TOKA TINDUNG PROJECT

PLAN TASK OBSERVATION (PTO) FORM

1. OBSERVER INX No.

52217
Name : John Nainggolan OBJECTIVES OF OBSERVATION
TO KNOW:
Job Title : Project Engineer
1. The team's ability to do assignments
following work guidelines.
ID. Badge No : 04210882 2. The adequacy of work guides becomes
guidance for carrying out tasks safely
Date & Time : 18 Sep 2023 / 09:00-10:00 and efficiently.

Observer Team
1. Name : Shancha Ricardo ID No. : Job Title : Project Engineer
2. Name : Deriel Jeff Dompas ID No. : Job Title : Mining
3. Name : Robinson Sulle ID No. : Job Title : OHS
4. Name : Terry Lasapu ID No. : Job Title : OHS

2. TASK BEING OBSERVED

Task Name : Fabrication Fire Line Pipe

Supervisor Area : Matius Durand – PT. MSM

No. of Worker : 5 persons

Location : Area-10 Magazine

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Type of Observation :  New Follow Up
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Scope of Observation :  Partial Full
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Job Guidance :  JSEA SOP or COP
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Reason of Observation : Follow up Incident  Critical Task Audit
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� Follow up Training
� Non Routine Task
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3. TYPES OF ACTIVITIES

Originator : Document No :
Rudolf Lengkong TT – OHS – FOP – 60 – 030
Revision: Rev Date : Expiry Date : Department: Document Type:
00 18/08/2020 18/08/2022 OHS Form
Uncontrolled Document When Printed Page 1 of 3
 TOKA TINDUNG PROJECT

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Working at height 󠇮 Isolation, Lock Out and Tag Out
󠇮 Working Near Hot Water

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Electrical Safety Working in Confined Space
󠇮 Working near TSF Mud

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Operating vehicle & Mobile
Equipment
Blasting Activities
󠇮 Lifting & Supporting Load

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� Hazardous Substance
� Fatigue Management  Work Permit

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� Other activities :

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4. OSERVATION CHECKLIST
5.

Abilities of the Team Performing Task

No. ITEM YES NO No. ITEM YES NO
1. Step of the task in correct order  Equipment & tools being used:
2. All task steps are followed  a. In good condition 
a. Worker Qualification (job title and
3.  b. Used properly and appropriately 
level as per JSEA)
Communication among worker
b. No. of worker as per JSEA  
properly
c. Appropriate PPE as per JSEA  Adequate Supervision 
4. Work permit completed  Sufficient time to work safely 
Housekeeping maintained during
5. TAKE 5 properly conducted  
performing the task
Pre-job safety talk conducted
6.  Job conducted safely as plan 
properly
Adequacy of Work Guidance
JSEA
No. Items YES NO No. Items YES NO
1. Still Valid, Not Expired  4. All hazards adequately controlled 
2. Steps of the task in correct order  5. Align with referred SOP or COP 
3. All hazards identified  6. Any other effective work method 
SOP or COP
No
Items YES NO No. Items YES NO
.
1. Still valid, Not Expired  3. Adequately covered the JSEA 
2. Specific and controlled  4. Still appropriate to current condition 
Originator : Document No :
Rudolf Lengkong TT – OHS – FOP – 60 – 030
Revision: Rev Date : Expiry Date : Department: Document Type:
00 18/08/2020 18/08/2022 OHS Form
Uncontrolled Document When Printed Page 1 of 3
 TOKA TINDUNG PROJECT

Feedback for improvement

1. Area pengelasan dan pemotongan tidak di barikade untuk menghindari orang yang tidak
berkepentingan mendekati area kerja.
2. Pipe line baru belum dibuatkan rencana proteksi dari mobil atau truk yang akan parker diarea
tersebut.
Do Follow-up of observation on workers or duty needs to be followed up ?  Yes No
6. DETAIL OF CORRECTIVE ACTIONS
Describe the actions that have been taken to effect this change, Note the actions below
No. Actions By Who Due Date
1 Membuat pita barikade disekeliling area kerja pengelasan dan pemotongan project done
25-09-
2 Akan dibuatkan bollard atau proteksi dari ban bekas. Derryl
2023

Signed Signed Signed

Sign
ed
Name: John Nainggolan Name: Robinson Sulle Name: Terry Lapasu Name: Derryl Dompas
[

Originator : Document No :
Rudolf Lengkong TT – OHS – FOP – 60 – 030
Revision: Rev Date : Expiry Date : Department: Document Type:
00 18/08/2020 18/08/2022 OHS Form
Uncontrolled Document When Printed Page 1 of 3