TAIL GATE MEETING

Project /Proyek : Date / Tanggal :

Time / Jam:
Location / Lokasi :

Job Description / Uraian Kerja : Foreman /Mandor :

CPI Coreps :

Atendance List / Daftar Hadir :

No Name / Nama Sign / Tanda Tangan No Name / Nama Sign / Tanda Tangan
1 6

2 7

3 8

4 9

5 10
Meeting Agenda :
Remarks
No Description Sub - Description
Yes No NA
1 Man Power / Pekerja Number of employee refer to job needed / Jumlah pekerja sesuai dengan
kebutuhan kerja

Health of Employee / Kondisi kesehatan karyawan

2 Tool and Equipment
3 Paper Work / Dokumen
(Understood by
Employees/Dimengerti oleh
pekerja)
4 Environment /Lingkungan
Enough Equipment & Tools / Jumlah Equipment & Tools cukup
Condition Equipment & Tools / Kondisi Equipment dan Tools baik
General Work Permit ?
Job Site Inspection ?
Job Safety Analysis ?
Standar Operating Procedure ?
Excavation Permit ?
Hot Work Permit ?
Hotline Permit ?
Confined Space Permit ?
Vehicle Permit ?
Other Permit ?

5 Other Issue / Issue lain Scope of work understood by employees ? / Skop pekerjaan dimengerti
oleh karyawan

Role and Responsibilty understood by each employees? / Tugas dan

tanggung jawab masing masing di mengerti oleh karyawan ?

PPE complete and proper condition ? / PPE lengkap dan kondisi baik?

Minute Of Meeting / Hasil Meeting :

Prepared by / Disiapkan Oleh, Aknowledged by / Diketahui Oleh,

_________________________ ____________________________
Foreman / Mandor Field HES Compliance
Lampiran 11
HES Program CS Paket 2 (C855141)
No. Dok QSHE-2007/CO9/CO/P/002