PT.

SHOETOWN GRUP

PT. CTCI Iternational Indonesia - Consultan

WEEKLY REPORT - WEEK to 3

20 - 26 NOVEMBER 2023
WORK :

"E3 BUILDING"
PEKERJAAN ELECTRICAL
COLLECTIVE NUMBER :

STG/005/OCT/2023

SUBMITTED By :

PT. INDOWIN ENGINEERING INDONESIA

JL. Ruko Kagum City. D/19. JL Tuparev No.168

Rt/Rw, 001/004 Des,Kedawung,Kec,Kedawung, Kab,Cirebon - 45653
Telp. : 0851-7425-6798
Fax. : .............................
e-mail : [email protected]
 WEEKLY REPORT
"E3 BUILDING"

Company PT. INDOWIN ENGINEERING INDONESIA Report Period 13 - 19 November - 2023

Name
Manpower 55 No. of Licensed Crane Operator 0 persons
Man-hours 3650
No. of Licensed Rigger 0 persons
Man-hours week 1&2 4137
total manhours 7787
No. of Licensed excavator 1 persons
Total no. of Safety Personnel 1 persons
Certfied Ahli MUDA K3 Konstruksi 2 persons No. of Licensed Scaffolder 0 persons
Certified Ahli MADYA K3 Konstruksi 0 persons No. of Licensed Scaffold Inspector 0 persons
Certified Ahli MADYA K3 Konstruksi 0 persons No. of Licensed Scaffold Supervisor 0 persons
Certified Ahli K3 UMUM 0 persons No. of Licensed Electrical Worker 0 persons
No. of Licensed First Aider persons No. of Trained Fire Watcher 0 persons
No. of Certified Fire Fighter persons No. of Licensed Welder 0 persons
A. Leading Indicators

No. Indicators DEFINITION TARGET Details No. of recorded this week

Inspection Weekly Panel Electical

Distribution
Tools and Equipment

Inspection Monhly FBH

Site visits carried out by the
HSE supervisors in order to
1 SHE Inspection 3 WEEK 1
check that HSE instructions are
correctly applied

Number of near misses: Events

Near Misses/ Dangerous that could have caused an
2 N/A N/A
Situations accident or an environmental
nuisance

Visitors Induction N/A persons

Arrived people on Site (visitor or
3 Inductions 100 % handled Full Induction N/A persons
employee)
Refreshment Induction > 1 year worked N/A persons

Toolbox Meeting before starting Weekly General TBM (if any) N/A persons
4 Toolbox Meeting 4/week
to work in early morning
Work groups TBM 4 groups
Hand safety 1 persons
Working At height N/A persons
These trainings are formalized Follow-up of the SHE training flagman N/A persons
5 SHE Training
by a program programme Confined Space N/A persons
Permit to work 14 persons
Induction 22 persons

Number of drills realized on the

Emergency Preparedness
6 basis of pre-established N/A event
Drills
emergency situations scenarios

7 SOC program Safety observation program N/A cards

Internal JO & Subcont safety

8 Meeting N/A event
Meeting

9 Weekly Safety Meeting with Safety Meeting 1/week N/A event

A program that show how to do

10 Show me tell me program something in proper and safe 1/week Wash My hand 1-6 step N/A event
way.

safety Campaign as per

11 Campaign observation Trend or general Every Week N/A event
Campaign by banner

Noise Monitoring N/A event

Make sure the levels of 1/week
Lux/ Illumination Monitoring N/A event
emissions from projects or
operations meet regulatory Drinking Water Monitoring N/A event
12 Enviromental Monitoring
requirements for the health &
safety of workplace and 1/ month
Waste Water Monitoring N/A event
community.
 Program to manage the wastes Weekly N/A kg
Domistic Wastes disposal
Waste Controls & produced from during
13 construction activities to ensure
Monitoring
all wastes are handled in a Not more than 90 days Hazardous Chemical Waste disposal N/A kg
manner that protects human
a Hyperkes doctor and or Daily Check Temp body worker 0 persons
medical assessment done to Daily Pre Checking panel & power Tools 0 persons
ensure an employee can safely
do a specific job or task. The
purpose is to determine if Daily Pre Checking Daily weekly Driver 0 persons
14 Fitness Check Monitoring medically the employee can Daily Gymnastics 0 persons
perform the job or task under
the working conditions

15 Audit OHS Management system

Audit inspection
Plant/ Equipment
takes place upon entering the
project site and having valid
16 Incoming Plant Inspection
certification

B. Lagging Indicators
No Type of Incident No of Incident this Week Project To Date
1 First Aid Incident 0 0
2 Medical Treatment Incident 0 0
3 Restricted Work Case Incident 0 0
4 Lost Time Incident 0 0
5 Fatality 0 0
6 HiPo (High Potential Incident) 0 0
7 Property Damaged 0 0
8 Environmental Incident 0 0

C. Incident Register
No. Date Type of Incident Description Corrective Action Status
1

Date : 27 - 11 - 2023
F. Signature F. Signature F. Signature
PT. SHOETOWN GROUP PT. SHOETOWN GROUP PT.CTCI International Indonesia PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known / Appproved By, Known / Appproved By, Preparation By,

Zhao Xiao Yong DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA NUGRAHA
FS - CONSTRUCTION SHE - PT. STG SHE COORDINATOR DIREKTUR SHE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager - PT.CTCI International Indonesia
 Inspection Schedule
NO
Week 1 Week 2 Week 3 Week 4
- Working at height and Drop object - Working at height and Drop object - Working at height and Drop object - Working at height and Drop object
Inspection Inspection Inspection Inspection
1 1 1 1
- HOT WORK Inspection - HOT WORK Inspection - HOT WORK Inspection - HOT WORK Inspection

2 Weekly Electrical panel Inspection 2 Weekly Electrical panel Inspection 2 Weekly Electrical panel Inspection 2 Weekly Electrical panel Inspection
(join inspection with Electrician) (join inspection with Electrician) (join inspection with Electrician) (join inspection with Electrician)

Weekly Scaffold & Access Egress Weekly Scaffold & Access Egress Weekly Scaffold & Access Egress Weekly Scaffold & Access Egress
inspection (join inspection with scaffold inspection (join inspection with scaffold inspection (join inspection with scaffold inspection (join inspection with scaffold
3 supervisor) 3 supervisor) 3 supervisor) 3 supervisor)

Weekly Golden Rules Inspection (join Body Harness Inspection and Weekly Golden Rules Inspection (join
inspection with PT.INDOWIN Recording inspection with PT.INDOWIN
4 VEHICLE INSPECTION 4 safetyman) 4 4 safetyman)

Weekly Golden Rules Inspection (join

inspection with PT.INDOWIN
5 safetyman) 5 PTW Inspection 5 PTW Inspection 5 PTW Inspection

Weekly Golden Rules Inspection (join

inspection with PT.INDOWIN
6 PTW Inspection 6 Fire Extinguisher Inspection 6 safetyman) 6 JSA review

7 7 7 7

Inspection Tools and Equipment Inspection Tools and Equipment PPE Inspection and Stock Monitoring PPE Inspection and Stock Monitoring
 FINDING AND CORRECTIVE ACTION
by Client

Contractor : PT. INDOWIN ENGINEERING INDONESIA

No. Date Open Date Close Finding Photo Description Action to be taken Close Out Photo

20/11/2023 Jam 20/11/2023 Jam 10. 40 PEKERJA TIDAK MENGUNAKAN HELM MEMBERIKAN PERINGATAN SECARA
1
10.32 WIB WIB SAFETY DILANTAI 1 LISAN

MEMBERI PENGERTIAN KEPADA

21 NOV 23 Jam 21 NOV 23 Jam 08 .27
2 RODA SCAFFOLDING TIDAK DIKUNCI PEKERJA UNTUK SELALU MENGCU
08.49 WIB WIB
SACFF KETIKA DIGUNAKAN

22 NOV 2023 22 NOV 2023 Jam BANYAK NYA PUTUNG ROKOK DIAREA MEMASANG RAMBU, DILARANG
3
JAM 09.15 WIB 09.30 WIB KERJA MEROKOK DIAREA KERJA

MEMBERIKAN ARAHAN AGAR PEKERJA

23 NOV 23 Jam 22 NOV 23 Jam 13.25 PEKERJA TIDAK MENGGUNAKAN HOOC
3 SELALU MEMAKAI APD YANG TELAH DI
13.20 WIB WIB NYA SAAT BEKERJA DILETINGGIAN
ARAHKAN KETIKA TBM DI PAGI HARI

24 NOV 23 Jam 24 NOV 23 Jam 10.55 PEKERJA SEDANG MENGGERINDA BESI MEMBERIKAN TEGURAN UNTUK
4
10.47 WIB WIB TIDAK MENGGUNAKAN HELM SAFETY MEMAKAI APD

25 NOV 23 Jam TEMUAN TIDAK ADA APAR DIAREA TEGURAN KERAS KEPADA VENDOR UNTUK VENDOR MEMINTA WAKTU
5 BELUM CLOSE
10.30 WIB PEKERJAAN API MENYIAPKAN APAR DIAREA PEKERJAAN API UNTUK MEMBELI APAR

TEMUAN SCAFFOLDING TIDAK LAYAK VENDOR MEMINTA WAKTU

25 NOV 23 Jam SCAFFOLDING TIDAK BOLEH
6 BELUM CLOSE DIGUNAKAN KETIKA SAFETY PATROLY UNTUK MEMPERBAIKI
08.10 WIB DIGUNAKAN SEBELUM DIPERBAIKI
BERSAMA SHE CONSULTAN PT.CTCI SCAFFOLDING

NO SERTIFIKAT DOKUMENTASI SERTIFIKAT

SURAT IJIN
1 OPERASI (SIO)
EXCAVATOR
 PT. SHOETOWN GRUP

PT. CTCI Iternational Indonesia - Consultan

DAILY REPORT - WEEK to 3

20 - 26 NOVEMBER 2023
WORK :
"E3 BUILDING"

PEKERJAAN ELECTRICAL
COLLECTIVE NUMBER :
STG/005/OCT/2023

SUBMITTED By :

PT. INDOWIN ENGINEERING INDONESIA

JL. Ruko Kagum City. D/19. JL Tuparev No.168

Rt/Rw, 001/004 Des,Kedawung,Kec,Kedawung, Kab,Cirebon - 45653

Telp. : 0851-7425-6798
Fax. : .............................
e-mail : [email protected]
 SHE PERFORMANCE DAILY REPORT
PROJECT SHOETOWN GRUP - LIGUNG
20 NOVEMBER - PERIODE 2023

Week : 3
Period
: Daily Report - SHE- 20\ 11\ 2023 - \ Week - 3\ PT.INDOWIN \ SHE \ PROJECT JAVA - SHOETOWN GRUP.
Report
Date : 20/11/2023

A. Lagging Indicator B. Lagging Indicator - Ratio

Items Parameter Amount Items Parameter Amount
WEATHER REPORT
Manpower Amount ∑ Manpower - PT.CTCI 7 Injury Frequency Rate (IFR) ∑ IFR 0,0
Manpower Amount ∑ Manpower - PT.INDOWIN 32 0 - 1
Manhours by Today ∑ Manhour PT.CTCI 10 Accumulation Injury Frequency Rate (IFR) ∑ IFR 0,0 1 - 2
Manhours by Today ∑ Manhour PT.INDOWIN 10 2 - 3
Manhours (YTD) ∑ Manhour PT.CTCI 70 3 - 4
Manhours (YTD) ∑ Manhour PT.INDOWIN 320 Corporate IFR ∑ IFR 0,0 4 - 5
Accumulatif Manhours Total Hours 390 5 - 6
First Aid Case (FAC) ∑ FAC 0 Total Recordable Injury Rate (TRIR) ∑ TRIR 0,0 6 - 7
Medical Treatment Case ∑ MTC 0 Accumulation TRIR ∑ TRIR 0,0 7 - 8
Lost Time Incident (LTI) ∑ LTI 0 Corporate TRIR ∑ TRIR 0,0 8 - 9
Fatality ∑ FAT 0 Injury Severity Rate (ISR) ∑ ISR 0,0 9 - 10
Near Miss Case ∑ NMC 0 Accumulation Injury Severity Rate (ISR) ∑ ISR 0,0 10 - 11
Lost Working Days ∑ LWD 0 Corporate ISR ∑ ISR 0,0 11 - 12
Fire Accident ∑ Incident 0 Lost Time Injury Frequency Rate (LTIFR) ∑ LTIFR 0,0 12 - 13
Property Damage ∑ Incident 0 Accumulation LTIFR ∑ LTIFR 0,0 13 - 14
Environment Incident ∑ Incident 0 Corporate LTIFR ∑ LTIFR 0,0 14 - 15
Traffic Accident ∑ Incident 0 15 - 16
16 - 17
17 - 18
C. Leading Indicator - Program Implementation D. Leading Indicator - Non Conformance Finding 18 - 19
Items Number Of
Parameter Amount Activity Status "Open" Status "Close" % Progress 19 - 20
Findings
HIRADC / JSA Created ∑ JSA 18 Daily Safety Observation 0 20 - 21
Permit To Work Issued ∑ PTW 18 Management Safety Patrol 0 21 - 22
Emergency Drill ∑ Drill 0 Behaviour Observation Scheme 0 22 - 23
HSE Induction ∑ People 0 23 - 24
Medical Checkup / Surat Sehat ∑ MCU / Surat Sehat 0 Days Without Fatality Days Without Lost Time Injury S = SUNNY
Life Training Program Conducted ∑ Training 0 C = CLOUDY
Tool Box Meeting Conducted
Safety Morning Talk Conducted
Audit Conducted
CEVTM Inspection Conducted
Environment Inspection Conducted
∑ TBM
∑ SMT
∑ Audit
∑ Inspection
∑ Env.Inspect
3
0
0
0
0
0 0 LR
HR
=
=
LIGHT RAIN
HEAVY RAIN

Hygiene Inspection Conducted ∑ Hgn.Inspect 0 Last Fatality Incident Last LTI Incident
Houskeeping Conducted ∑ HSK 1 0 / 0 / 2023 0 / 0 / 2023
Waste Disposal ∑ Disposal 1
Resource Control ∑ RC 0

E. Highlighted HSE Event (Including HSE Critical Issue, Award Receive, and Brief Of Incident)

Event Types Brief Event Description Status Remarks

F. Signature F. Signature F.Signature F. Signature

PT.SHOETOWN GRUP PT.CTCI PT. INDOWIN ENGINEERING INDONESIA PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known Preparation By,

DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY RANGGA SURYA NUGRAHA

SHE - PT. STG ( SHE COORDINATOR ) DIKREKTUR ( SHE OFFICER )

Tembusan Cc.
1.Bp. Solichin - Project Manager

FOTO DOCUMENTATION -
Date : 20-November 2023
Picture No. 1 TOOL BOX MEETING Lt1 Picture No. 2 TOOL BOX MEETING Lt3 Picture No. 3 TOOL BOX MEETING TIM BORING

Picture No.4 PERSIAPAN MEMAKAI SAFETY FULL BODY HARNEESS Picture NO.5 PENGERJAAN PEMBORAN UNTUK PEMASANGAN KABEL TM

REMARKS

SIGN BOARD E3 BUILDING

 DAILY REPORT MONITORING SHE ACTIVITY AND FOTO DOCUMENTATION
Foto Documentation Pekerjaan - PT.INDOWIN Date : 20- 11 - 2023
Picture Picture Picture

FINAL DESIGN BUILDING

Remaks Activity,
1,1 MATERIAL
1 BESI,PIPA PLASTIK,KABEL 600v, FLEXSIBLE STEEL, RAK KABEL
2,1 ACTIVITY
1 MARKING UNTUK PEMASANGAN RAK BESI ATAU SUPPORT TRAY
2 PEMOTONGAN, PENGELASAN , PEMASANGAN SAPORT TRAY LANTAI 2
3 MARKING UNTUK PEMASANGAN KABEL LAMPU LT 3
4 PEMASANGAN KABEL LAMPU LT 1,2&3
5
6
7
8
3,1 TOMORROW
1 MELANJUTKAN PROGRESS HARI INI
2 PEMASANGAN RAK KABLE LT 2
3 PEMASANGAN KABEL LAMPU LANTAI 2&3
4,1 Aspek SHE - Safety, Health and Enviroment

SELALU MELAKSANAKAN TBM(TOOL BOX MEETING) SETIAP HARI SENIN,RABU DAN JUMAT UNTUK
MEMBERIKAN INFORMASI ATAU MENGINGATKAN SETIAP PEKERJA BAHWA PENTINGNYA UNTUK MENJAGA
1 KESELAMATAN DAN KEBERSIHAN (HOUSE KEEPING) DI AREA KERJA.SERTA MENGINGATKANSELALU UNTUK
PENGGUNAAN APD(ALAT PELINDUNG DIRI) SEPERTI HELM,SEPATU SAFETY DAN ROMPI DENGAN KONDISI BAIK
DAN MASIH LAYAK PAKAI

Signature Signature Signature Signature

PT.SHOETOWN GRUP PT.CTCI PT.INDOWIN PT.INDOWIN
Approved By, Known By, Known By Preparation by :

DWI FAKHRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA N

( FS - Construction ) ( SHE COORDINATOR ) DIREKTUR HSE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager
 FOTO DOCUMENTATION - ACTIVITY

Date : 20-NOV 2023

Picture No. 1 Picture No. 2 Picture No. 3
HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA
PENGELASAN SUPORT TRAY LT 3 PEMOTONGAN SAPOT LANTAI 2 PEMOTONGAN BESI SIKU UNTUK SUPPORT TRAY

Picture No. 4 Picture No. 5 Picture No. 6

PEMASANGAN RAK BESI LT 1 PEMASANGAN STABIL STEEL PEMASANGAN SAMPLE LEDDER LT 3

FOTO DOCUMENTATION - ACTIVITY

Date : 20 - NOV 2023

20-Nov-23 20-Nov-23 20-Nov-23
TEMUAN NO 1 TEMUAN NO 2 TEMUAN NO 3
BANYAKNYA PUTUNG ROKOK DIAREA KERJA PEKERJA TIDAK MENGGUNAKAN HELM LOCK PADA RODA SCAFF TIDAK TERKUNCI

STATUS : OPEN STATUS : OPEN STATUS : OPEN

20-Nov-23 20-Nov-23 20-Nov-23
PUTUNG ROKOK DIBUANG PEKERJA SUDAH MENGGUNAKAN HELM PEKERJA SUDAH MENGGUNAKAN SARUNG TANGAN
 SHE PERFORMANCE DAILY REPORT
PROJECT SHOETOWN GRUP - LIGUNG
21 NOVEMBER - PERIODE 2023

Week : 3
Period
: Daily Report - SHE- 21\ 11\ 2023 - \ Week - 3\ PT.INDOWIN \ SHE \ PROJECT JAVA - SHOETOWN GRUP.
Report
Date : 21/11/2023

A. Lagging Indicator B. Lagging Indicator - Ratio

Items Parameter Amount Items Parameter Amount
WEATHER REPORT
Manpower Amount ∑ Manpower - PT.CTCI 7 Injury Frequency Rate (IFR) ∑ IFR 0,0
Manpower Amount ∑ Manpower - PT.INDOWIN 43 0 - 1
Manhours by Today ∑ Manhour PT.CTCI 10 Accumulation Injury Frequency Rate (IFR) ∑ IFR 0,0 1 - 2
Manhours by Today ∑ Manhour PT.INDOWIN 10 2 - 3
Manhours (YTD) ∑ Manhour PT.CTCI 70 3 - 4
Manhours (YTD) ∑ Manhour PT.INDOWIN 430 Corporate IFR ∑ IFR 0,0 4 - 5
Accumulatif Manhours Total Hours 500 5 - 6
First Aid Case (FAC) ∑ FAC 0 Total Recordable Injury Rate (TRIR) ∑ TRIR 0,0 6 - 7
Medical Treatment Case ∑ MTC 0 Accumulation TRIR ∑ TRIR 0,0 7 - 8
Lost Time Incident (LTI) ∑ LTI 0 Corporate TRIR ∑ TRIR 0,0 8 - 9
Fatality ∑ FAT 0 Injury Severity Rate (ISR) ∑ ISR 0,0 9 - 10
Near Miss Case ∑ NMC 0 Accumulation Injury Severity Rate (ISR) ∑ ISR 0,0 10 - 11
Lost Working Days ∑ LWD 0 Corporate ISR ∑ ISR 0,0 11 - 12
Fire Accident ∑ Incident 0 Lost Time Injury Frequency Rate (LTIFR) ∑ LTIFR 0,0 12 - 13
Property Damage ∑ Incident 0 Accumulation LTIFR ∑ LTIFR 0,0 13 - 14
Environment Incident ∑ Incident 0 Corporate LTIFR ∑ LTIFR 0,0 14 - 15
Traffic Accident ∑ Incident 0 15 - 16
16 - 17
17 - 18
C. Leading Indicator - Program Implementation D. Leading Indicator - Non Conformance Finding 18 - 19
Items Number Of
Parameter Amount Activity Status "Open" Status "Close" % Progress 19 - 20
Findings
HIRADC / JSA Created ∑ JSA 20 Daily Safety Observation 0 20 - 21
Permit To Work Issued ∑ PTW 20 Management Safety Patrol 0 21 - 22
Emergency Drill ∑ Drill 0 Behaviour Observation Scheme 0 22 - 23
HSE Induction ∑ People 0 23 - 24
Medical Checkup / Surat Sehat ∑ MCU / Surat Sehat 0 Days Without Fatality Days Without Lost Time Injury S = SUNNY
Life Training Program Conducted ∑ Training 0 C = CLOUDY
Tool Box Meeting Conducted
Safety Morning Talk Conducted
Audit Conducted
CEVTM Inspection Conducted
Environment Inspection Conducted
∑ TBM
∑ SMT
∑ Audit
∑ Inspection
∑ Env.Inspect
3
0
0
0
0
0 0 LR
HR
=
=
LIGHT RAIN
HEAVY RAIN

Hygiene Inspection Conducted ∑ Hgn.Inspect 0 Last Fatality Incident Last LTI Incident
Houskeeping Conducted ∑ HSK 1 0 / 0 / 2023 0 / 0 / 2023
Waste Disposal ∑ Disposal 1
Resource Control ∑ RC 0

E. Highlighted HSE Event (Including HSE Critical Issue, Award Receive, and Brief Of Incident)

Event Types Brief Event Description Status Remarks

F. Signature F. Signature F.Signature F. Signature

PT.SHOETOWN GRUP PT.CTCI PT. INDOWIN ENGINEERING INDONESIA PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known Preparation By,

DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY RANGGA SURYA NUGRAHA

SHE - PT. STG ( SHE COORDINATOR ) DIKREKTUR ( SHE OFFICER )

Tembusan Cc.
1.Bp. Solichin - Project Manager

FOTO DOCUMENTATION -
Date : 21-November 2023
Picture No. 1 TOOL BOX MEETING TIM BORING Picture No. 2 TOOL BOX MEETING Lt3 Picture No. 3

Picture No.4 PERSIAPAN MEMAKAI SAFETY FULL BODY HARNEESS Picture NO.5 PENGERJAAN PEMBORAN UNTUK PEMASANGAN KABEL TM

REMARKS

SIGN BOARD E3 BUILDING

 DAILY REPORT MONITORING SHE ACTIVITY AND FOTO DOCUMENTATION
Foto Documentation Pekerjaan - PT.INDOWIN Date : 21- 11 - 2023
Picture Picture Picture

FINAL DESIGN BUILDING

Remaks Activity,
1,1 MATERIAL
1 BESI,PIPA PLASTIK,KABEL 600v, FLEXSIBLE STEEL, RAK KABEL
2,1 ACTIVITY
1 PEMASANGAN CABLE LEADER LANTAI 1
2 PENGEBORAN & PEMASANGAN LONG DRAT UNTUK TRAY LANTAI 1
3 PENGECATAN SUPPORT TRAY LANTAI 2
4 PEMASANGAN KABEL LAMPU LT 1,2&3
5
6
7
8
3,1 TOMORROW
1 MELANJUTKAN PROGRESS HARI INI
2 PENGEBORAN & PEMASANGAN LONG DRAT UNTUK TRAY LANTAI 1
3 PEMASANGAN CABLE LEADER LANTAI 1 & 2
4,1 Aspek SHE - Safety, Health and Enviroment

SELALU MELAKSANAKAN TBM(TOOL BOX MEETING) SETIAP HARI SENIN,RABU DAN JUMAT UNTUK
MEMBERIKAN INFORMASI ATAU MENGINGATKAN SETIAP PEKERJA BAHWA PENTINGNYA UNTUK MENJAGA
1 KESELAMATAN DAN KEBERSIHAN (HOUSE KEEPING) DI AREA KERJA.SERTA MENGINGATKANSELALU UNTUK
PENGGUNAAN APD(ALAT PELINDUNG DIRI) SEPERTI HELM,SEPATU SAFETY DAN ROMPI DENGAN KONDISI BAIK
DAN MASIH LAYAK PAKAI

Signature Signature Signature Signature

PT.SHOETOWN GRUP PT.CTCI PT.INDOWIN PT.INDOWIN
Approved By, Known By, Known By Preparation by :

DWI FAKHRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA N

( FS - Construction ) ( SHE COORDINATOR ) DIREKTUR HSE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager
 FOTO DOCUMENTATION - ACTIVITY

Date : 21-NOV 2023

Picture No. 1 Picture No. 2 Picture No. 3
HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA
PENGGALIAN UNTUK PIPA KABEL TM PENGELASAN BESI SIKU PEMASANGAN CABLE LEADER LANTAI1

Picture No. 4 Picture No. 5 Picture No. 6

PENAMBAHAN AIR UNTUK PENGGALIAN JALUR
PEMASANGAN KABEL LAMPU PEMASANGAN LONG DRAT UNTUK TRAY
PIPA KABEL TM

FOTO DOCUMENTATION - ACTIVITY

Date : 21 - NOV 2023

21-Nov-23 21-Nov-23 21-Nov-23
TEMUAN NO 1 TEMUAN NO 2 TEMUAN NO 3
RODA SCAFFOLDING TIDAK TERKUNCI HOOX TIDAK TERPASANG TIDAK MENGGUNAKAN HELM

STATUS : OPEN STATUS : OPEN STATUS : OPEN

21-Nov-23 21-Nov-23 21-Nov-23
RODA TERKUNCI HOOX SUDAH TERPASANG SUDAH MENGGUNAKAN HELM
 SHE PERFORMANCE DAILY REPORT
PROJECT SHOETOWN GRUP - LIGUNG
22 NOVEMBER - PERIODE 2023

Week : 3
Period
: Daily Report - SHE- 22\ 11\ 2023 - \ Week - 3\ PT.INDOWIN \ SHE \ PROJECT JAVA - SHOETOWN GRUP.
Report
Date : 22/11/2023

A. Lagging Indicator B. Lagging Indicator - Ratio

Items Parameter Amount Items Parameter Amount
WEATHER REPORT
Manpower Amount ∑ Manpower - PT.CTCI 7 Injury Frequency Rate (IFR) ∑ IFR 0,0
Manpower Amount ∑ Manpower - PT.INDOWIN 43 0 - 1
Manhours by Today ∑ Manhour PT.CTCI 10 Accumulation Injury Frequency Rate (IFR) ∑ IFR 0,0 1 - 2
Manhours by Today ∑ Manhour PT.INDOWIN 10 2 - 3
Manhours (YTD) ∑ Manhour PT.CTCI 70 3 - 4
Manhours (YTD) ∑ Manhour PT.INDOWIN 430 Corporate IFR ∑ IFR 0,0 4 - 5
Accumulatif Manhours Total Hours 500 5 - 6
First Aid Case (FAC) ∑ FAC 0 Total Recordable Injury Rate (TRIR) ∑ TRIR 0,0 6 - 7
Medical Treatment Case ∑ MTC 0 Accumulation TRIR ∑ TRIR 0,0 7 - 8
Lost Time Incident (LTI) ∑ LTI 0 Corporate TRIR ∑ TRIR 0,0 8 - 9
Fatality ∑ FAT 0 Injury Severity Rate (ISR) ∑ ISR 0,0 9 - 10
Near Miss Case ∑ NMC 0 Accumulation Injury Severity Rate (ISR) ∑ ISR 0,0 10 - 11
Lost Working Days ∑ LWD 0 Corporate ISR ∑ ISR 0,0 11 - 12
Fire Accident ∑ Incident 0 Lost Time Injury Frequency Rate (LTIFR) ∑ LTIFR 0,0 12 - 13
Property Damage ∑ Incident 0 Accumulation LTIFR ∑ LTIFR 0,0 13 - 14
Environment Incident ∑ Incident 0 Corporate LTIFR ∑ LTIFR 0,0 14 - 15
Traffic Accident ∑ Incident 0 15 - 16
16 - 17
17 - 18
C. Leading Indicator - Program Implementation D. Leading Indicator - Non Conformance Finding 18 - 19
Items Number Of
Parameter Amount Activity Status "Open" Status "Close" % Progress 19 - 20
Findings
HIRADC / JSA Created ∑ JSA 20 Daily Safety Observation 0 20 - 21
Permit To Work Issued ∑ PTW 22 Management Safety Patrol 0 21 - 22
Emergency Drill ∑ Drill 0 Behaviour Observation Scheme 0 22 - 23
HSE Induction ∑ People 0 23 - 24
Medical Checkup / Surat Sehat ∑ MCU / Surat Sehat 0 Days Without Fatality Days Without Lost Time Injury S = SUNNY
Life Training Program Conducted ∑ Training 0 C = CLOUDY
Tool Box Meeting Conducted
Safety Morning Talk Conducted
Audit Conducted
CEVTM Inspection Conducted
Environment Inspection Conducted
∑ TBM
∑ SMT
∑ Audit
∑ Inspection
∑ Env.Inspect
3
0
0
0
0
0 0 LR
HR
=
=
LIGHT RAIN
HEAVY RAIN

Hygiene Inspection Conducted ∑ Hgn.Inspect 0 Last Fatality Incident Last LTI Incident
Houskeeping Conducted ∑ HSK 1 0 / 0 / 2023 0 / 0 / 2023
Waste Disposal ∑ Disposal 1
Resource Control ∑ RC 0

E. Highlighted HSE Event (Including HSE Critical Issue, Award Receive, and Brief Of Incident)

Event Types Brief Event Description Status Remarks

F. Signature F. Signature F.Signature F. Signature

PT.SHOETOWN GRUP PT.CTCI PT. INDOWIN ENGINEERING INDONESIA PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known Preparation By,

DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY RANGGA SURYA NUGRAHA

SHE - PT. STG ( SHE COORDINATOR ) DIKREKTUR ( SHE OFFICER )

Tembusan Cc.
1.Bp. Solichin - Project Manager

FOTO DOCUMENTATION -
Date : 22-November 2023
Picture No. 1 TOOL BOX MEETING LANTAI 1 Picture No. 2 TOOL BOX MEETING TIM PENGGALIAN Picture No. 3 TOOL BOX MEETING LANTAI 3

Picture No.4 PEMBOBOKAN MANHOLE Picture NO.5 PENGELASAN BESI SIKU

REMARKS

SIGN BOARD E3 BUILDING

 DAILY REPORT MONITORING SHE ACTIVITY AND FOTO DOCUMENTATION
Foto Documentation Pekerjaan - PT.INDOWIN Date : 22- 11 - 2023
Picture Picture Picture

FINAL DESIGN BUILDING

Remaks Activity,
1,1 MATERIAL
1 BESI,PIPA PLASTIK,KABEL 600v, FLEXSIBLE STEEL, RAK KABEL
2,1 ACTIVITY
1 PEMASANGAN CABLE LEADER LANTAI 1
2 PENGEBORAN & PEMASANGAN LONG DRAT UNTUK TRAY LANTAI 1
3 PENGECATAN SUPPORT TRAY LANTAI 2
4 PEMASANGAN KABEL LAMPU LT 1,2&3
5 PENGGALIAN & PEMBOBOKAN MANHOLE
6
7
8
3,1 TOMORROW
1 MELANJUTKAN PROGRESS HARI INI
2 PENGEBORAN & PEMASANGAN LONG DRAT UNTUK TRAY LANTAI 1
3 PEMASANGAN CABLE LEADER LANTAI 1 & 2
4,1 Aspek SHE - Safety, Health and Enviroment

SELALU MELAKSANAKAN TBM(TOOL BOX MEETING) SETIAP HARI SENIN,RABU DAN JUMAT UNTUK
MEMBERIKAN INFORMASI ATAU MENGINGATKAN SETIAP PEKERJA BAHWA PENTINGNYA UNTUK MENJAGA
1 KESELAMATAN DAN KEBERSIHAN (HOUSE KEEPING) DI AREA KERJA.SERTA MENGINGATKANSELALU UNTUK
PENGGUNAAN APD(ALAT PELINDUNG DIRI) SEPERTI HELM,SEPATU SAFETY DAN ROMPI DENGAN KONDISI BAIK
DAN MASIH LAYAK PAKAI

Signature Signature Signature Signature

PT.SHOETOWN GRUP PT.CTCI PT.INDOWIN PT.INDOWIN
Approved By, Known By, Known By Preparation by :

DWI FAKHRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA N

( FS - Construction ) ( SHE COORDINATOR ) DIREKTUR HSE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager
 FOTO DOCUMENTATION - ACTIVITY

Date : 22-NOV 2023

Picture No. 1 Picture No. 2 Picture No. 3
HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA
PEMOTONGAN BESI LONG DRAT LANTAI 3 PEMASANGAN PIPA CONDUIT Lt3 PEMOTONGAN BESI SIKU LT 3

Picture No. 4 Picture No. 5 Picture No. 6

PEMASANGAN KABEL LAMPU LANTAI 1 PEMOTONGAN BESI SIKU LT 3 PEMASANGAN LONG DRAT UNTUK TRAY

FOTO DOCUMENTATION - ACTIVITY

Date : 22 - NOV 2023

22-Nov-23 22-Nov-23 22-Nov-23
TEMUAN NO 1 TEMUAN NO 2 TEMUAN NO 3
TIDAK MENGGUNAKAN SAFETY GLASS GERINDA TIDAK MENGGUNAKAN COVER PENGAMAN LOCK RODA SCAFF TIDAK TERKUNCI

STATUS : OPEN STATUS : OPEN STATUS : OPEN

22-Nov-23 22-Nov-23 22-Nov-23
RODA SUDAH TERKUNCI

SAFETY GLASS HILANG DA VENDOR MEMINTA

COVER PENGAMAN HILANG
WAKTU UNTUK MEMBELI NYA
 SHE PERFORMANCE DAILY REPORT
PROJECT SHOETOWN GRUP - LIGUNG
23 NOVEMBER - PERIODE 2023

Week : 3
Period
: Daily Report - SHE- 23\ 11\ 2023 - \ Week - 3\ PT.INDOWIN \ SHE \ PROJECT JAVA - SHOETOWN GRUP.
Report
Date : 23/11/2023

A. Lagging Indicator B. Lagging Indicator - Ratio

Items Parameter Amount Items Parameter Amount
WEATHER REPORT
Manpower Amount ∑ Manpower - PT.CTCI 7 Injury Frequency Rate (IFR) ∑ IFR 0,0
Manpower Amount ∑ Manpower - PT.INDOWIN 43 0 - 1
Manhours by Today ∑ Manhour PT.CTCI 10 Accumulation Injury Frequency Rate (IFR) ∑ IFR 0,0 1 - 2
Manhours by Today ∑ Manhour PT.INDOWIN 10 2 - 3
Manhours (YTD) ∑ Manhour PT.CTCI 70 3 - 4
Manhours (YTD) ∑ Manhour PT.INDOWIN 430 Corporate IFR ∑ IFR 0,0 4 - 5
Accumulatif Manhours Total Hours 500 5 - 6
First Aid Case (FAC) ∑ FAC 0 Total Recordable Injury Rate (TRIR) ∑ TRIR 0,0 6 - 7
Medical Treatment Case ∑ MTC 0 Accumulation TRIR ∑ TRIR 0,0 7 - 8
Lost Time Incident (LTI) ∑ LTI 0 Corporate TRIR ∑ TRIR 0,0 8 - 9
Fatality ∑ FAT 0 Injury Severity Rate (ISR) ∑ ISR 0,0 9 - 10
Near Miss Case ∑ NMC 0 Accumulation Injury Severity Rate (ISR) ∑ ISR 0,0 10 - 11
Lost Working Days ∑ LWD 0 Corporate ISR ∑ ISR 0,0 11 - 12
Fire Accident ∑ Incident 0 Lost Time Injury Frequency Rate (LTIFR) ∑ LTIFR 0,0 12 - 13
Property Damage ∑ Incident 0 Accumulation LTIFR ∑ LTIFR 0,0 13 - 14
Environment Incident ∑ Incident 0 Corporate LTIFR ∑ LTIFR 0,0 14 - 15
Traffic Accident ∑ Incident 0 15 - 16
16 - 17
17 - 18
C. Leading Indicator - Program Implementation D. Leading Indicator - Non Conformance Finding 18 - 19
Items Number Of
Parameter Amount Activity Status "Open" Status "Close" % Progress 19 - 20
Findings
HIRADC / JSA Created ∑ JSA 22 Daily Safety Observation 0 20 - 21
Permit To Work Issued ∑ PTW 24 Management Safety Patrol 0 21 - 22
Emergency Drill ∑ Drill 0 Behaviour Observation Scheme 0 22 - 23
HSE Induction ∑ People 0 23 - 24
Medical Checkup / Surat Sehat ∑ MCU / Surat Sehat 0 Days Without Fatality Days Without Lost Time Injury S = SUNNY
Life Training Program Conducted ∑ Training 0 C = CLOUDY
Tool Box Meeting Conducted
Safety Morning Talk Conducted
Audit Conducted
CEVTM Inspection Conducted
Environment Inspection Conducted
∑ TBM
∑ SMT
∑ Audit
∑ Inspection
∑ Env.Inspect
3
0
0
0
0
0 0 LR
HR
=
=
LIGHT RAIN
HEAVY RAIN

Hygiene Inspection Conducted ∑ Hgn.Inspect 0 Last Fatality Incident Last LTI Incident
Houskeeping Conducted ∑ HSK 1 0 / 0 / 2023 0 / 0 / 2023
Waste Disposal ∑ Disposal 1
Resource Control ∑ RC 0

E. Highlighted HSE Event (Including HSE Critical Issue, Award Receive, and Brief Of Incident)

Event Types Brief Event Description Status Remarks

F. Signature F. Signature F.Signature F. Signature

PT.SHOETOWN GRUP PT.CTCI PT. INDOWIN ENGINEERING INDONESIA PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known Preparation By,

DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY RANGGA SURYA NUGRAHA

SHE - PT. STG ( SHE COORDINATOR ) DIKREKTUR ( SHE OFFICER )

Tembusan Cc.
1.Bp. Solichin - Project Manager

FOTO DOCUMENTATION -
Date : 23-November 2023
Picture No. 1 TOOL BOX MEETING LANTAI 1 Picture No. 2 TOOL BOX MEETING TIM PENGGALIAN Picture No. 3 TOOL BOX MEETING LANTAI 3

Picture No.4 INSPEKSI MESIN LAS TRAFO Picture NO.5 INSPEKSI TOOLS & EQUIPMENT

REMARKS

SIGN BOARD E3 BUILDING

 DAILY REPORT MONITORING SHE ACTIVITY AND FOTO DOCUMENTATION
Foto Documentation Pekerjaan - PT.INDOWIN Date : 23 - 11 - 2023
Picture Picture Picture

FINAL DESIGN BUILDING

Remaks Activity,
1,1 MATERIAL
1 BESI,PIPA PLASTIK,KABEL 600v, FLEXSIBLE STEEL, RAK KABEL
2,1 ACTIVITY
1 PEMASANGAN CABLE LEADER LANTAI 1
2 PENGEBORAN & PEMASANGAN LONG DRAT UNTUK TRAY LANTAI 1
3 PENGECATAN SUPPORT TRAY LANTAI 2
4 PEMASANGAN KABEL LAMPU LT 1,2&3
5 PENGGALIAN & PEMBOBOKAN MANHOLE
6
7
8
3,1 TOMORROW
1 MELANJUTKAN PROGRESS HARI INI
2 PENGEBORAN & PEMASANGAN LONG DRAT UNTUK TRAY LANTAI 1
3 PEMASANGAN CABLE LEADER LANTAI 1 & 2
4,1 Aspek SHE - Safety, Health and Enviroment

SELALU MELAKSANAKAN TBM(TOOL BOX MEETING) SETIAP HARI SENIN,RABU DAN JUMAT UNTUK
MEMBERIKAN INFORMASI ATAU MENGINGATKAN SETIAP PEKERJA BAHWA PENTINGNYA UNTUK MENJAGA
1 KESELAMATAN DAN KEBERSIHAN (HOUSE KEEPING) DI AREA KERJA.SERTA MENGINGATKANSELALU UNTUK
PENGGUNAAN APD(ALAT PELINDUNG DIRI) SEPERTI HELM,SEPATU SAFETY DAN ROMPI DENGAN KONDISI BAIK
DAN MASIH LAYAK PAKAI

Signature Signature Signature Signature

PT.SHOETOWN GRUP PT.CTCI PT.INDOWIN PT.INDOWIN
Approved By, Known By, Known By Preparation by :

DWI FAKHRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA N

( FS - Construction ) ( SHE COORDINATOR ) DIREKTUR HSE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager
 FOTO DOCUMENTATION - ACTIVITY

Date : 23 - NOV 2023

Picture No. 1 Picture No. 2 Picture No. 3
HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA
GELAR PASIR UNTUK DASAR PEMASANGAN PIPA KABEL PEMASANGAN KABEL LAMPU PEMASANGAN LONG DRAT LT 1

Picture No. 4 Picture No. 5 Picture No. 6

PENGANGKUTAN TANAH KE
PEMASANGAN KABEL WEARING LT 2 PEMOTONGAN BESI LONG DRAT LANTAI 1
PERMUKAAN

FOTO DOCUMENTATION - ACTIVITY

Date : 23 - NOV 2023

23-Nov-23 23-Nov-23 23-Nov-23
TEMUAN NO 1 TEMUAN NO 2 TEMUAN NO 3
HOOX TIDAK TERPASANG LT 3 TEMUAN RODA SACFFOLDING TIDAK TERKUNCI

STATUS : OPEN STATUS : OPEN STATUS : OPEN

23-Nov-23 23-Nov-23 23-Nov-23
HOOX SUDAH TERPASANG LOCK SUDAH TERPASANG
 SHE PERFORMANCE DAILY REPORT
PROJECT SHOETOWN GRUP - LIGUNG
24 NOVEMBER - PERIODE 2023

Week : 3
Period
: Daily Report - SHE- 24\ 11\ 2023 - \ Week - 3\ PT.INDOWIN \ SHE \ PROJECT JAVA - SHOETOWN GRUP.
Report
Date : 24/11/2023

A. Lagging Indicator B. Lagging Indicator - Ratio

Items Parameter Amount Items Parameter Amount
WEATHER REPORT
Manpower Amount ∑ Manpower - PT.CTCI 7 Injury Frequency Rate (IFR) ∑ IFR 0,0
Manpower Amount ∑ Manpower - PT.INDOWIN 49 0 - 1
Manhours by Today ∑ Manhour PT.CTCI 10 Accumulation Injury Frequency Rate (IFR) ∑ IFR 0,0 1 - 2
Manhours by Today ∑ Manhour PT.INDOWIN 10 2 - 3
Manhours (YTD) ∑ Manhour PT.CTCI 70 3 - 4
Manhours (YTD) ∑ Manhour PT.INDOWIN 490 Corporate IFR ∑ IFR 0,0 4 - 5
Accumulatif Manhours Total Hours 560 5 - 6
First Aid Case (FAC) ∑ FAC 0 Total Recordable Injury Rate (TRIR) ∑ TRIR 0,0 6 - 7
Medical Treatment Case ∑ MTC 0 Accumulation TRIR ∑ TRIR 0,0 7 - 8
Lost Time Incident (LTI) ∑ LTI 0 Corporate TRIR ∑ TRIR 0,0 8 - 9
Fatality ∑ FAT 0 Injury Severity Rate (ISR) ∑ ISR 0,0 9 - 10
Near Miss Case ∑ NMC 0 Accumulation Injury Severity Rate (ISR) ∑ ISR 0,0 10 - 11
Lost Working Days ∑ LWD 0 Corporate ISR ∑ ISR 0,0 11 - 12
Fire Accident ∑ Incident 0 Lost Time Injury Frequency Rate (LTIFR) ∑ LTIFR 0,0 12 - 13
Property Damage ∑ Incident 0 Accumulation LTIFR ∑ LTIFR 0,0 13 - 14
Environment Incident ∑ Incident 0 Corporate LTIFR ∑ LTIFR 0,0 14 - 15
Traffic Accident ∑ Incident 0 15 - 16
16 - 17
17 - 18
C. Leading Indicator - Program Implementation D. Leading Indicator - Non Conformance Finding 18 - 19
Items Number Of
Parameter Amount Activity Status "Open" Status "Close" % Progress 19 - 20
Findings
HIRADC / JSA Created ∑ JSA 25 Daily Safety Observation 0 20 - 21
Permit To Work Issued ∑ PTW 26 Management Safety Patrol 0 21 - 22
Emergency Drill ∑ Drill 0 Behaviour Observation Scheme 0 22 - 23
HSE Induction ∑ People 0 23 - 24
Medical Checkup / Surat Sehat ∑ MCU / Surat Sehat 0 Days Without Fatality Days Without Lost Time Injury S = SUNNY
Life Training Program Conducted ∑ Training 0 C = CLOUDY
Tool Box Meeting Conducted
Safety Morning Talk Conducted
Audit Conducted
CEVTM Inspection Conducted
Environment Inspection Conducted
∑ TBM
∑ SMT
∑ Audit
∑ Inspection
∑ Env.Inspect
3
0
0
0
0
0 0 LR
HR
=
=
LIGHT RAIN
HEAVY RAIN

Hygiene Inspection Conducted ∑ Hgn.Inspect 0 Last Fatality Incident Last LTI Incident
Houskeeping Conducted ∑ HSK 1 0 / 0 / 2023 0 / 0 / 2023
Waste Disposal ∑ Disposal 1
Resource Control ∑ RC 0

E. Highlighted HSE Event (Including HSE Critical Issue, Award Receive, and Brief Of Incident)

Event Types Brief Event Description Status Remarks

F. Signature F. Signature F.Signature F. Signature

PT.SHOETOWN GRUP PT.CTCI PT. INDOWIN ENGINEERING INDONESIA PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known Preparation By,

DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY RANGGA SURYA NUGRAHA

SHE - PT. STG ( SHE COORDINATOR ) DIKREKTUR ( SHE OFFICER )

Tembusan Cc.
1.Bp. Solichin - Project Manager

FOTO DOCUMENTATION -
Date : 24-November 2023
Picture No. 1 TOOL BOX MEETING LANTAI 1 Picture No. 2 TOOL BOX MEETING TIM PENGGALIAN Picture No. 3 TOOL BOX MEETING LANTAI 3

Picture No.4 PEMASANGAN RAMBU K3 AWAS ADA PEKERJAAN DIKETINGIAN Picture NO.5 PEMASANGAN RAMBU JALUR EVAKUASI

REMARKS

SIGN BOARD E3 BUILDING

 DAILY REPORT MONITORING SHE ACTIVITY AND FOTO DOCUMENTATION
Foto Documentation Pekerjaan - PT.INDOWIN Date : 24 - 11 - 2023
Picture Picture Picture

FINAL DESIGN BUILDING

Remaks Activity,
1,1 MATERIAL
1 BESI SIKU,PIPA PLASTIK,KABEL 600v, FLEXSIBLE STEEL, RAK KABEL,LONG DRAT
2,1 ACTIVITY
1 PEMASANGAN TITIK LAMPU LANTAI 1
2 PABRIKASI SUPPORT TRAY LANTAI 1
3 PEMASANGAN KABEL UNTUK LAMPU LANTAI 1
4 PENGELASAN , PEMOTONGAN LONG DRAT LANTAI 3
5 PEMBOBOKAN MANHOLE, PEMASANGAN PIPA UNTUK JALUR KABEL TM
6
7
8
3,1 TOMORROW
1 MELANJUTKAN PROGRESS HARI INI
2 PENGEBORAN & PEMASANGAN LONG DRAT UNTUK TRAY LANTAI 1
3 PENGGALIAN MANUAL JALUR PIPA KABEL TM
4,1 Aspek SHE - Safety, Health and Enviroment

SELALU MELAKSANAKAN TBM(TOOL BOX MEETING) SETIAP HARI SENIN,RABU DAN JUMAT UNTUK
MEMBERIKAN INFORMASI ATAU MENGINGATKAN SETIAP PEKERJA BAHWA PENTINGNYA UNTUK MENJAGA
1 KESELAMATAN DAN KEBERSIHAN (HOUSE KEEPING) DI AREA KERJA.SERTA MENGINGATKANSELALU UNTUK
PENGGUNAAN APD(ALAT PELINDUNG DIRI) SEPERTI HELM,SEPATU SAFETY DAN ROMPI DENGAN KONDISI BAIK
DAN MASIH LAYAK PAKAI

Signature Signature Signature Signature

PT.SHOETOWN GRUP PT.CTCI PT.INDOWIN PT.INDOWIN
Approved By, Known By, Known By Preparation by :

DWI FAKHRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA N

( FS - Construction ) ( SHE COORDINATOR ) DIREKTUR HSE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager
 FOTO DOCUMENTATION - ACTIVITY

Date : 24 - NOV 2023

Picture No. 1 Picture No. 2 Picture No. 3
HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA
PEMOTONGAN BESI SIKU LANTAI 1 PEMASANGAN KABEL WEARING LANTAI 2 PEMASANGAN DUDUKAN LAMPU LANTAI 1

Picture No. 4 Picture No. 5 Picture No. 6

PEMASANGAN WARNING TAP ELECTRICAL PABRIKASI SUPPORT TRAY LANTAI 1 PENGGALIAN AREA MANHOLE PANEL

FOTO DOCUMENTATION - ACTIVITY

Date : 24 - NOV 2023

24-Nov-23 24-Nov-23
TEMUAN NO 1 TEMUAN NO 2
PEKERJA TIDAK MENGGUNAKAN HELM LANTAI 3 TPEKERJA TIDAK MENGGUNAKAN HELM LANTAI 1

STATUS : OPEN STATUS : OPEN STATUS : OPEN

23-Nov-23 23-Nov-23
SUDAH MEMAKAI HELM SUDAH MEMAKAI HELM

PENEGURAN SECARA LISAN DAN

PENEGURAN SECARA LISAN DAN PERINGATAN
PERINGATAN AGAR SELALU
AGAR SELALU MENGGUNAKAN APD LENGKAP
MENGGUNAKAN APD LENGKAP
KETIKA BEKERJA
KETIKA BEKERJA
 SHE PERFORMANCE DAILY REPORT
PROJECT SHOETOWN GRUP - LIGUNG
25 NOVEMBER - PERIODE 2023

Week : 3
Period
: Daily Report - SHE- 25\ 11\ 2023 - \ Week - 3\ PT.INDOWIN \ SHE \ PROJECT JAVA - SHOETOWN GRUP.
Report
Date : 25/11/2023

A. Lagging Indicator B. Lagging Indicator - Ratio

Items Parameter Amount Items Parameter Amount
WEATHER REPORT
Manpower Amount ∑ Manpower - PT.CTCI 7 Injury Frequency Rate (IFR) ∑ IFR 0,0
Manpower Amount ∑ Manpower - PT.INDOWIN 55 0 - 1
Manhours by Today ∑ Manhour PT.CTCI 10 Accumulation Injury Frequency Rate (IFR) ∑ IFR 0,0 1 - 2
Manhours by Today ∑ Manhour PT.INDOWIN 10 2 - 3
Manhours (YTD) ∑ Manhour PT.CTCI 70 3 - 4
Manhours (YTD) ∑ Manhour PT.INDOWIN 550 Corporate IFR ∑ IFR 0,0 4 - 5
Accumulatif Manhours Total Hours 620 5 - 6
First Aid Case (FAC) ∑ FAC 0 Total Recordable Injury Rate (TRIR) ∑ TRIR 0,0 6 - 7
Medical Treatment Case ∑ MTC 0 Accumulation TRIR ∑ TRIR 0,0 7 - 8
Lost Time Incident (LTI) ∑ LTI 0 Corporate TRIR ∑ TRIR 0,0 8 - 9
Fatality ∑ FAT 0 Injury Severity Rate (ISR) ∑ ISR 0,0 9 - 10
Near Miss Case ∑ NMC 0 Accumulation Injury Severity Rate (ISR) ∑ ISR 0,0 10 - 11
Lost Working Days ∑ LWD 0 Corporate ISR ∑ ISR 0,0 11 - 12
Fire Accident ∑ Incident 0 Lost Time Injury Frequency Rate (LTIFR) ∑ LTIFR 0,0 12 - 13
Property Damage ∑ Incident 0 Accumulation LTIFR ∑ LTIFR 0,0 13 - 14
Environment Incident ∑ Incident 0 Corporate LTIFR ∑ LTIFR 0,0 14 - 15
Traffic Accident ∑ Incident 0 15 - 16
16 - 17
17 - 18
C. Leading Indicator - Program Implementation D. Leading Indicator - Non Conformance Finding 18 - 19
Items Number Of
Parameter Amount Activity Status "Open" Status "Close" % Progress 19 - 20
Findings
HIRADC / JSA Created ∑ JSA 25 Daily Safety Observation 0 20 - 21
Permit To Work Issued ∑ PTW 28 Management Safety Patrol 0 21 - 22
Emergency Drill ∑ Drill 0 Behaviour Observation Scheme 0 22 - 23
HSE Induction ∑ People 0 23 - 24
Medical Checkup / Surat Sehat ∑ MCU / Surat Sehat 0 Days Without Fatality Days Without Lost Time Injury S = SUNNY
Life Training Program Conducted ∑ Training 0 C = CLOUDY
Tool Box Meeting Conducted
Safety Morning Talk Conducted
Audit Conducted
CEVTM Inspection Conducted
Environment Inspection Conducted
∑ TBM
∑ SMT
∑ Audit
∑ Inspection
∑ Env.Inspect
3
0
0
0
0
0 0 LR
HR
=
=
LIGHT RAIN
HEAVY RAIN

Hygiene Inspection Conducted ∑ Hgn.Inspect 0 Last Fatality Incident Last LTI Incident
Houskeeping Conducted ∑ HSK 1 0 / 0 / 2023 0 / 0 / 2023
Waste Disposal ∑ Disposal 1
Resource Control ∑ RC 0

E. Highlighted HSE Event (Including HSE Critical Issue, Award Receive, and Brief Of Incident)

Event Types Brief Event Description Status Remarks

F. Signature F. Signature F.Signature F. Signature

PT.SHOETOWN GRUP PT.CTCI PT. INDOWIN ENGINEERING INDONESIA PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known Preparation By,

DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY RANGGA SURYA NUGRAHA

SHE - PT. STG ( SHE COORDINATOR ) DIKREKTUR ( SHE OFFICER )

Tembusan Cc.
1.Bp. Solichin - Project Manager

FOTO DOCUMENTATION -
Date : 25-November 2023
Picture No. 1 TOOL BOX MEETING LANTAI 1 Picture No. 2 TOOL BOX MEETING TIM PENGGALIAN Picture No. 3 TOOL BOX MEETING LANTAI 3

Picture No.4 SAFETY PATROLI BERSAMA SHE CONSULTAN PT.CTCI Picture NO.5 SAFETY PATROLI BERSAMA SHE CONSULTAN PT.CTCI

REMARKS

SIGN BOARD E3 BUILDING

 DAILY REPORT MONITORING SHE ACTIVITY AND FOTO DOCUMENTATION
Foto Documentation Pekerjaan - PT.INDOWIN Date : 25 - 11 - 2023
Picture Picture Picture

FINAL DESIGN BUILDING

Remaks Activity,
1,1 MATERIAL
1 BESI SIKU,PIPA PLASTIK,KABEL 600v, FLEXSIBLE STEEL, RAK KABEL,LONG DRAT
2,1 ACTIVITY
1 PEMASANGAN TITIK LAMPU LANTAI 1
2 PABRIKASI SUPPORT TRAY LANTAI 1
3 PEMASANGAN KABEL UNTUK LAMPU LANTAI 1
4 PENGELASAN , PEMOTONGAN LONG DRAT LANTAI 3
5 PEMBOBOKAN MANHOLE, PEMASANGAN PIPA UNTUK JALUR KABEL TM
6 LOADING MATRIAL TRAY
7 PENGUKURAN,PEMOTONGAN,PEMBORAN,PENGELASAN BESI SIKU LANTAI 3
8
3,1 TOMORROW
1 MELANJUTKAN PROGRESS HARI INI
2 PEMBOBOKAN MANHOLE PANEL
3 PENGGALIAN MANUAL JALUR PIPA KABEL TM
4,1 Aspek SHE - Safety, Health and Enviroment

SELALU MELAKSANAKAN TBM(TOOL BOX MEETING) SETIAP HARI SENIN,RABU DAN JUMAT UNTUK
MEMBERIKAN INFORMASI ATAU MENGINGATKAN SETIAP PEKERJA BAHWA PENTINGNYA UNTUK MENJAGA
1 KESELAMATAN DAN KEBERSIHAN (HOUSE KEEPING) DI AREA KERJA.SERTA MENGINGATKANSELALU UNTUK
PENGGUNAAN APD(ALAT PELINDUNG DIRI) SEPERTI HELM,SEPATU SAFETY DAN ROMPI DENGAN KONDISI BAIK
DAN MASIH LAYAK PAKAI

Signature Signature Signature Signature

PT.SHOETOWN GRUP PT.CTCI PT.INDOWIN PT.INDOWIN
Approved By, Known By, Known By Preparation by :

DWI FAKHRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA N

( FS - Construction ) ( SHE COORDINATOR ) DIREKTUR HSE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager
 FOTO DOCUMENTATION - ACTIVITY

Date : 25 - NOV 2023

Picture No. 1 Picture No. 2 Picture No. 3
HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA
PEMASANGAN LAMPU KABEL LANTAI 3 PEMASANGAN PIPA CONDUIT LT 3 MARKING&PASANG DUDUKAN LAMPU 100x10

Picture No. 4 Picture No. 5 Picture No. 6

PEMOTONGAN BESI SIKU LANTAI 3 PABRIKASI SUPPORT TRAY LANTAI 1 PEMBORAN BESI LANTAI 3

FOTO DOCUMENTATION - ACTIVITY

Date : 25 - NOV 2023

25-Nov-23 25-Nov-23 25-Nov-23
TEMUAN NO 1 TEMUAN NO 2 TEMUAN N0 3
FRAME SCAFFOLDING TIDAK KUAT AREA KERJA TERDAPAT BANYAK SAMPAH BERSERAKAN TIDAK APAR DIAREA PEKERJAAN API

STATUS : OPEN STATUS : OPEN STATUS : OPEN

25-Nov-23 25-Nov-23 25-Nov-23
PERINGATAN PERINGATAN PERINGATAN

MERENCANAKAN PERTEMUAN
PENEGURAN SECARA LISAN KEPADA VENDOR ANTAR MAINCONT UNTUK
PENEGURAN SECARA LISAN KEPADA VENDOR UNTUK
DAN MEMINTA VENDOR SEGERA UNTUK MEMBAHAS MASALAH LIMBAH DAN
SEGERA MELENGKAPI PROTECTION YANG DIBUTUHKAN
MEMPERBAIKI NYA CARA MENANGGULANGINYA YANG
ADA DI AREA GEDUNG E3
 SHE PERFORMANCE DAILY REPORT
PROJECT SHOETOWN GRUP - LIGUNG
26 NOVEMBER - PERIODE 2023

Week : 3
Period
: Daily Report - SHE- 26\ 11\ 2023 - \ Week - 3\ PT.INDOWIN \ SHE \ PROJECT JAVA - SHOETOWN GRUP.
Report
Date : 26/11/2023

A. Lagging Indicator B. Lagging Indicator - Ratio

Items Parameter Amount Items Parameter Amount
WEATHER REPORT
Manpower Amount ∑ Manpower - PT.CTCI 7 Injury Frequency Rate (IFR) ∑ IFR 0,0
Manpower Amount ∑ Manpower - PT.INDOWIN 55 0 - 1
Manhours by Today ∑ Manhour PT.CTCI 10 Accumulation Injury Frequency Rate (IFR) ∑ IFR 0,0 1 - 2
Manhours by Today ∑ Manhour PT.INDOWIN 10 2 - 3
Manhours (YTD) ∑ Manhour PT.CTCI 70 3 - 4
Manhours (YTD) ∑ Manhour PT.INDOWIN 550 Corporate IFR ∑ IFR 0,0 4 - 5
Accumulatif Manhours Total Hours 620 5 - 6
First Aid Case (FAC) ∑ FAC 0 Total Recordable Injury Rate (TRIR) ∑ TRIR 0,0 6 - 7
Medical Treatment Case ∑ MTC 0 Accumulation TRIR ∑ TRIR 0,0 7 - 8
Lost Time Incident (LTI) ∑ LTI 0 Corporate TRIR ∑ TRIR 0,0 8 - 9
Fatality ∑ FAT 0 Injury Severity Rate (ISR) ∑ ISR 0,0 9 - 10
Near Miss Case ∑ NMC 0 Accumulation Injury Severity Rate (ISR) ∑ ISR 0,0 10 - 11
Lost Working Days ∑ LWD 0 Corporate ISR ∑ ISR 0,0 11 - 12
Fire Accident ∑ Incident 0 Lost Time Injury Frequency Rate (LTIFR) ∑ LTIFR 0,0 12 - 13
Property Damage ∑ Incident 0 Accumulation LTIFR ∑ LTIFR 0,0 13 - 14
Environment Incident ∑ Incident 0 Corporate LTIFR ∑ LTIFR 0,0 14 - 15
Traffic Accident ∑ Incident 0 15 - 16
16 - 17
17 - 18
C. Leading Indicator - Program Implementation D. Leading Indicator - Non Conformance Finding 18 - 19
Items Number Of
Parameter Amount Activity Status "Open" Status "Close" % Progress 19 - 20
Findings
HIRADC / JSA Created ∑ JSA 28 Daily Safety Observation 0 20 - 21
Permit To Work Issued ∑ PTW 31 Management Safety Patrol 0 21 - 22
Emergency Drill ∑ Drill 0 Behaviour Observation Scheme 0 22 - 23
HSE Induction ∑ People 0 23 - 24
Medical Checkup / Surat Sehat ∑ MCU / Surat Sehat 0 Days Without Fatality Days Without Lost Time Injury S = SUNNY
Life Training Program Conducted ∑ Training 0 C = CLOUDY
Tool Box Meeting Conducted
Safety Morning Talk Conducted
Audit Conducted
CEVTM Inspection Conducted
Environment Inspection Conducted
∑ TBM
∑ SMT
∑ Audit
∑ Inspection
∑ Env.Inspect
3
0
0
0
0
0 0 LR
HR
=
=
LIGHT RAIN
HEAVY RAIN

Hygiene Inspection Conducted ∑ Hgn.Inspect 0 Last Fatality Incident Last LTI Incident
Houskeeping Conducted ∑ HSK 1 0 / 0 / 2023 0 / 0 / 2023
Waste Disposal ∑ Disposal 1
Resource Control ∑ RC 0

E. Highlighted HSE Event (Including HSE Critical Issue, Award Receive, and Brief Of Incident)

Event Types Brief Event Description Status Remarks

F. Signature F. Signature F.Signature F. Signature

PT.SHOETOWN GRUP PT.CTCI PT. INDOWIN ENGINEERING INDONESIA PT.INDOWIN ENGINEERING INDONESIA
Approved By, Known / Appproved By, Known Preparation By,

DWI FAKRUROJI AGUNG ARIYANSYAH JIMMY RANGGA SURYA NUGRAHA

SHE - PT. STG ( SHE COORDINATOR ) DIKREKTUR ( SHE OFFICER )

Tembusan Cc.
1.Bp. Solichin - Project Manager

FOTO DOCUMENTATION -
Date : 26-November 2023
Picture No. 1 TOOL BOX MEETING LANTAI 1 Picture No. 2 TOOL BOX MEETING LANTAI 3 Picture No. 3 PERSIAPAN PABRIKASI SUPPORT TRAY LANTAI 3

Picture No.4 PEMASANGAN LAMPU KABEL LT 3 Picture NO.5 PENGELASAN SUPPORT TRAY

REMARKS

SIGN BOARD E3 BUILDING

 DAILY REPORT MONITORING SHE ACTIVITY AND FOTO DOCUMENTATION
Foto Documentation Pekerjaan - PT.INDOWIN Date : 26 - 11 - 2023
Picture Picture Picture

FINAL DESIGN BUILDING

Remaks Activity,
1,1 MATERIAL
1 BESI SIKU,PIPA PLASTIK,KABEL 600v, FLEXSIBLE STEEL, RAK KABEL,LONG DRAT
2,1 ACTIVITY
1 PENIMBUNAN JALUR PIPA KABEL TM
2 PABRIKASI SUPPORT TRAY LANTAI 1
3 PABRIKASI SUPPORT TRAY LANTAI3
4 PENGELASAN , PEMOTONGAN LONG DRAT LANTAI 3
5 PEMBOBOKAN MANHOLE, PEMASANGAN PIPA UNTUK JALUR KABEL TM
6 PENGUKURAN,PEMOTONGAN,PEMBORAN,PENGELASAN BESI SIKU LANTAI 3
7
8
3,1 TOMORROW
1 MELANJUTKAN PROGRESS HARI INI
2 PEMASANGAN TRAY LANTAI 1
3 LOADING TRAY LT 3
4,1 Aspek SHE - Safety, Health and Enviroment

SELALU MELAKSANAKAN TBM(TOOL BOX MEETING) SETIAP HARI SENIN,RABU DAN JUMAT UNTUK
MEMBERIKAN INFORMASI ATAU MENGINGATKAN SETIAP PEKERJA BAHWA PENTINGNYA UNTUK MENJAGA
1 KESELAMATAN DAN KEBERSIHAN (HOUSE KEEPING) DI AREA KERJA.SERTA MENGINGATKANSELALU UNTUK
PENGGUNAAN APD(ALAT PELINDUNG DIRI) SEPERTI HELM,SEPATU SAFETY DAN ROMPI DENGAN KONDISI BAIK
DAN MASIH LAYAK PAKAI

Signature Signature Signature Signature

PT.SHOETOWN GRUP PT.CTCI PT.INDOWIN PT.INDOWIN
Approved By, Known By, Known By Preparation by :

DWI FAKHRUROJI AGUNG ARIYANSYAH JIMMY LU RANGGA SURYA N

( FS - Construction ) ( SHE COORDINATOR ) DIREKTUR HSE OFFICER

Tembusan Cc.
1.Bp. Solichin - Project Manager
 FOTO DOCUMENTATION - ACTIVITY

Date : 26 - NOV 2023

Picture No. 1 Picture No. 2 Picture No. 3
HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA HSE SELALU MENGAWASI AKTIFITAS PEKERJA
PENIMUBUNAN JALUR PIPA KABEL TM PAABRIKASI LANTAU 1 PEMASANGAN KABEL LAMPU LANTAI 3

Picture No. 4 Picture No. 5 Picture No. 6

PEMOTONGAN BESI SUPPORT TRAY
REVISI SUPPORT TRAY LT 3
LANTAI 3

FOTO DOCUMENTATION - ACTIVITY

Date : 26 - NOV 2023

26-Nov-23 26-Nov-23 26-Nov-23
TEMUAN NO 1 TEMUAN NO 2 TEMUAN N0 3

TIDAK TERDAPAT TEMUAN PADA HARI INI TIDAK TERDAPAT TEMUAN HARI INI TIDAK TERDAPAT TEMUAN HARI INI

STATUS : OPEN STATUS : OPEN STATUS : OPEN

26-Nov-23 26-Nov-23 26-Nov-23