RAINFALL RECORDED : mm DATE : TIME : 07:00 WIB

Clear : Heavy Rain (HR)

:
Drizzle :
Rain :

NO
1
2
3
4
5
NO
1
2
3 Pipeline (PL)
4 Fractionation Plant (SG)
CONTRACTORS :
A.Fractionation Plant
1 PT. Nusa Indah Lestari
2 PT Patra Teknik Preparing landscape project
3 Daily Housekeeping Housekeeping
4

4 PT Indoturbin PM Engine washing
5 CSO Support Operation team
6 PKL fieldwork practice
Fractionation Plant
Contractors :
a. Extraction Plant
b. Pipeline
c. Fractionation Plant
NO


B.1. : :
B.2. : :
B.3. : :
B.4. : :
B.5. : :
B.6. : :
1 Light Vihicle 96
2 Pick Up 8 loading


NO
1 Safety Induction
2 JSA & Risk Assessment 5 at Fractionation & 2 at extraction
3 Safety Talk / Toolbox meeting 5 at Fractionation & 2 at extraction
4 Work Permit :
4.1. Cold Work Permit 5 at Fractionation & 2 at extraction
4.2. Hot Work Permit
4.3. Excavation
4.5. Radiography
4.6. Site Entry & Leaving
4.7. Gate Pass PT Patra Teknik for loading material
4.8. Over Time (OT)
4.9. Others :
5 Inspection/Audit
6 Others :
6.1.
Prepared By : Checked By : Acknowledge :
HSE Adm HSE Supervisor General Manager
7
7
7
4.4. Confined space
1
D. OTHERS :
TYPE/ITEMS TOTAL REMAKRS
TOTAL EQUIPMENT 13 96 12 96


12 12 96 192
1
Total Hours Remarks Total Total Hours Remarks Equipment Operating Today
NO TYPE EQUIPMENT
Fractionation Plant PIPE LINE Extraction Plant Summary Total Hours
Total Total Hours Remarks Total
Nearmiss 1 B.12. Others 0
C. EQUIPMENT OPERATING TODAY :
MTI (Medical Treatment Incase) 0 B.10. Fire 0
First Aid 0 B.11 Enviromental 0
LTI (Lost Time injury) 0 B.8. Construction Vehicle 0
RCW (Restrictied Work Case) 0 B.9. Support Vehicle 0
B. ACCIDENT/INCIDENT
Fatalities 0 B.7. Equipment 0
1 11-Mar-14
Near Miss at Extraction Plant ( forklift
menabrak drainase didepan warehouse)
Need Special Driver for Forklift and has
been certificated
Maintenance, Warehouse, HSE, HRD
Follow Up, Investigated and Continuous
Improvement
DATE HAZARD CORRECTIVE ACTION PERSON INCHARGE STATUS REMARKS
TOTAL 725,872 2,416 728,288

A. Hazard Finding of Unsafe Action/Condition & Corrective Action Plan :
1,216 - 1,216
236,186 376 236,562
8,182,286.00
Extraction Plant 194,600 928 195,528
195,648 792 196,440
-
MAN HOURS
PSG Jakarta
7,453,998
43,152 232 43,384
55,070 88 55,158
TOTAL OPERATION Cut Off SSNP PREVIUOS (HOURS) TODAY (HOURS) COMMULATIVE (HOURS) OPERATION PERIOD TOTAL
302 232 1016 0 1168 2416
0 88 0 376 464
ACCUMULATE TOTAL TODAY 29 127 0 146
Total Worker Contractor 11 0 47 58
0 48
4 0 4 0 32 0 0 32
6 0 6 0 48 0
B.Extraction Plant
1 0 1 0 8 0 0 8
40 40 Shelter Panel Hot Oil Heater PT. Diqo Teknindo Perkasa 5 5 0 0 0
272
2 2 0 0 0 16 16
0 48 48 Cutting Grass
34 34 0 0 0 272
6 6 0 0
244 232 928 0 792 1952
0 0 0 792 792
Total Worker PSG 29 116 0 99
0 0 0 0
99 99
0 0
0 928 0 0 928 Extraction Plant (PMB) 116 116
232 0 0 0 232
PL HOURS SG HOURS TOTAL HOURS REMARKS
PSG Jakarta 29 29
MAN POWER JKT PMB PIPELINE SG TOTAL WORKER JKT HOURS PBM HOURS
Monitoring activities all contractors for Land scaping project, Cutting Grass , & House keeping Fractionation Plant
Handling ID IMKP refinery RU III for shift Driver PT Perta Samtan Gas Fractionation Plant
Preparation of emergency safety drill scenario Fractionation Plant
ACTIVITY REMARKS
01:00 02:00 03:00 04:00 05:00 06:00 19:00 20:00 21:00 22:00 23:00 24:00
17:00 18:00
Cloudy
11:00 12:00 13:00 14:00 15:00 16:00
OPERATION PERIOD WEATHER CONDITION REMARKS WEATHER
01 May 2013 - 10-Apr-14 Time
07:00 08.00 09:00 10:00
DAILY REPORT HSE
F-HSE-PSGAS
REV : 00
TITLE : OPERATION PT.PERTA - SAMTAN GAS 0 Thursday, April 10, 2014