FORM KERJA Dokumen :

HSE MONTHLY REPORT

Project Name : WTC - 3

Company : PT. JAGA CITRA INTI
Date of Report : JANUARI 2017

A. Activities

Previous
This Month YTD
Month YTD

Toolbox Meeting 16 0 16
Inspection 4 0 4
Safety Induction 43 0 43
Training 1 0 1
Permit to Work 8 0 8

B. Number of Worker and Working Hours

Previous
This Month Month YTD Current YTD
Totals

Total Working Days 24 0 24

Total Working Days Free Since Last LTI 24 0 24
Total Average Workers 32 0 32
Total Man Hours 6184 0 6184
Total Man Hours Free Since Last LTI 6184 0 6184

C. Accident Statistics
Previous
This Month Month YTD Current YTD
Totals
Near Miss 5 0 5
First Aid Injury 0 0 0
Medical Treatment Injury 0 0 0
Lost Time Injury 0 0 0
Fatality 0 0 0
Total Incident / Accident 5 0 5

Fire/Other Incident 0 0 0
D. Victim's Condition
Previous
This Month Month YTD Current YTD
Totals
Minor Injuries 0 0 0
Major Injuries 0 0 0
Death 0 0 0
Total Injuries 0 0 0

E. Frequency and Severity Rate

Total
Frequency Rate 808.538163001
Severity Rate 0

Jakarta, 1 February 2017

Reported By
Safety Officer

( Yosep Margen )
 Rev :2
Halaman : 1 dari 1
Tanggal : 28 Februari 2017

Times
Times
Times
Times
Times

Current YTD

24
24
32 Average 16
6184
6184

Current YTD

5 Case
0 Case
0 Case
0 Case
0 Case
5 Case

0 Case
Current YTD

0 People
0 People
0 People
0 People

Approved By
Project Manager

( Warsigit Budianto )
 FORM KERJA Dokumen : Rev
Halaman
HSE MONTHLY REPORT Tanggal

Project Name : WTC - 3

Company : PT. JAGA CITRA INTI
Date of Report : FEBUARY 2017

A. Activities

Previous
This Month YTD
Month YTD

Toolbox Meeting 15 16 31 Times

Inspection 8 4 12 Times
Safety Induction 16 43 59 Times
Training 1 1 2 Times
Permit to Work 4 8 12 Times

B. Number of Worker and Working Hours

Previous
This Month Month YTD Current YTD
Totals

Total Working Days 25 24 49

Total Working Days Free Since Last LTI 25 24 49
Total Average Workers 31 32 63
Total Man Hours 9870 6184 16054
Total Man Hours Free Since Last LTI 9870 6184 16054

C. Accident Statistics
Previous
This Month Month YTD Current YTD
Totals
Near Miss 4 5 9 Case
First Aid Injury 2 0 2 Case
Medical Treatment Injury 0 0 0 Case
Lost Time Injury 0 0 0 Case
Fatality 0 0 0 Case
Total Incident / Accident 0 5 11 Case

Fire/Other Incident 0 0 0 Case

D. Victim's Condition
 Previous
This Month Month YTD Current YTD
Totals
Minor Injuries 0 0 0 People
Major Injuries 0 0 0 People
Death 0 0 0 People
Total Injuries 0 0 0 People

E. Frequency and Severity Rate

Total
Frequency Rate 685.187492214
Severity Rate 0

Jakarta, 1 Maret 2017

Reported By
Safety Officer

( Yosep Margen )
 :2
man : 1 dari 1
ggal : 28 Februari 2017

Average 31.5
 Approved By
Project Manager

( Warsigit Budianto )