The Safety Declaration Form is a crucial document required under Indonesian safety regulations, particularly aligned with Law No. 1 of 1970 and Government Regulation No. 50 of 2012. This document is typically required before commencing operations, during safety audits, or when undertaking new projects that involve significant safety considerations. It serves as both a legal commitment and a practical tool for safety management, requiring declarants to formally acknowledge their understanding of safety requirements and accept responsibility for maintaining safe working conditions. The form typically includes comprehensive details about safety measures, risk assessments, and emergency procedures, making it an essential component of Indonesia's workplace safety compliance framework.
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1. Declarant Details: Information about the person or entity making the safety declaration, including full name, position, company details, and relevant registration numbers
2. Scope of Declaration: Clear description of the activities, locations, or projects covered by this safety declaration
3. Compliance Statement: Formal declaration of compliance with Indonesian safety regulations, specifically referencing Law No. 1 of 1970 and other applicable regulations
4. Safety Management Commitment: Declaration of commitment to implementing and maintaining safety management systems in accordance with Government Regulation No. 50 of 2012
5. Risk Acknowledgment: Recognition of potential risks and hazards associated with the work activities
6. Safety Measures: Overview of implemented safety measures, protocols, and control systems
7. Incident Reporting Commitment: Declaration of commitment to report safety incidents and maintain proper documentation
8. Legal Responsibility: Acknowledgment of legal obligations and liabilities under Indonesian law
9. Declaration Validation: Date, signature, and company stamp section
1. Environmental Impact Statement: Required when activities may have environmental implications, referencing compliance with Government Regulation No. 27 of 2012
2. Specific Activity Declarations: Additional declarations for specialized activities like working at heights or confined spaces
3. Subcontractor Management: Required when declaration covers work involving subcontractors, detailing safety responsibilities and oversight
4. Equipment Certification: Required when declaration involves use of specialized or high-risk equipment
5. Chemical Handling Declaration: Required when activities involve handling of hazardous materials or chemicals
6. Training Compliance: Detailed section about safety training compliance when required by specific regulations or industry standards
1. Schedule A - Risk Assessment: Detailed risk assessment for the declared activities
2. Schedule B - Safety Protocols: Specific safety procedures and protocols relevant to the declared activities
3. Schedule C - Emergency Procedures: Emergency response procedures and contact information
4. Appendix 1 - Certificates: Copies of relevant safety certificates and qualifications
5. Appendix 2 - Insurance: Details of relevant insurance coverage
6. Appendix 3 - PPE Requirements: List of required Personal Protective Equipment for declared activities
Relevant legal definitions
Applicable Laws
Competent Person
Dangerous Occurrence
Emergency Procedure
Hazard
Health and Safety Management System
Incident
Near Miss
Occupational Health and Safety
Personal Protective Equipment (PPE)
Premises
Risk Assessment
Risk Control Measures
Safety Equipment
Safety Officer
Safety Protocol
Site
Work Activity
Workplace
Authorized Representative
Compliance
Declarant
Designated Authority
Emergency Services
Hazardous Material
Industrial Accident
Safety Documentation
Safety Standards
Safe Work Method Statement
Safety Management Representative
Competent Person
Dangerous Occurrence
Emergency Procedure
Hazard
Health and Safety Management System
Incident
Near Miss
Occupational Health and Safety
Personal Protective Equipment (PPE)
Premises
Risk Assessment
Risk Control Measures
Safety Equipment
Safety Officer
Safety Protocol
Site
Work Activity
Workplace
Authorized Representative
Compliance
Declarant
Designated Authority
Emergency Services
Hazardous Material
Industrial Accident
Safety Documentation
Safety Standards
Safe Work Method Statement
Safety Management Representative
Clauses
Declaration
Compliance
Safety Management
Risk Assessment
Emergency Procedures
Training and Competency
Reporting and Documentation
Equipment and PPE
Incident Management
Legal Responsibility
Certification
Inspection Rights
Safety Standards
Hazard Management
Environmental Compliance
Worker Safety
Subcontractor Management
Insurance
Liability
Verification
Compliance
Safety Management
Risk Assessment
Emergency Procedures
Training and Competency
Reporting and Documentation
Equipment and PPE
Incident Management
Legal Responsibility
Certification
Inspection Rights
Safety Standards
Hazard Management
Environmental Compliance
Worker Safety
Subcontractor Management
Insurance
Liability
Verification
Relevant Industries
Construction
Manufacturing
Mining
Oil and Gas
Chemical Processing
Transportation
Logistics
Heavy Industry
Infrastructure Development
Maritime Operations
Aviation
Healthcare
Food Processing
Utilities
Telecommunications Infrastructure
Relevant Teams
Health and Safety
Operations
Risk Management
Compliance
Quality Assurance
Facilities Management
Project Management
Production
Environmental Health
Technical Operations
Emergency Response
Occupational Health
Site Operations
Maintenance
Relevant Roles
CEO
Managing Director
Operations Manager
Health and Safety Manager
Site Supervisor
Project Manager
Compliance Officer
Risk Management Director
Facility Manager
Construction Manager
Production Supervisor
Quality Control Manager
Environmental Health Officer
Industrial Safety Specialist
Occupational Health Coordinator
Technical Director
Plant Manager
Safety Engineer
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