WEEKLY SAFETY REPORT

WASTE WATER TREATMENT PLANT PROJECT

REVISI : 00 LOCATION : Gerem, Cilegon
NO. PROJECT : 2006-MFI02 AREA : WWTP Existing MFI
PERIODE : 02-08 April 2021 REPORTED BY : Much. Gufron

ACTIVITY SHE
A. SAFETY INDUCTION
DATE
No. NAME/COMPANY Remarks
2 3 4 5 6 7 8
1 PT LOW 0 0 0 0 0 0 0
2 CV Hasan Teknik 0 0 0 4 2 0 0 Some man power already
3 0 0 0 0 0 0 0 induction on March 17 & 18
Total of Safety Induction (Person) 0 0 0 4 2 0 0
- Duration time for safety induction: 1 hours - Training Hours:
- Materi: 6 man hours for safety induction
1. PPE
2. General Safety Rules - Inductor:
3. SOP work in IFC Project 1. Imam (HSE Kajima)
4. Emergency Procedure
5. 5R/5S Implementation

B. TOOLBOX MEETING/SAFETY TALK ACTIVITIES

Date Speaker Attendant Topic Remarks
4/2/2021
(07.30 a.m) No Activities

4/3/2021
(07.30 a.m) No Activities

4/4/2021
(07.30 a.m) No Activities

4/5/2021
(07.30 a.m) No Activities

4/6/2021 Gufron, Hilal, Hastek : 4 man power Manual handling, Risk of preparation
(07.30 a.m) Muji LOW : 2 man power warehouse area

4/7/2021 Gufron, Hilal, Hastek : 7 man power Completion PPE to worker, Provide hand
(07.30 a.m) Wawan, Muji LOW : 2 man power sanitizer and disinfectant, Hp register
Wira and procedures
4/8/2021 Gufron, Hilal, Hastek : 7 man power COVID 19 Protocol, Forklift Inspection
(07.30 a.m) Wawan, Muji LOW : 2 man power HP allowed to site
Wira

C. WHEATHER RECORD (Rain Hours)

DATE
No. ITEM Total (hours)
2 3 4 5 6 7 8

0 0 0 0 0 0 0 0
1 Rain Hours

Page 1 of 31 SHE Report

 WEEKLY SAFETY REPORT
WASTE WATER TREATMENT PLANT PROJECT
REVISI : 00 LOCATION : Gerem, Cilegon
NO. PROJECT : 2006-MFI02 AREA : WWTP Existing MFI
PERIODE : 02-08 April 2021 REPORTED BY : Much. Gufron

SHE PERFORMANCE
D. MAN HOURS STATISTICS
DATE
No. ITEM 2 3 4 5 6 7 8 Remarks
I. Normal Time
1 Man Power (Personnal) 0 0 0 5 9 9 9
2 Man Hours (Hours) 0 0 0 40 72 72 72
II. Over Time
1 Man Power (Personnal) 0 0 0 0 0 0 0
2 Man Hours (Hours) 0 0 0 0 0 0 0
III. Total Man Hours per day 0 0 0 40 72 72 72
(Hours)
IV. Total Man Hours only This
256
Week (Hours)
V. Total Man Hours per end 0 0 0 40 112 184 256
date(Hours)
Note:

10 Recapitulation Man Power Hastek LOW

9
8
7
7 7
Man Power

6 7
5
4
3 4
2
1 2 2 2
1
0
2 3 4 5 6 7 8
Date

E. ACCIDENT RECORD
DATE TOTAL
No. ITEM
2 3 4 5 6 7 8 THIS WEEK
1 Medical Treatment (Freq.) 0 0 0 0 0 0 0
2 Lost Time Injured (Freq.) 0 0 0 0 0 0 0
3 Fatality (Frequency/Person) 0 0 0 0 0 0 0
4 Zero Accident 0 0 0 40 112 184 256
CORRELATION MAN HOURS ≈ ZERO ACCIDENT ≈ MAN POWER

300 Total Man Power man hours zero accident 10

9
250 256 8
200 184 7 P
6 e
9 o
150 5
Hours

112 p
4 l
100 9
9 3 e
40 5 2
50
0 0 1
0
0 0
Page 2 of 31 2 3 4 5 6 7 8 SHE Report
Date
 250 256 8
200 184 7
6
150 WEEKLY SAFETY REPORT 9 5
Hours

112
100 WASTE WATER TREATMENT PLANT PROJECT
9
4
9 LOCATION 3
REVISI : 00 40 5 : Gerem, Cilegon
2
50
NO. PROJECT : 2006-MFI02 0 AREA : WWTP Existing MFI
0 0 1
PERIODE 0 : 02-08 April 2021 REPORTED BY : Much. Gufron 0
2 3 4 5 6 7 8
Date

TOTAL RECORDABLE ACCIDENT (This Week)

5
Medical Treatment
(Freq.)
4 Lost Time Injured (Freq.)
Frequency/Person

3 Fatality (Frequency/
Person)
2

1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
2 3 4 5 6 7 8
Date

Description:
1. Total Manhours a week : 256 hours during project: 256 hours (2-8 April 2021)
2. Total Zero Accident : 256 hours
3. Total Man Power : 9 mp
4. Total of Mandays : 4 days (2-8 April 2021)
5. Total training Hours : 12 hours (Since 17 March 2021)
6. Safety awareness : Zero accident
7. Safety activity : Safety talks & TBM, Safety monitoring, Safety Inspection, Safety meeting

8. Safety Issue/ Concern :

- Lifting activities will be held on 13 April, safety documents and inspection the heavy equipment already done on
this week

Page 3 of 31 SHE Report

 SAFETY ACTIVITY

PERIOD : 02-08 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Much. Gufron

SAFETY PROGRAM
06-07
Taisho and Safety Talks held on Taisei Pulau Intan (TPI) Company everyday
April

05 & 06 Toolbox meeting per group/contractor after

Safety Induction by TPI Company for new comer 06-07 Apr
Apr safety talks

7-Apr Premobilization Crane Inspection by MFI & TPI Inspector before come to site

Lamp Safety Report WWTP

 SAFETY ACTIVITY

PERIOD : 02-08 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Much. Gufron

Lamp Safety Report WWTP

 LIST MAN POWER M/E CONSTRUCTION PT LAUTAN ORGANO WATER
WASTE WATER TREAATMENT PLANT
IFC PROJECT-MFI
2021
Update: 07-08 April 2021
Labour Insurance
NO. NAME POSITION COMPANY Induction Date ID CARD STATUS REMARKS
(BPJS)
001 Akhmad Muhilal Site Manager PT Lautan Organo Water 17 Maret 2021 √ √ On Site

002 Muchamad Gufron HSE Coordinator PT Lautan Organo Water 18 Maret 2021 √ √ On Site

003 Dadan Kadarsah Electrical Engineer PT Lautan Organo Water 17 Maret 2021 √ √ Off Site

004 Hoerudin Electrical Engineer PT Lautan Organo Water 18 Maret 2021 √ √ Off Site

005 Agus Salim Spv Subcon CV Hasan Teknik 18 Maret 2021 √ Off Site Tentative

006 Setiawan Utomo Leader Mechanical CV Hasan Teknik 18 Maret 2021 √ On Site

007 Muji Rahardjo Leader Electrical CV Hasan Teknik 5 Apr 2021 √ On Site

008 Putra Wira Pratama Safety Officer CV Hasan Teknik 5 Apr 2021 √ On Site

009 Sacse Enceng Hidayat Mechanical CV Hasan Teknik 5 Apr 2021 √ On Site

010 Muhamad Yahya Iswanto Helper CV Hasan Teknik 5 Apr 2021 √ On Site

011 Rokhmad Santoso Mechanical CV Hasan Teknik 6 Apr 2021 On Site

012 Sunaryo Electrician CV Hasan Teknik 6 Apr 2021 On Site

Note: Reported by,

Total on site : 21
Man Power (Active) : 23
Man Power (FInish) :7
Muchamad Gufron
 WEATHER RECORD PT. LAUTAN ORGANO WATER
Project Name : WASTE WATER TREATMENT PLAN EXPANSION PROJECT (MFI Project) Client : PT MFI

Project Location : Gerem, Cilegon Month : Apr-21

Project Number : 2006-MFI02 Document No :
TIME\DATE 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 TIME\DATE
07:00-07:30 07:00-07:30
07:31-08:00 07:31-08:00
08:01-08:30 08:01-08:30
08:31-09:00 08:31-09:00
09:01-09:30 09:01-09:30
09:31-10:00 09:31-10:00
10:01-10:30 10:01-10:30
10:31-11:00 10:31-11:00
11:01-11:30 11:01-11:30
11:31-12:00 11:31-12:00
12:01-12:30 12:01-12:30
12:31-13:00 12:31-13:00
13:01-13:30 13:01-13:30
13:31-14:00 13:31-14:00
14:01-14:30 14:01-14:30
14:31-15:00 14:31-15:00
15:01-15:30 15:01-15:30
15:31-16:00 15:31-16:00
16:01-16:30 16:01-16:30
16:31-17:00 16:31-17:00
17:01-17:30 17:01-17:30
17:31-18:00 17:31-18:00
18:01-18:30 18:01-18:30
18:31-19:00 18:31-19:00
19:01-19:30 19:01-19:30
19:31-20:00 19:31-20:00
20:01-20:30 20:01-20:30
20:31-21:00 20:31-21:00
21:01-21:30 21:01-21:30
21:31-22:00 21:31-22:00
22:01-22:30 22:01-22:30
22:31-23:00 22:31-23:00
23:01-23:30 23:01-23:30
23:31-24:00 23:31-24:00
∑ WH/ ∑ RH 8/0 8/0 8/0 8/0
NOTE:

Prepared by, Acknowledge by, : Rainy/ Thunder

Muchamad Gufron WH : Work Hours RH : Rain Hours

 WEEKLY SAFETY REPORT
WASTE WATER TREATMENT PLANT PROJECT
REVISI : 00 LOCATION : Gerem, Cilegon
NO. PROJECT : 2006-MFI02 AREA : WWTP Existing MFI
PERIODE : 09-15 April 2021 REPORTED BY : Putra Wira P.

ACTIVITY SHE
A. SAFETY INDUCTION
DATE
No. NAME/COMPANY Remarks
9 10 11 12 13 14 15
1 PT LOW 0 0 0 0 0 0 0
2 CV Hasan Teknik 4 0 0 3 2 1 0
3 0 0 0 0 0 0 0
Total of Safety Induction (Person) 4 0 0 3 2 1 0
- Duration time for safety induction: 1 hours - Training Hours:
- Materi: 10 man hours for safety induction
1. PPE
2. General Safety Rules - Inductor:
3. SOP work in IFC Project 1. Wahyu/ Bagus (Taisei)
4. Emergency Procedure
5. 5R/5S Implementation

B. TOOLBOX MEETING/SAFETY TALK ACTIVITIES

Date Speaker Attendant Topic Remarks
4/9/2021 Gufron, Hilal, Hastek : 7 man power Mechanical/Electrical Job,
(07.30 a.m) Muji , wira LOW : 2 man power warehouse area , Unloading tools

4/10/2021 Gufron, Hilal, Hastek : 10 man power Mechanical/Electrical Job,

(07.30 a.m) Udin, Wawan LOW : 3 man power warehouse area, Fabrikasi Rail Temporary
Wira Fabrication W/H
4/11/2021 Wira, Hilal, Hastek : 10 man power Mechanical/Electrical Job,
(07.30 a.m) Wawan, uddin LOW : 2 man power warehouse area, Shutdown Cable Tray
Fabrication Rail Temporary
4/12/2021 Gufron, Hilal, Hastek : 10 man power Mechanical/Electrical Job,
(07.30 a.m) Wawan, Wira LOW : 3 man power warehouse area, Fabrication Handrail
Fabrication Rail Temporary
4/13/2021 Gufron, Hilal, Hastek : 15 man power Mechanical/Electrical Job,
(07.30 a.m) Wawan, Wira LOW : 3 man power sanitizer and disinfectant, Hp register
Positioning Aeration tnk & FRP tnk
4/14/2021 Gufron, Hilal, Hastek : 12 man power Mechanical/Electrical Job,
(07.30 a.m) Wawan, Muji LOW : 3 man power Platform Fabrication, Fabrication Handrail
Wira Unloading & Position Aeration & FRP tnk
4/15/2021 Gufron, Hilal, Hastek : 14 man power Mechanical/Electrical Job,
(07.30 a.m) Wawan, Uddin LOW :3 man power Leak test instrument air, Material handling
Wira pvc pipe & conduit

C. WHEATHER RECORD (Rain Hours)

DATE
No. ITEM Total (hours)
9 10 11 12 13 14 15

0 0 0 0 0 0 0 0
1 Rain Hours

Page 8 of 31 SHE Report

 WEEKLY SAFETY REPORT
WASTE WATER TREATMENT PLANT PROJECT
REVISI : 00 LOCATION : Gerem, Cilegon
NO. PROJECT : 2006-MFI02 AREA : WWTP Existing MFI
PERIODE : 09-15 April 2021 REPORTED BY : Putra Wira P.

SHE PERFORMANCE
D. MAN HOURS STATISTICS
DATE
No. ITEM 9 10 11 12 13 14 15 Remarks
I. Normal Time
1 Man Power (Personnal) 13 13 12 16 19 18 17
2 Man Hours (Hours) 104 104 96 128 152 144 136
II. Over Time
1 Man Power (Personnal) 0 0 10 12 12 12 13
2 Man Hours (Hours) 0 0 40 48 48 48 52
III. Total Man Hours per day 104 104 136 176 200 192 188
(Hours)
IV. Total Man Hours only This
1,100
Week (Hours)
V. Total Man Hours per end 360 464 600 776 976 1,168 1,356
date(Hours)
Note:

20 Recapitulation Man Power Hastek LOW

18
16
14
Man Power

12 16 15 14
10 13
11 10 10
8
6
4
2 2 3 2 3 3 3 3
0
9 10 11 12 13 14 15
Date

E. ACCIDENT RECORD
DATE TOTAL
No. ITEM
9 10 11 12 13 14 15 THIS WEEK
1 Medical Treatment (Freq.) 0 0 0 0 0 0 0
2 Lost Time Injured (Freq.) 0 0 0 0 0 0 0
3 Fatality (Frequency/Person) 0 0 0 0 0 0 0
4 Zero Accident 360 464 600 776 976 1,168 1,356
CORRELATION MAN HOURS ≈ ZERO ACCIDENT ≈ MAN POWER

1,600 Total Man Power man hours zero accident 20

1,400 18
1,168 1,356 16
1,200
976 14 P
1,000
776 12 e
17 o
800 10
Hours

600 p
464 16 8 l
600 18
36013 13 19 6 e
12
400
4
200 2
0 0
Page 9 of 31 9 10 11 12 13 14 15 SHE Report
Date
 1,400 18
1,168 1,356 16
1,200
976 14
1,000 WEEKLY SAFETY
776
REPORT 12
800 WASTE WATER TREATMENT PLANT PROJECT 17 10
Hours

600 16
464 8
REVISI 600 : 00360 13 LOCATION 18: Gerem, Cilegon
13 12 19 6
NO. PROJECT
400 : 2006-MFI02 AREA : WWTP Existing MFI
4
PERIODE200 : 09-15 April 2021 REPORTED BY : Putra Wira P. 2
0 0
9 10 11 12 13 14 15
Date

TOTAL RECORDABLE ACCIDENT (This Week)

5
Medical Treatment (Freq.)
4 Lost Time Injured (Freq.)
Fatality (Frequency/
Frequency/Person

3 Person)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
9 10 11 12 13 14 15
Date

Description:
1. Total Manhours a week : 1,100 hours during project: 1,356 hours (5-15 April 2021)
2. Total Zero Accident : 1,356 hours
3. Total Man Power : 19 mp
4. Total of Mandays : 11 days (5-15 April 2021)
5. Total training Hours : 22 hours (Since 17 March 2021)
6. Safety awareness : Zero accident
7. Safety activity : Safety talks & TBM, Safety monitoring, Safety Inspection, Safety meeting

8. Safety Issue/ Concern :

- Provide First Aid Kit
- Provide Accessway For Construction Phase On Existing WWTP

Page 10 of 31 SHE Report

 SAFETY ACTIVITY

PERIOD : 16-22 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Putra Wira P.

SAFETY PROGRAM
9-15 Apr Taisho and Safety Talks held on Taisei Pulau Intan (TPI) Company everyday

9, 12, 13,
Safety Induction by TPI Company for new comer
14

09-15 Apr Safety Meeting by Client, Contractor, Sub- 09-15 Apr

Leak test the pressurize bottles with soap water
2021 Contractor 2021

Lamp Safety Report WWTP (2)

 SAFETY ACTIVITY

PERIOD : 16-22 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Putra Wira P.

09-15 Apr
Inspection Chain block tools by HSE TPI
2021

Lamp Safety Report WWTP (2)

 LIST MAN POWER M/E CONSTRUCTION PT LAUTAN ORGANO WATER
WASTE WATER TREAATMENT PLANT
IFC PROJECT-MFI
2021
Update: 15 April 2021
Labour Insurance
NO. NAME POSITION COMPANY Induction Date ID CARD STATUS REMARKS
(BPJS)
001 Akhmad Muhilal Site Manager PT Lautan Organo Water 17 Maret 2021 √ √ On Site

002 Muchamad Gufron HSE Coordinator PT Lautan Organo Water 18 Maret 2021 √ √ On Site

003 Dadan Kadarsah Electrical Engineer PT Lautan Organo Water 17 Maret 2021 √ √ Off Site

004 Hoerudin Electrical Engineer PT Lautan Organo Water 18 Maret 2021 √ √ Off Site

005 Agus Salim Spv Subcon CV Hasan Teknik 18 Maret 2021 √ √ Off Site Tentative

006 Setiawan Utomo Leader Mechanical CV Hasan Teknik 18 Maret 2021 √ √ On Site

007 Muji Rahardjo Leader Electrical CV Hasan Teknik 5 Apr 2021 √ √ On Site

008 Putra Wira Pratama Safety Officer CV Hasan Teknik 5 Apr 2021 √ √ On Site

009 Sacse Enceng Hidayat Mechanical CV Hasan Teknik 5 Apr 2021 √ √ On Site

010 Muhamad Yahya Iswanto Helper CV Hasan Teknik 5 Apr 2021 √ √ On Site

011 Rokhmad Santoso Mechanical CV Hasan Teknik 6 Apr 2021 √ √ On Site

012 Sunaryo Electrician CV Hasan Teknik 6 Apr 2021 √ √ On Site

013 Yopie Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

014 Arfadillah Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

015 Zainal Arifin Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

016 Fazar Afrizal Mechanical CV Hasan Teknik 12 Apr 2021 √ √ On Site

017 Rifat Muamar Helper CV Hasan Teknik 12 Apr 2021 √ √ On Site

018 Lhutfi Mechanical CV Hasan Teknik 12 Apr 2021 √ √ On Site

019 Sarjuli Mechanical CV Hasan Teknik 14 Apr 2021 √ √ On Site

020 Syarif Hidayat Scaffolder CV Hasan Teknik 17 Apr 2021 On Site

Note: Reported by,
Total on site : 18
Man Power (registered) : 19

Muchamad Gufron
 WEATHER RECORD PT. LAUTAN ORGANO WATER
Project Name : WASTE WATER TREATMENT PLAN EXPANSION PROJECT (MFI Project) Client : PT MFI

Project Location : Gerem, Cilegon Month : Apr-21

Project Number : 2006-MFI02 Document No :
TIME\DATE 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 TIME\DATE
07:00-07:30 07:00-07:30
07:31-08:00 07:31-08:00
08:01-08:30 08:01-08:30
08:31-09:00 08:31-09:00
09:01-09:30 09:01-09:30
09:31-10:00 09:31-10:00
10:01-10:30 10:01-10:30
10:31-11:00 10:31-11:00
11:01-11:30 11:01-11:30
11:31-12:00 11:31-12:00
12:01-12:30 12:01-12:30
12:31-13:00 12:31-13:00
13:01-13:30 13:01-13:30
13:31-14:00 13:31-14:00
14:01-14:30 14:01-14:30
14:31-15:00 14:31-15:00
15:01-15:30 15:01-15:30
15:31-16:00 15:31-16:00
16:01-16:30 16:01-16:30
16:31-17:00 16:31-17:00
17:01-17:30 17:01-17:30
17:31-18:00 17:31-18:00
18:01-18:30 18:01-18:30
18:31-19:00 18:31-19:00
19:01-19:30 19:01-19:30
19:31-20:00 19:31-20:00
20:01-20:30 20:01-20:30
20:31-21:00 20:31-21:00
21:01-21:30 21:01-21:30
21:31-22:00 21:31-22:00
22:01-22:30 22:01-22:30
22:31-23:00 22:31-23:00
23:01-23:30 23:01-23:30
23:31-24:00 23:31-24:00
∑ WH/ ∑ RH 8/0 8/0 8/0 8/0 8/0 8/0 12/0 12/0 12/0 12/0 12/0 12/0 9/0
NOTE:

Prepared by, Acknowledge by, : Rainy/ Thunder

Muchamad Gufron WH : Work Hours RH : Rain Hours

 WEEKLY SAFETY REPORT
WASTE WATER TREATMENT PLANT PROJECT
REVISI : 00 LOCATION : Gerem, Cilegon, Banten
NO. PROJECT : 2006-MFI02 AREA : WWTP Existing MFI
PERIODE : 16-22 April 2021 REPORTED BY : Putra Wira P.

ACTIVITY SHE
A. SAFETY INDUCTION
DATE
No. NAME/COMPANY Remarks
16 17 18 19 20 21 22
1 PT LOW 0 0 0 0 0 0 0
2 CV Hasan Teknik 0 1 0 0 0 0 0
3 0 0 0 0 0 0 0
Total of Safety Induction (Person) 0 1 0 0 0 0 0
- Duration time for safety induction: 1 hours - Training Hours:
- Materi: 1 man hours for safety induction
1. PPE
2. General Safety Rules - Inductor:
3. SOP work in IFC Project 1. Wahyu/ Denny (Taisei)
4. Emergency Procedure
5. 5R/5S Implementation

B. TOOLBOX MEETING/SAFETY TALK ACTIVITIES

Date Speaker Attendant Topic Remarks
4/16/2021 Gufron, Hilal, Hastek : 11 man power Mechanical/Electrical Job, Usage Faceshield,
(07.30 a.m) Wawan, wira LOW : 2 man power Toilet hygiene schedule & Housekeeping,
Usage individual glasses
4/17/2021 Gufron, Hilal, Hastek : 14 man power Mechanical/Electrical Job, Dsitribute
(07.30 a.m) Wawan, Wira LOW : 2 man power APAR 6kg & 3kg, Hot pipe existing, Procedure
BPJS labour, PTW socialization, Accessway
4/18/2021 Wira, Hilal, Hastek : 13 man power Mechanical/Electrical Job, Usage faceshield
(07.30 a.m) Wawan, Gufron LOW : 2 man power PTW Socialization & Work analysis,
Syarif Signing HSE comitment
4/19/2021 Gufron, Hilal, Hastek : 9 man power Mechanical/Electrical Job, Barrier existing &
(07.30 a.m) Wawan, Wira LOW : 2 man power construction has been installed, Safety
performance already recording
4/20/2021 Gufron, Hilal, Hastek : 15 man power Mechanical/Electrical Job, PTW socialization,
(07.30 a.m) Wawan, Wira LOW : 2 man power Usage Ear plug, Fire protection with Fire

4/21/2021 Gufron, Hilal, Hastek : 12 man power Mechanical/Electrical Job, Usage first aid box,
(07.30 a.m) Wawan, Muji LOW : 3 man power Screening worker for safety, Fire work protection,
Wira Usage body harness at Height work
4/22/2021 Gufron, Hilal, Hastek : 14 man power Mechanical/Electrical Job, Implementation
(07.30 a.m) Wawan, Uddin LOW :3 man power Housekeeping, Placement B3 material properly,
Wira Usage & Install fire blanket

C. WHEATHER RECORD (Rain Hours)

DATE
No. ITEM Total (hours)
16 17 18 19 20 21 22

0 0 0 0 1 0 0 1
1 Rain Hours

Page 16 of 31 SHE Report

 WEEKLY SAFETY REPORT
WASTE WATER TREATMENT PLANT PROJECT
REVISI : 00 LOCATION : Gerem, Cilegon, Banten
NO. PROJECT : 2006-MFI02 AREA : WWTP Existing MFI
PERIODE : 16-22 April 2021 REPORTED BY : Putra Wira P.
SHE PERFORMANCE
D. MAN HOURS STATISTICS
DATE
No. ITEM 16 17 18 19 20 21 22 Remarks
I. Normal Time
1 Man Power (Personnal) 16 16 16 15 16 12 15
2 Man Hours (Hours) 128 128 128 120 128 96 120
II. Over Time
1 Man Power (Personnal) 11 0 0 14 14 10 12
2 Man Hours (Hours) 55 0 0 56 56 40 48
III. Total Man Hours per day 183 128 128 176 184 136 168
(Hours)
IV. Total Man Hours only This
1,103
Week (Hours)
V. Total Man Hours per end 1,539 1,667 1,795 1,971 2,155 2,291 58,853
date(Hours)
Note:

18 Recapitulation Man Power Hastek LOW

16
14
12
Man Power

10 14 14 14 14 12
14 10
8
6
4
2 2 2 3
2 1 2 2
0
16 17 18 19 20 21 Date 22

E. ACCIDENT RECORD
DATE TOTAL
No. ITEM
16 17 18 19 20 21 22 THIS WEEK
1 Medical Treatment (Freq.) 0 0 0 0 0 0 0
2 Lost Time Injured (Freq.) 0 0 0 0 0 0 0
3 Fatality (Frequency/Person) 0 0 0 0 0 0 0
4 Zero Accident 1,539 1,667 1,795 1,971 2,155 2,291 58,853
CORRELATION MAN HOURS ≈ ZERO ACCIDENT ≈ MAN POWER

70,000 Total Man Power man hours zero accident 18

60,000 16
58,853 14
50,000 P
12
e
40,000 10 o
15
Hours

30,000 16 16 15 8 p
16 l
6 e
20,000 16
12 4
10,000 1,539 1,667 1,971 2
1,795 2,155 2,291
0 0
16 17 18 19 20 21 22
Date

Page 17 of 31 SHE Report

 WEEKLY SAFETY REPORT
WASTE WATER TREATMENT PLANT PROJECT
REVISI : 00 LOCATION : Gerem, Cilegon, Banten
NO. PROJECT : 2006-MFI02 AREA : WWTP Existing MFI
PERIODE : 16-22 April 2021 REPORTED BY : Putra Wira P.
TOTAL RECORDABLE ACCIDENT (This Week)
5
Medical Treatment (Freq.)
4 Lost Time Injured (Freq.)
Fatality (Frequency/
Frequency/Person

3 Person)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
16 17 18 19 20 21 22
Date

Description:
1. Total Manhours a week : 1,103 hours during project: 58,853 hours (5-22 April 2021)
2. Total Zero Accident : 58,853 hours
3. Total Man Power : 16 mp
4. Total of Mandays : 18 days (5-22 April 2021)
5. Total training Hours : 23 hours (Since 17 March 2021)
6. Safety awareness : Zero accident
7. Safety activity : Safety talks & TBM, Safety monitoring, Safety Inspection, Safety meeting

8. Safety Issue/ Concern :

-
-

Page 18 of 31 SHE Report

 SAFETY ACTIVITY

PERIOD : 16-22 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Putra Wira P.

SAFETY PROGRAM
16-22 Apr PT. LOW and CV. HASTEK Safety Talk held on Taisei Pulau Intan (TPI) Company everyday

17-Apr Safety Induction by TPI Company for new comer

16-22 Apr
Safety Meeting by Client, Contractor, Sub- Contractor
2021

Lamp Safety Report WWTP (3)

 SAFETY ACTIVITY

PERIOD : 16-22 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Putra Wira P.

16-22 Apr
Inspection Scaffolding by HSE TPI
2021

Lamp Safety Report WWTP (3)

 LIST MAN POWER M/E CONSTRUCTION PT LAUTAN ORGANO WATER
WASTE WATER TREAATMENT PLANT
IFC PROJECT-MFI
2021
Update: 15 April 2021
Labour Insurance
NO. NAME POSITION COMPANY Induction Date ID CARD STATUS REMARKS
(BPJS)
001 Akhmad Muhilal Site Manager PT Lautan Organo Water 17 Maret 2021 √ √ On Site

002 Muchamad Gufron HSE Coordinator PT Lautan Organo Water 18 Maret 2021 √ √ On Site

003 Dadan Kadarsah Electrical Engineer PT Lautan Organo Water 17 Maret 2021 √ √ On Site Tentative

004 Hoerudin Electrical Engineer PT Lautan Organo Water 18 Maret 2021 √ √ Off Site

005 Agus Salim Spv Subcon CV Hasan Teknik 18 Maret 2021 √ √ Off Site Tentative

006 Setiawan Utomo Leader Mechanical CV Hasan Teknik 18 Maret 2021 √ √ On Site

007 Muji Rahardjo Leader Electrical CV Hasan Teknik 5 Apr 2021 √ √ On Site

008 Putra Wira Pratama Safety Officer CV Hasan Teknik 5 Apr 2021 √ √ On Site

009 Sacse Enceng Hidayat Mechanical CV Hasan Teknik 5 Apr 2021 √ √ On Site

010 Muhamad Yahya Iswanto Helper CV Hasan Teknik 5 Apr 2021 √ √ On Site

011 Rokhmad Santoso Mechanical CV Hasan Teknik 6 Apr 2021 √ √ On Site

012 Sunaryo Electrician CV Hasan Teknik 6 Apr 2021 √ √ On Site

013 Yopie Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

014 Arfadillah Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

015 Zainal Arifin Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

016 Fazar Afrizal Mechanical CV Hasan Teknik 12 Apr 2021 √ √ On Site

017 Rifat Muamar Helper CV Hasan Teknik 12 Apr 2021 √ √ On Site

018 Lhutfi Mechanical CV Hasan Teknik 12 Apr 2021 √ √ On Site

019 Sarjuli Mechanical CV Hasan Teknik 14 Apr 2021 √ √ On Site

020 Syarif Hidayat Scaffolder CV Hasan Teknik 17 Apr 2021 Resign Finish 19 Apr 2021
Note: Reported by,
Total on site : 17
Resign :1
Man Power (registered) : 20
Muchamad Gufron
 WEATHER RECORD PT. LAUTAN ORGANO WATER
Project Name : WASTE WATER TREATMENT PLAN EXPANSION PROJECT (MFI Project) Client : PT MFI

Project Location : Gerem, Cilegon Month : Apr-21

Project Number : 2006-MFI02 Document No :
TIME\DATE 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 TIME\DATE
07:00-07:30 07:00-07:30
07:31-08:00 07:31-08:00
08:01-08:30 08:01-08:30
08:31-09:00 08:31-09:00
09:01-09:30 09:01-09:30
09:31-10:00 09:31-10:00
10:01-10:30 10:01-10:30
10:31-11:00 10:31-11:00
11:01-11:30 11:01-11:30
11:31-12:00 11:31-12:00
12:01-12:30 12:01-12:30
12:31-13:00 12:31-13:00
13:01-13:30 13:01-13:30
13:31-14:00 13:31-14:00
14:01-14:30 14:01-14:30
14:31-15:00 14:31-15:00
15:01-15:30 15:01-15:30
15:31-16:00 15:31-16:00
16:01-16:30 16:01-16:30
16:31-17:00 16:31-17:00
17:01-17:30 17:01-17:30
17:31-18:00 17:31-18:00
18:01-18:30 18:01-18:30
18:31-19:00 18:31-19:00
19:01-19:30 19:01-19:30
19:31-20:00 19:31-20:00
20:01-20:30 20:01-20:30
20:31-21:00 20:31-21:00
21:01-21:30 21:01-21:30
21:31-22:00 21:31-22:00
22:01-22:30 22:01-22:30
22:31-23:00 22:31-23:00
23:01-23:30 23:01-23:30
23:31-24:00 23:31-24:00
∑ WH/ ∑ RH 8/0 8/0 8/0 8/0 8/0 8/0 12/0 12/0 12/0 12/0 12/0 12/0 8/0 8/0 12/0 12/0 12/0 12/0
NOTE:

Prepared by, Acknowledge by, : Rainy/ Thunder

Muchamad Gufron WH : Work Hours RH : Rain Hours

 WEEKLY SAFETY REPORT
DEMIIN PLANT COGEN 7
REVISI : 00 LOCATION Kragilan, Serang, Banten
NO. PROJECT AREA Demin Plant Cogen 7
PERIODE 4-10 Juli 2021 REPORTED BY : Putra Wira P.

ACTIVITY SHE
A. SAFETY INDUCTION
DATE
No. NAME/COMPANY Remarks
4 5 6 7 8 9 10
1 PT SCYY 0 0 0 0 0 0 0
2 CV Hasan Teknik 0 0 0 2 0 0 0
3 0 0 0 0 0 0 0
Total of Safety Induction (Person) 0 0 0 2 0 0 0
- Duration time for safety induction: 1 hours - Training Hours:
- Materi: 2 man hours for safety induction
1. PPE
2. General Safety Rules - Inductor:
3. SOP work in area Cogen 7 Proejct 1. Firdaus (IKS)
4. Emergency Procedure
5. 5R/5S Implementation

B. TOOLBOX MEETING/SAFETY TALK ACTIVITIES

Date Speaker Attendant Topic Remarks
7/4/2021 Wira Hastek : 12 man power Mechanical/Electrical Job, fit up join mainlite
(07.30 a.m) SCYY : 0 man power inlet degasser tank, welding mainlite pipe at piperack,
erection WF piperack, install support UNP at piperack
7/5/2021 Wira Hastek : 13 man power Mechanical/Electrical Job, fit up join mainlite
(07.30 a.m) SCYY : 0 man power inlet degasser tank, welding mainlite pipe at piperack,
erection WF piperack, install support UNP at piperack
7/6/2021 Wira Hastek : 9 man power Mechanical/Electrical Job, fit up join mainlite
(07.30 a.m) SCYY : 0 man power inlet degasser tank, welding mainlite pipe at piperack,
erection WF piperack, install support UNP at piperack
7/7/2021 Wira Hastek : 13 man power Mechanical/Electrical Job, fit up join mainlite
(07.30 a.m) SCYY : 0 man power inlet degasser tank, welding mainlite pipe at piperack,
erection WF piperack, install support UNP at piperack
7/8/2021 Wira Hastek : 12 man power Mechanical/Electrical Job, fit up join mainlite
(07.30 a.m) SCYY : 0 man power inlet degasser tank, welding mainlite pipe at piperack,
erection WF piperack, install support UNP at piperack
7/9/2021 Wira Hastek : 12 man power Mechanical/Electrical Job, fit up join mainlite
(07.30 a.m) SCYY : 0 man power inlet degasser tank, welding mainlite pipe at piperack,
erection WF piperack, install support UNP at piperack
7/10/2021 Wira Hastek : 14 man power Mechanical/Electrical Job, fit up join mainlite
(07.30 a.m) SCYY :0 man power inlet degasser tank, welding mainlite pipe at piperack,
erection WF piperack, install support UNP at piperack

C. WHEATHER RECORD (Rain Hours)

DATE
No. ITEM Total (hours)
4 5 6 7 8 9 10

0 0 0 0 0 0 0
1 Rain Hours

Page 24 of 31 SHE Report

 WEEKLY SAFETY REPORT
DEMIIN PLANT COGEN 7
REVISI : 00 LOCATION Kragilan, Serang, Banten
NO. PROJECT AREA Demin Plant Cogen 7
PERIODE 4-10 Juli 2021 REPORTED BY : Putra Wira P.
SHE PERFORMANCE
D. MAN HOURS STATISTICS
DATE
No. ITEM 4 5 6 7 8 9 10 Remarks
I. Normal Time
1 Man Power (Personnal) 15 17 17 16 16 18 18
2 Man Hours (Hours) 120 136 136 128 128 144 144
II. Over Time
1 Man Power (Personnal) 0 0 0 0 0 0 0
2 Man Hours (Hours) 0 0 0 0 0 0 0
III. Total Man Hours per day 120 136 136 128 128 144 144
(Hours)
IV. Total Man Hours only This
936
Week (Hours)
V. Total Man Hours per end 58,973 59,109 59,245 59,373 59,501 59,645 59,789
date(Hours)
Note:

20 Recapitulation Man Power Hastek SCYY

18
16
14
Man Power

12
10 18
15 17 17
16 16
8
6
4
2
0 0 0 0 0 0 0
4 5 6 7 8 Date 9

E. ACCIDENT RECORD
DATE TOTAL
No. ITEM
4 5 6 7 8 9 10 THIS WEEK
1 Medical Treatment (Freq.) 0 0 0 0 0 0 0
2 Lost Time Injured (Freq.) 0 0 0 0 0 0 0
3 Fatality (Frequency/Person) 0 0 0 0 0 0 0
4 Zero Accident 58,973 59,109 59,245 59,373 59,501 59,645 59,789
CORRELATION MAN HOURS ≈ ZERO ACCIDENT ≈ MAN POWER

60,000 Total Man Power man hours zero accident 20

59,800 18
59,645 59,789 16
59,600 59,501
59,373 14 P
59,400 59,245 12 e
59,109 18 o
Hours

59,200 10
58,973 17 p
17 16 8 l
59,000 15 18
6 e
58,800 16 4
58,600 2
58,400 0
4 5 6 7 8 9 10
Date

Page 25 of 31 SHE Report

 WEEKLY SAFETY REPORT
DEMIIN PLANT COGEN 7
REVISI : 00 LOCATION Kragilan, Serang, Banten
NO. PROJECT AREA Demin Plant Cogen 7
PERIODE 4-10 Juli 2021 REPORTED BY : Putra Wira P.
TOTAL RECORDABLE ACCIDENT (This Week)
5
Medical Treatment (Freq.)
4 Lost Time Injured (Freq.)
Fatality (Frequency/
Frequency/Person

3 Person)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
4 5 6 7 8 9 10
Date

Description:
1. Total Manhours a week : 936 hours during project: 59,789 hours (4-10 Juli 2021)
2. Total Zero Accident : 59,789 hours
3. Total Man Power : 18 mp
4. Total of Mandays : 25 days (4-10 Juli 2021)
5. Total training Hours : 25 hours (Since 01 July 2020)
6. Safety awareness : Zero accident
7. Safety activity : Safety talks & TBM, Safety monitoring, Safety Inspection, Safety meeting

8. Safety Issue/ Concern :

-
-

Page 26 of 31 SHE Report

 SAFETY ACTIVITY

PERIOD : 16-22 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Putra Wira P.

SAFETY PROGRAM
16-22 Apr PT. LOW and CV. HASTEK Safety Talk held on Taisei Pulau Intan (TPI) Company everyday

17-Apr Safety Induction by TPI Company for new comer

16-22 Apr
Safety Meeting by Client, Contractor, Sub- Contractor
2021

Lamp Safety Report WWTP (4)

 SAFETY ACTIVITY

PERIOD : 16-22 April 2021 CONTRACTOR : PT Lautan Organo Water

END USER : PT Mitsubishi Film Indonesia LOCATION : Gerem, Cilegon

SYSTEM : WASTE WATER TREATMENT PLANT REPORTED BY : Putra Wira P.

16-22 Apr
Inspection Scaffolding by HSE TPI
2021

Lamp Safety Report WWTP (4)

 LIST MAN POWER M/E CONSTRUCTION PT LAUTAN ORGANO WATER
WASTE WATER TREAATMENT PLANT
IFC PROJECT-MFI
2021
Update: 15 April 2021
Labour Insurance
NO. NAME POSITION COMPANY Induction Date ID CARD STATUS REMARKS
(BPJS)
001 Akhmad Muhilal Site Manager PT Lautan Organo Water 17 Maret 2021 √ √ On Site

002 Muchamad Gufron HSE Coordinator PT Lautan Organo Water 18 Maret 2021 √ √ On Site

003 Dadan Kadarsah Electrical Engineer PT Lautan Organo Water 17 Maret 2021 √ √ On Site Tentative

004 Hoerudin Electrical Engineer PT Lautan Organo Water 18 Maret 2021 √ √ Off Site

005 Agus Salim Spv Subcon CV Hasan Teknik 18 Maret 2021 √ √ Off Site Tentative

006 Setiawan Utomo Leader Mechanical CV Hasan Teknik 18 Maret 2021 √ √ On Site

007 Muji Rahardjo Leader Electrical CV Hasan Teknik 5 Apr 2021 √ √ On Site

008 Putra Wira Pratama Safety Officer CV Hasan Teknik 5 Apr 2021 √ √ On Site

009 Sacse Enceng Hidayat Mechanical CV Hasan Teknik 5 Apr 2021 √ √ On Site

010 Muhamad Yahya Iswanto Helper CV Hasan Teknik 5 Apr 2021 √ √ On Site

011 Rokhmad Santoso Mechanical CV Hasan Teknik 6 Apr 2021 √ √ On Site

012 Sunaryo Electrician CV Hasan Teknik 6 Apr 2021 √ √ On Site

013 Yopie Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

014 Arfadillah Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

015 Zainal Arifin Mechanical CV Hasan Teknik 9 Apr 2021 √ √ On Site

016 Fazar Afrizal Mechanical CV Hasan Teknik 12 Apr 2021 √ √ On Site

017 Rifat Muamar Helper CV Hasan Teknik 12 Apr 2021 Resign Finish 22 Apr 2021

018 Lhutfi Mechanical CV Hasan Teknik 12 Apr 2021 √ √ On Site

019 Sarjuli Mechanical CV Hasan Teknik 14 Apr 2021 √ √ On Site

020 Syarif Hidayat Scaffolder CV Hasan Teknik 17 Apr 2021 Resign Finish 19 Apr 2021
Note: Reported by,
Total on site : 17
Resign :2
Man Power (registered) : 20
Muchamad Gufron
 WEATHER RECORD PT. LAUTAN ORGANO WATER
Project Name : WASTE WATER TREATMENT PLAN EXPANSION PROJECT (MFI Project) Client : PT MFI

Project Location : Gerem, Cilegon Month : Apr-21

Project Number : 2006-MFI02 Document No :
TIME\DATE 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 TIME\DATE
07:00-07:30 07:00-07:30
07:31-08:00 07:31-08:00
08:01-08:30 08:01-08:30
08:31-09:00 08:31-09:00
09:01-09:30 09:01-09:30
09:31-10:00 09:31-10:00
10:01-10:30 10:01-10:30
10:31-11:00 10:31-11:00
11:01-11:30 11:01-11:30
11:31-12:00 11:31-12:00
12:01-12:30 12:01-12:30
12:31-13:00 12:31-13:00
13:01-13:30 13:01-13:30
13:31-14:00 13:31-14:00
14:01-14:30 14:01-14:30
14:31-15:00 14:31-15:00
15:01-15:30 15:01-15:30
15:31-16:00 15:31-16:00
16:01-16:30 16:01-16:30
16:31-17:00 16:31-17:00
17:01-17:30 17:01-17:30
17:31-18:00 17:31-18:00
18:01-18:30 18:01-18:30
18:31-19:00 18:31-19:00
19:01-19:30 19:01-19:30
19:31-20:00 19:31-20:00
20:01-20:30 20:01-20:30
20:31-21:00 20:31-21:00
21:01-21:30 21:01-21:30
21:31-22:00 21:31-22:00
22:01-22:30 22:01-22:30
22:31-23:00 22:31-23:00
23:01-23:30 23:01-23:30
23:31-24:00 23:31-24:00
∑ WH/ ∑ RH 8/0 8/0 8/0 8/0 8/0 8/0 12/0 12/0 12/0 12/0 12/0 12/0 8/0 8/0 12/0 12/0 12/0 12/0 12/0 8/0 8/0
NOTE:

Prepared by, Acknowledge by, : Rainy/ Thunder

Muchamad Gufron WH : Work Hours RH : Rain Hours