Formulir

Formulir
FormulirFHSE-10-01/R0
Formulir FHSE-10-01/R0
FHSE-10-01/R0
FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 14 No.Contract :
Date : 31-Aug-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 140 140 q Fatality Case 0 0
q Elnusa HWU Team 28 392 392 q LTI Case 0 0
q Elnusa Scaffolding 0 35 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 567 567 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 6804 6804 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 1 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 0 0 0 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 0 1 1 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 1
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 28 28 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 2
q JSA Meeting (Pre-Job) 2 28 28 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 0 0 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 3 36
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 1 12
Total Meeting Conducted 4 56 56 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 2 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 4 48
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 28
q Fire Drill 0 1 1 q Orientation Program 0 0
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 28
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 3 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 6 139 139 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa
q Safe 4 62 62 R Update final completion HWU
Total Hazard Observation 10 201 201 R Monitor Kill Well And Slick Line Job
q Open 0 0 0 R
q Close 10 201 201
Total Status Finding 10 201 201 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
Nata H / Manson M Yohanes / Fabian Dhamas R
R
FHSE-10-01/R0
FHSE-10-01/R0
FHSE-10-01/R0
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
12
0
0
0
0
0
48
CTD
28
0
28
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 15 No.Contract :
Date : 1-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 10 150 q Fatality Case 0 0
q Elnusa Team 28 28 420 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 38 605 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 456 7260 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 1 1 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 1 2 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 2 30 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 2 30 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 0 0 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 3 3
Total Meeting Conducted 4 4 60 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 3 3
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 0
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 0
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 11 11 150 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 12 12 74 R Update final completion HWU
Total Hazard Observation 23 23 224 R Monitoring RIH E-Line for Perforation
q Open 0 0 0 R
q Close 23 23 224
Total Status Finding 23 23 224 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
15
0
0
0
0
0
51
CTD
28
0
28
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 16 No.Contract :
Date : 2-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 20 160 q Fatality Case 0 0
q Elnusa Team 28 56 448 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 76 643 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 912 7716 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 2 2 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 2 3 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 4 32 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 4 32 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 0 0 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 5
Total Meeting Conducted 4 8 64 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 5
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 0
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 0
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 7 18 157 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 11 23 85 R Monitoring RIH Completion
Total Hazard Observation 18 41 242 R
q Open 0 0 0 R
q Close 18 41 242
Total Status Finding 18 41 242 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
17
0
0
0
0
0
53
CTD
28
0
28
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 17 No.Contract :
Date : 3-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 30 170 q Fatality Case 0 0
q Elnusa Team 28 84 476 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 114 681 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 1368 8172 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 3 3 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 3 4 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 6 34 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 6 34 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 0 0 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 7
Total Meeting Conducted 4 12 68 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 7
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 0
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 0
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 5 23 162 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 13 36 98 R Monitoring RIH Completion
Total Hazard Observation 18 59 260 R
q Open 0 0 0 R
q Close 18 59 260
Total Status Finding 18 59 260 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
19
0
0
0
0
0
55
CTD
28
0
28
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 18 No.Contract :
Date : 4-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 40 180 q Fatality Case 0 0
q Elnusa Team 28 112 504 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 152 719 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 1824 8628 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 0 3 3 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 0 3 4 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 8 36 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 8 36 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 0 0 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 9
Total Meeting Conducted 4 16 72 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 9
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 0
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 0
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 6 29 168 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 12 48 110 R Monitoring Rig Down HWU
Total Hazard Observation 18 77 278 R
q Open 0 0 0 R
q Close 18 77 278
Total Status Finding 18 77 278 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
21
0
0
0
0
0
57
CTD
28
0
28
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 19 No.Contract :
Date : 5-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 50 190 q Fatality Case 0 0
q Elnusa Team 28 140 532 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 190 757 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 2280 9084 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 4 4 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 4 5 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 10 38 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 10 38 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 0 0 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 11
Total Meeting Conducted 4 20 76 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 11
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 0
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 0
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 6 35 174 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 12 60 122 R Monitoring Rig Down HWU
Total Hazard Observation 18 95 296 R
q Open 0 0 0 R
q Close 18 95 296
Total Status Finding 18 95 296 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
23
0
0
0
0
0
59
CTD
28
0
28
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 20 No.Contract :
Date : 6-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 60 200 q Fatality Case 0 0
q Elnusa Team 28 168 560 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 228 795 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 2736 9540 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 5 5 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 5 6 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 12 40 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 12 40 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 0 0 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 13
Total Meeting Conducted 4 24 80 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 13
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 0
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 0
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 0 35 174 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 0 60 122 R Moving from EQD P/F to LC P/F
Total Hazard Observation 0 95 296 R
q Open 0 0 0 R
q Close 0 95 296
Total Status Finding 0 95 296 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
25
0
0
0
0
0
61
CTD
28
0
28
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 21 No.Contract :
Date : 7-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 70 210 q Fatality Case 0 0
q Elnusa Team 28 196 588 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 266 833 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 3192 9996 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 6 6 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 6 7 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 14 42 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 14 42 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 1 1 1 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 15
Total Meeting Conducted 5 29 85 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 15
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 1 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 1 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 9 44 183 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 14 74 136 R Update final completion HWU
Total Hazard Observation 23 118 319 R Monitoring Kill Well
q Open 0 0 0 R
q Close 23 118 319
Total Status Finding 23 118 319 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
27
0
0
0
0
0
63
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 22 No.Contract :
Date : 8-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 80 220 q Fatality Case 0 0
q Elnusa Team 28 224 616 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 304 871 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 3648 10452 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 7 7 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 7 8 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 16 44 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 16 44 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 1 1 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 17
Total Meeting Conducted 4 33 89 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 0 2 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 17
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 0 3 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 10 54 193 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 11 85 147 R Update final completion HWU
Total Hazard Observation 21 139 340 R Monitoring Rig Up HWU
q Open 0 0 0 R
q Close 21 139 340
Total Status Finding 21 139 340 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
29
0
0
0
0
0
65
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 23 No.Contract :
Date : 9-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 90 230 q Fatality Case 0 0
q Elnusa Team 28 252 644 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 342 909 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 4104 10908 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 8 8 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 8 9 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 18 46 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 18 46 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 1 2 2 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 19
Total Meeting Conducted 5 38 94 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 1 1 3 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 19
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 1 1 4 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 6 60 199 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 12 97 159 R Update final completion HWU
Total Hazard Observation 18 157 358 R Monitoring E-Line job for RIH MPC
q Open 0 0 0 R
q Close 18 157 358
Total Status Finding 18 157 358 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
31
0
0
0
0
0
67
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 24 No.Contract :
Date : 10-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 100 240 q Fatality Case 0 0
q Elnusa Team 28 280 672 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 380 947 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 4560 11364 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 9 9 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 9 10 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 20 48 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 20 48 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 2 2 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 21
Total Meeting Conducted 4 42 98 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 1 3 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 21
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 1 4 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 11 71 210 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 9 106 168 R Monitoring Running kill string and completion
Total Hazard Observation 20 177 378 R
q Open 0 0 0 R
q Close 20 177 378
Total Status Finding 20 177 378 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H.Rokhim / Nata H Weida Ardi R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
33
0
0
0
0
0
69
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 25 No.Contract :
Date : 11-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 110 250 q Fatality Case 0 0
q Elnusa Team 28 308 700 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 418 985 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 5016 11820 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 10 10 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 10 11 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 22 50 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 22 50 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 1 3 3 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 23
Total Meeting Conducted 5 47 103 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 1 3 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 23
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 1 4 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 16 87 226 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 3 109 171 R Update final completion HWU
Total Hazard Observation 19 196 397 R Monitoring Cementing Job
q Open 0 0 0 R
q Close 19 196 397
Total Status Finding 19 196 397 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H.Rokhim / Nata H Weida Ardi R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
35
0
0
0
0
0
71
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 26 No.Contract :
Date : 12-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 120 260 q Fatality Case 0 0
q Elnusa Team 28 336 728 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 456 1023 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 5472 12276 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 11 11 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 11 12 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 24 52 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 24 52 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 3 3 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 25
Total Meeting Conducted 4 51 107 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 1 3 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 25
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 1 4 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 12 99 238 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 5 114 176 R Update final completion HWU
Total Hazard Observation 17 213 414 R Monitoring Rig Up EQD 6
q Open 0 0 0 R
q Close 17 213 414
Total Status Finding 17 213 414 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H.Rokhim / Nata H Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
37
0
0
0
0
0
73
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 27 No.Contract :
Date : 13-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 130 270 q Fatality Case 0 0
q Elnusa Team 28 364 756 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 494 1061 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 5928 12732 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 12 12 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 12 13 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 26 54 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 26 54 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 3 3 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 27
Total Meeting Conducted 4 55 111 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 1 2 4 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 27
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 1 2 5 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 10 109 248 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 8 122 184 R Update final completion HWU
Total Hazard Observation 18 231 432 R Monitoring e-Line for running MPC
q Open 0 0 0 R
q Close 18 231 432
Total Status Finding 18 231 432 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
39
0
0
0
0
0
75
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 28 No.Contract :
Date : 14-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 140 280 q Fatality Case 0 0
q Elnusa Team 28 392 784 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 532 1099 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 6384 13188 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 0 0 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 13 13 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 13 14 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 0
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 28 56 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 0
q JSA Meeting (Pre-Job) 2 28 56 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 1 4 4 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 29
Total Meeting Conducted 5 60 116 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 2 4 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 29
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 2 5 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day 4 CTD R Inspection HSE Equipment and Working area
q Unsafe 12 121 260 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 8 130 192 R Update final completion HWU
Total Hazard Observation 20 251 452 R Monitoring POOH Tubing Completion
q Open 0 0 0 R
q Close 20 251 452
Total Status Finding 20 251 452 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
1
0
0
0
0
2
CTD
0
36
0
41
0
0
0
0
0
77
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 29 No.Contract :
Date : 15-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 150 290 q Fatality Case 0 0
q Elnusa Team 28 420 812 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 570 1137 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 6840 13644 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 1 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 0 13 13 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 14 15 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 2 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 30 58 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 2 2
q JSA Meeting (Pre-Job) 2 30 58 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 4 4 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 31
Total Meeting Conducted 4 64 120 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 2 4 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 31
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 2 5 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 12 133 272 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 5 135 197 R Update final completion HWU
Total Hazard Observation 17 268 469 R Monitoring RIH CR set
q Open 0 0 0 R
q Close 17 268 469
Total Status Finding 17 268 469 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
3
0
0
0
0
4
CTD
0
36
0
43
0
0
0
0
0
79
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 30 No.Contract :
Date : 16-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 160 300 q Fatality Case 0 0
q Elnusa Team 28 448 840 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 608 1175 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 7296 14100 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 14 14 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 15 16 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 32 60 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 2
q JSA Meeting (Pre-Job) 2 32 60 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 4 4 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 33
Total Meeting Conducted 4 68 124 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 2 4 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 33
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 2 5 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 14 147 286 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 7 142 204 R Update final completion HWU
Total Hazard Observation 21 289 490 R Monitoring Cementing Job
q Open 0 0 0 R
q Close 21 289 490
Total Status Finding 21 289 490 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
3
0
0
0
0
4
CTD
0
36
0
45
0
0
0
0
0
81
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 31 No.Contract :
Date : 17-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 170 310 q Fatality Case 0 0
q Elnusa Team 28 476 868 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 646 1213 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 7752 14556 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 0 14 14 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 0 15 16 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 0
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 1 33 61 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 2
q JSA Meeting (Pre-Job) 0 32 60 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 4 4 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 0 33
Total Meeting Conducted 1 69 125 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 1 3 5 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 0 33
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 1 3 6 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 13 160 299 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 5 147 209 R Update final completion HWU
Total Hazard Observation 18 307 508 R Monitoring POOH MST
q Open 0 0 0 R
q Close 18 307 508 R
Total Status Finding 18 307 508 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
1
0
3
0
0
0
0
4
CTD
0
36
0
45
0
0
0
0
0
81
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Production, Operation & Maintenance Service Project/Location : EHR#01 Star Energy
Work Day : 32 No.Contract :
Date : 18-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 180 320 q Fatality Case 0 0
q Elnusa Team 28 504 896 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 684 1251 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 8208 15012 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 15 15 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 16 17 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 1 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 35 63 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 1 3
q JSA Meeting (Pre-Job) 2 34 62 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 4 4 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 3 36
Total Meeting Conducted 4 73 129 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 3 5 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 3 36
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 1
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 1
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 3 6 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 9 169 308 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 10 157 219 R Update final completion HWU
Total Hazard Observation 19 326 527 R Monitor e-line for perforation
q Open 0 0 0 R
q Close 19 326 527 R
Total Status Finding 19 326 527 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
2
0
3
0
0
0
0
5
CTD
0
36
0
48
0
0
0
0
0
84
CTD
28
1
29
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 33 No.Contract :
Date : 19-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 190 330 q Fatality Case 0 0
q Elnusa HWU Team 28 532 924 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Elnusa Subcontractor 2 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 722 1289 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 8664 15468 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 16 16 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 17 18 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 37 65 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 3
q JSA Meeting (Pre-Job) 2 36 64 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 2 6 6 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 38
Total Meeting Conducted 6 79 135 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 3 5 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 38
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 2 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 2 3
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 3 6 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 11 180 319 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 10 167 229 R Update final completion HWU
Total Hazard Observation 21 347 548 R Monitor e-line for perforation
q Open 0 0 0 R
q Close 21 347 548 R
Total Status Finding 21 347 548 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
2
0
3
0
0
0
0
5
CTD
0
36
0
50
0
0
0
0
0
86
CTD
28
3
31
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 34 No.Contract :
Date : 20-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 200 340 q Fatality Case 0 0
q Elnusa HWU Team 28 560 952 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Elnusa Subcontractor 2 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 760 1327 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 9120 15924 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 17 17 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 18 19 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 0
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 39 67 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 3
q JSA Meeting (Pre-Job) 2 38 66 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 2 8 8 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 3 41
Total Meeting Conducted 6 85 141 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 3 5 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 3 41
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 3
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 3 6 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 12 192 331 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 10 177 239 R Update final completion HWU
Total Hazard Observation 22 369 570 R Monitor RIH Completion
q Open 0 0 0 R
q Close 22 369 570 R
Total Status Finding 22 369 570 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
0
0
2
0
3
0
0
0
0
5
CTD
0
36
0
53
0
0
0
0
0
89
CTD
28
3
31
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 35 No.Contract :
Date : 21-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 210 350 q Fatality Case 0 0
q Elnusa HWU Team 28 588 980 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Elnusa Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 798 1365 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 9576 16380 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 18 18 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 19 20 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 1 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 41 69 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 1 4
q JSA Meeting (Pre-Job) 2 40 68 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 2 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 3 44
Total Meeting Conducted 6 91 147 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 3 5 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 3 44
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 0
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 3
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 3 6 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 12 204 343 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 9 186 248 R Update final completion HWU
Total Hazard Observation 21 390 591 R Monitor RIH Completion
q Open 0 0 0 R
q Close 21 390 591 R
Total Status Finding 21 390 591 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
56
0
0
0
0
0
92
CTD
28
3
31
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 36 No.Contract :
Date : 22-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 220 360 q Fatality Case 0 0
q Elnusa HWU Team 28 616 1008 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q Elnusa Patracom 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 836 1403 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 10032 16836 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 19 19 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 20 21 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 43 71 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 42 70 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 46
Total Meeting Conducted 4 95 151 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 3 5 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 46
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 1 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 1 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 3 6 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 10 214 353 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 8 194 256 R Update final completion HWU
Total Hazard Observation 18 408 609 R Monitoring Rig Down HWU from EQD 6
q Open 0 0 0 R
q Close 18 408 609 R
Total Status Finding 18 408 609 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
58
0
0
0
0
0
94
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 37 No.Contract :
Date : 23-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 230 370 q Fatality Case 0 0
q Elnusa HWU Team 28 644 1036 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 874 1441 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 10488 17292 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 20 20 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2019
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 21 22 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 45 73 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 44 72 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 48
Total Meeting Conducted 4 99 155 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 3 5 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 48
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R
Total Drill Conducted 0 3 6 R Arrange working permit to open and close
HAZARD OBSERVATION Day Month CTD R Toolbox meeting at morning and afternoon
q Unsafe 4 218 357 R Inspection HSE Equipment and Working area
q Nearmiss 0 0 0 R Review and record Tuntas Card (on line)/ HOC (offline)
q Safe 15 209 271 R Make Daily Report HSE Elnusa and PHE ONWJ
Total Hazard Observation 19 427 628 R Update final completion HWU
q Open 0 0 0 R Monitoring Rig Down HWU from EQD 6
q Close 19 427 628 R
Total Status Finding 19 427 628 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2019
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
60
0
0
0
0
0
96
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 38 No.Contract :
Date : 24-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 240 380 q Fatality Case 0 0
q Elnusa HWU Team 28 672 1064 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 912 1479 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 10944 17748 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 21 21 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................2020
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 22 23 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 47 75 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 46 74 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 50
Total Meeting Conducted 4 103 159 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 3 5 q Confined Space 0 0
q Man over board 0 0 0 l q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 50
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 3 6 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 9 227 366 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 11 220 282 R Monitoring Rig Up HWU from EQD 5
Total Hazard Observation 20 447 648 R
q Open 0 0 0 R
q Close 20 447 648 R
Total Status Finding 20 447 648 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

....................2020
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
62
0
0
0
0
0
98
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 39 No.Contract :
Date : 25-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 250 390 q Fatality Case 0 0
q Elnusa HWU Team 28 700 1092 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 950 1517 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 11400 18204 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 22 22 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 23 24 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 49 77 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 48 76 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 52
Total Meeting Conducted 4 107 163 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 1 4 6 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 52
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 1 4 7 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 6 233 372 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 16 236 298 R Update final completion HWU
Total Hazard Observation 22 469 670 R Monitoring Rig Up HWU from EQD 5
q Open 0 0 0 R
q Close 22 469 670 R
Total Status Finding 22 469 670 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
64
0
0
0
0
0
100
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 40 No.Contract :
Date : 26-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 260 400 q Fatality Case 0 0
q Elnusa HWU Team 28 728 1120 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 988 1555 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 11856 18660 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 23 23 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 24 25 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 51 79 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 50 78 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 54
Total Meeting Conducted 4 111 167 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 4 6 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 54
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 4 7 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 9 242 381 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 11 247 309 R Update final completion HWU
Total Hazard Observation 20 489 690 R Monitoring POOH Kill String
q Open 0 0 0 R
q Close 20 489 690 R
Total Status Finding 20 489 690 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
66
0
0
0
0
0
102
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 41 No.Contract :
Date : 27-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 270 410 q Fatality Case 0 0
q Elnusa HWU Team 28 756 1148 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 1026 1593 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 12312 19116 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 24 24 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 25 26 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 53 81 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 52 80 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 56
Total Meeting Conducted 4 115 171 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 4 6 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 56
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 4 7 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 9 251 390 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 11 258 320 R Update final completion HWU
Total Hazard Observation 20 509 710 R Monitoring RIH milling CR
q Open 0 0 0 R
q Close 20 509 710 R
Total Status Finding 20 509 710 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
68
0
0
0
0
0
104
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 42 No.Contract :
Date : 28-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 280 420 q Fatality Case 0 0
q Elnusa HWU Team 28 784 1176 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 1064 1631 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 12768 19572 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 25 25 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 26 27 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 55 83 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 54 82 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 58
Total Meeting Conducted 4 119 175 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 4 6 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 58
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 4 7 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 5 256 395 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 15 273 335 R Update final completion HWU
Total Hazard Observation 20 529 730 R Monitoring RIH CR and Set
q Open 0 0 0 R
q Close 20 529 730 R
Total Status Finding 20 529 730 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
70
0
0
0
0
0
106
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 43 No.Contract :
Date : 29-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 290 430 q Fatality Case 0 0
q Elnusa HWU Team 28 812 1204 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 1102 1669 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 13224 20028 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 26 26 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 27 28 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 57 85 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 0 0
q Monthly Meeting 0 0 0 Total Training Record 0 4
q JSA Meeting (Pre-Job) 2 56 84 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 2 60
Total Meeting Conducted 4 123 179 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 4 6 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 2 60
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 4 7 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 9 265 404 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 12 285 347 R Update final completion HWU
Total Hazard Observation 21 550 751 R Monitoring RIH Bit For DOC and CR
q Open 0 0 0 R
q Close 21 550 751 R
Total Status Finding 21 550 751 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
1
0
2
0
3
0
0
0
0
6
CTD
0
36
0
72
0
0
0
0
0
108
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 44 No.Contract :
Date : 30-Sep-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 300 440 q Fatality Case 0 0
q Elnusa HWU Team 28 840 1232 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 1140 1707 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 13680 20484 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 27 27 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 28 29 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 0 1
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 59 87 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 1 1
q Monthly Meeting 0 0 0 Total Training Record 1 5
q JSA Meeting (Pre-Job) 2 58 86 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 3 63
Total Meeting Conducted 4 127 183 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 4 6 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 3 63
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 4 7 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 9 274 413 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 13 298 360 R Update final completion HWU
Total Hazard Observation 22 572 773 R Monitoring RIH Bit For DOC and CR
q Open 0 0 0 R
q Close 22 572 773
Total Status Finding 22 572 773 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
1
0
2
0
3
0
0
0
1
7
CTD
0
36
0
75
0
0
0
0
0
111
CTD
29
3
32
 Formulir FHSE-10-01/R0
DAILY HSE ACTIVITY REPORT

Division : Drilling and Oilfield Services Division Project/Location : EHR#01 Star Energy
Work Day : 45 No.Contract :
Date : 1-Oct-20 Period Contract :

PERSONNEL ON BOARD Day Month CTD INCIDENTS / ACCIDENT CASE*) Day Month
q Client Rep's 10 310 450 q Fatality Case 0 0
q Elnusa HWU Team 28 868 1260 q LTI Case 0 0
q Elnusa Scaffolding 0 0 35 Injury q Restricted Work Case 0 0
q LD Service 0 0 0 Class. q Medical Treatmen Case 0 0
VISITOR 0 0 0 q First Aid Case 0 0
q Management Elnusa 0 0 0 Total Accident Case 0 0
q Management Client 0 0 0 Property q Vehicle 0 0
q 3rd Party(Inspector,Internship,etc) 0 0 0 Damage q Tools / Equipments 0 0
Total POB 38 1178 1745 case Total Prop. Damage Case 0 0
Man hours exposured #) 456 14136 20940 q illness Case 0 0
illness Case
INSPECTION REPORT Day Month CTD Total Prop. Illness Case 0 0
q Unit Performance (Function) Test 0 0 1 q Minor (1 BBls) 0 0
q House Keeping / Hygiene / Waste 0 1 1 q Midle Case (+1 ≤ 10 Bbls) 0 0
Spill Case
q Safety Equipment(Fire ext,Gas Test etc) 1 28 28 q Major ( > 10 BBls) 0 0
q PPE 0 0 0 Total Spill Case 0 0
q Workplace (Hazardous Area/Material) 0 0 0 "THE LAST ACCIDENT of LTI / FATALITY
q Tools & Equipment for Operation 0 0 0 CASE" .....................
q Vehicle Inspection 0 0 0 VEHICLE JOURNEY RECORD Day Month
q Electrical Installation 0 0 0 q Total Vehicle 0 0
q Work at heigh installation 0 0 0 q KM Driven 0 0
q Others Transport (Boat, Vessel, etc) 0 0 0
Total Inspection Conducted 1 29 30 HSE TRAINING RECORD Day Month
AUDIT REPORT Day Month CTD q HSE Awareness 0 1
q Elnusa Audit(ISO9001,OHSAS,etc) 0 0 0 q Fire Fighting 0 0
q Client Audit (Interm/WIP/End Proj, etc) 0 0 0 q First Aid 1 2
q 3rd Party (SGS, DNV, etc) 0 0 0 q FSWP / 8 SSP / Golden Role 0 0
q Regulator (DEPNAKER,MIGAS) 0 0 0 q Lifting, Rigging & Slinging 0 2
Total Audit Conducted 0 0 0 q Defensive Driving 0 0
MEETING ONSITE Day Month CTD q Incident Investigation 0 0
q Daily Safety Meeting 2 61 89 q PPE 0 0
q Weekly / bi-weekly Meeting 0 0 0 q Others Training 1 1
q Monthly Meeting 0 0 0 Total Training Record 2 6
q JSA Meeting (Pre-Job) 2 60 88 PERMIT SYSTEM Day Month
q Safety Stand Down Operation 0 10 10 q SIKA / General 0 0
q Service Quality meeting 0 0 0 q Hot Work 0 0
q Management Meeting Onsite 0 0 0 q Heavy Lifting 0 0
q Others Meeting 0 0 0 q Cold Work 3 63
Total Meeting Conducted 4 131 187 q Work At Heigh 0 0
EMERGENCY DRILL REPORT Day Month CTD q Driving 0 0
q Medical (Injury) Evacuation 0 0 0 q Isolation 0 0
q Blow Out 0 4 6 q Confined Space 0 0
q Man over board 0 0 0 q Others Permit 0 0
q Sabotage / Riot / Demonstration 0 0 0 Total Permit System 3 63
q Missfire drill 0 0 0 INDUCTION/ORIENTATION PROGRAM Day Month
q Trip drill 0 0 0 q Induction for Visitor 0 1
q Fire Drill 0 0 1 q Orientation Program 0 3
q Abandon Drill 0 0 0 Total Induction/Orentation Conducted 0 4
q Spills/Hazardous Material Drill 0 0 0 HSE ACTIVITY :
q Others Drill 0 0 0 R Arrange working permit to open and close
Total Drill Conducted 0 4 7 R Toolbox meeting at morning and afternoon
HAZARD OBSERVATION Day Month CTD R Inspection HSE Equipment and Working area
q Unsafe 11 285 424 R Review and record Tuntas Card (on line)/ HOC (offline)
q Nearmiss 0 0 0 R Make Daily Report HSE Elnusa and PHE ONWJ
q Safe 7 305 367 R Update final completion HWU
Total Hazard Observation 18 590 791 R Monitoring RIH Bit For DOC and CR
q Open 0 0 0 R
q Close 18 590 791
Total Status Finding 18 590 791 HIGH LIGHT ISSUE :
R
Acknowledged by : Prepared by: R
Supv / Supt/ FSM/ Chief HSE Officer R
R
R
R
H. Rokhim / Hamiruddin Fabian Dhamas R
R
FHSE-10-01/R0

CTD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 ###

.....................
CTD
0
0

CTD
1
0
3
0
3
0
0
0
1
8
CTD
0
36
0
75
0
0
0
0
0
111
CTD
29
3
32
 HSE PERFORMANCE MONITORING AND ACHIEVMENT
Division : POMS
Work Day : 14
Year : 2020

Bulan
Jan-20 Feb-20 Mar-20 Apr-20 May-20
Parameter
Leading
Man Hours
KM Driven

Lagging
qTRIR
qSR/LTIFR
qFatality Case
qLTI Case
qRestricted Work Case
qMedical Treatmen Case
qFirst Aid Case
qillness Case
qVehicle Damage
qTools / Equipments Damage
qMinor (1 BBls)
qMidle Case (+1 ≤ 10 Bbls)
qMajor ( > 10 BBls)

Leading
qInduction / Orientation
qInspection
qAudit
qMeeting On Site
qEmergency Drill Report
qHazard Observation Card
qHSE Training
qPermit System

Note : MAS BRO TOLONG DI ISI MANUAL BIAR PAS

ACHIEVMENT
Project/Location EHR#01 Star Energy
No.Contract
Period Contract :

Cummulativ
Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 e Achieved

6804 6804

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0
28 28
1 1
0 0
56 56
3 3
201 201
6 6
48 48

MANUAL BIAR PAS PINDAH BULAN G BERUBAH

TARGET INDICATOR

0 6804

0 100%
0 100%
0 100%
0 100%
0 100%
0 100%
0 100%
0 100%
0 100%
0 100%
0 100%
0 100%
4 4

2 26
2 -1
2 -2
2 54
2 1
0 201
2 4
2 46