Doc.

Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 243 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 243
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 221,482
Starting Date 01-Aug-20 Total Safe Manhour : 221,482
Reported Date 01-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 1-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear …..
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00 Clear
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 50 3. Present List TBM Report
POB Indirect person 20 4. Checking Blood Preasure for all manpower
POB Total person 70 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 700 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift - 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 251 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 244 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 244
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 221,837
Starting Date 01-Aug-20 Total Safe Manhour : 221,837
Reported Date 02-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 2-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear …..
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00
Environmental Damage Number of Case - - 13:00 - 14:00
First Aid Case Number of Case - - 14:00 - 15:00
Nearmiss Number of Case - - 15:00 - 16:00
Emergency Evacuation Number of Case - - 16:00 - 17:00
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 20 3. Present List TBM Report
POB Indirect person 51 4. Checking Blood Preasure for all manpower
POB Total person 71 5. Checking all working area for general situation
Working Hour hour 5 6. Checking all working area for general situation
MH day shift 355
Extended Work
POB Extended Work person -
Working Hour hour -
MH Extended Work -
Total MH Day Shift -
POB Night Shift -
POB Direct person -
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 206 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 245 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 245
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 222,577
Starting Date 01-Aug-20 Total Safe Manhour : 222,577
Reported Date 03-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 3-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00 Clear
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00 Clear
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00 Clear
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00 Clear
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00 Clear
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00 Clear
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 2 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 55 3. Present List TBM Report
POB Indirect person 19 4. Checking Blood Preasure for all manpower
POB Total person 74 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 740 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift - 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 245 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 246 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 246
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 223,026
Starting Date 01-Aug-20 Total Safe Manhour : 223,026
Reported Date 04-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 4-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00
Emergency Evacuation Number of Case - - 16:00 - 17:00
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 50 3. Present List TBM Report
POB Indirect person 14 4. Checking Blood Preasure for all manpower
POB Total person 64 5. Checking all working area for general situation
Working Hour hour 7 6. Checking all working area for general situation
MH day shift 448 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 213 Km -
Total HM Run hour 7 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 247 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 247
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 223,745
Starting Date 01-Aug-20 Total Safe Manhour : 223,745
Reported Date 05-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 5-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Rain
Emergency Evacuation Number of Case - - 16:00 - 17:00 Rain
17:00 - 18:00 Rain
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 2 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 53 3. Present List TBM Report
POB Indirect person 19 4. Checking Blood Preasure for all manpower
POB Total person 72 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 720 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 206 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 248 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 248
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 224,465
Starting Date 01-Aug-20 Total Safe Manhour : 224,465
Reported Date 06-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 6-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Rain
Emergency Evacuation Number of Case - - 16:00 - 17:00 Rain
17:00 - 18:00 Rain
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 56 3. Present List TBM Report
POB Indirect person 16 4. Checking Blood Preasure for all manpower
POB Total person 72 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 720 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 310 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number 1 -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number 1 -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 249 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 249
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 225,175
Starting Date 01-Aug-20 Total Safe Manhour : 225,175
Reported Date 07-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 7-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Rain
Environmental Damage Number of Case - - 13:00 - 14:00 Rain
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00 Clear
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 53 3. Present List TBM Report
POB Indirect person 18 4. Checking Blood Preasure for all manpower
POB Total person 71 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 710 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 265 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number 1 -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 250 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 250
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 225,925
Starting Date 01-Aug-20 Total Safe Manhour : 225,925
Reported Date 08-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 8-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Rain 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Rain 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Rain 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Rain 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Rain 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Rain
Environmental Damage Number of Case - - 13:00 - 14:00 Rain
First Aid Case Number of Case - - 14:00 - 15:00 Rain
Nearmiss Number of Case - - 15:00 - 16:00 Rain
Emergency Evacuation Number of Case - - 16:00 - 17:00 Rain
17:00 - 18:00 Rain
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 2 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 58 3. Present List TBM Report
POB Indirect person 17 4. Checking Blood Preasure for all manpower
POB Total person 75 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 750 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 265 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 251 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 251
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 226,635
Starting Date 01-Aug-20 Total Safe Manhour : 226,635
Reported Date 09-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 9-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Rain 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Rain 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Rain 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Rain 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Rain 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Rain
Environmental Damage Number of Case - - 13:00 - 14:00 Cloudy
First Aid Case Number of Case - - 14:00 - 15:00 Cloudy
Nearmiss Number of Case - - 15:00 - 16:00 Rain
Emergency Evacuation Number of Case - - 16:00 - 17:00 Cloudy
17:00 - 18:00 Rain
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 54 3. Present List TBM Report
POB Indirect person 17 4. Checking Blood Preasure for all manpower
POB Total person 71 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 710 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 211 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 252 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 252
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 227,325
Starting Date 01-Aug-20 Total Safe Manhour : 227,325
Reported Date 10-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 10-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Cloudy 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Cloudy 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Cloudy 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Cloudy 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Cloudy 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Cloudy
Environmental Damage Number of Case - - 13:00 - 14:00 Cloudy
First Aid Case Number of Case - - 14:00 - 15:00 Cloudy
Nearmiss Number of Case - - 15:00 - 16:00 Cloudy
Emergency Evacuation Number of Case - - 16:00 - 17:00 Cloudy
17:00 - 18:00 Cloudy
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 53 3. Present List TBM Report
POB Indirect person 16 4. Checking Blood Preasure for all manpower
POB Total person 69 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 690 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 255 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 253 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 253
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 227,995
Starting Date 01-Aug-20 Total Safe Manhour : 227,995
Reported Date 11-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 11-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Cloudy 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Cloudy 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Cloudy 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Cloudy 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Cloudy 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Cloudy
Environmental Damage Number of Case - - 13:00 - 14:00 Cloudy
First Aid Case Number of Case - - 14:00 - 15:00 Cloudy
Nearmiss Number of Case - - 15:00 - 16:00 Cloudy
Emergency Evacuation Number of Case - - 16:00 - 17:00 Cloudy
17:00 - 18:00 Cloudy
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 54 3. Present List TBM Report
POB Indirect person 13 4. Checking Blood Preasure for all manpower
POB Total person 67 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 670 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 201 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 254 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 254
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 228,635
Starting Date 01-Aug-20 Total Safe Manhour : 228,635
Reported Date 12-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 12-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Cloudy 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00 Clear
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 51 3. Present List TBM Report
POB Indirect person 13 4. Checking Blood Preasure for all manpower
POB Total person 64 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 640 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 201 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 255 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 255
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 50,747
Starting Date 01-Aug-20 Total Safe Manhour : 50,747
Reported Date 13-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 13-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00
Environmental Damage Number of Case - - 13:00 - 14:00
First Aid Case Number of Case - - 14:00 - 15:00
Nearmiss Number of Case - - 15:00 - 16:00
Emergency Evacuation Number of Case - - 16:00 - 17:00
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person -
Day Shift NO ACTIVITY
POB Direct person -
POB Indirect person -
POB Total person -
Working Hour hour -
MH day shift -
Extended Work
POB Extended Work person -
Working Hour hour -
MH Extended Work -
Total MH Day Shift -
POB Night Shift
POB Direct person -
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number - -
Heavy Vehicle Number - -
Crane Number - -
Heavy Equipment Number - -
Electrical Tools Number - -
Genset Number - -
Total KM Driven KM - -
Total HM Run hour - -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number - -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number - -

ACTIVITY (Picture & Caption)

NO ACTIVITY
 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 256 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 256
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 229,395
Starting Date 01-Aug-20 Total Safe Manhour : 229,395
Reported Date 14-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 14-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Rain 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Rain
Environmental Damage Number of Case - - 13:00 - 14:00 Rain
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 58 3. Present List TBM Report
POB Indirect person 18 4. Checking Blood Preasure for all manpower
POB Total person 76 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 760 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator, and Vibro -
Electrical Tools Number Griding, Hand Bor, Jack hammer, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 198 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 6 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 257 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 257
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 229,780
Starting Date 01-Aug-20 Total Safe Manhour : 229,780
Reported Date 15-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 15-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Rain 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Rain 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Rain 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Rain
Environmental Damage Number of Case - - 13:00 - 14:00 Rain
First Aid Case Number of Case - - 14:00 - 15:00 Rain
Nearmiss Number of Case - - 15:00 - 16:00
Emergency Evacuation Number of Case - - 16:00 - 17:00
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 56 3. Present List TBM Report
POB Indirect person 21 4. Checking Blood Preasure for all manpower
POB Total person 77 5. Checking all working area for general situation
Working Hour hour 5 6. Checking all working area for general situation
MH day shift 385 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 150 Km -
Total HM Run hour 8 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 258 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 258
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 230,390
Starting Date 01-Aug-20 Total Safe Manhour : 230,390
Reported Date 16-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 16-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 41 3. Present List TBM Report
POB Indirect person 20 4. Checking Blood Preasure for all manpower
POB Total person 61 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 610 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 189 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 259 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 259
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 231,000
Starting Date 01-Aug-20 Total Safe Manhour : 231,000
Reported Date 17-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 17-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 42 3. Present List TBM Report
POB Indirect person 19 4. Checking Blood Preasure for all manpower
POB Total person 61 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 610 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift
POB Direct person -
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 203 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 260 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 260
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 231,610
Starting Date 01-Aug-20 Total Safe Manhour : 231,610
Reported Date 18-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 18-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00
Emergency Evacuation Number of Case - - 16:00 - 17:00
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 43 3. Present List TBM Report
POB Indirect person 18 4. Checking Blood Preasure for all manpower
POB Total person 61 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 610 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift
POB Direct person -
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 210 Km -
Total HM Run hour 7 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 261 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 261
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 232,290
Starting Date 01-Aug-20 Total Safe Manhour : 232,290
Reported Date 19-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 19-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 2 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 48 3. Present List TBM Report
POB Indirect person 20 4. Checking Blood Preasure for all manpower
POB Total person 68 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 680 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 216 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 262 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 262
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 233,000
Starting Date 01-Aug-20 Total Safe Manhour : 233,000
Reported Date 20-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 20-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 50 3. Present List TBM Report
POB Indirect person 21 4. Checking Blood Preasure for all manpower
POB Total person 71 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 710 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 232 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 263 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 263
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 233,680
Starting Date 01-Aug-20 Total Safe Manhour : 233,680
Reported Date 21-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 21-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 48 3. Present List TBM Report
POB Indirect person 20 4. Checking Blood Preasure for all manpower
POB Total person 68 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 680 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 242 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 264 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 264
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 234,420
Starting Date 01-Aug-20 Total Safe Manhour : 234,420
Reported Date 22-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 22-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Cloudy
First Aid Case Number of Case - - 14:00 - 15:00 Cloudy
Nearmiss Number of Case - - 15:00 - 16:00 Cloudy
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 52 3. Present List TBM Report
POB Indirect person 22 4. Checking Blood Preasure for all manpower
POB Total person 74 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 740 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 230 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 265 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 265
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 235,120
Starting Date 01-Aug-20 Total Safe Manhour : 235,120
Reported Date 23-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 23-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 51 3. Present List TBM Report
POB Indirect person 19 4. Checking Blood Preasure for all manpower
POB Total person 70 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 700 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total - 16. Closing finding
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 198 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number 1 -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 266 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 266
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 235,840
Starting Date 01-Aug-20 Total Safe Manhour : 235,840
Reported Date 24-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 24-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 51 3. Present List TBM Report
POB Indirect person 21 4. Checking Blood Preasure for all manpower
POB Total person 72 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 720 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total - 16. Closing finding
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 178 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 267 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 267
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 236,460
Starting Date 01-Aug-20 Total Safe Manhour : 236,460
Reported Date 25-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 25-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 45 3. Present List TBM Report
POB Indirect person 17 4. Checking Blood Preasure for all manpower
POB Total person 62 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 620 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 15. Install traffic sign
POB Total - 16. Closing finding
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 178 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 3 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 268 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 268
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 237,180
Starting Date 01-Aug-20 Total Safe Manhour : 237,180
Reported Date 26-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 26-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 52 3. Present List TBM Report
POB Indirect person 20 4. Checking Blood Preasure for all manpower
POB Total person 72 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 720 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 182 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 4 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 269 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 269
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 237,900
Starting Date 01-Aug-20 Total Safe Manhour : 237,900
Reported Date 27-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 27-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 52 3. Present List TBM Report
POB Indirect person 20 4. Checking Blood Preasure for all manpower
POB Total person 72 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 720 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 206 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 4 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 270 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 270
PO No. / Subcontractor No. : RDMP -R-SC-CV-013 Total Manhour YTD : 238,600
Starting Date 01-Aug-20 Total Safe Manhour : 238,600
Reported Date 28-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 28-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case - - 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case - - 08:00 - 09:00 Rainy 19.00 - 20.00
Restricted Work Case Number of Case - - 09:00 - 10:00 Rainy 20.00 - 21.00
Medical Treatment Case Number of Case - - 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case - - 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case - - 12:00 - 13:00 Clear
Environmental Damage Number of Case - - 13:00 - 14:00 Clear
First Aid Case Number of Case - - 14:00 - 15:00 Clear
Nearmiss Number of Case - - 15:00 - 16:00 Clear
Emergency Evacuation Number of Case - - 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 -
LTISR 0.00 -
TRIR 0.00 -

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 50 3. Present List TBM Report
POB Indirect person 20 4. Checking Blood Preasure for all manpower
POB Total person 70 5. Checking all working area for general situation
Working Hour hour 10 6. Checking all working area for general situation
MH day shift 700 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 9. Ensure measure for observation hazard & Environment
Working Hour hour - 10.Handling and making report weekly and monthly
MH Extended Work - 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number Innova, L300, Elf, and bus -
Heavy Vehicle Number Dump Truck (150 HT) -
Crane Number Sany 35 Ton -
Heavy Equipment Number Excavator -
Electrical Tools Number Griding, Hand Bor, Bar cutting/ Bending -
Genset Number 50 Kva,30 Kva and 30 Kva -
Total KM Driven KM 216 Km -
Total HM Run hour 10 Hour -
ID Badge
ID Badge Issued Number - -
ID Badge Out Number - -
OTHER
PTW Number 4 -
e-COP Number 7 -
HSE Periodic Inspections conducted Object number - -
Premob Inspection conducted Object number - -
Random Alcohol Test Person - -
Submit MCU Record Person - -
General HSE Talk Number - -
Toolbox Meeting Number 1 -

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 271 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 271
PO No. / Subcontractor No. : RDMP - R-SC-CV-013_1 Total Manhour YTD : 239,340
Starting Date 01-Aug-20 Total Safe Manhour : 239,340
Reported Date 29-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 29-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case 0.00 0.00 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case 0.00 0.00 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case 0.00 0.00 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case 0.00 0.00 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case 0.00 0.00 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case 0.00 0.00 12:00 - 13:00 Clear
Environmental Damage Number of Case 0.00 0.00 13:00 - 14:00 Clear
First Aid Case Number of Case 0.00 0.00 14:00 - 15:00 Clear
Nearmiss Number of Case 0.00 0.00 15:00 - 16:00 Clear
Emergency Evacuation Number of Case 0.00 0.00 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 0.00
LTISR 0.00 0.00
TRIR 0.00 0.00

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 720 1. TBM (Toolboxmeeting)
Day Shift 2. Checking PPE on all manpower
POB Direct person 51 15,120 3. Present List TBM Report
POB Indirect person 23 5,198 4. Checking Blood Preasure for all manpower
POB Total person 74 19,876 5. Checking all working area for general situation
Working Hour hour 10 2,830 6. Checking all working area for general situation
MH day shift 740 200,540 7. Makesure the permit to work is valid
Extended Work 8. Maintenance safety sign & barricade on site
POB Extended Work person - 708 9. Ensure measure for observation hazard & Environment
Working Hour hour - 212 10.Handling and making report weekly and monthly
MH Extended Work - 150,096 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - 12.Handling and making report e-cop to requiment for owner
POB Night Shift 13.Coordination with supervisor and project manager
POB Direct person - 257 14.Giving a knowledge about HSE Golden Rules to all worker
POB Indirect person - 282
POB Total - 422
Working Hour hour - 320
MH NIght shift - 4,220
No. of Register Equipment
Light Vehicle Number 2 747
Heavy Vehicle Number 1 308
Crane Number 1 290
Heavy Equipment Number 2 545
Electrical Tools Number 10 2,710
Genset Number 3 750
Total KM Driven KM 308 83,468
Total HM Run hour 30 8,130
ID Badge
ID Badge Issued Number - 128
ID Badge Out Number - 54
OTHER
PTW Number 4 1,084
e-COP Number 7 1,897
HSE Periodic Inspections conducted Object number - 9
Premob Inspection conducted Object number - 54
Random Alcohol Test Person - -
Submit MCU Record Person - 128
General HSE Talk Number - 9
Toolbox Meeting Number 1 313

ACTIVITY (Picture & Caption)

 Doc. Number 26071-JO-HSE-F-002
Effective Date 28-Feb-20
Subcontractor Daily HSE Statistics Report No. of Revision 000
Page 1/1

Subcontractor Name : PT. Tekniko Total Working Days : 272 Prepared By Approved By
Scope of Work : Civil Work Package 13 Safe Working Days : 272
PO No. / Subcontractor No. : RDMP - R-SC-CV-013_1 Total Manhour YTD : 240,130
Starting Date 01-Aug-20 Total Safe Manhour : 240,130
Reported Date 30-Apr-21 Without LTI HSE Coord. Project Manager

Cummulative
Item UOM 30-Apr-21
Year To Date WEATHER REPORT

INCIDENT Time Status Time Status

Fatality Number of Case 0.00 0.00 07:00 - 08:00 Clear 18.00 - 19.00
Lost Time Injury (LTI) Number of Case 0.00 0.00 08:00 - 09:00 Clear 19.00 - 20.00
Restricted Work Case Number of Case 0.00 0.00 09:00 - 10:00 Clear 20.00 - 21.00
Medical Treatment Case Number of Case 0.00 0.00 10:00 - 11:00 Clear 21.00 - 22.00
Incident impact to environmental pollution Number of Case 0.00 0.00 11:00 - 12:00 Clear 22.00 - 23.00
Incident impact to fire / asset damage Number of Case 0.00 0.00 12:00 - 13:00 Clear
Environmental Damage Number of Case 0.00 0.00 13:00 - 14:00 Clear
First Aid Case Number of Case 0.00 0.00 14:00 - 15:00 Clear
Nearmiss Number of Case 0.00 0.00 15:00 - 16:00 Clear
Emergency Evacuation Number of Case 0.00 0.00 16:00 - 17:00 Clear
17:00 - 18:00
LTIFR 0.00 0.00
LTISR 0.00 0.00
TRIR 0.00 0.00

POB & Manhour HSE Activity

No. of Total HSE Personnel person 3 723 1. TBM (Toolboxmeeting)
Day Shift - 2. Checking PPE on all manpower
POB Direct person 56 15,176 3. Present List TBM Report
POB Indirect person 23 5,221 4. Checking Blood Preasure for all manpower
POB Total person 79 19,955 5. Checking all working area for general situation
Working Hour hour 10 2,840 6. Checking all working area for general situation
MH day shift 790 201,330 7. Makesure the permit to work is valid
Extended Work - 8. Maintenance safety sign & barricade on site
POB Extended Work person - 708 9. Ensure measure for observation hazard & Environment
Working Hour hour - 212 10.Handling and making report weekly and monthly
MH Extended Work - 150,096 11.Ensure and measure for gas testing before hot working
Total MH Day Shift - -
POB Night Shift -
POB Direct person - 257
POB Indirect person - 282
POB Total - 422
Working Hour hour - 320
MH NIght shift - 4,220
No. of Register Equipment
Light Vehicle Number 2 752
Heavy Vehicle Number 1 311
Crane Number 1 292
Heavy Equipment Number 2 549
Electrical Tools Number 6 2,724
Genset Number 3 756
Total KM Driven KM 356 84,225
Total HM Run hour 27 8,184
ID Badge
ID Badge Issued Number - 128
ID Badge Out Number - 54
OTHER
PTW Number 4 1,088
e-COP Number 7 1,904
HSE Periodic Inspections conducted Object number - 9
Premob Inspection conducted Object number - 54
Random Alcohol Test Person - -
Submit MCU Record Person - 128
General HSE Talk Number - 9
Toolbox Meeting Number 1 314

ACTIVITY (Picture & Caption)