LAPORAN PERTIGA BULANAN (AK3 UMUM)

(Periode Oktober – Desember 2020)

PT. xx
alamat
 kop surat

LAPORAN KEGIATAN PERTIGA BULANAN

AHLI KESELAMATAN DAN KESEHATAN KERJA UMUM (AK3U)

(SAFETY QUARTERLY REPORTS)

Nomor : xx-HSE-20/12/004/ AK3
Kepada : Menteri Tenaga Kerja dan Transmigrasi RI
Cq. Ditjend Binawasker
Jl. Gatot Subroto Kav 51
Jakarta Selatan

Bulan/ Month : Oktober - Desember 2020

PENGESAHAN AK3 UMUM Kepmenakertrans RI

Nama ak3u : xx

NAMA PERUSAHAAN/ Company Name : PT. xx

JENIS USAHA/ Type of Business : xx

ALAMAT/ Address : xx

Laporan Kemajuan K3 Bulan Oktober – Desember 2020 (HSE Progress Achievement on October– December 2020)

No Tanggal/ Program/ Implementasi peraturan Manfaat bagi Penanggung Keterangan/

Jadwal perundangan/ perusahaan/ Jawab/

Date/ Implementation of legal Benefit for company Responsible

Schedule Program requirement by Remarks

1 Harian Melaksanakan kegiatan
pembersihan dan perapihan
di seluruh area fasilitas.
Daily General housekeeping for
all area facility
Mengacu pada UU No. 3 tahun
1969 dan Permen no.7 1964
Refer to Act No.3 year 1969
and ministry of manpower law
no.7 year 1964
Menghindari potensi Production To Workshop
kecelakaan kerja. workers
To avoid potential
incident at workplace

2 Harian Melakukan pengarahan Mengacu pada UU No.13 tahun Menyatukan persepsi Production To Workshop
sebelum memulai pekerjaan 2003& UU No.01 tahun 1970 dan tujuan kerja sama workers
Daily dan berbagi informasi dalam tim dan
tentang K3 Refer to LAW.No13 year menyadararkan
2003 & Act No.1 year 1970 karwawan akan
Briefing prior to start work pentingnya K3
and share safety moment

Integrate perception and

awareness HSE
 Kop surat

No Tanggal/ Program/ Implementasi peraturan Manfaat bagi Penanggung Keterangan/

Jadwal perundangan/ perusahaan/ Jawab/
Remarks
Date/ Implementation of legal Benefit for company Responsible by
Program
Schedule requirement
4 Sesuai Melakukan Identifikasi Mengacu pada UU No.13 Mencegah terjadinya Production To Workshop
Kebutuhan bahaya terhadap pekerjaan tahun 2003 & UU No.01 kecelakaan kerja workers
yang akan dilakukan dan tahun 1970
cara pengendaliannya. Prevent work accident
Refer to LAW.No13 year
As required 2003 & Act No.1 year 1970
Conduct Tool Box Risk
Identification to identify the
Hazard and how to control

3 Mingguan Melakukan HSE Mass Mengacu pada UU No.13 tahun Berbagi pengetahuan HSE To all
meeting setiap hari senin 2003& UU No.01 tahun 1970 mengenai K3 dan employee
Weekly pagi membahas masalah yang
Refer to LAW.No13 year berkaitan dengan K3.
Conduct tool box talk every 2003 & Act No.1 year 1970
Sharing QHSE
Monday morning
knowledge and discus
issue relating to QHSE

4 Bulanan Inspeksi K3L ke seluruh Mengacu pada PP RI No. 50 Memastikan K3L HSE To all area
Monthly area fasilitas. tahun 2012 berjalan dengan baik
HSE inspection to all area Refer to government law no. Ensure implementing
in facility 50 year 2012 HSE.

5 Bulanan Inspeksi APAR Mengacu pada PERMENAKER Memastikan setiap HSE 100%
No.04 Tahun 1980 peralatan darurat siap
Monthly Fire extinguisher
digunakan kapan saja
inspection
Refer to Ministry of Ensure all emergency
manpower regulation no.04 equipment is ready to
year 1980 use.

6 Bulanan Inspeksi APD Mengacu pada PERMENAKER Memastikan HSE 100%

No.08 Tahun 2010 Kelengkapan APD
Monthly PPE Inspection
karyawan

Refer to Ministry of Ensure the

manpower regulation no.08 completeness PPE for
year 2010 employees

7 Bulanan Inspeksi Peralatan dan Mengacu pada PERMENAKER Memastikan Peralatan HSE 100%
Mesin No.38 Tahun 2016 dalam kondisi baik dan
Monthly
Tools and Machinery aman untuk digunakan
Refer to Ministry of
Inspection manpower regulation no.38 Ensure all tools and
year 2016 Machinery in good
condition dan safe for
use

8 Bulanan Inspeksi obat2an di kotak Mengacu pada PERMENAKER Memastikan setiap obat- HSE 100%
P3K No.15 Tahun 2008 obatan darurat lengkap &
Monthly siap digunakan kapan saja
First aid box inspection
Refer to Ministry of
manpower regulation no.15 Ensure all first aid
year 2008 medicine are complete &
ready to use.
 Kop surat
No Tanggal/ Program/ Implementasi peraturan Manfaat bagi Penanggung Keterangan/
Jadwal perundangan/ perusahaan/ Jawab/
Remarks
Date/ Implementation of legal Benefit for company Responsible by
Program
Schedule requirement

9 Sesuai Membagikan informasi Mengacu pada UU No.13 Mencegah terjadinya HSE Tergantung
kebutuhan tentang kecelakaan kerja yang tahun 2003 & UU No.01 kecelakaan kerja serupa kebutuhan
terjadi di perusahaan cabang tahun 1970 terjadi dan mengambil
As required lain pelajaran agar hal tersebut
dapat dihindari

Refer to LAW.No13 year Prevent the same

Share safety alert from 2003 & Act No.1 year 1970 happen and take lesson Depends on
other site learning to avoid the needed
accident

10 Bulanan Memberikan Pengahragan UU No.01 tahun 1970 Memberikan Motivasi HSE 100%
kepada karyawan kepada karaywan agar
Monthly Act No.1 year 1970 bekerja secara aman
Give safety reward to
employee Give motivation to
employees to work
safely

11 Sesuai Memberikan Berdasarkan UU No.1 tahun Mencegah Terjadinya HSE Tergantung

Kebutuhan training/Awareness safety 1970 kecelakaan Kerja kebutuhan
kepada kaeyawan
Refer to Regulation of Law Prevent work Injury
Share safety No.1 year 1970
As required training/Awareness to Depends on
employees needed
AHLI KESELAMATAN &
KESEHATAN KERJA UMUM
(AK3 U)
HSE EXPERT / AK3U
HSE MANAGEMENT SYSTEM
HSE Policy
SAFETY STATISTIC
HSE STATISTIC

TOTAL MANHOURS (YTD) 454517

FIRST AID CASE (FAC) 9

MEDICAL TREATMENT CASE (MTC) 0

RESTRICTED WORK CASE (RWC) 0

LOST TIME INJURY 0

FATALITY 0
 1000

1500

2000

2500
500

MONTHLY WORKING
0
928
11540
2595
J 18,153

1454
14120
2430
Fe

2080
12954
2595
M

2 3104
14 290
56
A
201

4839
2165
M

3601

8731
980
8075
J
201

6866
1740
9890
J

7304
2130
Au

12298

28745971
202

9321
Se

3810
10437
11349
O

4742
21706
202

9124

1280
15690
D

7056
 SAFE WORKING HOUR

Sum of (Normal WH + OT WH + WH)

500000 454517
436364
450000
400000
356574
350000
300000 273638
250000 222529
207108
200000 176463
150000
100000
82936 79790
50000 35895 30645 51109
15421
0 18153
2015 2016 2017 2018 2019 2020 2021

Yearly Working Hours Accumulative Working Hours

 FIRST AID CASE FREQUENCY RATE (FACFR)

FAC : When injured happened without days off but given first aid treatment (cuts & bruises) Qty of First Aid Case x 200.000 Man Hours Worked

30

25

20

15

10

5
2.
2.

2.
1.
1.

0.
0 0.44 0 0 0 0 0 0 0 0 0 0 0
20

20

20

April'

June'
20

20

Jan'

Feb'

Mar'

May'

July'

Aug

Sept

Oct

Nov

Dec

Accumulative
(YTD)
FACFR Monthly FACFR
 MEDICAL TREATMENT CASE FREQUENCY (MTCFR)

MTC : Any Injury requiring more than first aid treatment (paramedic, nurse,surgeon) Qty of Medical Treatment Case x 200.000 Man Hours W

30

25

20

15

10

5
0

0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20

20

20

Feb'

June'
Jan'

Mar'

April'

May'

July'

Oct

Nov
Aug

Sept

Dec

Accumulative
(YTD)
MTCFR Monthly MTCFR
 RESTRICTED WORK CASE FREQUENCY RATE (RWCFR)

RWC : Any Injury which prevents person from performing his normal duties, but is able to Qty of Restricted Work Case x 200.000 Man Hours W
perform other meaningful duties within the company

30

25

20

15

10

5
0

0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20

20

20

Feb'

June'
Jan'

Mar'

April'

May'

July'

Oct

Nov
Aug

Sept

Dec

Accumulative
(YTD)
RWCFR Monthly RWCFR
 LOST TIME INJURY FREQUENCY RATE (LTIFR)

LTI : A work injury that prevent a person from completing the next day’s shift Qty of LTIFR x 200.000
Man Hours Worked

30

25

20

15

10

5
0

0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20

20

20

Feb'

June'
Jan'

Mar'

April'

May'

July'

Oct

Nov
Aug

Sept

Dec

Accumulative
(YTD)
LTIFR Monthly LTIFR
 TOTAL RECORDABLE CASE FREQUENCY RATE (TRCFR)
TRCFR : SUM FAC+MTC+RWC+LTI SUM (FAC+MTC+RWC+LTI) x 200.000
Man Hours Worked

30

25

20

15

10

5
2.
2.

2.
1.
1.

0.
0 0.44 0 0 0 0 0 0 0 0 0 0 0
20

20

20

20

June'
20

Jan'

Feb'

Mar'

April'

May'

July'

Oct

Nov
Aug

Sept

Dec

Accumulative
(YTD)
TRCFR Monthly TRCFR
 SEVERITY RATE (SR)

SR : Number days off because of incidents Qty days off x 200.000 Man Hours Worked

30

25

20

15

10

5
0

0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20

20

20

Feb'

June'
Jan'

Mar'

April'

May'

July'

Oct

Nov
Aug

Sept

Dec

Accumulative
(YTD)
SR Monthly SR