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— SAFETY TOOLBOX MEETING FORM. a PERTAMIN: Doc. No. |: 26071-JO-HSE-049 R DMP tne © (Effective Date 11/07/2022 mixers) Revision No. 000 |PERUSAHAAN & PAKET PEKERJAAN : UNIT: LOKASI / AREA: [COMPANY & WORK PACKAGE: ONT: LOCATION AREA: PT. KUMYI PLANT INDONESIA PKGO1 ‘WORKSHOP 4C KARIANGAU 75, DESKRIPSI/DESCRIPTION J2-TBM HARIAN 3 SOSIALISAS! [2 TBM BERSAMA ssp | DAILY TOOLBOX | SAFETY ALERT SOCIALISATION: ROAD SHOW TEM . | SAFETY STAND DOWN: UMPAN BALIK DARI PERTEMUAN SEBELUMNYA OLEH FEEDBACK FROM THE LAST MEETING BY PEMBELAJARAN KECELAKAAN: 1 INCIDENT ALERT LESSON LEARNED: 2. 3. o 5. 6. TOPIK TOOLBOX: TOOLBOX DISCCUSED: ~ CHEMIcAt HAZARD +} Durr Hazen + Socmizarion gnc, - PPE Compumn dle MANAGEMENT INFORMATION work Plan, € MELD TO Papstine PEMIMPIN TBM TANDA TANGAN TBM LEADER POSITION loare SIGNATURE puree? Spy O6 SEP 2027 Es (ay BERHALANGAN / Unable to attend (Key personnel/performing authority only) NAMA/Name |ALASAN/REASON ‘SAFETY TOOLBOX MEETING ATTENDANCE LST INA [Doc. No 2607 IOASE ROMP JO eect Date on uy 2022 Revision No oor PPE i taoce | Postion | Sompllnces sion ves | no | age = Remarks *}arewormusum — | 14527 lenouecrmanacea| a ft Gf | 2} yassucio uasis | smeencmcen | \/ 2 up 3 NURMADI asia | suremvsor |.) * | (ho | 990 | 26 | G0 | ee — abe f 4 * 1 muspa nasi a79s7 | acinspecron | | 4 Ihoky | 98 | Oy} Pre s F RESTIAN OCTAVIAGIT 24685 | HSE COORDINATOR| vy 2 6 | ‘LUKMAN HAKIM 43568 | SAFETYMAN lb ers ow |fe 4 TATWAWINDA KART DOCMENT 8 a s7o0 | “Sowen | u/ 28 ltnfro | 98h | tg | OF] Fa | — : > FEL ARSIA, 59338 | ENGINEERADM | _/ B | _ owisenowan eae acaom | vy Py | 1) tn suasTa V g 1 i ural 334] 2caom ® | : lat vy 2] watasmuuna | acase | sooccomnas | 7 & [em [Uae *] suuawrowssisono | 52098 | spot contron Vv IS | per ta | reviruenamauu | seor0 | spooucontrot v 2 1% | ssf] | 94 Fr Gt. narronanoi | soon | seoorcontror |i | | a Mole jae, | lag | pm Ht BuDIsucTo sPootcontrot |. / 29 |l24G5 | 99+/ | w | 88 fir r OPERATOR \e) re Mewontrrvanro | org | OPERATOR lv 4 Ihe [98% | 20] 9 FH 1D oPeraron : cr aua $08 ecm | 28 112 | a4] Ig b | fr suono este | ose] —t ty | fT = ea | oer | ae ee — asyuNt uasia | easter | 07 2 [lot HL | | Pa Lad MUHAMMAD Gazal | qao6e BLASTER 4 25 {aby wl lw | 98 Ptr PL wumant s0es7 | austen |V/ 2 [Rebs 10] os [G0 | ey fd a. 2 THAMAIN ams7 | eawrer | 5 oF fit | [atic 25] wagsuom sess | pater | / “6 oe | PH 25) rexsaapvcuna | 17257 | panrer | \/ 2 as | pr as am KASWADI ‘$7195 PAINTER 38 — 8 arti sss | pater =| \/ «0 | afo| 99%| 19 |g | Fn MW 29) wuxmannaoinara | 51336 Hewes | / 8 lloho | el] 8 17 | Fr be poe eel 30] ResTuPAMUNGKAS | 54084 HELPER wf} |. + 31] munamman rioHo | 57086 weer — |/ a7 [nego | (0% | @ | 34 | FIT | By sa] momma | oy | aren Z=E 33] vicevpansanro | eases | newer | \/ 2 34] aon anwar zoss | never | / 2 {tego | 996/18 106 |Fa 35] jmunannaa SYUKUR ewer |\/ ax [he | 99% | 18 | 92 | fr Coft 2h.) Aster Kons Beli Orgtncer| 7 bt pate: 06/ 09-2023 Pos TOM Checked by, one TeM Leader Fitto Work Checked By, ie Paramedic

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