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NO :

LAPORAN STATISTIK INSIDEN


INCIDENT STATISTIC REPORT
Nama Cabang Bulan Tahun
Branch Name Month Year

Department A
2008

TOTAL PROPERTY
RECORDABLE PROPERTY DAMAGE ENVIRONMENT POLL

ALL INCIDENT

ENVIRONMENT
RECORDABLE

NEAR MISS

POLLUTION
DAY LOST
MANPOWER

MANHOUR

> US$10000

> US$10000
DAMAGE
< US$1000

< US$1000
TOTAL

US$1000 -

US$1000 -
US$10000

US$10000

TOTAL
SAFE DIRECT
COST COST RECORDABLE
ALL INCIDENT LOST TIME CASE
MANHOUR ( FAC COST INCIDENT
FREQUENCY RATE FREQUENCY RATE
SEVERITY RATE

BULAN / MONTH LTI Free ) FATAL LTC RWC MTC (USD) (USD) (USD) FREQUENCY RATE

JANUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!


FEBRUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MARCH 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
APRIL 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MAY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JUNE 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JULY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
AUGUST 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
SEPTEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
OCTOBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
NOVEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
DECEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Roll over 12 month 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Department B
2008

TOTAL PROPERTY
RECORDABLE PROPERTY DAMAGE ENVIRONMENT POLL
ALL INCIDENT

ENVIRONMENT
RECORDABLE

NEAR MISS

POLLUTION
DAY LOST
MANPOWER

MANHOUR

> US$10000

DAMAGE
< US$1000

< US$1000

> US$1000
TOTAL

US$1000 -

US$1000 -
US$10000

US$10000

TOTAL
SAFE DIRECT
COST COST RECORDABLE
ALL INCIDENT LOST TIME CASE
MANHOUR ( FAC COST INCIDENT
FREQUENCY RATE FREQUENCY RATE
SEVERITY RATE

BULAN / MONTH LTI Free ) FATAL LTC RWC MTC (USD) (USD) (USD) FREQUENCY RATE

JANUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!


FEBRUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MARCH 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
APRIL 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MAY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JUNE 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JULY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
AUGUST 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
SEPTEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
OCTOBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
NOVEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
DECEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Roll over 12 month 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
CONTRACTOR
2008

TOTAL PROPERTY
RECORDABLE PROPERTY DAMAGE ENVIRONMENT POLL

ALL INCIDENT

ENVIRONMENT
RECORDABLE

NEAR MISS

POLLUTION
DAY LOST
MANPOWER

MANHOUR

> US$10000

DAMAGE
< US$1000

< US$1000

> US$1000
TOTAL

US$1000 -

US$1000 -
US$10000

US$10000

TOTAL
SAFE DIRECT
COST COST RECORDABLE
ALL INCIDENT LOST TIME CASE
MANHOUR ( FAC COST INCIDENT
FREQUENCY RATE FREQUENCY RATE
SEVERITY RATE

BULAN / MONTH LTI Free ) FATAL LTC RWC MTC (USD) (USD) (USD) FREQUENCY RATE

JANUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!


FEBRUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MARCH 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
APRIL 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MAY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JUNE 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JULY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
AUGUST 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
SEPTEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
OCTOBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
NOVEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
DECEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Roll over 12 month 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!

REKAP
2008

TOTAL PROPERTY
RECORDABLE PROPERTY DAMAGE ENVIRONMENT POLL

ALL INCIDENT

ENVIRONMENT
RECORDABLE

NEAR MISS

POLLUTION
DAY LOST
MANPOWER

MANHOUR

> US$10000

DAMAGE
< US$1000

< US$1000

> US$1000
TOTAL

US$1000 -

US$1000 -
US$10000

US$10000

TOTAL
SAFE DIRECT
COST COST RECORDABLE
ALL INCIDENT LOST TIME CASE
MANHOUR ( FAC COST INCIDENT
FREQUENCY RATE FREQUENCY RATE
SEVERITY RATE

BULAN / MONTH LTI Free ) FATAL LTC RWC MTC (USD) (USD) (USD) FREQUENCY RATE

JANUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!


FEBRUARY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MARCH 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
APRIL 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MAY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JUNE 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
JULY 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
AUGUST 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
SEPTEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
OCTOBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
NOVEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
DECEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MTD 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
YTD / ROLL OVER 0 0 0 0 0 0 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
NO :

KINERJA SHE
SHE PERFORMANCE
Nama Cabang Bulan Tahun
Branch Name Month Year

A. GENERAL INFORMATION

TOTAL MAN POWER : 0 employees

TOTAL MAN HOURS : 0 (MTD) 0 (YTD)

TOTAL FATALITY 0 (MTD) 0 (YTD)

TOTAL LTC : 0 (MTD) 0 (YTD)

TOTAL RWC : 0 (MTD) 0 (YTD)

TOTAL MTC : 0 (MTD) 0 (YTD)

TOTAL RECORDABLE INCIDENT : 0 (MTD) 0 (YTD)

TOTAL FAC : 0 (MTD) 0 (YTD)

TOTAL PROPERTY DAMAGE : 0 (MTD) 0 (YTD)

TOTAL ENVIRONMENT POLLUTION : 0 (MTD) 0 (YTD)

TOTAL INSIDENT : 0 (MTD) 0 (YTD)

LAST FATAL / LTA INCIDENT : Month date, Year (Department)


DAY LOST : 0 (MTD) 0 (YTD)

SAFE MAN HOURS : 0 Working hours

B. INCIDENT RATE

ALL INCIDENT FREQUENCY RATE : #DIV/0! (MTD) #DIV/0! (YTD)


AI FR TARGET : 0.0

RECORDABLE INC FREQUENCY RATE : #DIV/0! (MTD) #DIV/0! (YTD)


RIFR TARGET : 0.0

LOST TIME CASE FREQUENCY RATE : #DIV/0! (MTD) #DIV/0! (YTD)


LTCFR TARGET : 0.0

SEVERITY RATE : #DIV/0! (MTD) #DIV/0! (YTD)


SR TARGET : 0.0

Bagian dari / Part of - SHE.SOP.028.R00 Form Number : SHE.FRM.009.R00


INCIDENT FREQUENCY RATE

12.00

10.00

8.00

6.00
Rate

4.00

2.00

0.00
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Bulan
RIFR AIFR LTCFR SR

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