You are on page 1of 5

Project No.

P-XxxXXX
PROJECTS GROUP Document No. P-XxxXXX -100-15-RPT-XXXX
Revision No. 0
LAPORAN PROGRAM DAN Page 1 of 5
RENCANA K3 KONSTRUKSI Issue Date dd - mm - yyyy

PEMBANGUNAN HOTEL
LAPORAN PERIODE MEI 2022
NO KONTRAK 123456

dd - mm - yyyy 00 Issued for projects HSE Engineer CM / PM

Tanggal Revisi Deskripsi Yang Membuat Menyetujui

This document is to be considered confidential, and shall not be reproduced in whole or in part by any means without the prior written consent of Group
Form: -100-01-RPT Document_Report Jan 13, 2014
Project No. P-XxxXXX
PROJECTS GROUP Document No. P-XxxXXX -100-15-RPT-XXXX
Revision No. 0
LAPORAN PROGRAM DAN Page 2 of 5
RENCANA K3 KONSTRUKSI Issue Date dd - mm - yyyy

DAFTAR ISI
A. MAN POWER DATA.................................................................................................................................. 2
B. LAGGING INDICATOR.............................................................................................................................. 2
C. LEADING INDICATOR.............................................................................................................................. 2
D. HSE HIGHLIGHT....................................................................................................................................... 3

Site Project : Pembangunan Hotel Tanggal : 30 Mei 2022


Site HSE Engineer : Ridwan Project Manager : Sayed
A. MAN POWER DATA / TENAGA KERJA
PROJECT TO
ITEMS TARGET THIS MONTH LAST MONTH
DATE
Total Owner Personal ( Pemberi Kerja ) n/a 10 5
Total Contractor Personal / ( Pelaksana ) n/a 20 10
10 orang x 8
Total Owner Man-hours / ( Pemberi Kerja ) n/a Jam x 20 Hari 5x8x20=800 2400
= 1600 Jam
20 orang x 8
Total Contractor Man-hours ( Pelaksana ) n/a jam x 20 hari 10x8x20=1600 4800
kerja = 3200
Accumulated Safe Man Working Hours w/o LTI 10.000.000 4800 2400 7200

B. LAGGING INDICATOR / REAKTIF


PROJECT TO
ITEMS TARGET THIS MONTH LAST MONTH
DATE
Fatality 0 0 0 0
Lost Time Injury (LTI) Disability 0 0 0 0
Lost Workday Case 0 0 0 0
Restricted Workday
0 0 0 0
Case
Non Lost Time Injury Medical Treatment
( Non LTI ) 0 0 0 0
Case
First Aid Case 100% Reported 0 0 0
Fire / Explosion 0 0 0 0
Property Damage / Loss 0 0 0 0
Environmental Pollution 0 0 0 0
Near Miss (NM) 100% Reported 100 100 200

This document is to be considered confidential, and shall not be reproduced in whole or in part by any means without the prior written consent of Group
Form: -100-01-RPT Document_Report Jan 13, 2014
Project No. P-XxxXXX
PROJECTS GROUP Document No. P-XxxXXX -100-15-RPT-XXXX
Revision No. 0
LAPORAN PROGRAM DAN Page 3 of 5
RENCANA K3 KONSTRUKSI Issue Date dd - mm - yyyy

C. LEADING INDICATOR / PROAKTIF


PROJECT TO
ITEMS TARGET THIS MONTH LAST MONTH
DATE
SAFETY /KESELAMATAN Harian
1.HSE Training Mingguan 4 4 8
2.HSE Audit Semester 1 0 1
3.Safety Briefing Harian 25 25 50

HEALTH /KESEHATAN
1.MEDICAL CHECK UP Tahunan 1 0 1
2.Senam Kesehatan jasmani Mingguan 4 4 8

ENVIRONMENTAL/LINGKUNGAN
1.Housekeeping Harian 20 20 40
2.Pemisahan Limbah Minggu 4 4 8

This document is to be considered confidential, and shall not be reproduced in whole or in part by any means without the prior written consent of Group
Form: -100-01-RPT Document_Report Jan 13, 2014
Project No. P-XxxXXX
PROJECTS GROUP Document No. P-XxxXXX -100-15-RPT-XXXX
Revision No. 0
LAPORAN PROGRAM DAN Page 4 of 5
RENCANA K3 KONSTRUKSI Issue Date dd - mm - yyyy

D. Perhitungan FREQUENCY RATE ( FR )

Perhitungan SEVERITY RATE ( SR )

E. HSE HIGHLIGHT
E.1. HSE ISSUE THIS MONTH
- Sosial Distancing masa Covid 19
- Curah Hujan,Banjir , dan Gempa tektonik
- Pencemaran Asap , Bau kimia pabrik
- Pemsangan mesin baru

E.2. HSE PLAN A MONTH LOOK AHEAD


- Hand sanitizer , Jarak satu dengan lain 1 meter , Suhu Tubuh , Masker
- Disaster Emergency drill
- Safety Campaign APD , safety campaign pelaksanaan safety golden rules
- Blood Donation ( Donor Darah )
- Fogging
- SKJ dan Pembagian Vitamin,Susu, Kacang Ijo

This document is to be considered confidential, and shall not be reproduced in whole or in part by any means without the prior written consent of Group
Form: -100-01-RPT Document_Report Jan 13, 2014
Project No. P-XxxXXX
PROJECTS GROUP Document No. P-XxxXXX -100-15-RPT-XXXX
Revision No. 0
LAPORAN PROGRAM DAN Page 5 of 5
RENCANA K3 KONSTRUKSI Issue Date dd - mm - yyyy

Prepared By , Checked By , Approved By,

(……………………) (…………………………..) (………………………………….)

This document is to be considered confidential, and shall not be reproduced in whole or in part by any means without the prior written consent of Group
Form: -100-01-RPT Document_Report Jan 13, 2014

You might also like