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DAILY INSPECTION REPORT/ LAPORAN PEMERIKSAAN HARIAN - OUTDOOR CLEANING / PEMBERSIHAN AREA LUAR

PROJECT : DAY / DATE :


HKA : NIK :
HKL/HKS/AM :

No Point of Attention Location


Remarks

A CLEANLINESS Time
1 Vehicle Lane / Jalan Kendaraan
2 Canstein / Kanstin
3 Gutter / Saluran
4 Grass / Rumput
5 Bush / Semak
6 Trees / Pepohonan
7 Vines Plant / Tanaman Rambat
8 Indoor Plants / Tanaman Indoor
9 Path Way / Jalan Setapak
10 Nursery / Area Pendayaan Tanaman
11 List Garden / Lis Taman
12 Pedestrian Way / Jalur Pejalan Kaki
13 Stones Exposure / Batu Hias
14 Loose Pables / Batu Sebar Lepas
15 Pot Plants / Tanaman Dalam Pot
16 Water Plants / Tanaman Air
17 Fruit Plant /Tanaman Buah
18 Garden Lamp / Lampu Taman
19 Bench/Bangku Taman
20 Water Feature / Hiasan Air
21 Sculpture / Patung Hias
22 Fence / Pagar
23 Pergola
24 Gazebo/ Bale Bengong

25 Play Ground / Tempat Bermain Anak

26 Fish Pond / Kolam Ikan


27 Umbrella Place/Area Payung
28
29
30
Total Satisfaction (1)/ Total Jumlah (1) yang baik
Total Inspection Object/ Jumlah Obyek yang diperiksai
Score Satisfaction : (Jumlah Satisfaction / total item inspeksi) x 100%

B PERSONAL PROTECTIVE EQUIPMENT / APD


1 Helmet / Pelindung Kepala
2 Safety Glass / Kaca Mata Pengaman
3 Masker / Pelindung Pernapasan
4 Safey Hand Gloves / Sarung Tangan Pengaman
5 Safety Shoes / Safety Boot / Canvas
6 Safety Vest / Rompi
7
Total Satisfaction (1)
Total Item Inspeksi
Score Satisfaction : (Jumlah Satisfaction / total item inspeksi) x 100%

Remarks : Jumlah
Total Penilaian Score (%)
0 = Unsatisfaction / PPE Not Used Item Inspeksi Satifaction
1 = Satisfaction / PPE Used A. Hygiene Quality
N/A = leave blank B. Kedisiplinan Pemakaian APD

Range : Diperiksa Oleh Diketahui Oleh


A > 91 % Sangat Baik/Execellent
B 81 % - 90 % Baik/Good
C 61 % - 80 % Cukup/fair
D < 60 % Kurang/Poor

HKL/ HKS/ AM Sr.Ops Mgr/GM


Nomor Form : QF 16-73-00

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