Findings HSE 2019 - 2

TETRA PAK BINH DUONG JSC
SUMMARY OF UNSAFE ACTS/CON

Total 157 165
Statistics
Open 0 0
Overdue 8 0
Closed 145 0
No Finding date Week Where Category (UA/UC)
1 1/23/2019 4 Laminator UC
2 23-Jan-19 4 Laminator UA
3 23-Jan-19 4 All UC
5 23-Jan-19 4 Laminator UC
10 23-Jan-19 4 Printing&Prepress UC
14 23-Jan-19 4 Printing&Prepress
18 20-Feb-19 8 Printing&Prepress UC
20 20-Feb-19 8 Laminator UA
23 20-Feb-19 8 Finishing UC
25 20-Feb-19 8 Finishing UA
26 20-Feb-19 8 Printer UC
30 27-Feb-19 9 Laminator UC
34 6-Mar-19 10 Laminator UC
35 6-Mar-19 10 Laminator UA
36 6-Mar-19 10 Laminator UA
37 6-Mar-19 10 Finishing UA
38 6-Mar-19 10 Finishing UC
40 13-Mar-19 11 Printing&Prepress UC
55 2-Apr-19 14 Laminator UC
56 2-Apr-19 14 Finishing UC
59 2-Apr-19 14 Printing&Prepress UC
67 9-Apr-19 15 Printing&Prepress UA
70 9-Apr-19 15 Raw material warehouse UC
71 7-May-19 19 Printing&Prepress UC
72 7-May-19 19 Laminator UC
73 7-May-19 19 Finishing UC
76 22-May-19 21 Printing&Prepress UC
79 5-Jun-19 23 Printing&Prepress UC
80 5-Jun-19 23 Printing&Prepress UC
81 5-Jun-19 23 Laminator UC
82 26-Jun 26 Laminator UC
83 26-Jun 26 Waste Collected area UC
84 26-Jun 26 Finished good warehouse UC
85 26-Jun 26 Finished good warehouse UC

86 24-Jul 30 Ink Mixing room UC
87 24-Jul 30 Ink Pan Cleaning room UC
88 24-Jul 30 Laminator UC
89 24-Jul 30 Finishing UC
90 24-Jul 30 Finish Good Warehouse UC
91 31-Jul 31 Pre Press room UC

92 7-Aug 32 External UC
93 7-Aug 32 WWTP UC
94 14-Aug 33 Recycling building UC

97 14-Aug 33 Lubricant storage UC

98 14-Aug 33 CNG UC
99 21-Aug 34 Ink Pan Cleaning room UC
100 21-Aug 34 Ink Pan Cleaning room UC
101 21-Aug 34 Laminator UC

102 4-Sep 36 BM Warehouse UC
103 4-Sep 36 Finish Good Warehouse UC

106 18-Sep 38 PE unloading room UC
107 18-Sep 38 Base material WH UC
108 18-Sep 38 Base material WH UC
109 18-Sep 38 FG Warehouse UC
110 25-Sep 39 PE Silo UC
111 25-Sep 39 Generator Room UC

112 25-Sep 39 Sprinkler Room UC
113 25-Sep 39 Chemical Room UC
114 25-Sep 39 Next to Chemical Room UC
115 9-Oct 41 Loading Dock UC
117 9-Oct 41 FG Warehouse UC

123 9-Oct 41 BM Warehouse UC

124 9-Oct 41 BM Warehouse UC
16-Oct 42 Recycling building UC

16-Oct 42 Loading Dock UC
16-Oct 42 Warehouse Office UC

23-Oct 43 Ink Mixing room UC
23-Oct 43 Ink Cleaning room UC
23-Oct 43 Pre Press room UC
23-Oct 43 Pre Press room UC
23-Oct 43 Printing&Prepress UC
23-Oct 43 Printing&Prepress UC
23-Oct 43 Laminator UC
23-Oct 43 Laminator UC
23-Oct 43 Electrical room UC
30-Oct 44 Chargin Room UC
30-Oct 43 Chargin Room UC

30-Oct 43 Finished Goods Warehouse UC

30-Oct 43 Loading Bay UC
30-Oct 43 Loading Bay UC
30-Oct 43 Recycle Building UC

6-Nov 44 Recycle Building UC

H DUONG JSC
UNSAFE ACTS/CONDITIONS
Description Pictures/ evidence Correction picture
Evacuation maps were not available at

the wall by process control room
Lilama18 used brooms to clean dirt

Not enouigh waste bin
FFE boxes had hard lock/handle to open
Door of process control room on the left

obstructs the FFE box
All temporary FFE and their labels were
not removed
Hazardous label on waste bin is not

proper (color)
Material by laminator was messy

Unnecessary barricade
Monthly inspection date expired
FFE were placed on staircase, by printing

unit
Electric cable hanging on the wall and no
longer being used
Waste paper direct on the floor instead

on waste bin
Air compressed near of wall and no

longer being used
Tape used to hold the cores has not been
cut, people Can trip
Cabinet identification and warning

information it is damaged
Ground cable should have piping until

close cable tray
Wall next to Operator side of Printer,
cracks on the wall
Cable tray in front of tools store, unused

object in cable tray
Unused extinguisher after Flame Treater

commissioning
Wrong position of chill roller's cover.
Water bottle in shopfloor.
Obstacles on the walkway.

Empty can of hydraulic oil should be
removed.
Electrical socket is not in use should be

removed from the source.
Bended edge of wooden plates can cause

tripping.
The put out incorrectly
Iron flat put on the control panel, it can

be fall down
Way to take extinguisher get obstruction

Way to take extinguisher get obstruction
The label of waste bin is not clear
The cable put on the way of printer area

The label of hazardous waste bin is
missing safety label of No Fire and type of
waste
Equipment and paper on the walk way at

Unwinder.
Working tables should be removed from

the line.
Unused tool on carriage 1 can cause risk
of hitting.
Tools and equipment were out of limited

range of barricade.
Some missing ceiling's cover plates.

The gap between fences is too wide,
causes risk of falling.
The printing area need to have a sign to

inform people do not ste inside the
installation area
Have obstaccle in front of exstiguisher

Lock of extinguisher is damaged
Core put vertically on the floor
Lilama welding inside the site

Component of machine put on the way
Electric wire need to be hang on
Contractor place equiment messy, no 5s

Lilama use the ladder improperly
Roll place inproperly
Core stand vertically

Glue melt flash around flat of winder
the paper place on the floor
Teflon belt place improperly

The PE trolley have no sign board and put
infront of extighuisher station.
Surface damaged due to hot work spark
No clear escape route

Sticking up pipe
Obstructed exit route
Table is close to fire extinguisher station

Electrical eqipment need to be inspected
No clear escape route
Hot surface without warning

Gate to secure from falling
Stair was not available for access
FF box was obstructed

Power cabke was placed on floor
Safety harness with absorber, this will not

protect person from falling
Cable tray was hung up to the ceiling

hazardous trash bin was placed at the
wrong location
temporary Exit sign was still being hung
Trash was full

The HW bins did not have the standard label
Trash carts were over the place
No barrier for cutting by contractor

Handle of FF box broken
Unsecured core
Obstruct FE cabinet
Obstruct access way from ground to basement
and vice versa
Chemical on the floor without secondary

containment
Hazardous waste is overload the bin
Chemical on the floor without secondary

containment
Exit sign does not function
Reels are on stand up position
FE box was blocked by rolls
Charging battery at wrong location

Spill kit is on floor
House keeping
Core trolley obstruct FFE station

Oil dripped from clamp truck
Spill kit is on floor

Paints on ground
Light was covered by section door
Unknown bottle of chemical

=> dispose the bottle to hazadous waste area.
Improper ladder
=> the Ladder was put at wrong position, correct
the position with designed hook
Unknown oil container

Signages fell down
Opening cabinet
Waste bin is not in correct location
Access to eye wash is obstructed

Damaged floor
Pit is not covered
Rubber stopper is not well bolted, gate #2, 5

Water on floor
lights were not functioning
Poor housekeeping in electrical room
Floor has holes
5S not clean, many un-used stuff lying around
1 light was broken

Some empty bottles lying around
Oil dropped to floor
No Air exhauster
2 pallets in wrong position (right at the gate)
Pest control
Mixing Plastic and Paper in Thrash Bin
Crack on the wall
No instruction how to open the box

Wall has high humidity
Dust on the corner of Charging Area
Wooden Pallet stack not vertically
Thrash bin was not labeled
Emergency Exit door & Eye washer was blocked
Unnecessary walk way; need to remove

Scratch on Yellow painted walkway
Cover underneath of shredder was removed
No designated area to store metal wire

House keeping
PE trims still are baled into bad shape
shredded paper can easily go into draining

system
Rubber stopper is not well bolted
Unused pushing cart

Temperature and humidity board is not
functioning
Poor housekeeping
Assets at wrong lcoation
Chemical container without label
No marking for trash bins
Messy material on printers' upstair

PE trolley in wrong location
Poor housekeeping
Condensate water spillage
Distilled Water without proper label
MHE not correct position

Easy to break hole cover
Tidiness on floor
Detector not working
Water leaking from pipe
Scratch on floor
Long cable, drive forklift through
5S on Loading Bay
Truck lorry inside
Floor damage unreported
Mobile ramp not locked, bend

forklift hole
PE lump 5S
Manual call point is obstructed
The flammable material is near electrical cabinet
Using improper cleaning tools
Incorrect waste bin label

PIC Due date Statisrtics Remark
Khuong 24-Jan Closed

Hoa/Binh Closed Thom to discuss with Zouxi on the solutution

Nam 25-Jan Closed

Sodexo Closed

Hoa/Binh Closed
Diep Closed
Diep Closed
Diep Closed
Pull off the termporary warning sign

Hung 25 Apr. 19 Closed - Need order more warning sign for some
cabinet on the upstair of printer 12
Hoa/Binh 25 Apr. 19 Closed

Hoa/Binh 25 Apr. 19 Closed
Hoa 25 Apr. 19 Closed
Cat 20-Feb-19 Closed

Dam 20-Feb-19 Closed

Diep Closed
Diep Closed
Diep Closed
Diep Closed
Cat 7-Mar-19 Closed
Cat 18-Apr-19 Closed
Diep Closed
All processes 18-Apr-19 Closed
Cat 7-Mar-19 Closed
Cat 7-Mar-19 Closed

Cat 7-Mar-19 Closed
Dam 22-Apr-19 Closed

Diep 18-Apr-19 Closed

Cat 18-Apr-19 Closed Phuong to update pic of correction

Dam 14-Mar-19 Closed

Điep Closed
Điep Closed
Điep Closed
Điep Closed
Cat Closed
Cat Closed
Zou Xi
Hoa 29-Apr-19 Closed
Binh
Dam 2-Apr-19 Closed

Cat Closed
Dam 2-Apr-19 Closed
Diep Closed
Dinh 5-May-19 Closed
Diep
5-May-19 Closed
LLM18
Cat 20-May-19 Closed To study for hood in this area for hot
trolley
Zou Xi
Hoa 20-May-19 Closed
Binh
Dam 23 Apri 2019 Closed
Diep, LLM18 Closed

Diep, LLM18 Closed
LLM18 Closed
SRF 15-Apr Closed

Diep Closed
SRF Closed
Diep 10-May Closed

Cat 10-May Closed
Dam 10-May Closed
Dam/LLM18 10-May Closed

Zou Xi
Hoa 10-May Closed
Binh
Make a box/barricade for the cores to prevent

Diep 23-May Closed falling
Cat 23-May Closed

Cat 23-May Closed
Diep 5-Jun-19 Closed
Sodexo 5-Jun-19 Closed
Cat 5-Jun-19 Closed

Nghiem 28-Jun-19 Closed
Thai/Dong An 28-Jun-19 Closed

Truong 31-Jul Closed 6-Sep-19
Truong 26-Jul Closed
Vo Quang Phuc 26-Jul Closed

Ngo Hoang Duy 26-Jul Closed
Phuong 31-Jul Closed
Truong 7-Aug Closed

Unicon 8-Aug Closed
Senid 14-Aug Closed
Thai 16-Aug Closed 17-Sep-19

Thai 16-Aug Closed 17-Sep-19
Thai 16-Aug Closed
Phuoc 21-Aug Closed 4-Sep-19

Hung 31-Aug Closed 7-Oct-19
Truong 23-Aug Closed
Truong 23-Aug Closed 6-Sep-19
Vo Quang Phuc 23-Aug Closed S

Duy 9-Sep Closed 20-Sep-19
Nghiem 30-Sep Closed 31-Oct-19

Nghiem Closed Update evidence
Nghiem Closed Update evidence
Nghiem Closed
Nghiem Closed 31-Oct-19
Nghiem 2-Oct Closed
Nghiem 2-Oct Closed

Nghiem 2-Oct Closed Add oil refill into SOP
Truong 4-Oct Closed
Nghiem 10-Oct Closed Cleaned
Phuong 24-Oct Overdue Nghiem to provide Phuong 3 trash bin
Nghiem 18-Oct Overdue Request UNICONS to fix the cracks
Inside: Done
Nghiem 18-Oct Closed Outside: Nov 30th
Nghiem 18-Oct Closed Remove
Phuong 18-Oct Closed Update picture/evidence
Phuong 18-Oct Closed Standard is 30 pallets stacking
Phuong 18-Oct Closed Label as normal paper due to daily operation need
Phuong 18-Oct Closed Clear the walk way of emergency door
To check with vendor on taking over with Hoang

Nghiem 18-Oct Overdue Viet
To check with vendor on taking over with Hoang
Nghiem 18-Oct Overdue Viet
Installed, but operator take out again. When

Hung 31-Oct Overdue
operation machine, paper stuck at that point.
Desined area for wire stock

Phuong 31-Oct Closed Also need to keep material beside the machine for
continuous running
Phuong 31-Oct Closed
Hung 31-Oct Closed
Monitor last 2 week no problem
Nghiem 30-Nov Pending
Nghiem 31-Oct Closed
Nghiem 25-Oct Closed

Truong 24-Oct Closed
Truong 31-Oct Pending

[Truong 17 - Nov - 19]Factory have already plan to
painting for layout in shop floor 23-Nov to 24 nov -
2019
Hung 31-Oct Closed

Phuc 24-Oct Closed
Phuc 24-Oct Closed
Nghiem 15-Nov Closed
Phuong 8-Nov Closed
Phuong 8-Nov Overdue

Phuong 8-Nov Closed
Nghiem 8-Nov Closed Cam Thanh needs to renew, Nov 13th
Nghiem 8-Nov Overdue
Nghiem 8-Nov Closed

Phuong 8-Nov Closed
Phuong 8-Nov Closed
Phuong 8-Nov Closed
Phuong 8-Nov Closed Inccidence reported
Phuong 8-Nov Closed

Phuong 8-Nov Closed
Phuong 6-Nov Closed Need to pain the area
Phuong 8-Nov Overdue
Phuong 8-Nov Closed Through out the defect cleanning tools
Nghiem 8-Nov Closed

No. Date Type Process/Dept From Description
During 2nd shift on 3rd November 2019, operator (3.5

years experience) at Doc 63 was injured while he was
transferring a midd
le reel from
1 6/11/2019 GAR Finishing Jurong doctor tray to reel trolley. He was trying to move a
reel so that adjacent reels do not interrupt the
subsequent horizontal m ove ment. He lost
control when he pulled the reel with excessive
motion. As a result, the reel fell and hit his right lower
shin.
The FLT driving was operation a forklift truck to

transport the plastic pallet in the maintenance spare
part warehouse, he didn‘t notice that the one stack
upper pallet’s corner was overlapping with the beside
2 23/10/2019 GAR Warehouse Kunshan under layer pallet, when he lifted up the under layer
pallet, and move back, the upper layer pallet was fall
down and hit the forklift, the FLT mirror was hit and
fell out then hit the EE's face.
Action Evidence PIC Deadline
LTA on reel rolling to person 11/11/2019
Communicate with team on the
GAR Done 11/11/2019
Dedvelop OPL and
communicate with team about Duy
this OPL 11/11/2019
Add this activity to SOP and Risk
Assessment Done 11/11/2019
Implement CML measures 11/11/2019
keep leave the enough
Phuong
separation space
Recheck other areas to see if
Phuong
similar risk exist
Standardized the operation

procedure and retained all Phuong
other FLT drivers in this.
Process/De Summary of Sub section activity &
SOP No. SOP ID SOP PIC
partment work/activity exposure
Prepress/Prin
ting
056 11W056 Hoang Anh Foil Unwinder Foil Load/Unloading
072 11W072 Hoang Anh Ozone system Cleaning Ozone Pipe

Laminator
Measure Nip with

286 11W286 Hoai Nam Nip Roller close
Tekscan
AM activities or
cleaning machine Nip Roller close.
Roller Rotation.
during SS,BD
Sterilizing knives Sterilize by machine
Milling meat Use machine of milling meat
Confined space Work in pipes, closed rooms,

activities deep holes, elevator box
Sodexo
Climb up to the ceiling, the roof

to inspect (using outdoor
Maintenance staircase). Working at height
building activities over 10 metters)
UPS Maintenance Maintain UPS System
MSB Maintenance Maintain MSB (Main Switch

Board) System
Splice table Lock the paper
Change cutting blade of splice
Splice table table
Manual control at Rewind

Rewind
Finishing
Rewind Reel failing down

Doctor Unload reel from manual buffer
APM activity Not apply LOTO
Hazard/
Additional
Environment PIC Deadline Status
Aspect measure
- Paint green mark

on the slings that
Falling and moving
helps the operator Q.Phuc 29/11/2019 On-going
heavy object
easily identify the
status of
- Create Ozone
Ozone leakage checklist. Q.Phuc 29/07/2019 Done
- Update SOP.
Heavy machine - Apply LOTO for this
moving back & Q.Phuc 29/11/2019 On-going
activites.
forth.
Heavy machine
moving back & - Apply LOTO for Q.Phuc 29/11/2019 On-going
these activites.
forth.
Falling Post warning sign Thu 2/10/2019 Closed
Rolling mills Post warning sign Thu 2/10/2019 Closed
Mapping confined
Lack of air space area, post Nghiem 20/10/2019 Closed
warning sign for
identified areas
When
Work at height JSA Nhut
working
When
Electricity JSA Nhut Closed
working
When
Electricity JSA Nhut
working
Moving part Supplier provied safetSupplier Designed Closed
SOP made + PPE sign Closed
Sharp object OP team
OPL + Safety curtain
Closed
Moving part barrie Process tea Designed
Update the program
+ Closed
Heavy material falli interlock IPB team Sep-19
Heavy material falli OPL Duy 16/11
Body impact LOTO training HSE On-going
Total 1 1
Open 0 0
Statistics
Overdue 0 0
Closed 0 0
No Finding date Week Where Category (UA/UC) Description
1 20/08/2019 35 Laminator IPA volume at Laminator

35
2 22/08/2019 PE Unloading PE tilter cleaning underneat
3 22/08/2019 35 Conduct Investigation Clamp truck damage
4 20/08/2019 35 Recycling PE is in bad shape
35 Battery on wooden pallet

Charging room next to
5 28/08/2019 Waste Collected Area
35 label for specific waste in

6 28/08/2019 All Processes trolley
Chemical use in Printer 12
35 need to have warnigg sign,
7 28/08/2019 Printer 12 eyewash, MSDS
Need to have PPE lockers to

35
store PPE when not in use
8 28/08/2019 All Processes
35
Drive MHE on to green

9 28/08/2019 All Processes walkway
39 stair rail is low for the step

24/09/2019 Recycling UC ladder at shredder machine
Install fence to cover the
43 back of baler (exposure to
21/10/2019 Recycling UC wire)
Emergency exit and lights
43 were found not sufficient in
21/10/2020 Production UC case of power cut
43
22/10/2020 Base Material WH UC Bad smell in charging room

Bypass the interlock at
23/10/2019 43 conveyor
Need to instal fences for
conveyor, wiring machine,
23/10/2019 43 Recycling UC lock for safety fence
Need to incorporate Fire

fighting box, electrical panel
no obstruction in the daily
23/10/2019 43 Recycling UC checklist
Fire hydrant no inspection
23/10/2019 43 Recycling UC since Aug 2019 until now
22/10/2019 43 Laminator UC Overflowed PE trolleys
Ink spill on floor, many ink

bucket on shop floor,
sleeves and matrial stored
22/10/2019 43 Printer 12 UC messily
Maintenace spare part Liquid substance stored with

18/10/2019 42 storage UC carton box and no MSDS
Pictures/ evidence Correction picture PIC Due date Status Remark
Phuc 28/08/2019
Developed
Nghiem 30/08/2019 procedure
Phuong 30/08/2019 4-Oct
Hung 30/08/2019 Monitoring
To remove
Hung wooden pallet
and lock the
6/8/2019 room
All production
safety pillar
members 6/8/2019 18-Sep-19
Truong/Kim 16/8/2019
All production
safety pillar
members 6/8/2019
post warning
signs on MHE
on 5km/hr and
All production DO NOT DRIVE
safety pillar ON GREEN
members 6/8/2019 WALKWAY
Phuoc 10/10/2019
Hung 6/11/2019
Nghiem 30/11/2019
To work with
Binh on the
ventilation in
Hung 25/10/2019 this room
Phuong 6/11/2019
Hung 6/11/2019
Phuong 6/11/2019
Nghiem 6/11/2019
Phuc 6/11/2019
Truong
Hung
Incident findings - Follow up
No Incident Type Findings Findings Pictures Recommendations Where PIC Date Status Due date
Provide refresh training

PTW was not understand correctly Apply different PTW for this room HSE/LLM18 Close 31-3-2019
1 No. 13 Near Miss Dropped plate Near Miss Electrical room, 1st floor Feb 1 2019
in electrical room Review all installation of plates on production
Uninspected plates on raise floor raise floor UNC Close 8/3/2019
Missing support stands for areas which not strong Adding the support stands for areas
enough which missing or not strong enough
UNC Close 8/3/2019
Develop inspection checklist for the

No inspection checklist for the room acceptance room acceptance TTCL Close 1/3/2019
JSA does not cover risk of overflow Revise JSA to cover risk of overflow An Close 8/3/2019
Separate condensate water from ink

waste pipe
Set the control barriers to ensure Hoa/Binh Overdue closed 10/4/2019
Missing the second barrier for level monitoring future operation not reoccur when
the pump failed to perform
2 No. 1 Chemical Spillage on Feb 15 Chemical Spill Waste ink tank Feb 15 2019
2019
Re-arrange manpower to ensure
Shift/Process Manager or PM Leader
No on-scene commander during incident to act as On Scene Commander to be Hambir Close 8/3/2019
available during working hours
No ERP training for Shift/Process Manager or PM Provide ERP training for

Leader Shift/Process Manager or PM Leader HSE Close 8/3/2019
Unaware of the hazard - pinch point Inform all staff HSE Close 26/3/2019
3 No. 1 First Aid case - Finger First Aid Door at staircase by slitter Mar 12 2019
trapped in door and frame area
Door handle is too close to door edge Review the design Zou Xi/Binh Overdue closed 31/3/2019
Door handle is too close to door edge Inform all staff HSE Overdue closed 26/3/2019
3 No. 2 First Aid case - Finger First Aid Laminator process door Mar 12 2019
trapped in door and frame
No action since last findings Review the design Zou Xi/Binh Overdue closed 31/3/2019
No procedure/SOP to operate the outlet valve to

waste ink pit
develop the procedure/SOP Printing Overdue closed 29/3/2019
4 No. 2 Ink spilled on Printer area Chemical Spill Printer ES36 area Mar 14 2019
Mar 14 2019
No communication for operators Put warning sign at the valve Van Close 26/3/2019
No. 3 Waste Ink dumped into No procedure and training for related staff on Communicate and instruct the right
5
drain
Chemical Spill
HW handling location of ink waste pit
Sum drain Sodexo Mar 14 2019 Close 26/3/2019
6 Re-tighten the connection Jonas (Flint) Close 22/3/2019
No. 4 Flooded contaiminated Hose connection was loose due to wrong method
water in ink mixing room Mar 20 Chemical Spill Ink Mixing room Mar 20 2019
2019 of installing
Add this point into CIL checklist for
AM team Jonas (Flint) Close 22/3/2019
Separate the drainage system for

condensate water pipe of AHU. Binh Close 29/4/2019
The drain pump didn’t working while AHU still
works. The condensate water pipe drain in surge
tank Separate the signal of ink waste
7
No. 5 Chemical Spillage on Mar
Chemical Spill water pump Printer area Binh Mar 23 2019 Close 29/3/2019
23 2019
Toolbox meeting regarding “Drain

Not communicate with IBP for changing the
design out the ink waste water surge tank Khau Tu Van Close 26/3/2019
before leaving factory”
Kim/Hoa Close 29/4/2019

Provide LOTO & Isolation training to
No. 19 No LOTO when cleaning operator
8 on machine Near Miss Lack of awareness on LOTO implementation Finishing Apr 3 2019
Close 29/4/2019
Hoa
Incorporate LOTO into AM
Review on quantity of LOTO sets Close 29/4/2019
No. 20 Reel dropped while being Segregate defected reels Dam Close 19/4/2019
9 lifting by Dalmec stacker at Near Miss Unaware of defected reel Finishing Apr 11 2019
finishing area
dedicated area for product during
commissioning Dam Close 29/4/2019
Conduct risk assessment for unloading Thai, HSE May 30 2019 Close
10 No. 4 Lorry truck hit the wall at Property Damage The Driver failed to have a comprehensive view at the Docking #5 at loading bay
loading bay rear of container when he drove back to dock # 5
Communicate the risks to all drivers in

tool box Thai, logistic team May 3 2019 Close
20-May
21-May
Enable all smoke detector and Check 22-May
Smoke detectors did not function when was being every smoke detector with detail action Finish good warehouse TVC, SRF May 17 2019
tested with smoke trigger tool 23-May
plan; and inform TPBD
24-May
25-May
20-May
21-May
22-May
Enable all MCP and Check every MCP Finish Good warehouse,
Manual Call Points did not work with detail action plan; and inform TPBD Laminating area TVC, SRF May 17 2019 23-May
24-May
25-May
Enable the sound and beacon. Laminating, 1st floor production

Fire alarms did not work Check the sound to reduce the sound for and office TVC May 17 2019 20-May
non-production area.
Check the regulation on sound choice
Check the panel and train security guard 20-May
on the notification (TVC, SRF)
Set up procedure for next step action
(Sodexo)
TVC send TPBD HSE document on the
sensitivity of smoke detetctor activation
All Manual Call Point, Fire Alarm, smoke detector's

notification sound are not available the Control room in Guard house TVC, SRF, Sodexo May 17 2019
Guard House
31-May
Check the panel and train security guard

Fire alarm not stop ringing after the fire drill completed on the notification (TVC, SRF) All areas TVC, SRF, Sodexo May 17 2019 20-May
Set up procedure for next step action
11 (Sodexo)
Page 141/150
11
Hydrants have been tightened by rope and not

accessible during drill, no daily inspection Check and untie all ropes for every External areas Sodexo May 17 2019 20-May
hydrants
Apply monthly checklist
Fire Pumps's batteries not inspected Add into the inspection list daily for fire Fire pump room Sodexo May 17 2019 20-May
pumps
Fire Drill on May 17 Drill
20-May
TVC, SRF to check the design in which

Some emergency lights were not available or function area does have or does not have Fire pump, Locker room, TVC, SRF May 17 2019
sprinkler room 21-May
emergency lights
24-May
Sprinkler room: All valves were locked by the chain and

the keys were not available, not accessible. Nobody SRF to handover keys to Sodexo Sprinkler room SRF, Sodexo May 17 2019 20-May
knows.
Mapping : May 20
SRF to install piping tagging/
mapping/marking with operational
There is not flow indicator or lay-out of pipes in guideline and handover document to
sprinkler room. No label or name to identify the Sodexo. Fire Pump room, Sprinkler room TVC, SRF, Sodexo May 17 2019 Instruction: May 24
sprinkler room TVC check with Ms. Tam for the room
plate
Room label: May
20
1&2) Access control doors, turnstile were not open and

released in case of fire and power off. Access control
can only manage people access not egress so can't 1&2) May 24
count exactly # of people present at factory. 3) All data 1) Sodexo check with TNT if the card Office Sodexo May 17 2019
of headcount through access control are stored in the 3) May 29
reader releases the doors when there is
IT room which is not accessible in case of fire. It shall be fire.
in control room in Guard House 2) Sodexo check UPS connection
3) Sodexo to move CPU to guard house
No daily inspection for Fire extinguishers Start daily inspection All areas Sodexo May 17 2019 20-May
Level of sound alarm all building Level of sound alarm all building TVC May 17 2019 26-May
Page 142/150
Incident findings - Follow up
Closing Evidence Remark
Technical solution agreed for alarm

setting and waiting for SUM's review on
quotation. New deadline 10 May 19
Intsall rubber stopper to prevent

trapped
Intsall rubber stopper to prevent

trapped
Included in item #2
included in item#2
Align with process Managers to give suitalbe

deadline and present the plan in a separate
meeting
- Printer:end
1setof Apr.
- Laminator: 1set
- Finishing: 4 set
Closed There is no longer commissioned reel as we

are in comercial production
Done Communicate during tool box every time
-Enable Smoke detector 100%

-Production: 21-May
-Office: 22-May
-Warehouse: 24-May
-Fire pump: 24-May
-Recycle: 25-May
-Solvent storage: 25-May
-Enable MCP: 100%
-Production: 21-May SRF still have some trouble on MCP, smoke
detector, On/ Off valve, flame detector. SRF
-Office: 22-May must check within May 25th.
-Warehouse: 24-May
-Fire pump: 24-May
-Recycle: 25-May
-Solvent storage: 25-May
Enable sound and beacon 100%
-Panel already active beacon
-ASD will send 4 signals to Fire (Alarm

with level as attach picture:
-Pre Alarm 1 ASD matrix is not done yet, all smoke
-Pre Alarm 2 detectors trigger alarm even at level 1.
-Alarm Security should check the location when
-Fault.) they receive the level 1 activation.
SRF to set the ASD level and critical defects.

Then update the actual installation of the
-Training to Security guys by Sodexo alarm system --> Sodexo will take handover
and train the security guard to response for
fire alarm
-Panel already active beacon
Page 143/150
-External, Production and Office done
-Remaining: Warehouse, Recycling finish
on May 21st
- check the batteries of the fire pump (on

the control panel) and record to the
check list
-Fire Pump and Locker room have

emergency light.
- Sprinkler valve room don't design.
- Mapping design EM light will be report

on May 21st.
- Mapping EM fail light will be report on

May 22nd
Office will be finish on May 22st.
Nam Bao sub-contractor labeled in the

spinkler room at production areas, the office
area is lacking
-All room have room name and do by
Nam Bao
1) The card reader is not released when

fire.
2) the PACS is not connect to UPS
3) Move the CPU to Guard house by May
29
Inpsction the fire extinguisher
-Design base on TCVN: 7568-3 2015

standard: Fire detection and alarm
system
'-Beacon can adjust tones level:
-Tones:1,4,5,6: public mode: >75 db
-Tones:2,3: private mode: <75 db
Activites today: Creasing tool, prepress to reduce sound level
- to selected the tones of sound with
Mr.Kim
- Mr. Kim confirmed tone 3 (<75 db) for
all area except Production hall, Raw
material, Warehouse...will be slected
later.
Page 144/150
% ISO 15% 5% 80% 50%
NC Status Observation Status Sum 20 10 3 1 16 5
7 7 4 4 Dept NC OFI
On GoingEffective Close OFI close
MASTER DATA OF FINDINGS (NC) 6 6

3 3
HR
0 0 0 0 0 0
5 5
Sodexo
4 1 0 1 3 0
4 4
2 2
Flint
3 3 2 1 0 0 2 1
HSE 0 0 0 0 0 0
2 2
1 1
Logs
1 1 2 1 0 0 2 1
PM
0 0 0 0 1 0 1 0 0 0
HR xo nt E gs on ng g ng QA CM
T g HR xo nt E gs PM M on g g ng QA CM
T g
de Fli HS Lo PM Su
M in PE
S nin de Fli HS Lo Su cti tin in
ati PE
S
nin
So
cti inti is h ati So du in is h T-
W
Pla SuM
du Pr Fin am
in T-W Pla Pr Fin am
in 0 0 0 0 0 0
pro E& ro E&
L ll p L
all ra Overall
er e
Ov Ov production 2 0 2 0 0 0
Printing
On Going Effectiveness Close NC OFI close OFI 6 3 0 0 6 1
Finishing 1 1 0 0 1 1
Laminating 2 2 0 0 2 1
QA 0 0 0 0 0 0 On going: Dept doing
E&T-WCM 0 1 0 0 0 0 Effectiveness: Dept done --> wait for evidence confirmation
PEST 0 0 0 0 0 0 Close: All done
Planing 0 0 0 0 0 0
BD ID: 01T006
Issued by: Ho Thi Tuong Vi Tetra Pak Internal
Approved by: Nguyen Vo Bich Du
Issued date: 20180626 [Page] /150
Version: 1.0
Type Clause Detail comments/ Evidence Results Nonconf Audit Root cause Recommendation Action Dept PICS Status Remark
(C, NC, orming date Late, On going,
No
OFI) report effectiveness,
No close
BD ID: 01T006
Version: 1.0
-Communicate/recommunicate & desploy information relevant to
the OH&S management system(policy, objective, plan to
As site observation & interview with representatives at All Dept, overall comments: achieve, process...) to various levels and functions of the
-There are GAP(s) in communication & deployment of information OHS & Env. management systems to functions & employees. organization
ISO 45001:2018
-There are GAP(s) in setting Objectives & Target for Environmental Protection programs. - Set up objective & target for enviromental protection
#7.4 Communication
-There are GAP(s) in managing outsourcing to keep them up and having consistently performance. programms
ISO 8.1.3 Management of Change OFI OFI-I10 E&T-WCM all On Going
- Manufacturing is at beginning stage, there are the challenges in monitoring and recording data for tracking performance both OHS Environmental management system. - Communicate Env. management system( policy, objective, plan
9.2 Internal Audit
- Change process that affect to OH&S & Env. management systems to achieve, process...) to various levels and functions of the
9.3 Management Review
- Internal Audit has not been conducted organization
- Management Review has not been conducted - Apply change process for the implementation and control of
changes that impact OH&S performance.
- Conduct internal audit & management review
ISO 45001:2018
#8.2. – Emergency preparedness and
reponse WWTP (w/ Senid & Sodexo contractor)
1. Nghiem/Nhut
#8.1.4.3: Outsourcing: The organization Based on site observation & document review, there are below findings: - Provide eyewash in this area
2. Contractor &
ensure that outsourced functions and - Emergency Response devices are not ready for using: Eyewash station is empty, not ready for use. - Lacking of management -Implement eyewash monthly checklist Please update OH&S
ISO NC ISO-019 Sodexo Sodexo employees Close
processes are controlled - organization - On the PPE notice, it is required respirator mask for operator working at WWTP. Actually, operator did not know where to take it. - There is a shortcoming when designing, no ventilation system in these room '- Provide PPE cabinet, design the PPE signate in WWTP area and En RA of this area
3. Nghiem
ensure that its outsourcing arrangements - There is no Risk assessment of this area in case no ventilation fan. Open door and use temporarily fan will generate toxic or hazardous gas emission to environment. Operator '- Update OH&S and Env. RA of this area
are consistent with other requirements still work at the outside of door in front of fan direction without any resperiator
and with achieving the intended outcomes
of the OH&S management system
ISO 14001:2015
#9.1.1. Organization monitor, measure WWTP (w/ Senid & Sodexo contractor)
1.
analyse and evaluate its environmental As per # 9.1.1 ISO 14001:2015 requirment, organization monitor, measure analyse and evaluate its environmental performance. Organization ensure that calibrated or verified -Develop SOP to sampling waste water.
Nghiem/Senid/TTC -Please share SOP to
ISO performance. Organization ensure that monitoring and measurement equipment is used and maintained as required. It's observed that the WWTP is under trial operation phase and all waste water parameters have NC ISO-020 - The WWTP is under commissioning stage '- Make the master plan for parameters testing quartely as legal Sodexo Close
L sampling waste water.
calibrated or verified monitoring and not been tested quarterly as EIA/legal requirement. requirement by 3rd party
2. Nghiem
measurement equipment is used and - The SOP to sampling waste water is not yet developed.
maintained as required.
ISO 45001:2018 - Provide eyewash in this area

HAZARDOUS WASTE STORAGE (w/ Sodexo contractor)
ISO #8.2.a – EPRP NC ISO-017 '- Lacking of management '- Implement eyewash monthly checklist Sodexo Nghiem/Nhut Close
- Emergency Response devices are not ready for using: Empty eyewash station is on the floor, not ready for use.
#8.1.1.B
- Communication with other department to transfer waste to

HAZARDOUS WASTE STORAGE (w/ Sodexo contractor) designated area
ISO 14001:2015 Nhat
ISO It is observed that not enough space for hazardous waste, part of the haz.waste stored in the chemical warehouse, where has not been set-up for haz.waste, then no waste code NC ISO-018 - Lacking of monitoring '- Notification with security department to guide employees Sodexo Effectiveness Wait for evidence
#6.1.3 Cleaning/Nghiem
labelled. This is violated legal requirement: Circular 36/2015/TT-BTNMT, Article #6 & 7.2) putting waste in designated area
'- Assign one employees to check waste after putting in storage
- Communication with other department to transfer waste to

HAZARDOUS WASTE STORAGE (w/ Sodexo contractor) designated area 1. Procedure: SHE
ISO ISO 14001:2015 Based on site observation, many bags (20-30) of plastic film stored in hazadous waste storage. It is could not verified these waste are pure hazadous waste or not. It is OFI OFI-I09 - Lacking of monitoring '- Notification with security department to guide employees Sodexo 2. Check: Nhut Effectiveness Wait for evidence
recommended that waste segratation should be strictly implemented. Decree 38/2015/NĐ-CP, Article #5 & 7) putting waste in designated area Cleaning/Nghiem
'- Assign one employees to check waste after putting in storage
CHEMICAL WAREHOUSE STORAGE

As site observation, there are some below findings:
"- Separate PPE storage from chemical warehouse
ISO 45001:2018 Emergency Response devices are not ready for using:
- Put eyewash station as assigned location & check water level
ISO #8.2.a – EPRP; 1. Empty eyewash station is on the floor, not ready for use. NC ISO-015 Lack of management Overall Production Hung On Going
regularly to ensure ready for use.
#8.1.1. -PPE (mask, gloves, etc.) are stored in chemical warehouse, where the hazardous sources: PPE are put at risk to be contaminated with dust, chemical vapor, etc… not ready,
-Ensure MSDS available for all type chemical stored in this area
not safe to protect users
- Only 2 MSDS available where total 5 type of chemical stored
ISO 14001:2015 CHEMICAL WAREHOUSE STORAGE

ISO NC ISO-016 *-Ensure chemical is stored & packed properly Overall Production Hung On Going
It is observed that there is a hazadous chemical can without cap
RECYLED WASTE STORAGE

Based site observation, there are some below findings:
Fire hose is blocked => after installtion, contractor forgot to keep this unit open Asking contractor came to put all Fire hose unit in ready status.
ISO 45001:2018 1. Emergency Response devices are not ready for using:
Exit route is obstructed=> this was validation time with lots of material need to be scrapt, - Remove the waste bale to keep route open. Putting each type
#7.3.Awareness - Fire hose is blocked.
but it was not enough space to store of waste in proper location.
ISO #8.2.a – EPRP - Exit route is obstructed. NC ISO-013 Machine safety instruction is still in English version, not in operators’ language => the Logs Thai Close
Get support from maintenance team to translate. Paste the VN
#8.1.1.B 2. Presona machine: original guidance from supplier. version on each machine unit
#8.1.4.3: Out-sourcing - Machine safety instruction is still in English version, not in operators’ language. - Operator works without assigned PPE =>Tetra Pak didn't provide full set of PPE at that time - Provide full set of PPE to operator.
3. Operator works without assigned PPE (earplug, glove, goggles, safety shoes). Their feedback is that they were not provided PPE.(DongAn supplier needs to keep up &
performance consistently with company safety regulations)
RECYLED WASTE STORAGE

ISO 14001:2015
Not official checklist Make the checklist
ISO #6.1.1 As per # 6.2.1 ISO 14001:2015 requirement, organization shall establish environmental objectives at relevant functions and levels, taking into account its significant NC ISO-014 Logs Thai Close
Record waste storage input-output properly
#6.2.1 environmental aspects, associated compliance obligations, and risk and opportunities. Based on site observation & interview with -person in charge( PIC), data of waste storage
input – out put has not yet properly recorded to support the task setting up env. objectives at function level.
RECYLED WASTE STORAGE (w/ DongAn contractor) _ Take a pics of stamp calibration to verify with auditor
ISO Linked w/ ISO 9001:2015 As per # 9.1.1 ISO 9001:2015 requires Monitoring, Measurement, Analysis, and Evaluation of process, equipments…in order to ensure of the “performance” and the OFI OFI-I08 Actual calibration, stamp at hard detection position -_Make sure that all measurement tools/equipments are logs Thai Close
“effectiveness” of the quality management system. As site obsevation, the scale has not been calibrated but put in use. calibrated & checked before using.
ISO 45001:2018
#7.3.c: Employees are made aware of the
implications and potential consequences
LAMINATING Lack of awareness
of not conforming to the OH&S Ask revise the SOPs
ISO As site observation, there is below finding: NC ISO-011 PPE visualize sign Laminating Khuong Close Update revised SOP
management system requirements Install PPE sign
- Inconsistent in wearing earplugs (someone used, someone missed)
#8.1.1.d: organization implemented
control of its processes to adapt the work
to employees
ISO 14001:2015
#6.2.1: organization established
environmental objectives at relevant There is no checklist points Create checklist.
LAMINATING
ISO functions and levels, taking into account NC ISO-012 No daily tracking Weekly safety tour monitorig tracking Laminating Khuong Close
-As site observation, no available MSDS & no expired date stated on label for chemical( IPA) used. It is applied to clean roller that affected to quality also Don't have chemical maps.
its significant environmental aspects, Create chemical maps
associated compliance obligations, and
risk and opportunities
#8.1.3. Managing of Change - in LAMINATING

ISO knowledge or information about hazards & The full machineries are operated. Company might consider to update industrial hygiene performance with data that reflect actual working condition and process improving OFI OFI-I06 Lack of procedure and check list. Create checklist and procedure. Laminating Khuong Close
OH&S Risks actions accordingly.
Measure noise level again if this noise level confirmed by legal inspection, the operators are
LAMINATING
ISO OFI OFI-I07 required to involve in Occupational Health Disease of hearing loss program as per legal To review the risk assessment of noise in this area Laminating Khuong On Going C.Thom provide Due date
-As site obsevation, noise is measured by internal monitoring tool on audit date (Jul 18): noise level exceed limitation of 85dbA (reference: 90 – 95dbA) requirement.
ISO 45001
FINISHING
#7.3.c.
As observation at site
# 8.2.a. Emergency Preparedness & 1+2. Traning for OP about chemical using procedure
- Labelling/hazard signs of IPA chemical are not in proper form – lack of information of expiration. 1+2. Procedure available but Lack of training for OP
ISO Response; NC ISO-010 3. Traning for team member and Provided PPE sign in each area Finishing Finishing Close
On label, have no expire date of IPA. It is applied to clean roller that affected to quality also 2: 3. Don't have warning sign => OP don't know which PPE required in each area
- MSDS are not available in full for all chemical used (Missing MSDS of IPA and Loctite 406) .
- Inconsistent wearing PPE in desinaged areas. Someone wear cap (without net behind).
to employees;
ISO 45001
1. Eyewash near QM station: narrow area, they usually put core sample 1. Make 5S standard for this area included eyewash station
ISO # 8.2.a. Emergency Preparedness & *-Eyewash station is not accessable/obstructed OFI OFI-005 2. Eyewash near CLS machine: front of area is using for placing WIP Finishing Finishing Close
2. Move to other postion near charging station
Response;
ISO 45001:2018
MAINTENANCE
of not conforming to the OH&S 'To make sure PPE instruction available & undertood by all
ISO NC ISO-009 PM Hoa On Going
management system requirements operators. All operators should wear appropriate PPE as
- Inconsistent in wearing PPE as assigned at workplace (mask, gloves, goggles, closed hairnet/cap) . It is obserbed that someone wear, someone missed
#8.1.1.d: organization implemented assigned at workplace
to employees;
ISO 45001:2018
PRINTING
of not conforming to the OH&S
ISO NC ISO-007 PPE instruction not available & all operators don't understand PPE instruction have available Printing Diep Close Lack of Training records ??
management system requirements
-As site observation & interview with operators, there is a Inconsistent/misunderstanding in wearing PPE as assigned at workplace (mask, gloves, goggles, closed hairnet/cap) Install again PPE sign
ISO 45001:2018
to employees; 1. 'Ensure chemical management implemetation properly/'To
PRINTING label all chemical used properly & make sure that MSDS is
ISO #8.1.1 organization implemented control NC ISO-008 Printing Diep Close
It’s observed that DI foam used without proper standard label(no expired date). No MSDS of DI foam). available where chemical used
of its processes to adapt the work to
2. Weekly management site tour
employees;
PRINTING
ISO ISO 14001:2015 & ISO 45001:2018 As per # 6.1.2 ISO 14001:2015 & ISO 45001:2018, OHS & Env. Risk Assessment should be indentified. Based on document review, OHS & Env. Risk Assessment of Printing OFI OFI-I04 Combine RA of Flint with RA of Printing. Printing Diep Effectiveness Lack of training records for Flint
area is missing ink mixing room activity( Flint).
BD ID: 01T006
Version: 1.0
ISO 45001:2018
#8.1.1.
Ink mixing( Flint) Make MSDS with full version in English/Vietnamese language for
#8.1.4.3: out-sourcing (FlintGroup supplier
ISO - Lack of MSDS with full version in English/Vietnamese language for Flexo clean super. NC ISO-005 Flexo clean super. Flint Diep Close
needs to keep up & performance
- First-aid-kit: instruction is not available for checking. -Make instruction for first-aid kit available
consistently with company safety &
environmental protection program)
Ink mixing( Flint)

ISO 14001:2015 Store hazadous waste in hazadous waste bin( orange bin-
ISO As stated in waste management procedure of company, hazadous waste should be stored in orange bin. As observation at site, hazadous waste is stored in contaiminated NC ISO-006 Flint Diep Close
company regulation).
waste bin.(Bin with label "Chất thải lây nhiễm")
Ink mixing( Flint) Update OHS & Env. RA of Flint. And provide it to Printing.
ISO ISO 14001: 2015 & ISO 45001:2018 OFI OFI-I03 Flint Diep Close
The OHS Risk Assessment, Environment Impact & Aspect Assessment specific for Flint/ Ink should be updated & combined with OHS & Enviromental RA of Printing Printing will combine the Flint RA with theirs.
BD ID: 01T006
Version: 1.0
Pre-Press
ISO 45001:2018 It's observed that PPE instruction not available & all operators don't understand Have already print MSDS English and 'Vietnammese Version
ISO #8.1.1.b - Chemical in used (Glycol) is not listed in approval master list (company rule): Glycol is in used without standard label (company rule) & no MSDS in Vietnamese. The drum is NC ISO-003 Not MSDS English and Vietnamese version Training for Operator about wearing PPE Printing Truong Close x
#8.1.1.d not proper closed after use. Not have area to keep PPE Make plan and order equipment to keep PPE
- Dryer machine: PPE when not in use are placed in non-assigned area(on top machine). Risk of unexpected hazardous waste generating.
Pre-Press
Tracking data( input and output) from operation of the tissue
ISO 14001:2015 As per # 6.2.1 ISO 14001:2015 requirement, organization shall establish environmental objectives at relevant functions and levels, taking into account its significant Don't make tracking data for tissue by Operator ????
ISO NC ISO-004 cleaning from Sleeve Washer. (How much paper is used, how Printing Truong Close Add code docs
#6.2.1 environmental aspects, associated compliance obligations, and risk and opportunities. Based on site observation & interview with -person in charge( PIC)/Acting Manager , the Why operator do not make? …(If no system? No guide line, do not know require?)
much waste )
tissue cleaning from Sleeve Washer has not have any data (input or output) to support the task setting up env. objectives at function level.
Pre-Press Tracking waste data of printing plate waste. And tracking data of
ISO 14001:2015 Article 6.2.1: organization established environmental objectives at relevant functions and levels, taking into account its significant environmental aspects, associated compliance solvent used. Input – output for chemical used at these
ISO OFI OFI-I02 Don't make tracking data for tissue by Operator ???? Printing Prepress Close Add code docs
#6.2.1 obligations, and risk and opportunities. Based on site observation & interview with -person in charge( PIC)/Acting Manager, no input or output data for printing plate waste nor machines help to established environmental objectives at
solvent been used in order to support the task setting up env. objectives at function level relevant functions and levels.
Ink cleaning:
ISO 45001:2018 As site observation, there are below findings: *-To ensure fire alarm is not blocked
#7.3.c: Employees are made aware of the 1. Emergency Response devices are not ready for using: - To develop SOP or plan, to monitor water sources available &
implications and potential consequences -Fire alarm is blocked enough for emergency use-Sodexo.
of not conforming to the OH&S -Eyewash station without the monitoring plan & evident of checking to ensure portable water souses available & enough for emergency use. -To label all chemical used properly & make sure that MSDS in
ISO NC ISO-001 Printing ink cleaning Close
management system requirements. 2. Chemical( Flexo wash) used without proper standard label (company rule) & MSDS is not clean & clear the language of operator is available, clear & clean where
#8.1.1.d: organization implemented 3. PPE( mask) is not put in assigned location chemical used
control of its processes to adapt the work Risk to increase hazardous waste* (linked with Environmental performance) -To make sure PPE is put in assigned location.
to employees Risk to impact OHS performance: quality of PPE, effectiveness of protecting operators, etc. - Make sure SOP available in place.
4. SOP of cleaning ink washing with Flexowash machine (& drainage) is not available in place.
1a. To assign & mark location for waste bin

1b. Make layout of ink cleaning waste bin
Ink cleaning: Please send me NCR record
ISO 14001:2015 - No marking for location of waste bin 1. No layout of waste bin 2a. Make risk assessment of OHSE for cleaning activities in ink (Evidence of waste bin layout at ink
ISO #6.2.1 Enviromental objective - As per # 6.2 ISO 14001:2015 requirement, organization shall establish environmental objectives at relevant functions and levels, taking into account its significant NC ISO-002 cleanining room Printing ink cleaning Close cleaning, Risk assessment OHSE of ink
# 6.1.2 Enviromental aspect environmental aspects, associated compliance obligations, and risk and opportunities. Based on site observation & interview with person in charge( PIC), waste generated from 2. No system is built up for impact/aspect environment monitoring cleaning activities, tracking of waste control
cleaning activities are not tracked the in-put and out-put 2b. Tracking input and output of chemical used for cleaning quantity (chemical, waste disposal…)
activities. (How is about water disposal volumn??
Ink cleaning: 1. Prepare SOP of cleaning activitiy of Flexowash cleaning

machine and drainage
Based on document review, SOP of Flexowash machine is available. However, it is missing task of cleaning activity of Flexowash machine and drainage. The Unclear requirements
ISO ISO 14001: 2015 & ISO 45001:2018 OFI OFI-I01 2. Share Risk assessment of OHS-ENV of ink cleaning inclued Printing ink cleaning On Going I added action 2.3. Please review
discharge used flexowash solution activities (impact both OHS & Env. Risk assessment) Flexowash machine impact
3. Checksheet to record Discharge
BD ID: 01T006
Version: 1.0
BD ID: 01T006
Version: 1.0

Findings HSE 2019 - 2

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TETRA PAK BINH DUONG JSC

SUMMARY OF UNSAFE ACTS/CON

No Finding date Week Where Category (UA/UC)

70 9-Apr-19 15 Raw material warehouse UC

83 26-Jun 26 Waste Collected area UC

84 26-Jun 26 Finished good warehouse UC

85 26-Jun 26 Finished good warehouse UC

87 24-Jul 30 Ink Pan Cleaning room UC

90 24-Jul 30 Finish Good Warehouse UC

91 31-Jul 31 Pre Press room UC

94 14-Aug 33 Recycling building UC

96 14-Aug 33 Recycling building UC

97 14-Aug 33 Lubricant storage UC

99 21-Aug 34 Ink Pan Cleaning room UC

100 21-Aug 34 Ink Pan Cleaning room UC

101 21-Aug 34 Laminator UC

103 4-Sep 36 Finish Good Warehouse UC

104 4-Sep 36 Finish Good Warehouse UC

105 4-Sep 36 Finish Good Warehouse UC

107 18-Sep 38 Base material WH UC

108 18-Sep 38 Base material WH UC

109 18-Sep 38 FG Warehouse UC

110 25-Sep 39 PE Silo UC

111 25-Sep 39 Generator Room UC

113 25-Sep 39 Chemical Room UC

114 25-Sep 39 Next to Chemical Room UC

115 9-Oct 41 Loading Dock UC

116 9-Oct 41 Loading Dock UC

117 9-Oct 41 FG Warehouse UC

119 9-Oct 41 Loading Dock UC

120 9-Oct 41 FG Warehouse UC

121 9-Oct 41 FG Warehouse UC

122 9-Oct 41 Loading Dock UC

123 9-Oct 41 BM Warehouse UC

16-Oct 42 Recycling building UC

16-Oct 42 Recycling building UC

16-Oct 42 Recycling building UC

16-Oct 42 Recycling building UC

16-Oct 42 Loading Dock UC

16-Oct 42 Warehouse Office UC

23-Oct 43 Ink Cleaning room UC

23-Oct 43 Pre Press room UC

23-Oct 43 Pre Press room UC

23-Oct 43 Electrical room UC

30-Oct 44 Chargin Room UC

30-Oct 43 Chargin Room UC

30-Oct 43 Finished Goods Warehouse UC

30-Oct 43 Finished Goods Warehouse UC

30-Oct 43 Finished Goods Warehouse UC

30-Oct 43 Finished Goods Warehouse UC

30-Oct 43 Loading Bay UC

30-Oct 43 Recycle Building UC

30-Oct 43 Recycle Building UC

30-Oct 43 Recycle Building UC

6-Nov 44 Recycle Building UC

6-Nov 44 Recycle Building UC

6-Nov 44 Recycle Building UC

6-Nov 44 Recycle Building UC

Description Pictures/ evidence Correction picture

Evacuation maps were not available at

Lilama18 used brooms to clean dirt

FFE boxes had hard lock/handle to open

Door of process control room on the left