INSPEKSI PERALATAN KESELAMATAN

Rev Tanggal Terbit Halaman Nomor Informasi Dokumen

03 11 Mei 2020 1/1 F-HES-035
Isilah cheklist dibawah ini sesuai dengan kondisi berikut:
Rig / Unit : Terpenuhi / bagus / layak :ü Atau Ya
Tidak Terpenuhi/Tidak Bagu: O Atau Tidak
Tidak Diterapkan : N/A
Tgl: Tgl: Tgl: Tgl: Tgl:

Lokasi Lokasi Lokasi Lokasi Lokasi

No Spesifikasi Qty Keterangan

Minggu Ke 1 Minggu Ke 2 Minggu Ke 3 Minggu Ke 4 Minggu Ke 5

1 First Aid Kit c/w Snake Bite Kit
2 Burn pack
3 Derrick safety Belt
4 Lanyard
5 Anti fall and Climbing Devices
6 Derrick Escape (Slow Speed DBI SALA)
7 Stretcher
8 Wind Shock
9 Multi Gas Detector
10 Bug Blower
11 Eye Wash
12 Axes
13 SCBA
14 Fire Extinguisher Dry Powder : 20 lbs
15 Fire Extinguisher Dry Powder : 150 lbs
16 safety goggles
17 Ear Protector
18 Yellow Line
19 Yellow Flag
20 Oxygen
21 (1)Loto station, (2) Pad Lock (5 pcs yellow pad lock, 5 pcs blue,
pad lock, 5 pcs red pad lock) (3) 3 pcs HASP
22 Emergency Response Box (1) Emergency Response Plan BP and
NWW Book. (2)Incident Reporting Procedure. (3)Incident
Preliminary Report (MVC, IA, EA, Fire, Spill) Form. (4) Stationary,
calculator, clip board. (5) Flash light + battery. (6) P3K. (7) Yelow
line
23 Hi Voltage hand Gloves
24 Bee Net
25 Fire Suit
26 PPE Visitor in Access Control (1)Safety Shoes
27 PPE Visitor in Access Control (2)Safety Helmet
28 PPE Visitor in Access Control (3)Safety Glassess
29 PPE Visitor in Access Control (4) Ear Plug
30 PPE Visitor in Access Control (5) Flas light 6 battery
31 Mask (Organic vapor respirator dust)
32 Flagman and Swamper Jacket

Diinspeksi Oleh (HES Field),

Disetujui Oleh,

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