 PERTAMINA
7 7/22/2019 07.00 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh
8 7/22/2019 07.05 Susianudin 11/5/1971 200900 PT. Nurcahya Intan
9 7/22/2019 07.10 Panji Setyo Wibowo PERTAMINA
10 7/22/2019 07.15 Viki Dharma Alghozali PERTAMINA
11 7/22/2019 07.20 Rustamadji 745012 PERTAMINA
12 7/22/2019 07.25 Hanito Kusuma PERTAMINA
13 7/22/2019 07.30 Ari Yunanto PERTAMINA
14 7/22/2019 07.35 Waryudi PT.Alpha&Omega El Jireh
15 7/22/2019 07.40 Suradi 7/24/1974 20534 PT. Prima Armada Raya
16 7/22/2019 07.45 Rangga P 11/20/1975 PERTAMINA
17 7/22/2019 07.50 Cholik Santoso 6/23/1976 27275 PT. Nurcahya Intan
18 7/22/2019 07.55 M. Walid Noldi 5/18/1996 321214180596 0002 8/31/1976 PT. Alpha & Omega El Jireh
19 7/22/2019 08.00 Wahyono PT. Nurcahya Intan
20 7/22/2019 08.03 Akhmad Mubarok PT. Nurcahya Intan
21 7/22/2019 08.05 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan
22 7/22/2019 08.07 Febriyono PT.Alpha&Omega El Jireh
23 7/22/2019 08.09 Moh.Solek 15/3/1980 113889 PTC
24 7/22/2019 08.11 Agus Santoso PTC
25 7/22/2019 08.13 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan
26 7/22/2019 08.15 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh
27 7/22/2019 08.17 Memet Rahmat Hidayat 11/20/1975 JR 0270267 PT. Nurcahaya Intan
28 7/22/2019 08.19 Hanikha Alamsyah 10/24/1997 321214241097 0001
29 7/22/2019 08.21 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh
30 7/22/2019 08.23 Suherman 11/29/1963 663555 PERTAMINA
31 7/22/2019 08.25 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA
32 7/22/2019 08.27 Zamroni 7/13/1989 PT. Prima Armada Raya
33 7/22/2019 14.30 Mustafid PT. Nurcahya Intan
34 7/22/2019 14.40 Abdul Basit 7/10/1983 113908 PT. PTC
35 7/22/2019 14.50 Runedi PT. Alpha & Omega El Jireh
36 7/22/2019 15.10 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan
37 7/22/2019 15.15 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh
38 7/22/2019 15.20 Fery Eliswanto 8/29/1996 PT. Nurcahaya Intan
39 7/22/2019 15.25 Warka'i PT.Alpha O
40 7/22/2019 15.30 Dicky Ortega 6/17/1992 36007 PT. Alpha & Omega El Jireh
41 7/22/2019 22.30 Khafid PT.Nurcahya Intan
42 7/22/2019 22.31 Deden Arif.R Patra traiding
43 7/22/2019 22.32 Brohim Alpha O
44 7/22/2019 22.33 Nasion Tri Utomo PTC
45 7/22/2019 22.34 Juandana Organik

Total kunjungan Tanggal 22/07/2019 : 45 Orang

Total FIT : 45 Orang
Total UNFIT : 0 Orang
Check Up MOR III

Tes Alcohol Kesimp

Kelu Nadi Pernaf Kesad Reflek Tes
Jabatan/Jenis Pekerjaan TD Romberg Walking Breath
Tandem
han asan aran Cahaya ulan
Tester

CS (-) 72 110/70 21 CM (-) (-) (-) (-) FIT

HSE (-) 78 100/70 21 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 81 120/80 20 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 87 120/80 20 CM (-) (-) (-) (-) FIT
Teknik (-) 76 110/70 20 CM (-) (-) (-) (-) FIT
Ast. Fire & Safery (-) 79 110/80 20 CM (-) (-) (-) (-) FIT
CS (-) 72 110/70 21 CM (-) (-) (-) (-) FIT
Mecanic (-) 68 90/70 22 CM (-) (-) (-) (-) FIT
Jr. Ast. Fire&Safety (-) 79 110/80 20 CM (-) (-) (-) (-) FIT
Tech. Maintenance (-) 65 90/70 20 CM (-) (-) (-) (-) FIT
Ast. Environmental & Hygiene Ind(-) 86 120/80 20 CM (-) (-) (-) (-) FIT
Spv Receiving, Storage & Distribution
(-) 92 140/90 20 CM (-) (-) (-) (-) FIT
Spv Engineering Planning & Maintenance
(-) 86 120/80 20 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 71 100/70 19 CM (-) (-) (-) (-) FIT
Driver (-) 86 120/70 20 CM (-) (-) (-) (-) FIT
Spv HSSE (-) 72 100/70 20 CM (-) (-) (-) (-) FIT
Gate Keeper (-) 78 110/80 20 CM (-) (-) (-) (-) FIT
P2 (-) 85 120/80 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 76 110/80 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 73 110/70 20 CM (-) (-) (-) (-) FIT
Teknik (-) 88 120/80 19 CM (-) (-) (-) (-) FIT
Cleaning Services (-) 78 110/70 19 CM (-) (-) (-) (-) FIT
Security (-) 71 100/70 20 CM (-) (-) (-) (-) FIT
Security (-) 80 120/80 19 CM (-) (-) (-) (-) FIT
Teknik (-) 78 110/70 20 CM (-) (-) (-) (-) FIT
P1 (-) 82 120/80 21 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 69 100/70 22 CM (-) (-) (-) (-) FIT
CS (-) 78 110/70 18 CM (-) (-) (-) (-) FIT
OH Depot LPG Balongan (-) 80 120/80 20 CM (-) (-) (-) (-) FIT
Distribution Bottle (-) 74 100/70 21 CM (-) (-) (-) (-) FIT
Driver (-) 85 130/80 20 CM (-) (-) (-) (-) FIT
Gate Keeper (-) 77 120/80 20 CM (-) (-) (-) (-) FIT
Security (-) 76 110/80 20 CM (-) (-) (-) (-) FIT
P2 (-) 80 120/80 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 78 120/80 19 CM (-) (-) (-) (-) FIT
Operator Loading (-) 80 130/80 20 CM (-) (-) (-) (-) FIT
HSE Operation Support (-) 76 110/80 19 CM (-) (-) (-) (-) FIT
P2 (-) 76 110/80 19 CM (-) (-) (-) (-) FIT
P1 (-) 78 110/80 19 CM (-) (-) (-) (-) FIT
HSE (-) 80 110/80 19 CM (-) (-) (-) (-) FIT
Security (-) 78 120/80 18 CM (-) (-) (-) (-) FIT
P2 (-) 80 120/80 18 CM (-) (-) (-) (-) FIT
Security (-) 82 110/80 20 CM (-) (-) (-) (-) FIT
P2 (-) 81 90/70 18 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No
No Tanggal DCU DCU Nama Tanggal Lahir NIK/No. KTP PJP Jabatan/Jenis Pekerjaan Keluhan
ID Card

1 23 juli 2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-)
2 23 juli 2019 06.33 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE (-)
3 23 juli 2019 06.36 Durma PT.Alpha&Omega El Jireh Cleaning Services (-)
4 23 juli 2019 06.39 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services (-)
5 23 juli 2019 06.42 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-)
6 23 juli 2019 06.45 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-)
7 23 juli 2019 06.48 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-)
8 23 juli 2019 06.51 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-)
9 23 juli 2019 06.54 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-)
10 23 juli 2019 06.57 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene Ind (-)
11 23 juli 2019 07.00 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution (-)
12 23 juli 2019 07.05 Ari Yunanto PERTAMINA Spv Engineering Planning & Maintenance (-)
13 23 juli 2019 07.10 Waryudi PT.Alpha&Omega El Jireh Cleaning Services (-)
14 23 juli 2019 07.15 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-)
15 23 juli 2019 07.20 Rangga P 11/20/1975 PERTAMINA Spv HSSE (-)
16 23 juli 2019 07.25 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan (-)
17 23 juli 2019 07.30 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support (-)
18 23 juli 2019 07.35 Moh.Solek 15/3/1980 113889 PTC Security (-)
19 23 juli 2019 07.40 Agus Santoso PTC Security (-)
20 23 juli 2019 07.45 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh P1 (-)
21 23 juli 2019 07.50 Hanikha Alamsyah 10/24/1997 321214241097 0001 (-)
22 23 juli 2019 07.55 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS (-)
23 23 juli 2019 08.00 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle (-)
24 23 juli 2019 08.03 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-)
25 23 juli 2019 08.06 Cholik Santoso 6/23/1976 27275 PT. Nurcahya Intan Gate Keeper (-)
26 23 juli 2019 08.09 Harry R 4/4/1990 PT. Nurcahya Intan Adm (-)
27 23 juli 2019 08.12 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE (-)
28 23 juli 2019 Yaseer Gary Rigel Hakim Khan ###
08.15 PERTAMINA Administrator Sales & General Adm (-)
29 23 juli 2019 08.18 Yuyun Wahyuni PT. Nurcahya Intan Operator Administration (-)
30 23 juli 2019 08.21 Ismail 11/20/1969 PT. Nurcahya Intan HSE (-)
31 23 juli 2019 08.24 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-)
32 7/23/2019 14.15 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage (-)
33 7/23/2019 14.16 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading (-)
34 7/23/2019 14.17 Kamir 10/10/1976 321214101076 0003 77 PT. Alpha&Omega EL Jireh Operator Loading (-)
35 7/23/2019 14.18 Hary D S PT. Alpha & Omega El Jireh P2 (-)
36 7/23/2019 14.25 Caskam 15/6/1973 113910 PTC Security (-)
37 7/23/2019 14.39 Fery Eliswanto 8/29/1996 PT. Nurcahaya Intan HSE Operation Support (-)
38 7/23/2019 15.15 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan HSE Operation Support (-)
39 7/23/2019 22.30 Khafid PT.Nurcahya Intan HSE (-)
40 7/23/2019 22.31 Sumarto PT.Nurcahya Intan HSE (-)
41 7/23/2019 22.32 Juandana Organik P2 (-)
42 7/23/2019 22.33 Nasion Tri Utomo PTC Security (-)

Total kunjungan Tanggal 23/07/2019 : 42 Orang

Total FIT : 42 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
TD Pernafa Kesadara Reflek Tes
Nadi Tandem Breath Kesimpulan
san n Cahaya Romberg Walking Tester
72 110/70 21 CM (-) (-) (-) (-) FIT
79 110/70 21 CM (-) (-) (-) (-) FIT
81 110/80 20 CM (-) (-) (-) (-) FIT
78 110/70 20 CM (-) (-) (-) (-) FIT
76 100/70 20 CM (-) (-) (-) (-) FIT
87 120/80 20 CM (-) (-) (-) (-) FIT
72 110/70 21 CM (-) (-) (-) (-) FIT
81 110/70 22 CM (-) (-) (-) (-) FIT
75 110/80 20 CM (-) (-) (-) (-) FIT
86 110/70 20 CM (-) (-) (-) (-) FIT
92 130/80 20 CM (-) (-) (-) (-) FIT
78 110/80 20 CM (-) (-) (-) (-) FIT
82 120/80 19 CM (-) (-) (-) (-) FIT
86 120/70 20 CM (-) (-) (-) (-) FIT
71 100/70 20 CM (-) (-) (-) (-) FIT
89 130/80 20 CM (-) (-) (-) (-) FIT
87 120/80 20 CM (-) (-) (-) (-) FIT
82 120/80 20 CM (-) (-) (-) (-) FIT
89 130/80 19 CM (-) (-) (-) (-) FIT
82 120/80 21 CM (-) (-) (-) (-) FIT
69 90/70 22 CM (-) (-) (-) (-) FIT
76 110/70 18 CM (-) (-) (-) (-) FIT
79 110/70 21 CM (-) (-) (-) (-) FIT
79 110/70 20 CM (-) (-) (-) (-) FIT
67 100/70 20 CM (-) (-) (-) (-) FIT
66 90/70 20 CM (-) (-) (-) (-) FIT
69 100/70 19 CM (-) (-) (-) (-) FIT
69 90/60 19 CM (-) (-) (-) (-) FIT
72 90/70 20 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
78 100/70 20 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
80 140/80 20 CM (-) (-) (-) (-) FIT
78 130/80 20 CM (-) (-) (-) (-) FIT
77 110/80 20 CM (-) (-) (-) (-) FIT
78 120/80 19 CM (-) (-) (-) (-) FIT
76 110/80 19 CM (-) (-) (-) (-) FIT
78 120/80 19 CM (-) (-) (-) (-) FIT
80 120/80 18 CM (-) (-) (-) (-) FIT
78 120/80 20 CM (-) (-) (-) (-) FIT
85 90/70 22 CM (-) (-) (-) (-) FIT
82 110/70 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/No Jabatan/Jenis Keluh

No Tanggal DCU Nama PJP Nadi
DCU Lahir KTP ID Card Pekerjaan an

1 7/24/2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-) 84
2 7/24/2019 06.33 Durma PT.Alpha&Omega El Jireh Cleaning Services (-) 86
3 7/24/2019 06.36 Alam Kurniawan PT.Alpha&Omega El Jireh Cleaning Services (-) 69
4 7/24/2019 06.39 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-) 67
5 7/24/2019 06.42 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-) 79
6 7/24/2019 06.45 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-) 82
7 7/24/2019 06.48 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic (-) 76
8 7/24/2019 06.51 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-) 81
9 7/24/2019 06.54 Panji Setyo Wibowo PERTAMINA Jr. Ast. Fire&Safety (-) 79
10 7/24/2019 06.57 Viki Dharma Alghozali PERTAMINA Tech. Maintenance (-) 81
11 7/24/2019 07.00 Rustamadji 745012 PERTAMINA Ast. Environmental & Hygiene (-)
Ind 70
12 7/24/2019 07.03 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
(-) 94
13 7/24/2019 07.06 Ari Yunanto PERTAMINA Spv Engineering Planning & Maintenance
(-) 79
14 7/24/2019 07.09 Harry R 4/4/1990 PT. Nurcahya Intan Adm (-) 81
15 7/24/2019 07.12 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS (-) 80
16 7/24/2019 07.15 Parjan PT. Alpha&Omega El Jireh Operator Loading (-) 87
17 7/24/2019 07.18 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver (-) 71
18 7/24/2019 07.21 Rangga P 11/20/1975 PERTAMINA Spv HSSE (-) 76
19 7/24/2019 07.24 Suherman 11/29/1963 663555 PERTAMINA OH Depot LPG Balongan (-) 80
20 7/24/2019 07.27 Warka'i 11/5/1981 28004 PT. Alpha & Omega El Jireh P2 (-) 67
21 7/24/2019 07.30 Nendi PT.Alpha&Omega El Jireh Cleaning Services (-) 63
22 7/24/2019 07.33 Dicky Ortega PT. Alpha&Omega El Jireh Operator Loading (-) 72
23 7/24/2019 07.36 Rakhmanto 10/25/1979
321210251079 000127272 PT. Nurcahya Intan HSE (-) 78
24 7/24/2019 07.39 Kasdi 4/14/1984
32121414 0487 0001 PT. Nurcahya Intan Teknik (-) 84
25 7/24/2019 07.42 Runedi PT. Alpha & Omega El Jireh P2 (-) 87
26 7/24/2019 07.45 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE (-) 71
27 7/24/2019 07.48 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage (-) 68
28 7/24/2019 07.51 Aryanto PT. Nurcahya Intan Maintenance&Utilities (-) 89
29 7/24/2019 07.54 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-) 82
30 7/24/2019 07.57 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support (-) 81
31 7/24/2019 08.00 Alif Akbar Satria N 4/17/1999
321215171499 0005
754787 PERTAMINA Distribution Bottle (-) 78
32 7/24/2019 Yaseer Gary Rigel Hakim Khan ###
08.03 PERTAMINA Administrator Sales & General Adm
(-) 72
33 7/24/2019 08.06 Fery Eliswanto PT. Nurcahya Intan HSE Operation Support (-) 79
34 7/24/2019 08.09 Ismail 11/20/1969 PT. Nurcahya Intan HSE (-) 78
35 7/24/2019 14.30 Rudi Harno 5/29/1973
321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading (-) 91
36 7/24/2019 14.31 Wahidin 15/09/1973
321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading (-) 78
37 7/24/2019 14.32 Sodikin PT. Alpha & Omega El Jireh P2 (-) 79
38 7/24/2019 14.33 Ahmad Taufik PT. Nurcahya Intan Gate Keeper (-) 71
39 7/24/2019 14.34 Khamir PT.Alpha&Omega El Jireh Operator Loading (-) 89
40 7/24/2019 14.35 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage (-) 80
41 7/24/2019 14.36 Caskam 15/6/1973 113910 PTC Security (-) 81
42 7/24/2019 14.37 Toifudin PTC Security (-) 86
43 7/24/2019 14.38 Abdul Basit 7/10/1983 12/17/1930 PT. PTC Security (-) 69
44 7/24/2019 14.39 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading (-) 88
45 7/24/2019 22.30 Wahyono PT.Nurcahya Intan HSE (-) 80
46 7/24/2019 22.31 Memet R.H PT.Nurcahya Intan HSE (-) 82
47 7/24/2019 22.32 Juandana Organik P2 (-) 85
48 7/24/2019 22.33 M.Walid Noldi Alpha O P2 (-) 78
49 7/24/2019 22.34 Nasion Tri Utomo PTC Security (-) 80

Total kunjungan Tanggal 24/07/2019 : 49 Orang

Total FIT : 49 Orang
Total UNFIT : 0 Orang
 Tes Alcohol
Pernafasa Kesadaran Reflek Tes
TD Tandem Breath Kesimpulan
n Cahaya Romberg Walking Tester
120/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
90/70 20 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 19 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
100/60 20 CM (-) (-) (-) (-) FIT
130/90 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 18 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
100/60 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
90/70 19 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
110/70 21 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
110/70 19 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
130/80 19 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 21 CM (-) (-) (-) (-) FIT
90/60 19 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
130/80 19 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
130/80 20 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
130/80 19 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
130/80 19 CM (-) (-) (-) (-) FIT
110/70 22 CM (-) (-) (-) (-) FIT
110/80 18 CM (-) (-) (-) (-) FIT
90/70 22 CM (-) (-) (-) (-) FIT
120/80 22 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No ID Jabatan/Jenis

No Tanggal DCU DCU Nama Tanggal Lahir NIK/No. KTP PJP Keluhan
Card Pekerjaan

1 7/25/2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS (-)
2 7/25/2019 06.34 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE (-)
3 7/25/2019 06.38 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik (-)
4 7/25/2019 06.42 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery (-)
5 7/25/2019 06.46 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS (-)
6 7/25/2019 06.50 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS (-)
7 7/25/2019 06.54 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan Teknik (-)
8 7/25/2019 06.58 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Verification(-)
9 7/25/2019 07.00 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading (-)
10 7/25/2019 07.03 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE (-)
11 7/25/2019 07.06 Warka'i 11/5/1981 28004 PT. Alpha & Omega El Jireh P2 (-)
12 7/25/2019 07.09 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS (-)
13 7/25/2019 07.12 Aryanto PT. Nurcahya Intan Maintenance&Utilities (-)
14 7/25/2019 07.15 Harry R 4/4/1990 PT. Nurcahya Intan Adm (-)
15 7/25/2019 07.18 Parjan (-)
16 7/25/2019 07.21 Dicky Ortega PT. Alpha&Omega El Jireh Operator Loading (-)
17 7/25/2019 07.24 Runedi PT. Alpha & Omega El Jireh P2 (-)
18 7/25/2019 07.27 Durma PT.Alpha&Omega El Jireh Cleaning Services (-)
19 7/25/2019 07.30 Alam PT.Alpha&Omega El Jireh Cleaning Services (-)
20 7/25/2019 07.33 Dayana PT.Alpha&Omega El Jireh Cleaning Services (-)
21 7/25/2019 07.36 Hanikha Alamsyah 10/24/1997 321214241097 0001 (-)
22 7/25/2019 07.39 Ismail 11/20/1969 PT. Nurcahya Intan HSE (-)
23 7/25/2019 07.42 Rangga P 11/20/1975 PERTAMINA Spv HSSE (-)
24 7/25/2019 07.45 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle (-)
25 7/25/2019 07.48 Zamroni 7/13/1989 PT. Prima Armada Raya Driver (-)
26 7/25/2019 07.51 Panji Setyo W 3/24/1995 3204282403950000 PERTAMINA OJT HSSE (-)
27 7/25/2019 14.30 Kadrawi PT.Alpha&Omega El Jireh Handling 12 kg (-)
28 7/25/2019 14.35 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage (-)
29 7/25/2019 14.40 Toifudin PTC Security (-)
30 7/25/2019 14.45 Deny Suryana ### PERTAMINA Administrator Distribution Verification
(-)
31 7/25/2019 14.50 Adhita Adhitya Sudrajat PERTAMINA Jr Spv Distribution Bulk LPG (-)
32 7/25/2019 14.55 Abdul Basit 7/10/1983 PT. PTC Security (-)
33 7/25/2019 15.00 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage (-)
34 7/25/2019 15.05 Khafid 3/8/1982 PT.Nurcahya Intan HSE (-)
35 7/25/2019 15.10 Sumarto 10/6/1984 JR 02768 PT. Nurcahya Intan HSE (-)
36 7/25/2019 15.15 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading (-)
37 7/25/2019 15.20 Ahmad Taufik PT. Nurcahya Intan Gate Keeper (-)
38 7/25/2019 15.25 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading (-)
39 7/25/2019 22.30 Wahyono PT.Nurcahya Intan HSE (-)
40 7/25/2019 22.31 Memet R.H PT.Nurcahya Intan HSE (-)
41 7/25/2019 22.32 Agus Santoso PTC Security (-)
42 7/25/2019 22.33 M.Walid Noldi Alpha O P2 (-)

Total kunjungan Tanggal 25/07/2019 42Orang

Total FIT : 42 Orang
Total UNFIT : 0 Orang
 Tes Alcohol Kesimpul
Pernafasa Kesadaran Reflek Tes
Nadi TD Tandem Breath
n Cahaya Romberg Walking an
Tester
79 110/70 21 CM (-) (-) (-) (-) FIT
69 100/70 20 CM (-) (-) (-) (-) FIT
71 110/70 20 CM (-) (-) (-) (-) FIT
71 110/80 20 CM (-) (-) (-) (-) FIT
78 110/80 21 CM (-) (-) (-) (-) FIT
78 120/80 18 CM (-) (-) (-) (-) FIT
84 110/80 21 CM (-) (-) (-) (-) FIT
79 110/70 20 CM (-) (-) (-) (-) FIT
81 120/80 19 CM (-) (-) (-) (-) FIT
76 110/70 19 CM (-) (-) (-) (-) FIT
74 100/70 20 CM (-) (-) (-) (-) FIT
82 110/80 20 CM (-) (-) (-) (-) FIT
90 130/80 19 CM (-) (-) (-) (-) FIT
81 110/80 20 CM (-) (-) (-) (-) FIT
91 130/80 20 CM (-) (-) (-) (-) FIT
78 120/80 19 CM (-) (-) (-) (-) FIT
78 110/70 20 CM (-) (-) (-) (-) FIT
72 110/70 20 CM (-) (-) (-) (-) FIT
73 110/70 19 CM (-) (-) (-) (-) FIT
89 130/80 19 CM (-) (-) (-) (-) FIT
71 110/70 22 CM (-) (-) (-) (-) FIT
89 130/80 20 CM (-) (-) (-) (-) FIT
72 110/70 20 CM (-) (-) (-) (-) FIT
74 100/70 21 CM (-) (-) (-) (-) FIT
81 120/80 20 CM (-) (-) (-) (-) FIT
75 100/70 19 CM (-) (-) (-) (-) FIT
80 120/80 20 CM (-) (-) (-) (-) FIT
82 120/80 19 CM (-) (-) (-) (-) FIT
81 120/80 19 CM (-) (-) (-) (-) FIT
88 120/80 19 CM (-) (-) (-) (-) FIT
67 100/70 19 CM (-) (-) (-) (-) FIT
82 120/80 20 CM (-) (-) (-) (-) FIT
78 110/70 19 CM (-) (-) (-) (-) FIT
69 90/60 20 CM (-) (-) (-) (-) FIT
76 100/70 20 CM (-) (-) (-) (-) FIT
88 130/80 19 CM (-) (-) (-) (-) FIT
69 100/70 19 CM (-) (-) (-) (-) FIT
89 130/80 19 CM (-) (-) (-) (-) FIT
78 100/70 18 CM (-) (-) (-) (-) FIT
80 110/80 20 CM (-) (-) (-) (-) FIT
82 130/90 19 CM (-) (-) (-) (-) FIT
78 110/80 20 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Nopek/No ID Jabatan/Jenis
No Tanggal DCU Jam DCU Nama Tanggal Lahir NIK/No. KTP PJP
Card Pekerjaan

1 7/26/2019 06.30 M. Abdul Musa 10/2/1992 28006 PT. Alpha & Omega El Jireh CS
2 7/26/2019 06.31 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE
3 7/26/2019 06.32 Hanito Kusuma PERTAMINA Spv Receiving, Storage & Distribution
4 7/26/2019 06.33 Suradi 7/24/1974 20534 PT. Prima Armada Raya Driver
5 7/26/2019 06.34 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
6 7/26/2019 06.35 Bambang Winarto 12/21/1964 748515 PERTAMINA Ast. Fire & Safery
7 7/26/2019 06.36 Mustahil 7/10/1988 PT. Alpha & Omega El Jireh CS
8 7/26/2019 06.37 Waryudi PT.Alpha&Omega El Jireh Cleaning Services
9 7/26/2019 06.38 Susianudin 11/5/1971 200900 PT. Nurcahya Intan Mecanic
10 7/26/2019 06.39 Juandana 30/7/1982 744125 Organik P2
11 7/26/2019 06.40 Abdul Basit 7/10/1983 12/17/1930 PT. PTC Security
12 7/26/2019 06.41 Kartisa 9/20/1975 28007 PT. Alpha & Omega El Jireh CS
13 7/26/2019 06.42 Kasdi 4/14/1984 32121414 0487 0001 PT. Nurcahya Intan Teknik
14 7/26/2019 06.43 Rudi Harno 5/29/1973 321215290573 0005 PT. Alpha & Omega El Jireh Operator Loading
15 7/26/2019 06.44 Warka'i 11/5/1981 28004 PT. Alpha & Omega El Jireh P2
16 7/26/2019 06.45 Hermanto 1/9/1992 PT. Alpha & Omega El Jireh CS
17 7/26/2019 06.46 Harry R 4/4/1990 PT. Nurcahya Intan Adm
18 7/26/2019 06.47 Runedi PT. Alpha & Omega El Jireh P2
19 7/26/2019 06.48 Durma PT.Alpha&Omega El Jireh Cleaning Services
20 7/26/2019 06.49 Alam PT.Alpha&Omega El Jireh Cleaning Services
21 7/26/2019 06.50 Hanikha Alamsyah 10/24/1997 321214241097 0001
22 7/26/2019 06.51 Rangga P 11/20/1975 PERTAMINA Spv HSSE
23 7/26/2019 06.52 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle
24 7/26/2019 06.53 Panji Setyo W 3/24/1995 3204282403950000 PERTAMINA OJT HSSE
25 7/26/2019 06.54 Deny Suryana ### PERTAMINA Administrator Distribution Verification
26 7/26/2019 06.55 Khamir PT.Alpha&Omega El Jireh Operator Loading
27 7/26/2019 06.56 Cholik Santoso 6/23/1976 27275 PT. Nurcahya Intan Gate Keeper
28 7/26/2019 06.57 nendi PT.Alpha&Omega El Jireh Cleaning Services
29 7/26/2019 06.58 Fery Eliswanto PT. Nurcahya Intan HSE Operation Support
30 7/26/2019 06.59 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan HSE Operation Support
31 7/26/2019 06.60 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support
32 7/26/2019 14.30 Hamdan Fauzi 4/2/1971 JR 036008 PT. Alpha & Omega El Jireh P1
33 7/26/2019 14.31 Brohim PT. Alpha&Omega El Jireh Receiving&Storage
34 7/26/2019 14.32 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2
35 7/26/2019 14.33 Viki Dharma Alghozali PERTAMINA Tech. Maintenance
36 7/26/2019 14.34 Khafid 3/8/1982 PT.Nurcahya Intan HSE
37 7/26/2019 14.35 Toifudin PTC Security
38 7/26/2019 14.36 Aryanto PT. Nurcahya Intan Maintenance&Utilities
39 7/26/2019 14.37 M. Walid Noldi 5/18/1996 321214180596 0002 PT. Alpha & Omega El Jireh P2
40 7/26/2019 14.38 Denny Ryan Putra 8/6/1983 752338 PERTAMINA Administrator Dist. Veri
41 7/26/2019 22.30 Wahyono PT.Nurcahya Intan HSE
42 7/26/2019 22.31 Memet R.H PT.Nurcahya Intan HSE
43 7/26/2019 22.32 Agus Santoso PTC Security
44 7/26/2019 22.33 M.Solek PTC Security

Total kunjungan Tanggal 26/07/2019 : 44 Orang

Total FIT : 44 Orang
Total UNFIT : 0 Orang
R III

Tes Alcohol Kesimpul

Pernafasa Kesadaran Reflek Tes
Keluhan Nadi TD Tandem Breath
n Cahaya Romberg Walking an
Tester
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 81 120/80 20 CM (-) (-) (-) (-) FIT
(-) 92 130/80 20 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 71 100/70 20 CM (-) (-) (-) (-) FIT
(-) 81 110/70 20 CM (-) (-) (-) (-) FIT
(-) 72 110/70 21 CM (-) (-) (-) (-) FIT
(-) 79 110/70 19 CM (-) (-) (-) (-) FIT
(-) 82 120/80 22 CM (-) (-) (-) (-) FIT
(-) 71 100/60 18 CM (-) (-) (-) (-) FIT
(-) 78 100/60 20 CM (-) (-) (-) (-) FIT
(-) 71 100/60 18 CM (-) (-) (-) (-) FIT
(-) 73 100/60 21 CM (-) (-) (-) (-) FIT
(-) 82 120/80 19 CM (-) (-) (-) (-) FIT
(-) 69 100/70 20 CM (-) (-) (-) (-) FIT
(-) 86 110/80 20 CM (-) (-) (-) (-) FIT
(-) 81 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 120/80 20 CM (-) (-) (-) (-) FIT
(-) 71 110/70 20 CM (-) (-) (-) (-) FIT
(-) 81 120/80 19 CM (-) (-) (-) (-) FIT
(-) 69 90/60 19 CM (-) (-) (-) (-) FIT
(-) 78 110/70 20 CM (-) (-) (-) (-) FIT
(-) 78 100/70 21 CM (-) (-) (-) (-) FIT
(-) 78 100/70 19 CM (-) (-) (-) (-) FIT
(-) 80 100/70 19 CM (-) (-) (-) (-) FIT
(-) 92 140/90 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 20 CM (-) (-) (-) (-) FIT
(-) 69 90/60 19 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 78 100/70 19 CM (-) (-) (-) (-) FIT
(-) 81 120/80 20 CM (-) (-) (-) (-) FIT
(-) 83 120/80 21 CM (-) (-) (-) (-) FIT
(-) 77 120/80 20 CM (-) (-) (-) (-) FIT
(-) 69 100/70 22 CM (-) (-) (-) (-) FIT
(-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70- 20 CM (-) (-) (-) (-) FIT
(-) 79 110/70 19 CM (-) (-) (-) (-) FIT
(-) 81 110/70 19 CM (-) (-) (-) (-) FIT
(-) 85 120/80 20 CM (-) (-) (-) (-) FIT
(-) 68 90/60 20 CM (-) (-) (-) (-) FIT
(-) 76 100/70 20 CM (-) (-) (-) (-) FIT
(-) 78 110/80 18 CM (-) (-) (-) (-) FIT
(-) 80 120/80 19 CM (-) (-) (-) (-) FIT
(-) 75 90/70 22 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Nopek/No ID
No Tanggal DCU Nama Tanggal Lahir NIK/No. KTP PJP Jabatan/Jenis Pekerjaan
DCU Card

1 7/27/2019 06.30 Rakhmanto 10/25/1979 321210251079 0001 27272 PT. Nurcahya Intan HSE
2 7/27/2019 06.31 Khafid 3/8/1982 PT.Nurcahya Intan HSE
3 7/27/2019 06.32 Harry R 4/4/1990 PT. Nurcahya Intan Adm
4 7/27/2019 06.33 Aryanto 5/4/1983 321214040583 0003 JR 027088 PT. Nurcahya Intan Teknik
5 7/27/2019 06.34 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787 PERTAMINA Distribution Bottle
6 7/27/2019 06.35 Zamroni 7/13/1989 PT. Prima Armada Raya Driver
7 7/27/2019 06.36 Khamir PT.Alpha&Omega El Jireh Operator Loading
8 7/27/2019 06.37 Afdilah 8/30/1981 JR 027 087 PT. Nurcahya Intan Teknik
9 7/27/2019 06.38 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage
10 7/27/2019 06.39 Sodikin PT. Alpha & Omega El Jireh P2
11 7/27/2019 06.40 Wahidin 15/09/1973 321214150973 0002 PT. Alpha & Omega El Jireh Operator Loading
12 7/27/2019 06.41 Syarifudin PT. Nurcahya Intan HSE Operation Support
13 7/27/2019 06.42 Akhmad Mubarok PT. Nurcahya Intan HSE Operation Support
14 7/27/2019 06.43 Fery Eliswanto PT. Nurcahya Intan HSE Operation Support
15 7/27/2019 06.44 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage
16 7/27/2019 14.30 Taka 7/8/1983 PT. Alpha & Omega El Jireh Operator Loading
17 7/27/2019 14.31 Abdul Basit 7/10/1983 PT. PTC Security
18 7/27/2019 14.32 Abdul Cholik PT. Alpha&Omega El Jireh Operator Loading
19 7/27/2019 14.33 Nasion Tri Utomo PT. PTC Security
20 7/27/2019 14.34 Caskam 15/6/1973 113910 PTC Security
21 7/27/2019 14.35 Adhita Adhitya Sudrajat PERTAMINA Jr Spv Distribution Bulk LPG
22 7/27/2019 14.36 Brohim PT. Alpha&Omega El Jireh Receiving&Storage
23 7/27/2019 14.37 Syamsul Fuady 1/26/1973 JR 027269 PT. Nurcahya Intan HSE
24 7/27/2019 14.38 Parjan
25 7/27/2019 14.39 sumarto 1/29/1973 32121529173 0001 PT. Alpha & Omega El Jireh Operator Loading
26 7/27/2019 14.40 Juandana 30/7/1982 744125 Organik P2
27 7/27/2019 22.30 Isma'il PT.Nurcahya Intan HSE
28 7/27/2019 22.31 Runedi Alpha O P2
29 7/27/2019 22.32 Agus Santoso PTC Security
30 7/27/2019 22.33 M.Solek PTC Security
31 7/27/2019 22.34 Warka'i Alpha O P2
Total kunjungan Tanggal 27/07/2019 : 26 Orang
Total FIT : 26 Orang
Total UNFIT : 0 Orang
I

Tes Alcohol Kesimpul

Pernaf Kesad Reflek Tes
Keluhan Nadi TD Tandem Breath
asan aran Cahaya Romberg Walking an
Tester
(-) 81 110/70 21 CM (-) (-) (-) (-) FIT
(-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 87 120/80 20 CM (-) (-) (-) (-) FIT
(-) 81 110/70 19 CM (-) (-) (-) (-) FIT
(-) 79 100/70 21 CM (-) (-) (-) (-) FIT
(-) 80 110/70 20 CM (-) (-) (-) (-) FIT
(-) 89 120/80 20 CM (-) (-) (-) (-) FIT
(-) 81 120/80 20 CM (-) (-) (-) (-) FIT
(-) 79 120/80 19 CM (-) (-) (-) (-) FIT
(-) 82 120/80 20 CM (-) (-) (-) (-) FIT
(-) 78 110/70 19 CM (-) (-) (-) (-) FIT
(-) 79 110/70 20 CM (-) (-) (-) (-) FIT
(-) 81 110/80 20 CM (-) (-) (-) (-) FIT
(-) 80 110/70 20 CM (-) (-) (-) (-) FIT
(-) 80 110/70 19 CM (-) (-) (-) (-) FIT
(-) 71 100/70 19 CM (-) (-) (-) (-) FIT
(-) 78 110/70 20 CM (-) (-) (-) (-) FIT
(-) 80 110/70 19 CM (-) (-) (-) (-) FIT
(-) 84 130/80 19 CM (-) (-) (-) (-) FIT
(-) 78 110/70 20 CM (-) (-) (-) (-) FIT
(-) 78 100/70 19 CM (-) (-) (-) (-) FIT
(-) 81 120/80 20 CM (-) (-) (-) (-) FIT
(-) 69 90/60 19 CM (-) (-) (-) (-) FIT
(-) 87 130/90 20 CM (-) (-) (-) (-) FIT
(-) 83 110/70 20 CM (-) (-) (-) (-) FIT
(-) 68 90/60 18 CM (-) (-) (-) (-) FIT
(-) 80 110/80 20 CM (-) (-) (-) (-) FIT
(-) 78 120/80 18 CM (-) (-) (-) (-) FIT
(-) 76 120/80 19 CM (-) (-) (-) (-) FIT
(-) 77 90/70 18 CM (-) (-) (-) (-) FIT
(-) 75 110/70 22 CM (-) (-) (-) (-) FIT
 Rekap Daily Check Up MOR III
Lokasi DCU: Depot LPG Balongan

Jam Tanggal NIK/No. Nopek/No Kelu Nadi

No Tanggal DCU DCU Nama PJP Jabatan/Jenis Pekerjaan
Lahir KTP ID Card han

1 7/28/2019 06.30 Brohim PT. Alpha&Omega El Jireh Receiving&Storage (-) 79

2 7/28/2019 06.31 Cholik Santoso 6/23/1976 27275 PT. Nurcahya Intan Gate Keeper (-) 78
3 7/28/2019 06.32 Nevi Yandra 3/8/1990 750206 PERTAMINA Spv Receiving & Storage (-) 79
4 7/28/2019 06.33 Sodikin PT. Alpha & Omega El Jireh P2 (-) 82
5 7/28/2019 06.34 Caskam 15/6/1973 113910 PTC Security (-) 80
6 7/28/2019 06.35 Syarifudin 2/15/1985 27 PT. Nurcahaya Intan HSE Operation Support (-) 71
7 7/28/2019 06.36 Toifudin PTC Security (-) 80
8 7/28/2019 06.37 Deny Suryana ### PERTAMINA Administrator Distribution Verification
(-) 77
9 7/28/2019 14.30 Nasion Tri Utomo PT. PTC Security (-) 84
10 7/28/2019 14.31 Hary Duwi S. PT. Alpha&Omega El Jireh Receiving&Storage (-) 80
11 7/28/2019 14.32Memet Rahmat Hidayat11/20/1975 JR 0270267 PT. Nurcahaya Intan HSE Operation Support (-) 72
12 7/28/2019 14.33 M. Sulkhin 9/10/1985 PT. Alpha & Omega El Jireh P2 (-) 78
13 7/28/2019 14.34 Wahyono PT. Nurcahya Intan HSE Operation Support (-) 76
14 7/28/2019 14.35 Juandana 30/7/1982 744125 PERTAMINA P2 (-) 68
15 7/28/2019 22.30 Isma'il PT.Nurcahya Intan HSE (-) 82
16 7/28/2019 22.31 Fery Eliswanto PT.Nurcahya Intan HSE (-) 80
17 7/28/2019 22.32 M.Toha PTC Security (-) 78
18 7/28/2019 22.33 Abdul Basit PTC Security (-) 85

Total kunjungan Tanggal 28/07/2019 : 18 Orang

Total FIT : 18 Orang
Total UNFIT : 0 Orang
 Tes Alcohol Kesimpul
Pernafa Kesadara Reflek Tes
TD Tandem Breath
san n Cahaya Romberg Walking an
Tester
110/70 20 CM (-) (-) (-) (-) FIT
110/70 20 CM (-) (-) (-) (-) FIT
110/70 19 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
120/80 20 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
110/80 19 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
100/70 19 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
100/80 22 CM (-) (-) (-) (-) FIT
100/70 20 CM (-) (-) (-) (-) FIT
90/60 18 CM (-) (-) (-) (-) FIT
120/80 19 CM (-) (-) (-) (-) FIT
120/80 18 CM (-) (-) (-) (-) FIT
110/80 20 CM (-) (-) (-) (-) FIT
100/70 18 CM (-) (-) (-) (-) FIT
 Rekap Daily Check
Lokasi DCU: Depot LPG Balongan

Tanggal NIK/No. Nopek/No

No Tanggal DCU Jam DCU Nama Lahir KTP ID Card

1 7/29/2019 06.30 M. Abdul Musa 10/2/1992 28006

2 7/29/2019 06.31 Rakhmanto 10/25/1979 32121025127272
3 7/29/2019 06.32 Durma
4 7/29/2019 06.33 Alam Kurniawan
5 7/29/2019 06.34 Mustahil 7/10/1988
6 7/29/2019 06.35 Susianudin 11/5/1971 200900
7 7/29/2019 06.36 sumarto 1/29/1973 32121529173 0001
8 7/29/2019 06.37 Harry R 4/4/1990
9 7/29/2019 06.38 Kartisa 9/20/1975 28007
10 7/29/2019 06.39 Waryudi
11 7/29/2019 06.40 Suradi 7/24/1974 20534
12 7/29/2019 06.41 Aryanto 5/4/1983 321214040JR 027088
13 7/29/2019 06.42 Kasdi 4/14/1984 32121414 0487 0001
14 7/29/2019 06.43 Hamdan Fauzi 4/2/1971 JR 036008
15 7/29/2019 06.44 Memet Rahmat Hidaya11/20/1975 JR 0270267
16 7/29/2019 06.45 Hanikha Alamsyah 10/24/1997 321214241097 0001
17 7/29/2019 06.46 Alif Akbar Satria N 4/17/1999 321215171754787
18 7/29/2019 06.47 Zamroni 7/13/1989
19 7/29/2019 06.48 Hermanto 1/9/1992
20 7/29/2019 06.49 Afdilah 8/30/1981 JR 027 087
21 7/29/2019 06.50 Sodikin
22 7/29/2019 06.51 Caskam 15/6/1973 113910
23 7/29/2019 06.52 Toifudin
24 7/29/2019 06.53 Deny Suryana ### Administrato
Shif
25 7/29/2019 06.54 Mustafid
26 7/29/2019 14.30 Denny Ryan Putra 8/6/1983 752338
27 7/29/2019 14.31 Fery Eliswanto
28 7/29/2019 14.32 Rudi Harno 5/29/1973 321215290573 0005
29 7/29/2019 14.33 Rustamadji 745012
30 7/29/2019 14.34 Abdul Cholik
31 7/29/2019 14.35 Parjan
32 7/29/2019 14.36 M. Walid Noldi 5/18/1996 3212141808/31/1976
33 7/29/2019 14.37 Wahyono
34 7/29/2019 14.38 Suherman 11/29/1963 663555
35 7/29/2019 14.39 Febriyono
36 7/29/2019 14.40 Agus Santoso

Total kunjungan Tanggal 29/07/2019 : 36 Orang

Total FIT : 36 Orang
Total UNFIT : 0 Orang
 Rekap Daily Check Up MOR III

Jabatan/Jenis Pernafasa Kesadara Reflek

PJP Keluhan Nadi TD
Pekerjaan n n Cahaya

PT. Alpha & Omega El JCS (-) 87 130/80 20 CM (-)

PT. Nurcahya Intan HSE (-) 72 100/70 21 CM (-)
PT.Alpha&Omega El Ji Cleaning Services (-) 81 110/80 20 CM (-)
PT.Alpha&Omega El Ji Cleaning Services (-) 71 100/70 20 CM (-)
PT. Alpha & Omega El JCS (-) 76 110/70 21 CM (-)
PT. Nurcahya Intan Mecanic (-) 88 120/80 22 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 83 110/80 20 CM (-)
PT. Nurcahya Intan Adm (-) 81 120/80 20 CM (-)
PT. Alpha & Omega El JCS (-) 83 120/80 18 CM (-)
PT.Alpha&Omega El Ji Cleaning Services (-) 82 120/80 19 CM (-)
PT. Prima Armada RayDriver (-) 88 130/80 20 CM (-)
PT. Nurcahya Intan Teknik (-) 79 110/70 19 CM (-)
PT. Nurcahya Intan Teknik (-) 72 110/70 20 CM (-)
PT. Alpha & Omega El JP1 (-) 79 110/80 21 CM (-)
PT. Nurcahaya Intan HSE Operation Support (-) 80 120/80 20 CM (-)
(-) 71 100/70 22 CM (-)
PERTAMINA Distribution Bottle (-) 80 100/70 21 CM (-)
PT. Prima Armada RayDriver (-) 78 110/70 20 CM (-)
PT. Alpha & Omega El JCS (-) 72 100/70 20 CM (-)
PT. Nurcahya Intan Teknik (-) 78 110/70 20 CM (-)
PT. Alpha & Omega El JP2 (-) 87 130/80 20 CM (-)
PTC Security (-) 80 110/80 20 CM (-)
PTC Security (-) 78 110/70 19 CM (-)
PERTAMINA (-) 72 100/70 19 CM (-)
PT. Nurcahya Intan Gate Keeper (-) 84 120/80 19 CM (-)
PERTAMINA Administrator Dist. Veri (-) 76 100/70 20 CM (-)
PT. Nurcahya Intan HSE Operation Support (-) 79 100/70 20 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 89 140/90 19 CM (-)
PERTAMINA Ast. Environmental & H (-) 71 100/70 20 CM (-)
PT. Alpha&Omega El JiOperator Loading (-) 79 110/70 19 CM (-)
(-) 89 130/90 20 CM (-)
PT. Alpha & Omega El JP2 (-) 81 110/70 20 CM (-)
PT. Nurcahya Intan HSE Operation Support (-) 80 110/70 20 CM (-)
PERTAMINA OH Depot LPG Balonga (-) 82 120/80 20 CM (-)
PT.Alpha&Omega El Ji Cleaning Services (-) 81 120/80 19 CM (-)
PTC Security (-) 86 120/80 19 CM (-)
 Tes Alcohol Kesimpul
Tes Tandem Breath
Romberg Walking an
Tester
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
 Rekap Da
Lokasi DCU: Depot LPG Balongan

Nopek/No ID
No Tanggal DCU Jam DCU Nama Tanggal Lahir NIK/No. KTP Card

1 7/30/2019 06.30 M. Abdul Musa 10/2/1992 28006

2 7/30/2019 06.35 Rakhmanto 10/25/1979 321210251079 0001 27272
3 7/30/2019 06.40 Durma
4 7/30/2019 06.45 Alam Kurniawan
5 7/30/2019 06.50 Mustahil 7/10/1988
6 7/30/2019 06.55 Susianudin 11/5/1971 200900
7 7/30/2019 07.00 Brohim
8 7/30/2019 07.05 Khafid 3/8/1982
9 7/30/2019 07.10 sumarto 1/29/1973 32121529173 0001
10 7/30/2019 07.15 Viki Dharma Alghozali
11 7/30/2019 07.20 Ari Yunanto
12 7/30/2019 07.25 Kartisa 9/20/1975 28007
13 7/30/2019 07.30 Waryudi
14 7/30/2019 07.35 Suradi 7/24/1974 20534
15 7/30/2019 07.40 Suherman 11/29/1963 663555
16 7/30/2019 07.45 Akhmad Mubarok
17 7/30/2019 07.50 Aryanto 5/4/1983 321214040583 0003 JR 027088
18 7/30/2019 07.55 Hermanto 1/9/1992
19 7/30/2019 08.00 Afdilah 8/30/1981 JR 027 087
20 7/30/2019 08.05 Kasdi 4/14/1984 32121414 0487 0001
21 7/30/2019 08.05 Hanikha Alamsyah 10/24/1997 321214241097 0001
22 7/30/2019 08.07 Mustafid
23 7/30/2019 08.09 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787
24 7/30/2019 14.30 Memet Rahmat Hidaya11/20/1975 JR 0270267
25 7/30/2019 14.32 M. Walid Noldi 5/18/1996 321214180596 0002 8/31/1976
26 7/30/2019 14.33 Wahyono
27 7/30/2019 14.36 Moh.Solek 15/3/1980 113889
28 7/30/2019 14.39 Khamir
29 7/30/2019 14.42 Nevi Yandra 3/8/1990 750206
30 7/30/2019 14.45 Wahidin 15/09/1973 321214150973 0002
31 7/30/2019 14.48 Ahmad Taufik
32 7/30/2019 14.51 M. Sulkhin 9/10/1985
33 7/30/2019 14.54 Rustamadji 745012
34 7/30/2019 14.57 Adhita Adhitya Sudrajat
35 7/30/2019 15.15 Denny Ryan Putra 8/6/1983 752338
36 7/30/2019 15.22 Rudi Harno 5/29/1973 321215290573 0005
37 7/30/2019 15.28 Zamroni 7/13/1989

Total kunjungan Tanggal 30/07/2019 : 37 Orang

Total FIT : 37 Orang
Total UNFIT : 0 Orang
Rekap Daily Check Up MOR III

Jabatan/Jenis Pernafasa Kesadara Reflek

PJP Keluhan Nadi TD
Pekerjaan n n Cahaya

PT. Alpha & Omega El JCS (-) 82 110/80 20 CM (-)

PT. Nurcahya Intan HSE (-) 69 100/70 21 CM (-)
PT.Alpha&Omega El Ji Cleaning Services (-) 88 120/80 20 CM (-)
PT.Alpha&Omega El Ji Cleaning Services (-) 75 100/70 20 CM (-)
PT. Alpha & Omega El JCS (-) 72 110/70 21 CM (-)
PT. Nurcahya Intan Mecanic (-) 85 120/80 22 CM (-)
PT. Alpha&Omega El JiReceiving&Storage (-) 80 120/80 20 CM (-)
PT.Nurcahya Intan HSE (-) 82 110/80 20 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 79 110/70 20 CM (-)
PERTAMINA Tech. Maintenance (-) 70 90/70 20 CM (-)
PERTAMINA Spv Engineering Plann (-) 72 100/70 20 CM (-)
PT. Alpha & Omega El JCS (-) 82 110/70 18 CM (-)
PT.Alpha&Omega El Ji Cleaning Services (-) 78 110/70 19 CM (-)
PT. Prima Armada Ray Driver (-) 80 110/80 20 CM (-)
PERTAMINA OH Depot LPG Balong (-) 88 130/80 20 CM (-)
PT. Nurcahya Intan HSE Operation Suppor (-) 87 130/80 20 CM (-)
PT. Nurcahya Intan Teknik (-) 80 120/0 19 CM (-)
PT. Alpha & Omega El JCS (-) 70 100/70 20 CM (-)
PT. Nurcahya Intan Teknik (-) 71 100/70 20 CM (-)
PT. Nurcahya Intan Teknik (-) 81 120/80 20 CM (-)
(-) 70 90/60 22 CM (-)
PT. Nurcahya Intan Gate Keeper (-) 86 120/80 19 CM (-)
PERTAMINA Distribution Bottle (-) 75 100/70 21 CM (-)
PT. Nurcahaya Intan HSE Operation Suppor (-) 79 110/70 20 CM (-)
PT. Alpha & Omega El JP2 (-) 79 110/70 20 CM (-)
PT. Nurcahya Intan HSE Operation Suppor (-) 80 110/70 20 CM (-)
PTC Security (-) 76 90/60 20 CM (-)
PT.Alpha&Omega El Ji Operator Loading (-) 86 120/80 20 CM (-)
PERTAMINA Spv Receiving & Stora (-) 79 110/70 19 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 80 120/80 19 CM (-)
PT. Nurcahya Intan Gate Keeper (-) 70 90/60 19 CM (-)
PT. Alpha & Omega El JP2 (-) 78 100/70 22 CM (-)
PERTAMINA Ast. Environmental & (-) 82 120/80 20 CM (-)
PERTAMINA Jr Spv Distribution Bul (-) 77 100/70 19 CM (-)
PERTAMINA Administrator Dist. Ver (-) 72 90/60 20 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 87 120/80 19 CM (-)
PT. Prima Armada Ray Driver (-) 79 100/70 20 CM (-)
 Tes Alcohol Kesimpul
Tes Tandem Breath
Romberg Walking an
Tester
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
 Rekap Daily
Lokasi DCU: Depot LPG Balongan

Nopek/No ID
No Tanggal DCU Jam DCU Nama Tanggal Lahir NIK/No. KTP Card

1 7/31/2019 06.30 M. Abdul Musa 10/2/1992 28006

2 7/31/2019 06.31 Rakhmanto 10/25/1979 321210251079 0001 27272
3 7/31/2019 06.32 Durma
4 7/31/2019 06.33 Bambang Winarto 12/21/1964 748515
5 7/31/2019 06.34 Mustahil 7/10/1988
6 7/31/2019 06.35 Susianudin 11/5/1971 200900
7 7/31/2019 06.36 Brohim
8 7/31/2019 06.37 Khafid 3/8/1982
9 7/31/2019 06.38 sumarto 1/29/1973 32121529173 0001
10 7/31/2019 06.39 Viki Dharma Alghozali
11 7/31/2019 06.40 M. Sulkhin 9/10/1985
12 7/31/2019 06.41 Rustamadji 745012
13 7/31/2019 06.42 Ari Yunanto
14 7/31/2019 06.43 Harry R 4/4/1990
15 7/31/2019 06.44 Kartisa 9/20/1975 28007
16 7/31/2019 06.45 Parjan
17 7/31/2019 06.46 Waryudi
18 7/31/2019 06.47 Suradi 7/24/1974 20534
19 7/31/2019 06.48 Rangga P 11/20/1975
20 7/31/2019 06.49 Ruswan Purnasetia Binangkit
21 7/31/2019 06.50 Suherman 11/29/1963 663555
22 7/31/2019 06.51 Febriyono Cleaning Services PT.Alpha&Omega E
23 7/31/2019 06.52 Kasdi 4/14/1984 32121414 0487 0001
24 7/31/2019 06.53 Alif Akbar Satria N 4/17/1999 321215171499 0005 754787
25 7/31/2019 06.54 Zamroni 7/13/1989
26 7/31/2019 06.55 Mustafid
27 7/31/2019 06.56 Denny Ryan Putra 8/6/1983 752338
28 7/31/2019 06.57 Hermanto 1/9/1992
29 7/31/2019 06.58 Afdilah 8/30/1981 JR 027 087
30 7/31/2019 14.30 Ismail 11/20/1969
31 7/31/2019 14.32 Hanikha Alamsyah 10/24/1997 321214241097 0001
32 7/31/2019 14.33 Khamir
33 7/31/2019 14.36 M. Walid Noldi 5/18/1996 321214180596 0002
34 7/31/2019 14.39 Nevi Yandra 3/8/1990 750206
35 7/31/2019 14.42 Wahidin 15/09/1973 321214150973 0002
36 7/31/2019 14.45 Ahmad Taufik
37 7/31/2019 14.48 Deny Suryana ###
38 7/31/2019 14.51 Moh.Solek 15/3/1980 113889
39 7/31/2019 14.54 Agus Santoso
40 7/31/2019 15.28 Rudi Harno 5/29/1973 321215290573 0005
Total kunjungan Tanggal 31/07/2019 : 40 Orang
Total FIT : 40 Orang
Total UNFIT : 0 Orang
 Rekap Daily Check Up MOR III

Jabatan/Jenis Pernafasa Kesadara Reflek

PJP Keluhan Nadi TD
Pekerjaan n n Cahaya

PT. Alpha & Omega El JCS (-) 82 120/80 20 CM (-)

PT. Nurcahya Intan HSE (-) 78 110/70 21 CM (-)
PT.Alpha&Omega El JirCleaning Services (-) 86 110/80 20 CM (-)
PERTAMINA Ast. Fire & Safery (-) 88 120/80 20 CM (-)
PT. Alpha & Omega El JCS (-) 78 110/70 21 CM (-)
PT. Nurcahya Intan Mecanic (-) 89 130/80 22 CM (-)
PT. Alpha&Omega El Ji Receiving&Storage (-) 78 110/70 20 CM (-)
PT.Nurcahya Intan HSE (-) 85 120/80 20 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 80 120/80 20 CM (-)
PERTAMINA Tech. Maintenance (-) 78 110/70 20 CM (-)
PT. Alpha & Omega El JP2 (-) 74 110/70 22 CM (-)
PERTAMINA Ast. Environmental & H (-) 87 120/80 20 CM (-)
PERTAMINA Spv Engineering Plann (-) 77 110/80 20 CM (-)
PT. Nurcahya Intan Adm (-) 79 110/70 20 CM (-)
PT. Alpha & Omega El JCS (-) 80 110/70 18 CM (-)
(-) 90 130/80 20 CM (-)
PT.Alpha&Omega El JirCleaning Services (-) 74 100/70 19 CM (-)
PT. Prima Armada RayaDriver (-) 83 120/80 20 CM (-)
PERTAMINA Spv HSSE (-) 69 100/70 20 CM (-)
PERTAMINA Jr Spv Sales & General (-) 80 110/70 20 CM (-)
PERTAMINA OH Depot LPG Balonga (-) 87 120/80 20 CM (-)
PT.Alpha&Omega El Jireh (-) 81 110/80 19 CM (-)
PT. Nurcahya Intan Teknik (-) 88 130/80 20 CM (-)
PERTAMINA Distribution Bottle (-) 78 100/70 21 CM (-)
PT. Prima Armada RayaDriver (-) 81 120/80 20 CM (-)
PT. Nurcahya Intan Gate Keeper (-) 86 120/80 19 CM (-)
PERTAMINA Administrator Dist. Veri (-) 81 110/70 20 CM (-)
PT. Alpha & Omega El JCS (-) 75 110/70 20 CM (-)
PT. Nurcahya Intan Teknik (-) 75 100/70 20 CM (-)
PT. Nurcahya Intan HSE (-) 80 110/80 20 CM (-)
(-) 70 100/60 22 CM (-)
PT.Alpha&Omega El JirOperator Loading (-) 88 120/80 20 CM (-)
PT. Alpha & Omega El JP2 (-) 80 120/80 20 CM (-)
PERTAMINA Spv Receiving & Storag (-) 79 110/70 19 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 85 120/80 19 CM (-)
PT. Nurcahya Intan Gate Keeper (-) 73 90/60 19 CM (-)
PERTAMINA Administrator Distribut (-) 72 90/70 19 CM (-)
PTC Security (-) 72 90/60 20 CM (-)
PTC Security (-) 86 110/70 19 CM (-)
PT. Alpha & Omega El JOperator Loading (-) 89 140/90 19 CM (-)
 Tes Alcohol Kesimpul
Tes Tandem Breath
Romberg Walking an
Tester
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT
(-) (-) (-) FIT