Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Safety chek

  • Apakah area kerja bersih

  • Apakah APD sudah sesuai

  • Apakah instruksi kerja tersedia, jika tidak buat JSA

  • Apakah pekerjaan berhubungan dengan: kerja panas, ruang te rbatas, ketinggian dan penggalian.

  • Jika jawabannya Ya. Lengkapi safety permit.

  • Apakah energy isolasi diperlukan

  • Jika jawabannya Ya. lakukan prosedur LOTO

  • Jelaskan bahaya yang mungkin timbul

  • Jelaskan kontrol yang akan diterapkan

  • Re-check kontrol, apakah pekerjaan aman untuk dilanjutkan. Jika tidam review kembali langkah 1-3.

  • Tanda tangan

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.