Laporan P2K3 & AK3
Laporan P2K3 & AK3
LAPORAN KEGIATAN
Tanggal :......................................
AHLI K3 UMUM di Perusahaan
Triwulan ........ Tahun .......... Kepada Yth.,
Direktur Pengawasan Norma K3
Nomor : .................................................. d.a : Gedung Kemnakertrans Blok B Lantai 7,
Hal : Laporan Kegiatan Ahli K3 Jl. Gatot Subroto Kav. 51 Jakarta Selatan
Umum Email : k2smk3@pnk3.com
Lampiran : .................................................
3. Uraian Kegiatan :
Kondisi
No Objek Pemeriksaan Rekomendasi
Pemeriksaan /
Temuan
(2)
III. Hal-hal yang perlu dilaporkan
..................., ..........................20...
Mengetahui,
Pimpinan Perusahaan
Tembusan :
No : Kepada
Lamp : Yth. Kepala Dinas
Perihal : Laporan Triwulan
....................................................
di-
LAPORAN P2K3
B. DATA K3
(2)
b. Unit Tanggap Darurat
Jumlah Anggota :....................................................................... orang
c. Unit P3K
Jumlah Anggota :....................................................................... orang
d. Lain-lain (jika ada) : ………………….…………………………………
C. KEGIATAN K3
(3)
D. HAMBATAN
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
(4)
E. SARAN
...........................................................................................................................................
...........................................................................................................................................
..........................................................................................................
………………………..….. 20……
Menyetujui
Sekretaris P2K3
Ketua P2K3,
_________________________
1. Pimpina
Perusahaan ...........................................
2. Kadisnaker
Provinsi ............................................
3. Dirjen PPK & K3 cq. Direktur Pengawasan
Norma K3, Kementerian Ketenagakerjaan RI
LAMPIRAN : II A
Usulan /
Kemungkinan
No. Bahaya Potensial Pemecahan /
Kecelakaan
Rekomendasi
1 2 3 4
………………………………… 2016
Mengetahui,
Ketua P 2 K 3 Sekretaris,
________________ __________________
……………………………………………………2016
Mengetahui,
Ketua P 2 K 3 Sekretaris,
________________ __________________