LAPO

JOB

Tanggal : 27-May-2019 (dd/mm/yyyy) HSE :

Pjs Supt
Total POB : 58 clean water (m3) 12.5 Total
Today's safety man hours 644 waste water 12.1
total safe man hour this month 18320 Organik 28.0
Unorganik 6.0
Kompos 20.0
fuel 1,700.0
Klinik 1.0
ijin kerja 5.0
KM trip 161.5
SAFETY LAG
Kasus Fatality (FAT) : 0
Loss Time Incident (LTI) : 0
Kasus Hari Kerja Terbatas (RWD) : 0
Kasus Tindakan Medis (MTC) : 1
Kasus Pertolongan Pertama (FAC) : 0
Kasus Nyaris Celaka (NM) : 0

KEBAKARAN/KERUSAKAN MATERIAL
Tingkat Keparahan Berat (≥ US$ 500.000) (MDH) : 0
Tingkat Keparahan Sedang (< US$ 500.000) (MDM) : 0
Tingkat Keparahan Ringan (≥ US$ 10.000) (MDL) : 0

RASIO KECELAKAAN
Tingkat Kejadian ( Incident Rate) (IR) : 0
Tingkat Kekerapan ( Frequency Rate ) (FR) : 0
Tingkat Keparahan ( Severity Rate ) (SR) : 0
 tool box meeting PM HP production separator

Work permit
Cold work Naked Flame fab clamp antenna omni
bongkar barang
PM HP production separator
pemasangan keramik warehouse
perawatan jalan SSB 4 dan 7

Breaking Spark
Contaiment Potential
 LAPORAN HARIAN KESELAMATAN KERJA
JOB PERTAMINA-MEDCO E&P SIMENGGARIS

Yopie handrian Lokasi : Tanjung Keramat

Eddy himawan
clean water (m3) 379.521
waste water 328.148
Sampah Organik 1071
Unorganik 259
Kompos 346
fuel 6812
Klinik 18
ijin kerja 102
KM trip 4725.1
SAFETY LEAD
Safety Talk/Toolbox 1 26 Org
Safety Induction 3
Training 0
Lesson Learn 0
Latihan Kondisi Darurat 0
Inspeksi Gabungan 0

Work permit
Cold work 4
Breaking Contaiment 0
Naked Flame 1
Spark Potential 0
Confined Space Entry certificate 0

FOTO AKTIVITAS
 Site visit dari PLN & Dinas PUPR Kab KTT fab antena om

amp antenna omni Confined Space Entry

certificate
fab antena omni
 LAPORAN HARIAN KESELAM
JOB PERTAMINA-MEDCO E

Tanggal : (dd/mm/yyyy) HSSE Rep :

rum

PENGELOLAAN KESELAMATAN KERJA KONTRAKTOR

Mitra Kerja 1 : Mitra Kerja 2 :
C O
WIP - 06 : WIP - 06 :
WIP - 07 : WIP - 07 :
WIP - 08 : WIP - 08 :
WIP - 09 : WIP - 09 :
TOTAL TOTAL

Mitra Kerja 4 : Mitra Kerja 5 :

C O
WIP - 06 : WIP - 06 :
WIP - 07 : WIP - 07 :
WIP - 08 : WIP - 08 :
WIP - 09 : WIP - 09 :
TOTAL TOTAL
ORAN HARIAN KESELAMATAN KERJA
PERTAMINA-MEDCO E&P SIMENGGARIS

Lokasi :

ja 2 : Mitra Kerja 3 :
C O C O
WIP - 06 :
WIP - 07 :
WIP - 08 :
WIP - 09 :
TOTAL

ja 5 : Mitra Kerja 6 :
C O C O
WIP - 06 :
WIP - 07 :
WIP - 08 :
WIP - 09 :
TOTAL
 PERSONAL ON BOARD
Location : JOB P-MEPS Tanjung Keramat

SUB TOTAL
No Name Position Date Arv
1 Process Engingeer 22-May-2019
2 Arif Rahman Operator 15-May-2019
3 Hadriansyah Operator 15-May-2019
4 Kamimi Operator 15-May-2019
5 Handriansyah Operator 15-May-2019
6 Kisnadi Operator 22-May-2019
7 Yahya Operator 22-May-2019
8 Purwanto Operator 22-May-2019
9 Ismail Operator 22-May-2019
10
11
12
13
14
SUB TOTAL

PT. NKTI (Catering)

No Name Position Date Arv
1 Susanto Camp Boss 8-May-2019
2 Kamarudin Cook 8-May-2019
3 Rizky Pramusaji 8-May-2019
4 Fadli Laundry 8-May-2019
5 Wisnu Cook 15-May-2019
6 Irwan Pramusaji 15-May-2019
7 Firly Roomboy 15-May-2019
8 Ahyar Roomboy 15-May-2019
9
10
SUB TOTAL

PT. INDAH DEWI TRANSPORT dan HEAVY EQUIPMEN

No Name Position Date Arv
1 Iyansyah Motoris 1-May-2019
2 Junardi Cook 1-May-2019
3 Basri Opoerator Excavator 8-May-2019
4 Mansyur Motoris 22-May-2019
5 Ahmad Yani Admin 26-May-2019
6 Mulrif Driver 15-May-2019
7 Sumarno Cook 15-May-2019
Page 9 of 28
 PERSONAL ON BOARD
8 Nanda Helper Cook 16-May-2019
9 Firdaus Driver 22-May-2019
10 Dedyansyah ABK 22-May-2019
11
12

SUB TOTAL

PT. PERTAMEDIKA & PES CONTROL

No Name Position Date Arv
1 dr. Primanto Doctor 15-May-2019
2 M. Dede Paramedic 22-May-2019

SUB TOTAL

POLISI & TNI

No Name Position Date Arv
1 Soleh Lantamal 15-May-2019
2 Prayitno Lantamal 22-May-2019

SUB TOTAL

Page 10 of 28
 PERSONAL ON BOARD

PT. GARDATAMA NUSANTARA (Security JOB PME

No Name Position Date Arv
1 Junaidi Danru 22-May-2019
2 Masdar Security 22-May-2019
3 Umar Security 22-May-2019
4 Sei Intan Security 22-May-2019
5 Abdul Rahim Security 22-May-2019
6 Yoga Security 22-May-2019
7 Wandi Security 22-May-2019
8 Nurdin Danru 15-May-2019
9 Saharudin Security 15-May-2019
10 Henri Security 15-May-2019
11 Lukman Security 15-May-2019
12 Iwan Security 15-May-2019
13 Gholib Security 15-May-2019
14 Arjulang Driver 15-May-2019
15 Nurhalim Admin 20-May-2019
16
17
SUB TOTAL

PT. GEARINDO
No Name Position Date Arv
1 Nurcahyo SPV Maintenance 15-May-2019
2 Andi Lao Maintenance 22-May-2019
3 Yopie Handrian HSSE 1-May-2019
4 Darisman Foreman 22-May-2019
5 Imat Rohimat Warehouse 22-May-2019
6 Agus Priyanto Maintenance 22-May-2019
7 Ardi Gumelar Field Admin 15-May-2019
8
9
10
11
12
SUB TOTAL

RAVINDO
No Name Position Date Arv
Page 11 of 28
 PERSONAL ON BOARD
1 Damar Maintenance Civil 22-May-2019
2 Tarmuji Maintenance Civil 15-May-2019
3 Ruslan Maintenance Civil 8-May-2019
SUB TOTAL

ELSHADDAI ETAM MANUNGGAL

No Name Position Date Arv
1 Adi darmawan Composting 15-May-2019
2 Miswanto Composting 22-May-2019
3
SUB TOTAL

PHOENIX
No Name Position Date Arv
1
2
SUB TOTAL

VISITOR
No Name Perusahaan Date Arv
1
2
3
4

Page 12 of 28
 PERSONAL ON BOARD
SUB TOTAL

NO Company Representatives PERSONAL

1 JOB PERTAMINA MEDCO E&P SIMENGGARIS 9
2 PT. NKTI (Catering) 8
3 PT. INDAH DEWI TRANSPORT dan HEAVY EQUIPMENT 10
4 PT PERTAMEDIKA 2
5 POLISI & TNI 2
6 PT. GARDATAMA NUSANTARA (Security JOB PMEPS) 15
7 PT. GEARINDO 7
8 RAVINDO 3
9 ELSHADDAI ETAM MANUNGGAL 2
10 PHOENIX 0
11 VISITOR 0

TOTAL POB 58

TODAY MANHOURS 644

Yopie handrian Eddy himaw

Field HSSE Officer Pjs Field Superintendent

Page 13 of 28
ONAL ON BOARD
27-May-19
SUB TOTAL
Days On Nation STATUS Times Work
6 INA Day Shift 10
13 INA Night Shift 12
13 INA Night Shift 12
13 INA Night Shift 12
13 INA Night Shift 12
6 INA Day Shift 12
6 INA Day Shift 12
6 INA Day Shift 12
6 INA Day Shift 12

SUB TOTAL 106

PT. NKTI (Catering)

Days On Nation STATUS Times Work
20 INA Day Shift 12
20 INA Night Shift 12
20 INA Night Shift 12
20 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12

SUB TOTAL 96

RANSPORT dan HEAVY EQUIPMENT

Days On Nation STATUS Times Work
27 INA Day Shift 10
27 INA Day Shift 10
20 INA Day Shift 10
6 INA Day Shift 10
2 INA Day Shift 10
13 INA Day Shift 10
13 INA Day Shift 10
Page 14 of 28
ONAL ON BOARD
12 INA Day Shift 10
6 INA Day Shift 10
6 INA Day Shift 10

SUB TOTAL 100

MEDIKA & PES CONTROL

Days On Nation STATUS Times Work
13 INA Day Shift 10
6 INA Day Shift 10

UB TOTAL 20

POLISI & TNI

Days On Nation STATUS Times Work
13 INA Day Shift 12
6 INA Day Shift 12

UB TOTAL 24

Page 15 of 28
ONAL ON BOARD

USANTARA (Security JOB PMEPS)

Days On Nation STATUS Times Work

6 INA Night Shift 12

6 INA Night Shift 12
6 INA Night Shift 12
6 INA Night Shift 12
6 INA Night Shift 12
6 INA Night Shift 12
6 INA Night Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
13 INA Day Shift 12
8 INA Day Shift 10

SUB TOTAL 178

PT. GEARINDO
Days On Nation STATUS Times Work

13 INA Day Shift 10

6 INA Day Shift 10
27 INA Day Shift 10
6 INA Day Shift 10
6 INA Day Shift 10
6 INA Day Shift 10
13 INA Day Shift 10

UB TOTAL 70

RAVINDO
Days On Nation STATUS Times Work
Page 16 of 28
ONAL ON BOARD
6 INA Day Shift 10
13 INA Day Shift 10
20 INA Day Shift 10
UB TOTAL 30

DAI ETAM MANUNGGAL

Days On Nation STATUS Times Work

13 INA Day Shift 10

6 INA Day Shift 10

UB TOTAL 20

PHOENIX
Days On Nation STATUS Times Work

UB TOTAL 0

VISITOR
Days On Nation STATUS Times Work

Page 17 of 28
ONAL ON BOARD
UB TOTAL 0

PERSONAL Man Hours

9 106
8 96
10 100
2 20
2 24
15 178
7 70
3 30
2 20
0 0
0 0
58 644
644

Eddy himawan
Pjs Field Superintendent JOB P-MEPS

Page 18 of 28
 Tanggal 1 2 3 4 5 6
Air Bersih (m3) 16.3 12.9 15.6 10.9 14.4 13.5
Air Limbah 39.1 10.0 14.5 7.5 18.5 0.9
Sampah Organik 37 29 41 41 31 54
Sampah Anorganik 7 7 5 7 26 5
Kompos 9 0 13 12 25 15
Solar 0 100 100 0 0 750
Klinik 1 1 0 1 0 1
ijin kerja 1 2 3 3 3 4
km trip 202.4 177.3 276.2 186.9 61.7 73.7
Tanggal 1 2 3 4 5 6
JOB 10 10 10 10 10 10
Gearindo 8 8 8 8 8 8
Ravindo 3 3 3 3 3 3
NKTI 8 8 8 8 8 8
ID 9 9 9 9 9 9
Gardatama 16 16 16 16 16 16
Pertamedika 2 2 2 2 2 2
TNI 2 2 2 2 2 2
EEM 2 2 2 2 2 2
Phoenix 2 2 2 2 2 2
Tamu 0 0 0 0 0 0
POB Total 62 62 62 62 62 62
Man Hours 686 686 686 686 686 686

Tanggal POB Total 58

Air Bersih (m3) 12.8 Man Hours 644
Air Limbah 6.8 total man hour 18320
Sampah Organik 26
Sampah Anorganik 6
Kompos 12
Solar 0
Klinik 1
ijin kerja 4
km trip 154.5
Tanggal 1 2 3 4 5 6
Hilux L 9745 M 104,610.0 104,666.0 104,724.0 104,823.0 104,889.0 104,911.0
Hilux L 9748 M 0.0 0.0 0.0 0.0 0.0 0.0
Triton NKTI 8,568.5 8,632.9 8,651.2 8,709.4 8,728.3 8,743.0
Triton Security 20,420.0 20,498.0 20,579.0 20,656.0 20,746.0 20,771.0
Ambulance 0.0 0.0 0.0 0.0 0.0 0.0
Dump Truck 16,093.0 16,097.0 16,117.0 16,159.0 16,171.0 16,171.0

Tanggal 1 2 3 4 5 6
Hilux L 9745 M 56.0 58.0 99.0 66.0 22.0 38.0
Hilux L 9748 M 0.0 0.0 0.0 0.0 0.0 0.0
Triton NKTI 64.4 18.3 58.2 18.9 14.7 11.7
Triton Security 78.0 81.0 77.0 90.0 25.0 24.0
Ambulance 0.0 0.0 0.0 0.0 0.0 0.0
Dump Truck 4.0 20.0 42.0 12.0 0.0 0.0
km trip 202.4 177.3 276.2 186.9 61.7 73.7
 7 8 9 10 11 12 13 14
14.0 14.7 11.9 12.9 11.6 24.7 21.6 14.1
1.4 0.4 1.3 13.4 12.0 21.4 19.7 15.9
42 42 46 54 32 43 30 28
5 11 12 13 8 8 5 8
14 11 11 12 16 10 12 9
350 50 0 100 50 0 0 1000
2 0 0 0 0 0 0 0
3 2 3 3 6 3 2 5
245.3 148.1 279.2 135.2 176.1 184.1 175.2 0.0
7 8 9 10 11 12 13 14
10 8 8 8 8 8 8 8
8 6 6 6 6 6 6 6
3 3 3 3 3 3 3 3
8 9 9 9 9 8 8 8
9 8 9 9 9 9 9 9
16 17 17 17 17 15 16 16
2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2
2 1 1 1 1 1 1 1
0 0 0 0 0 0 0 0
62 58 59 59 59 56 57 57
686 646 656 656 656 622 632 632

12.5
12.1
28
6
20
1700
1
5
161.5
7 8 9 10 11 12 13 14
104,949.0 105,000.0 105,013.0 105,110.0 105,158.0 105,210.0 105,262.0 105,292.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
8,754.7 8,861.0 8,928.1 8,993.3 9,012.5 9,045.6 9,074.7 9,128.9
20,795.0 20,883.0 20,951.0 21,068.0 21,136.0 21,227.0 21,330.0 21,421.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
16,171.0 16,171.0 16,171.0 16,171.0 16,171.0 16,171.0 16,171.0 16,171.0

7 8 9 10 11 12 13 14
51.0 13.0 97.0 48.0 52.0 52.0 30.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
106.3 67.1 65.2 19.2 33.1 29.1 54.2 0.0
88.0 68.0 117.0 68.0 91.0 103.0 91.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
245.3 148.1 279.2 135.2 176.1 184.1 175.2 0.0
 15 16 17 18 19 20 21 22
11.6 10.0 9.7 13.2 10.3 12.8 16.6 11.6
28.8 0.1 13.6 11.3 11.5 6.8 10.3 0.7
32 49 20 39 52 26 52 30
7 8 35 8 8 6 8 6
12 13 5 11 9 12 12 0
50 0 12 50 300 0 1100 0
1 1 1 0 0 1 0 1
2 4 5 6 8 4 5 0
378.6 158.8 216.1 105.5 154.5 118.9 110.2 150.9
15 16 17 18 19 20 21 22
7 7 7 7 7 7 7 7
7 7 7 7 7 7 7 7
3 3 3 3 3 3 3 3
9 9 9 9 9 9 9 9
9 10 10 10 10 10 10 10
16 16 16 16 16 16 16 16
2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
57 58 58 58 58 58 58 58
634 644 644 644 644 644 644 644

15 16 17 18 19 20 21 22
105,292.0 105,375.0 105,411.0 105,433.0 105,486.0 105,516.0 105,565.0 105,591.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
9,128.9 9,238.5 9,262.3 9,331.4 9,353.9 9,412.4 9,442.3 9,459.5
21,421.0 21,596.0 21,695.0 21,820.0 21,850.0 21,916.0 21,956.0 22,023.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
16,171.0 16,182.0 16,182.0 16,182.0 16,182.0 16,182.0 16,182.0 16,182.0

15 16 17 18 19 20 21 22
83.0 36.0 22.0 53.0 30.0 49.0 26.0 17.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
109.6 23.8 69.1 22.5 58.5 29.9 17.2 21.9
175.0 99.0 125.0 30.0 66.0 40.0 67.0 92.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
11.0 0.0 0.0 0.0 0.0 0.0 0.0 20.0
378.6 158.8 216.1 105.5 154.5 118.9 110.2 150.9
 23 24 25 26 27 28 29 30
14.1 12.6 10.6 13.8 11.3 12.5
12.5 10.5 12.0 11.1 10.8 12.1
41 40 39 41 32 28
8 15 6 7 4 6
17 9 25 15 17 20
50 0 350 650 50 1700
1 1 1 1 2 1
4 3 5 3 5 5
227.2 143.4 155.4 207.8 114.9 161.5 0.0 0.0
23 24 25 26 27 28 29 30
7 7 9 7 7 9
7 7 7 7 7 7
3 3 3 3 3 3
9 9 8 9 9 7
10 10 11 10 10 10
16 16 15 16 16 16
2 2 2 2 2 2
2 2 2 2 2 2
2 2 2 2 2 2
0 0 0 0 0 0
0 0 0 0 0 0
58 58 59 58 58 58 0 0
644 644 656 644 644 644

23 24 25 26 27 28 29 30
105,608.0 105,660.0 105,712.0 105,755.0 105,799.0 105,825.0 105,854.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
9,481.4 9,562.6 9,582.0 9,637.4 9,685.2 9,704.1 9,773.6
22,115.0 22,199.0 22,254.0 22,304.0 22,402.0 22,462.0 22,517.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
16,202.0 16,212.0 16,229.0 16,236.0 16,254.0 16,264.0 16,272.0

23 24 25 26 27 28 29 30
52.0 52.0 43.0 44.0 26.0 29.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
81.2 19.4 55.4 47.8 18.9 69.5 0.0 0.0
84.0 55.0 50.0 98.0 60.0 55.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
10.0 17.0 7.0 18.0 10.0 8.0 0.0 0.0
227.2 143.4 155.4 207.8 114.9 161.5 0.0 0.0
31 Total
379.5
328.1
1,071 768
259
346 231
6,812
18
102
0.0 4,725
31
30.07813

Total Man
Hours
(Monthly)

0
18320

31 Total
3,053,499.0
0.0
265,887.6
623,011.0
0.0
469,290.0

31 Total
0.0 1,244.0
0.0 0.0
0.0 1,205.1
0.0 2,097.0
0.0 0.0
0.0 179.0
0.0 4,725.1