PT.

MOBILKOM TELEKOMINDO Class : HSE

Radio Communication Solution Provider No. : Form-HSE-005-004
Revision Date : 01-07-2015 Page : 1 / 1
Rencana Tindak Lanjut K3LL
(Inspection and Audit) Revision No. : 0 Sign :

Location Mobilkom Jakarta

Date Inspection / Audit 14 Maret 2022
HSE Team MBK Muchamad Bachrul Ulum
Close date corective act (*paling lama 60 har)

Inspector by
No Name Company (Client or MBK) Ttd..
1 Muchamad Bachrul Ulum MBK 1.
2.
2
3 3.
4.
4

No Status
No Tanggal Hasil Temuan Masalah yang perlu ditindak lanjuti Open Close
*paraf HSE officer *paraf HSE Mngr

1. 14 Maret 2022 Request PPE :

MARIO : Dibutuhkan Safety Shoes

untuk kebutuhan pekerjaan
1. Safety Shoes King’s personel MBK di Pertamina RU
UK.44/45 ( 1 Unit ) IV Cilacap.

*Dikarenakan sepatu sudah

rusak seperti gambar di
halaman berikutnya.

Prepared by; Issued by; Approved by;

Ttd

Name Muchamad Bachrul Ulum Dilla Devky Arif Miradi

Position HSE Officer HSE Coordinator GM Operational
Date 14 Maret 2022 14 Maret 2022

Folder E.HSE/File name Form RTL

 PT.MOBILKOM TELEKOMINDO Class : HSE
Radio Communication Solution Provider No. : Form-HSE-005-004
Revision Date : 01-07-2015 Page : 2 / 1
Rencana Tindak Lanjut K3LL
(Inspection and Audit) Revision No. : 0 Sign :

Folder E.HSE/File name Form RTL