SAFETY STATISTIC

Period of month :
Week Period
No DESCRIPTION
Week I Week II Week III
A. Incidents
1 Near Misses 0 0 0
2 Accidents 0 0 0
a) First Aid Case 0 0 0
b) Medical Treatment Cases 0 0 0
c) Lost Time Injury Case 0 0 0
d) Fatality 0 0 0
3 Material Damage 0 0 0
4 Environment Incident 0 0 0
Fire
Spill

B. Lost Workday
1 Number of Lost Workdays* 1 2 0

C. Injury Index
1 Incident Rate*
2 Frequency Rate*
3 Severity Rate*
4 Fatality Rate*

D. Number of Manpower
1 Locals (Average) 15 15 15
2 Total 15 15 15

E. Mandays Worked
1 Locals (No. of Manpower x 5 days) 43 60 75
2 Total 43 60 75
3 Manhours Worked (Manday x 8 hours) 528 584 600
2,224
Note:
in Desember there are 1 person were sick
(Poetri )

Incident Rate: Frequency Rate:

No of Incidents x 1,000 No of Incidents x 1,000,000
Total Manpower Total Manhours Worked

Fatality Rate: Severity Rate:

No of Fatalities x 1,000 Total Lost Warkdays x 1,000,000
Total Manhours Worked Total Manhours Worked

Jakarta, 3 Januari2013

Prepared by, Aknowledge by,

(Syaifuddin) (Novia Zulfa Hanum )

Safety Officer QHS Coordinator
Y STATISTIC

ek Period TOTAL CUMM. CUMM.

THIS LAST TOTAL
Week IV Week V
MONTH MONTH TO DATE

0 0 0 0 0
0 0 0 0 0 Manpower

0 0 0 0 0 Man Hours

0 0 0 0 0 Nearmiss
0 0 0 0 0 Fire
0 0 0 0 0 Spill
0 0 0 0 0 Material Damage
0 0 0 0 0 First Aid

Medical Treatment Case ( MTC )

Production Interuption
2 0 5 8 13 Loss Time Incident ( LTI )

Fatality
HSE Inspection

Equipment Inspection

0.00 0.00 HSE Management Tour

0.00 0.00 HSE Talk /Tool Box & Pre Job Meeting

0.00 0.00 HSE Drill

0.00 0.00 HSE Induction

Work Permit Report

16 16
16 16

64 72
64 72
384 128 6,936 4712
2,224
owledge by,

via Zulfa Hanum )

S Coordinator
Material Damage

Medical Treatment Case ( MTC )

Production Interuption

Loss Time Incident ( LTI )

Equipment Inspection

HSE Management Tour

HSE Talk /Tool Box & Pre Job Meeting

Work Permit Report