WATERPROOFING WATER TANK & GAS TANK

GUNUNG SUGIH CILEGON

LAPORAN MINGGUAN HSE

Report Number :
Date :
Periode :
MAINPOWERS & MAIN HOURS
MAINPOWER STRENGTH MANHOURS
NO COMPANY REMARKS
OFFICE SITE TOTAL PREVIOUS TO DATE TOTAL
1 PT. NITEKSINDO MULTITECH PERKASA
TOTAL

SSHE ACTIVITIES
DRESCRIPTION LAST WEEK THIS WEEK TOTAL DRESCRIPTION PREVIOUS THIS WEEK TOTAL
SAFETY TALK / TOOLBOX SAFETY ALERT & SIGN BOARD
HSE INDUCTION EQUIPMENT/TOOL INSPECTION
SHE TRAINING SITE INSPECTION
SHE MEETING HAZARD REPORT
DRILL JOB SAFETY ANALISYS
SOCIALIZATION/FREE MEDICATION SAFETY AWARD
WALK THROUGH WARNING LETTER
HSE AUDIT

ACCIDENT / INCIDENT
DRESCRIPTION PREVIOUS THIS WEEK TOTAL DRESCRIPTION PREVIOUS THIS WEEK TOTAL
FATALITY NEAR MISSES
LOST TIME INCIDENT (LTI) SECURITY CASES
DAY LOST PROPERTY DAMAGE
NO LOST TIME INJURY VILLAGER COMPLAINT
MEDICAL TREATMENT CASES MEDIA ATTENTION
FIRST AID CASES (FAC) SEVERITY RATE
ENVIROMENTAL DAMAGE FREQUENCY RATE

SSHE PERSONNEL
NO DRESCRIPTION SITE & OFFICE TOTAL REMARKS
1 SHE LEAD
2 PTW OFFICER / HSE ADMIN
3 SAFETY OFFICER
4 FIRST AIDER
5 SITE SAFETY
TOTAL

SSHE ISSUE DESCRIPTION

NO ITEM LOCATION
1
2
3
4

AREA OF CONCERN
NO DESCRIPTION LOCATION

3
PREPARED BY AKNOWLEGED BY

HSE LEAD PROJECT MANAGER