1. Lamp.8 PP/BIROQHSE/M/001-HSE 07
FORM K3L - 07
LAPORAN HARIAN PRESTART BRIEFING (TOOLBOX MEETING)
FORM DAILY PRESTART BRIEFING (TOOLBOX MEETING)
Nama Proyek :
NameofProject
BENDUNGAN LOLAK Number :
Kegiatan / Activity Drilling & Blasting Lokasi/Location : Quarry C ,Quarry D ,Riverbed
Tanggal / Date …../………../ 2020 Waktu Mulai/Start time: WITA
Nomor JSA /JSA number
Ijin Persyaratan, jika ada/Permit
Requirements, ifany
☐ Kerja di ketinggian / Working at Height ☐ Ruang Terbatas / Confined space
☐ Penggalian/Excavation ☐ Bekerja diatas/dekat Air/WorkingNear Water
☐ Kerja bunga api/panas(pengelasan dll)/ Hot work ☐ Alat Berat/Heavy Equipment
☐ ME/ Energized (mechanic/electric) ☐ Lain-lain/Others :Drilling& Blasting…
Alat yang digunakan, Tools used,
Uraian Materi/Description
GSP/SP/Staff Eng/Log :
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Partisipasi/masukan:
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PPE required for the task/APD yang dibutuhkan untuk bekerja
YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO
APD Tambahan/Additional PPE : Earplug
Daftar Nama / List of Name Jabatan / Designation Paraf/Small Sign
1. Abdurahman Driver / Helper
2. Burhanudin Oprator Crawl Rock Drill
3. Mat Rahmat Oprator Crawl Rock Drill
4. Rohmat Helper
5. Ucep Hermawan Helper
6. Hamdan Nugraha Helper
7. Wawan Gunawan Oprator Crawl Rock Drill
8.Ujang Suryadi Oprator Crawl Rock Drill
9. Bubun Bunyamin Oprator Crawl Rock Drill
10.Izha Sukmana Jr Mechanic
11.Bayu Koswara Helper
12.Tatang Mechanic
Petugas Pengawas/Engineer/Mandor Task Supervisor / Engineer / Foreman
Nama / Name Jabatan / Designation Tanda tangan / Signature
1. Atun Koordinator Lapangan
2. Rexsy Andika Ab Jr Eng
3.Irpan Permana Jr Blaster
4.Edi Sukaedi Blaster
Tanggal/Date : ………/ ………../ 2020 Waktu Selesai / End Time:…………………. WITA
Dilakukan Oleh,
Rexsy Andika Ab
GSP/SP/Staf Eng/Log
Mengetahui,
Carto Andriyanto
SOM/SEM
Mengetahui,
Atun
HSE Officer
