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Found volume bottle of instrument gas supply, V-3253, at HT-01 Tingkat Keparahan/ Severity Real Severity Potential Likelihood
MAN without name plate. Level (1-6) Severity (1-6) (1-6)
Cedera Manusia / Human Injury
Kerusakan Lingkungan/Environment Damage
Kerusakan Finansial/ Financial Loss:
[ ] Production Loss [ ] Material Loss
Media
Name / Nama :
l
Pelapor - Diisi jika diperlukan (Filled if required) RSES - CSR
Nama (Name): Gede Andi Dipayadnya l Date / Tanggal :
Bagian (Entity): CST/OPB Perusahaan (Co.): INCONIS Name / Nama :
Signature / Td. Tangan :
Atasan Pelapor (Line Supervisor) ; SRI widadi *Internal Deadline (Estimated date for the case to be closed) :
Bagian (Entity): CST/OPB Td. Tangan (Signature): Date: Signature&Name:
CeRMATi sekeliling anda untuk meningkatkan keselamatan. Do CeRMAT in your surrounding to improve safety. Use CR EP HSE 102 as reference to define severity level of the case