PT.

WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building
Date :
Inspektor :
Office & Mess PT.Waringin Arum
Compliance
Item / Questions Yes No Fixed Notes Photo/Notes

( General Inspection/1.00 – Premises & Housekeeping/Lighting: Natural & Articial ) Building and Area Lighting ( 1.12 )
1 Are all lights operational ?
(Make note if more than 10% are inoperable in any one area)
Apakah semua lampu berfungsi baik ?

2 Is lighting adequate for work being performed ?

Apakah tempat kerja yang sedang sibuk cukup mendapat penerangan?

3 Are light covers and diffusers clean ?

Apakah tutup dan alat difusi lampu bersih ?

4 Are emergency lights provided where required ?

Apakah tersedia lampu darurat apabila dipelukan ?

5 Are emergency lights working - test to ensure

correct operation ?
Apakah lampu darurat berfungsi - periksa untuk memastikan apakah lampu benar-benar
berfungsi ?

6 Has a lighting survey been conducted within last 3

years ?
Apakah lampu-lampu pernah diperiksa selama 3 tahun terakhir ?

7 Has a safety glass survey been conducted ?

Apakah kaca pengamannya pernah diperiksa ?

8 Have recommendations from lighting & safety

glass surveys been acted upon ?
Apakah rekomendasi dari pemeriksaan lampu dan kaca pengaman telah dilaksanakan ?

General Inspection/1.00 – Premises & Housekeeping/Buildings ? Building ( 1.11 )

9 Are area maps outlining custodial responsibility
displayed ?
Apakah ada peta lokasi yang menggambarkan tanggung-jawab penjaga gedung ?

10 Are areas around the building clean and free from

obstrutions ?
Apakah daerah di sekitar gedung bersih dan bebas dari segala benda penghalang ?

11 Are outside walls, roof etc, clean and in good

condition ?
Apakah dinding sebelah luar, atap dsb, bersih dan dalam kondisi baik ?

12 Are doors in good condition and doorways clear

of obstructions ?

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 PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
Apakah pintu-pintu dalam kondisi baik dan apakah ambang-ambang pintu terbebas dari
segala benda penghalang ?

13 Are windows free of damage and clean ?

Apakah jendela-jendela dalam kondisi baik dan bersih ?

14 Are floors coverings in good condition ?

Apakah lantai dan karpet dalam kondisi baik ?

15 Are internalwalls clean and free from damage ?

Apakah dinding sebelah dalam bersih & tidak rusak ?

16 Are internal fixtures and fittings secure and free

from damage
Apakah benda-benda yang terpasang di dalam gedung aman dan tidak rusak ?
berfungsi ?

( General Inspection/1.00 - Premises & Housekeeping ) Ventilation: Natural & Articial (1.13)
17 Is adequate air conditioning provided in offices ?
Apakah kantor-kantor dilengkapi dengan penyejuk yang cukup ?

18 Are vehicles with enclosed cabins provided with

adequate air conditioning ?
Apakah kendaraan dengan kabin tertutup dilengkapi dengan penyejuk udara yang cukup ?

19 Are air conditioners well maintained - eg: filter

servicing ?
Apakah mesin penyejuk udara dirawat dengan baik - mis,:service filter ?

20 Are inside of offices and operator cabins free from

dust build up?
Apakah bagian dalam kantor dan kabin operator terbebas dari debu ?

21 Are active mining areas and roadways

appropriately watered to reduce dust ?
(watering should not to be to excess)
Apakah daerah tambang aktif dan jalan disiram dengan baik untuk mengurangi debu ?
(tidak boleh terlalu basah)

22 Has a dust survey been conducted per

requirements of PN Element 1.13 ?
Apakah debu telah diperiksa sesuai persyaratan PN Elemn 1.13 ?

( General Inspection/1.00 - Premises & Housekeeping/Amenities & Sanitation ) Toiets & Wash Rooms (1.14)
23 Are toilet and wash rooms in good order and well
cleaned ?
Apakah toilet dan ruang cuci dalam keadaan baik dan bersih ?

24 Are toilets, urinals and fixtures clean and in good

order ?
Apakah toilet, tempat urin dan benda-benda lain yang terpasang di sana dalam keadaan
baik ?

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 PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
25 Are wash basins and fixtures clean and in good
order ?
Apakah tempat cuci muka dan benda-benda lain yang terpasang di sana bersih dan
dalam keadaan baik ?

26 Are appropriate rubbish bins provided - are these

emptied regularly ?
Apakah tersedia tong sampah - apakah sampahnya dibuang secara teratur ?

27 Are soap and clean towels (or tissues) available ?

Apakah tersedia sabun dan handuk bersih (kertas tissue)

( General Inspection/1.00 - Premises & Housekeeping/Amenities & Sanitation ) Lunch Rooms (1.14)
28 Are lunch rooms clean and in good order ?
Apakah ruang makan bersih dan dalam keadaan baik ?

29 Are facilities appropriate and adequate for the

number of people ?
Apakah sarananya cocok dan cukup untuk jumlah karyawan ?

30 Are benches, shelves, tables, chairs etc, clean and

in good order ?
Apakah bangku, rak, meja, kursi dsb, bersih dan dalam keadaan baik ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Labelling of Switches, Isolators & Valves ( 2.
33 Are all switches, isolators and controls clearly
labelled ?
Apakah semua sakelar, isolator dan alat kontrol diberi label yang jelas ?

34 Is labelling to consistent standards ?

Apakah pemberian label sesuai dengan standar ?

35 Are critical valves labelled ?

(eg:air isolation / discharge valves, fuel valves etc.)
Apakah katub-katub kritis diberi label ?
(mis.: isolasi udara/katub pembuangan, katub bahan bakar, dsb.)

36 Are emergency stop buttons clearly identified ?

Apakah tombol penyetop darurat mudah ditemukan ?

( General Inspection/1.00 - Premises & Housekeeping ) Good Stacking & Storage Practices (1.22)
37 Are all stacks and stores in authorised places ?
Apakah rak dan tempat-tempat penyimpanan semuanya ditempatkan pada posisi yang
benar ?

24 Are toilets, urinals and fixtures clean and in good

order ?
Apakah toilet, tempat urin dan benda-benda lain yang terpasang di sana dalam keadaan
baik ?

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 PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
38 Are all stacs properly (safely) constructed ?
Apakah konstruksi rak aman ?

39 Is storage in cupboards and on shelves neat and

tidy ?
Apakah barang yang tersimpan di lemari dn rak bersih dn rapi ?

40 Are heavierietms appropriately placed on shelves ?

(heavier items should be between waist and shoulder height - no heavy items on top
shelves)
Apakah benda-benda yang lebih berat disimpan di tempat yang tepat di atas rak ?
(benda-benda yang lebih berat harus disimpan sepinggang tingginya atau lebih sampai
batas bahu - benda berat tidak boleh disimpan di bagian atas rak?

41 Are cupboard tops and shelves above 1.5 meters

clear ?
Apakah bagian atas lemari dan rak yang tingginya melebihi 1,5m bersih ?

( General Inspection/1.00 - Premises & Housekeeping) Scrap & Refuse Bins (1.24)
42 Are there sufficient and appropriate type rubbish
bins in the area ?
Apakah tersedia tong sampah yang tepat untuk setiap jenis sampah dan dalam jumlah
memadai di daerah itu ?

43 Are rubbish bins provided with lids that are kept in

place ?
Apakah tong-tong sampah bertutup dan pada posisi yang benar ?

44 Are rubbish bins reqularly emptied and cleaned ?

Apakah tong-tong sampah dibersihkan secara teratur ?

45 Are flammable materials placed in metal bins with

appropriate lids ?
Apakah bahan yang mudah terbakar disimpan dalam kaleng bertutup ?

46 Are hazardous materials disposed of correctly ?

Apakah bahan-bahan berbahaya dibuang pada tempatnya ?

47 Are bins colour coded for type of waste - per

standards ?
Apakah tong-tong sampah diberi kode warna untuk masing-masing jenis sampah - sesuai
standard ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding/Ladders, Stairs, Walkways, & Scaffolding )
48 Are steps or rungs in good condition (not loose or
movabl) ?
Apakah anak tangga dalam kondisi baik (tidak longgar atau goyang) ?

49 Is the ladder free from any loose nails, screws,

 bolts or other metal parts ?
Apakah di tangga tidak ada tonjolan paku, sekerup, baut atau benda logam lain ?

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PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
50 Is the ladder free of cracke, split or broken
uprights, braces, steps or rungs ?
Apakah anak tangga tidak retak, pecah atau rusak ?

51 Are the steps clear of obstructios ?

Apakah tangga bebas hambatan ?

52 Are ladder stable ?

Apakah tangga stabil ?

53 Are hanrails and cages (if fitted) in good

condition ?
Apakah sandaran tangan dan kurungan (jika ada) dalam kondisi baik ?

54 Are ladders to overhead crane buss bars fitted

with locked cages to prevent unauthorised access ?
Apakah tangga menuju ujung kran dilengkapi dengan kurungan berkunci guna
mencegah masuknya orang lain yang tidak berkepentingan ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Hazardous Substances Control (2.17)
55 Is there an alphabetical register of hazardous
substances ?
Apakah bahan-bahan berbahaya didaftar secara abjat ?

56 Is the register up to date - all substancesincluded ?

Apakah daftarnya masih baru -mencakup semua bahan ?

57 Are product/substances properly labelled and in

suitable containers ?
Apakah produk/bahan diberi label yang tepat dan dimuat dalam wadah yang sesuai ?

58 Are MSDS sheets readily available for all

substances ?
Apakah lembaran MSDS tersedia bagi semua bahan ?

59 Are procedures written for safe handling, storage

and transportation of hzardous substances ?
(eg:flammable. Explosives products, radiation sources, etc.)
Apakah ada prosedur tertulis untuk penanganan, penyimpanan dan pengangkutan bahan
berbahaya secara aman ?
(mis.:bahan peledak, sumber radiasi, dsb)

60 Have fire/rescue team members been trained in

fire procedures involving radion-active sources ?
Apakah semua anggota tim pemadam kebakaran telah dilatih dalam menagani
kebakaran termasuksumber radio-aktif ?
61 Is sufficient and appropriate signage in place ?
Apakah dipasang tanda-tanda bahaya yang tepat ?

62 Are adequate procedures in place for disposal of

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PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
hazardous substances ?
(eg:asbestos, radio-active sources, explosives product, waste oil, old tyres, etc.)
Apakah ada prosedur untuk pembuangnan bahan-bahan berbahaya ?
(mis.:asbestos, sumber radio-aktif, bahan peledak, limbah minyak, ban-ban bekas, dsb.)

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Electrical Equipment - Plug In (2.21)
63 Are all portable (plug-in) electrical devices
identified and registered ?
Apakah semua alat listrik portabel (plug-in) diidentifikasi dan terdaftar ?

64 Are portable (pulg-in) electrical devices free from

damage or defects ?
Apakah alat listrik portabel (plug-in) tidak rusak atau macet ?

65 Are electrical leads and plugs free from damage -

cuts, burns, etc. ?
Apakah kabel and plug listrik tidak rusak - tersayat, terbakar, dsb ?

66 Are regular checks arried out by authorised

person(s), in accordance with the equipment usage
- as per schedule ?
Apakah petugas resmi memeriksanya secara teratur sesuai dengan penggunaan alat ?

67 Are up-to-date inspection tags attached ?

Apakah diberi label inspeksi baru ?

68 Are faulty items removed from service and

correctly tagged ?
Apakah alat0alat rusak dikeluarkan dari tempat service dan diberi label yang tepat ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Ergonomics (2.31)

69 Has a survey (ergonomic study) been conducted
for the area ?
Apakah telah dilakukan survey/study ergonomik ditempat kerja ?

70 Are ergonomic considerations included when

purchasing and/or installing new equipment ?
Apakah ergonomik diperhitungkan saat membeli dan/atau memasang peralatan baru ?

71 Are body posture problems evident, eg: seating,

back rests, foot support etc. ?
Apakah ada masalah dengan postur tubuh, mis.:kursi, sandaran punggung, injakan, dsb. ?

72 Are accessiblity problems evident, eg:location of

valves, switches, controls, steps/ladders etc.?
 Apakah ada masalah aksesibilitas, mis.: lokasi katub, sakelar, alat kontrol, tangga, dsb.?

73 Has condideration been given to access by

disabled person(s) ?
Apakah telah diperhitungkan jalan masuk bagi orang cacat ?

74 Are appropriate actions carried out when

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PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
non-conformances are identified ?
Apakah dilakkukan tindakan yang tepat saat ditemukannya pelanggaran ?

( General Inspection/3.00 - Fire Protection & Prevention ) Fire Extinguishing Equipment (3.01)
75 Is appropriate type/capacity fire fighting
equipment identified and installed ?
Apakah dikenal dan dipasang alat pemadam jenis/kapasitas yang tepat ?

76 Is equipment placed in easly accessible

location(s) ?
Apakah alat pemadam ditempatkan pada tempat yang mudah dijangkau ?

77 Is access to all equipment unrestricted ?

Apakah jalan menuju ke semua alat pemadam bebas hambatan ?

78 Has a fire risk survey been conducted to ensure

correct type and location ?
Apakah telah dilakukan suatu survey risiko kebakaran guna memastikan jenis dan lokasi
yang tepat ?

( General Inspection/3.00 - Fire Protection & Prevention ) Fire Drill & Instruction (3.07)
79 Are fire/rescue teams designated ?
Apakah ditunjuk tim pemadam/penolong kebakaran ?

80 Are fire/rescue team members appointed in writing ?

Apakaha penunjukan anggota tim pemadam/penolong kebakaran dilakukan secara tertulis ?

81 Are all shifts covered by fire/rescue response ?

Apakah semua shift dilengkapi enan tim pemadam/penolong kebakaran ?

82 Are emergency evacuations plans placed

thoughout work areas ?
Apakah rencana evakuasi darurat diterapkan di seluruh daerah kerja ?

83 Are fire wardens identified in each area ?

Apakah karyawan masing-masing daerah kerja mengenal fire wardennya ?

84 Are fire drills (evacuation and response)

conducted, at least 12 monthly ?
Apakah pelatihan kebakaran (evakuasi dan respon) dilakukan minimum setahun ?

( General Inspection/3.00 - Fire Protection & Prevention ) emergency Preparation (3.09)

85 Is there a written Emergency Plan for the area ?
 Apakah ada Rencana darurat untuk daerah kerja ?

86 Does the emergency plan cover all likely

emergencies ?
(both natural and man-caused sources)
Apakah rencanan darurat tersebut mancakup semua keadaan darurat yang mungkin timbul ?
(baik yang terjadi secara alami maupun karena ulah manusia)

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PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
87 Is there a Co-ordinator appointed totake control
in the event of an emergency ?
Apakah ada koordinator yang bertugas mengontrol dalam keadaan darurat ?

88 Are emergency communications clearly

established and understood ?
Apakah komunikasi darurat dilakukan dengan jelas dan dimengerti ?

89 Are there regular emergency drills conducted by

EMT or CMT Leader ?
Apakah pelatihan keadaan darurat dilakukan secara teratur oleh EMT atau CMT Leader ?

( General Inspection/4.00 - Incident/Accident Recording & Investigation ) Injury/Disease Statistics (4.13)

90 Are incident/accident statistics kept ?
Apakah disimpan statistik insiden/kecelakaan ?

91 Are incident/accident statistics displayed on

noticeboards ?
Apakah statistik insiden/kecelakaan ditempel di papan pengumuman ?

( General Inspection/5.00 - Health & Safety Organisation ) First Aiders & FAcilities (5.15)
92 Are appropriate first-aid facilities available in the
workplace ?
Apakah sarana P3K tersedia ditempat kerja ?

93 Are contents of first-aid kits checked and

replenished regularly ?
Apakah isi kotak P3K diperiksa dan ditambah secara teratur ?

94 Are all first-aid boxes under the control of a

qualified first-aider ?
Apakah semua kotak P3K berada di bawah pengawasan seorang petugas P3K yang
berpengalaman ?

95 Are first-aid boxes / facilities clearly identifed by

means of signage ?
Apakah kotak/sarana P3K diidentifikasi dengan jelas dengan memberi tanda ?

96 Are there sufficient person(s) with first-aid

qualification in the workgroup ?
Apakah dalam kelompok kerja cukup tersedia orang yang memilki kwalifikasi P3K ?
97 Are safety - eye wash and showers placed in areas
where chemicals, fuel etc,. Are handled ?
(eg: at refuelling areas, battery and chemical stores, etc.)
Apakah tersedia tempat cuci mata dan bersiram di daerah tempat penggunaan bahan
kimia dan bahan bakar sebagai sarana keselamatan kerja ?
(mis.: di tempat pengisian bahan bakar, gudang akki dan bahan kimia, dsb.)

98 Are safety - eye wash and showers regularly

inspected and maintained ?

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PT. WARINGIN ARUM First Priority

Inspection Checklist
Office & Mess Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
Apakah sarana keselamatan kerja tersebut diperiksa dan dirawat secara teratur ?

( General Inspection/1.00 - Premises & Housekeeping ) Aisles, Storage, In-Pit Roads & Sections Demarcated (1.21)
99 Have aisles and walkways been appropriately
demarcated ?
Apakah lorong dan jalan untuk pejalan kaki telah diberi tanda yang tepat ?
(tidak diperlukan di dalam kantor)

100 Have storage areas been appropriately

demarcated ?
Apakah udang dan tempat penyimpanan lainnya telah diberi tanda yang tepat ?

101 Have electrical switchboards been demarcated as

keep clear zones ?
Apakah papan-papan switch listrik telah diberi tanda sebagai daerah terlarang ?

102 Have vehicle roadways been appropriately

delineated ?
(eg: guideposts, signposting and traffic control devices)
Apakah rambu-rambu lalu-lintas dipasang di jalan-jalan kendaraan (mis.: tiang penunjuk,
tanda-tanda arah dan alat kontrol lalu-lintas) ?

103 Are guideposts and sign maintained and cleaned

regularly ?
Apakah tiang penunjuk dan tanda-tanda arah tersebut dirawat dan dibersihkan secara
teratur ?

( General Inspection/1.00 - Premises & Housekeeping ) Workshop, Yards, Storage & Mining Areas (1.23)
104 Are yards and back areas free from rubbish or
redundant material ?
Apakah halaman dan perkarangan belakang bersih ?

105 Are yards and back areas neat and tidy ?

Apakah halaman dan perkarangan belakang bersih dan tertata rapi ?

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 PT. WARINGIN ARUM First Priority

Inspection Checklist
Workshop Building
Date :
Inspektor :
Workshop PT.Waringin Arum
Compliance
Item / Questions Yes No Fixed Notes Photo/Notes

( General Inspection/1.00 – Premises & Housekeeping/Lighting: Natural & Articial ) Building and Area Lighting ( 1.12 )
1 Are all lights operational ?
(Make note if more than 10% are inoperable in any one area)
Apakah semua lampu berfungsi baik ?

2 Is lighting adequate for work being performed ?

Apakah tempat kerja yang sedang sibuk cukup mendapat penerangan?

3 Are light covers and diffusers clean ?

Apakah tutup dan alat difusi lampu bersih ?

4 Are emergency lights provided where required ?

Apakah tersedia lampu darurat apabila dipelukan ?

5 Are emergency lights working - test to ensure

correct operation ?
Apakah lampu darurat berfungsi - periksa untuk memastikan apakah lampu benar-benar
berfungsi ?

6 Has a lighting survey been conducted within last 3

years ?
Apakah lampu-lampu pernah diperiksa selama 3 tahun terakhir ?

7 Has a safety glass survey been conducted ?

Apakah kaca pengamannya pernah diperiksa ?

8 Have recommendations from lighting & safety

glass surveys been acted upon ?
Apakah rekomendasi dari pemeriksaan lampu dan kaca pengaman telah dilaksanakan ?

General Inspection/1.00 – Premises & Housekeeping/Buildings ? Building ( 1.11 )

9 Are area maps outlining custodial responsibility
displayed ?
Apakah ada peta lokasi yang menggambarkan tanggung-jawab penjaga gedung ?

10 Are areas around the building clean and free from

obstrutions ?
Apakah daerah di sekitar gedung bersih dan bebas dari segala benda penghalang ?

11 Are outside walls, roof etc, clean and in good

condition ?
Apakah dinding sebelah luar, atap dsb, bersih dan dalam kondisi baik ?

12 Are doors in good condition and doorways clear

of obstructions ?

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 PT. WARINGIN ARUM First Priority

Inspection Checklist
Workshop Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
Apakah pintu-pintu dalam kondisi baik dan apakah ambang-ambang pintu terbebas dari
segala benda penghalang ?

13 Are windows free of damage and clean ?

Apakah jendela-jendela dalam kondisi baik dan bersih ?

14 Are floors coverings in good condition ?

Apakah lantai dan karpet dalam kondisi baik ?

15 Are internalwalls clean and free from damage ?

Apakah dinding sebelah dalam bersih & tidak rusak ?

16 Are internal fixtures and fittings secure and free

from damage
Apakah benda-benda yang terpasang di dalam gedung aman dan tidak rusak ?
berfungsi ?

( General Inspection/1.00 - Premises & Housekeeping ) Ventilation: Natural & Articial (1.13)
17 Is adequate air conditioning provided in offices ?
Apakah kantor-kantor dilengkapi dengan penyejuk yang cukup ?

18 Are vehicles with enclosed cabins provided with

adequate air conditioning ?
Apakah kendaraan dengan kabin tertutup dilengkapi dengan penyejuk udara yang cukup ?

19 Are air conditioners well maintained - eg: filter

servicing ?
Apakah mesin penyejuk udara dirawat dengan baik - mis,:service filter ?

20 Are inside of offices and operator cabins free from

dust build up?
Apakah bagian dalam kantor dan kabin operator terbebas dari debu ?

21 Are active mining areas and roadways

appropriately watered to reduce dust ?
(watering should not to be to excess)
Apakah daerah tambang aktif dan jalan disiram dengan baik untuk mengurangi debu ?
(tidak boleh terlalu basah)

22 Has a dust survey been conducted per

requirements of PN Element 1.13 ?
Apakah debu telah diperiksa sesuai persyaratan PN Elemn 1.13 ?

( General Inspection/1.00 - Premises & Housekeeping/Amenities & Sanitation ) Toiets & Wash Rooms (1.14)
23 Are toilet and wash rooms in good order and well
cleaned ?
Apakah toilet dan ruang cuci dalam keadaan baik dan bersih ?

24 Are toilets, urinals and fixtures clean and in good

order ?
Apakah toilet, tempat urin dan benda-benda lain yang terpasang di sana dalam keadaan
baik ?

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 PT. WARINGIN ARUM First Priority

Inspection Checklist
Workshop Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
25 Are wash basins and fixtures clean and in good
order ?
Apakah tempat cuci muka dan benda-benda lain yang terpasang di sana bersih dan
dalam keadaan baik ?

26 Are appropriate rubbish bins provided - are these

emptied regularly ?
Apakah tersedia tong sampah - apakah sampahnya dibuang secara teratur ?

27 Are soap and clean towels (or tissues) available ?

Apakah tersedia sabun dan handuk bersih (kertas tissue)

( General Inspection/1.00 - Premises & Housekeeping/Amenities & Sanitation ) Lunch Rooms (1.14)
28 Are lunch rooms clean and in good order ?
Apakah ruang makan bersih dan dalam keadaan baik ?

29 Are facilities appropriate and adequate for the

number of people ?
Apakah sarananya cocok dan cukup untuk jumlah karyawan ?

30 Are benches, shelves, tables, chairs etc, clean and

in good order ?
Apakah bangku, rak, meja, kursi dsb, bersih dan dalam keadaan baik ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Labelling of Switches, Isolators & Valves ( 2.
33 Are all switches, isolators and controls clearly
labelled ?
Apakah semua sakelar, isolator dan alat kontrol diberi label yang jelas ?

34 Is labelling to consistent standards ?

Apakah pemberian label sesuai dengan standar ?

35 Are critical valves labelled ?

(eg:air isolation / discharge valves, fuel valves etc.)
Apakah katub-katub kritis diberi label ?
(mis.: isolasi udara/katub pembuangan, katub bahan bakar, dsb.)

36 Are emergency stop buttons clearly identified ?

Apakah tombol penyetop darurat mudah ditemukan ?

( General Inspection/1.00 - Premises & Housekeeping ) Good Stacking & Storage Practices (1.22)
37 Are all stacks and stores in authorised places ?
Apakah rak dan tempat-tempat penyimpanan semuanya ditempatkan pada posisi yang
benar ?

24 Are toilets, urinals and fixtures clean and in good

order ?
Apakah toilet, tempat urin dan benda-benda lain yang terpasang di sana dalam keadaan
baik ?

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Workshop Building

Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
38 Are all stacs properly (safely) constructed ?
Apakah konstruksi rak aman ?

39 Is storage in cupboards and on shelves neat and

tidy ?
Apakah barang yang tersimpan di lemari dn rak bersih dn rapi ?

40 Are heavierietms appropriately placed on shelves ?

(heavier items should be between waist and shoulder height - no heavy items on top
shelves)
Apakah benda-benda yang lebih berat disimpan di tempat yang tepat di atas rak ?
(benda-benda yang lebih berat harus disimpan sepinggang tingginya atau lebih sampai
batas bahu - benda berat tidak boleh disimpan di bagian atas rak?

41 Are cupboard tops and shelves above 1.5 meters

clear ?
Apakah bagian atas lemari dan rak yang tingginya melebihi 1,5m bersih ?

( General Inspection/1.00 - Premises & Housekeeping) Scrap & Refuse Bins (1.24)
42 Are there sufficient and appropriate type rubbish
bins in the area ?
Apakah tersedia tong sampah yang tepat untuk setiap jenis sampah dan dalam jumlah
memadai di daerah itu ?

43 Are rubbish bins provided with lids that are kept in

place ?
Apakah tong-tong sampah bertutup dan pada posisi yang benar ?

44 Are rubbish bins reqularly emptied and cleaned ?

Apakah tong-tong sampah dibersihkan secara teratur ?

45 Are flammable materials placed in metal bins with

appropriate lids ?
Apakah bahan yang mudah terbakar disimpan dalam kaleng bertutup ?

46 Are hazardous materials disposed of correctly ?

Apakah bahan-bahan berbahaya dibuang pada tempatnya ?

47 Are bins colour coded for type of waste - per

standards ?
Apakah tong-tong sampah diberi kode warna untuk masing-masing jenis sampah - sesuai
standard ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding/Ladders, Stairs, Walkways, & Scaffolding )
48 Are steps or rungs in good condition (not loose or
movabl) ?
Apakah anak tangga dalam kondisi baik (tidak longgar atau goyang) ?

49 Is the ladder free from any loose nails, screws,

 bolts or other metal parts ?
Apakah di tangga tidak ada tonjolan paku, sekerup, baut atau benda logam lain ?

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Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
50 Is the ladder free of cracke, split or broken
uprights, braces, steps or rungs ?
Apakah anak tangga tidak retak, pecah atau rusak ?

51 Are the steps clear of obstructios ?

Apakah tangga bebas hambatan ?

52 Are ladder stable ?

Apakah tangga stabil ?

53 Are hanrails and cages (if fitted) in good

condition ?
Apakah sandaran tangan dan kurungan (jika ada) dalam kondisi baik ?

54 Are ladders to overhead crane buss bars fitted

with locked cages to prevent unauthorised access ?
Apakah tangga menuju ujung kran dilengkapi dengan kurungan berkunci guna
mencegah masuknya orang lain yang tidak berkepentingan ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Hazardous Substances Control (2.17)
55 Is there an alphabetical register of hazardous
substances ?
Apakah bahan-bahan berbahaya didaftar secara abjat ?

56 Is the register up to date - all substancesincluded ?

Apakah daftarnya masih baru -mencakup semua bahan ?

57 Are product/substances properly labelled and in

suitable containers ?
Apakah produk/bahan diberi label yang tepat dan dimuat dalam wadah yang sesuai ?

58 Are MSDS sheets readily available for all

substances ?
Apakah lembaran MSDS tersedia bagi semua bahan ?

59 Are procedures written for safe handling, storage

and transportation of hzardous substances ?
(eg:flammable. Explosives products, radiation sources, etc.)
Apakah ada prosedur tertulis untuk penanganan, penyimpanan dan pengangkutan bahan
berbahaya secara aman ?
(mis.:bahan peledak, sumber radiasi, dsb)

60 Have fire/rescue team members been trained in

fire procedures involving radion-active sources ?
Apakah semua anggota tim pemadam kebakaran telah dilatih dalam menagani
kebakaran termasuksumber radio-aktif ?
61 Is sufficient and appropriate signage in place ?
Apakah dipasang tanda-tanda bahaya yang tepat ?

62 Are adequate procedures in place for disposal of

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Inspection Checklist
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Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
hazardous substances ?
(eg:asbestos, radio-active sources, explosives product, waste oil, old tyres, etc.)
Apakah ada prosedur untuk pembuangnan bahan-bahan berbahaya ?
(mis.:asbestos, sumber radio-aktif, bahan peledak, limbah minyak, ban-ban bekas, dsb.)

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Electrical Equipment - Plug In (2.21)
63 Are all portable (plug-in) electrical devices
identified and registered ?
Apakah semua alat listrik portabel (plug-in) diidentifikasi dan terdaftar ?

64 Are portable (pulg-in) electrical devices free from

damage or defects ?
Apakah alat listrik portabel (plug-in) tidak rusak atau macet ?

65 Are electrical leads and plugs free from damage -

cuts, burns, etc. ?
Apakah kabel and plug listrik tidak rusak - tersayat, terbakar, dsb ?

66 Are regular checks arried out by authorised

person(s), in accordance with the equipment usage
- as per schedule ?
Apakah petugas resmi memeriksanya secara teratur sesuai dengan penggunaan alat ?

67 Are up-to-date inspection tags attached ?

Apakah diberi label inspeksi baru ?

68 Are faulty items removed from service and

correctly tagged ?
Apakah alat0alat rusak dikeluarkan dari tempat service dan diberi label yang tepat ?

( General Inspection/2.00 - Mechanical, Electrical & Personal Safeguarding ) Ergonomics (2.31)

69 Has a survey (ergonomic study) been conducted
for the area ?
Apakah telah dilakukan survey/study ergonomik ditempat kerja ?

70 Are ergonomic considerations included when

purchasing and/or installing new equipment ?
Apakah ergonomik diperhitungkan saat membeli dan/atau memasang peralatan baru ?

71 Are body posture problems evident, eg: seating,

back rests, foot support etc. ?
Apakah ada masalah dengan postur tubuh, mis.:kursi, sandaran punggung, injakan, dsb. ?

72 Are accessiblity problems evident, eg:location of

valves, switches, controls, steps/ladders etc.?
 Apakah ada masalah aksesibilitas, mis.: lokasi katub, sakelar, alat kontrol, tangga, dsb.?

73 Has condideration been given to access by

disabled person(s) ?
Apakah telah diperhitungkan jalan masuk bagi orang cacat ?

74 Are appropriate actions carried out when

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non-conformances are identified ?
Apakah dilakkukan tindakan yang tepat saat ditemukannya pelanggaran ?

( General Inspection/3.00 - Fire Protection & Prevention ) Fire Extinguishing Equipment (3.01)
75 Is appropriate type/capacity fire fighting
equipment identified and installed ?
Apakah dikenal dan dipasang alat pemadam jenis/kapasitas yang tepat ?

76 Is equipment placed in easly accessible

location(s) ?
Apakah alat pemadam ditempatkan pada tempat yang mudah dijangkau ?

77 Is access to all equipment unrestricted ?

Apakah jalan menuju ke semua alat pemadam bebas hambatan ?

78 Has a fire risk survey been conducted to ensure

correct type and location ?
Apakah telah dilakukan suatu survey risiko kebakaran guna memastikan jenis dan lokasi
yang tepat ?

( General Inspection/3.00 - Fire Protection & Prevention ) Fire Drill & Instruction (3.07)
79 Are fire/rescue teams designated ?
Apakah ditunjuk tim pemadam/penolong kebakaran ?

80 Are fire/rescue team members appointed in writing ?

Apakaha penunjukan anggota tim pemadam/penolong kebakaran dilakukan secara tertulis ?

81 Are all shifts covered by fire/rescue response ?

Apakah semua shift dilengkapi enan tim pemadam/penolong kebakaran ?

82 Are emergency evacuations plans placed

thoughout work areas ?
Apakah rencana evakuasi darurat diterapkan di seluruh daerah kerja ?

83 Are fire wardens identified in each area ?

Apakah karyawan masing-masing daerah kerja mengenal fire wardennya ?

84 Are fire drills (evacuation and response)

conducted, at least 12 monthly ?
Apakah pelatihan kebakaran (evakuasi dan respon) dilakukan minimum setahun ?

( General Inspection/3.00 - Fire Protection & Prevention ) emergency Preparation (3.09)

85 Is there a written Emergency Plan for the area ?
 Apakah ada Rencana darurat untuk daerah kerja ?

86 Does the emergency plan cover all likely

emergencies ?
(both natural and man-caused sources)
Apakah rencanan darurat tersebut mancakup semua keadaan darurat yang mungkin timbul ?
(baik yang terjadi secara alami maupun karena ulah manusia)

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Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
87 Is there a Co-ordinator appointed totake control
in the event of an emergency ?
Apakah ada koordinator yang bertugas mengontrol dalam keadaan darurat ?

88 Are emergency communications clearly

established and understood ?
Apakah komunikasi darurat dilakukan dengan jelas dan dimengerti ?

89 Are there regular emergency drills conducted by

EMT or CMT Leader ?
Apakah pelatihan keadaan darurat dilakukan secara teratur oleh EMT atau CMT Leader ?

( General Inspection/4.00 - Incident/Accident Recording & Investigation ) Injury/Disease Statistics (4.13)

90 Are incident/accident statistics kept ?
Apakah disimpan statistik insiden/kecelakaan ?

91 Are incident/accident statistics displayed on

noticeboards ?
Apakah statistik insiden/kecelakaan ditempel di papan pengumuman ?

( General Inspection/5.00 - Health & Safety Organisation ) First Aiders & FAcilities (5.15)
92 Are appropriate first-aid facilities available in the
workplace ?
Apakah sarana P3K tersedia ditempat kerja ?

93 Are contents of first-aid kits checked and

replenished regularly ?
Apakah isi kotak P3K diperiksa dan ditambah secara teratur ?

94 Are all first-aid boxes under the control of a

qualified first-aider ?
Apakah semua kotak P3K berada di bawah pengawasan seorang petugas P3K yang
berpengalaman ?

95 Are first-aid boxes / facilities clearly identifed by

means of signage ?
Apakah kotak/sarana P3K diidentifikasi dengan jelas dengan memberi tanda ?

96 Are there sufficient person(s) with first-aid

qualification in the workgroup ?
Apakah dalam kelompok kerja cukup tersedia orang yang memilki kwalifikasi P3K ?
97 Are safety - eye wash and showers placed in areas
where chemicals, fuel etc,. Are handled ?
(eg: at refuelling areas, battery and chemical stores, etc.)
Apakah tersedia tempat cuci mata dan bersiram di daerah tempat penggunaan bahan
kimia dan bahan bakar sebagai sarana keselamatan kerja ?
(mis.: di tempat pengisian bahan bakar, gudang akki dan bahan kimia, dsb.)

98 Are safety - eye wash and showers regularly

inspected and maintained ?

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Compliance
Item / Questions Yes No Fixed Notes Photo/Notes
Apakah sarana keselamatan kerja tersebut diperiksa dan dirawat secara teratur ?

( General Inspection/1.00 - Premises & Housekeeping ) Aisles, Storage, In-Pit Roads & Sections Demarcated (1.21)
99 Have aisles and walkways been appropriately
demarcated ?
Apakah lorong dan jalan untuk pejalan kaki telah diberi tanda yang tepat ?
(tidak diperlukan di dalam kantor)

100 Have storage areas been appropriately

demarcated ?
Apakah udang dan tempat penyimpanan lainnya telah diberi tanda yang tepat ?

101 Have electrical switchboards been demarcated as

keep clear zones ?
Apakah papan-papan switch listrik telah diberi tanda sebagai daerah terlarang ?

102 Have vehicle roadways been appropriately

delineated ?
(eg: guideposts, signposting and traffic control devices)
Apakah rambu-rambu lalu-lintas dipasang di jalan-jalan kendaraan (mis.: tiang penunjuk,
tanda-tanda arah dan alat kontrol lalu-lintas) ?

103 Are guideposts and sign maintained and cleaned

regularly ?
Apakah tiang penunjuk dan tanda-tanda arah tersebut dirawat dan dibersihkan secara
teratur ?

( General Inspection/1.00 - Premises & Housekeeping ) Workshop, Yards, Storage & Mining Areas (1.23)
104 Are yards and back areas free from rubbish or
redundant material ?
Apakah halaman dan perkarangan belakang bersih ?

105 Are yards and back areas neat and tidy ?

Apakah halaman dan perkarangan belakang bersih dan tertata rapi ?

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