NAMA PROJECT / NAMA PERUSAHAAN

Plan Impelmented Percentage

Title :

SHE PROGRAM PLAN

Bulan-Tahun
0%
NO PROGRAM STATU 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 SCORE PIC PERIOD NOTE
S
Minggu 1 Minggu 2 Minggu 3 Minggu 4
2. Training
PLAN Refers to SEGS Safety
2.1 Orientation Training 0% HSE Engineer AR
ACTUAL Induction
Requirement
3. Communication
3.1 Meeting
PLAN VVVVVVVVV V V V V V V V V V V V V V V V V V V V V V 0% HSE Manager,
3.1.2 Toolbox Meeting Daily Daily Tool Box MOM
ACTUAL Supervisor,
Engineer, Officer
PLAN V V V V 0% HSE Manager,
3.1.3 HSE Talk Weekly Signed HSE Topic
ACTUAL Supervisor,
Engineer, Officer
PLAN V V V V V 0%
3.1.4 Construction Meeting HSE Manager Weekly MOM & Attandance List
ACTUAL
PLAN V V V V V 0% HSE Supervisor,
3.1.5 HSE Patrol/ Walkthrough Weekly MOM & Attandance List
ACTUAL Engineer,
Officer
Management HSE Committee Meeting PLAN V 0%
3.1.6 HSE Manager Monthly MOM & Attandance List
ACTUAL
PLAN V V V V 0%
3.1.7 Driver Safety Briefing HSE Engineer Monthly MOM & Attandance List
ACTUAL
3.2 Campaign/Socialization
PLAN V V V V V V 0%
3.2.1 Information Board & Signboard Update Admin HSE Weekly Photograph
ACTUAL
3.3 Report
PLAN VVVVVVVVV V V V V V V V V V V V V V V V V V V V V V 0%
3.3.1 Daily Report HSE Engineer Daily DCT Record and
ACTUAL Dashboard
PLAN V V V V V 0%
3.3.2 Weekly Report HSE Engineer Weekly DCT Record and
ACTUAL Dashboard
PLAN V 0%
3.3.3 Monthly Report HSE Engineer Monthly DCT Record and
ACTUAL Dashboard
4. Inspection & Audit
PLAN 0%
4.1 Pre-mobilization Inspection HSE Supervisor AR Inspection Report
ACTUAL
PLAN VVVVVVVVV V V V V V V V V V V V V V V V V V V V V V 0%
4.2 Daily Safety Inspection HSE Supervisor AR Daily Report
ACTUAL
PLAN V 0% HSE Supervisor &
4.4 Electrical Inspection Monthly Maintenance Record
ACTUAL Electrical
Engineer
PLAN V 0%
4.5 Motor Vehicle Inspection HSE Supervisor Monthly Inspection Report
ACTUAL
PLAN V 0%
4.7 PPE HSE Supervisor Monthly Inspection Report

ACTUAL
PLAN V V
4.8 LV & HE Random Check 0% HSE Supervisor Weekly Inspection Report
 ACTUAL
5. Risk Management System
PLAN HSE Manager, Engineer,
5.1 Work Permit Review and Assessment 0% AR Work Permit Summary
ACTUAL Supervisor

PLAN HSE Manager,

5.2 JSA 0% A JSA
Engineer,
ACTUAL R
Supervisor
6. SHE Reward and Incentive
PLAN V V V V V
6.1 SHE Awards 0% HSE Representaive Monthly Awards
ACTUAL
7. Health and Environmental
Waste Handling for Construction PLAN VVVVVVVVV V V V V V V V V V V V V V V V V V V V V V
7.1 0% HSE Supervisor Daily Clean Area
debris, office activity. ACTUAL
PLAN V V V V V
7.2 Environmental Inspection 0% HSE Supervisor Weekly Weekly Report
ACTUAL
PLAN
7.3 Waste Handling for Hazardous Waste 0% HSE Supervisor A Weekly Report
ACTUAL R
PLAN V V V V Room & Car Inspection
7.4 Car & Office Disinfection Spray 0% Medic Weekly
ACTUAL Checklist
Tag
PLAN VVVVVVVVV V V V V V V V V V V V V V V V V V V V V V
7.5 Fatigue Check 0% Medic Daily Inspection Report
ACTUAL
PLAN V V
7.6 Alcohol Random Check 0% Medic Weekly Inspection Report
ACTUAL
PLAN V V
7.7 Drug Random Check 0% Medic Monthly Inspection Report
ACTUAL
9. Fire Prevention and Protection
PLAN V Inspection checklist &
9.1 Firefighting System Inspection 0% HSE Supervisor Monthly
ACTUAL report

Prepared by Check & Approved by

M. Alfian Tito Rizqi

HSE Engineer HSE Manager