Daily Safetyman PGAS

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PT.

PGN Solution
CS WUR EW - SPHR00079A
DAILY SAFETYMAN REPORT
Date :
Location :
SR Number :
Man Power Staff : Person's Non Staff : Person's
Job Description :

WORK PERMIT AND OTHER DOCUMENT ON JOB SITE


HOT WORK CONFINED EXCAVATION HOT LINE SUPERVISOR TAILGATE TMP COLOR
Description GPTW PPHA On Site JSA
PERMIT SPACE PERMIT PERMIT CHECKLIST MEETING CHECKLIST CODE TAG
Valid
Available
N/A

LIGHT VEHICLE, BUS, AND EQUIPMENT ON JOB SITE


COMMENTARY ELECTRICAL HOUSE
Description SIO PERMIT SILO PTI SEAT BELT P3K FIRE EX TIRES
DRIVE / LAMP KEEPING

Valid / Good
Available / Not Good
N/A

PERSONAL PROTECTIVE EQUIPMENT CONDITION

HAND SAFETY SAFETY SAFETY WELDING WELDING WELDING DUST SAFETY


Description UNIFORM EAR PLUG FACE SHIELD
GLOVE GLASES SHOES HELMET APRON SLEEVE CUP MASKER VEST

Good
Not Good
N/A

KM DRIVEN RECORD

LIGHT DUMP FOCO


Description BUS CRANE TRUCK TRAILER WATER TRUCK FUEL TANK OTHERS
VEHICLE TRUCK TRUCK

Jumlah

KM Start

KM Finish

TOTAL KM

OPERATING HOURS RECORD

WELDING MOTOR
Description DOZER BACK HOE EXCAVATOR CRANE COMPRESSOR COMPACTOR OTHERS
MACHINE GRADER

Jumlah
Start
Finish
TOTAL HOURS

FINDING ON JOB SITE

NO FINDING ACTION TAKEN PIC DUE DATE STATUS

Reported by, Acknowledge by, Recorded by,

SAFETYMAN SUPERVISOR CONSTRUCTION HES ADMINISTRATION


NOTE : Isilah lembaran ini sesuai dengan kondisi yang ada dilapangan.

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