Behavior-based Safety Checklist - PT Padi Flour Nusantara

• Area

• Area Proses ?
  Address

• Nama Pengisi

• Safety Observation Steps:
  1. Perkenalan diri anda, dan berikan maksud dan tujuan serta meminta izin untuk melakukan pengamatan.
  2. Minta pekerja untuk menjelaskan pekerjaan yang dilakukan, observasi bahaya dan kontrol atas pekerjaan tersebut.
  3. Ajukan pertanyaan terbuka (Seperti : Apasaja kecelakaan yang pernah terjadi? dan Bagaimana kecelakaan tersebut terjadi?)

• [Berikut adalah contoh dalam melakukan observasi! Berikan foto terbaik anda untuk menjelaskan observasi tersebut!)

  

• 4. Amati pekerjaan, dan berikan feedbak untuk pekerjaan yang aman dan tindakan perbaikan yang harus dilakukan.
  5. Berikan tindakan untuk komitmen bersama agar tindakan tersebut tidak berulang.

CRITICAL SAFE BEHAVIOR

PPE

• Pelindung Kepala - (Pelindung kepala sesuai fungsi dengan bahaya lingkungan area)

  Aman

  Beresiko

  N/A

• Pelindung Mata dan Wajah Eye & Face Protection (Perlindungan yang proper (aman) - glasses, face shield, goggles)

  Date

• Pelindung Telinga (Perlindungan yang proper saat terjadi bahaya di lingkungan sekitar - ear plugs, ear muffs)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Sarung Tangan (Sarung tangan yang sesuai fungsi (anti gores, listrik dll)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Fall Protection (Perlindungan dengan alat yang proper - Self Body Hardness, SRL, Lifeline, Hand Railing)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

BODY USAGE & POSITION

• Pekerja memposisikan tubuh untuk menghindari akibat cedera (Terjepit, Kejatuhan Material)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Angkat Material yang ergonimis (teknik mengangkat - Tumpuan di kaki, punggung lurus, beban dekat dengan tubuh, telapak kaki setapak dengan lantai, lutut ditekuk)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Pinch Point/area terjepit (waspada dan hindari area terjepit - menutup akses agar menghindari tubuh terjepit)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Posisi tubuh tidak proper (Teknik yang tepat - proper body mechanics - menggunakan kaki untuk tumpuan saat menarik bukan punggung)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

TOOLS & EQUIPMENT

• Pemilihan/Penggunaan Alat yang benar (menggunakan sesuai fungsi dari alat - Kunci pas, Tang, Obeng dll)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Condition - Alat Penunjang dalam kondisi baik (selang udara, Fitting Pneumatic dll)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Pakir Forklift (forklift ditinggalkan dengan kondisi minim bahaya - Kunci tidak ditinggal, mesin keadaan off, parkir sesuai tempat)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

EYES ON PATH/HANDS

• Eyes on Path (waspada terhadap area sekitar - Memperhatikan petunjuk saat berjalan, dan pada jalur walkway)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Eyes On Hands (Waspada pada penempatan material/tools sesuai tempat dan penggunaan)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Jalur Pejalan Kaki (Jalur dengan potensi bahaya kecil - Melewati jalur walkway, terpisahnya jalur forklift dan pejalan kaki)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

• Kecepatan Pejalan Kaki (tingkat kecepatan berjalan untuk meminimalkan terjadinya bahaya berdasarkan lingkungan sekitar dan kondisi)

  Aman

  Beresiko

  N/A

• At-Risk Barrier

  Select Training Issue, Unfamiliar Management Pressure/System Apathy, Insignificant Facility or Equipment Condition Disagreement on At-Risk Practices Personal Factors or Distractions Accepted Culture, Peer Pressure Environment-related

  • Training Issue, Unfamiliar
  • Management Pressure/System
  • Apathy, Insignificant
  • Facility or Equipment Condition
  • Disagreement on At-Risk Practices
  • Personal Factors or Distractions
  • Accepted Culture, Peer Pressure
  • Environment-related

COMPLETION

• Tambahan Catatan Observasi

• Observer Name & TTD

  Sign