LAPORAN HARIAN "KONSTRUKSI" GRESEM

PIPELINE PROJECT
KONSORSIUM WIKA-RABANA-KELSRI

Proyek Jasa Perancangan, Pengadaan dan Konstruksi Pembangunan Pipa Gas dari Gresik - Semarang
Disiplin : Pipeline Daily Report No. : GEN-SPREAD1-28-VII-28
Lokasi : Section 3 (KM 152+800 - 140+100 / KP 66+270 - 79+050) Date : 28-Jul-16

No. Man Power Unit Qty. No. Construction Equipment Unit Qty. No. Construction Material Unit Qty.
1 Superintendent Psn 2 1 Light Vechicle unit 7 1
2 Lead Logistic Psn 1 2 Pick Up unit 1 2
3 Material Control Psn 2 3 Excavator unit 0 3
4 Safety Officer Psn 4 4 Hydraulic Crane, 35 T unit 0 4
5 Quality Control Psn 4 5 Truck Crane 8 Ton unit 0 5
6 Community Psn 3 6 Buldozer unit 0 6
7 Supervisor Psn 2 7 Welding Machine & Rectifier unit 0 7
8 Worker Psn 10 8 Cutting & Bevelling Machine unit 0 8
9 Driver LV Psn 8 9 Generator Set 40 KVA unit 0 9
10 Operator Psn 0 10 Crawler Crane, 45 T Unit 0 10
11 Rigger Psn 0 11 11
12 Driver HD Psn 0 12 12
13 Welder Psn 0 13 13
14 Pipe Fitter Psn 0 14 14
15 Grinder Psn 0 15 15
16 Helper Psn 0 16 16
Total Man Power Person 36

No. Permit Number Description Type of Permit Validity of Permit

1
2
3
4
5
6
7
8
9

No. To Day Activities Remark

1 No Activity
2
3
4
5
6
7
8
9
No. Tomorrow Activities Remark
1
2
3
4
5
6
7
8
9
No. Area of Concern Remark
1 Land Clearing
2 Stringing
3 Welding dan NDT
4 Field Joint Coating
5 TLB

PREPARED BY REVIEWED BY APPROVED BY

Tandatangan: Tandatangan: Tandatangan:

Nama : Elwing / Turmudi Nama : Widjaja Dharma Nama : Nanang Ivan

Posisi : Superitendent Posisi : Construction Manager Posisi : Project Control
Kontraktor : Konsorsium Wika-Rabana-Kelsri Kontraktor : Konsorsium Wika-Rabana-Kelsri PMC : PT Bintang Persada Abadi
 LAPORAN HARIAN "KONSTRUKSI" GRESEM
PIPELINE PROJECT
KONSORSIUM WIKA-RABANA-KELSRI

Proyek Jasa Perancangan, Pengadaan dan Konstruksi Pembangunan Pipa Gas dari Gresik - Semarang
Disiplin : Pipeline Daily Report No. : GEN-SPREAD1-28-VII-28
Lokasi : Section 3 (KM 152+800 - 140+100 / KP 66+270 - 79+050) Date : 28-Jul-16

PROGRESS KONSTRUKSI PIPELINE

NO Description Location (KP) Unit Progress Previous Progress today Progress Commulative Remark

1 Construction Survey m' #REF! 0 #REF!

2 ROW Clearing, Cut & Fill, and Grading m' #REF! 0 #REF!
3 Access Road m' #REF! 0 #REF!
m' #REF! 0 #REF!
4 Stringing
pcs #REF! 0 #REF!
5 Trenching / Push Pull m' #REF! 0 #REF!
6 Bending m' #REF! 0 #REF!
joint #REF! 0 #REF!
7 Welding
m' #REF! 0 #REF!
8 Repair joint #REF! 0 #REF!
9 NDT Test joint #REF! 0 #REF!
10 Holiday Test m' #REF! 0 #REF!
11 Joint Coating joint #REF! 0 #REF!
12 Lowering m' #REF! 0 #REF!
13 Backfilling and Compaction m' #REF! 0 #REF!
14 Re-instatement m' #REF! 0 #REF!
Pemasangan Aerial Marker, Warning
15 Sign, Marker Sign pcs #REF! 0 #REF!

16 Painting All Steel Substrate m' #REF! 0 #REF!

Road Crossing (Auger Boring, Open Cut)

17 include Casing, venting and spacer & titik #REF! 0 #REF!
Accessories

River Crossing (HDD,c/w reinforced Joint

18 Coating) titik #REF! 0 #REF!

River Crossing Open Cut c/w Concrete

19 Coating (minor river, ditch, irrigation titik #REF! 0 #REF!
channel, etc)

Railway Crossing include Casing, venting

20 and spacer & Accessories titik #REF! 0 #REF!

21 Hot Bend pcs #REF! 0 #REF!

22 Barred Tee 28" x 24" pcs #REF! 0 #REF!
23 Anchor Flange pcs #REF! 0 #REF!
24 Insulating Joint pcs #REF! 0 #REF!

PREPARED BY REVIEWED BY APPROVED BY

Tandatangan: Tandatangan: Tandatangan:

Nama : Elwing / Turmudi Nama : Widjaja Dharma Nama : Nanang Ivan

Posisi : Superitendent Posisi : Construction Manager Posisi : Project Control
Kontraktor : Konsorsium Wika-Rabana-Kelsri Kontraktor : Konsorsium Wika-Rabana-Kelsri PMC : PT Bintang Persada Abadi
 FOTO KEGIATAN GRESEM PIPELINE PROJECT
KONSORSIUM WIKA-RABANA-KELSRI

Proyek Jasa Perancangan, Pengadaan dan Konstruksi Pembangunan Pipa Gas dari Gresik - Semarang
Tanggal :

28-Jul-16

Item Pekerjaan :

Lokasi :

NO ACTIVITY Jumlah Pekerja :

Lama Pekerjaan :

Alat yang dipakai :

Keterangan : Belum ada pembebasan lahan/Penyerahan lahan dari PTG Lahan ke KWRK untuk melakukan konstruksi.

Kendala : Tidak bisa melakukan pekerjaan konstruksi Pipeline.

Tanggal :

28-Jul-16

Item Pekerjaan :

Lokasi :

NO ACTIVITY Jumlah Pekerja :

Lama Pekerjaan :

Alat yang dipakai :

Keterangan : Belum ada pembebasan lahan/Penyerahan lahan dari PTG Lahan ke KWRK untuk melakukan konstruksi.

Kendala : Tidak bisa melakukan pekerjaan konstruksi Pipeline.

 HSE DAILY ACTIVITIES

PEKERJAAN JASA PERANCANGAN, PENGADAAN DAN KONSTRUKSI (EPC) PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING
No Laporan : Hari : Minggu 1. Dzafran Fauzi
2. Purwanto
HSE Incharge
Area : Tanggal : 18-4-2021
Cuaca :
V CERAH
Pukul : 07.00 - 18.00
MENDUNG
POS : HUJAN Tool Box Ok Preparation HSE Activity
Meeting V No HSSE Plan, HIRAC etc
SAFE WORK DAY : 168 Day STOP CARD : Unsafe : Safe :

QTY
Man Prev Man Total Man
No. Man Power Person Qty Hours Hours Hours No. Construction Equipment Unit Qty. Description
Today Cumm Prev Today Cumm

A Indirect Manpower 1 Total Station Unit 0 General Safety Talk/Toolbo 0 0 0

1 Project Manager 1 10 0 10 2 Light Vehicle & Double Cabin Unit 0 HSE Induction 0 0 0
2 Construction Manager 0 0 0 0 3 Pick up Unit 0 HSE Meeting/Meeting Koordinasi 0 0 0
3 Site Manager 0 0 0 0 4 Isuzu Elf Unit 0 HSE Training 0 0 0
4 Procurement & asst 0 0 0 0 5 Welding Truck Unit 0 Drill 0 0 0
5 QA/QC Coordinator 0 0 0 0 6 Dolly Truck Unit 0 Safety Patrol 0 0 0

HSE Activities
6 Finance & Asst 0 0 0 0 7 Dump Truck Unit 0 Walk Trought 0 0 0
7 HRD & Asst 0 0 0 0 8 Trailer Unit 0 HSE Audit 0 0 0
8 GA 0 0 0 0 9 Self Loader Unit 0 Safety Alert 0 0 0
9 Project Control 0 0 0 0 10 Truck Boom / Truck Crane / Hi-up Unit 0 Equipment/Tools Inspection 0 0 0
10 Engineering 0 0 0 0 11 Excavator Unit 0 Site Inspection/ Site Visit 0 0 0
11 HSE Coordinator 1 10 0 10 12 Miller Welding Machine Unit 0 SIKA/JSA 0 0 0
12 Fasilities & asst 0 0 0 0 13 Grinding Tools ea 0 Safety Award 0 0 0
13 Office Boy / Girl 0 0 0 0 14 External Clamp 16'' Ea 0 Warning Letter 0 0 0
14 Security Mess 0 0 0 0 15 Coating Tools Set 0 Hazardous Waste 0 0 0
B Direct Manpower 16 Holiday Detector Ea 0 Non Hazardous Waste 0 0 0
14 Surveyor 0 0 0 0 17 Temperature Gun Ea 0 Fatality 0 0 0
15 Asst Surveyor 0 0 0 0 18 Compressor Unit 0 Lost Time Incident (LTI.s) 0 0 0
16 Data Processing Survey 0 0 0 0 19 Genset Unit 0 Day Lost 0 0 0
17 Security Workshop / Alat 0 0 0 0 20 Stamper Unit 0 Lost Time Injury(LTI) 0 0 0
18 Welding Inspector 0 0 0 0 21 Water Pump Unit 0 First Aid Case (FAC) 0 0 0

Accident/Incident
19 Coating Inspector 0 0 0 0 22 Motorcycle Unit 0 Severty Rate (SR) 0 0 0
20 HSE Officer 1 10 0 10 23 HDD unit Unit 0 Frequency Rate (FR) 0 0 0
21 Safetyman 0 0 0 0 24 Auger Boring unit Unit 0 Environmental Damage 0 0 0
22 HSE Admin 0 0 0 0 25 Hydrotest unit Unit 0 Property Damage (PD) 0 0 0
23 Flagman 0 0 0 0 Motor Vehicle Accident (MVA) 0 0 0
24 Warehouseman 0 0 0 0 Fire Incident/Explosion 0 0 0
25 Fuelman 0 0 0 0 Security Case 0 0 0
26 Superintendent 0 0 0 0 Villager Complaint 0 0 0
27 Foreman 0 0 0 0 Media Attention 0 0 0
28 Welder 0 0 0 0 Near Miss 0 0 0
29 Pipe Fitter 0 0 0 0
30 Grinderman 0 0 0 0
31 Rigger 0 0 0 0
32 Coater 0 0 0 0
33 NDT Team 0 0 0 0
34 Mechanic/Electrician 0 0 0 0
35 Operator 0 0 0 0
36 Mess Laundry 0 0 0 0
37 Helper 0 0 0 0
38 Driver LV / Elf / 4x4 0 0 0 0
39 Driver Self Loader, Hi-up, etc 0 0 0 0
Driver Welding Truck, Truck Box,
40 Dump Truck 0 0 0 0

41 HDD Team 0 0 0 0
42 Auger Boring 0 0 0 0
43 Hydrotest 0 0 0 0
44 Civil 0 0 0 0
45 HDPE Installer 0 0 0 0
Total 3 30 0 30

NO AKTIVITAS HARI INI LOKASI NO RENCANA BESOK LOKASI

1 Update Kick Off Meeting 21-4-2021 at 09:00 AM WFH 1 None Note
2 2
3 3
at 4
5 5
6 6

PREPARED BY ACKNOELEDGE BY
Tandatangan: Tandatangan:

Nama : Purwanto Nama : Dfran Fauzi

Posisi : HSE Officer Posisi : HSE Coordinator
Perusahaan : PT. PBAS Perusahaan : PT. PBAS
 HSE DAILY ACTIVITIES

PEKERJAAN JASA PERANCANGAN, PENGADAAN DAN KONSTRUKSI (EPC) PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING
No Laporan : Hari : Senin 1. Dzafran Fauzi
2. Purwanto
HSE Incharge
Area : Tanggal : 19-4-2021
Cuaca :
V CERAH
Pukul : 07.00 - 18.00
MENDUNG
POS : HUJAN Tool Box Ok Preparation HSE Activity
Meeting V No HSSE Plan, HIRAC etc
SAFE WORK DAY : 168 Day STOP CARD : Unsafe : Safe :

QTY
Man Prev Man Total Man
No. Man Power Person Qty Hours Hours Hours No. Construction Equipment Unit Qty. Description
Today Cumm Prev Today Cumm

A Indirect Manpower 1 Total Station Unit 0 General Safety Talk/Toolbo 0 0 0

1 Project Manager 1 10 10 20 2 Light Vehicle & Double Cabin Unit 0 HSE Induction 0 0 0
2 Construction Manager 0 0 0 0 3 Pick up Unit 0 HSE Meeting/Meeting Koordinasi 0 0 0
3 Site Manager 0 0 0 0 4 Isuzu Elf Unit 0 HSE Training 0 0 0
4 Procurement & asst 0 0 0 0 5 Welding Truck Unit 0 Drill 0 0 0
5 QA/QC Coordinator 0 0 0 0 6 Dolly Truck Unit 0 Safety Patrol 0 0 0

HSE Activities
6 Finance & Asst 0 0 0 0 7 Dump Truck Unit 0 Walk Trought 0 0 0
7 HRD & Asst 0 0 0 0 8 Trailer Unit 0 HSE Audit 0 0 0
8 GA 0 0 0 0 9 Self Loader Unit 0 Safety Alert 0 0 0
9 Project Control 0 0 0 0 10 Truck Boom / Truck Crane / Hi-up Unit 0 Equipment/Tools Inspection 0 0 0
10 Engineering 0 0 0 0 11 Excavator Unit 0 Site Inspection/ Site Visit 0 0 0
11 HSE Coordinator 1 10 10 20 12 Miller Welding Machine Unit 0 SIKA/JSA 0 0 0
12 Fasilities & asst 0 0 0 0 13 Grinding Tools ea 0 Safety Award 0 0 0
13 Office Boy / Girl 0 0 0 0 14 External Clamp 16'' Ea 0 Warning Letter 0 0 0
14 Security Mess 0 0 0 0 15 Coating Tools Set 0 Hazardous Waste 0 0 0
B Direct Manpower 16 Holiday Detector Ea 0 Non Hazardous Waste 0 0 0
14 Surveyor 0 0 0 0 17 Temperature Gun Ea 0 Fatality 0 0 0
15 Asst Surveyor 0 0 0 0 18 Compressor Unit 0 Lost Time Incident (LTI.s) 0 0 0
16 Data Processing Survey 0 0 0 0 19 Genset Unit 0 Day Lost 0 0 0
17 Security Workshop / Alat 0 0 0 0 20 Stamper Unit 0 Lost Time Injury(LTI) 0 0 0
18 Welding Inspector 0 0 0 0 21 Water Pump Unit 0 First Aid Case (FAC) 0 0 0

Accident/Incident
19 Coating Inspector 0 0 0 0 22 Motorcycle Unit 0 Severty Rate (SR) 0 0 0
20 HSE Officer 1 10 10 20 23 HDD unit Unit 0 Frequency Rate (FR) 0 0 0
21 Safetyman 0 0 0 0 24 Auger Boring unit Unit 0 Environmental Damage 0 0 0
22 HSE Admin 0 0 0 0 25 Hydrotest unit Unit 0 Property Damage (PD) 0 0 0
23 Flagman 0 0 0 0 Motor Vehicle Accident (MVA) 0 0 0
24 Warehouseman 0 0 0 0 Fire Incident/Explosion 0 0 0
25 Fuelman 0 0 0 0 Security Case 0 0 0
26 Superintendent 0 0 0 0 Villager Complaint 0 0 0
27 Foreman 0 0 0 0 Media Attention 0 0 0
28 Welder 0 0 0 0 Near Miss 0 0 0
29 Pipe Fitter 0 0 0 0
30 Grinderman 0 0 0 0
31 Rigger 0 0 0 0
32 Coater 0 0 0 0
33 NDT Team 0 0 0 0
34 Mechanic/Electrician 0 0 0 0
35 Operator 0 0 0 0
36 Mess Laundry 0 0 0 0
37 Helper 0 0 0 0
38 Driver LV / Elf / 4x4 0 0 0 0
39 Driver Self Loader, Hi-up, etc 0 0 0 0
Driver Welding Truck, Truck Box,
40 Dump Truck 0 0 0 0

41 HDD Team 0 0 0 0
42 Auger Boring 0 0 0 0
43 Hydrotest 0 0 0 0
44 Civil 0 0 0 0
45 HDPE Installer 0 0 0 0
Total 3 30 30 60

NO AKTIVITAS HARI INI LOKASI NO RENCANA BESOK LOKASI

1 Membuat HSE Plan dan Presentasi Kick Off Meeting 21-4-2021 WFH 1 None None
at 09:00 AM
2 2
3 3
4 4
5 5

PREPARED BY ACKNOELEDGE BY
Tandatangan: Tandatangan:

Nama : Purwanto Nama : Dfran Fauzi

Posisi : HSE Officer Posisi : HSE Coordinator
Perusahaan : PT. PBAS Perusahaan : PT. PBAS
 HSE DAILY ACTIVITIES

PEKERJAAN JASA PERANCANGAN, PENGADAAN DAN KONSTRUKSI (EPC) PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING
No Laporan : Hari : Selasa 1. Dzafran Fauzi
2. Purwanto
HSE Incharge
Area : Tanggal : 20-4-2021
Cuaca :
V CERAH
Pukul : 07.00 - 18.00
MENDUNG
POS : HUJAN Tool Box Ok Preparation HSE Activity
Meeting V No HSSE Plan, HIRAC etc
SAFE WORK DAY : 168 Day STOP CARD : Unsafe : Safe :

QTY
Man Prev Man Total Man
No. Man Power Person Qty Hours Hours Hours No. Construction Equipment Unit Qty. Description
Today Cumm Prev Today Cumm

A Indirect Manpower 1 Total Station Unit 0 General Safety Talk/Toolbo 0 0 0

1 Project Manager 1 10 20 30 2 Light Vehicle & Double Cabin Unit 0 HSE Induction 0 0 0
2 Construction Manager 0 0 0 0 3 Pick up Unit 0 HSE Meeting/Meeting Koordinasi 0 0 0
3 Site Manager 0 0 0 0 4 Isuzu Elf Unit 0 HSE Training 0 0 0
4 Procurement & asst 0 0 0 0 5 Welding Truck Unit 0 Drill 0 0 0
5 QA/QC Coordinator 0 0 0 0 6 Dolly Truck Unit 0 Safety Patrol 0 0 0

HSE Activities
6 Finance & Asst 0 0 0 0 7 Dump Truck Unit 0 Walk Trought 0 0 0
7 HRD & Asst 0 0 0 0 8 Trailer Unit 0 HSE Audit 0 0 0
8 GA 0 0 0 0 9 Self Loader Unit 0 Safety Alert 0 0 0
9 Project Control 0 0 0 0 10 Truck Boom / Truck Crane / Hi-up Unit 0 Equipment/Tools Inspection 0 0 0
10 Engineering 0 0 0 0 11 Excavator Unit 0 Site Inspection/ Site Visit 0 0 0
11 HSE Coordinator 1 10 20 30 12 Miller Welding Machine Unit 0 SIKA/JSA 0 0 0
12 Fasilities & asst 0 0 0 0 13 Grinding Tools ea 0 Safety Award 0 0 0
13 Office Boy / Girl 0 0 0 0 14 External Clamp 16'' Ea 0 Warning Letter 0 0 0
14 Security Mess 0 0 0 0 15 Coating Tools Set 0 Hazardous Waste 0 0 0
B Direct Manpower 16 Holiday Detector Ea 0 Non Hazardous Waste 0 0 0
14 Surveyor 0 0 0 0 17 Temperature Gun Ea 0 Fatality 0 0 0
15 Asst Surveyor 0 0 0 0 18 Compressor Unit 0 Lost Time Incident (LTI.s) 0 0 0
16 Data Processing Survey 0 0 0 0 19 Genset Unit 0 Day Lost 0 0 0
17 Security Workshop / Alat 0 0 0 0 20 Stamper Unit 0 Lost Time Injury(LTI) 0 0 0
18 Welding Inspector 0 0 0 0 21 Water Pump Unit 0 First Aid Case (FAC) 0 0 0

Accident/Incident
19 Coating Inspector 0 0 0 0 22 Motorcycle Unit 0 Severty Rate (SR) 0 0 0
20 HSE Officer 1 10 20 30 23 HDD unit Unit 0 Frequency Rate (FR) 0 0 0
21 Safetyman 0 0 0 0 24 Auger Boring unit Unit 0 Environmental Damage 0 0 0
22 HSE Admin 0 0 0 0 25 Hydrotest unit Unit 0 Property Damage (PD) 0 0 0
23 Flagman 0 0 0 0 Motor Vehicle Accident (MVA) 0 0 0
24 Warehouseman 0 0 0 0 Fire Incident/Explosion 0 0 0
25 Fuelman 0 0 0 0 Security Case 0 0 0
26 Superintendent 0 0 0 0 Villager Complaint 0 0 0
27 Foreman 0 0 0 0 Media Attention 0 0 0
28 Welder 0 0 0 0 Near Miss 0 0 0
29 Pipe Fitter 0 0 0 0
30 Grinderman 0 0 0 0
31 Rigger 0 0 0 0
32 Coater 0 0 0 0
33 NDT Team 0 0 0 0
34 Mechanic/Electrician 0 0 0 0
35 Operator 0 0 0 0
36 Mess Laundry 0 0 0 0
37 Helper 0 0 0 0
38 Driver LV / Elf / 4x4 0 0 0 0
39 Driver Self Loader, Hi-up, etc 0 0 0 0
Driver Welding Truck, Truck Box,
40 Dump Truck 0 0 0 0

41 HDD Team 0 0 0 0
42 Auger Boring 0 0 0 0
43 Hydrotest 0 0 0 0
44 Civil 0 0 0 0
45 HDPE Installer 0 0 0 0
Total 3 30 60 90

NO AKTIVITAS HARI INI LOKASI NO RENCANA BESOK LOKASI

1 Membuat HSE Plan dan Presentasi Kick Off Meeting 21-4-2021 WFH 1 Kick off meeting Project Pekerjaan Alas Dara Kemuning WFH
at 09:00 AM
2 2
3 3
4 4
5 5

PREPARED BY ACKNOELEDGE BY
Tandatangan: Tandatangan:

Nama : Purwanto Nama : Dfran Fauzi

Posisi : HSE Officer Posisi : HSE Coordinator
Perusahaan : PT. PBAS Perusahaan : PT. PBAS
 HSE DAILY ACTIVITIES

PEKERJAAN JASA PERANCANGAN, PENGADAAN DAN KONSTRUKSI (EPC) PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING
No Laporan : Hari : Rabu 1. Dzafran Fauzi
2. Purwanto
HSE Incharge
Area : Tanggal : 21-4-2021
Cuaca :
V CERAH
Pukul : 07.00 - 18.00
MENDUNG
POS : HUJAN Tool Box V Ok Presentation HSE Plan Jasa
Meeting No EPC Pemb. Pipa gas ADK
SAFE WORK DAY : 168 Day STOP CARD : Unsafe : Safe :

QTY
Man Prev Man Total Man
No. Man Power Person Qty Hours Hours Hours No. Construction Equipment Unit Qty. Description
Today Cumm Prev Today Cumm

A Indirect Manpower 1 Total Station Unit 0 General Safety Talk/Toolbo 0 0 0

1 Project Manager 1 10 30 40 2 Light Vehicle & Double Cabin Unit 0 HSE Induction 0 0 0
2 Construction Manager 0 0 0 0 3 Pick up Unit 0 HSE Meeting/Meeting Koordinasi 0 0 0
3 Site Manager 0 0 0 0 4 Isuzu Elf Unit 0 HSE Training 0 0 0
4 Procurement & asst 0 0 0 0 5 Welding Truck Unit 0 Drill 0 0 0
5 QA/QC Coordinator 0 0 0 0 6 Dolly Truck Unit 0 Safety Patrol 0 0 0

HSE Activities
6 Finance & Asst 0 0 0 0 7 Dump Truck Unit 0 Walk Trought 0 0 0
7 HRD & Asst 0 0 0 0 8 Trailer Unit 0 HSE Audit 0 0 0
8 GA 0 0 0 0 9 Self Loader Unit 0 Safety Alert 0 0 0
9 Project Control 0 0 0 0 10 Truck Boom / Truck Crane / Hi-up Unit 0 Equipment/Tools Inspection 0 0 0
10 Engineering 0 0 0 0 11 Excavator Unit 0 Site Inspection/ Site Visit 0 0 0
11 HSE Coordinator 1 10 30 40 12 Miller Welding Machine Unit 0 SIKA/JSA 0 0 0
12 Fasilities & asst 0 0 0 0 13 Grinding Tools ea 0 Safety Award 0 0 0
13 Office Boy / Girl 0 0 0 0 14 External Clamp 16'' Ea 0 Warning Letter 0 0 0
14 Security Mess 0 0 0 0 15 Coating Tools Set 0 Hazardous Waste 0 0 0
B Direct Manpower 16 Holiday Detector Ea 0 Non Hazardous Waste 0 0 0
14 Surveyor 0 0 0 0 17 Temperature Gun Ea 0 Fatality 0 0 0
15 Asst Surveyor 0 0 0 0 18 Compressor Unit 0 Lost Time Incident (LTI.s) 0 0 0
16 Data Processing Survey 0 0 0 0 19 Genset Unit 0 Day Lost 0 0 0
17 Security Workshop / Alat 0 0 0 0 20 Stamper Unit 0 Lost Time Injury(LTI) 0 0 0
18 Welding Inspector 0 0 0 0 21 Water Pump Unit 0 First Aid Case (FAC) 0 0 0

Accident/Incident
19 Coating Inspector 0 0 0 0 22 Motorcycle Unit 0 Severty Rate (SR) 0 0 0
20 HSE Officer 1 10 30 40 23 HDD unit Unit 0 Frequency Rate (FR) 0 0 0
21 Safetyman 0 0 0 0 24 Auger Boring unit Unit 0 Environmental Damage 0 0 0
22 HSE Admin 0 0 0 0 25 Hydrotest unit Unit 0 Property Damage (PD) 0 0 0
23 Flagman 0 0 0 0 Motor Vehicle Accident (MVA) 0 0 0
24 Warehouseman 0 0 0 0 Fire Incident/Explosion 0 0 0
25 Fuelman 0 0 0 0 Security Case 0 0 0
26 Superintendent 0 0 0 0 Villager Complaint 0 0 0
27 Foreman 0 0 0 0 Media Attention 0 0 0
28 Welder 0 0 0 0 Near Miss 0 0 0
29 Pipe Fitter 0 0 0 0
30 Grinderman 0 0 0 0
31 Rigger 0 0 0 0
32 Coater 0 0 0 0
33 NDT Team 0 0 0 0
34 Mechanic/Electrician 0 0 0 0
35 Operator 0 0 0 0
36 Mess Laundry 0 0 0 0
37 Helper 0 0 0 0
38 Driver LV / Elf / 4x4 0 0 0 0
39 Driver Self Loader, Hi-up, etc 0 0 0 0
Driver Welding Truck, Truck Box,
40 Dump Truck 0 0 0 0

41 HDD Team 0 0 0 0
42 Auger Boring 0 0 0 0
43 Hydrotest 0 0 0 0
44 Civil 0 0 0 0
45 HDPE Installer 0 0 0 0
Total 3 30 90 120

NO AKTIVITAS HARI INI LOKASI NO RENCANA BESOK LOKASI

1 Kick off meeting Project Pekerjaan Alas Dara Kemuning WFH 1 HSSE Bridging Pertamina Gas and PBAS Project Pekerjaan Alas Dara Kemuning WFH
21-4-2021 at 09:00
2 2
3 3
4 4
5 5

PREPARED BY ACKNOELEDGE BY
Tandatangan: Tandatangan:

Nama : Purwanto Nama : Dfran Fauzi

Posisi : HSE Officer Posisi : HSE Coordinator
Perusahaan : PT. PBAS Perusahaan : PT. PBAS
 HSE DAILY ACTIVITIES

PEKERJAAN JASA PERANCANGAN, PENGADAAN DAN KONSTRUKSI (EPC) PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING
No Laporan : Hari : Kamis 1. Dzafran Fauzi
2. Purwanto
HSE Incharge
Area : Tanggal : 22-4-2021
Cuaca :
V CERAH
Pukul : 07.00 - 18.00
MENDUNG
POS : HUJAN Tool Box V Ok Sosialisasi SIKA dan PEKA
Meeting No sistem on line oleh PTG
SAFE WORK DAY : 168 Day STOP CARD : Unsafe : Safe :

QTY
Man Prev Man Total Man
No. Man Power Person Qty Hours Hours Hours No. Construction Equipment Unit Qty. Description
Today Cumm Prev Today Cumm

A Indirect Manpower 1 Total Station Unit 0 General Safety Talk/Toolbo 0 0 0

1 Project Manager 1 10 40 50 2 Light Vehicle & Double Cabin Unit 0 HSE Induction 0 0 0
2 Construction Manager 0 0 0 0 3 Pick up Unit 0 HSE Meeting/Meeting Koordinasi 0 0 0
3 Site Manager 0 0 0 0 4 Isuzu Elf Unit 0 HSE Training 0 0 0
4 Procurement & asst 0 0 0 0 5 Welding Truck Unit 0 Drill 0 0 0
5 QA/QC Coordinator 0 0 0 0 6 Dolly Truck Unit 0 Safety Patrol 0 0 0

HSE Activities
6 Finance & Asst 0 0 0 0 7 Dump Truck Unit 0 Walk Trought 0 0 0
7 HRD & Asst 0 0 0 0 8 Trailer Unit 0 HSE Audit 0 0 0
8 GA 0 0 0 0 9 Self Loader Unit 0 Safety Alert 0 0 0
9 Project Control 0 0 0 0 10 Truck Boom / Truck Crane / Hi-up Unit 0 Equipment/Tools Inspection 0 0 0
10 Engineering 0 0 0 0 11 Excavator Unit 0 Site Inspection/ Site Visit 0 0 0
11 HSE Coordinator 1 10 40 50 12 Miller Welding Machine Unit 0 SIKA/JSA 0 0 0
12 Fasilities & asst 0 0 0 0 13 Grinding Tools ea 0 Safety Award 0 0 0
13 Office Boy / Girl 0 0 0 0 14 External Clamp 16'' Ea 0 Warning Letter 0 0 0
14 Security Mess 0 0 0 0 15 Coating Tools Set 0 Hazardous Waste 0 0 0
B Direct Manpower 16 Holiday Detector Ea 0 Non Hazardous Waste 0 0 0
14 Surveyor 0 0 0 0 17 Temperature Gun Ea 0 Fatality 0 0 0
15 Asst Surveyor 0 0 0 0 18 Compressor Unit 0 Lost Time Incident (LTI.s) 0 0 0
16 Data Processing Survey 0 0 0 0 19 Genset Unit 0 Day Lost 0 0 0
17 Security Workshop / Alat 0 0 0 0 20 Stamper Unit 0 Lost Time Injury(LTI) 0 0 0
18 Welding Inspector 0 0 0 0 21 Water Pump Unit 0 First Aid Case (FAC) 0 0 0

Accident/Incident
19 Coating Inspector 0 0 0 0 22 Motorcycle Unit 0 Severty Rate (SR) 0 0 0
20 HSE Officer 1 10 40 50 23 HDD unit Unit 0 Frequency Rate (FR) 0 0 0
21 Safetyman 0 0 0 0 24 Auger Boring unit Unit 0 Environmental Damage 0 0 0
22 HSE Admin 0 0 0 0 25 Hydrotest unit Unit 0 Property Damage (PD) 0 0 0
23 Flagman 0 0 0 0 Motor Vehicle Accident (MVA) 0 0 0
24 Warehouseman 0 0 0 0 Fire Incident/Explosion 0 0 0
25 Fuelman 0 0 0 0 Security Case 0 0 0
26 Superintendent 0 0 0 0 Villager Complaint 0 0 0
27 Foreman 0 0 0 0 Media Attention 0 0 0
28 Welder 0 0 0 0 Near Miss 0 0 0
29 Pipe Fitter 0 0 0 0
30 Grinderman 0 0 0 0
31 Rigger 0 0 0 0
32 Coater 0 0 0 0
33 NDT Team 0 0 0 0
34 Mechanic/Electrician 0 0 0 0
35 Operator 0 0 0 0
36 Mess Laundry 0 0 0 0
37 Helper 0 0 0 0
38 Driver LV / Elf / 4x4 0 0 0 0
39 Driver Self Loader, Hi-up, etc 0 0 0 0
Driver Welding Truck, Truck Box,
40 Dump Truck 0 0 0 0

41 HDD Team 0 0 0 0
42 Auger Boring 0 0 0 0
43 Hydrotest 0 0 0 0
44 Civil 0 0 0 0
45 HDPE Installer 0 0 0 0
Total 3 30 120 150

NO AKTIVITAS HARI INI LOKASI NO RENCANA BESOK LOKASI

1 HSSE Bridging Pertmina Gas and PT. PBAS Project Pekerjaan WFH 1 Sosialisasi Pengisian SIKA dan PEKA Pertamina gas secara On line WFH
Alas dara Kemuning 22-4-2021 at 09:00
2 2
3 3
4 4
5 5

PREPARED BY ACKNOELEDGE BY
Tandatangan: Tandatangan:

Nama : Purwanto Nama : Dfran Fauzi

Posisi : HSE Officer Posisi : HSE Coordinator
Perusahaan : PT. PBAS Perusahaan : PT. PBAS
 HSE DAILY ACTIVITIES

PEKERJAAN JASA PERANCANGAN, PENGADAAN DAN KONSTRUKSI (EPC) PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING
No Laporan : Hari : Jum'at 1. Dzafran Fauzi
2. Purwanto
HSE Incharge
Area : Tanggal : 23-4-2021
Cuaca :
V CERAH
Pukul : 07.00 - 18.00
MENDUNG
POS : HUJAN Tool Box V Ok Training Sosialisasi pengisian
Meeting No SIKA dan PEKA oleh PTG
SAFE WORK DAY : 168 Day STOP CARD : Unsafe : Safe :

QTY
Man Prev Man Total Man
No. Man Power Person Qty Hours Hours Hours No. Construction Equipment Unit Qty. Description
Today Cumm Prev Today Cumm

A Indirect Manpower 1 Total Station Unit 0 General Safety Talk/Toolbo 0 0 0

1 Project Manager 1 10 50 60 2 Light Vehicle & Double Cabin Unit 0 HSE Induction 0 0 0
2 Construction Manager 0 0 0 0 3 Pick up Unit 0 HSE Meeting/Meeting Koordinasi 0 0 0
3 Site Manager 0 0 0 0 4 Isuzu Elf Unit 0 HSE Training 0 0 0
4 Procurement & asst 0 0 0 0 5 Welding Truck Unit 0 Drill 0 0 0
5 QA/QC Coordinator 0 0 0 0 6 Dolly Truck Unit 0 Safety Patrol 0 0 0

HSE Activities
6 Finance & Asst 0 0 0 0 7 Dump Truck Unit 0 Walk Trought 0 0 0
7 HRD & Asst 0 0 0 0 8 Trailer Unit 0 HSE Audit 0 0 0
8 GA 0 0 0 0 9 Self Loader Unit 0 Safety Alert 0 0 0
9 Project Control 0 0 0 0 10 Truck Boom / Truck Crane / Hi-up Unit 0 Equipment/Tools Inspection 0 0 0
10 Engineering 0 0 0 0 11 Excavator Unit 0 Site Inspection/ Site Visit 0 0 0
11 HSE Coordinator 1 10 50 60 12 Miller Welding Machine Unit 0 SIKA/JSA 0 0 0
12 Fasilities & asst 0 0 0 0 13 Grinding Tools ea 0 Safety Award 0 0 0
13 Office Boy / Girl 0 0 0 0 14 External Clamp 16'' Ea 0 Warning Letter 0 0 0
14 Security Mess 0 0 0 0 15 Coating Tools Set 0 Hazardous Waste 0 0 0
B Direct Manpower 16 Holiday Detector Ea 0 Non Hazardous Waste 0 0 0
14 Surveyor 0 0 0 0 17 Temperature Gun Ea 0 Fatality 0 0 0
15 Asst Surveyor 0 0 0 0 18 Compressor Unit 0 Lost Time Incident (LTI.s) 0 0 0
16 Data Processing Survey 0 0 0 0 19 Genset Unit 0 Day Lost 0 0 0
17 Security Workshop / Alat 0 0 0 0 20 Stamper Unit 0 Lost Time Injury(LTI) 0 0 0
18 Welding Inspector 0 0 0 0 21 Water Pump Unit 0 First Aid Case (FAC) 0 0 0

Accident/Incident
19 Coating Inspector 0 0 0 0 22 Motorcycle Unit 0 Severty Rate (SR) 0 0 0
20 HSE Officer 1 10 50 60 23 HDD unit Unit 0 Frequency Rate (FR) 0 0 0
21 Safetyman 0 0 0 0 24 Auger Boring unit Unit 0 Environmental Damage 0 0 0
22 HSE Admin 0 0 0 0 25 Hydrotest unit Unit 0 Property Damage (PD) 0 0 0
23 Flagman 0 0 0 0 Motor Vehicle Accident (MVA) 0 0 0
24 Warehouseman 0 0 0 0 Fire Incident/Explosion 0 0 0
25 Fuelman 0 0 0 0 Security Case 0 0 0
26 Superintendent 0 0 0 0 Villager Complaint 0 0 0
27 Foreman 0 0 0 0 Media Attention 0 0 0
28 Welder 0 0 0 0 Near Miss 0 0 0
29 Pipe Fitter 0 0 0 0
30 Grinderman 0 0 0 0
31 Rigger 0 0 0 0
32 Coater 0 0 0 0
33 NDT Team 0 0 0 0
34 Mechanic/Electrician 0 0 0 0
35 Operator 0 0 0 0
36 Mess Laundry 0 0 0 0
37 Helper 0 0 0 0
38 Driver LV / Elf / 4x4 0 0 0 0
39 Driver Self Loader, Hi-up, etc 0 0 0 0
Driver Welding Truck, Truck Box,
40 Dump Truck 0 0 0 0

41 HDD Team 0 0 0 0
42 Auger Boring 0 0 0 0
43 Hydrotest 0 0 0 0
44 Civil 0 0 0 0
45 HDPE Installer 0 0 0 0
Total 3 30 150 180

NO AKTIVITAS HARI INI LOKASI NO RENCANA BESOK LOKASI

1 Prepare weekly Report 18-24 April 2021 WFH 1 Koordinasi Weekly Report to HSE Coordinator PBAS at HO site WFH
2 2
3 3
4 4
5 5
6 6

PREPARED BY ACKNOELEDGE BY
Tandatangan: Tandatangan:

Nama : Purwanto Nama : Dfran Fauzi

Posisi : HSE Officer Posisi : HSE Coordinator
Perusahaan : PT. PBAS Perusahaan : PT. PBAS
 HSE DAILY ACTIVITIES

PEKERJAAN JASA PERANCANGAN, PENGADAAN DAN KONSTRUKSI (EPC) PEMBANGUNAN PIPA GAS ALAS DARA KEMUNING
No Laporan : Hari : Jum'at 1. Dzafran Fauzi
2. Purwanto
HSE Incharge
Area : Tanggal : 23-4-2021
Cuaca :
V CERAH
Pukul : 07.00 - 18.00
MENDUNG
POS : HUJAN Tool Box V Ok Training Sosialisasi pengisian
Meeting No SIKA dan PEKA oleh PTG
SAFE WORK DAY : 168 Day STOP CARD : Unsafe : Safe :

QTY
Man Prev Man Total Man
No. Man Power Person Qty Hours Hours Hours No. Construction Equipment Unit Qty. Description
Today Cumm Prev Today Cumm

A Indirect Manpower 1 Total Station Unit 0 General Safety Talk/Toolbo 0 0 0

1 Project Manager 1 10 60 70 2 Light Vehicle & Double Cabin Unit 0 HSE Induction 0 0 0
2 Construction Manager 1 10 0 10 3 Pick up Unit 0 HSE Meeting/Meeting Koordinasi 0 0 0
3 Site Manager 1 10 0 10 4 Isuzu Elf Unit 0 HSE Training 0 0 0
4 Material Control 1 10 0 10 5 Welding Truck Unit 0 Drill 0 0 0
5 QA/QC Coordinator 1 10 0 10 6 Dolly Truck Unit 0 Safety Patrol 0 0 0

HSE Activities
6 Project Admin 1 10 0 10 7 Dump Truck Unit 0 Walk Trought 0 0 0
7 GA 1 10 0 10 8 Trailer Unit 0 HSE Audit 0 0 0
8 Project Control 1 10 0 10 9 Self Loader Unit 0 Safety Alert 0 0 0
9 Field Engineering 1 10 0 10 10 Truck Boom / Truck Crane / Hi-up Unit 0 Equipment/Tools Inspection 0 0 0
10 HSE Coordinator 1 10 0 10 11 Excavator Unit 0 Site Inspection/ Site Visit 0 0 0
11 Office Boy / Girl 1 10 60 70 12 Miller Welding Machine Unit 0 SIKA/JSA 0 0 0
12 Security Mess 1 10 0 10 13 Grinding Tools ea 0 Safety Award 0 0 0
B Direct Manpower 14 External Clamp 16'' Ea 0 Warning Letter 0 0 0
13 Surveyor 1 10 0 10 15 Coating Tools Set 0 Hazardous Waste 0 0 0
14 Asst Surveyor 1 10 0 10 16 Holiday Detector Ea 0 Non Hazardous Waste 0 0 0
15 Data Processing Survey 1 10 0 10 17 Temperature Gun Ea 0 Fatality 0 0 0
16 Security Workshop / Alat 1 10 0 10 18 Compressor Unit 0 Lost Time Incident (LTI.s) 0 0 0
17 Welding Inspector 1 10 0 10 19 Genset Unit 0 Day Lost 0 0 0
18 Coating Inspector 1 10 0 10 20 Stamper Unit 0 Lost Time Injury(LTI) 0 0 0
19 HSE Officer 1 10 0 10 21 Water Pump Unit 0 First Aid Case (FAC) 0 0 0

Accident/Incident
20 Safetyman 3 30 0 30 22 Motorcycle Unit 0 Severty Rate (SR) 0 0 0
21 Foreman 3 30 0 30 23 HDD unit Unit 0 Frequency Rate (FR) 0 0 0
22 Welder 4 40 0 40 24 Auger Boring unit Unit 0 Environmental Damage 0 0 0
23 Pipe Fitter 4 40 0 40 25 Hydrotest unit Unit 0 Property Damage (PD) 0 0 0
24 Coater 2 20 0 20 Motor Vehicle Accident (MVA) 0 0 0
25 NDT Team 4 40 0 40 Fire Incident/Explosion 0 0 0
26 Mechanic/Electrician 1 10 0 10 Security Case 0 0 0
27 Driver 1 10 0 10 Villager Complaint 0 0 0
28 Helper 8 80 0 80 Media Attention 0 0 0
29 Supervisor Piping 1 10 0 10 Near Miss 0 0 0
30 Supervisor Civil 1 10 0 10
31 Teknisi Joint Coating 3 30 0 30
32 Catodic Protection Team 3 30 0 30
33 Pre Comm Test 4 40 0 40
34 Instrument Supervisor 1 10 0 10
35 Teknisi Insrumentation 2 20 0 20
36 Electrical Supervsor 1 10 0 10

37 Teknisi Grounding & Lighning 3 30 0 30

Protection
38
39
40
Total 68 680 120 800

NO AKTIVITAS HARI INI LOKASI NO RENCANA BESOK LOKASI

1 Koordinasi Weekly Report to HSE Coordinator PBAS at HO site WFH 1 Koordinasi pekerjaan Konsynering dengan HSE Koordinator HO Office WFH
2 2
3 3
4 4
5 5
6 6

PREPARED BY ACKNOELEDGE BY
Tandatangan: Tandatangan:

Nama : Purwanto Nama : Dfran Fauzi

Posisi : HSE Officer Posisi : HSE Coordinator
Perusahaan : PT. PBAS Perusahaan : PT. PBAS