STATEMENT LETTER

Incident Title : 2 Pekerja tertimpa pipa scaffolding saat merakit scaffolding di

area Transformer Substation Benete.
Nama : Mr Zhu Fagui.
ID Badge : 33009816.
Jabatan : Project Manager PT Shake.
Lama bekerja : 26 Desember 2023.
Tanggal Kejadian : 5 Januari 2024.
Jam Kejadian : 15:.30 wita.
Lokasi Kejadian : Transformer substasion lantai 2 SWI Area.

Kronologi.

Area 33KV, Pukul 13.00 Mr Zhu Fagui berada di 33KV melakukan pengontrolan bangunan
33KV yang sedang didempul/plamir.
Saat kejadian pada jam 15:30 Mr zhu Fagui mendapatkan informasi kecelakaan kerja tertimpa
pipa scaffolding melalui telpon dari Mr Fan Liuyi.
Mr Zhu Fagui menanyakan kondisi pekerja yang tertimpa pipa (untuk mengetahui keparahaan
dan tindakan yang akan di lakukan).
Mr Zhu Fagui segera menelpon penerjemah untuk menyampaikan ke driver untuk segera
datang ke SWI.
Mengetahui kendaraan Mr Zhu Fagui sedang tidak ada dilokasi, Mr Zhu Fagui segera
mendatangi kantor SCC6 menemui Mr Liu Jun (Construction Manager SCC6) untuk
meminjam kendaraan dan menuju SWI (lokasi kejadian).
Setelah sampai di lokasi kejadian, Mr Zhu Fagui langsung memerintahkan korban naik ke
kendaraan untuk menuju pusat kesehatan maluk (puskesmas) kemudian dilanjutkan ke RSUD
Assyfa Taliwang untuk melanjutkan pemeriksaan Radiologi.

Mr Zhu Fagui tidak banyak mengetahui peraturan / prosedur Scaffolding PT. PIL / SCC6 dan
tidak mengetahui syarat pelatihan / sertifikasi operator scaffolding.
Mr Zhu Fagui mengetahui 2 personil operator scaffolding berkebangsaan china telah
mengikuti pelatihan operator scaffolding dari Trainer PT. PIL.

Mr. Zhu mengetahui nomor kontak darurat PT. AMNT. Mr Zhu tidak memanggil nomor kontak
darurat PT. AMNT dikarenakan ingin mempercepat pertolongan pekerjanya, sehingga
pekerja yang tertimpa pipa scaffolding langsung di berangkatkan ke rumah sakit.

Chronology.
Area 33KV, At 13.00 Mr. Zhu Fagui at 33KV, He was monitoring the 33KV building that was
being caulked/plamir.
At 3:30 p.m., Mr. Zhu Fagui received information about a work accident hit by a scaffolding
pipe by telephone from Mr. Fan Liuyi.
Mr. Zhu Fagui asked about the condition of the workers who were hit by the pipeline (to find
out the severity and action to be taken).
Mr. Zhu Fagui immediately called the translator to convey to the driver to come to SWI im-
mediately.
 STATEMENT LETTER
Knowing that Mr. Zhu Fagui's vehicle was not at the location, Mr. Zhu Fagui immediately
went to the SCC6 office to meet Mr. Liu Jun (Construction Manager SCC6) to borrow the
vehicle and went to SWI (the location of the incident).
After arriving at the scene, Mr. Zhu Fagui immediately ordered the victim to board the vehi-
cle to go to the maluk health center (puskesmas) then continued to Assyfa Taliwang Hos-
pital to continue the radiological examination.

Mr. Zhu Fagui is not very aware of the regulations/procedures of Scaffolding PT. PIL / SCC6
and does not know the requirements for training / certification of scaffolding operators in
detail.
Mr. Zhu Fagui knew that 2 Chinese scaffolding operator personnel had attended scaffolding
operator training from PT. PILL.

Mr. Zhu knows the emergency contact number of PT. AMNT. Mr Zhu did not call PT's emer-
gency contact number. AMNT because it wants to speed up the help of its workers, so
workers who are hit by scaffolding pipes are immediately dispatched to the hospital.

Histori Pelatihan / Training History.

• Pelatihan Safety Induction PT. PIL Smelter (Sudah).
• Pelatihan Safety Induction AMNT (Belum).
• Pelatihan Bekerja Diketinggian (belum).
• Safety Induction Training PT. PIL Smelter (already).
• AMNT Safety Induction Training (haven’t).
• Training Working at Height (haven’t).

Fakta/Fact.
• Pak Zhu Fagui tidak berada di Transformenr SWI, Mr Zhu Fagui berada di 33 KV
saat kejadian.
• Pak Zhu Fagui memberikan instruksi untuk membawa IP ke pusat pelayanan
kesehatan.
• ATW & JHA ada dilokasi.
• Mr. Zhu Fagui was not in the SWI Transformer, Mr. Zhu Fagui was at 33 KV at the
time of the incident.
• Mr. Zhu Fagui gave instructions to take IP to the health care center.
• ATW & JHA are on site.

Yang bertanda tangan,

( Zhu Fagui )
Carpenter ID 33009816