I Care Leader Observation Form

Name/Nama :
Entity/Entitas :
Position/Posisi :
Date of period/Periode tanggal :
Place/Tempat :
Activity/Kegiatan :
Observation/Observasi

I. Unsafe Act/Perilaku Tidak aman :

Reported into CeRMAT and attached 

II. Unsafe Condition/Situasi Tidak Aman :

Reported into CeRMAT and attached 

III. Incident/Kecelakaan :

Reported into CeRMAT and attached 

IV. Golden Rules Socialization :

Picture and attendance list attached

V. STOP Card issue :

Reported into CeRMAT and attached

VI. Other HSE Issue/Safety Feedback Notice talk

Note: Reported by, Acknowledge by,

- Observation period will be on Saturday to Friday in every week
- this report to be sent to SPS/S&E Secretary on Friday at the latest