REPORT SHEET (BUKTI HASIL OBSERVASI) UNTUK BUKTI LANGSUNG

FR-PA-06

Perangkat asesmen: Observasi Auditor K3 Migas

Nama Asesi:

Nama Asesor:

Unit kompetensi:
1. Menerapkan Peraturan dan Perundangan K3
2. Menerapkan Keselamatan dan Kesehatan Kerja di tempat kerja
3. Menerapkan safety permit di tempat kerja
4. Melaksanakan pelaporan dan pencatatan kecelakaan kerja.
5. Melakukan inspeksi K3
6. Melakukan Audit K3 di tempat kerja

Kualifikasi: Auditor K3 Migas

Tanggal:
Setiap pertanyaan harus terkait dengan elemen/KUK

Petunjuk Pengisian:
1. Buatlah laporan melaksanakan pekerjaan sebagai Auditor K3 IMG sesuai dengan unit
elemen dan KUK di dalam SKKNI pada lembar berikut!
2. Apabila bukti tersebut diatas sudah terdapat pada laporan yang sudah ada maka bisa disi
“bukti laporan terlampir”
3. Lampirkan Bukti-bukti yang dimaksud nomor 1 dan 2 diatas

Auditor K3 IMG 0
ASSESSMENT TOOLS
 Kode Unit IMG.KK01.001.01
1 Unit Kompetensi Menerapkan Peraturan dan Perundangan K3

Bukti Hasil Pekerjaan Menerapkan Peraturan dan Perundangan K3:

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Kode Unit IMG.KK01.002.01

2 Unit Kompetensi Menerapkan Keselamatan dan Kesehatan Kerja di tempat kerja

Bukti Hasil Pekerjaan Menerapkan Keselamatan dan Kesehatan Kerja di tempat kerja :
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Auditor K3 IMG 1
ASSESSMENT TOOLS
 Kode Unit IMG.KK02.009.01
3 Unit Kompetensi Menerapkan safety permit di tempat kerja.

Bukti Hasil Pekerjaan Menerapkan safety permit di tempat kerja.:

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Kode Unit IMG.KK02.011.01

4 Unit Kompetensi Melaksanakan pelaporan dan pencatatan kecelakaan kerja

Bukti Hasil Pekerjaan Melaksanakan pelaporan dan pencatatan kecelakaan kerja:

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Kode Unit IMG.KK02.012.01
5 Unit Kompetensi Melakukan inspeksi K3

Bukti Hasil Pekerjaan Melakukan inspeksi K3

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Auditor K3 IMG 2
ASSESSMENT TOOLS
 Kode Unit IMG.KK03.002.01
6 Unit Kompetensi Melakukan Audit K3 di tempat kerja

Bukti Hasil Pekerjaan Melakukan Audit K3 di tempat kerja :

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...................................., .....................................2016

Dibuat Oleh, Diperiksa oleh,

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Auditor K3 IMG 3
ASSESSMENT TOOLS