EVALUATION

CONTRACTOR REPORT
PERIOD OF 24-31 Oktober 2022

CONTENT OF REPORTS
1. HSE Performance
2. Corrective Action Report (CAR)
3. Injury / Ilness
4. JSEA Register
5. Disciplinary Action
6. Documentations

WEEKLY HSE REPORT

Project : AMNK Reporting Period 17-23 Oktober 202

Manhours Period : 14.630 Manhours Project To Date 3.797.591

1.1 MANPOWER & MANHOURS

Employee Manhours
PROJECT EMPLOYEE
Last Week This Week Last Week This Week
Staff Non Staff Variance
(Cummulative) (Cummulative) (Cummulative) (Cummulative)
PT. HPMU 15 160 160 175 3.771.004 3.784.479 13.475
PT. KPP 4 0 4 4 3.608 3.916 308
PT. DKD 1 10 10 11 8.349 9.196 847

Total 20 170 174 190 3.782.961 3.797.591 14.630

1.2 HSE STATISTICS

This Week This Month
HSE STATUS
Weekly Target Actual Monthly Target Actual
Total of Incident 0 0 0 0
Near Miss 0 0 0 0
HPRI (High Potential Risk Incident) 0 0 0 0
First Aids 0 0 0 0
Medical Treatment 0 0 0 0
Minor Injury 0 0 0 0
Major Injury 0 0 0 0
Lost Time Injury 0 0 0 0
Fatal Incident 0 0 0 0
Fire Case 0 0 0 0
Property Damage (PD) Incidents 0 0 0 0
Environmental Incident 0 0 0 0

1.3 HSE TRAINING PROGRAM

No Date Duration Training Program No. of Participant Trainer

1 2 Hours Safety Induction Pekerja

2 1 Hours Refresh Induction After Field Break

3 2 Hours LOTO Training

4 2 Hours Defensive Driving

5 2Hours Training Spotter

6 2 Hours Fit for Work

7 2 Hours PIT Induksi

8 2 Hours HLO Induksi 15 BSI

1.5 ACTIVITIES THIS WEEK :

1 Input absensi Toolbox meeting & monitoring jam tidur karyawan

2 Prosses SIMPER

3 Spot Check Internal

4 Spot Check With BSI

5 Ordering HSE Material and Equipment

6 HSE Inspection

7 Commite meeting with PT BSI

8 Inspeksi APAR

9 Update HAZID, TAHAN, & OK-Kan

1.6 ACTIVITIES NEXT WEEK :

1 Input absensi Toolbox meeting & monitoring jam tidur karyawan

2 Prosses SIMPER

3 Spot Check Internal

4 Spot Check With BSI

5 Ordering HSE Material and Equipment

6 HSE Inspection

7 Commite meeting with PT BSI

8 Inspeksi APAR

9 Update HAZID, TAHAN, & OK-Kan

10 Fatigue Check
No. of Inspection Findings 18 Severity A Immediate
Open 4 B < 1 Week
Closed 15
CORRECTIVE ACTION REPORT Of
Deviations C > 1 Week
Cancelled 0 (CAR)
Closure (%) 83% Tracked By: Fery Pratama

Corrective Action Required,

No Date Inspection Source Inspection Findings
Attach a photo, if done
Department Close Date Status Severity *

Belum tersedia daftar periksa sebagai alat bantu untuk Membuat daftar periksa sebagai panduan dalam
1 13-Jan-22 SMSI HSE 01-Feb-22 Closed C
melakukan inspeksi di area kerja. melakukan inspeksi di area kerja.

Membuat jadwal perawatan peralatan yang terintegrasi

dengan matrix perawatan peralatan.//Create an
2 21 Juli 2022 Others Incident LV 35 Plant 10-Aug-22 Open C
equipment maintenance schedule that is integrated with
the equipment maintenance matrix

Memberikan pelatihan Teknik perawatan kendaraan

3 21 Juli 2022 Others Incident LV 35 ringan kepada mekanik.//Providing light vehicle Plant 30-Aug-22 Open c
maintenance engineering training to mechanics
Memberikan training identifikasi bahaya (hazard
4 22-Sep-22 Others Incident EX55 awareness) kepada personil yang terlibat
Trainer 31-Oct-22 Open c
Mensosialisasikan kepada pekerja kewajiban untuk
5 22-Sep-22 Others Incident EX55 mengisi take on 7 ketika berpindah area kerja atau HSE 07-Oct-22 Closed c
Melakukan sosialisasi Prosedure pengoprasian fuel truck
6 22-Sep-22 Others Incident EX55 UA/HIS-SOP/HSE-30 yang sudah di revisi
HSE 07-Oct-22 Closed c
Menyusun metode komunikasi terhadap personil yang
7 22-Sep-22 Others Incident EX55 HSE 31-Oct-22 Closed c
melakukan hot change shift
Melakukan maping area berbahaya untuk melakukan
8 22-Sep-22 Others Incident EX55 HSE 07-Oct-22 Closed c
refueling
Melakukan pendampingan terhadap operator arkato
9 22-Sep-22 Others Incident EX55 yang baru bergabung sesuai dengan prosedure training Trainer 22-Nov-22 Open c
BSI (200 jam kerja)
Merevisi risk assessment secara spesifik mengidentifikasi
10 22-Sep-22 Others Incident EX55 area berbahaya untuk melakukan pengisian fuel HSE 07-Oct-22 Closed c

Memberikan surat peringatan dan coaching kepada

11 22-Sep-22 Others Incident EX55 HR 07-Oct-22 Closed c
operator Excavator dan operator fuel.
Merevisi Prosedure pengoprasian fuel truck UA/HIS-
12 22-Sep-22 Others Incident EX55 SOP/HSE-30 dengan menambahkan secara detail area Opeartion 07-Oct-22 Closed c
berbahaya pengisian refueling
Masih ditemukan cairan B3 yang diletakkan di sembarang Mengamankan cairan B3 ke lokasi penyimpanan yang
13 6-Oct-22 smsi tempat. lebih aman HSE 10-Oct-22 Closed c
Tempat penyimpanan kopi dan gula dalam kondisi yang Menyediakan cabinet penyimpanan yang bersih atau
14 6-Oct-22 smsi kotor dan berpotensi terkontaminasi oleh banyak bakteri. membersihkan Kembali cabinet penyimpanan kopi dan HSE 10-Oct-22 Closed c
gula tersebut.
Tempat penyimpanan kopi dan gula ditempatkan Menyingkirkan drum oli agar tidak berdekatan dnegan
15 6-Oct-22 smsi berdekatan dengan drum oli. bahan makanan dan minuman. HSE 07-Oct-22 Closed c
Penempatan P3K yang kurang sesuai karena terhalang Menempatkan kotak P3K pada lokasi yang lebih mudah
16 6-Oct-22 smsi oleh Dispenser dan meja. dijankau dan tidak terhalang oleh material lain. HSE 15-Oct-22 Closed c
Ditemukan shackle omega yang belum diberikan label Menyarankan untuk menyerahkan kepada department
17 6-Oct-22 smsi inspeksi bulanan RISCA untuk diinspeksi dan diberikan label inspeksi. HSE 15-Oct-22 Closed c
Ditemukan jerry can yang belum diberikan label B3 terkait Melengkapi jerry can dengan label B3.
18 6-Oct-22 smsi kandungan dan bahaya pada cairan tersebut. HSE 15-Oct-22 Closed c
Terdapat material terpauline yang tidak tertata diatas Memindahkan tarpaulin dari atas container.
19 6-Oct-22 smsi container dibelakang oil storage. HSE 22-Oct-22 Closed c
 EMPLOYEE REPORTS OF INJURY / ILLNESS
Site :
Period :
No. Name Position Department Age (th) INJURIES / ILLNESS Keterangan dokter

Keterangan :
- Lakukan pencatatan pada setiap karyawan yang diantar berobat ke klinik atau puskesmas
 JOB SAFETY ENVIRONMENTAL ANALYSIS REGISTER
JSEA REGISTER
SITE Malinau
No JSEA Reg. Number Rev. Work Activity / JSA Name Deaprtment Work Area Date Approved

1 UA-JSEA-001(01) 1 Remove ADT tyre use backhoe loader Plant Workshop 13 14-Sep-15
2 UA-JSEA-002(01) 1 Welding activity in the container Plant Workshop 13 25-Oct-15
3 UA-JSEA-003(01) 1 Remove Grader tyre Plant Workshop 13 17-Nov-15
4 UA-JSEA-004(01) 1 Install Grader tyre Plant Workshop 13 17-Nov-15
5 UA-JSEA-005(01) 1 Remove vibro compactor drum Plant Workshop 13 21-Jan-16
6 UA-JSEA-006(01) 1 SIMPER Test Operational Workshop 13 23-Mar-16
7 UA-JSEA-007(01) 1 Heavy Equipment Mobilization (LCT-W/S) Operational Workshop 13 13-Apr-16
8 UA-JSEA-008(01) 1 Install cutting edge to grader MG Plant Workshop 13 27-May-16
9 UA-JSEA-009(01) 1 Welding excavator bucket Plant Workshop 13 28-May-16
10 UA-JSEA-010(01) 1 Minor repair Plant Workshop 13 16-Aug-16
11 UA-JSEA-011(01) 1 Replace rotary joint Plant Workshop 13 18-Aug-16
12 UA-JSEA-012(01) 1 Repair bucket Plant Workshop 13 20-Aug-16
13 UA-JSEA-013(01) 1 Machine trouble shooting Plant Workshop 13 25-Aug-16
14 UA-JSEA-014(01) 1 Repair rockbreaker Plant Workshop 13 07-Sep-16
15 UA-JSEA-015(01) 1 Instal pin breaker Plant Workshop 13 09-Sep-16
16 UA-JSEA-016(01) 1 Dump truck service Plant Workshop 13 23-Sep-16
17 UA-JSEA-017(01) 1 Add air pressure Plant Workshop 13 01-Oct-16
18 UA-JSEA-018(01) 1 Assembly hyd breaker Plant Workshop 13 03-Oct-16
19 UA-JSEA-019(01) 1 Auto lube inspect Plant Workshop 13 04-Oct-16
20 UA-JSEA-020(01) 1 Clean up contamination Plant Workshop 13 08-Oct-16
21 UA-JSEA-021(01) 1 Replace hose boom Plant Workshop 13 02-Oct-16
22 UA-JSEA-022(01) 1 Hose bucket Plant Workshop 13 11-Oct-16
23 UA-JSEA-023(01) 1 Hose greader Plant Workshop 13 05-Oct-16
24 UA-JSEA-024(01) 1 Minor repair electrical LV Plant Workshop 13 18-Oct-16
25 UA-JSEA-025(01) 1 Minor repair electrical system Plant Workshop 13 16-Oct-16
26 UA-JSEA-026(01) 1 Minor repair ganti v-belt AC Plant Workshop 13 22-Oct-16
27 UA-JSEA-027(01) 1 Pergantian cable gass & service backhoe loader Plant Workshop 13 12-Oct-16
28 UA-JSEA-028(01) 1 Pergantian pada daerah rotary joint Plant Workshop 13 17-Oct-16
29 UA-JSEA-029(01) 1 Periodik maintenance service unit Plant Workshop 13 24-Oct-16
30 UA-JSEA-030(01) 1 Troubleshooting lever dump problem Plant Workshop 13 20-Oct-16
31 UA-JSEA-031(01) 1 Troubleshooting machine low power Plant Workshop 13 15-Oct-16
32 UA-JSEA-032(01) 1 Welding dozer Plant Workshop 13 13-Oct-16
33 UA-JSEA-033(01) 1 Replace cutter blade dozer Plant Workshop 13 23-Oct-16
34 UA-JSEA-034(01) 1 Replace cutter blade grader Plant Workshop 13 25-Oct-16
35 UA-JSEA-035(01) 1 Welding and doubling bucket Plant Workshop 13 06-Oct-16
36 UA-JSEA-036(01) 1 Repaire wiry and workshop Plant Workshop 13 07-Oct-16
37 UA-JSEA-037(01) 1 Repaire wiry and sensor hyd Plant Workshop 13 09-Oct-16
38 UA-JSEA-038(01) 1 Repaire and modification wirny LV Plant Workshop 13 19-Oct-16
39 UA-JSEA-039(01) 1 Replace stater motor compact Plant Workshop 13 26-Oct-16
40 UA-JSEA-040(01) 1 Replace ac compressor and component related Plant Workshop 13 21-Oct-16
41 UA-JSEA-041(01) 1 Replace pump pc 400 Plant Workshop 13 27-Oct-16
42 UA-JSEA-042(01) 1 Welding component area enggine Plant Workshop 13 28-Oct-16
43 UA-JSEA-043(01) 1 Replace tyre greader Plant Workshop 13 29-Oct-16
44 UA-JSEA-044(01) 1 Replace tyre Wheelloader Plant Workshop 13 14-Oct-16
45 UA-JSEA-045(01) 1 Replace tyre ADT Plant Workshop 13 01-Oct-16
46 UA-JSEA-046(01) 1 Replace pinion circle greader Plant Workshop 13 30-Oct-16
47 UA-JSEA-047(01) 1 Diassembly and assembly drum compactor Plant Workshop 13 30-Oct-16
48 UA-JSEA-048(01) 1 Greasing all unit Plant Workshop 13 14-Oct-16
49 UA-JSEA-049(01) 1 Instal back lamp dump truck Plant Workshop 13 28-Oct-16
50 UA-JSEA-050(01) 1 Instal mirror glass & apar Plant Workshop 13 26-Oct-16
51 UA-JSEA-051(01) 1 Instal wiper + minnor repair electric Plant Workshop 13 15-Oct-16
52 UA-JSEA-052(01) 1 JAMPER BATTERY Plant Workshop 13 05-Oct-16
53 UA-JSEA-053(01) 1 minor repaire electrical LT Plant Workshop 13 17-Oct-16
54 UA-JSEA-054(01) 1 Monitoring engine blue bay Plant Workshop 13 27-May-16
55 UA-JSEA-055(01) 1 Pergantian Cylinder and Turnion arm Circle Greader Plant Workshop 13 04-Oct-16
56 UA-JSEA-056(01) 1 PM Service Unit Plant Workshop 13 16-Aug-16
57 UA-JSEA-057(01) 1 Re instal track lose pc 200 Plant Workshop 13 12-Oct-16
58 UA-JSEA-05801) 1 Remove & Install Disc Clutch ( DT ) Plant Workshop 13 24-Oct-16
59 UA-JSEA-059(01) 1 Remove & Install Front Spring ( DT ) Plant Workshop 13 25-Aug-16
60 UA-JSEA-060(01) 1 Re-oring control valve Plant Workshop 13 20-Aug-16
61 UA-JSEA-061(01) 1 repair and modification pipe line fuel pump Plant Workshop 13 23-Sep-16
62 UA-JSEA-062(01) 1 Repair muffler Plant Workshop 13 01-Oct-16
63 UA-JSEA-063(01) 1 Repair track exca Plant Workshop 13 23-Oct-16
64 UA-JSEA-064(01) 1 repair wiring AC system Plant Workshop 13 16-Aug-16
65 UA-JSEA-065(01) 1 Repaire and modification LV wiring Electrician Plant Workshop 13 16-Aug-16
66 UA-JSEA-066(01) 1 Repaire Bucket (WELDER) Plant Workshop 13 01-Nov-16
67 UA-JSEA-067(01) 1 Repaire Electrical Wiring and Sensor Hydraulic Plant Workshop 13 02-Nov-16
68 UA-JSEA-068(01) 1 Repaire Electrical Wiring and Work Lamp Plant Workshop 13 03-Nov-16
69 UA-JSEA-069(01) 1 Replace battery motor greader Plant Workshop 13 04-Nov-16
70 UA-JSEA-070(01) 1 Replace Bucket Plant Workshop 13 05-Nov-16
71 UA-JSEA-071(01) 1 replace cross joint backhoe loader Plant Workshop 13 06-Nov-16
72 UA-JSEA-072(01) 1 Replace Cutter blade Greader Plant Workshop 13 07-Nov-16
73 UA-JSEA-073(01) 1 Replace Cutter EDGE Greader Plant Workshop 13 08-Nov-16
74 UA-JSEA-074(01) 1 Replace Drive Shaft ADT Plant Workshop 13 09-Nov-16
75 UA-JSEA-075(01) 1 Replace Dryer + repair AC system Plant Workshop 13 10-Nov-16
76 UA-JSEA-076(01) 1 Replace End Bit D85 (TRACK) Plant Workshop 13 11-Nov-16
77 UA-JSEA-077(01) 1 Replace Radiator Dozer (Track) Plant Workshop 13 12-Nov-16
78 UA-JSEA-078(01) 1 Replace Roller Drum and Component Vibro Plant Workshop 13 13-Nov-16
79 UA-JSEA-079(01) 1 Replace sprocket Plant Workshop 13 14-Nov-16
80 UA-JSEA-080(01) 1 Replace Stater Motor Vibro Plant Workshop 13 15-Nov-16
81 UA-JSEA-081(01) 1 Replace Teeth Bucket Plant Workshop 13 16-Nov-16
82 UA-JSEA-082(01) 1 Replace Tyre Pos ADT Plant Workshop 13 17-Nov-16
83 UA-JSEA-083(01) 1 Replace Tyre Pos Whell Loader Plant Workshop 13 18-Nov-16
84 UA-JSEA-084(01) 1 Replace v-belt altenator exca Plant Workshop 13 19-Nov-16
85 UA-JSEA-085(01) 1 Replace Water Pump Enggine PC 400 Plant Workshop 13 20-Nov-16
86 UA-JSEA-086(01) 1 Reseal cylinder boom Plant Workshop 13 21-Nov-16
87 UA-JSEA-087(01) 1 Troubleshooting Brake system Plant Workshop 13 22-Nov-16
88 UA-JSEA-088(01) 1 Welding bucket excavator Plant Workshop 13 23-Nov-16
89 UA-JSEA-089(01) 1 Assembly engine LT Plant Workshop 13 24-Dec-16
90 UA-JSEA-090(01) 1 Inpection unit Plant Workshop 13 28-Feb-17
91 UA-JSEA-091(01) 1 JSEA Towing Greader Plant Workshop 13 08-Mar-17
92 UA-JSEA-092(01) 1 Parking brake Plant Workshop 13 21-Mar-17
93 UA-JSEA-093(01) 1 instal cylinder boom Plant Workshop 13 07-May-17
94 UA-JSEA-094(01) 1 hose breaker Plant Workshop 13 17-Oct-17
95 UA-JSEA-095(01) 1 Fuel System ADT Plant Workshop 13 25-Oct-17
96 UA-JSEA-096(01) 1 instal breaker & asembly piping Plant Workshop 13 28-Oct-17
 97 UA-JSEA-097(01) 1 Inpection unit after accidentr Plant Workshop 13 30-Oct-17
98 UA-JSEA-098(01) 1 Instal work lamp LT Plant Workshop 13 30-Oct-17
99 UA-JSEA-099(01) 1 Menurunkan Unit Dari Lowboy&Truck Plant Workshop 13 07-Nov-17
100 UA-JSEA-100(01) 1 Check coolant leak & R&I Water pump Plant Workshop 13 22-Nov-17
101 UA-JSEA-101(01) 1 penurunan oli Plant Workshop 13 22-Nov-17
102 UA-JSEA-102(01) 1 Painting unit (SUPPORT) Plant Workshop 13 27-Nov-17
103 UA-JSEA-103(01) 1 Instal block control valve Plant Workshop 13 22-Jan-18
104 UA-JSEA-104(01) 1 hose return control valve Plant Workshop 13 21-Feb-18
105 UA-JSEA-105(01) 1 Instalation work lamp unit baru Plant Workshop 13 08-Mar-18
106 UA-JSEA-106 (01) 1 Fuel system Exca Plant Workshop 13 14-Apr-18
107 UA-JSEA-107(01) 1 Inpection and training product komatsu Plant Workshop 13 20-Apr-18
108 UA-JSEA-108(01) 1 Instal pin & bushing bucket Plant Workshop 13 06-Jul-18
109 UA-JSEA-109(01) 1 Oil cooler HM 400 Plant Workshop 13 17-Jul-18
110 UA-JSEA-110(01) 1 Pemindahan barang menggunakan crane Plant Workshop 13 02-Aug-18
111 UA-JSEA-111(01) 1 hose hydraulic ADT Plant Workshop 13 05-Aug-18
112 UA-JSEA-112(01) 1 instal cylinder bucket Plant Workshop 13 09-Aug-18
113 UA-JSEA-113(01) 1 Instal kaca mika cabin Plant Workshop 13 18-Sep-18
114 UA-JSEA-114(01) 1 Auto lube inspect Plant Workshop 13 30-Sep-18
115 UA-JSEA-115(01) 1 Escord Forklift Plant Workshop 13 10-Oct-18
116 UA-JSEA-116(01) 1 Flashing Hydraulic system Plant Workshop 13 12-Oct-18
117 UA-JSEA-117(01) 1 hose boom Plant Workshop 13 14-Oct-18
118 UA-JSEA-118(01) 1 Monitoring engine blue bay Plant Workshop 13 23-Oct-18
119 UA-JSEA-119(01) 1 Assembly hyd breaker Plant Workshop 13 03-Feb-19
120 UA-JSEA-120(01) 1 Adjust Circle Grader Plant Workshop 13 14-Jun-19
121 UA-JSEA-121(01) 1 hose motor travel Plant Workshop 13 20-Jun-19
122 UA-JSEA-122(01) 1 Menaikkan Unit A2B ke Truck pengangkut Plant Workshop 13 27-Jun-19
123 UA-JSEA-123(01) 1 Assembly track link Plant Workshop 13 10-Jul-19
124 UA-JSEA-124(01) 1 Monthly inspection LV Plant Workshop 13 16-Jul-19
125 UA-JSEA-125(01) 1 Mounting drum compactor Plant Workshop 13 19-Jul-19
 TINDAKAN DISIPLIN TAHUN 2022
PELANGGARAN LAMA SAKSI
Posisi / USIA BUKTI TINDAKAN
NO HARI TANGGAL WAKTU JENIS PELANGGARAN Deskripsi LOKASI Nama PERUSAHAAN BEKERJA ADMINISTR PENGAWAS TINDAKAN PERBAIKAN
Pelanggaran Pelanggaran jabatan (TH) PERBAIKAN
Utama Umum (bulan) ASI

PT Uniteda
Surat
1 Sabtu 10/09/2022 Surat Teguran Incidet LV 35 V Workshop Arkato M. Ikbal Supt Plant Arkato Site Terlampir
Teguran
TBO

PT Uniteda
2 Incident EX 55 V Workshop Arkato Naufal Andirozaq F Operator Arkato Site SP 1 Terlampir
TBO

PT Uniteda
Surat
3 Incident EX 55 V Workshop Arkato Dasa Redi Operator Arkato Site Terlampir
Teguran
TBO

PT Uniteda
Melanggar OPP Lock Out ADT
4 V Adhika H Operator Arkato Site SP 1 Terlampir
Rambu STOP dan HT
TBO
 HSE ACTIVITY
1. Health Activity

Annual MCU Karyawan pemeriksaan tekanan darah

2. Enviro Activity

clean up TPS B3

3. Safety Activity

CRM Tyre With Custodian Inspeksi dan PCC Maintenance Unit Excavator OHS Highlight Joint Spot Check

Safety Kontraktor Meeting Pemilihan Spare Part dan house keeping Safety Patrol Komisioning Unit