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n-ii»•• s•°saii s•' HSE OBSERVATION CARD

I-USE OBSERVATION CARD FMSK/01/02/01/1tcv.00


EM/HSZ/01/02/01/IU.00
OSafe Act (Sale Behavior) /
OSafe Act (Safe Behavior) / 'I’ipdah an .Ainari ț l•erilakii .Uman l
1'iiidakan Aman ( Perilfi u Airline i OUitate Act (Unsafe Behavior) /
OUnsafe Act (Unsafe Behavior) / 'hndekaii TidnL Amin l Perilaku BcresikoJ
OSale Condition / kondisi Ainan
OUnsafe Condition 1
kondisi 7'idsi• \n1. n t konrh si Reresik‹4)
O Uiuafe Condition /
kondisi Tidak .Am an i iit›ndisi Bcresit.o i
Describe what you see :
Jclaskaii apa jciii anda liliat
Describe what you see

Cormctive action :
Tindakan pcrboikan i ung dilakukan
Corrective action :
3 iiid;£an prrb;ikan airy dilakukan

Recommendation : flekonicndasi

Observer / l°eiigarnilt
Name & Sign / Nama & Tnnde T.andean

Observer / Peng:rural
Name & Sign / N.aura ñ 'I'iiiids I augur Project / Pr‹•¿ cL

Project / Prue ck Datc/Ian¿¿;›I

Location / l.okasi
Date / I’a» al

Location / L‹›Lasi
SAFETY OBSERVATION CYCLE
SIKLIJS PENGAMATAN KESELA MATAN SH Lt*S Pb.NGAMATAN K ESELAAIATAN SIKLUS PENGWtATAN KESELݴMATA'$

1 S4 MO JUL IR I 6T FORMULIR

S€GERA NE¥TI¥AN

OISMSI DI*KuSI
MASALAH

Instruction / Instruksi :
lastrnctioa / instruksi : Instruction / Instruksi :
i. Observe your workplace cvory day by rcffcring
1, Oburvt your worlrplacc every day by reffering 1. Observe your workplace every day by bettering
the above cycle.
the above cycle. the above cycle.
Anuili tciiipat kcju anda setiap hari dcn;aii
.Aiuali tempat kerja Linda setiap h.ari deiq;iiii Aruati rem{›at kerja anda setiap hari dci init
iiierujuk sik his di *nas
n crujuL siklus di atos. incrujuk siklus di atas.
2, Ensure tht corrective action is taken.
2, Enswe the cormctivo ection is taken. 2, Ensure the corrective action is taken.
I'astikan IiiiduLan prrbaikan dianibil.
1'.astik:in iiiidaken pcrbaikan diainbil. P:red+kin tindakan pcrhaik;in diainbil
3, Complete Observation Report.
3, Complete Observation Report. 3, Complete Observation Report.
Lengkapi Lapran Ohscrv asi.
Lcnt,kapi Lumen Obseo asi. LcnJnpi Lapraii Ohscin asi
4. Send to HSE Coordinator for analysis.
4. Send to HSE Coordinator for analysis. 4. Send to HSE Coordinator for analysis.
Kiriili ke IN Sf_ kourdiiiator tin tuL dianali*.a.
Kirim ke HSE Coordinator unluk disn:ilisa. Eirim ko I US Coordinator untuk hari.a lisa.

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