L EPC ISBI & OSBI.

RDMP RU-V BATIKPAPAN

nH.MBuo
, PERTAMINA PROIECT
Job. No. :25071
HEALTH SAFETY & ENVIRONMENTAL CH E KLIST EYE WASH Doc. No. : 26071-100-G0l-cHK-000054
Effective Date :

Date
Location
Area
Company

No Descrlption Resulth lnspection Remarks

Good Poor
1 The eyewash station is free of obstruction. Stosiun /tempdt pencuci
mdtd bebas dori holangan
2 The eyewash is easily use. / Pencuci mata mudah digunakan
3 tools are equipped with protective covers./ alat dilengkapai dengan
tutup pelindung
4 The covers are removed by eyewash activation. / Saput dihapus dengan
aktivasi pencuci mata
5 The water is flowin8 from both eyepieces. / Air mengalir dari kedua
eyepieces
6 The flow of water is ofequal
height. / Aliran air sama tinggi
7 The flow of water is clear./ Aliran air bersih
8 The eyewash delivers a steady stream of water. / Pencuci mata
memberikan aliran air yang stabil

8alikpapan,.........................2020
Prepared by, Checked by, Acknowledged by,