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(Judul pekerjaan sesuai kontrak)
(Hari, dd mm yyyy)
(PT Pelaksana)
1. Deskripsi:
(diisi penjabaran dari deskripsi pekerjaan yang akan dilakukan)
2. Bahan dan alat yang digunakan:
(Diisi daftar alat yang digunakan)
3. Kondisi cuaca: (diisi kondisi cuaca saat pelaksanaan pekerjaan pada hari tersebut)
4. Manpower:
a. Pengawas Teknik: .... orang
b. HSE: ... orang
c. Teknisi Peralatan: .... orang
d. Mandor: ... orang
e. Kepala Tukang: ... orang
f. Tukang: .... orang
Total ... orang
5. Peserta TBM: .... orang
6. Topics TBM:
(diisi dengan topic pembahasan tool box meeting K3)
Contoh
a. Cek kesehatan
b. Cek APD
c. Potensi bahaya pada pekerjaan pembuatan decker dan pengangkutannya ke Saluran Pos 1
d. House keeping
7. Alat Pelindung Diri:
(Diisi APD yang digunakan sesuai risiko bekerja)
Contoh
a. Helm
b. Masker
c. Sarung tangan
d. Kacamata safety
e. Sepatu safety
8. Activity HSE:
(Diisi aktifitas HSE di lapangan yang dilakukan pada hari tersebut)
Contoh
a. Toolbox meeting
b. Pengawasan pekerjaan (K3)
c. Document report.
9. Progress Pekerjaan : ...
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