PROJECT MANAGEMENT SERVICES

MILK PROCESSING PLANT AND FARMS

Client:

PT. Global Dairi Alami

TeamworX Project No. : 3553

Doc No : QR-CM-3553-P-00-SJM-HSE-WR-06

HSE Weekly Report

HSE Weekly Report No. 06

Period Of : 09 AGUSTUS - 15 AGUSTUS 2019

Rev. Date Description Prepared Checked

R-0 15-Aug-19 For Information NURDIN SITE MANAGER

QF-CM-005. Rev.01 Document By : Doc. Date :
TeamworX 15-Aug-19
LIST OF COPYHOLDERS-DISTRIBUTION SHEET

Copy no. Function Location Name

Head of Construction,
1 Property and Maintenance GDA Jakarta Herman Saputra

2 Farm Manager GDA Jakarta Yuliantoni Queen

3 Manager GDA Jakarta Puguh Setiawan

4 Manager GDA Jakarta Fenny Wijaya

TeamworX CM
5 TeamworX Jakarta Marangkup Manik
Department Head
Project Manager
6 TeamworX Jakarta Cahyo Semeru
Engineering

7 Construction Manager TeamworX site Sugiono

8 Document Controller TeamworX Jakarta Vincent Zetaria Panjaitan

9 Document Controller TeamworX site Ahmad Kausar

HISTORY OF REVISIONS

Rev. No Date Page Description By

QF-CM-005. Rev.01 Document By : Doc. Date :
CT MANAGEMENT SERVICES
ROCESSING PLANT AND FARMS

Client:

PT. Global Dairi Alami

amworX Project No. : 3553

: QR-CM-3553-P-00-SJM-HSE-WR-06

HSE Weekly Report

E Weekly Report No. 06

Of : 09 AGUSTUS - 15 AGUSTUS 2019

Checked

SITE MANAGER
Doc. Date :
15-Aug-19
 Name

Herman Saputra

Yuliantoni Queen

Puguh Setiawan

Fenny Wijaya

Marangkup Manik

Cahyo Semeru

Sugiono

Vincent Zetaria Panjaitan

Ahmad Kausar

By
Doc. Date :
HSE Weekly Report (04)
Date Starting 09 Agustus 2019 Date Ending 15 Agustus 2019

Project Name DAIRI ALAMI FARM Reported by PT. SUBUR JAYA MUKTI

1. Statistical Data
Company Total /
No. Description Period Accummula
GDA TeamworX PT. SUBUR JAYA MUKTI ed
A Resources Data
1 Mgmt & Staf This Week 4 4 28 36
Last Week 4 4 28 36
2 Worker / Non-Staf This Week 0 0 75 75
Last Week 0 0 75 75
3 Man-Hours Worked This Week 12 12
Last Week 12 12
4 Man-Days Worked This Week 7 7
Last Week 7 7
5 Accum. Safe Man-hours This Week 8 8
Last Week 8 8
6 Nos. of Lost Workdays This Week 0 0
Last Week 0 0
7 Total Equipment Operated This Week 10 10
Last Week 10 10
8 Total Equipment Opr. Hours This Week 13 13
Last Week 13 13
9 Total Vehicles Operated This Week 11 11
Last Week 11 11
B Accident Case
1 Fatality This Week 0 0
(FAT) Last Week

2 Days Away From Work This Week

(DAFW) Last Week

3 Lost Time Accident This Week 0 0

(LTA = B1 + B2) Last Week

4 Restricted Work Activity This Week

(RWA) Last Week

5 Medical Treatment This Week 0 0

(MT) Last Week

6 Total Recordable Accident This Week 0 0

(TRA = B3 + B4 + B5) Last Week

7 First Aid Case This Week 1 1

(FAC) Last Week

8 Near Missed Accidnt This Week 0 0

 (NMA) Last Week

9 Equipment Accident This Week 0 0

(EA) Last Week

10 Fire Case This Week 0 0

(FC) Last Week

C Ratio
1 Injury Frequency Rate This Week

(IFR = (B6 : A3) * (200000 : 12Last Week

2 Equipment Damage Freq. RateThis Week
(EDFR = (B9 : A8) * 1000) Last Week
2. HSE Activities Carried-Out in CURRENT & NEXT Week
2.1.HSE Activities Carried Out in CURRENT Week
No. Activities Remarks
1 Merapikan & Melengkapi Dokumen / Adminitrasi HSE
2 Mensosialisasikan Untuk Menjaga Kebersihan Area Kerja
3 Memberikan Pertolongan Pertama Kecelakaan Di Area Kerja PT. S

2.2.HSE Activities Planned for NEXT Week

No. Activities Remarks
1 Safety Patrol Keseluruh Area Kerja PT. SJM
2 Melakukan Safety Inductions
3 Pendataan Stock APD PT. SJM

2.3.HSE Activities for Promoting and Enhancing Awareness

No. Activities Remarks
1 Diskusi Langsung Kepada Pekerja Tentang Kondisi Tidak Aman
2 Diskusi Langsung Kepada Pekerja Tentang Tindakan Tidak Aman
3 Memenuhi Target Zero Achident Setiap Hari Di Semua Area Kerja
4 Memberikan Reward Kepada Pekerja Yang Patuh Menggunakan A

2.3.1. Name of Conscious Workers / Staffs in CUR

No. Name Classification Department
1
2
3

2.4.Description of Critical Tasks / Activities in CURRENT Week

No. Activities Remarks
1 Safety Patrol Keseluruh Area Kerja PT. Subur Jaya Mukti
2 Selalu Mensosialisasikan & Mengingatkan Wajib Penggunaan AP
3 Memberikan Pertolongan Pertama Kepada Pekerja, Saat Terluka

2.5.Description of Critical Tasks / Activities planned for NEXT Week

No. Activities Remarks
1 Merapikan & Melengkapi Dokumen / Adminitrasi HSE
2 Memberikan Pemahaman Bahwa K3 Adalah Suatu Kebutuhan Pek
3 Melakukan Pendekatan Emosional Secara Perlahan Kepada Peker
3. HSE Training Carried-Out in CURRENT Week
3.1. HSE Orientation / Induction
Total of Attendan : Personnel

3.2. HSE Technical & Management Training

No. Training Subject Trainee Classification Total Remarks

4. HSE Personnel List

No. Name Classification Hire Date Remarks

5. HSE Violations Identified In CURRENT Week (Put Mark 'V' in the Appropriate Box)
V Fail to Wear Proper PPE (Prersonal Protective Equipment) = 3 Case(s)
V Poor House keeping = 1 Case(s)
Fail to Eliminate Fire / Explosion Hazards = 0 Case(s)
Improper Lifting or Crane Operation = 0 Case(s)
Fail to Provide Efective Barricade or Life-Line = 0 Case(s)
Environmental Pollution (e.g. Oil Spillage to Water, Noise, Black Smoke, etc.)= 0 Case(s)
Etc. (please mention) = 0 Case(s)

6. HSE Objectives & Target Achieved In CURRENT Week

Objectives Target Actual Achieve

Injury Frequency Rate (IFR) 0 (Zero) 0 (Zero) 0 (Zero

Equipment Damage Frequency Rate (EDF 0 (Zero) 0 (Zero) 0 (Zero
Better HSE Performance At Least One Tool Box Meeting Per Day Every Day Every Da
Prevention of Land, Water & Air Pollution ZERO Oil / Diesel Fuel Spillage no no
Proper Handling of Chemical Materials/W ZERO Reported Incident Due To Improper no no
Chemical Materials / Waste Handling Per Week no no

Prepared by : Approved by :

HSE Officer / Cord. ( ) Site / Project Manage (

(BAYU ARGA)
7. Attachments

7.1. Histogram

7.2. Photographs
TI

Total /
cummulat
ed

36
36
75
75
12
12
7
7
8
8
0
0
10
10
13
13
11
11

0
0

0
s

ent

s
marks

ks

se(s)
se(s)
se(s)
se(s)
se(s)
se(s)
se(s)

Achieved

0 (Zero)
0 (Zero)
Every Day
no
no
no