Scribd Logo
Upload

Welcome to Scribd!

  • Form Preliminary Incident Report FAC

    Uploaded by

    erwin kusuma Nasution
    11 views1 page
    The document is a preliminary incident report from the Lamipak New Plant Project site dated April 5, 2023. It reports a spillage of diesel fuel from an excavator at 9:30 AM. The operator was changing the excavator's dirty diesel filter which caused the spillage. The spilled diesel fuel spread on the ground around the location. The operator was unaware that heavy equipment maintenance should not be performed in the project area. No injuries or property damage were reported from the spill.

    Original Description:

    Incident report

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document is a preliminary incident report from the Lamipak New Plant Project site dated April 5, 2023. It reports a spillage of diesel fuel from an excavator at 9:30 AM. The operator was changing the excavator's dirty diesel filter which caused the spillage. The spilled diesel fuel spread on the ground around the location. The operator was unaware that heavy equipment maintenance should not be performed in the project area. No injuries or property damage were reported from the spill.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views1 page

    Form Preliminary Incident Report FAC

    Uploaded by

    erwin kusuma Nasution
    The document is a preliminary incident report from the Lamipak New Plant Project site dated April 5, 2023. It reports a spillage of diesel fuel from an excavator at 9:30 AM. The operator was changing the excavator's dirty diesel filter which caused the spillage. The spilled diesel fuel spread on the ground around the location. The operator was unaware that heavy equipment maintenance should not be performed in the project area. No injuries or property damage were reported from the spill.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    SAFETY, HEALTH & ENVIRONMENT

    PRELIMINARY INCIDENT REPORT (LAPORAN INSIDEN AWAL)

    SITE NAME : DATE OF OCCURRENCE : TIME :


    LAMIPAK NEW PLANT PROJECT 05-Apr-23
    NAMA LOKASI TANGGAL KEJADIAN WAKTU 09.30 WIB
    AREA OF INCIDENT : DATE REPORTED :
    05-Apr-23
    TEMPAT KEJADIAN TANGGAL LAPORAN
    INCIDENT CATEGORY PERSON INJURED/ PROPERTY DAMAGED
    KATEGORI INSIDEN CIDERA ORANG/ KERUSAKAN PROPERTY
    INCIDENT NAME :
    Fatality Property Damaged NAMA KEJADIAN Spillage of Diesel Fuel

    LTI Environmental Damage ESTIMATED COST & PROPERTY LOSS :


    PERKIRAAN BIAYA & KERUGIAN -
    Rawat Medis Near Miss PROPERTI
    MCB Tertabrak VICTIM & OCCUPATION :
    P3K Fire KORBAN & PEKERJAAN
    Explosio
    Others ................... Electrical Short Circuit WITNESS & OCCUPATION :
    (Jelaskan) Collaps of Scaffolding SAKSI & PEKERJAAN
    Object Falling from Height
    Lifting Equipment Failure
    Lift Failure
    Landslide Incident
    Release of Haarmful Substance
    Pressure System Failure
    Others ...................
    (Jelaskan)

    DESCRIBE CLEARLY THE OCCURRENCE

    Wedneday, 5 April 2023, 09.30 WIB


    There has been a spillage of diesel fuel from an excavator that has been used by LAMIPAK Project Indonesia. Spillage happen when operator chage diesel
    filter. Spillage of diesel fuel hit the ground and spreads around the location where the diesel filter replacement takes place. The operator excavator said that the
    excavator's diesel filter was already dirty and he was worried that if it wasn't replaced, it would result in damage to the excavator's engine. The operator was
    unaware that heavy equipment maintenance or servicing should not be performed with in the project area.

    ISSUED BY : REVIEWED BY : APPROVED BY :


    DIBUAT OLEH : DIPERIKSA OLEH : DISETUJUI OLEH :

    SPV / Site Manager EHS Deputi Project Manager/Project Manager

    You might also like