No Dokumen F-FDH-HSE-172-0

Consortium /
Tanggal Efektif 01 December 2017
Subcontractor Logo
(if any) INITIAL HAZARD REGISTER No Revisi 00
Halaman /

A. DAFTAR BAHAYA
A. HAZARD REGISTER

NAMA PROYEK/ PROJECT PLTU SULUT

LOKASI/ LOCATION

LINGKUP KERJA/ SCOPE OF WORK Struktur Baja

AKTIVITAS PEKERJAAN KEJADIAN TAK DIHARAPKAN KEMUNGKINAN KEJADIAN PENCEGAHAN DAN PENGENDALIAN MITIGASI
NO.
WORK ACTIVITY UNWANTED EVENT PROBABILITY EVENT PREVENTION AND MITIGATION CONTROLS

1 Liftting Kecelakaan pada pekerja Tinggi Toolbox Meeting dan Sosialisali Lifting Plan dan JSA, Pemakaian APD Kepada Pekerja

kerusakan material Tinggi Sosialisali Lifting Plan dan JSA

Sertifikasi Juru Las, Penerapan JSA dan Pemakaian APD Sesuai Pekerjaan, Penyediaan
2 Pengelasan Terpapar Sinar Las Tinggi
APAR diarea pengelasan

3 Pemotongan Percikan Bunga Api Tinggi Sosialisai JSA Saat Toolbox Meeting, Penggunaan APA yang sesuai dengan pekerjaan

TANDA TANGAN/ SIGNATURE

POSISI/ POSITION
 No Dokumen F-FDH-HSE-172-0
Consortium /
Tanggal Efektif 01 December 2017
Subcontractor Logo
(if any) INITIAL HAZARD REGISTER No Revisi 00
Halaman /
TANGGAL/ DATE
 No Dokumen F-FDH-HSE-172-0
Consortium /
Tanggal Efektif 01 December 2017
Subcontractor Logo
(if any) INITIAL HAZARD REGISTER No Revisi 00
Halaman /

B. DAFTAR B3
B. HAZARDOUS SUBSTANCE AND DANGEROUS GOODS REGISTER

KETERSEDIAAN MSDS
BAHAN KIMIA KUANTITAS PENGADAAN PENGENDALIAN RESIKO YANG DIPERSYARATKAN
NO AVALIABILITY OF MSDS
CHEMICAL QUANTITY HELD RISK CONTROL REQUIRED
(Y / N)

1 Cat 20 Liter Ya APD Sesuai Pekerjaan ( Masker, Kaca Mata, Sarung tangan )

Meyediakan Tempat tersendiri untuk Oli, serta disiapkan Spil Kit untuk pencegahan tumpaha oli,APD Sesuai
2 Oli 5 Liter Ya
Pekerjaan ( Masker, Kaca Mata, Sarung tangan )

TANDA TANGAN/ SIGNATURE

POSISI/ POSITION
TANGGAL/ DATE
 No Dokumen F-FDH-HSE-172-0
Consortium /
Tanggal Efektif 01 December 2017
Subcontractor Logo
(if any) INITIAL HAZARD REGISTER No Revisi 00
Halaman /

C. DAFTAR PERALATAN DAN MESIN INDUSTRI

C. EQUIPMENT AND PLANT REGISTER

TANGGAL
REGISTRATION/STATUTORY PENGGUNAAN (PEMAKAIAN
TIPE INSPEKSI FREKUENSI DIINSPEKSI OLEH
NO CERTIFICATION DI SITE)
TYPE INSPECTION FREQUENCY INSPECTED BY
REGISTRASI STATUTORI SERTIFIKAT PURPOSE (USE ON SITE)
DATE

1 Las - Proyek - Sering Peralatan dan HSE

2 Gerinda - Proyek - Sering Peralatan dan HSE

3 Chain Blok - Proyek - Sering Peralatan dan HSE

4 Mobile Crane Proyek - Sering Peralatan dan HSE

TANDA TANGAN/ SIGNATURE

POSISI/ POSITION
TANGGAL/ DATE
 No Dokumen F-FDH-HSE-172-0
Consortium / Tanggal Efektif 01 December 2017
Subcontractor Logo
(if any) INITIAL HAZARD REGISTER No Revisi 00
Halaman /

A. DAFTAR BAHAYA
A. HAZARD REGISTER SAMPLE
NAMA PROYEK/ PROJECT LOMBOK PEAKER 130 -150 MW

LOKASI/ LOCATION LOMBOK SITE Pratiwi Handayani:

Mention all event that related to human and Pratiwi Handayani:
LINGKUP KERJA/ SCOPE OF WORK WAREHOUSING High / Medium / Low
environmental impact

AKTIVITAS PEKERJAAN KEJADIAN TAK DIHARAPKAN KEMUNGKINAN KEJADIAN PENCEGAHAN DAN PENGENDALIAN MITIGASI
NO.
WORK ACTIVITY UNWANTED EVENT PROBABILITY EVENT PREVENTION AND MITIGATION CONTROLS

1 Forklift Operation Injury to human (grazed, struck by, slip, fall, caught in between, etc) High 1.1. Training of forklift operator
1.2. Forklift operation procedure socialization
1.3. Appropriate PPE

Property damage (dropped object, etc) High 2.1. Training of forklift operator
2.2. Forklift operation procedure socialization
Uncontrolled release / spill of oil Medium 3.1. Conduct inspection and maintenance periodically,
3.2. Oil spill handling procedure socialization
Emission of particulate matter (pollution of air) exceed the TLV High 4.1. Conduct maintenance (Inspection, PM-250, PM-500, PM-1000)
4.2. Conduct emission test periodically
2 xxx xxx XXX XXX

TANDA TANGAN/ SIGNATURE

POSISI/ POSITION
TANGGAL/ DATE
 No Dokumen F-FDH-HSE-172-0
Consortium / Tanggal Efektif 01 December 2017
Subcontractor Logo
(if any) INITIAL HAZARD REGISTER No Revisi 00
Halaman /

B. DAFTAR B3
B. HAZARDOUS SUBSTANCE AND DANGEROUS GOODS REGISTER SAMPLE
Pratiwi Handayani:
Estimate Quantity of chemical that will be used during project
Pratiwi Handayani:
As per MSDS
KETERSEDIAAN MSDS
BAHAN KIMIA KUANTITAS PENGADAAN PENGENDALIAN RESIKO YANG DIPERSYARATKAN
NO AVALIABILITY OF MSDS
CHEMICAL QUANTITY HELD RISK CONTROL REQUIRED
(Y / N)

1 Oil Lubricant 7.5 L Per 250 hour meters Y Eye Protector (chemical google, face shield)

2 Water Cooling Radiator Depend on usage Y 1. Ventilation (exhaust to control vapor, mist, spray)
2. PPE (Breath Protector, eye protection, skin protection)

3 Paint 500 kg Y 1. Ventilation (exhaust to control vapor, mist, spray)

2. PPE (Breath Protector, eye protection, skin protection)

TANDA TANGAN/ SIGNATURE

POSISI/ POSITION
TANGGAL/ DATE
 No Dokumen F-FDH-HSE-172-0
Consortium / Tanggal Efektif 01 December 2017
Subcontractor Logo
(if any) INITIAL HAZARD REGISTER No Revisi 00
Halaman /

C. DAFTAR PERALATAN DAN MESIN INDUSTRI

C. EQUIPMENT AND PLANT REGISTER SAMPLE
Pratiwi Handayani:
As per SILO, Certificate issued by Pratiwi Handayani:
Authorized Government Third Party / Local Government /
Authorized Inspector
REGISTRATION/STATUTORY PENGGUNAAN (PEMAKAIAN
TIPE TANGGAL INSPEKSI FREKUENSI DIINSPEKSI OLEH
NO CERTIFICATION DI SITE)
TYPE INSPECTION DATE FREQUENCY INSPECTED BY
REGISTRASI STATUTORI SERTIFIKAT PURPOSE (USE ON SITE)

1 Forklift PFD 30C (brand Patria) No. 361/PA-1/SKPP/18.05/DJM.T/2014 Warehouse Operational 1-Jan-18 Annually Local Disnaker
Daily Pre-use Operator

2 xxx xxxx xxx xxx xxx

TANDA TANGAN/ SIGNATURE

POSISI/ POSITION
TANGGAL/ DATE