006 Srp - 001 Safety Report Procedure (Latest) Revision

8/13/2019 006 Srp - 001 Safety Report Procedure (Latest) Revision

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HEALTH, SAFETY AND ENVIRONMENT PROCEDURE

SAFETY REPORT PROCEDURE- SRP-001

REVISION HISTORY

REV DATE BY CHCK’D APPR’D COMMENTS

A 12/07/2004 PJC JF – Ajeet - First draft for comment

B 07/07/2005 EH - A!"

C 24/11/200# EH A!" A!" $e%ision for &enera' (se)

* 2+/11/200+ EH A!"/F! 2 nd $e%ision and C,an&e of *esi&nation



SAAG DRILLING & WELL SERVICES - SAFETY REPORT PROCEDURE – SRP-001

TABLE OF CONTENTS

1) . $ * C .)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))2) !C PE BJEC 3E!))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))

) $E!P .! B E!))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))1) !afet6 Committee))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))2) !* ! ana&in& *irector)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) ) $i& ana&er)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))4) $i& !(8erintendent or !ite !(8er%isor)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))4)5) H!E fficer))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))

4) !AFE " $EP $ !)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))4)1) $i& *ai'6 H!E $e8ort)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))4)2) ncident / Accident .otification)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))4) ) Accident ncident .otification/ n%esti&ation $e8ort))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) 54)4) .ear Hit / .ear iss $e8ort)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))4)5) nsafe Act and nsafe Condition $e8ort)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) #4)#) Periodic !tatistica' $e8orts)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))4)7) A(dit/ ns8ection $e8orts)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))

5) A88endi9 A - !* ! - H!E *A " $EP $ )))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))+#) A88endi9 B - H!E .C *E. .3E! :A . $EP $ ))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) 107) A88endi9 C – .!AFE AC A.* .!AFE C .* . $EP $ ))))))))))))))))))))))))))))))))))))))))))))))))))))))))))14+) A88endi9 * - !* ! - H!E . H " $EP $ ))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))15

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1. INTRODUCTION

$e8ortin& of safet6 8erformance and incidents is an in,erent 8art of t,e o%era'' occ(8ationa' Hea't,;!afet6 and En%ironment contro's of t,e com8an6) $e&('ations; c'ient and t,e &enera' 8(<'ic can <eaffected <6 t,e cond(ct of !* ! 8ersonne' and its assets)

,e o%era'' !afet6 !6stem an(a' and associated 8roced(res are 8ro%ided to ens(re t,at ris=s areidentified; incidents and accidents are re8orted and means to remo%e or 'o>er t,e ris=s and incidentsare 8(t into 8'ace)

o t,is end; t,e com8an6 re?(ires acc(rate recordin& and re8ortin& of 8erformance and an6 incidents/ accidents; inc'(din& a(dits and in%esti&ations) ,is s,a'' <e t,e media t,at is 8(<'ici@ed >it,in t,eor&ani@ation and offered to o(r c'ient to 8ro%ide ass(rance t,at safet6 is ,i&, on t,e a&enda and t,at@ero to'erance is e98ected)

A'' incident or accident s,a'' <e re8orted) ,is inc'(des -

1 Em8'o6ee - An6 inj(r6 s(stained >,i'e on d(t6)

2 Com8an6 %e,ic'es - An6 dama&e to com8an6 %e,ic'es re&ard'ess of 8'ace and time ofocc(rrence)Com8an6 8ro8ert6 or e?(i8ment - An6 dama&e to com8an6 o>ned 8ro8ert6 ore?(i8ment re&ard'ess of 8'ace or time of occ(rrence)

4 ,ird 8art6 - An6 accident res('tin& in an6 dama&e of 8ro8ert6 not o>ned <6 t,ecom8an6 or inj(r6 s(ffered <6 an6one not em8'o6ed <6 com8an6 s(c, as s(<-!* !;cons('tants; c'ient 8ersonne' or &enera' 8(<'ic)

5 En%ironmenta' ncident – An accidenta' s8i'' of oi'; c,emica's or ot,er materia's t,at isdetrimenta' to t,e en%ironment or c,an&es to t,e nat(ra' conditions) ,is a'so inc'(dese9cessi%e ,(man occ(8ation; radiation; ,eat; %i<ration and noise t,at ,as a 'on& termim8act and dist(r<s t,e nat(ra' conditions)

# .ear iss

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. SCOPE & OB!ECTIVES

Pro%ide a frame>or= of essentia' information &at,erin& records t,at 'ead to on&oin& im8ro%ement int,e red(ction of ris=s to 8eo8'e and assets) !ome of t,e data co''ected is d(e to re&('ations or c'ient /contract re?(irements) ,e remainder forms t,e <a'ance of information t,at t,e com8an6 re?(ires inorder to mana&e ris= and red(ction to acce8ta<'e 'e%e's) ,e t68e of ri& o8erations re8orts re?(ired

to <e com8'eted on a re&('ar <asis are as fo''o>s -• ncident .otification/ n%esti&ation $e8ort• nsafe Act $e8ort• *ai'6 H!E $e8ort• ont,'6 and "ear'6 H!E $e8orts• ns8ection $e8orts

n addition to t,e a<o%e; !* ! !afet6 Committee and H$ *e8artment 8ro%ide t,e fo''o>in& -

• Committee min(tes of meetin&• rainin& 8'ans; co(rses and re&isters• Personne' records inc'(din& medica' and 8erformance• Corres8ondences >it, <oard; re&('ator or c'ient• arnin& 'etters to errant staff

". RESPONSIBILITIES

".1. S#$% ' C())* %%!* ! ,as a !afet6 Committee as descri<ed in t,e !afet6 !6stem an(a') ,e6 s,a'' re%ie> andassess t,e o(tcome of dai'6 and >ee='6 re8orts; incident and accident re8orts; a(dits andin%esti&ations) From time to time t,e6 ma6 re?(est additiona' information to <e 8ro%ided >it, are8ort)

". . SDWS M#+# *+ D* % ( He is a mem<er of t,e !afet6 Committee and as s(c, re%ie> a'' H!E re8orts and statistics to ens(ret,at tar&ets are <ein& met or action is ta=in& to miti&ate) t is essentia' t,at a'' t,e 8o'icies and8roced(res are endorsed or 8romote <6 t,e !* ! ana&in& *irector at e%er6 o88ort(nit6) Hes,o('d re8resent t,e com8an6 to c'ients; <e >e'' <riefed and com8etent to 8resent t,e s6stems and8erformance ac,ie%ed)

".". R* M#+# % ,e $i& ana&er is sin&'e 8oint res8onsi<'e for safe ri& o8erations and se'ection of 8ersonne' to

o8erate it) ,e6 are a mem<er of t,e !afet6 Committee and acts as t,e ad%isor and ar<itrator for t,eri& o8erations and 8ersonne' d(rin& re%ie> a'' H!E re8orts and statistics) ,eir jo< is to ens(re t,attar&ets can and are <ein& met or ta=in& action to miti&ate; inc'(din& disci8'inin& staff) t is essentia't,at a'' of t,e o8eration 8o'icies and 8roced(res are endorsed <6 t,e $i& ana&er) ,e6 s,o('dre8resent t,e com8an6 to c'ients; <e >e'' <riefed and com8etent to 8resent t,e s6stems and8erformance ac,ie%ed)

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"./. R* S % *+ %+2%+ ( S* % S % 3*4( ,e $i& !(8erintendent or !ite !(8er%isor ,as <een de'e&ated res8onsi<i'it6 for dai'6 o8eration of t,e

ri& and t,e safet6 of t,e ri& cre> com8risin& of %ario(s s=i'' 'e%e's and ca8a<i'ities) A'' mem<ers oft,e cre> ,a%e a common res8onsi<i'it6 to ens(re t,at t,e ri& is safe and safe'6 o8erated; ,o'd J!A sand too'<o9 meetin&s to re%ie> >,at 8reca(tions s,o('d <e ta=en; o<ser%e (nsafe acts andconditions t,at ma6 'ead to an incident or accident to a fe''o> cre> mem<er or to t,e ri& e?(i8ment)

A'' (nsafe conditions and concerns m(st <e immediate'6 re8orted to eit,er t,e $i& !(8erintendent or!ite !(8er%isor or t,e H!E fficer)

,e $i& !(8erintendent or !ite !(8er%isor s,a'' ens(re t,at ,and-o%er <et>een =e6 ri& staff on rosters,ifts is done 8ro8er'6 and t,e6 a'' (se standardi@ed re8orts to ref'ect im8ortant or si&nificant e%entsd(rin& t,e 8re%io(s s,ift and t,in&s to 8re8are for in t,e ne9t s,ift)

".5. HSE O$$* % ,e $i& H!E officer 8ro%ides first aid as >e'' as recordin& incidents; H!E faci'itation; 8re-to(r

<riefin&s; a(ditin& and mont,'6 re8ortin& d(ties) ,e6 s,a'' 8ro%ide a 8roacti%e ro'e as >e'' asreacti%e) ne of t,eir ro'es is to s(88ort H!E im8ro%ement initiati%es and 8artici8ate in (8dates of t,eH!E !6stem an(a' and Proced(res)

s-so-far as H!E re8ortin& is concerned; t,e H!E fficer s,a'' re8ort direct'6 to t,e $i& ana&er >it,a co86 to t,e $i& !(8erintendent or !ite !(8er%isor) ,e t68e of re8ortin& is as descri<ed in t,efo''o>in& section)

/. SAFETY REPORTS

/.1. R* D#*6' HSE R% ($i& dai'6 H!E re8orts s,a'' contain t,e fo''o>in& main 8oints -

• .(m<er of 8ersonne' on s,ift %ers(s re?(ired on s,ift) f s,ort staffin& occ(rs; note >,at im8acton o8erations safet6 t,is ma6 ,a%e)

• *ai'6 too'<o9 meetin&; notin& >,o >as 8resent and <rief of t,e s(<jects disc(ssed• J!A s carried o(t• *etai's of an6 H!E incidents; accidents or medica' treatment t,at da6• 68e of H!E acti%ities <ein& carried o(t and an6 ca(tionar6 iss(es disc(ssed• *etai's of an6 trainin& 8ro%ided or 8'anned to com8'ete d(rin& t,e da6 inc'(din& c'ient trainin& or

dri''s• PPE iss(es and 'osses / re8'acements

$efer to - A88endi9 A – H!E *ai'6 $e8ort

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/. . I+ *2%+ 7 A *2%+ N( *$* # *(+ An6 incident or accident; re&ard'ess of its se%erit6 m(st <e re8orted to t,e 'ine mana&ement) ,is >i''ens(re 8ro8er action is ta=en to sec(re t,e sit(ation; 8ro8er medication &i%en to t,e inj(red 8ersonand 8ro8er in%esti&ation <een done to identif6 t,e ca(ses t,(s 8re%entin& simi'ar incident from

rec(rrin&),en res8ondin& to a safet6 incident; 8ersonne' s,o('d

• !to8 >or= and sec(re t,e incident scene to 8re%ent f(rt,er inj(ries• Pro%ide necessar6 first aid or medica' care to t,e inj(red 8ersonne'

Fo''o>in& t,is; a'' 8ersonne' m(st

• .otif6 t,e >or=site mana&ement of t,e incident <6 8ro%idin& =e6 facts) ,e >or=sitemana&ement >i'' 'ater inform t,e $i& ana&er and H!E *e8artment)

• Fi'' (8 and s(<mit t,e ncident .otification/ n%esti&ation Form in a time'6 manner)

(Preliminary report will be sufficed for notification. Full report will be completed by the investigationteam)

/.". A *2%+ & I+ *2%+ N( *$* # *(+7I+3%4 * # *(+ R% (E%er6 accident or incident s,a'' <e re8orted in accordance >it, t,e C'ass 1; 2 or C'ass Emer&enc6$es8onse incident re8ortin& re?(irements) inor non- D cases need on'6 <e recorded on t,e dai'6H!E $e8ort) An6 e?(i8ment incidents t,at do not effect t,e o8erations or t,e safet6 of t,e ri& or cre>s,a'' a'so <e re8orted in t,e dai'6 H!E $e8ort)

,e $i& ana&er (8on cons('tation >it, !* ! ana&in& *irector and H!E *e8artment >i'' decidet,e com8osition of an in%esti&ation team)

,e com8osition of t,e in%esti&ation team ma6 %ar6 accordin& to t,e serio(sness of t,e incident andit s 8otentia') $i& 8ersonne' ma6 <e a88ointed to in%esti&ate near miss or first aid incident; >,ere<6assistance from s(88ort &ro(8 at ons,ore ma6 <e re?(ired for 'ost time or major 8ro8ert6 dama&eincident)

,en re?(ested; t,e in%esti&ation team >i'' <e ca''ed in front of t,e committee to e98'ain t,eidentified incident)

$efer to - A88endi9 B - ncident .otification / n%esti&ation $e8ort Form

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/./. N%# H* 7 N%# M*44 R% (f an incident is cate&ori@ed as .ear Hit / .ear iss <6 t,e H!E fficer or an6 ri& cre> mem<er; t,is

s,a'' <e recorded in t,e dai'6 H!E $e8ort) n addition; t,e H!E fficer s,a'' maintain a 'o& of a'' .earHit / .ear iss incidents e)&) o<ject fa''in& from (88er dec= and not ,ittin& an6one; ,oo= s>in&in&and co('d ,a%e ,it someone )

Fo''o>in& a re8orted incident; t,e H!E fficer and t,e $i& !(8erintendent or !ite !(8er%isor m(stre%ie> ,o> it occ(rred; >,at t,e ris=s >ere 8otentia' and 8ro%ide a remed6 for t,is not to re8eat)

,is information m(st <e disc(ssed and reinforced at t,e ne9t too'<o9 meetin&)

/.5. U+4#$% A #+2 U+4#$% C(+2* *(+ R% ( A'' (nsafe acts or conditions m(st <e re8orted in order to immediate'6 sto8 t,e 8ro<'em from<ecomin& an incident) A'' 8ersonne' are enco(ra&ed to re8ort an6 (nsafe act or (nsafe condition; ta=ea88ro8riate action to rectif6 and re8ort %ia HAGC $P) ,e n(m<ers of HAGC $P raised >i'' <erecorded in t,e dai'6 H!E $e8ort e.g. Using wrong tools, not using work permit or lock out,equipment switched on (or off) without firstly notifying other crew members, safety gate left open )

n addition; t,e H!E fficer s,a'' maintain a 'o& of a'' HAGC $P and t,e remedia' action ta=en) ,eH!E fficer and t,e $i& !(8erintendent or !ite !(8er%isor m(st re%ie> ,o> it occ(rred; >,at t,eris=s >ere 8otentia' and 8ro%ide a remed6 for t,is not to re8eat) ,is information m(st <e disc(ssedand reinforced at t,e ne9t too'<o9 meetin&) nformation o<tained from t,e s(<mission of t,eHAGC $P >i'' <e com8i'ed and mont,'6 ana'6sis re8ort >i'' <e 8re8ared <6 t,e H!E officer) ,eana'6sis s,o('d ,i&,'i&,ts cate&or6 in%o'%es and most common reason for (nsafe act or (nsafecondition)

$efer to A88endi9 – C nsafe Act and nsafe Condition $e8ort Form

/.8. P% *(2* & S # *4 * #6 R% ( 4,e dai'6 H!E re8orts s,a'' <e s(mmari@ed into a mont,'6 re8ort for iss(e to t,e $i& ana&er and

!afet6 Committee mem<ers) ,e re8ort >i'' contain t,e fo''o>in& detai's -• ota' acc(m('ated man,o(rs; $ s; $ F• Co86 of (nsafe act or condition 'o&• Co86 of near ,it / miss 'o&• Co8ies of H!E a(dits com8'eted and forecast a(dits in comin& mont,• !(<jects co%ered in too'<o9 meetin&s• !afet6 A'erts; dri''s or incidents t,at affected ri& o8erations or cre>• Com8an6 trainin& dri''s• An6 ot,er 8ertinent information or o<ser%ation inc'(din& forecast trainin& re?(irements

$efer to - A88endi9 * – H!E ont,'6 $e8ort

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/.9. A 2* 7I+4 % *(+ R% ( 4,ere%er 8ossi<'e; (se standard a(dit c,ec= 'ists and forms) C,ec= caref(''6 t,at eac, 8oint is %a'id

and disc(ss an6 non-com8'iance >it, t,e $i& !(8erintendent or !ite !(8er%isor or oo'8(s,er) A''a(dit re8orts s,a'' <e iss(ed to t,e $i& ana&er on com8'etion) t is t,e res8onsi<i'it6 of t,e H!E

fficer to te'' it 'i=e it isD and not distort t,e facts; <e ne(tra') f a conf'ict arises in %ie>s on a(dit8oints or findin&s; t,ese m(st <e disc(ssed >it, t,e $i& ana&er for reso'(tion)

$efer to $i& !afet6 A(dit Proced(re !AP-001

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5. A %+2*: A - SDWS - HSE DAILY REPORT

T( SAAG DRILLING & WELL SERVICES ;M< S2+ B=2 – K.L. C(+ # N(>A + - R* . S .C - R* M#+# %

- SDWS M#+# *+ D* % ( F () - HSE O$$* %O % # *(+ D# % P *( * ' >N( )#6

SAFETY EXPOSURE HOURS

SAAG-DRILLING & WELL SERVICESSDN BHD ;KSB< TODAY

POB

TODAY;HRS<

YESTERDAYACCUM ;HRS< ACCUM ;HRS<

TOTAL FOR RIG OPERATION TEAM>TOTAL FOR PRO!ECT TEAM>TOTAL FOR CONTRACTORS>

TOTAL FOR OFFICE CREW>TOTAL ON BOARD

TOTAL MAN-HOURS FOR TELAGA USAHA YTDGRAND TOTAL MAN-HOURS FOR TELAGA USAHA

CONTRACTORSWELDERS7FITTERS > 00ELECTRICIANS > 00TOTAL > 00

REMARK:!F"#$ %!&' U *&+ U-"- *#' ! P" &&" , /" !&- 0* *#*#' #'" P 1"+# #"!%.

*escri8tion of ncident

BB HA?CORP FINDINGS> DAY MTD*ri''in& cre>

ec,anica'E'ectrica'

t,ers

CC SAFETY ISSUES> A *(+ P# ' R%)# @4

- + -

AA STATISTIC>DAY MTD DAY MTD

LTI E . DAMAGERWI FIREMTI SPILLFA HCRNM OTHERS




DD OCCUPATIONAL HEALTH ISSUES> A *(+ P# ' R%)# @4

EE ENVIRONMENTAL ISSUES> A *(+ P# ' R%)# @4

FF SPECIAL HIGHLIGHTS A *(+ P# ' R%)# @4

REPORTED BY> VERIFIED BY >

H!E FF CE$ $ : ! PE$ . E.*E. $ ! E ! PE$3 ! $)

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8. A %+2*: B - HSE INCIDENT INVESTIGATION REPORT

I+ *2%+ N( *$* # *(+7I+3%4 * # *(+ F( ).C *E. .F $ A .

*a6 *ate f ncident ime !,ift *e8artment ocation

.C *E. C A!! F CA .ost ime edica' reatment $estricted or= First Aid

Fire !8i'' Pro8ert6 *ama&e H6drocar<on $e'ease.ear iss t,ers

.J $E* PE$! ..ame Address

A&e P,oneJo< it'e !(8er%isor .ame

en&t, of Em8'o6ment at Com8an6 en&t, of Em8'o6ment at Jo<Em8'o6ment C'assification F('' ime Part ime Contract em8orar6

.at(re of nj(r6 Br(isin& *is'ocation t,er s8ecif6 nj(red Part of Bod6!train/!8rain !cratc,/A<rasion nterna'Fract(re Am8(tation Forei&n Bod6

aceration/C(t B(rn/!ca'd C,emica' $eaction.ame and Address of reatin& P,6sician or Faci'it6

*A A:E P$ PE$ "/E.3 $ . E.Pro8ert6; E?(i8ment; ateria' or En%ironment

*ama&ed

*escri<e *ama&e

<ject or !(<stance nf'ictin& *ama&e

*E!C$ BE HA HAPPE.E* A ACH PH :$APH! $ * A:$A ! F .ECE!!A$"

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$ CA !E A.A "! ! C,ec= A'' ,at A88'6nsafe Acts nsafe Conditions ana&ement *eficienciesm8ro8er >or= tec,ni?(e Poor >or=station desi&n or 'a6o(t ac= of >ritten 8roced(res or 8o'icies

!afet6 r('es %io'ation Con&ested >or= area !afet6 r('es not enforcedm8ro8er PPE or PPE not (sed Ha@ardo(s s(<stances Ha@ard not identified8eratin& >it,o(t a(t,orit6 Fire or e98'osion ,a@ard PPE (na%ai'a<'e

Fai'(re to >arn or sec(re nade?(ate %enti'ation ns(fficient >or=er trainin&8eratin& at im8ro8er s8eed m8ro8er materia' stora&e ns(fficient s(8er%isor trainin&B6-8assin& safet6 de%ices m8ro8er too' or e?(i8ment m8ro8er maintenance:(ard not (sed ns(fficient =no>'ed&e of jo< nade?(ate s(8er%ision

m8ro8er 'oadin& or 8'acement !'i88er6 condition nade?(ate jo< 8'annin&m8ro8er 'iftin& Poor ,o(se=ee8in& nade?(ate ,irin& 8ractices

!er%icin& mac,iner6 in motion E9cessi%e noise nade?(ate >or=8'ace ins8ectionHorse8'a6 nade?(ate &(ardin& of ,a@ard nade?(ate e?(i8ment*r(& or a'co,o' (sed *efecti%e too'/e?(i8ment nsafe desi&n or constr(ction

nnecessar6 ,aste ns(fficient 'i&,tin& nrea'istic sc,ed('in&nsafe act of ot,ers nade?(ate fa'' 8rotection Poor 8rocess desi&nt,er t,er t,er

.C *E. A.A "! !

sin& t,e root ca(se ana'6sis 'ist on t,e 8re%io(s 8a&e; e98'ain t,e ca(se s of incident in as detai's as 8ossi<'e)

Ho> <ad co('d t,e incident ,a%e <eenI ,at is t,e c,ance if t,e incident ,a88enin& a&ainI3er6 !erio(s !erio(s inor Fre?(ent ccasiona' $are

P$E3E. 3E AC .!*escri<e actions t,at >i'' <e ta=en to 8re%ent rec(rrence *ate'ine B6 ,om Com8'ete

- 11 -




- 12 -




.3E! :A . EA!i&nat(re .ame Position

- 1 -




9. A %+2*: C – UNSAFE ACT AND UNSAFE CONDITION REPORT

- 14 -

MONTH NO

A. UNSAFE ACTS OBSERVED 1. IMMEDIATE CORRECTIVE ACTION TAKEN

;PERILAKU YANG TIDAK SELAMAT< ;TINDAKAN PEMBETULAN SEGERA<

B. UNSAFE CONDITION OBSERVED . FURTHER ACTION TO PREVENT RECURRENCE ;KONDISI TIDAK SELAMAT< ;TINDAKAN PENCEGAHAN SUSULAN<

OBSERVER S SIGNATURE DATE

NAME ;OPTIONAL<

REVIEW BY SUPERVISOR > SIGNATURE DATE

5ACJ 0F !J 55/J.0 5E*:E 5ACJ 0$ .A*EK1A E 0PE$A 0.A5

P$0CE*1$E! 0$ 0$J ! A.*A$*!)

C0$$EC/ A" /A E! 70$E /-7E

.A*EK1A E C0771. CA 0.

!H0$ -C1 .: ! A.*A$* P$0CE*1$E $E:A$* .: P$0CE*1$E!

0$ 0$J ! A.*A$*!)

PE$!0. PE$C-E3E! *0-.: J0B ELAC/5"

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Documents

006 Srp - 001 Safety Report Procedure (Latest) Revision