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PERUSAHAAN
Safety Report PT. ABC
Period : Februari 2022

Month
Cummulative
No Parameter Safety Unit Remarks
Year to Month
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
1 Total Man Power man power
2 Total Man Day day
3 Total Man Hour hour
4 Incident Case times
5 People Accident :
- First Aid times
- Loss Time Injury times
- Fatality times
6 Property Damage times
- Fire Case
- Non Fire Case
7 Cost of Accident Loss
- People Injury Cost Rupiah
- Property Damage Cost Rupiah
8 Loss Time day
9 Frequency Rate (FR) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
10 Severity Rate (SR) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
11 Unsafe Action times
12 Unsafe Condition times
13 - UC Close
14 - UC Open
15 Safety Inspection times
16 Safety Talk times
17 Safety Training times

Remarks :
1. Formula Disiapkan oleh : Disetujui oleh :
• Frequency Rate (FR) = Number Lost Time Accident x 1,000,000
Total Man Hours
• Severity Rate (SR) = Total Lost Day x 1,000,000
Total Man Hours Fulan Fulana
Safety Officer CEO PT. ABC

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