No.

Form : FM-TR-IH-06
Revisi : 0
LAPORAN SIMULASI TANGGAP DARURAT Tgl. Eff : 1 April 2015

;
Lokasi Simulasi Darurat (Area ERP Simulation) Tanggal dan Waktu (Date and Time) Koordinator OKD (ERP Coordinator)

Nama Korban (Name of Potensi Kerusakan Lain (Other

Kerusakan Bangunan (Property Damage)
Injured) or potensial Loss)
1. ID -
Tipe/ Type :
2. ID
3. ID
Kerugian/ cost :
4. ID

Waktu Pengendalian Bencana (Response Time

To Handle Incident)

Fire Brigade Mengambil Alih Pemadaman (Fire Team Pemadam Kebakaran (Fire
: Hour Minute : Hour Minute
Bregade Come To Hndle) Fighting Extinguish The Fire)

Paramedis/ Ambulance (Paramedis/

: Hour Minute Team P3K (First Aid Team) : Hour Minute
Ambulance)

Pengungsian Seluruh Karyawan (Evacuation of Total Waktu Pengendalian (Total

: Hour Minute : Hour Minute
All Employee) Time To Control Incident)
 No. Form : FM-TR-IH-06
Revisi : 0
LAPORAN SIMULASI TANGGAP DARURAT Tgl. Eff : 1 April 2015

Kronologi Kejadian Bencana dan Tindakan Pengendalian (Describe How The Incident & Emergency Action)

Tindakan Perbaikan untuk mencegah terulangnya/ Recommendation for preventive of accident again