MINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * DECREE OF MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA NUMBER 432/MENKES/SK/IV/2007 REGARDING GUIDANCE ON WORK HEALTH AND SAFETY MANAGEMENT (K3) IN HOSPITAL, Considering In view of MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA, that hospital activities shall have potential on causing physical, chemical, biological, ergonomic and psychosocial hazards that may endanger health and safety both for workers, patients, visitors and people living around the hospital; that in order to prevent and to decrease health and safety problems upon workers, it shall require any efforts on work health and safety by stipulating Guidance on Work Health and Safety Management (K3) in Hospital by Decree of Minister of Health; Law Number 1 of 1970 regarding Work Safety (State Gazette of the Republic of Indonesia of 1970 Number 1, Supplement to the State Gazette of the Republic of Indonesia Number 2918); Law Number 23 of 1992 regarding Health (State Gazette of the Republic of Indonesia of 1992 Number 100, Supplement to the State Gazette of the Republic of Indonesia Number 4437); Law Number 13 of 2003 regarding Manpower (State Gazette of the Republic of Indonesia of 2003 Number 39, Supplement to the State Gazette of the Republic of© N @ MINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * Indonesia Number 4729); Law Number 32 of 2004 regarding Regional Governance (State Gazette of the Republic of Indonesia of 2004 Number 125, Supplement to the State Gazette of the Republic of Indonesia Number 4437); Regulation of Government Number 32 of 1996 regarding Health Worker (State Gazette of the Republic of Indonesia of 1996 Number 49, Supplement to the State Gazette of the Republic of Indonesia Number 3637); Regulation of Government Number 72 of 1992 regarding Securing Pharmaceutical Stocks and Health Equipment (State Gazette of the Republic of Indonesia of 1998 Number 139, Supplement to the State Gazette of the Republic of Indonesia Number 3781); Regulation of Government Number 27 of 1999 regarding Health Worker (State Gazette of the Republic of Indonesia of 1999 Number 59, Supplement to the State Gazette of the Republic of Indonesia Number 3838); Regulation of Government Number 63 of 2000 regarding Safety and Health towards the Use of Ionizing Radiation (State Gazette of the Republic of Indonesia of 2000 Number 136, Supplement to the State Gazette of the Republic of Indonesia Number 3992); Decree of President Number 22 of 1993 regarding Any Diseases Caused by Work Relationship;10. "1 12. 13. 14. 15. 16. 47. MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Decree of President Number 7 of 1999 regarding Obligatory to Report Diseases Caused by Work Relationship: Decree of Minister. of -~—-Health = Number 876/Menkes/SK/VIII/2001 regarding Technical Guidance on Environmental Health Impacts Analysis; Decree of Minister. of -~— Health + Number 1217/Menkes/SK/IX/2001 regarding Guidance on Radiation Impact Security; Decree of Minister of '~—- Health += Number 1335/Menkes/SK/X/2002 regarding Standard Operation for Taking and Measuring Room Air Quality in Hospital; Decree of Minister. of _-~— Health = Number 1439/Menkes/SK/XI/2002 regarding the Use of Medical Gas in Health Service Facility; Decree of Minister of ~~‘ Health = Number 351/Menkes/SKIIII/2003 regarding Committee on Work Health and Safety for Health Sector; Decree of Minister. ~ of -—-Health ~=— Number 1204/Menkes/SK/X/2004 regarding Environmental Health Requirements for Hospital; Regulation of Minister of Health Number 1575/Menkes/Per/XI/2005 regarding Organization and Management of Ministry of HealthTo Stipulate Firstly Secondly Thirdly Fourthly Fifthly MINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * HAS DECIDED: DECREE OF MINISTER OF HEALTH REGARDING GUIDANCE ON WORK HEALTH AND SAFETY MANAGEMENT (K3) IN HOSPITAL. Guidance on Work Health and Safety (K3) in Hospital as attached in the Appendix of this Decree. Guidance as referred to in Second Dictum shall be reference for management and employees of Hospital in making efforts ‘on work health and safety Development and monitoring to implementation of the Guidance as referred to in the Second Dictum shall be implemented by Minister of +Health, Head of Province/Regeney/City Office, by involving professional organization and community. This Decree shall be effective as of the date of stipulation Stipulated in Jakarta On : April 10, 2007 THE MINISTER OF HEALTH, signed and sealed Dr. dr. SITI FADILAH SUPARI, Sp. JP(K)MINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * ‘Appendix Decree of Minister of Health Number 432/Menkes/SK/IV/2007 Date April 10, 2007 GUIDANCE ON WORK HEALTH AND SAFETY MANAGEMENT (K3) IN HOSPITAL, |. INTRODUCTION A. Background Law Number 23 of 1992 regarding Health, Article 23 states that any efforts in Work Health and Safety (K3) shall be carried out in any workplace, especially that having risk on health problems, vulnerable to disease or having minimum 10 employees. If we consider contents of abovementioned article, it is clear that hospital is included into criteria of workplace with hazardous threats possibly causing impacts on health, not only to the direct actors working in the hospital, but also to the patients and visitors of hospital. So that management of hospital should apply any efforts on work health and safety in hospital. Potential hazards in hospital, other than infectious diseases, are also potential hazardous influencing situation and condition in hospital, namely accident (explosion, fire, accidents related to electricity installation, and other causes of injuries), radiation, hazardous chemical substances, anesthesia gases, psychosocial disorder and ergonomic one. All potential hazards above clearly threat the souls and lives of employees in hospital, patients as well as visitors in the environment of hospital Results of National Safety Council (NSC) report of 1988 shows that accident occurs in hospital was 41% higher than those in other industry. The cases often occur include pierced by needles, wrenched, waist pain, scratched/cut off, and infections, etc. A number of cases were reported to get compensation for employees of hospital, namely sprains, strains: §2%; contussion, crushing, bruising : 11%; cuts, laceration, punctures: 10.8%; fractures: 5.6%; multiple injuries: 2.1%; thermal bums: 2%; scratches, abrasions: 1.9%: infections: 1.3%; dermatitis: 1.2%; and others: 12.4% (US Department of Laboratory, Bureau of Laboratory Statistics, 1983).MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Other report, namely in Israel, the highest back injury prevalence number is on nurse (16.8%) compared to employee in other industrial sector. In Australia, among 813 nurses, 87% of them have once suffered low back pain, prevalence 42% and in US musculoskeletal injury incident was 4.62/100 nurses annually. Back injury required highest compensation, namely more than $ 1 billion per annum. Special for Indonesia, research data related to any hazards in hospital has not yet been described clearly. However, it is believed that many complaints from officers in hospital in relation to the hazards existing in hospital In addition, Gun (1983) noted that there were several chronic disease cases suffered by officers of hospital, namely hypertension, varicose veins, anemia (mostly female), kidney disease and urine canal (69% female), dermatitis, and urtikaria (57% female) as well as backbone pain and invertebrate discus friction. It is added that there were several cases of acute diseases suffered by officers of hospital at 1.5 times higher than other officers or workers, namely infection and parasite, respiration disorder; digesting canal and other complaints like ear sickness, headache, urine canal disorder, childbirth problem, disorder during pregnancy, skin disease and muscle system as well as skeleteon. Of various potential hazards, there requires several efforts to control, to minimize and, if possible, to abolish them, thus, Work Health and Safety in Hospital shall be required to be well-managed. For more effective, efficient and integrated Work Health and Safety in Hospital, it shall require a guidance on Work Health and Safety in Hospital management, both for management and employees of hospital B. Objective and Benefit Objective: The creation of health, safe, pleasant work procedure, work environment in order to improve health status of employees in hospital Benefits: 1. For hospital a. Improving service qualityMINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * b. Keeping operational sustainability of the hospital c. Improving the hospital's image. 2. For employees of hospital: a. Protecting employees from any Diseases Due To Work (PAK) b. Preventing Accident Due to Work (KAK) 3. For patients and visitors: a. Good service quality b. Satisfactions of patients and visitors . Targets 4. Hospital 2, Employees of hospital 3. Patients and visitors |. WORK HEALTH AND SAFETY IN HOSPITAL . Definition Health according to WHO/ILO (1995) Work health shall be aimed at improving and keeping physical, mental and social health status as high as possible for worker at any kind of occupations, prevention to health disorders, worker caused by work conditions; and placement as well as keeping worker in a work environment adjusted to physiologic and psychological conditions. In brief, itis, an adjustment between work and human and any human and his/her work or position. Work Health and Safety Any efforts to provide with safety security and improving health status of workers/labors by preventing accident and diseases due to work, hazard control in workplace, health promotion, medication and rehabilitation,MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Management of Work Health and Safety in Hospital A process of activity started by phases of planning, organizing, implementation and control aiming at civilizing Work Health and Safety in hospital . Effort on Work Health and Safety in Hospital Any efforts on Work Health and Safety in hospital shall concer about labor, work method, work equipment, work process and work environment. These efforts shall include improvement, prevention, medication and recovery. Performance of any health and non-health officers shall be a resultant of three components of Work Health and Safety including work capacity, work load and work environment By: 1. Work capacity shall be a labor's competence to accomplish his/her duties well in a work place within certain period of time. 2. Work load shall mean a condition loaded to worker both physically and non- Physically in accomplishing duties, such condition can be heavier due to environmental condition not supporting physically and non-physical. 3. Work Environment shall be work place environmental condition including physical, chemical, biological, ergonomic and psychosocial factors influencing worker in implementing his/her tasks. . Potential Hazards in Hospital Potential hazards in hospital may cause diseases and accidents caused by work Namely caused by biological factors (virus, bacteria and fungus); chemical factors (antiseptic, anesthesia gas); ergonomic factor (wrong work method); physical factors (temperature, light, noise, electricity, vibration and radiation); psychosocial factors {alternating work, fellow employees/superior relationship) Potential hazards possible occur in hospital shall include among others microbiologic, design/physical, firing, mechanical, chemical/gas/carcinogen, radiation and law/security risks,MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Diseases Caused by Work (PAK) in hospital, shall be generally related to biologic factors (pathogen germs derived from patients); chemical factors (exposure in small dosage but continuous like antiseptic on skin, anesthesia gas on liver; ergonomic factors (wrong sitting position, wrong patient lifting method); physical factors in continuously small dosage (heat on skin, high pressure on reproductive system, radiation on blood produc 1g system); psychological factors (stress in surgical room, patient receiving, emergency and psychiatric ward). D. Emergency Response in Hospital Emergency may occur in hospital Emergency is an incident that may cause death or serious injuries to workers, visitors and common people or may close business activities, disturbing surgical operation, causing physical damages environmentally and threatening hospital's finance and image. Hospital shall absolutely require Emergency Response System as a part of Work Health and Safety in Hospital Management. lll. WORK HEALTH AND SAFETY IN HOSPITAL MANAGEMENT SYSTEM A. Commitment and Policy Commitment shall be implemented in form of written, clear and understandable as well as known policy by all employees of hospital. Hospital management shall identify and provide with all essential resources like financing, Work Health and Safety worker and facilities for the implementation of Work Health and Safety in Hospital program. Policy on Work Health and Safety in Hospital shall be implemented in form of organization of Work Health and Safety in Hospital within organization structure of hospital. In order to implement commitment and policy on Work Health and Safety in Hospital, the following strategies shall be required to arrange’ 1, Advocacy for Work Health and Safety in Hospital program socialization. 2. Determining clear objectives. 3. Clear organization and assignment 4, Improving professional human resources on Work Health and Safety in Hospital at any work unit within the environment of hospital.MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Any resources to support by top management Qualitative and quantitative on risks Making work program on Work Health and Safety in Hospital prioritizing any efforts on improvement and prevention. 8. Periodically internal and external monitoring and evaluation B. Planning Hospital shall make effective planning for attaining successful application for Work Health and Safety management system with clear and measurable targets. Planning of Work Health and Safety in Hospital may refer to standard Work Health and Safety in Hospital Management System including, among others, self assessment on accreditation of Work Health and Safety in Hospital and Work Health and Safety Management System Planning shall include as follows 1, Identification of hazard sources, assessment and control on risk factors. Hospital shall conduct a study and identification on hazard sources, assessment as well as controlling risk factors. a. Identification of hazard sources It can be conducted by considering + Conditions and incidents those may cause potential hazards, + Types of accident and disease caused by work that may happen. Hazard sources that exist in hospital shall be defined and assessed to determine level of risks that becomes benchmark for possibility of accident and disease caused by work. Potential hazards by location and task in hospital shall include as follows: No. | Potential Hazards Location Most risky worker 7 |PHYSICAL: IPS-Hospital, laundry, Kitchen, |Any employee working in the| — CSSD, —_generator-set-boiler location building, Waste Water Disposal Installation =10-MINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * No. | Potential Hazards Location Most risky worker Room for machineries and |Nurse, cleaning service, ete. Vibration ‘equipment producing vibration (dental room, etc.) Generator set, workshop, dental|Sanitation official, dental Dust laboratory, medical record|technician, IPS and medical ‘storehouse, incinerator record officers Kitchen worker, laundry worker, CSSD, kitchen, —_laundry| Heat sanitation worker, and IP- incinerator, boiler Hospital Radiation Ray, OK that uses c-arm,|Radiologist, radiotherapist, and physiotherapy room, dental unit |radiographer, physiotherapist, land dental roentgen officials. 2 [CHEMICAL: Disinfectant Any area Cleaning service officer, nurse Cytotoxics Pharmacy, waste disposal area,|Pharmaceutical worker, nurse, ward waste collector Ethylene oxide ‘Surgical room Physician, nurse as Laboratory, mortuary, Mortuary officer, laboratory and pharmaceutical storehouse pharmaceutical officers Methyl: Dental room Officer/dentist, surgeon, nurse Methacrylat, Hg (amaigam) Laboratory, workshop, any arealTechnician, laboratory _ officer, Solvents in hospital cleaning service officer anesthesia Dental surgery room, OK|Dentist, nurse, surgeon, recovery room (RR) anesthesia physician/nurse 3 |BIOLOGICAL: IGD, Surgical Room, dental |Physician, dentist, nurse, 'AIDS, Hepatitis 8 [examination room, laboratory, |laboratory officer, sanitation and land Non A-Non B laundry laundry officers tteMINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * No. Potential Hazards Location’ Cytomegalovirus Midwifery, children room Most risky worker Nurse, mother and child section Rubella Mother and child room, Physician and nurse Tuberculosis Ward, laboratory, isolating Nurse, laboratory officers, room physiotherapist 4 |ERGONOMIC: ‘Any duties done |Patient area and storehouse [Any officer handling patients andi manually |goods [Wrong position [Any area [Any employee while working Dentist, cleaning service officer, eee ane physiotherapist, driver, computer| loperator, those related with] lcorrespondence 5 |PSYCHOSOCIAL: Often making contact with patients, work in cycle, —excessive|Any area |Any employee work, physically| threats b. Assessment on risk factors It shall mean any process to determine whether any risk exist by assessing potential hazards caused by health and safety risks. ¢. Risk factors controlling Implemented through 4 levels of risk control including omitting hazards, replacing risk sources with other equipment/instrument having risks lower/no risk (engineering), administration and personal protector. -12-MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * 2. Making rules Hospital shall make, determine and implement standard operational procedure (SOP) pursuant to the rules, legislations and other regulation regarding Work Health and Safety. This SOP shall be evaluated, renewed and communicated as well as socialized to any related employee and party. 3. Objectives and targets Hospital shall consider measurable legislations, potential hazards and Work Health and Safety risks, measuring unitindicator, achievement target and term of achievement (SMART). 4. Performance indicator Indicator shall be measurable as a basis for Work Health and Safety performance assessment as well as information on success to achieve Work Health and Safety in Hospital Management System. 5. Work Health and Safety Program Hospital shall determine and implement Work Health and Safety in Hospital program; for achieving targets, monitoring, evaluation and recording as well as reporting shall be required. C. Organizing The implementation of Work Health and Safety in Hospital shall depend much on responsibility of management and officers, towards respective duties and obligations as well as cooperation in implementing Work Health and Safety. This responsibility shall be planted through clear rules/regulations. Pattern of responsibility distribution, elucidation to all officers, guide and training as well as discipline enforcement. Chairperson of corganization/executing unit of Work Health and Safety in Hospital shall specifically prepare data and information on the implementation of Work Health and Safety in any work place, formulate problems as well as analyze causal factors along with work units, then shall also search for solution and communicate it to work units, so that it can be run well. Further, monitoring and evaluating program implementation to assess level of 13+MINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * ‘success implementation for the programs. In case there are still be any lacks, there should be ide ied for deviation and searched for solution. 1. Duties and functions of organization/executing unit for Work Health and Safety in Hospital a, Main Duties: * Giving recommendation and consideration to director of hospital regarding any problems related to Work Health and Safety. + Formulating policies, regulations, manuals, instruction on implementation and procedure. + Making program of Work Health and Safety in Hospital b. Function + Collecting and processing all data and information as well as problems related to Work Health and Safety + Assisting director of hospital in organizing and improving Work Health and Safety promotion efforts, training and research on Work Health and Safety in Hospital. + Supervising the implementation of Work Health and Safety program. + Providing with suggestions and considerations related to corrective actions + Coordination with other units being members of Work Health and Safety in Hospital + Providing with advices on Work Health and Safety management in work place, hazard control, issuing regulation and initiative for prevention. + Investigating and reporting accidents, and making recommendation according to the activities. + Participating in planning new equipment purchase, structure development and its process. 2. Organizational Structure of Work Health and Safety in Hospital Work Health and Safety Organization shall be 1 level under director and not a double-function one. 14.MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Model 4 It shall be structured organization responsible to the Director of hospital. Form of Work Health and Safety in Hospital organization shall be structural organization integrated into committee of hospital and adjusted to respective condition/class of hospital, for example, Medical Committee/Nosokomial Model 2: It shall be functional (non-structural) organization, directly responsible to the Director of Hospital. It shall be named executing unit for Work Health and Safety in Hospital assisted by Work Health and Safety unit having members all work units in hospital Membership: + Organization/executing unit of Work Health and Safety in Hospital shall have members from any elements of officers and management of Hospital Board of Directors + Organization/executing unit of Work Health and Safety in RS shall consist of at least Chairperson, Secretary and member. Organization/executing unit of Work Health and Safety in RS shall be chaired by a chairperson. + Implementation of chairperson’s duties shall be assisted by vice chairperson and secretary as well as member. + Chairperson of organization/executing unit of Work Health and Safety in Hospital should be one of top management in hospital or at least a member of management directly under director of hospital. + Whereas secretary of organization/executing unit of Work Health and Safety in Hospital shall be a professional worker on Work Health and Safety in Hospital, namely manager of Work Health and Safety in Hospital or Work Health and Safety expert. . Work Mechanism Chairperson of organization/executing unit of Work Health and Safety in Hospital shall lead and coordinate activities conducted by organization/executing unit of Work Health and Safety in Hospital -15-MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Secretary of organization/executing unit for Work Health and Safety in Hospital shall lead and coordinate secretarial duties and implement decisions made by organization/executing unit of Work Health and Safety in Hospital Member of organization/executing unit of Work Health and Safety in Hospital shall join the meeting of organization/executing unit of Work Health and Safety in Hospital and discuss any problems proposed in meeting, as well as implementing any duties given by organization/executing unit of Work Health and Safety in Hospital. In order to implement its main duties and functions, organization/executing unit of Work Health and Safety in Hospital shall collect data and information on the implementation of Work Health and Safety in Hospital. Data sources shall be among others from personnel division including total sickness, absent without confirmation, total accidents, record on sick duration and hospital treatment, especially those related to accident consequences. And other sources can be from hospital treatment location including, among others, total visits, First Aids and medical actions for accidents, referral to hospital if advanced treatment is required and term of treatment. From engineering department, it can be obtained data on damages caused by accident and repair costs Information shall also be collected from results of monitoring work place and work environment of hospital, especially those related with sources of potential hazards both those from hazardous condition and hazardous actions as well as data from Work Health and Safety department in form of report on the implementation of Work Health and Safety and its analysis. Data and information shall be discussed in organization/executing unit of Work Health and Safety in Hospital in order to find out the causal factors for such problems and to formulate any corrective actions as well as preventive ones. Results of formulation shall be submitted in form of recommendation to the director of Hospital. Recommendation shall contain any suggestion for follow up from organization/executing unit of Work Health and Safety in Hospital as well as alternatives as well as prediction on results/consequence for each option. -16-MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * Organization/executing unit of Work Health and Safety in Hospital shall assist in carrying out any efforts on promotion in the hospital environment both to officers, patients and visitors, namely regarding any efforts on preventing Accident Caused by Work and Disease caused by work in hospital. It may also organize contest on the implementation of Work Health and Safety among departments or work units in work environment of hospital, and the best in implementing and applying Work Health and Safety shall obtain a ‘reward’ from director of hospital. D. Steps of Implementation For facilitating the implementation of Work Health and Safety in Hospital, steps of Policy on Work Health ‘and Safely implementation shall be as follows: 1. Preparation phase ent. a. Declaring com Commitment shall be started from president director/director of hospital (top management). Declaration of commitment by top management shall not only be in words, but also in real actions, that can be known, leamt, comprehended and implemented by all staffs and officers of hospital. b. Determining way of applying Work Health and Safety in Hospital. It may use consultant services or may not use them if the hospital has capable personnel to organize and to direct people. “17+MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * c. Establishment of organization/executing unit of Work Health and Safety in Hospital. d. Establishing work group on applying Work Health and Safety. Members of work group should consist of a representative for each work unit, usually manager of work unit. Roles, responsibilities and duties of members of work group shall be determined. Whereas classification and total members of work group shall be according to the need of hospital e. Determining required resources. Resources shall include human (having Work Health and Safety worker), facilities, time and fund. Implementation Phase a. Work Health and Safety elucidation to all officers of hospital b. Training on Work Health and Safety adjusted to individual and group needs in organization of hospital. Its function shall be to process individual with certain behavior to have behavior pursuant to that previously determined as final products of the training c. Implementing Work Health and Safety program pursuant to the prevailing legislations including, among others, as follows: Examination on officer's health (before working, periodic and special) — Providing with self and work safety protector — Preparing guidance on preventing and controlling emergency condition — Worker placement on proper jobs according to health condition — Treatment for any sick worker. Creating managed hygienic work environment through monitoring work environment from existing hazards — Implementing biological monitoring Implementing work health surveillance -18-MINISTER OF HEALTH OF ‘THE REPUBLIC OF INDONESIA * Monitoring and Evaluation Phase Basically, monitoring and evaluating Work Health and Safety in Hospital shall be ‘one of Work Health and Safety in Hospital management functions in form of a step taken to determine and to value level of completed process of Work Health and Safety in Hospital activities, and to question effectiveness and efficiency for implementation of Work Health and Safety in Hospital in achieving any determined objectives, Monitoring and evaluation shalll include as follows a b. Recording and reporting Work Health and Safety integrated in reporting system of hospital (SPRS); Recording and reporting Work Health and Safety — Recording all activities on Work Health and Safety — Recording and reporting accident caused by work Recording and reporting disease caused by work Inspection and testing Inspection of Work Health and Safety shall mean a kind of activity to assess general condition of Work Health and Safety and shall not be a too deep one. Inspection on Work Health and Safety in Hospital shall be conducted periodically, especially by officers of Work Health and Safety in Hospital so that disease caused by work and accident caused by work can be prevented as early as possible, Other acti ies shall include testing both to the environment and examination on risky workers like biological monitoring, Auditing Work Health and Safety Work Health and Safety audit shall include philosophy and objectives, administration and management, employee and management, facility and equipment, policy and procedure, employee development and education program, evaluation and control Objectives of Work Health and Safety Audit shall be as follows: — To assess potential hazards, health and safety disorders. -19-MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA * — To ensure and to assess that Work Health and Safety management has been implemented following the rules Determining any steps to control potential hazards as well as for quality development. Improvement and prevention shall be based on results of audit findings, identification, assessment on risk recommended to top management. Review and improvement by management sustainable to secure appropriateness and effectiveness in achieving policy and objectives of Work Health and Safety. IV. CLOSING Work Health and Safety in Hospital management is significant to improve work environment of hospital to be safe, health and comfortable for employees, patients, visitors and common people living around the hospital. Work Health and Safety in Hospital management can run well if the top management or Director of hospital has high commitment to the implementation of Work Health and Safety in Hospital. In addition, it shall require full understanding, awareness and attention of any party involved in hospital, so that what expected to the application of Work Health and Safety in Hospital can be achieved. For the success of Work Health and Safety in Hospital management, it can not be separated from governmental efforts in developing any processes of Work Health and Safety in Hospital phases. It can also from side of legislation and allocation of guidance both Work Health and Safety technical and strategy of applying Work Health and Safety in Hospital MINISTER OF HEALTH, signed and sealed Dr. dr. SITI FADILAH SUPARI, Sp. JP.(K) -20-