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SSHE PERFORMANCE MONTHLY REPORT

PROJECT : PERIOD :
Monthly Year to Date Target per
NO SUBJECT DESCRIPTION ACTION TO BE TAKEN STATUS
(Current) (YTD) Month
A PROJECT DATA
1 Manpower

2 Man hours

3 Free hours LWC

Fatal Accident Rate (per 100 million


4
hours worked)

Lost Time Injury frequency (per


5
million hours worked)

Total Recordable Incident Rate (per


6
million hours worked)
B LAGGING MATRIC
1 Fatality

2 LTI (Lost Time Injury)

3 LWC (Lost Workday Case)

4 RWC (Restricted Workday Case)

5 MTC (Medical Treatment Case)

6 FAC (First Aid Case)

7 Property Damages

8 Occupational Illness

9 Environment Spill Case

10 Major Fire Case

C LEADING MATRIC

1 Near Miss

2 HAZARD OBSERVATION

- Unsafe Act

- Unsafe Condition

3 Memo from

4 Warning Letter to Subcontractor

5 HSE INSPECTION

- HSE Aspect

- Scaffolding and ladder

- PPE Inventory

- Observation PPE

- Fire Extinguisher

- Tools & Equipment

6 HSE MEETING

- Toolbox Meeting

- HSE Talk

7 HSE Induction

8 HSE Meeting

- HSE Committee/ Project meeting

9 Number of HIRAC or JSA Developed

10 HSE TRAININGS

- Basic Safety Training

- Safe work practice

- Safety Scaffolding & Rigging

- Handling hazardous material

- Manual handling

- Working at Height

- Behavior base safety

- Hazardous waste management

- AK3U

D Security

1 Security Incident
2 Irregularity Activities

3 Absentism
4 Security Awarenes Program
5 Security Training
Security Reporting in 3 hrs by verbal
6
and 24 hrs by written

E PROJECT MANAGER COMMENT

Project Manager Comment :

Remarks:

LWC (Lost Workday Case): an injury or an illness, in which the employee is unable to, or prescribed, by a licensed health care provider, not to return to work the next calendar day, whether or not
the employee is scheduled to work that day

RWC (Restricted Workday Case): an injury or an illness that prevents the employee from performing one or more of the routine functions of his or her job, or from working the full workday that he
or she would otherwise have been scheduled to work.

MTC (Medical Treatment Case): an injury or illness involving any treatment other than what is listed as first aid treatment

FAC (First Aid Case): is any case that involves the treatment but not considered Medical Treatment

Total Recordable Rare (TRR): the sum of fatalities, lost workday cases (LWC), restricted workday cases (RWC), and medical treatment cases (MTC) multiplied 200,000 and divided total man-hour

Reported by, Acknowledged by,

NANANG NURHAYUDI TEDDY DHARMAWAN.S


( HSE Manager
Officer ) ) ( Direktur
Director)Utama)

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