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  • Report & Investigation Pencurian

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    Ichsan Yusran Mare
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    This incident report summarizes an incident that occurred between March 27-28, 2019 at the Innalahi 02 location of the Penataan Lahan Reklamasi 2018-2020 project. An excavator (Exc-07) was damaged during this period. The investigation was led by Ichsan Yusran and Angga Eko P. Short term corrective actions included reporting the incident to the project manager and user as well as communicating with the mine rehabilitation department. Long term actions involve making a report at the security gate, police station, and securing the unit while waiting further instruction.

    Original Description:

    Laporan Berita Acara Pelaporan dan Investigasi kasus Pencurian

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    This incident report summarizes an incident that occurred between March 27-28, 2019 at the Innalahi 02 location of the Penataan Lahan Reklamasi 2018-2020 project. An excavator (Exc-07) was damaged during this period. The investigation was led by Ichsan Yusran and Angga Eko P. Short term corrective actions included reporting the incident to the project manager and user as well as communicating with the mine rehabilitation department. Long term actions involve making a report at the security gate, police station, and securing the unit while waiting further instruction.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    19 views3 pages

    Report & Investigation Pencurian

    Uploaded by

    Ichsan Yusran Mare
    This incident report summarizes an incident that occurred between March 27-28, 2019 at the Innalahi 02 location of the Penataan Lahan Reklamasi 2018-2020 project. An excavator (Exc-07) was damaged during this period. The investigation was led by Ichsan Yusran and Angga Eko P. Short term corrective actions included reporting the incident to the project manager and user as well as communicating with the mine rehabilitation department. Long term actions involve making a report at the security gate, police station, and securing the unit while waiting further instruction.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 3

    Form.

    04-HES-IPW-XII-2013
    PT. INDRA PRATAMA WASUPONDA

    INCIDENT REPORT

    1. PROJECT DETAILS

    Project : Penataan Lahan Reklamasi 2018-2020


    Contract no. : 4600043278
    Location : Innalahi
    Report no. : 05/INV/IPW/HES/III/2019

    INVESTIGATION TEAM MEMBERS POSITION


    1. Ichsan Yusran Safety Koord.
    2. Angga Eko P. Supervisior
    3.
    4.
    5.
    6.

    2. ACCIDENT DETAILS

    Days/Date/Time of Incident : Between Wednesday (27 March 19) - Thuesday (28 March 19)
    Days/Date/Time Reported : Thuesday, 28 March 2019
    Locations : Innalahi 02
    Weather Conditions : Cloudy

    Work hours : from 07:00 WITA to 17:00 WITA


    Overtime : from - to -

    Journey/work travel related : Yes No a


    Environmental damaged Property damaged a Near miss

    Personal Damage Class I Personal Damage Class II Personal Damage Class III

    3. DETAILS OF THE DAMAGE

    PERSON/ ENVIRONMENT/ DAYS LOST (IF PERSON) ESTIMATED COST REMARKS


    EQUIPMENT/ TOOLS
    Excavator CAT320 D (Exc-07) -
    CT 2719

    WITNESS NAME ID NUMBER OCCUPATION EMPLOYER


    OGHAN SARJONO C - 11612 SUPERVISIOR
    PURDIANTO C - 18650 OPERATOR
    4. DESCRIPTION OF ACCIDENT/INCIDENT

    (Include detail of injuries/damage and assessment of apparent cause)

    QUESTION RELATED TO DETAILS OF INCIDENT DESCRIPTION (Please use and attach additional paper if this space is
    INCIDENT/ACCIDENT
    Where & when did the incident happen? insufficient)
    What was the task? LAMPIRAN 1
    What kind of PPE, equipment, tools, and
    materials were being used?
    (Attach witness statement, sketches, comments, photographs and other details where appropriate)

    5. ROOT CAUSE ANALYSIS OF ACCIDENT/ HAZARD/ NEAR MISS

    BASIC CAUSES IMMEDIATE CAUSES


    JOB FACTORS PERSONAL FACTORS SUBSTANDARD PRACTICES/ACTS SUBSTANDARD CONDITION
    Operating equipment without
    Caused by employee Physical incapability Inadequate guard/sign
    authority/permit
    Defective tools,equipment or
    Caused by another employee Inattention to hazard Failure to make secure
    material
    Defective from normal use Unaware of safe method Failure to warn Inadequate/improper PPE

    Abuse/misuse of equipment Low level job skill Operating at improper speed Inadequate warning system

    Safety inspection failure Tried to avoid discomfort Removing safety devices Poor Housekeeping
    Housekeeping failure Tried to gain or safe time Use defective equipment Radiation exposure
    Inadequate
    Tried to avoid extra effort Use equipment unsafely Fire & explosion hazard
    design/construction/engineering
    Inadequate leadership/supervision Influence of emotions Use PPE improperly Inadequate ventilation

    Preventive maintenance failure Fatigue/stress (physics/mental) Improper lifting, loading Temperatures extremes

    Services equipment in
    Purchasing failure Lack of knowledge Chemical hazard
    operation
    Miscommunication/misunderstand Improper motivation Improper placement Inadequate illumination
    Inadequate work procedures/no Inexperiences in task being
    Improper position for task Congested/restricted work area
    documented procedures performed
    Act or omission of another
    Inadequate training provided Horseplay Excessive noise
    person
    Under influence of Environment condition (wind,
    Production pressure Possible personal problem
    alcohol/drugs dust, rain, etc)

    a Others
    a Others
    a Others
    aOthers

    6. CORRECTIVE ACTION

    6.1 Short Term Action


    Corrective Action By whom By when
    1. Melaporkan kejadian tersebut ke Project Manager (Contr.)
    dan User PT. Vale (DONE) SPV Saat itu juga
    2. Melakukan komunikasi dengan pihak Mine Rehabilitation
    dan Dept. DSS Untuk membuat laporan pencurian. (DONE) PM Saat itu juga
    6.2 Long Term Action
    Corrective Action By whom By when
    1. Membuat laporan di Security Gate Gunung Batu, Dept. DSS
    PTVI dan ke Polsek Nuha untuk investigasi dan penyelidikan Contractor (IPW) & Saat Itu juga
    lebih lanjut. DSS Dept.

    2. Mengamankan unit menunggu instruksi lebih lanjut. Contractor (IPW) & Saat Itu juga
    Construction Dept.

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