Doc.

Number
Subcontractor Daily HSE Statistics Report Effective Date
No. of Revision
Page

Subcontractor Name PT Sepuluh Sumber Anugerah Total Working Days :

Safe Working Days :

PO No. / Subcontractor No. RDMP-H-SC-SM-001 Total Manhour YTD :

Starting Date 10-Mar-20 Total Safe Manhour Without :

Reported Date 27-Jun-23 LTI

Item UOM 1-Sep-20

INCIDENT

Fatality Number of Case -

Lost Time Injury (LTI) Number of Case -

Restricted Work Case Number of Case -

Medical Treatment Case Number of Case -

Incident impact to environmental pollution Number of Case -

Incident impact to fire / asset damage Number of Case -

Environmental Damage Number of Case -

First Aid Case Number of Case -

Nearmiss Number of Case -

Emergency Evacuation Number of Case -

LTIFR 0.00

LTISR 0.00
TRIR

POB & Manhour

No. of Total HSE Personnel person -

Safety Coordinator person -

Safety Officer/Safety Spv / Safetyman person -
Paramedic person -
First Aider person -
Day Shift
POB Direct person 77
POB Indirect person 20
POB Total person 97
Working Hour hour 10
MH day shift 970
Extended Work
POB Extended Work person -
Working Hour hour -
MH Extended Work 970
Total MH Day Shift -
POB Night Shift
POB Direct person -
POB Indirect person -
POB Total -
Working Hour hour -
MH NIght shift -
No. of Register Equipment
Light Vehicle Number -
Heavy Vehicle Number -
Crane Number -
Heavy Equipment Number -
Electrical Tools Number -
Genset Number -
Total KM Driven KM 162
Total HM Run hour 68
ID Badge
ID Badge Issued Number -
ID Badge Out Number -
OTHER
PTW Number 2
e-COP Number 2
HSE Periodic Inspections conducted Object number -
Premob Inspection conducted Object number -
Random Alcohol Test Person -
Submit MCU Record Person -
General HSE Talk Number -
Toolbox Meeting Number -
Updated Job Safety Analysis Number -
Domestic Waste M3 -
Construction Waste M3 -
Hazardous Waste M3 -
ACTIVITY (Picture & Caption)
Loading Unloading Steel Structure
Area 46

PJSM
26071-JO-HSE-039
29-Oct-21
1
1-Jan

805
805

700.388

Cummulative Year To
Date

Time Status Status

07:00 - 18.00 -
- Sunny Sunny
08:00 19.00
08:00 - 19.00 -
- Sunny Sunny
09:00 20.00
09:00 -
- Sunny
10:00
10:00 -
- Sunny
11:00
11:00 -
- Sunny
12:00
12:00 -
- Sunny
13:00
12:00 -
- Sunny
13:01
12:00 -
- Sunny
13:02
12:00 -
- Sunny
13:03
12:00 -
- Sun ny
13:04
12:00 -
- Sunny
13:05
-
 -

HSE
6
Activity
1 1 DCU
3 2 TBM
2 3 PJSM
- 4 Pre -use inspection
5 Perapihan baricade dan sign
Melakukan pengawasan pada
6
pekerjaan mechanical
Melakukan pengawasan pada
7
pekerjaan structure
Loading Unloading Steel Structure
8
Area 46
Tightening & Bolting Handrail PR-053-
9
08
10 Tightening & Bolting STR-066-01
11 Prepare Allignment Pump G-053-11B
12 Tightening & Bolting STR-063-01
13 Finishing Coloum STR-063-03
14 Housekeeping

8
1
4
6
55
3
387.503
32.594

164
 -

1.311
1.11
22
12
1
93
20
222
36
-
-
-

Tightening & Bolting

Handrail PR-053-08