MONTHLY HSE PERFORMANCE REPORT

Project: SUTT 150 KV Seputih Banyak-

Menggala
Doc. No.: CTI / SBM / HSE / X / 10 / 2017

MONTHLY HSE PERFORMANCE REPORT SUMMARY

SUTT 150 KV Seputih Banyak-Menggala

For The Month Of: Oktober 2017

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PERIOD: 23th to 29th of Oktober 2017

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 MONTHLY HSE PERFORMANCE REPORT
Project: SUTT 150 KV Seputih Banyak-
Menggala
Doc. No.: CTI / SBM / HSE / X / 10 / 2017

Table of Contents

A. INJURY & INCIDENT RECORDED IN THIS MONTH...................................................................................... 3

1. INJURY CASE .................................................................................................................................................... 3
1.1. First Aid Injury ............................................................................................................................................. 3
1.2. Medical Treatment Injury ........................................................................................................................... 3
1.3. Restricted Duty Injury ................................................................................................................................ 3
1.4. Lost Time Injury .......................................................................................................................................... 3
1.5. Fatality .......................................................................................................................................................... 3
2. INCIDENT RECORDED IN THIS MONTH ..................................................................................................... 3
2.1. Light Vehicle or Heavy Equipment Damage .......................................................................................... 3
2.2. Property Damage ....................................................................................................................................... 3
2.3. Environmental ............................................................................................................................................. 3
3. SERIOUS POTENTIAL INCIDENT (SPI) RECORDED IN THIS MONTH ................................................ 3
B. HSE PERFORMANCE .......................................................................................................................................... 4
1. PROJECT SAFETY PERFORMANCE INDICATOR .................................................................................... 4
2. HSE ACTIVITIES................................................................................................................................................ 4
3. HSE PLAN FOR NEXT MONTH ...................................................................................................................... 5

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 MONTHLY HSE PERFORMANCE REPORT
Project: SUTT 150 KV Seputih Banyak-
Menggala
Doc. No.: CTI / SBM / HSE / X / 10 / 2017

A. INJURY & INCIDENT RECORDED IN THIS MONTH

1. INJURY CASE

1.1. First Aid Injury

None

1.2. Medical Treatment Injury

None

1.3. Restricted Duty Injury

None

1.4. Lost Time Injury

None

1.5. Fatality
None

2. INCIDENT RECORDED IN THIS MONTH

2.1. Light Vehicle or Heavy Equipment Damage

None

2.2. Property Damage

None

2.3. Environmental
None

2.4. Near Miss

None

3. SERIOUS POTENTIAL INCIDENT (SPI) RECORDED IN THIS MONTH

None

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 MONTHLY HSE PERFORMANCE REPORT
Project: SUTT 150 KV Seputih Banyak-
Menggala
Doc. No.: CTI / SBM / HSE / X / 10 / 2017

B. HSE PERFORMANCE

1. PROJECT SAFETY PERFORMANCE INDICATOR

Last Month
This Month (Oktober’17) TOTAL
(September’17)
No Indicator Project to
Citramas Sub-Cont. Citramas Sub-Cont Date
1. Man-Power 0 0 5 5 10
2. Man-Hours Worked 0 0 280.0 280.0 560.0
3. Fatality 0 0 0 0 0
4. Lost Time Injury (LTI) 0 0 0 0 0
5. Restricted Duty Injury 0 0 0 0 0
6. Medical Treatment Injury 0 0 0 0 0
(MTI)
7. First Aid Injury (FAI) 0 0 0 0 0
8. Light / Heavy Equipment
Damage
0 0 0 0 0
9. Property Damage 0 0 0 0 0
10. Environmental Case 0 0 0 0 0
11. Fire 0 0 0 0 0
12. Nearmiss 0 0 0 0 0
13. Hazard 0 0 0 0 0

FREQUENCY RATES TOTAL

a. LTIFRLost Time Injury Frequency Rate=(Number of LTI x 200,000 / Man-hours worked) 0.0
b. IFRIncident Frequency Rate = (Number of incident x 200,000/Man-hour worked) 0.0
c. TRIFRTotal Recordable Injury Frequency Rate= (Number of (FAI+MTI+RDI)x200,000/Man-hours worked 0.0

MAN-HOURS RECORDED CTI Sub-Cont. TOTAL

Man-Hours Worked Project To Date 280.0 280.0 560

Man-Hours Worked LTI Free 280.0 280.0 560

2. HSE ACTIVITIES (LEAD INDICATORs)

A. HSE INSPECTION/AWARENESS
1. Hand Tools Inspection : 01 time This (monthly)
2. Electrical Tools Inspection : 01 times (Monthly)
3. Vehicle Inspection : 01 times (Monthly)
4. Rigging Gear Inspection : None
5. Full Body Harness Inspection : None
6. First Aid Kit Inspection : 01 Time (Monthly)
7. Management Site Inspection : 01 time (Monthly)
8. Grinder Inspection : None
9. Ladder Inspection : On The Spot Action
10. Fire Extinguisher Inspection : None
11. Weekly Site Clean Up : 4 time (Monthly)
12. On Spot HSE Checks : None
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 MONTHLY HSE PERFORMANCE REPORT
Project: SUTT 150 KV Seputih Banyak-
Menggala
Doc. No.: CTI / SBM / HSE / X / 10 / 2017

13. Checklist LK3 : Not applicable currently

14. Tripping / Hole Inspection : None
15. Safety Signage Inspection : On Spot action
16. Eye Wash Pre-Use Inspection : Not applicable currently
17. Concrete Vibrator Pre-Use Inspectio : None

B. UPDATING PERMIT/JSA
1. Approved New Permits : 01 times (Re-Check Survey)
2. Approved New JSA : 01 times (Re-Check Survey)
3. Extend Permit :
4. Extend Permit :
5. Extend Permit :

C. HSE TRAINING / SOCIALIZATION

1. HSE Induction : New employee & Refresh
2. HSE Refress induction : None
3. Permit / JSA Socialization : 01 time (Monthly)
4. Supervisory HSE Training : 0 Time (Monthly)
5. Safety Drills : On going proses (next month)
6. Hazob Training/Socialization : None
7. Wearing PPE Training/Socialization : 01 time (Sosialisation in daily toolboxmeeting)
8. Other HSE Socializations : 01 time (sosialisation in daily toolboxmeeting)
9. Following Client HSE Training : None

D. HSE MEETINGS
1. Daily Toolbox Meeting : 2 times (Site project)
2. Weekly Safety Meeting : 01 time (Monthly)
3. Monthly Client Project Meeting : None

E. HSE AUDITS
1. Internal Divisional HSE Audit : None
2. Client HSE Audit : None
3. Government Visit : None
: None
F. OTHER HSE ACTIVITIES
1. Update safety alert : 0 time (Monthly)
2. Update HSE performance board : 0 time (Monthly)
3. Field Monitoring activities : 30 times activities (Re-Check Survey dan Revisi
Tower)
4. Completed JSA pondasi and
Loading Unloading material Rebar
: 0 Time (Monthly)
5. Monitoring unloading material tower
: None

3. HSE PLAN FOR NEXT MONTH

A. Following Safety Plan Three Month Ahead
 Morning toolbox meeting : 4 times
 Weekly HSE Meeting : 1 time (Monthly)
 Client Meeting : 1 time
 Hand tool inspection : None

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 MONTHLY HSE PERFORMANCE REPORT
Project: SUTT 150 KV Seputih Banyak-
Menggala
Doc. No.: CTI / SBM / HSE / X / 10 / 2017

 Electrical inspection : 01 time (Monthly

 Vehicle inspection : 01 time (Montly)
 First Aid Kit : 01 Time (Monthly)
 Management site inspection : 01 Time (Monthly)
 Review JSA/jobs : As working progress
 Fire Extinguisher : 0 Time (Monthly)
 Weekly site clean up : 05 Time (Monthly)
 Update Work Permit/JSA : As working progress
 HSE Induction : New employee & Refresh
 Sosialisasi Permit / JSA : 31 times
 Safety Alert Update : 01 time (Monthly)
 Pre-Start check LV : 24 times for one LV
 Appointment Safety Representative : for delegated supervisor area

B. Continue execute Site Safety Activities for The Next Month

 Safety Induction
 Completing Investigation report
 PPE monitoring & Control
 JSA & Permit Implementation Control
 All suitable Inspection
 Continue to Individual score
 Small Training for incident and reporting
C. Etc.
 Follow up HIRAC, JSA, Inspection Tools and Equipment Civil.
 Monitoring and support Foundation excavation activity.
 Coordination with HSE PLN for arrange Permit work to foundation excavation
 Coordination with site manager for arranges schedule people to attend training.
 Continue HSE Reporting ( Daily, Weekly, Monthly)
 Continue HSE Weekly Meeting.
 Improve Filling system of HSE Documentation.
 Preparing safety sign in workplace in order to Completing safety standart before
excavation foundation.

Lampung, 31 Oktober 2017

Prepared by: Reviewed by, Ackonowledge by:

HSE Dept,

(Fajar Kurniawan) ( Erif W. Hendrayana ) ( Azwar )

HSE Officer QHSE Manager Project / Site Manager

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