Form No : FGC - 19

Revision : 1.8
Date Of Issued : 190910
PT. SMART Tbk - Belawan

Bulan Permintaan isi kotak p3k juli 2020 REALISASI PENGECEKAN KOTAK P3K

TPS LB3 SBE Refinery 3

TPS LB3 SBE Refinery 2

Pos Utama Security

TPS LB3 Non Rutin

Office Operation
Main Office Lt 1

Main Office Lt 2

Main Office Lt 3

TPS LB3 Bulking

Pompa Hydrant
Fractionation 3

Fractionation 2

WH Spareparts

CBS Hydro Lt 2
WTP & WWTP

TPS LB3 FABA

LAB Incoming
No AREA

Main Lab Lt 1

Main Lab Lt 2
Power House

Pump House
TPS LB3 CBS

Timbangan
Texturizing
Rerfinery 2

Workshop
Refinery 3

GBJ 2 Lt 2
CBS Lt 2

CBS Lt 3

Bulking
Boiler
Filling

T. PK

KCP
ISS
A Isi Kotak P3K Jlh 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
1 Kasa Steril 40 bks 8 10 3 4
2 Perban ( lebar 5 cm ) 4 pc
3 Perban ( lebar 10 cm ) 4 pc 2 1 1
4 Plester ( lebar 1,2 cm ) 4 pc 3 3 3 3 2 2 4 3 3 3
5 Plester Cepat 15 pc 5 3 4 9 9 6 7 7 7 1
6 Kapas ( 25 Gram ) 2 bks 1 1 1 1 1
7 Kain Segitiga / Mitella 4 pc
8 Masker 1 btl 2 2 2 2 2 2 2 2 2 2
9 Aquades (100 ml lar. sarine) 4 pc 1 1 1 1 1 1
10 Povidon iodin ( 60ml ) 1 btl 1 1 1
11 Alkohol 70 % 1 btl 1 1 1 1 1 1 1 1
12 Sarung tangan sekali pakai 4 pasang 2 1 2 1
13 Kantong Plastik Bersih 1 pc
14 Gelas cuci mata 2 pc
15 Peniti 12 pc 2 2 2 6 3
 Form No : FGC - 19
Revision : 1.8
Date Of Issued : 190910

NGECEKAN KOTAK P3K

TOTAL
25
0
4
29
58
5
0
20
6
3
8
6
0
0
15
 FGC - 19
Rev : 1.5
Issued date : 140701

REALISASI PENGECEKAN KOTAK P3K

Tanggal/Bulan :

Kondisi Kotak ISI KOTAK P3K Petugas Pemilik Keterangan

NO DEPT / AREA
1. 2. 3. 4. 5. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Lokasi
1 Gudang Sparepart Kondisi Kotak
2 Power House 1 Ada gembok

3 Weight Bridge 2 Bersih

4 KCP AB 3 Punya catatan yang baik

5 Tank Farm 4 Punya catatan tidak baik

6 Op. Terminal 5 Tidak mempunyai catatan

7 Laboratorium

8 Elektrik Isi Kotak P3K

9 Margarine Plant 1. Alkohol 70 % (1 pc)

10 Filling Plant 2. Aquades 1 Botol

11 GBJ Warehouse 3. Bio Placenton (1 Pc)

12 Kernel lauric 4. Gunting (1 pc)

13 Produksi Refinery 5. Iodine Povidone (1 pc)

14 Produksi Fraksinasi 6. Kain Mitella (1 pc)

15 WWTP 7. Kapas 25 gr 1 bungkus

16 Workshop 8. Kasa Hydrofill (2 kotak)

17 PMC 9. Peniti (1 lsn)

18 CBS 10. Pinset (1 pc)

19 Pos Satpam 11. Plastic Bening (1 pc)

20 Bulking 12. Perban (10 cm) 2 gulung
21 Boiler 13. Perban 5 cm (2 gulung)

22 Gudang LB3 14.Pot pencuci mata (1 pc)

23 TPS FABA 15. Rubber HG (1pc)

24 TPS LB3 Container 16. Senter (1 pc)

25 Refinery III 17. Y-Rins ( 1 Pc)

26 Fraksinasi III 18. Masker 2pcs

Follow Up petugas Tindakan yang diambil hingga selesai Penegasan 19. Plester cepat 10 Pcs

................................................................................................... ........................................................................................................ 20. Buku P3K

................................................................................................... ........................................................................................................

................................................................................................... ........................................................................................................

................................................................................................... ........................................................................................................ Diketahui Oleh

( ) ( Foreman ) ( Officer ) ( EHFS Section Head )

NB : Buku P3K diletakkan di area 4,7,8,9,10,11,17,18,19

untuk area Margarine, KCP, Filling Plant Isi kotak P3K antara lain Kasa steril 4 kotak, perban 10 cm dan 5 cm sebanyak 4 pcs, plester cepat 15 pcs,
Kapas 2 pcs, Rubber HG 4 pasang, Gelas pencuci mata 2 Pcs
 Form No : FGC - 19
Revision : 1.6
Date Of Issued : 141104

PT. SMART Tbk - Belawan

Tgl Pengecekan :
REALISASI PENGECEKAN KOTAK P3K

TPS LB3 Container

Pemeriksaan

Op. Terminal AB
GBJ Warehouse
No

Margarine Plant

Weight Bridge
Power House
Filling Bawah

Pump Kernel
Gudang LB3
Fracsinasi 3

LAB Bawah

Refinery1,2

Texturizing
Filling Atas

Tank Farm

TPS FABA
Hidro CBS

Refinery 3

Workshop
Sparepart
CBS LT 3

PGA Sipil
LAB Atas
Frac 1,2

KCP AB

Security
A

Elektrik
Bulking

WWTP
Boiler
Isi Kotak P3K

PMC
CBS
isi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
1 Alkohol 70% (100 ml) 1 btl
2 Aquades (100 ml lar.saline) (y Rins) 1 btl
3 Buku Panduan P3K 1 pc
4 Buku catatan. Daftar isi kotak P3K (FGC-39) 1 pc
5 Gelas cuci mata 2 pc
6 Gunting 1 pc
7 Sarung tangan sekali pakai 3 psg
8 Plester cepat 15 pc
9 Plester 1,25 cm 4 pc
10 Kain segitiga/Mittela 4 pc
11 Kantong plastik bersih 1 pc
12 Kapas (25 gr) 2 pc
13 Perban 5cm 4 pc
14 Perban 10 cm 4 pc
15 Kasa Steril 40 lbr
16 Masker 4 pc
17 Peniti 1 lusin
18 Pinset 1 pc
19 Povidon iodin(60 ml) 1 pc
20 Lampu Senter 1 pc
B Kondisi kotak :
1 Ada Gembok
2 Bersih
3 Punya catatan yg baik
4 Punya catatan tdk baik
5 Tidak mempunyai catatan
Follow Up Petugas Tindakan yang diambil hingga selesai Penegasan

( EHFS ) ( Foreman ) ( Officer ) ( EHFS Section Head )

NB : Buku P3K diletakkan di area CBS,Elektrik,Filling bwh,GBJ Warehouse,KCP AB,LAB bwh,Margarin Plant,PMC,Security,Sparepart Item penilaian :
untuk area Margarine, KCP, Filling Plant Isi kotak P3K antara lain Kasa steril 4 kotak, perban 10 cm dan 5 cm sebanyak 4 pcs, plester cepat 15 pcs, Ö : sesuai jumlah
Kapas 2 pcs, Rubber HG 4 pasang, Gelas pencuci mata 2 Pcs X :Tidak sesuai
 Form No : FGC - 19
Revision : 1.7
Date Of Issued : 151109
PT. SMART Tbk - Belawan

Tgl Pengecekan :
REALISASI PENGECEKAN KOTAK P3K

Pump House Hydrant

TPS LB3 Container

Pemeriksaan

Main Office LT III

Op. Terminal AB
Main Office LT II
No

GBJ Warehouse

Main Office LT I

Main Office LT I
Margarine Plant

Weight Bridge
Power House
Filling Bawah

Pump Kernel
Gudang LB3
Fracsinasi 3

LAB Bawah

Refinery1,2
Filling Atas

Texturizing

TPS FABA
Tank Farm
Hidro CBS

Refinery 3

Workshop
Sparepart
CBS LT 3

PGA Sipil
LAB Atas
KCP AB
Frac 1,2

Security
A

Bulking

Elektrik

WWTP
Boiler
Isi Kotak P3K

PMC
CBS
isi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37
1 Alkohol 70% (100 ml) 1 btl
2 Aquades (100 ml lar.saline) (y Rins) 1 btl
3 Buku Panduan P3K 1 pc
4 Buku catatan. Daftar isi kotak P3K (FGC-39) 1 pc
5 Gelas cuci mata 2 pc
6 Gunting 1 pc
7 Sarung tangan sekali pakai 4 psg
8 Plester cepat 15 pc
9 Plester 1,25 cm 4 pc
10 Kain segitiga/Mittela 4 pc
11 Kantong plastik bersih 1 pc
12 Kapas (25 gr) 2 pc
13 Perban 5cm 4 pc
14 Perban 10 cm 4 pc
15 Kasa Steril 40 lbr
16 Masker 4 pc
17 Peniti 1 lusin
18 Pinset 1 pc
19 Povidon iodin(60 ml) 1 pc
20 Lampu Senter 1 pc
B Kondisi kotak :
1 Ada Gembok
2 Bersih
3 Punya catatan yg baik
4 Punya catatan tdk baik
5 Tidak mempunyai catatan
Follow Up Petugas Tindakan yang diambil hingga selesai Penegasan

( EHFS ) ( Foreman ) ( Officer ) ( EHFS Section Head )

NB : Buku P3K diletakkan di area CBS,Elektrik,Filling bwh,GBJ Warehouse,KCP AB,LAB bwh,Margarin Plant,PMC,Security,Sparepart Item penilaian :
untuk area Margarine, KCP, Filling Plant Isi kotak P3K antara lain Kasa steril 4 kotak, perban 10 cm dan 5 cm sebanyak 4 pcs, plester cepat 15 pcs, Ö : sesuai jumlah
Kapas 2 pcs, Rubber HG 4 pasang, Gelas pencuci mata 2 Pcs X :Tidak sesuai
 Form No : FGC - 19
Revision : 1.8
Date Of Issued : 190910
PT. SMART Tbk - Belawan

Bulan Pengecekan : Januari 2021 REALISASI PENGECEKAN KOTAK P3K

TPS LB3 SBE Refinery 3

TPS LB3 SBE Refinery 2

Pos Utama Security

TPS LB3 Non Rutin

Office Operation
Main Office Lt 1

Main Office Lt 2

Main Office Lt 3

TPS LB3 Bulking

Pompa Hydrant
Fractionation 3

Fractionation 2

WH Spareparts

CBS Hydro Lt 2
WTP & WWTP

TPS LB3 FABA

LAB Incoming
No AREA

Main Lab Lt 1

Main Lab Lt 2
Power House

Pump House
TPS LB3 CBS

Timbangan
Texturizing
Rerfinery 2

Workshop
Refinery 3

GBJ 2 Lt 2
CBS Lt 2

CBS Lt 3

Bulking

TOTAL
Boiler
Filling

T. PK

KCP
ISS
A Isi Kotak P3K Jlh 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
1 Kasa Steril 40 bks 0
2 Perban ( lebar 5 cm ) 4 pc 0
3 Perban ( lebar 10 cm ) 4 pc 0
4 Plester ( lebar 1,2 cm ) 4 pc 0
5 Plester Cepat 15 pc 0
6 Kapas ( 25 Gram ) 2 bks 0
7 Kain Segitiga / Mitella 4 pc 0
8 Masker 1 btl 0
9 Aquades (100 ml lar. sarine) 4 pc 0
10 Povidon iodin ( 60ml ) 1 btl 0
11 Alkohol 70 % 1 btl 0
12 Sarung tangan sekali pakai 4 pasang 0
13 Kantong Plastik Bersih 1 pc 0
14 Gelas cuci mata 2 pc 0
15 Peniti 12 pc 0