Safety, Health and Environmental Doc :

TGPU-OPS-PR -
2022
Effective : 1 Maret 2021
Revision : 0
PRELIMINARY REPORT [LAPORAN AWAL] Page : Page 1 of 2

□ CIDERA LOKASI :
□ BAHAYA LINGKUNGAN
□ KERUSAKAN PROPERTI TGLKejadian :
□ KERUGIAN PROSES DEPARTEMEN/DIVISI:
□ KEJADIAN LAIN

SUMBER KERUGIAN/BAHAYA:
(Hal-hal yg mungkin menyebabkan terjadinya Cidera, Kerusakan, Kerusakan Lingkungan, Kerugian Proses atau Potensi Kerugian)

URAIAN KEJADIAN:
( Informasi yang ada pada saat ini)

Group Safety, Health and Environmental Management System

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

 Safety, Health and Environmental Doc :
TGPU-OPS-PR -
2022
Effective : 1 Maret 2021
Revision : 0
PRELIMINARY REPORT [LAPORAN AWAL] Page : Page 2 of 2

KEMUNGKINAN PENYEBAB:
(penyebab-penyebab yang kelihatan pada saat ini)

PENYEBAB LANSUNG.
1. Tindakan Substanda

2. Kondisi tidak aman

☺ PENYEBAB DASAR
1. Faktor Pribadi:

2. Faktor Pekerjaan:

Tindakan yang harus dilakukan

DILAPORKAN OLEH:

Safety Health and Environment Pelapor

Group Safety, Health and Environmental Management System

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

 Safety, Health and Environmental Doc :
TGPU-OPS-PR -
2022
Effective : 1 Maret 2021
Revision : 0
PRELIMINARY REPORT [LAPORAN AWAL] Page : Page 3 of 2

Group Safety, Health and Environmental Management System

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT