FIRE EXTINGUISHER INSPECTION FORM

Hari / Tanggal : Senin / 03 Agustus 2020

Bulan : Agustus
INSPECTION RESULT

PRESSURE
CYLINDER

CONTENT
NOZZLE

LABEL
NO TYPE BRAND WEIGHT POSITION EXPIRED DATE REMARKS

HOSE

PIN
1 0 0 0 0 0 BELUM DIBELI
2
3
4
5
6
7
8
9
10

Diperiksa Oleh Diketahui oleh

M. Kasim Herdinan Dito

HSE Officer PT. TAT HSE Officer PT. ETI
 CHECK LIST INSPECTION P3K

TANGGAL : 3
BULAN : Aug-2020

aquades
plester 1,2

kain segitiga

sarung tangan

obat merah

buku catatan
pinset

daftar isi obat

alqohol 70%
kantong plastik

panduan p3k
N0

gelas cuci
perban 5 cm

perban 10cm

kapas 25 gr

masker

lampu senter
plester cepat
kasa steril
Lokasi Ket

gunting

peniti
P3K
1 Laydown X X X X X X X X X V V X X X X X X X X X X
2 Direksi Keet X X X X X X X X X V V X X X X X X X X X X
3
4
5

Note: V Ada X Tidak ada

Catatan : Alat-alat P3K belum tersedia dikedua area tersebut dan mohon segera dilakukan pengadaan kebutuhan alat-alat P3K.

Diperiksa Oleh Diketahui Oleh

M. Kasim Herdinan Dito
HSE Officer PT. TAT HSE OFFICER PT. ETI
 HSE Daily Report

Company Name : PT. TAT

Description of Work : Direksi Keet & Laydown Work Area
Date : 03 Agustus 2020 Weather
Perusahaan Jumlah Man Hours Keterangan
Project Manager 0 0
Site Manager 0 0
Supervisor 1 8
Site Engineer 0 0
QA / QC 0 0
Admind 1 8
Safety 1 8
Surveyor 0 0
Foreman 0 0
Operator 0 0
Electric 0 0
Mechanic 0 0
Helper 14 8
Scurity 0 0
Driver 0 0
Total Man Hours 17 136
Lagging Indicator
Case Jumlah Total Keterangan
Fatality 0 0
Lost Time Accident 0 0
Medical Treatment Case 0 0
First Aid Case 0 0
Near - Miss Case 0 0
Hazard Report / Temuan 0 0
Properti Damage case 0 0
Environment Damaged Case 0 0
Clinic Visited 0 0
Equipment Loss 0 0

Leading Indicator
Activity Jumlah Total Keterangan
Tool Box Meeting 10 11
Safety Meeting 0 0
Meeting By Clien 0 0
Training 0 0
Managemen Visit 0 0
Inspection Equipment 1 1
Inspection Work area 0 0
Safety Induction 0 0
Permit To Work 1 1
Job Safety Analisys 1 1

Job activity Equipment

Prepared By : Approved By:

M. Kasim Herdinan Dito

HSE Officer PT. TAT HSE Officer PT. ETI
 : Laydown
: Sunny
Keterangan

Keterangan

Keterangan
Equipment

Approved By:

Herdinan Dito
HSE Officer PT. ETI
 HSE Daily Report

Company Name : PT. TAT

Description of Work : Laydown Area & Direksi Keet Work Area
Date : 03 Agustus 2020 Weather

Item Previous Today Cumm. Keterangan

Total Man Power 170 17 187
Total Manhours 1360 136 1496
Case Previous Today Cumm. Keterangan
Total Recorable Incident Rate 0 0 0
Kecelakaan hilang hari kerja (LWD) 0 0 0
Kasus Fatality 0 0 0
Insiden kebakaran 0 0 0
Pencemaran Lingkungan 0 0 0
Property Damage 0 0 0
First Aid Case 0 0 0
Security Issue 0 0 0
Total Safe Man Hours 1360 136 1496
Leading Indicator
Activity Previous Today Cumm. Keterangan
Tool Box Safety Meeting 10 1 11
Weekly Safety Meeting 0 0 0
HSE Induksi 1 0 1
ID Card / SIMA (Surat Izin Masuk Area) 17 0 17
SIKA (Surat Izin Kerja Aman) 2 1 3
JSA (Job Safety Analysis) 2 1 3
MCU (Medical Check Up) 17 0 17
JMP (Journey Management Plan) Moving 0 0 0
HSE Drill (Fire, Medivac, Kick, H2S Drill) 0 0 0
Observasi Card 0 0 0
Pelaporan Nearmiss 0 0 0
Investigasi Kecelakaan 0 0 0
Fire Extinguisher Inspection 0 0 0
Eyewash & Shower Station Insp. 0 0 0
PPE Inspection 1 0 1
Light Vehicle Inspection 1 0 1
Heavy Vehicle Inspection 0 0 0
HSE General Inspection 1 0 1
Lain-lain (Inspeksi) 0 0 0
Job activity Equipment

Prepared By,
M. Kasim
HSE Officer PT. TAT
Work Area : Laydown
: Sunny

Keterangan

Keterangan

Keterangan

Equipment

Reported by,
 Herdinan Dito
HSE Officer PT. ETI