project hse plan - EXIM.GOV

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

PROJECT HSE PLAN

PROJECT : Engineering, Procurement, Construction for Refinery Master

Plan (RDMP) RU V Balikpapan

LOCATION : Refinery Unit V Balikpapan, East Kalimantan, Indonesia

OWNER : PT. PERTAMINA (Persero)

___________ Djoko Koen Soewito Chief Engineer (KTT) PERTAMINA RDMP RU-V

002 28 Oct 19 RE-ISSUED FOR CONSTRUCTION

YUZAR ISPRANTO Y.D.KIM

001 01 Oct 19 RE-ISSUED FOR CONSTRUCTION

YUZAR ISPRANTO Y.D.KIM

000 13 Aug 19 ISSUED FOR

CONSTRUCTION YUZAR ISPRANTO Y.D.KIM

00C 10 July 19 RE-ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM

00B 12 June 19 RE-ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM

00A 16 April 19 ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM

REV. DATE DESCRIPTION PREPARED CHECKED APPROVED

Mrs Faulina Kustiawati

Stamp

Dr Barrie O'Sullivan

Line


Line


Stamp

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

i

REVISION LOG

REV. NO. DATE PAGE DESCRIPTION

00A 16 April 19 - Issued for review

00B 12 June 19 - Re-Issued for Review

00C 10 July 19 - Re-Issued for Review

000 13 Aug 19 - Revised as PMC Comments

001 01 Oct 19 - Refer to Comment Resolution Sheet

002 28 Oct 19 - Refer to Comment Resolution Sheet

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

ii

Table of Contents

Table of Contents............................................................................................................................................. ii

List of Tables ................................................................................................................................................... vi

List of Figures .................................................................................................................................................. vi

1. INTRODUCTIONS ..................................................................................................................................... 1

2. PURPOSE ................................................................................................................................................. 1

3. SCOPE ...................................................................................................................................................... 1

4. DEFINITIONS AND ABBREVIATIONS ......................................................................................................... 2

5. REFERENCES ............................................................................................................................................ 4

6. LEADERSHIP AND COMMITMENT ............................................................................................................ 7

HSE POLICY ............................................................................................................................................ 7

STRATEGIC OBJECTIVES AND KPI’s ........................................................................................................ 7

ROLES AND RESPONSIBILITIES ............................................................................................................... 9 6.3.1. PROJECT DIRECTOR ...................................................................................................................... 9 6.3.2. PROJECT MANAGER ...................................................................................................................... 9 6.3.3. CONSTRUCTION MANAGER .......................................................................................................... 9 6.3.4. CONSTRUCTION DISCIPLINE SUPERINTENDENT ........................................................................... 9 6.3.5. HSE MANAGER ........................................................................................................................... 10 6.3.6. DEPUTY HSE MANAGER .............................................................................................................. 10 6.3.7. CHIEF HSE ................................................................................................................................... 11 6.3.8. HSE ENGINEER ............................................................................................................................ 11 6.3.9. INSPECTOR .................................................................................................................................. 11 6.3.10. HSE TRAINING COORDINATOR ................................................................................................... 11 6.3.11. SITE DOCTOR .............................................................................................................................. 12 6.3.12. HEALTH/MEDICAL ADVISOR ....................................................................................................... 12 6.3.13. PARAMEDIC ................................................................................................................................ 12 6.3.14. SUBCONTRACTOR/SUPPLIER/VENDORS ..................................................................................... 12

7. RISK MANAGEMENT .............................................................................................................................. 13

HIRAC .................................................................................................................................................. 13

JOB SAFETY ANALYSIS (JSA) ................................................................................................................. 14

JOB HAZARD ANALYSIS (JHA) .............................................................................................................. 16

8. MANAGEMENT OF CHANGE (MOC) ....................................................................................................... 16

9. PRE-MOBILIZATION MANAGEMENT ...................................................................................................... 19

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

iii

MANPOWER READINESS ..................................................................................................................... 19

EQUIPMENT / TOOLS / VEHICLES READINESS ..................................................................................... 19

DOCUMENTATION READINESS ............................................................................................................ 20

10. SUBCONTRACTOR MANAGEMENT......................................................................................................... 20

11. TRANSPORTATION MANAGEMENT ....................................................................................................... 22

VEHICLES ............................................................................................................................................. 22

PEDESTRIAN AREA ............................................................................................................................... 23

12. HEALTH MANAGEMENT ........................................................................................................................ 24

BIOLOGICAL HAZARDS ......................................................................................................................... 24 12.1.1. WILDLIFE ANIMAL ....................................................................................................................... 25 12.1.2. BLOOD-BORNE PATHOGENS ...................................................................................................... 25

DRINKING WATER ............................................................................................................................... 25

EXTENDED WORK AND SHIFT WORK ................................................................................................... 26

FITNESS TO WORK ............................................................................................................................... 26

HYGIENE AND OCCUPATIONAL HEALTH .............................................................................................. 27 12.5.1. CATERING PRACTICES ................................................................................................................. 27 12.5.2. FATIGUE MANAGEMENT ............................................................................................................ 27 12.5.3. HOUSEKEEPING .......................................................................................................................... 28 12.5.4. HEAT STRESS ............................................................................................................................... 28 12.5.5. HEARING PROTECTION ............................................................................................................... 28 12.5.6. RESPIRATORY PROTECTION ........................................................................................................ 30 12.5.7. RADIATION PROTECTION ............................................................................................................ 30

13. ENVIRONMENTAL MANAGEMENT ......................................................................................................... 31

HAZARDOUS WASTE MANAGEMENT .................................................................................................. 32

14. OPERATING PROCEDURES AND SAFETY STANDARDS ............................................................................ 32

ABRASIVE BLASTING ............................................................................................................................ 32

ASSURED GROUNDING ........................................................................................................................ 33

CAMERAS (SECURITY) .......................................................................................................................... 33

CHAIN BLOCKS AND COME-A-LONGS .................................................................................................. 33

CRANE AND LIFTING GEAR REQUIREMENTS ....................................................................................... 33 14.5.1. CRANE REQUIREMENTS .............................................................................................................. 33 14.5.2. LIFTING GEAR REQUIREMENTS................................................................................................... 34 14.5.3. LIFTING PLAN .............................................................................................................................. 34 14.5.4. CRANE OPERATOR QUALIFICATION ............................................................................................ 34

COMPRESSED GAS CYLINDERS ............................................................................................................ 34

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

iv

CONFINED SPACE ................................................................................................................................ 35

EXCAVATION AND TRENCHING ........................................................................................................... 38

ELECTRICAL SAFETY ............................................................................................................................. 39

FIRE PREVENTION AND PROTECTION .................................................................................................. 39 14.10.1. FLAMMABLE COMBUSTIBLE LIQUID STORAGE & HANDLING .................................................... 40 14.10.2. SMOKING AREA .......................................................................................................................... 41 14.10.3. MOBILE CELL PHONE .................................................................................................................. 42 14.10.4. FIRE EXTINGUISHER AND FIRE WATCHER ................................................................................... 43

FALL PREVENTION / PROTECTION ....................................................................................................... 43

FLOOR AND WALL OPENING ............................................................................................................... 44

HEAVY MOBILE EQUIPMENT ............................................................................................................... 45

HAZARDOUS CHEMICAL HANDLING .................................................................................................... 45

HYDROGEN SULFIDE (H2S) ................................................................................................................... 47

HAND AND POWER TOOLS .................................................................................................................. 47

LADDER USE AND INSPECTION ............................................................................................................ 48

LOCK OUT / TAG OUT – ENERGY ISOLATION ....................................................................................... 48

PERSONAL PROTECTIVE EQUIPMENT (PPE) ........................................................................................ 49

PNEUMATIC TOOLS ............................................................................................................................. 50

PEDESTAL, BENCH AND PORTABLE GRINDERS .................................................................................... 51

FALLING OBJECTS PROTECTION ........................................................................................................... 51

SITE OFFICE, STORES, WORKSHOPS, LIVING ACCOMODATION AND CANTEEN FACILITIES ................. 52 14.23.1. WORKSHOP FACILITIES ............................................................................................................... 53 14.23.2. LIVING ACCOMODATION ............................................................................................................ 53 14.23.3. ABLUTION FACILITIES ................................................................................................................. 53 14.23.4. CANTEEN FACILITIES ................................................................................................................... 54

SIGNAGE & BARRICADES ..................................................................................................................... 54

SCAFFOLDING ...................................................................................................................................... 54

SIMOPS ................................................................................................................................................ 55

WELDING. CUTTING & GRINDING ....................................................................................................... 55

WORK PERMIT PROCEDURE ................................................................................................................ 56

15. TRAINING AND COMPETENCY ............................................................................................................... 56

HSE TRAINING REQUIREMENTS .......................................................................................................... 56

IIF® PROGRAMS ................................................................................................................................... 57

COMPETENCY ...................................................................................................................................... 58

TRAINING RECORD AND TRACKING METHOD ..................................................................................... 58

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

v

TRAINING PROVIDER ........................................................................................................................... 58

TRAINING KEY PERFORMANCE INDICATOR (KPI) ................................................................................ 59

CONTRACTOR INTERNAL TRAINER ...................................................................................................... 59

SITE SPECIFIC ORIENTATION PROGRAMS ............................................................................................ 59

SHORT SERVICE EMPLOYEE PROGRAM (SSE) ...................................................................................... 60

16. COMMUNICATION................................................................................................................................. 60

TOOLBOX MEETING (TBM) .................................................................................................................. 60

PRE-JOB SAFETY MEETING (PJSM)....................................................................................................... 61

GENERAL SAFETY TALK ........................................................................................................................ 62

WEEKLY SITE HSE COORDINATION MEETING ...................................................................................... 62

PROJECT MANAGEMENT SAFETY COMMITTEE MEETING ................................................................... 63

MONTHLY HSE COMMITTEE MEETING................................................................................................ 63

HSE POSTER, SLOGAN, NOTICE BOARD ............................................................................................... 63

CONTRACTOR RADIO COMMUNCATION NETWORK ........................................................................... 64

17. STOP WORK AUTHORITY (SWA) ............................................................................................................ 64

18. EMERGENCY RESPONSE PROCEDURE .................................................................................................... 65

EMERGENCY RESPONSE DRILL ............................................................................................................ 65

EMERGENCY SIREN .............................................................................................................................. 66

MEDICAL FACILITIES AND MEDICAL SERVICES REQUIREMENTS .......................................................... 66

MUSTER POINT AND ASSEMBLY POINT ............................................................................................... 66

19. INCIDENT INVESTIGATION ..................................................................................................................... 67

20. PERFORMANCE EVALUATION ................................................................................................................ 68

AUDITS ................................................................................................................................................ 68 20.1.1. QUARTERLY HSE JOINT AUDITS BY CONTRACTOR AND OWNER ................................................ 68 20.1.2. EXTERNAL AUDITS ...................................................................................................................... 68

INSPECTIONS ....................................................................................................................................... 68 20.2.1. CONSTRUCTION OBSERVATION PROGRAM (e-COP) .................................................................. 68 20.2.2. DAILY/ROUTINE ASSESSMENT .................................................................................................... 68 20.2.3. WEEKLY SITE MANAGEMENT WALKDOWNS .............................................................................. 69 20.2.4. QUARTERLY ENVIRONMENTAL INSPECTIONS AND ASSESSMENT .............................................. 69

INCENTIVES AND CONSEQUENCES ...................................................................................................... 69 20.3.1. HSE INCENTIVE PROGRAMS ........................................................................................................ 69 20.3.2. HSE CONSEQUENCE PROGRAMS ................................................................................................ 70

21. ATTACHMENTS ...................................................................................................................................... 71

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

vi

Attachment 1. Project HSE Policy ..................................................................................................................... 71

Attachment 2. List of Regulations .................................................................................................................... 71

Attachment 3. HSE Matrix Training .................................................................................................................. 71

Attachment 4. CSMS Questionnaire ................................................................................................................. 71

Attachment 5. HSE Program............................................................................................................................. 71

Attachment 6. PPE Matrix ................................................................................................................................ 71

Attachment 7. Incident Process Flowchart ....................................................................................................... 71

Attachment 8. HSE Organization Chart ............................................................................................................ 71

Attachment 9. Change Management Request Form ........................................................................................ 71

Attachment 10. HIRAC Form ............................................................................................................................. 71

Attachment 11. JSA Form.................................................................................................................................. 71

Attachment 12. JHA Form ................................................................................................................................. 71

List of Tables Table 1. HSE KPI’s .................................................................................................................................... 8

Table 2. MOC Risk Assessment Requirements...................................................................................... 17

Table 3. MOC Authorization Level Required ......................................................................................... 18

Table 4. Listing of Personnel Included in the Hearing Conservation Program ..................................... 29

Table 5. Requirements for Respirable and Non-Respirable Confined Space ........................................ 37

Table 6. Colour Code Period ................................................................................................................. 39

Table 7. List of Required Authority to Certify Heavy Mobile Equipment ............................................. 45

Table 8. Personal Protective Equipment (PPE) Standard ...................................................................... 50

Table 9. HT Radio Communication Channel ......................................................................................... 64

Table 10. Emergency Siren Tones ......................................................................................................... 66

Table 11. Disciplinary Action to be Taken up to The Penalty Points .................................................... 71

List of Figures Figure 1. Probability/Severity Matrix .................................................................................................... 13

Figure 2. Risk Categories ....................................................................................................................... 13

Figure 3. Severity Definition .................................................................................................................. 14

Figure 4. CSMS Process Flow ................................................................................................................ 22

Figure 5. Calculation for Potential Fall Distance ................................................................................... 44

Figure 6. Lock, Tag and HASP for LOTO ................................................................................................. 49

Figure 7. Out of Service Tag .................................................................................................................. 49

Figure 8. Muster Point Map .................................................................................................................. 67

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 1 of 71

1. INTRODUCTIONS Refinery Development Master Plan Project hereinafter RDMP Project is comprised of Revamp

of existing units, and construction of new licensed unit, non-licensed unit (for ISBL) as well as

new offsite and utilities (OS & US) in Pertamina RU V Balikpapan Located in Balikpapan, East

Kalimantan. The Project focuses on the need to modernize the refining configuration and

capabilities to produce more gasoline and other products by converting residue or fuel oil into

more valuable products, primarily gasoline and diesel. An Integrated Performance Management

System, as part of the ICSS, will be implemented to improve the quality of service and

production reliability of the Refinery.

This plan addresses the Health, Safety, and Environment requirements established by Owner,

as stated in exhibit H of the contract and enables the Contractor’s project teams to successfully

manage HSE throughout the project’s life cycle to achieve the goal of zero Lost Time Injury (LTI)

during the execution of the project. In the event of conflicts between Project HSE Plan,

Contractor standards, and applicable government rules & regulations, further discussion shall

be conducted with Owner (government rules and regulations over rules the other

requirements).

2. PURPOSE The purpose of Project HSE Plan is a specific plan to ensure all job activities in this project has

complied with Owner standards, Contractor standards, and applicable government rules and

regulations in order to get the best quality for Health, Safety, and Environmental to prevent the

adverse (human, property, and environment) incident. In addition, Project HSE Plan described

the detail of HSE schedule (based on project requirements) to support all of project activities.

3. SCOPE This Plan will be applied at boundary/demarcation of RDMP RU-V Project under control of

Contractor Management. The boundary area is limited to:

• In site fencing plant include ISBL and Offsites and Utilities (OS & US).

• Temporary facilities area (site office, warehouses, and lay down).

• Kariangau shop area.

Within the Brown field operation all Pertamina procedures and policies which are in line with

MIGAS requirements must be followed and are under the absolute authority of the Chief

Engineer (KTT).

The MIGAS regulations apply only to Brownfield areas (Oil and Gas Production facilities or

projects undertaken within the operating site).

In compliance with MIGAS regulations, the Greenfield area shall be clearly partitioned from

the Brownfield area, such that it is not possible for persons to arbitrarily cross between

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 2 of 71

the greenfield/brownfield areas without passing through a strict security check point (Under

the scope of work Pertamina retain responsibility for security at all access points). Safety

rules in that area are the responsibility of Pertamina’s Chief Engineer (KTT), who must ensure

that adequate safety management is applied given the nature of the work.

4. DEFINITIONS AND ABBREVIATIONS Accident : Unwanted or undesired event resulting from the occurrence of

one or more fault incident that have negative impact on the

system, product, equipment or personnel.

Brown Field

The new build processing plant that running partially or overall,

or existing plant area where there a possibility of hydrocarbon,

process hazard or risk expose to human, machinery and

environmental surrounding.

Contractor : Joint Operation (JO)

DEPNAKER : Ministry of Manpower of Republic Indonesia

ESDM

Simper

: Ministry of Energy and Mineral Resources

Driver License only in RU V Pertamina

FAR : Fatality Accident Rate is number of fatal incidents that may

cause death.

Calculation: (Fatality / Total Man Hours) x 100,000,000

First Aid Case : First aid refers to the immediate treatment of an individual(s)

that is injured or ill. First aid is not a full medical treatment, but

something that can be done to stabilize a person so they can

be moved to a hospital for regular medical treatment, or to

preserve life while waiting for medical professionals.

Green Field : The new open work area which clearly demarcation, declared

by land Owner there are no process plant exposed to this area

and nor existing underground pipeline & power line.

Hazard : Dangerous condition, potential or inherent which either has

previously cause or could reasonably be expected to cause

personal injury or property damage.

HIRAC : Hazard Identification Risk Assessment and Control

Health/Medical

Advisor

: A medical expert doctor who focuses on prevention, diagnoses

and treats illness.

IIF : Incident and Injury Free

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 3 of 71

SIMOPS : Simultaneous Operations, is two different or more activities

which have occurring in almost same time and area. Close

enough to each other that there is a risk of interference,

clashing, or risk transfer.

Incident : Work-related event(s) in which an injury or ill health

(regardless of severity) or fatality occurred, or could have

occurred.

JSA : Job Safety Analysis is one of the safety management tools that

can be used to define and control the hazards associated with

a certain process, job or procedure. The purpose of a JSA is to

ensure that the risk of each step of a task is reduced to ALARP

(As Low As Reasonably Practicable).

KPI’s : Key Performance Indicators

LTI : A work injury resulting disability and in which the injured

person is not able to work the next regularly scheduled shift.

Lost time injuries occur when the injured person (IP) unable to

work more than 2 x 24 hours since the final observation /

statement from doctor related to injured person (IP) condition

LTIFR : Lost Time Injury Frequency Rate is the number of injuries

causing lost time for employees and Contractors per million

hours worked.

Calculation: (Total LTI/Total Man Hours) x 1,000,000

LOTO System : Lock Out / Tag Out system is a procedure to ensure that

energized machines / equipment (such as mechanical static /

electrical / instrument equipment) / other process systems are

properly shut off and not started up again prior to the

completion of maintenance or servicing work.

MIGAS : Goverment agencies for Oil and Gas

Medical Treatment

Case (MTC)

: A Medical Treatment Case is any recordable injury that involves

neither Lost Workdays nor Restricted Workdays but which

requires treatment by, or under the specific order of, a

physician or could be considered as being in the province of a

physician.

Near miss : An incident where no property was damaged and no personal

injury was sustained, but where given a slight shift in time or

position, damage and/or injury easily could have occurred.

OWNER : PT Pertamina (Persero) RDMP RU-V Balikpapan

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 4 of 71

PROJECT : RDMP Project

Permit System : Safe system of work for the control of activities in hazardous

area.

PPE : Personal Protective Equipment

Risk : Effect of uncertainty on objectives. It could refer to positive

consequences of uncertainty, as well as negatives one.

Restricted Work

Case (RWC)

: When a person is injured such that they cannot perform their

normal duties.

RDMP RU V

Balikpapan

: Refinery Development Master Plan Refinery Unit V Balikpapan

SIKA (Surat Ijin

Kerja Aman)

: Permit To Work

SDS : Safety Data Sheet

Subcontractor : Successful Bidder(s) appointed by Contractor to provide

services to Contractor

Site Doctor : A qualified medical practitioner who attends the project site.

TRIR : Total Recordable Incident Rate is number of total recordable

incidents per million hours worked.

Calculation: (Total Record Case / Total Man Hours) x 1,000,000

e-COP : Electronic Construction Observation Programs

Vendor : The manufacturer of the equipment or the manufacturers

agent Bidder(s) the Contractor which intended to bid or submit

the quotation for this work

Workplace : Any physical location in which work related activities are

performed under the control of the Contractor organization.

5. REFERENCES Contractor shall implement HSE Management System refer to Government Regulations,

National & International Standard, Rules and others Regulation, such as but not limited:

1. Law No. 1/1970 regarding Occupational HSE (Consists of Health and Safety)

2. Law No. 23/1992 regarding Occupational Health

3. Law No. 32/2009 regarding Protection and Management of Life and Environment

4. Regulation of Indonesian Government No. 11/1979 regarding Work Safety at MIGAS

Refinery

5. Law No. 24/2011 regarding Social Security Organizing Body

6. Law No. 22/2001 regarding Oil and Gas

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 5 of 71

7. Regulation of Indonesian Government No. 50 / 2012 regarding Implementation of

Occupational Health and Safety Management System Law No. 1/1970 regarding

Occupational Health

8. Regulation of Indonesian Government No. 101 / 2014 regarding Hazardous Waste

Management

9. Minister of Labour and Transmigration No. PER/01/MEN/1980 regarding Work Safety at

Construction

10. Regulation of Indonesian Government No. 81 / 2012 regarding Management of

Household Waste and Similar to Household Waste;

11. Regulation of Indonesian Government No. 74 / 2001 regarding Hazardous Material

Management

12. Regulation of Indonesian Government No. 41 / 1999 regarding Air Pollution Control;

13. Regulation of the Minister of Manpower and Transmigration No. 05/ 2018 regarding

Occupational Health and Safety of Workplace Environmental

14. Regulation of the Minister of Manpower No. 15/MEN/VIII/2008 regarding First Aid for

Workplace Accidents

15. Regulation of the Minister of Environmental No. 18/2009 regarding Guideline of

Hazardous Waste Management Permit

16. Regulation of the Minister of Environmental No. 14/2013 regarding Symbols and

Labelling of Hazardous Material and Toxic Waste

17. Regulation of the Minister of Environmental No. 13/2009 regarding Quality Standards for

Stationary Sources of Emissions and / or Activity Oil and Gas Business

18. Regulation of the Minister of Environmental No. 51 / 1999 regarding Decision of

Threshold Value for Physical Factors in the Workplace

19. Decree of the Minister of Health No. 492 / 2012 regarding Requirements for Drinking

Water Quality

20. Decree of the Minister of Health No 1096 / 2011 regarding Sanitation Hygiene

Requirements for Catering Services

21. Decree of the Minister of Health No. 70 / 2016 regarding Standard and Requirement of

Occupational Health Industrial Work

22. Decree of the Minister of Environmental No. 48/MENLH/11/1996 regarding Noise Level

Standard

23. Decree of the Minister of Environmental No.35/MENLH/10/1993 regarding Standard of

Vehicle Emissions

24. Decree of the Head of Environmental Impact Control Agency No. 255/BAPEDAL/08/1996

regarding Procedures and Requirements for Storage and Collection of Used Lubricating

Oil


regarding Procedures and Requirements for Storage and Collection of Hazardous Waste


regarding Hazardous Waste Manifest


regarding Technical Requirements of Hazardous Waste Management

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 6 of 71


regarding Technical Guidelines for Air Pollution Control Stationary Sources.

29. Regulation of Manpower Ministry No. 09 Year 2016 regarding Working at Height

30. Regulation of Manpower Ministry No. 37 Year 2016 regarding Pressure Vessel and

Storage Tank

31. Regulation of Energy and Mineral Resources Ministry No. 18 Year 2018 regarding

Installation and Tools Inspection for Oil and Gas Activity

32. Local Regulation of East Kalimantan No. 02 Year 2011 regarding Water Quality

Management and Water Pollution Control

33. Local Regulation of Balikpapan No. 03 / 2012 regarding Permit for Building

34. Health, Safety, Security, and Environmental (HSSE) Plan Doc. No. 26070-203-G01-GHX-

J0001-000

35. Health, Safety, Security and Environmental (HSSE) Plan Document No. G01-GHX-J0001.

36. ISO 14001:2015 Environmental Management System – Requirements with guidance for

use.

37. ISO 45001:2018 Health and Safety Management System – Requirements with guidance

for use.

38. Regulation of the Minister of Manpower No. 01/MEN/I/2007 regarding Guidelines for

HSE Award.

39. Environmental Impact Analysis (EIA) of RDMP RU V Balikpapan Project.

40. Project HSE Management System Document No. 26071-100-G01-GHX-00008.

41. NFPA 30: Flammable and Combustible Liquids Code.

42. EN 397:2012 – Industrial Helmets.

43. ANSI Z89.1 – Safety Requirements for Industrial Head Protection.

44. EN 166 – Personal Eye Protection Specifications.

45. ANSI Z87.1 – American National Standard for Occupational and Educational Personal Eye

and Face.

46. ANSI Z88.2 – Practices for Respiratory Protection.

47. BS EN 4275 – Guide to Implementing an Effective Respiratory Protective.

48. BS EN 139 – Respiratory protective devices. Compressed air line breathing apparatus for

use with a full face mask, half mask or a mouthpiece assembly. Requirements, testing,

marking.

49. BS EN 137 – Specification for respiratory protective devices: self-contained open-circuit

compressed air breathing apparatus.

50. ANSI S3.19 – Noise Reduction Rating (NRR) Labelling

51. BS EN 420 – Protective gloves. General requirements and test methods.

52. BS EN 345-1 – Safety footwear for professional use. Specification.

53. ANSI Z.41 – Personal Protection - Protective Footwear.

54. ANSI A10.14 – Construction and Demolition Operations - Requirements for Safety Belts,

Harnesses.

55. BS 1139-1.1:1990 Metal Scaffolding, Tubes, Specification for Steel Tubes.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 7 of 71

6. LEADERSHIP AND COMMITMENT

HSE POLICY Refer to Attachment 01 for Project HSE Policy.

Contractor’s HSE management system established for this project is centered on Contractor’s

top management commitment to execute the work in such manner that health, environment,

and property are protected in accordance with all applicable laws and regulations as well as HSE

policy of RDMP project (which is in line with Owner and Contractor HSE policy). To do so,

Contractor’s top management has strong commitment that throughout the execution of the

project:

1. Establish Health, Safety and Environment (HSE) as a priority in every work in order to

achieve the best level of quality and optimum time completion.

2. Provide safety and comfort in the work for client, employee, partner, and communities,

by maintain the best safety and security in every activity.

3. Increase the level of Health, Safety and Environment, in order to prevent all unsafe action

and / or condition, workplace accidents, and environment pollution in RDMP project.

STRATEGIC OBJECTIVES AND KPI’s Contractor will implement a proper HSE programs and demonstrate leadership and

commitment to achieve the goal of zero harm to people, environment, and Zero Accidents.

The Strategic objective for the RDMP Project RU V Balikpapan is Zero Accident, which is defining

as:

a) Zero Lost Time Incident

b) Zero Total recordable incident

c) Zero significant environmental incident

d) Zero sabotage case

Contractor HSE Plan aligned with Owner’s Document 26070-203-G01-GHX-J0001 HSSE Plan to

minimize the gap between Contractor and Owner in terms of HSE Requirement including

Objectives, Target, and Program (OTP) that may be included in this HSE Plan.

To achieve project goals in HSE and minimize risks associated in the project activities, Contractor

will implement Incident Injury Free (IIF®) Programs covering all Contractor activities and

personnel. Contractor also set performance standards with the aim of eliminating and

controlling risks. The ultimate project specific HSE Performance Target as tabulated on the HSE

Objectives for this project in Table 1. HSE KPI’s Performance Target:

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 8 of 71

NO ITEM KPI MEASUREMENT TARGET REMARKS

LAGGING INDICATOR

1 Fatality Total case number 0

2 Lost Time Incident Total case number 0

3 Lost Time Incident Frequency Rate (LTIFR)

Ratio <1

4 Lost Time Incident Severity Rate (LTISR)

Ratio <1

5 Incident impacted to Environmental pollution

Total case number 0

6 Incident impacted to fire / asset damage

Total case number 0

7 Total Recordable Injury Rate (TRIR) Ratio <0.09 Per million manhours

8 First Aid Case Total case number 4% Total manpower on board

LEADING INDICATOR

1 HSE Meeting MoM / Attendant list Min. 1 / month

2 HSE Talk / briefing / toolbox Attendant list Daily

3 HSE Reporting Report submission record

Weekly

4 HSE Management Visit/ MWT MWT record Quarterly Level PMT

5 Closure Action Follow up action report

100% Closed

6 Inspection / audit Audit/ Inspection report

Monthly

7 PPE Compliance PPE compliance report

100%

8 Compliance on Waste Management

Waste management report

100% Comply

9 Compliance on Hygiene Industry Hygiene Industry report

100% Comply

10 Comply to Good housekeeping management

e-COP & Audit Record

100% at the end of project

Table 1. HSE KPI’s

The progress of KPI and program shall be updated regularly. Contractor shall submit, on a

weekly basis, a formal report summarizing Contractor and Subcontractors’ HSE performance to

the Owner representative. The report will be including total man-hours, leading and lagging

indicator as stated on HSE Objectives, Target, Programs, and any related additional data.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 9 of 71

ROLES AND RESPONSIBILITIES For Organization Chart refer to Attachment 8. HSE Organization Chart.

6.3.1. PROJECT DIRECTOR

• The Project Director acts as the overall Project leader for CMT. The Project

Director is responsible for communicating the safety expectations to the Project

team and with the PMC.

• Responsible for the project budget ensuring the resources necessary to carry

out the HSE Plan are made available.

• When onsite, the Project Director participates in safety observations, audits

and communicates safety enthusiasm to all levels.

6.3.2. PROJECT MANAGER

• Overall responsible for the implementation of deliverables in the HSE Plan.

• To lead Quarterly HSE Management Walkdowns.

• Provide sufficient resources for the implementation of this HSE plan.

• Ensure that all Contractor's HSE Plan and procedures are being well

implemented at RDMP project

• Achieve the HSE performance determined by Contractor's HSE policy for RDMP

project.

• Take necessary corrective and preventive action to gaps and weakness to

procedures and their implementations.

6.3.3. CONSTRUCTION MANAGER

• Responsible for the implementation of HSE Plan at site.

• To attend Project HSE Meetings.

• To attend Project HSE Committee Meeting.

• To attend Quarterly HSE Management Walkdowns.

• Ensure that all Contractor's HSE procedures are being well implemented at

project.

• Achieve the HSE performance determined by Contractor's HSE policy for

project.

• Ensure all construction activities are being done as per HSE requirements,

standards and codes, and all Contractor’s HSE procedures.

• Has authority to issue a Permit to Work.

6.3.4. CONSTRUCTION DISCIPLINE SUPERINTENDENT

Construction Discipline Superintendent are Superintendents responsible in

supervising and coordinating disciplines apart from HSE. E.g. Mechanical

Superintendent, Piping Superintendent, Civil Superintendent, etc. Their

responsibilities are:

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 10 of 71

• Responsible to implement of HSE Plan at site.

• To attend daily toolbox meeting and other HSE meeting related with their

activities.

• Ensure the work team members under their supervision are aware of the

hazards associated with their work activities and required control measures to

eliminate or reduce the risks.

• Ensure effective instruction, training and supervision is given to the employees

under their supervision, particularly to inexperienced or new employees and

those of any Subcontractors.

• To develop safe work practices through method statements, work instructions

which applicable to their activities.

6.3.5. HSE MANAGER

• To attend Project HSE Meetings.

• To attend Project HSE Committee Meeting.

• To attend Quarterly HSE Management Walkdowns.

• Accountable for the implementation of Contractor's HSE management system

on the project site.

• Coordinate / communicate with Deputy HSE and JO HSE Team lead regarding

the implementation of HSE Management System.

• Ensure all corrective actions raised to all gaps and weakness found during HSE

inspections and/or audits are being implemented.

• Ensure all rules and regulations related to HSE are regularly reviewed and

updated.

• Ensure all project activities are conducted in a safe manner.

• Establish and maintain regular interface discussion with PMC HSE

representative.

• Ensure the HSE Inspector has a qualification or certified as Inspector for each

respective area. E.g. HSE Inspector for scaffolding shall be a qualified or certified

Scaffolding Inspector.

6.3.6. DEPUTY HSE MANAGER

• Assist HSEM (HSE Manager) to ensure the implementation of Contractor's HSE

management system.

• Coordinate / communicate with JO’s Chief HSE and each JO member regarding

the implementation of HSE Management System.

• Ensure all rules and regulations related to HSE are updated.

• Establish and maintain regular interface discussion with Owner's HSE

representative and others project members.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 11 of 71

6.3.7. CHIEF HSE

• Ensure all HSE activities at site are being implemented properly.

• Ensure procedures and other HSE related documents are being properly

implemented at project site.

• Develop HSE performance statistic at the workplace.

• Develop training and education program for all workers at project site.

• Conduct regular inspections at the workplace.

• Prepare project regular report (weekly report, monthly report, HSE project

overview) through HSE e-Board.

6.3.8. HSE ENGINEER

• Manage procedures and documentation on management system

implementation.

• Assist HSE Manager to implement and report of Contractor management

system.

• Assist HSE Manager regarding the web-based information system (HSE e-Board)

utilization.

• Assist HSE Manager in conducting CSMS Assessment, subcontractor selection,

and evaluation

• Assist HSE Manager to prepare proposal and programs.

• Collect, maintain, and analyse statistic data.

6.3.9. INSPECTOR

• Assist Chief HSE to inspect all scaffolding, construction electricity system, heavy

equipment, machineries, tools, vehicles, and other equipment will be used in

RDMP project as per competency

• Develop an inspection report and communicate it with Chief HSE.

• Conduct regular inspections at infrastructure facility area.

• Has a qualification or certified as Inspector for each respective area. E.g.

Inspector for scaffolding shall be a qualified or certified Scaffolding Inspector.

6.3.10. HSE TRAINING COORDINATOR

• To ensure the implementation of HSE Training programs are run properly at site

project.

• To ensure training database updated and well maintained.

• To provide approved training material and update it regularly as any changes

happen. E.g. MOC to HSE Procedure, Lesson Learn, etc.

• To ensure required training records are available and well documented.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 12 of 71

6.3.11. SITE DOCTOR

• Review & Verify MCU result, ensure worker are fit for job position.

• Conduct Health Education & Training for worker on site.

• Conduct Health assessment / inspection for onsite facility.

• Conduct Site Clinic to deliver primary medical care, minor surgery and

consultation.

• Prepare referral case, coordinate with hospital & conduct Medical evacuation.

• Conduct Occupational Health Management system, include Prior to work.

Medical Examination, Return to Work, Recording & Reporting.

• Prepare health matters for weekly and monthly report.

• Deliver Prompt Treatment for Emergency cases.

• Update medical evacuation procedure.

• Ensure drugs & medical equipment are sufficient for medical emergency

service. Update of skill of Clinic Personnel & First Aider.

• Ensure Clinic permit, Medical license, Medical record.

• Ensure Medical waste management are complying to local regulation.

6.3.12. HEALTH/MEDICAL ADVISOR

• Organize Health assessment for medical provider & health related suppliers.

• Organize Fitness for Work program.

• Coordinate with local government and medical service provider.

• Develop Health Management Plan & Health Surveillance.

• Review Medical Evacuation Procedure.

• Provide advice for Doctor, IH & Paramedic on site.

6.3.13. PARAMEDIC

• Respond immediately and deliver initial stabilization for injured / illness person

at the scene prior transfer to site clinic.

• Assist Site Doctor in implementation of health management programs,

• Assist Site Doctor to identify health hazards in the work place, implement

control and monitoring program

6.3.14. SUBCONTRACTOR/SUPPLIER/VENDORS

• Comply with minimum HSE requirement, procedures, and related HSE

agreement.

• Report accidents / incidents immediately direct to HSE committee /

representative.

• Assist in any accident / incident investigation in their area.

• Maintain good housekeeping and physical arrangements.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 13 of 71

7. RISK MANAGEMENT

HIRAC Refer to Attachment 10. HIRAC Form

Contractor shall develop HIRAC (Hazard Identification, Risk Analysis and Control) throughout

project phase. HIRAC will be used as reference to develop JSA for specific activities at site.

At minimum HIRAC shall be consist of following stages:

• Hazard and Risk Identification Stage

Execution of Hazard Identification shall be conducted for all project stages.

• Hazard and Risk Assessment Stage

Risk assessment is based on identified hazards. Below Risk Assessment Matrix will be used

during this stage.

Figure 1. Probability/Severity Matrix

Figure 2. Risk Categories

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 14 of 71

Figure 3. Severity Definition

• Hazard and Risk Implementation/Control Stage

Contractor shall determine required control measures based on the level of risks. Also the

monitoring to the implementation of control measures shall be done.

• Review and Update

HIRAC shall be reviewed and updated periodically to ensure any change or new hazards

introduced at site already incorporated into HIRAC.

JOB SAFETY ANALYSIS (JSA) Refer to Attachment 11. JSA Form

Job Safety Analysis (JSA) relevant for the project in order to control risks of specific activities

which carried out at RDMP Project. Approved JSA shall be attached to the PTW.

JSA will be required for all jobs performed On or Off site. Construction Superintendent or

Supervisor shall be responsible to provide JSA and understood by all the work team member.

HSE are responsible to review the JSA. Normally during daily Tool Box Meeting (TBM). Employee

shall sign the JSA Attendance list and involving in any review of activity change. New hazard

identified in JSA shall be add on HIRAC register.

As minimum JSA shall described breakdown steps for the task and hazards identified for each

step including control measures.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 15 of 71

The JSA process flow to be done at site is as follows:

Step 1. Identify the job to be done.

Work Leader or Discipline Superintendent involved, shall identify the sequence of the job,

including HSE requirement for each of the sequence.

Step 2. Breakdown the job in to sequential steps.

Break the job down into sequential steps. Everyone should understand what is taking place and

where; what people are required; what equipment or plant is in use; and any other components

involved.

Step 3. Identify the hazards in each step.

To identify the potential hazards that could reasonably cause damage on each steps. Consider:

• Obvious hazards that can develop into an unwanted event

• Things that could go wrong. Discuss credible risks in terms of WHAT could happen, HOW it

could happen, and WHY it could happen

• Things that have been known to go wrong elsewhere (relevant incident reports)

• Weather conditions

• Day or night

• Experience of operators

• Other operations in the area

Step 4. Identify the control measures for each hazard.

A whole range of controls (elimination, substitution, etc.) should arise from such JSA, not just

procedural ones, as these are the least effective. Many of the non-procedural controls require

action before the job starts (E.g. purchasing of equipment (signs, harnesses etc), training and

certification of workers, re-design of equipment, installation of barriers, etc).

Step 5. Review the JSA with all workers on the works (Pre-Job Safety Meeting).

During Pre-Job Safety Meeting, work group will have a final discussion which includes HSE and

Discipline Superintendent review on the JSA then approval to proceed with the Work. Pre-job

Safety Meetings will be conducted at each work site prior to the start of job activities. During

these meetings the contents of the JSA will be discussed in detail in such a manner to meet the

expectations. In this meeting, The Supervisor or Crew Lead facilitates the JSA and asks specific

questions of multiple workers to obtain their input regarding planning and conducting Work

safely. Each crew member shall offer input, asks questions, and actively listens during the JSA

discussion. After completing final JSA discussion, all components of the JSA are accurately

documented on the appropriate project JSA form. The JSA is reviewed and signed by each crew

member, and signature approval is provided by the Supervisor or Crew Lead.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 16 of 71

Step 6. Ensure the JSA is reviewed periodically.

JSAs should be reviewed periodically but especially after changes in the work situation; after

related incidents; changes in legislation etc.

Generic JSAs should be reviewed each time they are used in a new work environment (E.g., a

JSA used by a Subcontractor to install scaffolding should be reviewed at the start of each job).

JOB HAZARD ANALYSIS (JHA) Job Hazard Analysis will be focuses on following items:

1. Break the task down into a defined sequence of steps.

2. Identify the potential hazards which may come from the relationship between the worker,

the task, the tools, and the work environment.

3. Develop control measures to eliminate or reduce them to an acceptable risk.

Supervisor or Foreman shall be responsible to provide JHA and to ensure that the work crew

aware and understand all the associated hazards with the jobs they will be performing. and also

know what are the preventive measures to be taken to eliminate or reduce them into

acceptable risk.

Supervisor and Foreman need to conduct periodical review to JHA to ensures that it remains

relevant to reduce workplace incidents.

Supervisor and Foreman shall be deliver and discuss about JHA with their work crews just before

starting the work (Pre-Job Safety Meeting).

During Pre-Job Safety Meeting, Supervisor or Foreman and their work crew will have a final

discussion to review on the JHA then approval to proceed with the Work. Pre-job Safety

Meetings will be conducted at each work site prior to the start of job activities. During these

meetings the contents of the JHA shall be discussed and confirmation/check to ensure all

precaution already at place. After completing final JHA discussion, JHA are accurately

documented on the appropriate JHA form. The JHA is signed by each crew member, and

Supervisor or Crew Lead.

Refer to the Attachment 12. JHA Form

8. MANAGEMENT OF CHANGE (MOC) MOC is required to provide a documented process for managing change in order to achieve an

acceptable level of risk. Change can be imposed from external and/or internal drivers and can

occur quickly or over a long period of time. Whatever form change takes, it must be properly

managed at the appropriate level so that unwanted risks do not evolve.

Change can be broadly defined as an alteration or modification, replacement, addition, revision

or deletion to any aspect of Contractor’s operations, systems or business. However, change as

it applies to this plan is limited to impacts on personal health & safety, environmental harm,

and regulatory compliance.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 17 of 71

Once a change or a need for future change is identified, it is necessary for that change to be

managed by the appropriate person which will be guided by the associated risk assessment as

to whether the proposed change(s) represents an acceptable level of risk.

The Change Management System consist of six (6) step process as follow:

Step 1 Change determination

Step 1 requires the Change Initiator to ask a series of questions with the aim of providing

clarification as to whether the change management process is required.

If “yes” is the response to any of the questions then the Change Initiator must move to the next

step.

Step 2 Risk Assessment

This Step need to determine the level of risk for a variety of change impact types.

The change impact types include:

• Impact on safety/harm to people.

• Impact to environment.

• Deviation from policy, procedures, compliance.

• Deviation from Government laws and/or regulations.

The Change Initiator is also required to make comment on the risks of undertaking and not

undertaking the proposed change.

Based on the level of risk identified, the following levels of risk assessment will be required to

be completed and details attached to the Change Management Request Form:

CHANGE RISK

CATEGORY RISK ASSESSMENT REQUIREMENTS

Low 1. JSA to be re-reviewed and re-written to incorporate

with the change occur.

Medium 2. Requirements 1 and method statement may need to be

provided and approved.

High 3. Requirements 2, Conduct a Risk Assessment Workshop

and Prepare Action Plan.

Table 2. MOC Risk Assessment Requirements

Step 3 Details of the change

This step requires the Change Initiator to detail the following:

• Describe the reasons for change, providing hard evidence to support the need/opportunity.

• Describe the benefits of this change.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 18 of 71

• When does the change need to take place and why?

Step 4 Commitment and Application

This step requires the Change Initiator to detail the following:

• List any Technical Expert who needs to be consulted about / approve the proposed change.

• List the people / groups who need to be consulted on the proposed change.

• List systems, policies, procedures, plans, schedules, competencies, etc which affected by

these changes.

A Technical Expert is generally the person who may own legal obligation/business accountability

in the area covering the change and may not necessarily be the Change Authorizer.

The Change Initiator is required to seek approval from the Technical Expert for the proposed

change if the risk is deemed to be High.

Step 5 Action Plan

This step requires the Change Initiator to develop an Action Plan for the successful

implementation of the proposed change.

It is required to review the effectiveness of the change at an agreed period following the change.

Step 6 Approval

• The Risk Category for the requested change is the highest risk rating from Step 2. That is, if

one category has a risk rating of Medium, but another has a risk rating of High, the overall

risk rating is High.

• This step is break down into two stages. The first stage, if required, is the review and

approval by a Technical Expert. This shall apply for all High-risk changes.

• The second stage is the approval by the Change Authorizer. The Change Authorizer is

identified by completing Step 2 Risk Assessment of the Change Management Request

Form. The Change Authorizer depends on the level of risk as defined in the following table.

TYPE OF CHANGE AUTHORISATION LEVEL REQUIRED

Low Discipline Superintendent

Medium Construction Manager

High Project Manager, HSE Manager

Table 3. MOC Authorization Level Required

Changes that are High risk shall be subject to a Post Implementation Review. The date for review

and person responsible for organizing the review shall be detailed in the Action Plan.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 19 of 71

Contractor’s HSE will keep a register of all approved change management activities.

Refer to Attachment 9. Change Management Request Form.

9. PRE-MOBILIZATION MANAGEMENT Premobilization inspections between Contractor and Subcontractor will be performed prior to

mobilization for agreed scopes of work to ensure readiness prior to mobilization. Subcontractor

shall fulfil all of premobilization readiness requirements before obtaining Contractor approved

and verified of workers SIML (Surat Ijin Masuk Lokasi= Site Entry Permit) and ID Badge and

Permit to Work. As a minimum, the scope of the inspection shall include but not limited to the

following:

MANPOWER READINESS Requirements for Man Power Readiness that shall be submitted and followed by Subcontractor

are as follow:

• Copy of valid competence certificate (including driving license) for specific position such as

heavy and light vehicles driver, heavy equipment operator, welder, scaffolder, rigger, etc.;

• Copy Medical Check Up (MCU) result;

• Complete filled of man power register form (for each personnel);

• Formal photograph (3x4) with Red colour as a background;

• Copy of identity card (for each personnel);

• Copy of Kartu Keluarga (for each personnel);

• Copy of Surat Domisili (for each personnel);

• Copy of employment card / BPJS (for each personnel);

• Attend HSE induction and matrix training (based on work position).

A visitor is defined as Contractor / Subcontractor / Sub-Subcontractor / Vendor personnel who

will visit project site to conduct short inspections or walkthroughs or supervise as experts within

max 7 days.

Visitor shall be accompanied by an appointed Contractor person (user / host). Visitor shall also

complete the visitor SIML & ID Badge following requirement:

• Complete man power register form (for each personnel);

• Attend HSE induction and matrix training (based on work position).

All of man power data will be documented on a man power register web-based system called

HSE e-Board. This data could be accessed regularly in line with RFID card system.

EQUIPMENT / TOOLS / VEHICLES READINESS Besides man power readiness, Subcontractor shall prepare and fulfil all requirements related to

equipment / tools / vehicles readiness. All of equipment / tools / vehicles shall pass a

premobilization inspection by Contractor (including heavy equipment, vehicles, generator set,

air compressor, and welding machine) prior to mobilize to project site.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 20 of 71

After mobilize to project site, Contractor will conduct gate inspection to have a final check prior

to use by Subcontractor. After Pass the inspection, sticker will be attached to the

equipment/tools/vehicles. The requirements related to equipment / tools / vehicles readiness

are as follow:

• Copy of valid equipment / tools / vehicles certificates (including KEUR, STNK, BPKB);

• Equipment / tools / vehicles manual book;

• Vehicle shall have Anti-lock Brake System, Air Bag System, safety belt for all passenger,

speed sensor attached, flame arrestor and safety accessories as per HSE requirement (back

up alarm, fire extinguisher, first aid kit).

• Vehicle shall not be older than 5 years for small vehicle and 10 years for truck and other

heavy vehicles.

DOCUMENTATION READINESS Prior to conduct work at project site, Subcontractor shall prepare several documents as a

requirements of document readiness. Those documents are as follow:

• Working procedures (for each activity)/Method Statement;

• Job Safety Analysis (JSA) (for each activity);

• Job Hazard Analysis (JHA);

• Drawing / lifting plan / etc (related to activities).

• SIKA / Work Permit has been approved.

10. SUBCONTRACTOR MANAGEMENT Contractor insists Subcontractors to be involved in the implementation of the Health, Safety

and Environmental Management Plan and to comply with requirements set within the

Contractor Project HSE Plan. To ensure Subcontractor’s compliance, project management team

shall conduct the following:

1. Project Manager, Procurement Manager and Construction Manager shall ensure that all

bidders for subcontracting passed the CSMS (Contractor Safety Management System)

before PQ (Pre-Qualification). CSMS scoring system not only based on documentation

(paper based) but also based on the scoring during shop visit in related Subcontractor

workshop. Refer to Attachment 4 CSMS Questionnaire and Flowchart of CSMS process

described in below Figure 4. CSMS Process Flow.

2. Contractor may sometimes conduct an audit to Subcontractors by prior appointment

arrangement. This audit will be carried out at least 7 days prior notice, and can be done

at Subcontractors Home Office or Project Office agreed. The results of this audit will be

determined as a reference for Subcontractors CSMS score validity.

3. Subcontractors shall responsible to Health, Safety, Security, and Environmental

performance within the project site area as appropriate to their relevant scope of work.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 21 of 71

4. Subcontractor shall meet the requirements of Contractor that contained in document

RDMP-SHRP000-S0-PRC-900-00039 HSE Minimum Requirement document. This

document covers all requirements that shall be met in carrying out RDMP project.

5. Subcontractor shall conduct HSE workshop to present their HSE management plan

including but not limited to man power plan (shall fulfil the requirements of 1 HSE

Coordinator + HSE Officer with ratio 1: 50 workers + First Aider with ratio 1:100 workers

+ Paramedic with ratio 1:250 workers).

6. Subcontractor shall provide their employees with proper equipment and skill certification

from relevant authorized government institution, provide adequate work tools and

provide all required personal protective equipment as required in the government rules

regulations and applicable industrial standard both national and international.

7. Subcontractor personnel shall be given a Health, Safety, and Environmental induction by

the Contractor HSE trainer or other appointed personnel at the workplace area.

8. All Subcontractors and outsource parties that contribute directly with Contractor is

obliged to provide health/safety and employment insurance facility to workers, both

individually and in groups.

9. A monthly KPI audit shall be conducted to all Subcontractors to measure the HSE

performance of the Subcontractors. Subcontractor that is actively working on the project

must be audited at least once a month to measure the performance of the Subcontractor

HSE, audit results in the form of Key Performance Indicator (KPI) HSE score will determine

whether to process Monthly Progress Report or not as a prerequisite of invoicing. Audit

findings listed in the KPI must be completed well within the allocated time, if not resolved

within the specified time, then the Monthly Progress Report Subcontractor approval will

be suspended until the findings resolved.

11. Upon the submission of the progress report, Subcontractors shall achieve a compliance

score (minimum 80 of 100) without any outstanding audit or inspection item from the

Subcontractor’s HSE Key Performance Indicator (KPI).

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 22 of 71

Figure 4. CSMS Process Flow

11. TRANSPORTATION MANAGEMENT

VEHICLES To minimize the risk and hazard during the transportation period, Contractor implement a

journey management system for vehicle operation included in Contractor’s area for supporting

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 23 of 71

Contractor’s activities. All vehicles shall pass an inspection. Minimum requirements for drivers

are as follows:

• Have good physical, mental and psychological condition.

• Drivers/operators are experienced, are medically examined, completed driving tests.

• Have special skills such as terrain and climatic experience, and first aid knowledge.

• Have licenses both from the government and Contractor (SIMPER), and any relevant types

of cargo licenses.

• Have completed safety defensive driving training.

• Have completed induction on local area characteristics and regulations.

Vehicles shall be:

• The vehicle shall have Anti-lock Brake System, Air Bag System, and safety belt for all

passenger.

• Speed sensor attached in vehicle.

• Have valid gate pass.

• Completed with inspection record.

• Completed with safety accessories as per HSE requirement (reverse alarm, fire

extinguisher, first aid kit, flame arrestor).

The General Affair Department will be responsible to control driver alertness and fitness by:

• Scheduling driver’s trip plan for a week considering their enough time to rest.

• Pre- Briefing before starting work.

• Maximum duty hours of drivers shall be 15 hours.

• All driver 100 % should have attend Safe driving course provided by JO.

• Refreshment training for all driver at site will be conducted on yearly basis.

Refer to 26071-100-GPP-GHX-00007 Transportation and Journey Management Plan.

PEDESTRIAN AREA • Contractor shall provide pedestrian walkways which capable to be used by employees to

move at site and office area by walk.

• At minimum dedicated pedestrian walkways shall provide with widths no less than 3 feet.

• Pedestrian way shall be clearly marked to show visible boundary between vehicle and

pedestrian access.

• Pedestrian crosswalk will have an interface with vehicles access. Contractor must treat

adequate control for this area such as put proper sign to stop their vehicles and give priority

to pedestrian to cross the road, provide dedicated signal man, speed limit, etc.

• Identified blind spot with potential crash between pedestrian and vehicles shall provide

with mirror and adequate safety sign. E.g. pedestrian walkways at warehouse, workshop.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 24 of 71

12. HEALTH MANAGEMENT

BIOLOGICAL HAZARDS Biological hazard identification, control, and emergency handling response is detailed on

specific HIRAC/JSA, 26071-100-G01-GHX-00005 Health Management Plan and 26071-100-

GPP-GHX-00002 Project Emergency Handling Procedure.

Biological hazards refer to organisms or organic matters produced by these organisms that are

harmful to human health. These include parasites, viruses, bacteria, fungi and protein.

The main types of biological materials that workers were potentially exposed to in workplaces

were:

• Human bodily matter (blood, tissues, vomit, urine, faeces, saliva, breast milk)

• Animal product (meat, offal, skins, bones, blood, milk, eggs)

• Live animals (mammals, birds, fish, invertebrates and their urine or faeces)

• Biohazard waste, sewerage and rubbish

• Laboratory cultures

Occupation and workplaces where people may come into contact with biological hazards are:

• Medical staff, cleaning staff and laboratory technicians.

• Healthcare services.

• Cleaning services.

• Employees in environmental hygiene services such as sewage treatment or

wastewater plant and rubbish collection and disposal.

• Indoor workplaces where employees generally work in enclosed areas with central

air-conditioning: –Any microorganism breeding inside the air-conditioning system or

cooling towers may spread in the workplace through the air-conditioning system.

• Employees who work with animals.

Biological hazards likely to affect workers in specific workplaces will be vary according to the

type of occupation, the location, the weather, the nature of the work, species known to occur

in the region and the environment. Liaison with specialist advisors may be required to

document the type and extent of the Biohazards relevant to a workplace and to prepare a risk

assessment and mitigation plan based on that assessment.

Control of Biohazards requires systematic, analytical application of a hierarchy of control that

takes account of the nature of biohazards agent, the workplace, the nature of work, and the

workers.

If the contact with Biohazards cannot be prevented, the employees must use PPE and adhere

strictly to the practice of personal hygiene. PPE will be including masks, gloves, protective

clothing, eye shields (safety googles), face shields, and shoe covers.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 25 of 71

12.1.1. WILDLIFE ANIMAL

• Contractor shall identify potential wildlife will be encountered at project site and also

conflict handling with the wildlife. There is several wildlife could be encountered but not

limited to following animal:

- Mosquitos

- Bees

- Snake

- Sun bear

- Crocodile

- Orangutan

- Clouded leopard

• Contractor shall educate employees to prevent matters that can attract the presence of

wildlife. Such as food, rubbish, garbage, humidity, etc.

• Contractor shall ensure that employees are aware with the characteristic of wildlife at

their working area.

• Contractor may liaise with Government agency which is authorized to handle wildlife

conflict.

• Contractor shall provide emergency number for emergency case involving wild animal

attack or being bitten by animal.

12.1.2. BLOOD-BORNE PATHOGENS

Construction Manager will be responsible for the implementation of Blood-borne pathogens.

The program will include:

• Training to personnel employees whose responsibilities include medical emergencies,

first aid, CPR, etc., and such training will adhere to the all requirements outlined in

Contractor standard.

• Necessary PPE for employees mentioned above.

• Post exposure evaluation and follow up to personnel who have been exposed.

• Labelling and Sign.

• Response to accidental exposure to blood-borne pathogens.

DRINKING WATER This provides guidance for the protection of site personnel from unsanitary and unhealthy

drinking.

• Contractor shall provide drinking water which comply with government water quality

standard for drinking water.

• It is prohibited to drink water directly from tap water, since tap water is often not

adequately treated. It is recommended to boil the water prior to drinking.

• Sampling of drinking water shall be conducted quarterly by Contractor HSE to ensure

drinking water supplies are health to consume.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 26 of 71

EXTENDED WORK AND SHIFT WORK To speed up the work and to continue the work that cannot be stopped, the contractor will

overtime with extended working time and double shift. HSE requirement is recommended prior

start of work during night activities.

As with other health and safety hazards, the greater exposure to shift work and extended hours,

the more likely the risk of some harm. The risk of working with shifts and the amount of night

work can undermine long term shifts and long hours of work and safety, those who work them.

For that there are several mitigations that need to be considered among others but not limited

to:

• Plan an appropriate and varied workload.

• Offer a choice of permanent or rotating shifts and try to avoid permanent night shifts.

• Limit shifts to 12 hour including overtime.

• Encourage workers to take regular breaks and allow some choice as to when they are taken.

• Consider the needs of vulnerable workers, such as young or aging workers.

• Consider providing warm drinking & food (beverage) and proper feeding zone.

• Weather condition would be a consideration for providing clothes to keep body warm.

• Provide similar facilities as those available during daytime and allow night time workers

time for training and development.

• Ensure temperature and lighting is appropriate and preferably adjustable.

• Information on the risks of night time work and ensure the implementation of toolbox

meeting and briefing.

• Supervisors and management can recognize problems.

• Consider increasing supervision during periods of low alertness.

• Provide health assessment for night time workers.

• Ensure the workplace and surroundings are well it, safe and secure.

Detail of Night Out of Hours Work procedure is described on document 26071-100-GPP-GHX-

00023.

FITNESS TO WORK Achieving good performance in doing the job or duty shall be equipped by fitness both physical

and mentally. Through this plan, Contractor needs to ensure that employees who working in

site area have to be in good condition to perform the job by conducting medical check-up

(MCU). Refer to attachment 1 Project HSE Policy.

The result of the medical check-up (MCU) will be reviewed by Site Doctor to determine the

fitness by considering to the job required by his/her supervisor. Only Fit to Work person shall

be obtained ID badges and enter the plant for work.

To be in line with Project HSE Policy, Contractor must conduct drug and alcohol test for the

employee. At minimum 1% of total number of employees per month shall be the target for the

test.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 27 of 71

Drug and Alcohol test will be carried out randomly. However, employee at high risk activities

will be the priority to participate in the test.

Detail of fitness for work please refer to 26071-100-G01-GHX-00005 Health Management Plan.

HYGIENE AND OCCUPATIONAL HEALTH Contractor will implement and maintain hygiene and occupational health programs throughout

the duration of this project. At a minimum the Supervisor General Affair will ensure the

implementation and maintenance of the following areas:

12.5.1. CATERING PRACTICES

At a minimum the Supervisor General Affair will ensure the implementation and maintenance

of the following areas:

• Monthly Inspection lead by Medical Advisor. Owner will be requested to participate.

• Weekly Tool Box Meeting for Catering Crew led by General Affair assisted by Medical

Advisor.

• Provide worker complaint and suggestion box about catering service.

• Contractor must engage the services of a suitable pest control for insects, rats, etc.

• It is not recommended to keep leftover foods for the next day consumption.

• However, if it is not possible, contractor shall ensure that catering providers are

implement adequate food storage procedure.

• Medical Check Up for food handler personnel shall be done in accordance with the

national regulation.

• Catering provider should follow food and catering safety management standard in

accordance with the national regulation.

12.5.2. FATIGUE MANAGEMENT

• Contractor must provide adequate rest periods for employees. It is recommended that

rest periods between shifts be at least 10 hours. In the event that an employee is required

to work longer than the normal allocated, consideration should be given to their start

time for the next shift.

• Where employees are required to work an extended shift, (i.e.: greater than 12 hours),

consideration should be given to:

- Maximum overtime on site is 15 (fifteen hours) in one day work cycle.

- At least 10 hours break should be given taking into consideration travel time, eating,

socializing, relaxing and sleeping.

- Adequate rest breaks should be given during the work shift.

• Where an employee is required to change shift from day to night shift, and vice versa,

they should be given a full 24-hour rest period prior to commencing the new shift.

• All employees shall not work more than thirteen (13) days straight without taking a day

rest.

• To effectively manage fatigue caused by on call work, consideration is to be given to:

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 28 of 71

- Limiting the number of consecutive 24-hour periods that an individual is on call.

- Rostering more than one person to be on call at any time so that someone who is

not well rested is not required to work.

- Make arrangements to have workers transported to and from site.

12.5.3. HOUSEKEEPING

• Housekeeping practices and clean-up of all project facilities will be maintained by

Construction Team.

• The work area shall be maintained to a high standard of cleanliness, and supervisors will

be expected to review and rectify their respective work areas as required on a daily basis.

• Waste material shall not be burned in site and shall be segregated when disposed of in

the bins.

12.5.4. HEAT STRESS

• Contractor shall implement Heat Stress Monitoring especially during hot weather and

conditions.

• Contractor must ensure that adequate supplies of cold water for drinking, together with

shaded rest areas, are provided around the work areas. Personnel will be permitted

reasonable access to water and rest, sufficient to prevent heat stress.

• All employees who are exposed or potentially exposed to heat stress will receive training

regarding heat stress-related injuries and prevention measures.

• Contractor shall ensure that all employee understand the early symptom of heat stress.

Detail of heat stress management refer to 26071-100-GPP-GHX-00008 Heat Stress Prevention

and Management Procedure.

12.5.5. HEARING PROTECTION

Hearing Protection programs is required to ensure personal noise exposure remains within

acceptable limits and to protect employees from permanent hearing loss.

Noise can be Continuous, Intermittent and Impulsive. Continuous noise is constant. For

example, ventilation fans are a source of continuous noise. Intermittent noise is a mix of quiet

and noisy periods. Most manufacturing noise is intermittent. Impulse noise is a short burst of

loud noise that lasts for short duration. They are associated with such sources as explosions,

impacts, and sonic booms.

Noise assessment will be made periodically by Contractor. Employees who work in areas with

noise levels greater than 85 dB shall wear hearing protection. Contractor will ensure that these

areas are adequately marked and communicated to personnel during safety meetings,

induction training and should be detailed within the relevant work task JSA.

Contractor shall monitor ambient noise or environmental noise that potential to cause

annoyance to surrounding areas during construction work. Contractor shall conduct noise

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 29 of 71

measurement in affected surrounding areas in periodically or if needed. The noise threshold

for resident is 55 dB, or as required by local regulation.

When information indicates that any employee’s exposure may equal or exceed the Action

noise level, i.e. 8-hour TWA of 85 dB, Contractor must develop and implement noise

monitoring programs and to be carried out by Competent Person.

All personnel with potential exposure greater than the action noise level, will be enrolled in

the medical surveillance program and undergo a baseline audiogram in accordance with

current program requirements. Thereafter, annual audiograms will be compared with the

baseline exam.

All personnel enrolled in the audiometric testing portion of the medical Surveillance program

shall be identified on the “Listing of Personnel Included in the Hearing Conservation Program”.

Employee Name Employee ID # Area or Task Employee’s Supervisor

Table 4. Listing of Personnel Included in the Hearing Conservation Program

When a Standard Threshold Shift (STS) is noted between the last valid baseline and

the annual audiogram, the following steps will be taken:

1. A retest will be conducted within 30 days to confirm the STS. The employee will not be

exposed to workplace/hobby noise for 14 hours or will be provided with adequate

hearing protection prior to testing.

2. If the STS persists, ear protection will be upgraded to one with a greater Noise

Reduction Rating (NRR). The minimum NRR will be 26 dBA.

3. The employee will be counselled, and information will be obtained regarding the

employee's possible noise exposure away from the workplace or existing ear pathology.

4. Qualified medical personnel will review the audiograms. This group will determine the

need for a medical referral.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 30 of 71

5. The employee and employee’s supervisor will be notified of the shift in hearing

threshold in writing by HSE within 21 days of determination.

6. If the employee who has experienced an STS is exposed to 85 dBA for 8 hours or 80 dBA

for 12 hours, mandatory use of ear protection is required.

7. Temporary employees will receive audiograms during their exit physicals if they have

worked around heavy equipment or have received an exposure to noise levels in excess

of 85 dBAs.

12.5.6. RESPIRATORY PROTECTION

Detail of respiratory protection refer to 26071-100-G01-GHX-00005 Health Management

Plan.

• Contractor will comply with Owner and industry standards for the specification and

provision of respiratory protection.

• Supervisor will be responsible to provide Respiratory protection base on assessment of

the job. The respiratory protection type shall be in accordance with the PPE standard.

• Any employee who requires respiratory protection to perform the work shall be trained,

medically qualified, and fit-tested.

• Contractor must ensure that respiratory protection equipment cleaned and stored

properly

12.5.7. RADIATION PROTECTION

Radiation protection will be under Construction Manager’s responsibility. At the minimum,

the Construction Manager will ensure the following:

• Provide special room / bunker for Radioactive storage complete with sign and according

regulation and standard radiation storage system.

• Provide Sign, Barricade, Orange & Red rotary lamp and other equipment/tools to alert

that dangerous activity being conducted.

• Provide qualified personnel to conduct radiation activity. The personnel shall be certified

by BATAN for conducting the activity.

• NDT (RT) without collimators are prohibited.

• Emergency procedure for Radioactive shall be provided.

• Radiography organization structure for Sub-Contractor shall be established. At minimum

shall describe Radiography Operator, Radiography Specialist, and Personal Protection

Radiography (PPR).

Contractor shall ensure that the following basic rules for Radiography are strictly enforced:

• Sources of ionizing radiation shall not be left unattended.

• Required to use the film badge / dosimeter for all personal involved with radioactive

activities.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 31 of 71

• Area exposed by radioactive sources shall clearly marked at four direction (north, south,

east & west), given signs with rope or other effective means and mounted alert signs to

the radiation.

• Accepted doses for radioactive worker shall not exceed 5 Sv/H or 50 mSv/Y and, in project

site areas, the doses shall be as low as reasonably achievable and shall only be accepted

by the public not exceed 0.5 Sv/H or 5 mSv/Y.

• Contractor will ensure that radiation measuring devices in the workplace are provided.

• Ensure that all operating radiographic or X-ray equipment (inclusive survey meter)

possess a valid Government Radiographic License by The National Atomic Energy Agency

(BAPETEN). A copy of the license shall be submitted to Contractor’s HSE for review.

• Shall control that the radioactive work will not affect any system or operating process

and surrounding people, prior to commencing any radioactive work.

13. ENVIRONMENTAL MANAGEMENT Environmental Management refer to 26071-100-G01-GHX-00004 Construction Environmental

Control Plan.

Contractor shall provide Environmental Monitoring programs and measurements in accordance

with Environmental Impact Analysis (EIA) of RDMP RU V Balikpapan Project (RKL-RPL).

All project activities of Contractor in RDMP RU V Balikpapan has been included in construction

phase Environmental Impact Analysis (EIA) of Owner. The potential impacts on the environment

of the Contractor activities on this project shall be assessed and stipulated with Owner’s and

Government regulations particularly environmental regulations.

Contractor shall provide Policy, Procedure, and other document in line with Owner’s

environmental management plan and EIA of Owner in construction phase.

The following environmental plan will be developed and implemented during the project by

Contractor:

• Comply with all applicable environmental laws, regulations, rules, and codes governing

environmental requirements.

• Provide all documentation required by all levels of governing authority concerning

environmental requirements.

Provide and maintain effective planning and field control measures for the following activities:

• Wastewater discharges to land, surface water, or groundwater,

• Spill prevention and response

• Erosion and sedimentation control

• Dust Control

• Noise control

• Waste & hazardous waste management

• Comply with EIA, Environmental Management Plan (RKL) & Environmental Monitoring Plan

(RPL).

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 32 of 71

HAZARDOUS WASTE MANAGEMENT Hazardous waste generated on site which meet the hazardous waste criteria are as follow:

• Flammable

• Combustible

• Reactive

• Toxic

• Infectious

• Corrosive

• Poisonous

Contractor shall ensure following requirements are implemented to manage waste of

hazardous chemical:

• Symbol and label shall be affixed on the hazardous chemical waste containers.

• The condition of the hazardous waste container/drum shall be inspected on a daily basis.

• Containers intended for hazardous waste disposal should not be used for other purpose.

• The waste should be kept at a proper temporary hazardous waste storage not more than

90 days.

• The hazardous waste temporary storage should be provided with license/permit from

authorized body.

• Contractor will provide third-party (who have license) to handle medical/clinic waste.

• Transfer of all hazardous wastes to a third-party should be accompanied by

manifest/document hazardous waste. Copies of document hazardous waste should be

maintained.

• Hazardous waste temporary storage shall comply with applied regulation and shall be

equipped with Fire extinguisher, PPE and spill kit equipment.

• Contractor shall provide Safety Data Sheet (SDS) for all waste of hazardous chemicals.

• Contractor will conduct basic waste management training periodically; this training must

be followed by personal who involved with waste of hazardous chemicals.

• Waste such as empty containers or drums with residue of flammable liquid should be

stacked in isolated area away from building and installation. Have notice displayed

forbidding smoking or naked lights. These containers should be thoroughly steam-

cleaned or washed before use.

14. OPERATING PROCEDURES AND SAFETY STANDARDS

ABRASIVE BLASTING • The Supervisor will ensure the blast cleaning nozzle is equipped with an operating valve

which must be held open manually.

• The Supervisor will ensure the abrasive blasting equipment and the object being blast

cleaned is grounded to eliminate static electricity.

• The Supervisor will ensure appropriate respiratory protection is worn during the blasting

operation.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 33 of 71

• The Supervisor shall ensure the thickness of sand pot in good condition and inspect

periodically.

• No silica-based material will be allowed on site as storage or for use.

• Containment will be maintained at all times including during use, for 100% cleaning and

removal.

ASSURED GROUNDING • Contractor shall ensure grounding system are provided to protect personnel and

installation against ground fault current, lightning and static discharge.

• Grounding system shall be installed and tested as per the standards.

• Only competence/certified person shall carry out electrical testing activities.

• PPE shall be used during working with electricity.

Contractor provides a written procedure 26071-100-GPP-GHX-00006 Electrical Equipment and

Assured Grounding Procedure for detail.

CAMERAS (SECURITY) Detail of operational and deployment of CCTV camera is described on 26071-100-G01-GHX-

00003 Security Plan.

To increase surveillance of important and high-risk area within Contractor’s premises,

Contractor has allocated CCTV cameras that operate 24 hours per day, live view, fully recorded,

and can be accessed by authorized users.

CHAIN BLOCKS AND COME-A-LONGS Refer to 26071-100-GPP-GHX-00011 Crane & Lifting Operation Procedure.

• Chain blocks and Come-a-longs shall have valid test certificate.

• Pre-use check for Chain blocks and Come-a-longs shall be done in daily basis by the rigger.

• Chain block shall never use for tensioning, pulling or anchoring loads.

• Chain block and Come-a-longs shall be inspected every three month and change the colour

code.

• It is prohibited to use rejected or out of service chain blocks and Come-a-longs. In case of

“out of service” for maintenance, chain blocks and Come-a-longs could be used only after

pass the inspection.

CRANE AND LIFTING GEAR REQUIREMENTS Detailed procedure for crane and lifting refer to document 26071-100-GPP-GHX-00011 Crane

and Lifting Operation Procedure.

14.5.1. CRANE REQUIREMENTS

Contractor will ensure that all cranes used for this project either provided by

Subcontractor and/or directly by Contractor shall have valid certificate from MIGAS.

All cranes shall pass the Contractor’s standard and can only be used after get an

approval from Contractors.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 34 of 71

14.5.2. LIFTING GEAR REQUIREMENTS

All lifting gears will be inspected by qualified inspector from Contractor and have

valid MIGAS certification.

Lifting gears will be inspected regularly by Contractor Inspector and follow the colour

code inspection system.

14.5.3. LIFTING PLAN

Detailed procedure for lifting plan refer to document 26071-100-GPP-GHX-00011

Crane and Lifting Operation Procedure.

Lifting plan will be applicable for critical lifting; non-critical lifting will be required

only the lifting calculation.

Rigging engineer will develop and prepare lifting plan and method statement then

submit to Contractor Sr. Rigging Engineer for review. Lifting plan and method

statement will be attached in PTW. This lifting plan would be submitted at least two

days prior to work execution.

14.5.4. CRANE OPERATOR QUALIFICATION

All crane operator and rigger shall meet the requirements of Contractor’s standard

and mandatory to have valid SIO/ Operator License (Surat Ijin Operator) from MIGAS

which has to be verified by Contractor on originality of the MIGAS SIO by

crosschecking through MIGAS.

COMPRESSED GAS CYLINDERS The use of compressed gas will follow Manpower Ministry standard (Regulation of Manpower

Ministry No. 37 Year 2016 regarding Pressure Vessel and Storage Tank) in terms of: how to

storage, how to handle, how to transport and use. Compressed gases are stored using the rack

and fastened using chain.

• Contractor must ensure that all gas cylinders are to be labelled to indicate the contents of

the cylinder.

• Flammable and oxygen cylinders shall be fitted with flashback arrestor (adjacent to the

regulator) and reverse flow check valve (at the torch).

• Contractor shall develop an inspection schedule of the gas cylinder.

• All compressed cylinders must be kept clear of oil, grease or other hydrocarbons.

• Cylinders must be inspected for leaks and/or defects prior to use.

• Cylinders must not be exposed to sparks, slag, flame or other heat sources.

• Cylinders must be secured in an upright position during use and storage. They must be

secured by the use of Chain, (never use barricade tape or rope).

• Protective caps must be in place over valve stems when cylinders are in storage or when

not in use.

• Cylinders must not be taken into confined spaces.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 35 of 71

• When cylinders are not in use, oxygen and fuel gas cylinders must be stored separately.

• Storage area for cylinders must be designated with signs stating” Oxygen Full or Empty,”

Acetylene Full or Empty,” etc.

The detail procedure related with welding and cutting activities using compressed gas cylinder

describe in Document No. 26071-100-GPP-GHX-00013 Cutting, Welding and Grinding

Procedure.

CONFINED SPACE Confined Space means a space which:

• Is not intended as a regular workplace (i.e. continuous employee occupancy)

• Has restricted means of entry or exit;

• Is large enough and so configured that an employee can bodily enter and perform assigned

work and is at atmospheric pressure during occupancy.

• All excavation activities more than 1.5-meter depth

• Has limited air circulation

In addition, this space has at least one of these characteristics:

• It contains or has a potential to contain a hazardous atmosphere;

• It contains material (solid or fluid) that has potential for engulfing an entrant;

• It has an internal configuration such that an entrant could be trapped or asphyxiated by

inwardly converging walls or by a floor which slopes downward and tapers to a smaller

cross-section; or

• It contains any other recognized serious safety or health hazards, for example exposed

rotor blades, noise etc.

• Examples of confined spaces are:

• Process vessels and related equipment (vessel tower skirts and flare stacks), boilers, water

storage tanks, other tanks including pontoons on floating roof tanks, tank cars and trucks;

• Spaces located below ground or deck level, such as drain pits, sewage pits and associated

tunnels, ducts, trenches, wells, shafts, cellars, vaults and unventilated rooms which may be

considered confined spaces under specific circumstances.

Entry into a confined space shall only be contemplated as a last resort, after all other possible

options have been ruled out. Tasks to be carried out in a confined space shall be subject to a

Risk Assessment at the planning stage. If all other options for completing the work without

confined space entry are ruled out, task-specific controls shall be implemented to ensure it is

safe to carry out the work.

Before entering the confined space (sewer, drain, manhole, vessel, tank, or other enclosed area

with restricted entry and exit), workers must be trained and have an Entry into Confined Space

Permit.

Contractor shall identify the position(s) or person(s) responsible to coordinate entry operations

and permitting for the site(s). These people and their responsibilities shall be shown on the

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 36 of 71

Confined Space list. As a minimum confined space activity should have these following position

(s) or role (s):

• Authorized entrants.

• Standby Man/Person.

• Authorize Gas Tester.

• Entry Supervisor.

Standby Man/Person responsibilities are:

• To monitor entrants during the job and during entry & exit to ensure their safety.

• The standby person may not abandon his post for any reason while personnel are in the

space. In case he/she need to leave, he/she MUST contact their supervisor/foreman to be

replaced by another trained standby person.

• To control access to the confined space.

• To summon emergency assistance as needed.

• To assess hazards in and around the space, and act on the same.

• To keep records of confined space work, such as air test results, personnel entry/exit.

• Standby person can ONLY watch one confined space at a time and shall have no other

duties.

Authorize Entrants responsibilities are:

• Understand the hazards involved with the job.

• Know the mode, signs and symptoms of exposure to chemicals hazards that could be

present.

• Use the required PPE correctly.

• To inform the standby person when noticing a warning indication of exposure to a hazard.

• Sign the entry log when entering or exiting the confined space.

• Will evacuate the space when any of the following conditions occur:

- An order to evacuate is given by the standby person

- Entrant recognizes a warning indication of hazard exposure

- The evacuation alarm is sounded

• To assure that the space has been adequately ventilated, isolated, emptied, or otherwise

made safe for entry.

• To immediately exit a space, without question, upon word of the standby person, no matter

what the reason.

• To follow all HSE rules and procedures that applies to the job.

All workers involved in confined space entry must be adequately trained to acquire the

understanding, knowledge, and skills necessary for the safe performance of the duties and to

ensure that safe work procedures are followed.

Contractor shall identify the training required to comply with this procedure and provide

training to ensure employees have the necessary understanding, knowledge, and skills to safely

perform Confined Space duties.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 37 of 71

This training as a minimum shall:

• Address safe work practices,

• Address roles and responsibilities of employees,

• Address the use of applicable safety equipment,

• Effectively communicate work conditions within the Confined Space and identified

potential and corrected hazards.

The training shall develop qualified employees and shall be continually improved to address

changes in the Confined Space program.

Confined space categorized as Gas Free/Respirable and Non-Gas Free/Non-Respirable Confined

Space. The conditions under which entry is permitted will depend primarily upon the results of

the atmospheric sampling using the table shown below.

NO Approved Entry Under Gas

Free/Respirable Condition

Approved Entry Under NON-Gas

Free/NON-Respirable Condition

1 Breathing Apparatus NOT required Breathing Apparatus required

2 OXYGEN: 20% TO 20.9% OXYGEN: <20% OR > 20.9%

3 LEL: <1% AND Toxic vapors ≤ 50%

of PEL

LEL: >1% but <10% AND/OR Toxic

vapors > 50% of PEL

4 Remarks – (a) Both conditions 2 & 3

above must be met for entry without

BA (b) Typical gas detectors will

provide reading for presence of

Oxygen, Flammables, CO and H2S.

Remarks – (a) For Inert conditions -

Refer to PTS 60.2110 Working in

Inert

Space (b) BA must be used if either

condition 2 or 3 is present (c)

Higher

presence of flammables indicates

presence of other gases which may

not

be detected using the typical gas

detector.

Table 5. Requirements for Respirable and Non-Respirable Confined Space

Pre-Entry requirements for Confined Space Entry are as following:

1. Carry out Risk Assessment.

2. Isolation of work area & surrounding.

3. Cleaning, draining, purging (if required).

4. Initial ventilation.

5. Pre-entry atmospheric testing.

6. Continuous ventilation.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 38 of 71

7. PPE & Tools.

8. Rescue Plan (for high risk confined space activity based on Risk Assessment).

9. Permit to Work.

A competent Rescue Team shall be available and on alert for high risk confined space entries

(based on Risk Assessment). Rescue Team members should have ready access to Breathing

Apparatus sets or airlines, harnesses, line rescue and any other equipment necessary for safely

retrieving injured or collapsed personnel from the confined space. The Rescue Team response

time must be considered during the Risk Assessment and Planning stages of the job preparation.

Specific Confined Space procedure with project site condition shall be provided to ensure all

Confined Space activities can be carried out safely.

EXCAVATION AND TRENCHING Requirements of excavation are as follow:

• Design for excavation > 1.5 m (5 feet) (including protection system) shall be developed by

Civil Engineer.

• Where the trench excavation is benched, the height between benches should not exceed

1.2 m unless designed by a consultant engineer. The overall width of the benched

excavation should not be less than the safe slope.

• Soil and materials must be kept at least 2 m from the edge of the excavation or transport

to another place to avoid landslide.

• For permanent retaining walls, check the overload capacity first.

• Support systems should only be erected, altered or dismantled by competent workmen

under supervision.

• Safe access must be provided into all excavations by means of ladders, ramps or stairs.

• Access ladders or other means of access shall be placed at regular distances (max. 7.5m) so

that workers only have to travel a short distance to escape if there any emergency

situations.

• Access ladders shall be placed at least 1 m protruding over surfaces and must be tied off to

prevent any movements.

• Climbing into or out of excavations using the waling and struts is prohibited. In narrow

trenches use vertical ladders.

• Walkways, bridges or ramps with standard guardrails must be provided where workers or

equipment are required to cross over excavations or trenches.

• At the edges of all excavations where a worker fall could occur ≥ 1.2 m, rigid barriers must

be erected or the excavation covered and clearly visible.

• Particular care is required where the public are required to cross over excavations. In a case

such as a footbridge, rigid hand railing must be provided with appropriate warning signs

advising of the hazards.

• Dewatering is necessary if the water table is less than 0.5m from the bottom of the

intended maximum depth of the excavation (i.e. more than 1.7 m depth)

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 39 of 71

• If the excavated pit or trench is deemed to be a Confined Space, the pit / trench shall be

treated as such and all Safe Working in a Confined Space shall be strictly adhered to.

Detailed of Excavation and Trenching refer to 26071-100-GPP-GHX-00024 Excavation and

Trenching Work Procedure.

ELECTRICAL SAFETY Contractor provides a written procedure 26071-100-GPP-GHX-00006 Electrical Equipment and

Assured Grounding Procedure for detail.

• Contractor will ensure that all electrical tools such as portable tools, hand tools, and other

portable electrical apparatus, meet standard safety requirement.

• Contractor will use Ground Fault Circuit Interrupter (GFCI) and institute assured grounding

program.

• Temporary electrical installation including distribution boards, cabling, and switch gear

shall comply with the current wiring regulations. Hand lights carried into vessels shall not

exceed 12 volts, unless protection is provided by a Ground Fault Circuit Interrupter (GFCI).

• All required tests will be performed prior to first use and/or prior to the equipment is

returned to service following any repairs.

• Colour code standard will refer to Contractor standard in three months basis. Loose lifting

equipment shall be colour coded to indicate compliance with periodic inspection and / or

re-certification. The colour code will be affixed or painted onto the lifting gear.

• The following four colours, blue, orange, green and yellow will be used in rotation.

Colour Code Valid Period

Blue January – March

Orange April – June

Green July – September

Yellow October – December

Table 6. Colour Code Period

• Colour Coding System also will be applicable for:

- Lifting Gear (sling, shackle, etc.)

- Electrical Cable – Contractor will provide inspection tags

- Hand tools

- Powered tools

- Equipment

FIRE PREVENTION AND PROTECTION Detail of fire prevention and protection is described on 26071-100-GPP-GHX-00005 Fire

Prevention and Protection Procedure.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 40 of 71

• All accidental fire on Contractor property, no matter how small, must be reported

immediately to the HSE Superintendent. The formal report should include all known or

reasonable summarized detail as an additional report may be required by government

agencies.

• The prevention of fires is of utmost importance. Good housekeeping and equipment

maintenance must be followed to keep fire hazards at a minimum.

• Contractor and Subcontractor shall provide gas detector if working in hazardous area, gas

detector that used will be calibrated annually.

• Contractor will conduct Fire Protection Training to employee. Storage and use of

flammable and combustible liquids will be per NFPA 30.

• All fire protection must be collected in designated area that are clearly identified with

appropriate marking. This equipment should be located near likely fire hazard but it must

also be accessible to operating personnel. The number type and location of extinguisher

must meet applicable standard.

• Partially used fire extinguisher must be discharger of pressure, recharged, or replace

immediately.

• All employee should be instructed in the proper use of available firefighting equipment.

14.10.1. FLAMMABLE COMBUSTIBLE LIQUID STORAGE & HANDLING

Following are the requirements for flammable combustible liquid storage:

• Since vaporization (the formation of vapor) increases when the temperature

is raised or when these liquids are more exposed to the air it is essential that

they are stored in a relatively cool place and in closed tanks, drums or cans.

Open containers should never be used for storing flammable and combustible

liquids.

• Storage in the open - in field conditions drums should be placed so that they

are not exposed to the direct rays of the sun, or any other source of heat.

• The storage area should have a warning sign clearly displayed indicating that

flammable and combustible liquids are stored there and that no smoking or

naked lights are permitted.

• A shallow trench or dike should be constructed around the storage area to

prevent any spillage or vapor spreading to lower ground areas where they

might contact a source of ignition and cause a flashback fire.

• The storage area must be at least 50 feet from any ignition source (e.g. open

fire, workshop area where grinding tools, or flame cutting equipment is used).

• Storage indoors - ideally, storage of flammable and combustible liquids should

be in a separate isolated building. If this is not possible, they should be stored

in a special room with fire resistant walls, doors, ceilings and floors.

• The storage indoor should be protected with an automatic fire-protection

system (sprinklers, foam, and carbon dioxide). The room should be well

ventilated, be equipped with explosion proof lighting and electrical fixtures

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 41 of 71

and have a warning sign at the entrance indicating that no smoking or naked

lights are permitted.

• Any storage area, whether in the open or indoors, should have a portable fire

extinguisher (approved for Class B fires) available outside the entrance. This

extinguisher may be of the foam type, carbon dioxide type, dry chemical type

of liquefied gas (halon) type. Personnel must be trained in the use of the

extinguisher.

During flammable liquids are transferred from one container to another, there is a

possibility of static electricity build-up which is a dangerous ignition source. To

prevent build-up of static electricity, following requirements are required during

handling of flammable liquids:

• Flammable liquids storage shall be provided with grounding (earthing) and

bonding facility. This is to minimize potency of build-up static electricity during

transfer of flammable liquids.

• Grounding facility for storage must be periodically tested to ensure it is still

working properly.

• Safety glasses, protective gloves and long sleeves uniform should be worn if

there is any chance of skin contact. Liquids should be washed from the skin

with non-abrasive soap or hand cleaner. It is recommended to provide safety

shower facilities and/or proper water supply near to storage area.

• The liquids should be used only in well ventilated areas to avoid breathing

vapours and fumes. If ventilation is not possible (e.g. in confined spaces) an

approved respirator must be worn.

If any personnel are splashed with a harmful or burning liquid, they must be taken

to a source of running water immediately and the splashed area should be flushed

with water for at least 15 minutes. Contaminated clothing should be removed and

medical attention sought immediately.

14.10.2. SMOKING AREA

It is prohibited to have smoking shelter and do smoking in brownfield area. At

greenfield area, only when approved by the Kepala Teknik of Project RDMP RU V

Balikpapan, Contractor will provide smoking shelter with requirements as follow:

• Smoking shelter should not be near to:

- Live existing pipe line

- Gas Processing Plant

- Sewer

- Oil Catcher area

• Smoking shelter should be located in open area.

• Dimension of smoking shelter 5x5 m2 with approved design. It is

recommended to provide roof for the smoking shelter.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 42 of 71

• Smoking shelter wall may provide however it should not fully close until the

roof. This is to ensure proper ventilation will be achieved and to prevent

flammable gas accumulation inside smoking shelter.

• Contractor must provide sufficient number of fire extinguisher at smoking

shelter.

• Minimum distance 100 m from process facility, pipe line, server, oil catcher.

• Smoking sign will be put at place.

• However, if any indication of hydrocarbon leaking, smoking will be prohibited

in smoking shelter area. Smoking sign will be replaced with No Smoking sign.

• Smoking shelter should be kept clean and tidy at any time. Contractor must

provide proper bins and periodically pick up smoking shelter rubbish. Treated

and dumped as waste.

• There will be one lighter provided on the shelter and it will be secured by

security personnel.

• This smoking shelter will be monitored by security personnel which must

standby there.

• Contractor must conduct periodical inspection of smoking shelter to ensure

the safety condition of this shelter.

14.10.3. MOBILE CELL PHONE

It is prohibited to bring and use mobile phone at brownfield area. At greenfield

area, Contractor may bring and use mobile phone only if get approval from the

Kepala Teknik of Project RDMP RU V Balikpapan.

In case approved by the Kepala Teknik of Project RDMP RU V Balikpapan, strict

control of mobile phone shall be taken to prevent mobile phone moving from

greenfield to brownfield area. Following requirements shall be implemented as

control measures:

• Perimeter/boundary of brownfield area shall protect with proper fence to

limit the access to brownfield area.

• Contractor must provide security gate with security personnel on each access

to brownfield area.

• Security personnel must standby at security gate and do screening to

everyone with intention to go to inside the brownfield area. During this

screening mobile phone must be surrendered to security in power off mode.

Furthermore, the mobile phone will be kept at dedicated place under security

control.

• Mobile phone will be returned back to the owner of mobile phone once

he/she left the brownfield area. To ensure the phone owner could get his/her

phone back, he/she must leave the brownfield through the same security gate

when he/she entering the brownfield area.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 43 of 71

• It is recommended to provide effective identification method for each of

mobile phone kept by security. E.g. using ID number for mobile phone,

registration in log book, etc.

14.10.4. FIRE EXTINGUISHER AND FIRE WATCHER

• Fire extinguisher shall be inspected every month by HSE.

• Seal and Pin shall in place and not broken.

• Pressure Gauge is showing in the green acceptable levels.

• Hose on the extinguisher is not dry rotted or cracked.

• Check the body of the extinguisher are free from defects and corrosions.

• Work supervisor and Fire watcher are responsible to maintain the conditions

and requirements listed on the Hot Work permit.

• Work supervisor and Fire watcher must Stop the job if observe any condition

that you consider being hazardous.

• The fire watcher shall have no other duties. Do not leave the jobsite while

welding or spark-producing operations are in progress. If other duties

required to leave the jobsite, he/she must first stop the job.

• The fire watcher shall be provided with a Florescent Vest, and a 20lb. fire

extinguisher. If the fire extinguisher has been discharged, return it to the tool

room for replacement.

• The fire watcher shall continually survey the work area for combustible

materials.

• More than one fire watcher may be required depending on potential impact

on other areas, such as floors below the hot work activity.

• If there is a fire that the fire watcher cannot extinguish quickly and safely, the

emergency notification and evacuation shall be activated.

• A Fire Watcher shall remain in the area for 30 minutes after the Hot Work is

completed. He/she must ensure there is no potential of fire could happen at

his/her working area.

FALL PREVENTION / PROTECTION • Working ≥ 1.8m is mandatory to use safety full body harness complete with double

lanyard.

• Shock absorber will be required to be attached to the full body harness by consider the

potential fall distance (with 3 ft safety factors). Below the picture illustration for the

calculation of potential fall distance.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 44 of 71

Figure 5. Calculation for Potential Fall Distance

• Workers who working above 10m should check by site paramedic to ensure the fitness’s

of workers (blood pressure, height consultation & others check) before commence the

works.

• Working at heights will not be permitted without supervision from authorized persons.

• When required a permit to work shall be issued under the authorization of Construction

Manager.

• Verification of job completion will be done by Project HSE Manager/ HSE Chief/ Site Safety

Superintendent.

FLOOR AND WALL OPENING If openings are made in walls on overhead floors or if openings are created in floors and/or

walking surfaces of overhead structures, or if handrails are removed, the following

precautions must be taken:

• Barricade tape can be used to warn of the hazard as long as personnel working on the

opening/hole attend the opening/hole.

• Permanent and temporary floor openings must have warning tags and standard guard

railing.

• Grating Removal permit shall be obtained prior to removing (for any reason) any

permanent or temporary floor openings (Grating, Checker Plate, Floor Plate, Stair Tread

or any Temporary Hole Cover) or standard guardrail, handrail system.

• Grating Removal permits shall be issued after visual inspection to the openings and assure

that the proper precautions have been taken.

• Floor holes into which persons can accidentally walk must be guarded by either a

standard railing with standard toe-boards on all exposed sides, or a floor hole cover of a

minimum 3/4” plywood if one dimension is 18” or less; otherwise 2” lumber is required.

The covering shall be secured against accidental displacement and clearly labelled “Floor

Opening — Do Not Remove”. At any time DO NOT leaving open holes without covering.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 45 of 71

HEAVY MOBILE EQUIPMENT All heavy mobile equipment used at worksites must be roadworthy and registered with the

appropriate authority, as per following table:

NO EQUIPMENT CERTIFICATION

1 Crane MIGAS / OIL & GAS (Government agency)

2 Truck Mounted Crane (TMC) MIGAS / OIL & GAS (Government agency)

3 Sky Lift MIGAS / OIL & GAS (Government agency)

4 Forklift MIGAS / OIL & GAS (Government agency)

5 Gondola MIGAS / OIL & GAS (Government agency)

6 Excavator DEPNAKER / MINISTRY OF MANPOWER

7 Dozer DEPNAKER / MINISTRY OF MANPOWER

8 Grader DEPNAKER / MINISTRY OF MANPOWER

9 Genset >200 KVA DEPNAKER / MINISTRY OF MANPOWER

10 Lifting gear such as webbing sling, chain, block, shackle, etc.

THIRD PARTIES

Table 7. List of Required Authority to Certify Heavy Mobile Equipment

• Vehicles shall not be older than 5 years for light vehicles and 10 years for trucks and

another heavy vehicle.

• All vehicles and heavy equipment’s must have reverse alarm installed.

• Contractor shall ensure that all vehicle drivers and heavy equipment operators are fit to

work and shall have a valid license for driving and/or operating issued by Government or

authorized institution.

• All heavy mobile equipment and vehicles must be in a safe operating condition at all

times. They are to be checked at the beginning of each shift. All heavy mobile equipment

and vehicles shall be attached by fire extinguisher, first aid equipment, seat belt and

flame/spark arrestor.

• The number of passengers of vehicles or equipment’s must follow the availability of seat

belt and it is prohibited to utilize the bed of truck and/or vehicles for passengers.

• Inspection to all heavy mobile equipment and vehicles will be done regularly. Inspection

Sticker will be attached to the heavy mobile equipment and vehicles after pass the

Inspection. With this sticker, equipment’s and/or vehicles permitted to be used at

greenfield and brownfield area.

• All heavy mobile equipment and vehicles to be used at RDMP JO will be manage to be

complied with RDMP JO Inspection procedure No. 26071-100-GPP-GHX-00026

Preventive Maintenance and Inspection Plant.

HAZARDOUS CHEMICAL HANDLING Contractor will ensure that all substances classified as hazardous to health, which are

transported, used or created during activities, are controlled to minimise the risk to the health

and to the environment.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 46 of 71

• The list of Chemical and Hazardous Materials to be used shall be available including Safety

Data Sheet (SDS).

• Required PPE as mention in SDS shall be used during handling with the chemicals.

• Required equipment and tools as mention in SDS to control any accidental release of

hazardous chemicals shall be provided.

• Before beginning a task where a hazardous substance is to be used, the risks, the

precautionary measures to be taken and the actions to be taken in the event of a spillage

(if applicable) or injury will be explained during the Pre-Job Safety Meeting (PJSM).

• It is recommended to use less harmful substances to minimise the risk to health and to

the environment.

• Only trained personnel should handle hazardous materials using the precautionary

measure that have to be taken, as instructed in the SDS.

• Used containers of hazardous substances/chemical will be disposed of as hazardous

waste.

• Hazardous chemicals will be disposed as per the instructions available in the SDS. Never

litter, or scatter used/empty chemical containers or used it for other storage purpose or

handling as it may be harmful to life and environment.

• Contractor must provide adequate eye-wash, shower and first aid boxes with medicines

at locations were hazardous chemicals are stored and handled, if deemed necessary.

Also, to ensure that it is well maintained and inspected regularly for defects or

malfunctioning.

• Employees are to be given information with regards to working with hazardous

substances and use and maintenance of applicable PPE. At minimum this shall be given

as part of the individuals Induction Training.

Storage of Hazardous Substances/Chemical shall consider following requirements:

• All chemicals containers must be labelled.

• Contractors shall ensure that adequate storage cabinets/ store rooms are available for

the proper segregation and storage of different types of hazardous substances/

chemicals.

• Incompatible chemicals shall be stored separately.

• Hazardous substance storage areas are to be identified with the correct signage,

indicating contents of the storage area and ‘No Smoking’ signs.

• Spill kits shall be provided where hazardous substances are being stored or used.

• Hazardous substance storage areas will be well ventilated and kept in hygienic manner

at time.

• Appropriate portable fire extinguishers and safety shower shall be provided at the

storage facilities and employees will be trained to use them effectively during an incident

with hazardous substances/chemical.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 47 of 71

HYDROGEN SULFIDE (H2S) • Contractor shall provide H2S Gas Detector to monitor the presence of H2S.

• Where H2S exists in concentrations greater than 10 ppm, employee protection shall be

ensured through following control:

- Engineering controls (ventilation, automatic tank gauging, etc.).

- A Hazard Assessment of the work to be performed including knowledge of the level

of hydrogen sulphide which may be encountered.

- An evaluation of the work area focusing on a means for egress, with respect to

conditions which may affect vapor migration, such as wind direction and speed.

- Use of a continuous personal monitor, that will provide an alarm when H2S

concentrations reach 10 ppm. The monitor shall be worn in the breathing zone.

- Supplied-air respirators shall be used

• Where H2S exposures exceed the IDLH level (100 ppm) or where H2S exposures are

unknown, SCBA’s or airline respirators that include escape provisions shall be used. In

addition, a standby person equipped with a SCBA and prepared to initiate rescue shall be

provided. Airline respirators are not approved for rescue from H2S atmospheres.

• Area with potential exposure of H2S shall be barricaded and informed with proper safety

sign.

• Contractor shall establish Emergency Response Procedure for H2S exposure.

• Contractor shall ensure that employee understand the hazards of H2S and know how to

response with H2S exposure.

HAND AND POWER TOOLS • A portable hand and power tools shall be inspected prior to use. Contractor site

management shall ensure that all tools are maintained in a safe condition and used in a

safe manner by all personnel.

• Defective tools must be removed from service until repaired or replaced.

• Site Supervisor must ensure that workers understand how to use the tools correctly and

care about other workers.

• Machine Guarding must be checked to ensure that it can be operated effectively.

• Guards and safe protection of the devices must remain in place and in operable condition

on all tools. Wooden handles on tools must be free of cracks or other defects. Tape or

other coverings that will hide defects are not to be placed on these handles.

• The colour code must be posted on the device to determine the condition of the

equipment (Good or Not Good).

• Damaged or defects tools should not be used and removed from site. Re-inspection

should be done for these tools after repair.

• Daily checks shall be done by tools user to ensure that tools is in good condition and safe.

• Always use appropriate tools for every job. Do not use improvised or modified tools.

• Non-spark, explosion proof or intrinsically safe tools are mandatory to be used at several

hazardous or flammable area.

• Impact surfaces of tools including, but not limited to, hammers, wrenches, drift pins,

chisels must be kept free of mushroomed heads.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 48 of 71

LADDER USE AND INSPECTION Access ladders or other means of access shall be placed at regular distances (max. 7.5m) so

that workers only have to travel a short distance to escape if there any emergency situations.

Access ladders shall be placed at least 1 m protruding over surfaces and must be tied off to

prevent any movements.

Contractor shall ensure to maintain portable ladders in safe condition. Ladders with the

following defects shall not be used, and shall either be tagged as unusable if kept on board, or

shall be removed from the site:

• Broken, split or missing rungs, cleats or steps;

• Broken or split side rails;

• Missing or loose bolts, rivets or fastenings;

• Defective ropes; or

• Any other structural defect.

Ladders shall be inspected for defects before each day's use, and after any occurrence, such

as a fall, which could damage the ladder.

Contractor will conduct a portable equipment inspection program for portable construction

equipment used in the work, including portable ladders. Inspection Schedule will be:

• Before mobilization to project site

• Upon delivery to site

• Daily at site (by user)

• Management joint safety patrol (Weekly)

• General inspection / internal audit (Monthly)

Frame ladders are possible to be used only with following criteria:

• No defects or structural damages.

• Only use ladders for their designed purpose and load capacity.

• Cannot use ladders near to power lines or electrical equipment’s.

• Maintain 3-point contact when climbing/descending ladders.

• Use barricade to keep traffic away from the ladder.

• Only put ladder on a stable and level surface that is not slippery.

• Implement buddy system when working with ladder.

• Cannot use ladder horizontally like a platform.

LOCK OUT / TAG OUT – ENERGY ISOLATION • LOTO system shall implement before performing repairs, adjustment of electrical,

pneumatic, hydraulic, thermal, gravity and radiations equipment.

• Personal Danger Tag tagging and padlocked (Red colour) will be used for equipment that

is being repaired by someone.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 49 of 71

Figure 6. Lock, Tag and HASP for LOTO

Out of Service Tags (yellow colour) shall be attached to faulty equipment or out of service

equipment and shall be left attached until the equipment is repaired and ready for use.

Figure 7. Out of Service Tag

Detail of LOTO procedure is described on document 26071-100-GPP-GHX-00010 Lock Out and

Tag Out (LOTO) Procedure.

PERSONAL PROTECTIVE EQUIPMENT (PPE) PPE mandatory is safety helmet with chin strap, clear safety glasses or goggle, ear plug,

coverall with high visibility reflector, and safety shoes. Employer also shall provide their

workers with others compulsory hand gloves PPE especially when working at height for

example. Inherent hazard when working at height and during night time could results in

unwanted fatal incident.

All personnel who work in RDMP project must be worn mandatory PPE. The standard PPE that

must be worn are:

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 50 of 71

TYPE OF PPE STANDARDS

Head protection All head protection with chinstrap shall meet requirements set out in EN 397, ANSI Z89.1 – 2003 Colour requirements of safety helmet Contractor’s Supervisor and above: White colour Sub-contractor helmet: Yellow colour Contractor & Sub-contractor HSE Personal: Red colour

Eye and face protection All eye and face protection shall meet the requirements set out in EN 166, ANSI Z87.1 – 2003

Respiratory protection All respiratory protection shall meet the requirements set out in ANSI Z88.2 – 1992, filter respirator set out in BS EN 4275, 1997; Airline mask BS EN 139, 1995; Self Contained Breathing Apparatus (SCBA) BS EN 137, 1993

Hearing protection All hearing protection shall meet the requirements set out in ANSI S3.19 – 1974, all type of hearing protective shall be used appropriately depend on noise level to protect noisy as state limit

Hand protection All hand protection shall meet the requirements set out in BS EN 420:2003 + A1 2009 and Super Duty gloves for specific activity

Body protection One-piece coverall (grey colour) with Contractor name and personnel name

Foot protection All foot protection shall meet the requirements set out in BS EN 345, 1993 ANSI Z.41

Fall protection All fall protection shall meet the requirements refer to ANSI A10.14

Table 8. Personal Protective Equipment (PPE) Standard

PNEUMATIC TOOLS Pneumatic tools include Chippers, Drills, Hammers, and Sanders. Pneumatic power tools shall

be secured by proper clamps and whip checks.

In addition to mandatory PPE, eye protection (goggles) or a face shield (with safety glasses or

goggles), and hearing protection are required for working with pneumatic tools.

Pneumatic tools may be used only by employees who are properly instructed and familiar

with these tools.

Employees must follow safe practices for operating pneumatic tools, including the following:

• Before assembling the system, check all hoses for cuts, breaks, and loose connections.

• Blow out all hoses before hooking up the equipment. If the connector has a rubber seal.

Remove it before (and replace it after) blowing.

• When possible, run air lines through areas with little traffic. If possible, avoid laying lines

across roads. Protect air lines or hoses against trucks and pedestrians either by building

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 51 of 71

runways over the hose or suspending the hose overhead with the lowest part of the hose

at least 7 feet (2 meters) above the ground.

• Tighten hammer-joint connections with a hammer. Do not tighten them by hand. Hoses

equipped with special connections require special tightening techniques or equipment.

One example is hammer-union connections, which must be tightened with a hammer.

Another example is spanner-wrench connections, who must be tightened with a spanner

wrench. Do not tighten these connections by hand.

• Do not turn on air valves until the hose connections are secure.

• Do not point an open-air hose at anyone.

• Compressed air shall not be used for cleaning purposes except where reduced to less

than 30 psi, and then only with effective chip guarding and proper personal protective

equipment.

• Unless the equipment has quick change connectors (with internal check valves), shut off

the air at the air supply valve ahead of the hose before breaking the connection.

PEDESTAL, BENCH AND PORTABLE GRINDERS Machinery, such as grinders or buffers, must be secured to a work bench or pedestal and the

bench or pedestal, in turn, must be secured to the floor to prevent walking or moving.

Pedestal or bench mounted grinders shall have an emergency stop button and be fitted with

a properly adjusted tool rest. Pedestal grinders must be securely fixed to the floor to prevent

them from walking when in operation.

Detail is described in 26071-100-GPP-GHX-00013 Cutting, Welding and Grinding Procedure.

FALLING OBJECTS PROTECTION The most effective way to eliminate/minimize the potential personnel exposure to falling

tools, materials and/or debris is to never allow employees to work and walk below others in

that are working at an elevated work area.

• Whenever possible, to secure below area of an elevated work location with barricade.

• Tools, equipment, material, etc., will be kept and arranged in an orderly manner and good

housekeeping will be practiced throughout the work day.

• Controlling/restricting the amount of material taken to the elevated work areas; only

stage/store what is needed to perform the task.

• Minimize hand carrying or handing material from person to person by hands.

• Use racks, baskets, containers, etc. to raise tools and materials.

• “Bundles” of long materials, such as scaffold tubes, will be banded together, rigged with

a minimum of two chokers/slings and will be kept horizontal.

• Loose material should be properly secured to prevent effect of wind.

• Scaffolding and work platforms shall require toe boards around the edge.

• Tools and equipment will be stored in appropriate containers/boxes to prevent dropped

objects.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 52 of 71

• Hot Work will not be performed overhead in areas where the potential for hot slags,

sparks or molten metal to contact employees working below without covering by fire

blanket or other similar protections.

• Tools, materials, will never be placed or stored on beams, pipes, valves unless they are

secured.

• Proper tool holsters shall be used when working at height/elevated area.

SITE OFFICE, STORES, WORKSHOPS, LIVING ACCOMODATION AND CANTEEN

FACILITIES Contractor must ensure that site office, stores, workshop, accommodation block and canteens

are designed in manner which prevents injury, damage or loss.

• All such facilities shall contain adequate number of suitable fire extinguisher. Contractors

must conduct periodical inspection to ensure fire extinguisher and others emergency

equipment maintained in good condition.

• Each facility shall have evacuation procedure posted at regular interval throughout. Shall

ensure that the facility evacuation procedures remain in clear view to all.

• All facility occupants shall be made aware of the evacuation procedures and the relevant

assembly/muster points for that facility.

• Lightning protection shall be provided to all such facilities. The electrical installation of

such facilities shall be approved standard and comply with the Contractor’s policy on

electrical installation.

• All emergency exits, shall be clearly marked by an A4 sized poster/notice. All emergency

exits shall remain free from obstruction at all time. Any obstruction found shall be

removed immediately.

• At no time will rubbish, refuse and combustible materials be permitted to accumulate

within any facility. All rubbish, refuse and combustible shall be removed from yard to a

designated tipping area. Open burning of rubbish, refuse and combustible material

generated by such facilities will not be permitted at any location within project boundary.

• Contractor shall provide adequate number of rubbishes, refuse and combustible

materials bins.

• Contractor shall provide all the facilities with adequate ventilation and lighting to prevent

injury or damage.

• All facilities must be kept clean and tidy at all time. Any spillage shall be cleaned

immediately.

• Contractor will provide Prayer room located at field and office area. Design and number

of Prayer room will be decided based on need at site. The Prayer room will be provided

with sufficient water for ablution tap and toilet. Cleanliness, hygiene and tap condition

must be maintained in good condition.

• Contractor must provide safe and adequate transport to pick up people from living

accommodation to the working area and vice versa.

• Contractor shall provide proper and adequate number of toilet and sanitation system.

• Contractor shall ensure the cleanliness and waste management in accordance with the

national regulation.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 53 of 71

14.23.1. WORKSHOP FACILITIES

Prior to any site workshop becoming operational, risk assessment shall be

completed and all related personnel shall have addressed the following items:

• All equipment used shall be maintained in a safe working condition.

• Any cranes or lifting devices used have been certified by a recognized

authority and shall clearly state their Safe Working Load.

• The lifting of heavy plant and equipment, by the use of the hydraulically

operated plant, i.e. Excavators or pay loaders, shall be prohibited.

• Adequate and suitable fire extinguishers shall be provided throughout, with

additional extinguishers being provided around hot work areas such as

welding/burning areas.

• Adequate screens shall be placed around hot work areas to prevent eye flash.

• All personnel working within the workshops are mandatory to follow PPE

requirements.

• All generators shall be properly earthed.

• All electric within the site workshop shall be fused correctly.

• Guards shall be fitted stored in upright drums. The drums shall be stored in an

orderly manner and shall be clearly marked to show their contents. Additional

fire extinguisher shall be located adjacent to lubricant storage areas.

• Used lubricants and oils shall be disposed of at an approved temporary waste

storage area. All spillage shall be cleaned up immediately.

• All used batteries, containing acids, shall be stored in an upright position and

shall be removed to temporary waste storage as soon as possible.

• The workshop facility shall be maintained in safe working condition at all times

14.23.2. LIVING ACCOMODATION

Contractor shall ensure that all accommodation blocks shall be provided with an

adequate number of suitable fire extinguishers and that adequate lighting and

ventilation is provided. Fire Exits shall be indicated as mentioned above.

Evacuation procedures shall be advised to all personnel living/sleeping within the

blocks.

Such accommodation blocks shall be erected as far away from the permanent

works as possible.

Contractor must provide safe and adequate transport to pick up people from living

accommodation to the working area and vice versa.

14.23.3. ABLUTION FACILITIES

Contractor will ensure that all site ablution facilities are designed, constricted and

operated in accordance with all statutory regulations. All such facilities shall be

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 54 of 71

maintained in a clean condition, at all times. Any defects found within the system

shall be rectified immediately

The user of each site ablution facilities shall discharge into a suitable designed

septic tank and soak way arrangement. All septic tank shall be designed to meet

demands from all site conditions. If at any time, septic tanks are found to be full or

overflowing they shall be pumped into a suitable tanker, immediately. The

resultant effluent shall be disposed of at an approved facility.

14.23.4. CANTEEN FACILITIES

Contractor must ensure that canteen facilities shall be maintained in a sanitary and

safe working condition at all time.

All Pressure Gas Cylinder (LPG) containers shall be stored outside the buildings,

except when in use.

Fly mesh shall be used at all window locations in an attempt to keep insects away

from the food preparation areas and the displayed food.

Food preparation areas shall be cleaned before and after each mealtime.

SIGNAGE & BARRICADES Barricades Refer to 26071-100-GPP-GHX-00017 Barricading and Signboard Procedure.

• The boundaries of critical work areas, excavation and others hazard must be clearly

delineated by visible barricade and signage.

• Hazard signage shall be posted in conspicuous place to warn workers about any hazard

that is present in the surrounding areas.

• Contractor shall ensure that employees understand with safety sign, colour coding and

barricade.

• Signage shall be well illuminated so that it could serve its purpose. Broken signage shall

be replaced immediately and maintenance of all hazard signage shall be performed

accordingly.

• Excavation and floor openings shall be barricaded with hard barricades instead of

barricade tape.

SCAFFOLDING Detail procedure for scaffolding refers to document 26071-100-GPP-GHX-00021 Scaffolding

Procedure.

• Installation, modification, and demolition of scaffolding shall be done by competent

persons (as common, in a team at least one person as a certified Scaffolder) and inspected

by certified Scaffolding Inspector (MIGAS Certificate)

• Employees shall not access scaffolds that have not been inspected and properly tagged.

• The standard of scaffolding that must be following: OSHA standard with material of the

frame scaffolding must be galvanized.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 55 of 71

• Work platforms must be equipped with standard guardrails, mid-rails and toe boards.

• Drop bars must be installed on all scaffolding deck/platform.

• Detail of scaffolding pipe specification and materials shall be followed Construction

Execution Plan (CEP) and in accordance with Contract.

• The uses of frame scaffolding for working at height platform are strictly prohibited.

• Movement of materials, tools, equipment, etc. to higher or lower levels will be affected

by hand line or hoist apparatus.

• Open sides and ends of platform 6 feet (1.8 meters) or more above will be guarded by

top rails, mid rails and toe boards with the top railing 42 inches (1.1 meters) above the

platform levels.

• Scaffolds must be erected plumb and on a solid foundation. Loose bricks, boxes, concrete

block, scrap lumber, etc. must not be used to level or support scaffolds or planks.

• All scaffolds must have an inspection tag placed at the point of access/egress by a

competent person.

• Employees, materials and tools must not ride on mobile scaffolds.

SIMOPS SIMOPS is define as execution of 2 or more operations with potential interaction that could

lead to an increase of risk or introduction of new hazards to each other’s.

SIMOPS procedure and SIMOPS matrix should be established as a guideline to identify and

manage simultaneous activities. Construction will provide the SIMOPS procedure and SIMOPS

matrix with the participation of HSE and other required discipline.

Where there are major interfaces between Contractor, Sub-contractors and Operations, these

shall be managed by the Construction Management representative to ensure agreement and

clarity on SIMOPS.

Contractor need to arrange following but not limited to this meeting:

• 30 day and 90 day look ahead meeting.

• Daily plan of the day meeting: attended by discipline Superintendents/Supervisor, HSE,

Permit Coordinator and Project control teams.

• Meeting to coordinate and prioritize simultaneous activities.

WELDING. CUTTING & GRINDING The detail procedure for welding, cutting & grinding describe in Document No. 26071-100-

GPP-GHX-00013 Cutting, Welding and Grinding Procedure.

Cutting Welding and Grinding or other flame or spark producing works are activities include

in hot work. All hot work activity shall be performed with hot work permit and job safety

analysis.

Hot work area shall be safe from flammable or explosive gases. Gas test shall be performed

before the job and continuously monitored until the job is completed.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 56 of 71

Area within 10-11 meter from hot work shall be free from combustible material such as dry

woods, rubbish, fuel, and chemicals.

All personnel that perform cutting, welding, and grinding, including welder, fitter, and helper

shall be properly trained.

WORK PERMIT PROCEDURE Contractor will use Work Permit system for any activities consider as High Risk at green field

to comply with Regulation of Indonesian Government No. 50 / 2012 regardigng

Implementation of Occupational Health and Safety Management System Law No. 1/1970,

which mentioned to establish Work Permit for High Risk activities. Also, Regulation of

Indonesian Government No. 11/1979 regarding Work Safety at MIGAS Refinery, which

mentioned any specific Hot Work activities and conducted at hazardous area shall get written

permission from “Kepala Teknik” (Technical Manager).

At green field area, most of the routine and not high-risk activities will use general work permit

with area/discipline wise, however JSA will use activity wise and shall attached to the PTW.

The details of the Contractor Work Permit System for Green Field area will be described on

document 26071-100-GPP-GHX-00001 Work Permit Procedure.

If required, during pre-commissioning and commissioning (including start up and performance

test) phases, permit to work system will be modified / adjusted to the work conditions

(especially associated with specific hazards when conducting pre-commissioning and/ or

commissioning activities).

Contractor activities carried out at brownfield area will follow the Pertamina SIKA procedure

No. A-005/E15500/2016-S9.

15. TRAINING AND COMPETENCY Contractor will provide Training Coordinators to administer all training requirement of

Contractor’s and subcontractor’s personnel.

Refer to 26071-100-GPP-GHX-00004 HSE Training Procedure. There are 26 topics of HSE

Trainings and will be delivered at project site regularly.

HSE TRAINING REQUIREMENTS Following are HSE Training general requirements:

• Contractor must ensure all workers are competent for the job assigned and completed the

training programs as per Training Matrix.

• Contractor’s Trainer are responsible to maintain the Training Program as per Training

Matrix (refer to Attachment 2.HSE Training Matrix).

• Training schedule shall be developed to ensure it complies with the minimum requirement

and in line with the construction stage (schedule).

• Training shall be conducted at classroom or practice.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 57 of 71

• Contractor must submit the HSE Training material to PMC for their review and approval, in

order to have alignment with Owner’s regulation.

• All training material shall be provided in dual languages which are English and Indonesia.

IIF® PROGRAMS Incident Injury Free (IIF) programs is a commitment-based approach to addressing safety issues.

This approach has been known to transform work cultures, leading to improved relationships,

improved communication and improved safety numbers.

Basic principle of IIF program is “the relationship is the foundation of the accomplishment”, in

which the more the relationship between employees are strengthened, and the better results

can be achieved. This concept is conveyed to the individual employee via IIF orientation

programs, which also provides training for the frontline supervisors, since frontline supervisors

are strategically the key players of the programs.

The purpose of IIF is prevent harm to plant, environment and people. The focus of IIF program

is on leadership and culture. To measure the effectiveness of IIF program will be as following:

1. IIF Leadership Team Members Participation:

Monthly participation on IIF Site walk throughs and meetings to demonstrate visible,

proactive safety leadership.

2. Listening Tour Action Items:

The number of “Closed” Action Items identified on Site walk-throughs. These

demonstrate management commitment and follow-through to rectifying site safety

concerns and hazards. This builds credibility and trust.

3. IIF Orientation Participation:

Track the number of workers participating in the IIF Orientation with a goal of 100%.

Typically combine IIF Orientation delivery with the project site induction.

4. Supervisors Trained in IIF Skills:

Track the number of supervisors participating in the IIF Supervisor Skills Training with

a goal of 100%.

5. TBT Quality Improvement metrics:

One focus of the IIF Supervisor Skill training is high-quality Tool Box Talks. An outcome

of the program is five specific areas to track and improve TBT metrics, including focus

on specific hazards, worker engagement and more.

6. Active IIF Champions:

The ratio of IIF champion per number of workers shall be decided with the

consideration of effective relation with the workers. Champions are volunteers from

the Contractor and Sub-contractor workforce who encourage and drive IIF actions in

their crews.

7. IIF Pulse Surveys:

IIF Pulse Surveys are an assessment tool for acquiring input, feedback and perceptions

from project team to establish new baselines on progress towards an IIF culture. IIF

pulse survey measurements will be:

• Trending of responses

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 58 of 71

• Action items logged and closed

• Track cultural development from “Reactive to Legislative to Proactive to

Generative”.

8. e-COP observations achieved weekly or monthly.

To achieve the target and maintain the focus of IIF, following programs shall be delivered:

1. IIF Program kick-off meeting

2. IIF pulse survey

3. IIF commitment workshop

4. Supervising IIF in action (Train the Trainer)

5. IIF orientation (Train the Trainer)

6. IIF Champions program

7. IIF leadership team and monthly meeting

8. Quarterly on-site coaching

COMPETENCY Contractor develop HSE Training Matrix based on required HSE competencies for each Job Task

at project site. Refer to Attachment 2. HSE Training Matrix for the detail.

To increase personnel awareness on working safely, Construction Manager with HSE Manager

are responsible to ensure that all personnel have completed all training required as per Training

Matrix.

Special skills/competency required for a specific job shall be certified by government

(Migas/Depnaker). E.g. Scaffolding, Crane Operator, Rigger, etc. In House (at site) training

deliver by Contractor in accordance with this special skills/competency only for refreshment

purpose.

TRAINING RECORD AND TRACKING METHOD Following are Training record which shall be documented and made available for auditing

purpose:

• Training attendance record.

• Database of employees training record. Include a record to verify all personnel who have

successfully completed the training.

• Training assessment.

• Approved Training material.

Training Sticker will be given to the participant who pass the assessment and this sticker must

be attached to their helmets. Database of employees training record shall be maintained and

used to track employee’s compliance to follow the required training.

TRAINING PROVIDER • Since contractor will have activities at brownfield area, Owner will conduct in house

training for transfer knowledge of HSE system and requirements to Contractor.

• Contractor have responsibilities to deliver required HSE Training at project site.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 59 of 71

• Incident Injury Free (IIF®) Orientation is delivered by licensed third party and/or

Contractor’s HSE Trainer which hold Training of Trainer (TOT) for IIF® and

authorize/certified by licensed third party (JMJ) to conduct IIF® Training.

• Others than IIF® Orientation will be delivered by Contractor’s Competence HSE Trainer

which hold Training of Trainer (TOT).

TRAINING KEY PERFORMANCE INDICATOR (KPI) Contractor’s Weekly Report contain Key Performance Indicator (KPI) related to training.

Progress against these KPI’s will be reported by weekly to PMC.

CONTRACTOR INTERNAL TRAINER Contractor shall provide qualified trainers.

• All Contractor’s HSE Trainer must Certified as Training of Trainer (TOT).

• Contractor will hire certified person to be assigned as HSE Trainer for the special

skills/competencies required training. i.e. Rigger, Crane Operator, Scaffolder refreshment

training.

Contractors will provide HSE Training centre to facilitate in house (at site) HSE Training. This

training centre will be located at Contractor’s temporary office and have capacity for 50

participants/trainee.

SITE SPECIFIC ORIENTATION PROGRAMS • HSE Orientation Training (HSE Induction) and Incident Injury Free (IIF) are deemed

mandatory to be followed by all Contractor and Subcontractor personals before starting

their work activities at site.

• Contractor’s HSE will provide a project specific orientation (HSE Induction) to all

Contractor, Subcontractor personnel, including visitors and vendors. The content of

orientation should describe some items below but not limited to:

- Project HSE Policy.

- Project Prohibition of Alcoholic Drink, Drugs, and Carry Weapon Policy.

- Project Top Management HSE Commitment.

- Project HSE Golden Rules.

- HSE Rules and Requirements.

- HSE Communication System.

- Emergency Response Procedure.

- Transportation Procedure.

- Personal Protective Equipment.

- Environmental Condition.

- Hazards Identification and Mitigation (JSA) in Work Area.

• At the end of training, training participant will be required to sign a personal declaration

which mention they are aware with the HSE matter delivered in the training and will give

their commitment to follow the HSE requirements. Trainee should pass the post-test

assessment to ensure that trainee understood.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 60 of 71

• Training participants who pass the assessment will be given with RDMP JO sticker to be

attached at the front side of their safety helmet.

• Training participants required to fill out the attendance list. This list will be registered to

the training database.

In addition, Contractor / Subcontractor / Sub-Subcontractor / Vendor personnel who will visit

project site to conduct short inspection or walkthrough or supervise as expert within 1 – max 7

days, identified as a Visitor. Visitor who will enter project site shall be accompanied with

appointed Contractor personnel (user / host). Visitor shall also complete the visitor SIML & ID

Badge following requirement:

• Complete filled of man power register form (for each personnel);

• Attend HSE induction and matrix training based on work position.

SHORT SERVICE EMPLOYEE PROGRAM (SSE) Contractor shall manage all Contractor, Subcontractor and Sub-subcontractor new &

inexperience hire employees through the SSE Program. After having passed the HSE Training

(Induction and Matrix training), all new employees will receive a New Employee Identification

Sticker and green colour tapes. This sticker and green colour tapes around the helmet will be

worn for the first 30 days of working at site.

Direct supervisor of new & inexperience hire employee shall be responsible to the

familiarization of the project requirement include, but not limited to:

• JSA.

• Project HSE Plan.

• Safe work procedures/practice.

• Location of designated assembly point, muster point, windsock, lunch/break areas/shelter,

smoking areas, routes to and from work areas, etc.

After 30 days of mentoring program, status may be removed at the discretion of the

Construction Manager, subject to the following criteria:

• The employee is deemed by their supervisor to have worked safely;

• The employee is deemed by their supervisor to have adhered to HSE policies; and

• The employee has no incidents attributable to him/her.

Personnel who have not met the above criteria in the specified period require written approval

from the Construction Manager for continued access to the site.

16. COMMUNICATION

TOOLBOX MEETING (TBM) Toolbox Meeting will be conducted by Contractor and Subcontractor in daily prior to the start

the activities at site. Contractor Discipline Superintendent is responsible for these meeting and

will ensure that all members of supervisor/work leader and workers are briefed on the following

prior to the start of any work activities:

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 61 of 71

• Today activities.

• Review for the tasks which have been carried out on previous day.

• Job distribution from each supervisor to all workers or team member. This is to prevent

misunderstanding and miss communication during execution of the job.

• HSE issues/concern, lesson learn, safety topics, etc. This is to remind and improve all the

members awareness concerning HSE aspects in their daily activities at site.

TBM shall be attended by:

• Work supervisor.

• Foreman.

• Discipline superintendent.

• Engineer.

• HSE.

• Workers.

TBM could be done per group to make it effective and efficient. For example, TBM for civil

group, TBM for mechanical group, etc.

PRE-JOB SAFETY MEETING (PJSM) Pre-Job Safety Meeting is a meeting carried out soon after the TBM at working area just before

started the job/task. PJSM shall be followed by all team members involved in the job/task.

At minimum PJSM shall be attended by:

• Work Supervisor/Work Leader in charge for the job/task.

• Foreman in charge for the job/task.

• Discipline Superintendent in charge for the job/task.

• HSE in charge for the job/task.

• Workers in charge for the job/task.

PJSM will be focus to discuss about the JSA prepared for the job/task and ensure all the

precautions mention in the JSA already in place.

Considering the number of HSE personnel and Discipline Superintendent will be not enough to

attend each PJSM, they shall prioritize to attend PJSM for high risk job/task such as:

• Job/task covered with specific PTW (not general PTW). i.e. Confined space, critical lifting,

etc.

• Job/task at brownfield area.

• Job/task with any change of working conditions, such as changes in engine conditions,

weather, personnel, execution time and work methods.

• Etc.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 62 of 71

GENERAL SAFETY TALK Safety talk will be conducted throughout the construction phase of the project. The agenda of

this activity shall include:

• Communication of general HSE issues.

• Socialization of procedure / requirements.

• Review of HSE issues from the previous week’s activities.

• Significant work planned for the current week, i.e. critical lifts, major equipment installs,

lockout tag outs being implemented, etc.

• Sharing of lesson learned from other projects.

• Review the previous week’s questions and concerns from the workforce and what was

done to address them.

• Session for a “Personal Safety Learning” or Guest Speaker.

• Rewards and recognition.

Site personnel (Contractor, Subcontractor, Sub-Subcontractor, and Owner) shall be in

attendance. All personnel in attendance will be required to sign the attendance sheet for each

meeting. Contractor Construction Manager is responsible to ensure the implementation of this

program.

General Safety Talk will be done in weekly basis. Venue for General Safety Talk shall be decided

by consider Site Project condition such as availability of space to be used by staff & workers.

Basically, it is preferred to carry out General Safety Talk at one place for all staff & workers.

However, at peak project stages, it seems not practicable to do it. In this case the most effective

and efficient method will be decided. It is recommended that General Safety Talk will be divided

into several big group at several work places or every week General Safety will be scheduled to

attended by different Sub-contractors.

WEEKLY SITE HSE COORDINATION MEETING Weekly HSE Coordination Meeting shall be conducted weekly at project site with the following

agenda:

• Review HSE Program Implementation

• Review HSE Key Performance Indicator

• Review HSE Statistic

• Review HSE Issues

• Other business (if any)

HSE representative from Subcontractor & Contractor (coordinator level) shall attend this

meeting. Contractor HSE Chief shall chair this meeting. The agenda and result of the meeting

will be documented and distributed to all participants.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 63 of 71

PROJECT MANAGEMENT SAFETY COMMITTEE MEETING Contractor’s PMT and Owner shall conduct this meeting on quarterly basis. Contractor shall use

this meeting as a means for reviewing recent HSE issues with Owner, developing corrective

action plans and identifying opportunities for improvement. Contractor’s Project Manager shall

chair this meeting.

Agenda for this meeting are as follow, but not limited to:

• Review HSE Programs.

• Review HSE Statistic.

• Safety Walkthrough

After the meeting, Contractor shall distribute meeting minutes to the following personnel:

• Owner and Contractor Project Manager

• Owner and Contractor HSE Manager

• Owner and Contractor Project Control Manager

• Owner and Contractor Procurement Manager

• Owner and Contractor Engineering Manager

• Owner and Contractor Construction Manager

• Owner and Contractor QC Manager

Minutes of meeting are subject to report to Owner.

MONTHLY HSE COMMITTEE MEETING Contractor will implement Safety Committee meeting in monthly basis. All Contractor key

persons including Subcontractors and Sub-Subcontractor site management and key

representatives will participate as members of committee. Construction Manager is appointed

as Chairman on the committee, HSE Chief as secretary and Representative as observer of

committee.

Agenda of the meeting will include a communication of general HSE issues and requirements,

communication of any other pertinent information compiled from the previous month’s

activities, and sharing of lessons learned from other projects. All attendees will be required to

sign an attendance sheet for each meeting. Minutes of meeting shall be taken by Contractor.

HSE POSTER, SLOGAN, NOTICE BOARD Posters, Rules of HSE, notices and HSE Policy shall be posted in key locations around the site to

maintain HSE awareness. HSE information will be issued to inform workforce about particular

issues and about progress in achieving objectives, results of inspections and lesson learn of Near

Miss and Incident.

HSE Information Boards will be used to display HSE Policy, slogans and other information as

statistics, awards, etc.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 64 of 71

CONTRACTOR RADIO COMMUNCATION NETWORK Radio communication shall be provided by Contractor as means of communication at site to

ensure urgent issues are resolved immediately. 1 (one) radio frequency will be used for

communication purposes between Contractor and Project Team. Communications network will

be compatible with the site system and radio communications network must have government

certificate/permit, and must be intrinsically safe for Class 1 Div. II. Each radio channel will be

used for the following purpose:

CHANNEL PURPOSE

1 Contractor and Communication

2 Civil Discipline Communication

3 Piping Discipline Communication

4 Mechanical Discipline Communication

5 Instrument Discipline Communication

6 Electrical Discipline Communication

7 Lifting Activity

8 HSE Discipline Communication

9 Emergency

Table 9. HT Radio Communication Channel

Note:

The channels above can be changed and/or added depend on the situation at site

17. STOP WORK AUTHORITY (SWA) The SWA should be initiated for conditions or behaviours that threaten danger or Imminent

Danger to person(s), equipment or the environment. Everyone who observe dangerous actions

and conditions could STOP the work and request for rectification before resume the work again.

Situations that warrant a SWA may include, but are not limited to the following:

• A modification or alteration that deviates from the way the job task is normally performed

may cause unsafe work actions or conditions.

• Unscheduled or unplanned event that distracts workers from the job task being performed.

• Observation with safety impact. Whenever a worker observes a condition or situation that

has an impact on safety.

• Incomplete understanding. Whenever a worker or co-worker does not completely

understand instructions, procedures or ongoing activities.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 65 of 71

• Relay information. Whenever a situation requires critical information to be relayed, an

unsafe work action or condition may occur. For example, shift change or employee

reassignment.

• Observing new hazards. Whenever a worker encounters risks that have not been addressed

during previous job safety analysis or risk assessments.

• Need to ask for help. Whenever a job requires additional people, or the experience level of

the person performing the job task requires support.

The affected area(s) will be reopened for work by personnel with restart authority. All affected

workers and contractors will be notified of what corrective actions were implemented and that

work will recommence.

No work will resume until all issues and concerns have been addressed.

18. EMERGENCY RESPONSE PROCEDURE The site ERP will be in accordance with document 26071-100-GPP-GHX-00002 Project

Emergency Handling Procedure (PEHP).

In the event of emergency, Construction Manager will be the person in charge from the

Contractor site. The project site PEHP will be aligned with Owner existing site CEHP. PEHP will

be explained more detail in Bridging Document of PEHP.

Contractor will include a process for identifying and reviewing potential emergency situation

and the mitigation and control events. In the PEHP will include as minimum, but not limited to

an emergency plan for rescuing personnel at the work site for the following events:

• Medical emergency including Medical Evacuation

• Rescue Injured Person (IP) at high elevations

• Falls from high elevations.

Train personnel by conducting regular emergency drills and exercises to test response

effectiveness.

EMERGENCY RESPONSE DRILL The Emergency Drill is one part of the Emergency Management Planning Process. This means

that the Emergency Response Plan, such as emergency communication flow, emergency

scenario, etc. must be tested to ensure that all existing provisions and guidelines can be

implemented and implemented properly.

In addition, the Emergency Response Guidelines are dynamic and must be renewed to maintain

their effectiveness in accordance with the developments and changes that exist.

Therefore, the Major Emergency Drill that involves all personnel must be carried out at least 1

(one) year. In addition, Minor Emergency Drill must be carried out at least 1 times per three

months.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 66 of 71

Emergency Response Plan provided by Contractor shall cover all area within scope/boundary of

RDMP RU-V Project.

EMERGENCY SIREN Below table describe emergency siren tones which informed the emergency situation.

No Condition Siren Remark

1 Incident occurred

3 min

3 minutes wavy siren

2 Evacuation

6 min 6 minutes repetitive siren (Hi low tone)

3 Safe/normal condition

1 minute Continuous siren

Table 10. Emergency Siren Tones

MEDICAL FACILITIES AND MEDICAL SERVICES REQUIREMENTS • In the event of medical evacuation, the IP (Injured Person) will be taken to Pertamina

hospital in Balikpapan for minor injury assessment and treatment.

• Contractor will provide the Ambulance and standby fulltime at site for emergency cases.

• Contractor will employ paramedics for site project. Paramedics will be assigned to assist

the Contractor’s site doctor. The paramedic will not be allowed to perform any medical

treatment without acknowledgement from the Contractor’s doctor. Paramedic will be

employed until final demobilization of all Contractor personnel. The Paramedic will be

assessed by Contractor’s Site Doctor or Medical Advisor.

MUSTER POINT AND ASSEMBLY POINT When an emergency evacuation siren is activated, all employees gather to the nearest assembly

point. Assembly point as the first destination that is considered safe and becomes the pick-up

point for workers before heading to the muster point if needed.

Assembly points will be set at each point of work, if there are several work points in an area, it

will be agreed and marked as a flag with the initial’s "A" indicating the assembly point. Workers

and guests will be directed to the nearest muster point.

There are 3 muster points when an emergency occurs in the refinery area:

1. Gate V

2. Head Quarter Pertamina RU V

3. HSE Pertamina RU V Office

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 67 of 71

Contractor shall provide and socialize to all employee the location of Assembly Point, Muster

Point and Wind sock. These location (map) shall be informed at HSE Notice board located at site

and office area.

Figure 8. Muster Point Map

19. INCIDENT INVESTIGATION Incident, accident and near-miss which involved to all personnel of Contractor and Sub-

Contractor shall be reported, investigated and analysed to prevent recurrence and improve

performance accordance to standards & procedures of Contractor. Investigations focus on root

causes and/or management system failures. Corrective actions and preventive measures are

utilized to reduce future injuries and losses.

The comprehensive incident / accident / near-miss investigation and reporting procedure

developed by HSE Committees includes measurement of recordable injury and illness

experience, incident preparedness, actions to be taken immediately after an incident, urgent

notice, investigation procedure, analysis of incident causes, incident potential assessment,

recommendation, implementation of recommendations, reporting and records.

The site Incident reporting will be in accordance with document 26071-100-GPP-GHX-00019

Incident Investigation Reporting and document 26071-100-GPP-GHX-00025 Illness

Notification & Reporting Procedure.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 68 of 71

20. PERFORMANCE EVALUATION

AUDITS Contractor shall conduct Audit programs to ensure HSE system are in place and effective. The

audit programs are defined as follows:

20.1.1. QUARTERLY HSE JOINT AUDITS BY CONTRACTOR AND OWNER

Involving both Contractor and Owner senior management and HSE team will be

participated in the audit and continued with HSE management system review, its

effectiveness and suitability in:

• Managing HSE risk

• Ensuring efforts to continually improve HSE performance

• Ensuring its continuing suitability and effectiveness

20.1.2. EXTERNAL AUDITS

The independent third party appointed by Contractor scheduled yearly to evaluate the

implementation in the project. HSE Audits are conducted to get information on how

HSE of the project are managed, the current shortcomings and concern and remedial

actions required to bring the situation to proper control and / or the risk to ALARP.

INSPECTIONS Coordinated by Contractor HSE Chief, these inspections maybe conducted with assistance from

the Project Management team, Site Management team, Project HSE Committee team, etc.

20.2.1. CONSTRUCTION OBSERVATION PROGRAM (e-COP)

Contractor shall develop program for reporting unsafe action and unsafe condition

through e-COP card. Also, Contractor shall respond and take corrective action on Owner

recommendation of inspection result.

The cause and corrective action shall be determined on e-COP report. Corrective Action

request shall be created after the audit report signed by observer. All observation and

closing status shall be registered.

20.2.2. DAILY/ROUTINE ASSESSMENT

Performed by HSE personnel’s and supervisors who supervise the work activities carry

out at site. The topic of audit could be focused in:

• Electrical safety implementation

• Working at height & scaffolding

• Confined space entrant

• LOTO & live system safety implementation

• Lifting & rigging safety implementation

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 69 of 71

Contractor Construction Manager has responsibility to ensure the audit attend by:

• Contractor & Subcontractor related discipline (refer the further topic and

schedule).

• Contractor & Subcontractor HSE.

The audit findings and recommendations will be reported to Contractor Construction

Manager and related discipline leader. If required it will be considered as attachment in

Subcontractor KPI HSE Performance.

20.2.3. WEEKLY SITE MANAGEMENT WALKDOWNS

In order to enforce safety rules, regulations and safety implementation at site on site

safe work practices, housekeeping, inspections, etc. Contractor has schedule of Site

Management Walkdowns in weekly basis. The Site Management Walkthrough is must

attend by:

• Owner Construction Manager

• Contractor and Subcontractor Construction Manager

• Contractor and Subcontractor Superintendent / Work Leader

• Contractor and Subcontractor HSE Chief

• Contractor and Subcontractor QC Coordinator

• Contractor and Subcontractor others Coordinator

During these programs, team members will do a walkdowns at worksite and observe

any unsafe action and condition. All team members shall take required immediate

action to close observed unsafe action and condition. Remaining issues which cannot

close at that time need to be registered into the findings list. The closing status for these

findings need to be updated to all team members regularly (e.g. every week).

20.2.4. QUARTERLY ENVIRONMENTAL INSPECTIONS AND ASSESSMENT

Performed by environmental superintendent and focus on environmental compliance

to ensure all applied environmental regulation from the government of Indonesia, local

government of East Kalimantan, International Standard, Company and Contractor rules

has been implemented. The HSE Manager will issue the report to Company as required.

INCENTIVES AND CONSEQUENCES

20.3.1. HSE INCENTIVE PROGRAMS

These programs will be expected to increase employee participation and they will be

more aware with HSE issues in their working environment.

HSE incentive programs will be rewarded to the following criteria:

• Displaying good/improvement initiative on HSE manner.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 70 of 71

• Setting a good example of safe work practices.

• A qualified hazards observation report – focusing on the work process/system

improvement – gives a beneficial input for work/process improvement.

• Influencing others in the working environment of positive/safe behaviour.

• Exceptional participation in HSE programs, PEKA, in terms of quantity and quality.

The detail of HSE Incentive Programs described in 26071-000-GPP-GHX-00029 Reward

and Punishment Procedure.

20.3.2. HSE CONSEQUENCE PROGRAMS

This procedure is designed to limit safety violations by imposing a set of measures that

would eventually lead to persistent violators being removed from the project to ensure

that all employees comply with HSE rules and requirements.

Contractor shall establish Consequence Management Committee which responsible to

decide the disciplinary action to be taken to the violators. The committee member shall

consist of following, but not limited to:

• Contractor’s Construction Manager.

• Contractor’s HSE Manager or Chief HSE.

• Sub-Contractor’s Construction Manager.

• Sub-Contractor’s HSE Coordinator.

• Contractor’s and Sub-contractor’s HR.

Disciplinary actions shall be applied to employees who violate safety rules and

requirements up to accumulated penalty points.

Penalty point are accumulated as per type of violations classified into 3 types as follows:

1. Minor offence (1 penalty point)

2. Major offence (2 penalty point)

3. Serious offence (6 penalty point)

Disciplinary action to be taken up to accumulated penalty points are referred to below

table:

Accumulated points Disciplinary actions to be taken

1 Point Verbal warnings are given to the offenders by Chief HSE

/Officer.

2 – 5 Points

Written warnings and re-trainings are given to the offenders

by Chief HSE /Officer. The training contains are specific

requirements related to that they had failed to comply with.

Doc. No.: 26071-100-G01-GHX-00002

Job No.: 26071 Rev.002

Page 71 of 71

> 5 Points

A consequence management committee meeting (refer to 8.4)

convenes to determine disciplinary actions such as follows, but

not limited to;

▪ Removal from project or

▪ Termination of employment or

▪ Temporary suspension of work or

▪ Temporary transfer to office work.

Table 11. Disciplinary Action to be Taken up to The Penalty Points

The detail of HSE Consequence Programs described in 26071-000-GPP-GHX-00029

Reward and Punishment Procedure.

21. ATTACHMENTS

Attachment 1. Project HSE Policy

Attachment 2. List of Regulations

Attachment 3. HSE Matrix Training

Attachment 4. CSMS Questionnaire

Attachment 5. HSE Program

Attachment 6. PPE Matrix

Attachment 7. Incident Process Flowchart

Attachment 8. HSE Organization Chart

Attachment 9. Change Management Request Form

Attachment 10. HIRAC Form

Attachment 11. JSA Form

Attachment 12. JHA Form

ATTACHMENT 1. PROJECT HSE POLICY

PROJECT HSE POLICY

RDMP BALIKPAPAN JO Management is committed to:1. Have the occupational health, safety and environment as a core value.2. Continual improvement in HSE performance, based on legal requirement,

government regulation, and HSE Management System which is adjusted tocondition and risk level identified in project.

3. Prevent all injuries, job illness and property damages resulted from projectactivities.

4. Prevent environmental pollution and environmental impact resulted from projectactivities.

5. Have a commitment to comply with all applicable Pertamina HSE Procedures.6. Provide workers who have understood / fulfilled the skill requirements in the HSE

aspect of the job.7. Organize documentation, implementation and maintenance of HSE Management

System.8. Prohibit the use of illegal drugs, liquor and firearms in the workplace.9. Review HSE Management System periodically to ensure that it is remains

relevant and appropriate to project.

This policy should be supported, understood and conducted by management,employees, vendors, and Subcontractors according to their role and responsibilitywithin this Project.

Jakarta, 27 February 2019

RDMP BALIKPAPAN JOProject Manager

ATTACHMENT 2. LIST OF REGULATIONS

NO REGULATIONS AND OTHER REQUIREMENTSHSEMS

ELEMENT/SECTION

CLAUSE

Requirements

1 26070-203-G01-GHX-J0001-000 Health, Safety, Security, AndEnvironmental (HSSE) Plan 4.6 All

2 26070-203-G80-GAX-J0001-B01 Scope of Work and ExecutionRequirements 8.2,

13.9All

EnvironmentGeneral

1 Undang-Undang No. 32 / 2009 – Perlindungan dan PengelolaanLingkungan Hidup 1 – 13 1, 2, 3, 4, 13, 14, 20, 21, 53,

54, 57, 58, 59, 60, 67, 68, 692 Peraturan Pemerintah No. 27 Tahun 2012 – Ijin Lingkungan 5 Pasal 53

3 PP No. 70 Tahun 2009 – Konservasi Energi 5 Pasal 7, BAB 3

4Permen LH No. 13 Tahun 2010 - UKL - UPL dan SuratPernyataan Kesanggupan Pengelolaan & PemantauanLingkungan Hidup 5

Pasal 2 - 9

Hazardous Material

5 Peraturan Pemerintah No. 74/2001 – Pengelolaan BahanBerbahaya dan Beracun 5, 9

6, 8, 9, 12, 13, 15, 16, 17,18, 19, 20, 22, 23, 25, 27, 28,29, 30, 31, 39

Hazardous Waste

6 Peraturan Pemerintah No. 101/2014 – Pengelolaan LimbahBahan Berbahaya dan Beracun 2, 5, 9

3, 4, 5, 7, 8, 9, 10, 11, 13, 14,16, 29, 30, 31, 54, 55, 56, 57,58, 59, 60, dst.

7 Peraturan Menteri Lingkungan Hidup No. 14/2013 – Simbol danLabel Limbah B3 2, 5, 9 Poin B dan C

8 Peraturan Menteri Lingkungan Hidup No. 18/2009 – Tata CaraPerIjinan Pengelolaan Limbah Bahan Berbahaya dan Beracun 2, 5, 9 1, 2, 3, 4,

9Keputusan Kepala Bapedal No. 01 Tahun 1995 – Tata Cara danPersyaratan Teknis Penyimpanan dan Pengumpulan LimbahBahan Berbahaya dan Beracun

5, 91, 2, 3, 4, 5, Lampiran 1 No.1, 2.1, 2.2, 3.1, 3.2, 4, 4.1,4.2, 4.3, 4.4,

10 Keputusan Kepala Bapedal No. 02 Tahun 1995 – DokumenLimbah Bahan Berbahaya dan Beracun 5, 9 1, 2, 3, 4, 5, Lampiran 1 No.

1, 2, 3, 4

11 Peraturan Menteri Lingkungan hidup - Simbol dan Label LimbahBahan Berbahaya Dan Beracun 5, 9 2, Lampiran

12Peraturan Menteri Negara Lingkungan Hidup No. 03 Tahun2008 – Tentang Tata Cara Pemberian Simbol dan Label BahanB3

5, 9 2,3, 4, dan Lampiran 1 No.

13 Surat Edaran Nomor : 08/Se/02/1997 - Penyerahan MinyakPelumas Bekas 5, 9 1 s.d. 6

Radioctive

14 Peraturan Pemerintah No. 61/2013 – Pengelolaan LimbahRadioaktif 5, 9 1, 5, 6, 12, 13, 14, 15, 16, 17,

20, 26, 30, 35

15 KEPBAPETEN No. 01/Ka-BAPETEN/V-99 - KetentuanKeselamatan Kerja Terhadap Radiasi

5 BAB II dan BAB IV

Water Resources16 Undang-Undang No.07/2004 – Sumber Daya Air 1 – 13 1, 7, 8, 9, 10

17 Peraturan Daerah Provinsi Kalimantan Timur No. 2/2011 -Pengelolaan Kualitas Air dan Pengendalian Pencemaran Air 5, 9 BAB IV - VII

18 Peraturan Daerah Provinsi Kalimantan Timur No. 14/2012 –Pengelolaan Air Tanah di Kalimantan Timur 5 BAB II dan BAB III

Liquid Waste

19 Peraturan Pemerintah No. 82/2001 – Pengelolaan Kualitas Airdan Pengendalian Pencemaran Air 2, 5, 9 7,8, 9, 10, 11, 12, 16, 17, 25,

26, 34, 35, 37, 38, 41, 42,

20Peraturan Menteri Lingkungan Hidup No. 19/2010 - Baku MutuAir Limbah bagi Usaha dan/atau Kegiatan Migas Serta PanasBumi

5, 9 TBA

21 Keputusan Menteri Lingkungan Hidup No. 51/1995 – Baku MutuLimbah Cair Bagi Kegiatan Industri 5, 9 1, 2, 5, 6, 8, Lampiran C

22Keputusan Menteri Lingkungan Hidup No. 122/2004 –Perubahan Atas KepMenLH No. 51/1995 tentang Baku MutuLimbah Cair Bagi Kegiatan Industri

5, 9 Pasal 1, 2, dan Lampiran

23 KepMenLH No. 112 Tahun 2003 - Baku Mutu Air LimbahDomestik 5,9 4,6,8 dan lampiran

Air Pollution, Odor, and Noise

24 Peraturan Pemerintah No. 41/1999 – Pengendalian PencemaranUdara 2, 5, 9

5, 9, 10, 20,22, 23, 24, 26,28, 30, 31, 34, 35, 36, 37,41, 42, 48, 49, 50, 51

25 Peraturan MenteriLingkungan Hidup No. 05/2006 – AmbangBatas Emisi Gas Buang Kendaraan Bermotor Lama 2, 5, 9 1, 2, 3, 4, 5, Lampiran No. B,

26 Keputusan Menteri Lingkungan Hidup No. 48/1996 – BakuTingkat Kebisingan 2, 5, 9 1, 2, 3, 5, 6, Lampiran 1, 2,

27 Keputusan Menteri Lingkungan Hidup No. 49/1996 – BakuTingkat Getaran 2, 5, 9

1, 2, 3, 5, 6, 7, Lampiran 1No, 1, 2, Lampiran 2 No. 1,2, Lampiran 3, Lampiran 4,Lampiran 5

28 Keputusan Menteri Lingkungan Hidup No. 50/1996 – BakuTingkat Kebauan 2, 5, 9 1, 2, 4, 5, Lampiran 1

Waste Management29 Undang-Undang No. 18/2008 – Pengelolaan Sampah 1 – 13 1, 2, 22, 23

Occupational Health and Safety30 UU No. 1/1970 – Keselamatan Kerja 1 – 13 1 s.d 18

31 UU No. 36/2009 – Kesehatan 1 1, 10, 28, 38,44, 46, 5632 PERMENKESNo 269/Menkes/per/III/2008 Rekam Medis 2, 5, 11 Bab I – Bab V

33 UU RI No. 22 Tahun 2009 – Lalu Lintas dan Angkutan Jalan 5 Bagian ketiga (Pasal 49 –56)

34 UU 03/1992 – JAMSOSTEK 1 3, 6, 8, 10, 17, 20

35 PP No. 53/2012 – JAMSOSTEK 1 Pasal 9, 22, dan 26

36 PER 02/MEN/1992 – Tata Cara Penunjukan Kewajiban danWewenang AK3 1 9, 10

37 PER 05/MEN/1996 – Sistem Manajemen K3 1 1 s.d. 8

38 PP No. 50 Tahun 2012 – Penerapan SMK3 1 1 s.d. 2239 PER 04/MEN/1987 – P2K3& Tata Cara Penunjukan AK3 1 2, 3, 12,

40 PER 02/MEN/1980 – Pemeriksaan Kesehatan Tenaga Kerjadalam Penyelenggaraan Keselamatan Kerja 5 9

41 PER 01/MEN/1976 – Kewajiban latihan Hiperkes Bagi DokterPerusahaan 5 1

42PER 01/MEN/1979 –Kewajiban Latihan Hygiene PerusahaanKesehatan dan Keselamatan Kerja Bagi Tenaga Para MedisPerusahaan.

5 1

43 PER 02/MEN/82 – Kwalifikasi Juru Las di Tempat Kerja 5 3, 4 , 30, 31

44 PERMENAKERTRANS No.09 /2010 – Operator dan PetugasPesawat Angkat dan Angkut 5 5, 6, 10, 12

45 PER 03/MEN/1999 – Syarat – Syarat K3 Lift untukPengangkutan Orang dan Barang 5 1, 3, 4, 5, 11, 12, 24, 27, 28

46 KEP 174/MEN/1986 – K3 pada Tempat Kegiatan Konstruksi 4 2

47 KEP 187/MEN/1999 – Pengendalian Bahan Kimia Berbahaya diTempat Kerja 7 2, 4, 5, 9

48 SK No. 261/MENKES/SK/II/1998 Persyaratan KesehatanLingkungan Kerja 5 BAB I. BAB II: A.1, B.1, C.1

49 KEPMENKES 1405/2002 – Persyaratan Kesehatan LingkunganKerja Perkantoran dan Industri 5 BAB VI: A, B. BAB XI

50 PERMENKES No. 492 / 2010 - Persyaratan Kualitas Air Minum 5 2, 6

51 PERMENKES No. 416 / 1990 – Syarat – syarat danPengawasan Kualitas Air 5 2, 4, 9

52 PER 02/MEN/1980 – Pemeriksaan Kesehatan Tenaga Kerjadalam Penyelenggaraan Keselamatan Kerja 5 1

53 PER 05/MEN/1985 – Pesawat Angkat dan Angkut 5 2, 3, 4, 7, 18, 19, 20, 27, 37,55, 54, 55, 101

54 PER 09/MEN/2010 – Operator Pesawat Angkat dan Angkut 5 Bab 2 – 8

55 KEPRES 22/1993 – Penyakit Yang Timbul Karena HubunganKerja 7 2, 3

56 KEPMENAKERTRANS No. 609/2012 - Pedoman PenyelesaianKasus Kecelakaan Kerja dan Penyakit Akibat Kerja 5, 6 2, 3

57 PER 04/MEN/1980 – Syarat – Syarat Pemasangan danPemeliharaan Alat Pemadam Api Ringan 7 3, 5, 11, 12

58 PER 02/MEN/1983 Instalasi Alarm Kebakaran Automatik 7 Bab 1 - 6

59 PERMENAKERTRANS No. 13/2011 NAB - Faktor Fisika danFaktor Kimia di Tempat Kerja 5, 6 4, 5, 12, 14, 15, 16, 17,

Lampiran 1 dan 2

60 KEP 186/MEN/1999 – Unit Penanggulangan Kebakaran diTempat Kerja 9 2, 3

61 PER 01/MEN/1981-Kewajiban Melapor Penyakit Akibat Kerja 1 4

62 PER 03/MEN/1998 – Tata Cara Pelaporan dan PemeriksaanKecelakaan 10 2

63 KEP 84/BW/1998 – Tata Cara Pengisian Formulir Laporan danAnalisis Statistik Kecelakaan 10 1 s.d 11

64 Kep. 333/MEN/1989 – Diagnosis dan Pelaporan Penyakit AkibatKerja 10 2

65 PERMENAKER No. 15/MEN/VIII/2008 - P3K 5 2 s.d 11, lampiran I, II, dan III

66 PERMENAKER No. 8 /MEN/VII/2010 – APD 5 2,5,6,7,8

67 KEPMEN Pertambangan dan Energi No. 300.K/38/M.PE/1997 –Keselematan Kerja Pipa Penyalur Minyak dan Gas Bumi 5 7,9,10,13

68PER.11/MEN/VI/2005 - Pencegahan dan PenanggulanganPenyalahgunaan dan Peredaran Gelap Narkotika, Psikotropikadan Zat Adiktif Lainnya di Tempat Kerja 1, 2, 5 2,3,4,5,6,7,8

69 PER.02/MEN/1989 - Pengawasan Instalasi Penyalur Petir 5 Bab 2 -10

70 PER. 01/MEN/1982 - Bejana Tekanan 5 Bab 1 - 5

71 KEP.68/MEN/IV/2004 - Pencegahan dan PenanggulanganHIV/AIDS di Tempat Kerja 5 2, 3, 4, 5

72 PER 01/MEN/1980 – K3 Pada Konstruksi Bangunan 2, 5, 9 1 - 105

73 PER07/MEN/1964 – Syarat Kesehatan , Kebersihan sertaPenerangan Dalam Tempat Kerja 5 5,6,8,11,14

74 PERMENKES No. 1096/MENKES/PER/VI/2011 – HigieneSanitasi Jasaboga 5 Bab 1-3

75 PP No. 55/2012 – Kendaraan 5 Bab 2-4

ATTACHMENT 3. HSE MATRIX TRAINING

No

T

R

A

I

N

I

N

G

I

N

S

T

R

U

C

T

U

R

E

FREQU

ENCY

Man

age

r

Ch

ief

Sup

eri

nte

nd

en

t

Engi

ne

er

Insp

ect

or

Sup

erv

iso

r

Fore

man

Ad

min

istr

atio

n

Secu

rity

P

ers

on

ne

l

Logi

stic

m

an

/ W

are

ho

use

Surv

eyo

r

Scaf

fold

er

Mat

eri

al

Han

dlin

g O

pe

rato

r

He

avy

Equ

ipm

en

t

Op

era

tor

Rig

gers

Ligh

t V

eh

icle

D

rive

r

We

lde

r

Pip

e

Fitt

er

Me

chan

ical

Fi

tte

r

Car

pe

nte

r /

Mas

on

Ele

ctri

cal

/ In

stru

me

nt

Re

bar

man

Pai

nte

r

Ge

ne

ral

Lab

or

Vis

ito

r

1 HSE Induction for Employee (Level 1)

JO HSE Trainer

Daily M M M M M M M M M M M M M M M M M M M M M M M M -

2 HSE Induction for Visitor (Level 1)

JO HSE Trainer

As required

- - - - - - - - - - - - - - - - - - - - - - - - M

3 Basic First Aid for Employee (Level 2)

JO Doctor/

Paramedic

As required

- O M M M M M O O O O O - - - - O O O O O O O - -

4 Basic Fire Fighting (Level 1)

JO HSE Trainer

Bi- weekly

O O M M M M M O M M O O O O O - M M M M M M O M -

5 Hand & Power Tools (Level 1)

JO HSE Trainer

Monthly - O - - - M M - - - - - - - - - O O O O O O - O -

6 Permit to Work (PTW) (Level 1)

JO HSE Trainer

As Required

O O M M - M M - - O O M - - - - - - - - - - - - -

7 Hazard Identification, Risk Assessment, JSA (Job Safety Analysis) (Level 1)

JO HSE Trainer

Weekly O M M M M M M - - M M M M M M O M M M M M M M M -

8 Working at Height & Fall Protection

JO HSE Trainer

Weekly O M M M M M M - O O O M M M M - M M M M M M M M -

No

T

R

A

I

N

I

N

G

I

N

S

T

R

U

C

T

U

R

E

FREQU

ENCY

Man

age

r

Ch

ief

Sup

eri

nte

nd

en

t

Engi

ne

er

Insp

ect

or

Sup

erv

iso

r

Fore

man

Ad

min

istr

atio

n

Secu

rity

P

ers

on

ne

l

Logi

stic

m

an

/ W

are

ho

use

Surv

eyo

r

Scaf

fold

er

Mat

eri

al

Han

dlin

g O

pe

rato

r

He

avy

Equ

ipm

en

t

Op

era

tor

Rig

gers

Ligh

t V

eh

icle

D

rive

r

We

lde

r

Pip

e

Fitt

er

Me

chan

ical

Fi

tte

r

Car

pe

nte

r /

Mas

on

Ele

ctri

cal

/ In

stru

me

nt

Re

bar

man

Pai

nte

r

Ge

ne

ral

Lab

or

Vis

ito

r

Equipment (Level 1)

9 Confined Space (Level 2)

JO HSE Trainer

As Required

O O M

O O M M - - - - M - - - - M O O - O - O O -

10 Scaffolder Training (Level 2)

JO HSE Trainer

Weekly - - - - M O - - - - - M - - - - - - - - - - - - -

11 PEKA/e-Construction Observation Program (Level 1)

JO HSE Trainer

Daily M M M M M M M M M M M M M M M M M M M M M M M M -

12 Respiratory Protection (Level 1)

JO HSE Trainer

Daily O M M M M M M - M O O O O O O O O O O O M O O M -

13 Safe Driving Course (Level 2)

JO HSE Trainer

Quarterly O O O O O O O - O O O - - - - M - - - - - - - - -

14 HSE Leadership (Level 1)

JO HSEM/Chief

Monthly M M M M M M M - - O O - - - - - - - - - - - - - -

15 Hot Work (Level 1)

JO HSE Trainer

Monthly - - M O O M O - - - - - - - - - M M M - M O - O -

16 Slinging, Rigging & Lifting Refreshment Training (Level 2)

JO HSE Trainer

Monthly - - M O M M - - - - - - M M M - - - - - - - - - -

No

T

R

A

I

N

I

N

G

I

N

S

T

R

U

C

T

U

R

E

FREQU

ENCY

Man

age

r

Ch

ief

Sup

eri

nte

nd

en

t

Engi

ne

er

Insp

ect

or

Sup

erv

iso

r

Fore

man

Ad

min

istr

atio

n

Secu

rity

P

ers

on

ne

l

Logi

stic

m

an

/ W

are

ho

use

Surv

eyo

r

Scaf

fold

er

Mat

eri

al

Han

dlin

g O

pe

rato

r

He

avy

Equ

ipm

en

t

Op

era

tor

Rig

gers

Ligh

t V

eh

icle

D

rive

r

We

lde

r

Pip

e

Fitt

er

Me

chan

ical

Fi

tte

r

Car

pe

nte

r /

Mas

on

Ele

ctri

cal

/ In

stru

me

nt

Re

bar

man

Pai

nte

r

Ge

ne

ral

Lab

or

Vis

ito

r

17 Incident Investigation Training (Level 2)

JO HSE Trainer

Quarterly O M M M M M O - O O - - O - - - - - - - - - - - -

18 Excavation Work (Level 1)

JO HSE Trainer

Bi- Weekly

- - M O - M M - - - - - - - - - - - - - - - - O -

19 Emergency Preparedness & Response (Level 1)

JO HSE Trainer

Bi- Weekly

O O M M M M M - M M M M M M M M M M M M M M M M -

20 Waste Management (Level 1)

JO HSE Trainer

Bi- Weekly

- O M O O M M - - - - - - - - - - - - - - - - - -

21 Electrical Safety (Level 1)

JO HSE Trainer

Bi- Weekly

- O M O O M M - - M - - - - - - - - - O M - - - -

22 Mechanical Safety (Level 1)

JO HSE Trainer

Bi- Weekly

- O M O O M M - - - - - - - - - - - M - - - - - -

23 Chemical & Hazardous Substance Handling (Level 1)

JO HSE Trainer

Bi- Weekly

- O M O O M M - - M - - M - - - - - - - - - - - -

24 Industrial Hygiene (Level 1)

JO Doctor/

Paramedic

Quarterly - O M O O M M - - - - - - - - - - - - - - - - - -

25 Lock Out Tag Out JO As - O M O O M M - - - - - - - - - - - M - M - - - -

No

T

R

A

I

N

I

N

G

I

N

S

T

R

U

C

T

U

R

E

FREQU

ENCY

Man

age

r

Ch

ief

Sup

eri

nte

nd

en

t

Engi

ne

er

Insp

ect

or

Sup

erv

iso

r

Fore

man

Ad

min

istr

atio

n

Secu

rity

P

ers

on

ne

l

Logi

stic

m

an

/ W

are

ho

use

Surv

eyo

r

Scaf

fold

er

Mat

eri

al

Han

dlin

g O

pe

rato

r

He

avy

Equ

ipm

en

t

Op

era

tor

Rig

gers

Ligh

t V

eh

icle

D

rive

r

We

lde

r

Pip

e

Fitt

er

Me

chan

ical

Fi

tte

r

Car

pe

nte

r /

Mas

on

Ele

ctri

cal

/ In

stru

me

nt

Re

bar

man

Pai

nte

r

Ge

ne

ral

Lab

or

Vis

ito

r

(LOTO) (Level 1)

HSE Trainer Required

26 Incident Injury Free (IIF) (Level 1)

3rd Party Daily M M M M M M M M M M M M M M M M M M M M M M M M O

Note: M: Mandatory O: Option

□ Perkakas Tangan / Hand Tools □ Mesin Las / Welding Machine □ Mesin Pilling / Pilling Machine

□ Alat Berat / Heavy Equipments (Dozer, Excavator,Compactor, Grader)

□ Tangga / Stairs □ Pompa / Pumps

□ Trailer, Lowboy □ Rigging/Hoisting □ Kapal Laut / Vessel

□ Truk / Truck □ Kompresor / Compressor □ …

□ Crane □ Scaffolding □ …

□ Bahan Kimia Berbahaya / Hazardous Chemicals □ ...

□ Bahan Peledak / Explosive Materials □ ...

□ Bahan Radioaktif / Radioactive Materials □ ...

□ Fabricator □ Batching Plant □ Earth Work & Earth Moving

□ Forwarder □ Coating & Painting □ Chemical Cleaning

□ Offshore □ Concrete & Foundation Activity □ Electrical

□ Diving □ Drainage □ Cathodic Protection Activity

□ Pipe Laying □ Scaffolding □ Post Trenching

□ Trenching of Dredging □ Barge & Vessel Owner □ Weather Forecast Activity

□ Architectural Work □ Deepwell Activity □ HVAC Installation

□ Instrument □ Piling □ Steel Structure

□ Insulation □ Plumbing □ Temporary Facility

□ Land Clearing □ Portacamp Mob. & Lifting □ Topography

□ Logging □ Raw Water Intake Work □ Transportation Provider

□ Mechanical □ Roofing & Siding □ …

□ Medical Services Provider □ Security Service □ …

□ NDT - Radiography □ Soil Investigation □ …

Perwakilan Perusahaan,Company Representative,

Nama / Name :Tgl / Date :

ATTACHMENT 4. CSMS QUESTIONNAIRE

CONTRACTOR SAFETY MANAGEMENT SYSTEM QUESTIONNAIRE

1. Nama Perusahaan / Company Name :

2. Bidang Pekerjaan / Work Field :

3. Peralatan yang Digunakan / Equipments Used :

4. Material yang Digunakan / Materials Used :

5. Lingkup Pekerjaan / Scope of Work :Catatan: jika lebih dari satu jenis pekerjaan, maka pastikan Anda melampirkan dokumen CSMS yang diminta seperti prosedur, pelatihan, dan sertifikasi sesuai denganmasing-masing jenis pekerjaan.

Note: if more than one kind of work, you shall to attached CSMS documents as requested such as procedure , training , and certification related to each kind of work

Catatan / Note : NO.1 s/d 5 harus diisi oleh Perusahaan yang mengajukan penilaian CSMS / No.1 to 5 shall be completted by Company who propose CSMS assessment



KUESIONER / QUESTIONNAIRE EVIDENCE / LAMPIRAN BUKTI NILAI / SCORE BOBOT / WEIGHT KETERANGAN / REMARKI

Apakah perusahaan Anda memiliki kebijakan K3LL,terdokumentasi & ditandatangani oleh pimpinanperusahaan?

Salinan kebijakan K3LL perusahaan

Does your company have HSE Policy, documented & approvedby Company Leader? Copy of HSE policy

Bagaimana cara perusahaan Anda mensosialisasikankebijakan K3LL?

Bukti sosialisasi: daftar hadir dan materiorientasi pekerja / tamu

(sebagai tambahan dapat melampirkanposter kebijakan, banner)

How does your company socialize the HSE policy?

Socialization evidences: attendance list andorientation materials

(in addition please attach poster, banner)

Siapakah orang yang bertanggung jawab dalampenerapan sistem manajemen K3LL di perusahaan Anda?

Riwayat kerja orang yang bertanggungjawab dalam penerapan sistem manajemenK3LL di perusahaan

Who is the responsible person for implementing the HSEmanagement system at your company?

CV of the responsible person for implementingthe HSE management system at the company

Jelaskan bagaimana keterlibatan pemimpin perusahaanAnda terkait dengan penerapan sistem manajemen K3LL?

Notulensi rapat P2K3 mengenai peninjauanulang sistem manajemen K3LL

Please, explain the involvement of your company leaderregarding HSE management system implementation?

P2K3 minutes of meeting about review of HSEmanagement system

0 8II

Apakah perusahaan Anda memiliki organisasi P2K3 danLL?

Struktur organisasi dilengkapi dengannama

Does your company have HSE committee organization? Complete organization chart with name

Sebutkan tugas dan tanggung jawab masing-masingpersonil dalam penerapan sistem manajemen K3LL diperusahaan Anda?

Tugas dan tanggung jawab masing-masingpersonil dalam penerapan sistemmanajemen K3LL

Please, explain the job description of each personnel regardingHSE management system implementation at your company?

Job description of each personnel in HSEmanagement system implementation

Apakah perusahaan Anda memiliki HSE personil yangkompeten untuk memberikan panduan dalam programK3LL?

Riwayat pekerjaan serta sertifikasi(Depnaker / Migas) pimpinan HSE personil

Does your company have competent HSE personnel that drivethe HSE program?

CV and certification (Depnaker / Migascertification) of HSE leader

Apakah perusahaan Anda melakukan pemeriksaankesehatan secara berkala? Catatan hasil MCU dan rekapitulasi

Does your company carry out the Medical Check Up regularly? MCU record and recapitulation

Apakah perusahaan Anda memiliki program Jamsostek /asuransi kesehatan dan kecelakaan?

Salinan kartu Jamsostek / asuransikesehatan dan kecelakaan

Does your company have Jamsostek / health and accidentinsurance program?

Copy of Jamsostek / health and accidentinsurance card

NOKEPEMIMPINAN & KEBIJAKAN K3LL / LEADERSHIP & HSE POLICY

1 0 2

2 0 2

3 0 2

4 0 2

NILAI TOTAL / TOTAL SCOREKEPATUHAN TERHADAP PERATURAN PERUNDANGAN K3LL / HSE REGULATION COMPLIANCE

1 0 2

2 0 2

3 0 3

4 0 2

5 0 2



Apakah perusahaan Anda memiliki personel kunci yangkompeten sesuai lingkup pekerjaan?

Riwayat pekerjaan dan sertifikasi keahliankerja (contoh: sertifikasi welder, SIOperalatan berat, dll)

Does your company have competent key personnel related tothe scope of work?

CV and certification of job skills (e.g. weldercertification, heavy vehicle license, etc.)

Apakah perusahaan Anda mengelola peralatan operasidengan mematuhi ketentuan dari pihak berwenang(sertifikasi, kalibrasi)?

Sertifikat alat berat, kalibrasi peralatan, ataulainnya

Does your company manage operation equipments comply withregulations (calibration, certification)?

Heavy vehicle certification, equipmentcalibration or etc.

0 15III

Apakah perusahaan Anda memiliki program danmemberikan pelatihan K3LL secara internal / eksternal?

Salinan prosedur pelatihan K3LL,matrikspelatihan, daftar hadir, materi pelatihaninternal (contoh: pelatihan APD, Bekerja diketinggian, pelatihan pengelolaan bahankimia, HSE induksi, dll)

Does your company have program and give HSE internal /external training?

Attendance list, copy of HSE training procedure,and training materials (e.g. PPE training,chemical handling, induction, etc.)

Apakah perusahaan Anda memberikan pelatihan kepadakaryawan sesuai dengan lingkup pekerjaan?

Matriks dan sertifikat pelatihan bidangkeahlian kerja

Does your company give training to employee related to thescope of work?

Matrix and training certificate of work skill

0 6IV

Bagaimana perusahaan Anda mengelola subkontraktoryang dapat mendukung program K3LL perusahaan?

Salinan prosedur pengelolaansubkontraktor / CSMS

How does your company manage subcontractor for supportcompany HSE program?

Copy of subcontractor management procedure /CSMS

Bagaimana perusahaan Anda memastikan bahwasubkontraktor memahami dan melaksanakan programK3LL?

Hasil evaluasi subkontraktor / dokumenkontrak yang memuat aspek K3LL

How does your company ensure that subcontractor understandand implement HSE program?

Subcontractor evaluation result / contractdocument that mention the HSE aspect

0 4V

Apakah perusahaan Anda memiliki prosedur kerja sesuaidengan lingkup pekerjaan?

Daftar dan salinan prosedur kerja sesuaidengan lingkup pekerjaan

Does your company have working procedure related to thescope of work?

List and copy of working procedure related tothe scope of work

Apakah perusahaan Anda memiliki rencana programK3LL untuk pelaksanaan proyek? Salinan rencana program K3LL

Does your company have HSE plan for project execution? Copy of HSE plan

Apakah perusahaan Anda memiliki prosedur identifikasibahaya dan penilaian risiko?

Salinan prosedur identifikasi bahaya danpenilaian risiko (JSA, RA)

Does your company have hazard identification and riskassesment procedure?

Copy of hazard identification and riskassesment procedure (JSA, RA)

Apakah perusahaan Anda memiliki contoh JSA dan RAsesuai dengan detail / lingkup pekerjaan?

Contoh JSA dan RA sesuai dengan detail /lingkup pekerjaan

Does your company have an example of JSA and RA related tothe detail / scope of work?

Example of JSA and RA related to the detail /scope of work

6 0 2

7 0 2

NILAI TOTAL / TOTAL SCOREPELATIHAN / TRAINING

1 0 4

2 0 2

NILAI TOTAL / TOTAL SCOREMANAJEMEN SUBKONTRAKTOR / MANAGEMENT OF SUBCONTRACTOR

1 0 2

2 0 2

NILAI TOTAL / TOTAL SCOREHSE DALAM DESAIN, KONSTRUKSI, DAN KOMISIONING / HSE IN DESIGN, CONSTRUCTION, AND COMISSIONING

1 0 2

2 0 4

3 0 2

4 0 2



Apakah perusahaan Anda memiliki prosedur Izin KerjaAman? Salinan prosedur Izin Kerja Aman

Does your company have Permit to Work procedure? Copy of Permit to Work procedure

Apakah perusahaan Anda memiliki prosedur tentang APDdan membuat daftar APD sesuai spesifikasi lingkuppekerjaan?

Salinan prosedur APD (perawatan,penyimpanan, dll) dan daftar APD sesuaidengan lingkup pekerjaan (jenis danspesifikasi sesuai standar nasional /internasional)

Does your company have PPE procedure and make a list ofPPE and specification related to the scope of work?

Copy of PPE procedure (maintenance, storage,etc.) and list of PPE related to the scope of work(type and specification according to national /international standards)

Bagaimana perusahaan Anda memastikan APD telahditerima oleh karyawan sesuai dengan lingkup pekerjaan? Catatan distribusi dan inventarisasi APD

How does your company ensuring PPE accept properly byworker related to the scope of work? PPE distribution record and inventory

Apakah perusahaan Anda memiliki program HigieneIndustri? (pencahayaan, debu, suhu, ergonomi, dll) Laporan pengukuran Higiene Industri

Does your company have Industrial Hygiene program?(illumination, dust, temperature, ergonomic, etc.)

Industrial Hygiene measurement report

Apakah perusahaan Anda memiliki prosedurpengendalian tumpahan bahan kimia?

Salinan prosedur pengendalian tumpahanbahan kimia

Does your company have chemical spill handling procedure? Copy of chemical spill handling procedure

Apakah perusahaan Anda memiliki prosedur pengelolaanlimbah? Salinan prosedur pengelolaan limbah

Does your company have waste management procedure? Copy of waste management procedure

Bagaimana cara perusahaan Anda menangani limbahB3? (oli bekas, tumpahan minyak, material B3 kadaluarsa,pelarut, dll)

Manifest limbah B3

How does your company handle hazardous waste? (used oil, oilspill, expired hazardous material, solvent, etc.)

Manifest of hazardous waste

0 24VI

Apakah perusahaan Anda memiliki prosedur manajemenperubahan? Salinan prosedur manajemen perubahan

Does your company have management of change procedure? Copy of management of change procedure

Bagaimana cara perusahaan Anda melakukanmanajemen perubahan?

Salinan form manajemen perubahan(contoh: perubahan struktur organisasiperusahaan, perubahan penggunaanperalatan di tempat kerja, dll)

How does your company perform management of change?Copy of management of change form (e.g.organizational-structural change, equipmentchange, etc.)

0 4VII

Apakah perusahaan Anda melakukan inspeksi umumtempat kerja?

Bukti inspeksi K3LL (min: 2 periodeinspeksi)

Does your company carry out the general workplaceinspection?

Evidence of HSE inspection (min: 2 inspectionperiods)

5 0 2

6 0 2

7 0 2

8 0 2

9 0 2

10 0 2

11 0 2

NILAI TOTAL / TOTAL SCOREMANAJEMEN PERUBAHAN / MANAGEMENT OF CHANGE

1 0 2

2 0 2

NILAI TOTAL / TOTAL SCOREINSPEKSI / INSPECTION

1 0 2



Bagaimana cara perusahaan Anda untuk menindak lanjutitemuan inspeksi? Laporan tindak lanjut hasil temuan

How does your company follow up the inspection findings? Report of follow up inspection finding

Apakah peralatan kerja Anda diinspeksi sebelum dikirimke lokasi proyek (mobilisasi)? Bukti hasil inspeksi peralatan

Does your company equipments inspected before sent toproject site area (mobilization)?

Evidence of equipment inspection results

Apakah perusahaan Anda melakukan inspeksi pada alatkerja yang digunakan? Jadwal dan hasil inspeksi alat kerja

Does your company do inspection for working equipments? Equipment inspection schedule and result

0 8VIII

Apakah perusahaan Anda melakukan rapat toolbox /safety talk?

Daftar hadir dan materi rapat toolbox /safety talk

Does your company carry out toolbox / safety talk meetingprogram?

Attendance list and materials of toolbox / safetytalk meeting

Apakah perusahaan Anda mengkomunikasikan JobSafety Analysis / Risk Assessment ? Daftar hadir komunikasi JSA / RA

Does your company communicate Job Safety Analysis / RiskAssessment?

Attendance list JSA / RA communication

Apakah perusahaan Anda memiliki sarana komunikasiK3LL lainnya? (HSE news , HSE bulletin , HSE Alert dll)

Contoh HSE news , HSE bulletin , HSE Alertdll

Does your company have other HSE communication tool? (HSEnews, HSE bulletin, HSE Alert etc.)

Example of HSE news, HSE bulletin, HSE Alertetc.

0 6IX

Apakah perusahaan Anda memiliki prosedur emergensi? Salinan prosedur emergensi

Does your company have emergency procedure? Copy of emergency procedure

Apakah perusahaan Anda melakukan pelatihanemergensi secara berkala? Laporan pelatihan emergensi

Does your company do the emergency drill regularly? Emergency drill report

0 6

X

Apakah perusahaan Anda memiliki prosedur pelaporankecelakaan kerja?

Salinan prosedur pelaporan kecelakaankerja

Does your company have incident reporting procedure? Copy of incident reporting procedure

Apakah perusahaan Anda mencatat statistik kecelakaandalam 3 tahun terakhir? (LTIFR, LTISR, dll)

Statistik kecelakaan tiga tahun terakhir(jika ada, mohon lampirkan contoh laporaninvestigasi kecelakaan)

Does your company record the accident statistic for last 3years? (LTIFR, LTISR, etc.)

Accident statistic report for last 3 years(if available, please attach example of accidentinvestigation report)

0 4XI

Bagaimana cara perusahaan Anda mendokumentasikandan memperbaharui program K3LL?

Kumpulan daftar dokumen, salinanprosedur pendokumentasian, dan lembarrevisi

How does your company document and renew the HSEprogram?

Master list of HSE document, copy of documentcontrol prosedur, and historical sheet

0 2

2 0 2

3 0 2

4 0 2

NILAI TOTAL / TOTAL SCOREKOMUNIKASI / COMMUNICATION

1 0 2

2 0 2

3 0 2

NILAI TOTAL / TOTAL SCORETANGGAP DARURAT / EMERGENCY RESPONSE

1 0 3

2 0 3

NILAI TOTAL / TOTAL SCOREPELAPORAN DAN PENYELIDIKAN KEJADIAN KECELAKAAN DAN PENCEMARAN LINGKUNGAN /REPORTING AND INVESTIGATION OF INCIDENT AND ENVIRONMENTAL POLLUTION

1 0 2

2 0 2

NILAI TOTAL / TOTAL SCOREDOKUMENTASI / DOCUMENTATION

1 0 2

NILAI TOTAL / TOTAL SCORE



XIISalinan prosedur evaluasi K3LL

Does your company have HSE evaluation procedure? Copy of HSE evaluation procedure

Apakah perusahaan Anda melakukan internal audit K3LL? Jadwal dan laporan hasil internal auditK3LL

Does your company carry out HSE internal audit? Schedule and report of HSE internal audit

Apakah perusahaan Anda memiliki sertifikat sistemmanajemen K3LL dari pemerintah / badan sertifikasi?

Salinan sertifikat OHSAS 18001: 2007, ISO14001: 2004, SMK3, penghargaan jam kerjaaman, dll

Does your company have HSE management systemcertification from government / certification agencies?

Copy certificate of OHSAS 18001:2007, ISO14001: 2004, SMK3, reward for zero accident,etc.)

0 9XIII

Apakah perusahaan Anda memiliki prosedur tentangpromosi / reward HSE ?

Salinan prosedur promosi / reward HSE

How does your company have HSE promotion / rewardprocedure?

Copy of HSE promotion / reward procedure

Bagaimana perusahaan Anda menerapkan programreward dan punishment HSE ?

Salinan penghargaan atau pemberianhadiah kepada pekerjaSalinan sangsi disiplin kepada pekerjamengenai pelanggaran K3LL

How does your company implement HSE reward andpunishment program?

Copy of reward for workerCopy of punishment for worker regarding HSEviolation

0 4

Date:Prepared by, Reviewed by,

(Name) (Name)(Position) (Position)

EVALUASI / EVALUATION

1 0 3

2 0 3

3 0 3


NILAI TOTAL KESELURUHAN / TOTAL SCORE OVERALL

0 100Minimal Skor kelulusan Offshore 70Minimal Skor kelulusan High Risk 60Minimal Skor kelulusan Low Risk 50

(COMPANY NAME) HAS PASSED / NOT PASSED THE QUALIFICATION

REWARD DAN PUNISHMENT / REWARD AND PUNISHMENT

1 0 2

2 0 2


ATTACHMENT 5. HSE PROGRAM

NO HEALTH & SAFETY ACTIVITY PLAN /

EXPECTATION

PROCEDURE / APPENDIX

REFERENCE

TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY PRIMARY RESPONSIBILITY

1. Project

Induction

Guideline.

2. Project Staff

Induction Record.

Record of Daily Tool Box

Meeting for attendance

and topics.

Site top management

have to attend this daily

tool box meeting

Weekly

Construction

Meeting

Construction progress

coordination and discussion

meeting, include HSE issues

Minutes of meeting

record with HSE as the

first agenda

Weekly Construction Manager

Safety Committee

Meeting

Discuss HSE issues and Project

progress

Minutes of Meeting of

record and attendance

record

Monthly Construction Manager

General safety

talk

A HSE discussion for All worker

on project

Make topics schedule and

record for Attendance list

Weekly Construction Manager, HSE

Manager

Internal Training

Course

Training Nomination Form

must be filled out prior to any

training taking place

Form to signed off by

Project Manager prior to

training taking place

Every time proposing

to attend a course

General Superintendent /

Construction Manager

Training

Attendance Sheet

Records have to be kept of all

persons attending training

Training attendance sheet

completed

At every training

course

Project HSE Admin. or HSE Chief

Training Register Records have to be kept of all

persons attending training

Training attendance sheet

completed

At every training

course

Project HSE Admin. or HSE Chief

Safety Notice

Board

Display all policies, Safety

minute of meeting, review

result of inspection, incidents,

audits and others

Safety notice boards are

placed in each work areas

and displaying

Monthly Project HSE Admin. or HSE

Coordinator

RDMP BALIKPAPAN JO

Ensure employees receive safety training

appropriate to their task and

responsibility

3

2 Conduct regular meetings with Contractor

staff, SubContractors and client to discuss

HSE

issues.

Project HSE Plan related

Communication Procedure

Project HSE Plan

Communicate HSEpolicy and procedures to all employees, sub-Contractors, COMPANY and other stakeholders as appropriate to ensure them

aware of their obligations with respect to Contractor’S operation.

HEALTH & SAFETY PROGRAM

Establish Health, Safety, and

Environmental promotional material to

improve the employee awareness

4 Project HSE Plan, HSE

Communication and

Training Procedure

1 Conduct orientation / induction for

employees, SubContractors and visitors to

the site.

HSEManagement Plan and

CSMS

Requirement

All project Contractor Staff,

SubContractor Staff and visitor

Personal induction record

is maintained.

New hire employees,

Transferred

employees and visitor

CM, HSE Chief, HSEM

Daily Tool Box

Meeting

A HSE discussion for each

group on worker readiness,

work plan for that day and

possible JSA.

Every starting of shift

work

Site Supervisor, Discipline

Superintendent


EXPECTATION


REFERENCE


RDMP BALIKPAPAN JO


Safety

Performance

Boards

Display project performance

review against its objective

and target

HSE performance board

placed in front of REK

office and displaying

project performance

review result

Update Weekly Project HSE Admin. or HSE

Coordinator

Safety Alerts A Safety Alert shall be

produced for high actual or

potential incidents

Safety Alerts produced

and displayed

Each occurrence PM, CM, HSE Chief or HSEM

Follow up all relevant

corrective action of incoming

safety alerts from other

projects

Follow up action

incorporated into the

Project HSE Plan

As Job condition

require

PM, CM, HSE Chief or HSEM

Cautionary and

Warning Sign

Develop and display relevant

cautionary and warning sign

(list of warning sign like tape

barricade, etc.)

Cautionary and warning

signs developed and

displayed on the

hazardous work places

Once when it's

determined

CM, Discipline Superintendent

5 Ensure that we are fully informed of all

applicable health and safety laws,

regulations, statutory obligations and

Company Safety requirement and comply

with those laws and regulation

None Legal Gap

Analysis

Review all relevant legal

aspects project such as:

relevant statutory

requirements, contractual

requirements and Company

HSE requirements

Legal Gap Analysis is

developed and reviewed.

Project procedures or

working instruction may

be developed to fill the

gap.

At start of project and

as a result of any

amendments to

legislations and client

requirements

CM, Discipline Superintendent

6 We will analyze all areas of our activity

and identify the risk level

Project HSE Plan and HSE

Register

JSA & Risk

Assessment

Identify all common hazards

and risks, which are associated

with each project activity

Conceptual Risk

Assessment is developed

At start of project /

every starting of job


Superintendent

Job Safety

Analysis

JSA must be completed for

new jobs and high-risk jobs.

Completed JSA Prior to start of the

jobs


Superintendent

JSA Review Ensure all JSA's are suited to

jobs carried out

JSA Review report During the job in

progress

HSE Chief

Comply with all applicable HSE laws, regulations, and statutory obligations.

Ensure that health and safety management and practices are incorporated into all aspects of Contractor operations

Establish Health, Safety, and

Environmental promotional material to

improve the employee awareness

4 Project HSE Plan, HSE

Communication and

Training Procedure

7 Where those procedures are not

applicable or suitable develop, implement

and maintain specific workplace

procedures to ensure operations are

conducted in such a manner that

eliminates the risk of injury, illness or

damage.


Register


EXPECTATION


REFERENCE


RDMP BALIKPAPAN JO


Workplace

Hazard Inspection

Carry out workplace hazard

inspection for each project

work area

Checklist of workplace

hazard inspection is

completed, followed up

and closed out

As per schedule Project Supervisor and HSE

Chief

8 Investigate a workforce safety

performance incentive scheme

Project HSE Plan Project Safety

Incentive Scheme

Safety Incentive criteria is

established and communicated

Safety Performance is

monitored and reviewed

by committee

Monthly CM

Regular meetings, which

attended all member of

project safety committee.

Minutes of meetings is

produced and

communicated

Monthly CM

Regular inspection, which are

to carried out by all member of

project safety committee.

A checklist for this

inspection is developed

and completed

Monthly HSE Chief

Workplace

Hazard Inspection

Carried out a workplace hazard

inspection for their own area

of responsibility

A checklist of this

inspection is completed,

followed up and closed

out by relevant

signatories, 85 % close out

action

Monthly Discipline Superintendent,

Project Supervisor

Project HSE

Committee

All signatories take a part in

Project Safety Committee, if

appointed as a member of it

Signatories attended on

meeting and recorded.

Take a part on inspection

Monthly CM

Tool Box Meeting All signatories involved in this

meeting on their own area of

responsibility



Daily Site Supervisor, Discipline

Superintendent

Safety Talks All signatories involved in this

meeting.

Signatories attended

meeting and record

Weekly CM, HSE Chief

Weekly

Construction

Meeting

All signatories involved in this

meeting, with "safety" as the

first agenda of meeting.



Weekly CM

7 Where those procedures are not

applicable or suitable develop, implement

and maintain specific workplace

procedures to ensure operations are

conducted in such a manner that

eliminates the risk of injury, illness or

damage.


Register

9 Involve the workforce in the

implementation of the safety program

through the formation of a workplace

safety committee

Project HSE Plan

Seek to achieve the personal commitment of all employees, sub-Contractors and suppliers to HSE workplace practices.

Provide Leadership on all issues of safety

management

Project HSE Plan

Project HSE

Committee

10


EXPECTATION


REFERENCE


RDMP BALIKPAPAN JO


Standard

Instruction

Developing specific standard

instruction or review existing

or template standard

instruction to be suited to the

works

Standard Instruction is

developed,

communicated and

maintained

All works shall

covered by standard

instruction

CM, HSEM

Permit to Work A restriction and limitation to

personnel in carrying out the

works known as a high risk

Excavation Permit,

Working at Height Permit,

Radiography Permit, Hot

Permit to Work, Entry Into

Confined Space Permit,

Electrical Permit to Work,

Crane Permit, Cold Permit

to Work

As required CM, HSE Chief

Job Safety

Analysis (JSA)


new jobs, risk jobs, or jobs that

are not covered by SOP or

Standard Instruction prior to

commencement of the jobs

Completed JSA (Job Safety

Analysis)

Prior to

commencement of

the jobs


Superintendent

JSA Review Ensure all the jobs are carry

out in accordance to JSA

JSA Review report,

Updated JSA revision

number

During the job in

progress

HSE Chief

Pre-start

inspection

Inspection of all equipment

must be carried out

Checklist completed Before mobilize to site CM, HSE Chief

Preventive

Maintenance

Inspection

All plant and equipment are

scheduled for maintenance

Checklist completed As per Schedule Project GSI and Mechanical

Supervisor

Workplace

Hazard Inspection

Carry out workplace hazard

inspection regularly

A checklist of this

inspection is completed

and closed out

weekly Discipline Superintendent,

Project Supervisor

Job Safety

Analysis


new jobs, risk jobs, or jobs that

are not covered by SOP or

Standard Instruction.

Completed JSA Prior to

commencement of

the jobs


Superintendent

Provide HSE risk management systems and procedures that are relevant to the nature and scale of work undertaken

11 Ensuring that operations are carried out

according to standard Contractor

procedures


Register

Risks to health, safety and environment

will be dealt with by elimination, or

removal, substitution, design, redesign, or

separation, administrative and personal

protection

12 Project HSE Plan

13 Provide risk identification and

management in their work areas

Risk Register


EXPECTATION


REFERENCE


RDMP BALIKPAPAN JO


JSA Review Ensure all the jobs are carry

out suited to JSA

JSA Review report,

Updated JSA revision

number

During the job in

progress

HSE Chief

Hazard Reporting Supervisory staff to enforce

the reporting of hazards that

may arise before, during and

after the works

Hazard report is

produced.

Hazard register is

maintained.

Corrective Action is

recorded.

Every Day Site Supervisor, Discipline

Superintendent, HSE

Superintendent

14 Ensuring that operations are carried out

according to environmental standard

Project HSE Plan Standard

Instruction (SI)

and Work

Instruction (WI)

Developing environment

standard instruction or review

existing or template

environment standard

instruction to be suited to the

works

Standard Instruction is

developed,

communicated and

maintained

All works shall

covered by standard

instruction

CM, HSEM

To do better that the

corporate target: LTIFR <1,

LTISR < 1.0, with Fatality=0,

Medical Treatment =0

Property Damages =0,

Environmental Damages = 0,

HSE Performance min 90

(based on HSE Evaluation

Safety Statistic

Performance, HSE

Evaluation

Twice a Month CM

Corporate HSE Audit

compliance rate minimum 90

Target is reviewed and

communicated

As per schedule CM

Audit internal project

minimum 1 sub- Contractor

per month

Target is reviewed and

communicated

Monthly CM

None

Project Safety

Performance

Target

15 Set the Safety Performance targets for the

project

Set measurable targets and seek to continually improve our HSE performance

13 Provide risk identification and

management in their work areas

Risk Register


EXPECTATION


REFERENCE


RDMP BALIKPAPAN JO


16 Conduct assessment and review of key

personal HSE in implementing HSE

Management System

None Assessment HSE

Management

System Checklist

Formal review of the

implementation HSE

Management System and

performance Project Manager

or HSE Chief

Action plan from the

review

Every 3 months or as

required

HSEM

Corporate HSE

Audit

Corporate HSE audit shall be

conducted on a regular basis

Corporate Audit Report As per schedule CM

Internal Safety

Audit

Every workplace shall be

audited against the HSE plan

by internal audit

Internal site HSE audit Monthly CM, HSE Chief, HSEM

Emergency

Response Plan

Develop emergency response

plan and maintain its

preparedness and equipment

Plans are regularly

reviewed. The

preparedness emergency

equipment is checked

regularly

Every Six-Month CM, HSE Chief

Emergency

Response

Training

Ensure all personnel involved

in Emergency Response Team

have been trained in ERP

ERP Training will be given

to Site Project Team by

Owner

Before project start HSEM, Owner HSEM

Emergency

Rehearsal

Practice the Plan by simulating

an emergency situation

A written emergency

rehearsal report

Quarterly PM, CM, HSE Chief or HSEM

Site Medical

Services and

Ambulance

First Aid Facilities to manned

per day (Working Hours) by

trained medic / paramedic

Medical Kit is maintained

and completed

Every Week Paramedic

Rehabilitation

Plan

Ensure that rehab plan is

developed and agreed to by

employee

Completed Rehab Plan Every Rehabilitation

Case

CM, HSE Chief

19 Conduct Exercise Program None Gym or Exercise All signatories involved in this

Gym or Exercise

Signatories attended this

Gym or Exercise

Weekly CM, PM, HSE Chief

Safety Notice

Board and Project

Induction

All contractor Staff,

SubContractor Staff and visitor

Result of Monitoring Monthly CM, HSE Chief

Drug Test Random drug test Drug test result Random (Weekly) HSE Chief & CM

Project HSE Plan

No smoking at office site and working

area, use drug and alcohol and carry

weapon

20

18 Undertake and establish Emergency

Preparedness

Project HSE Plan

Prepared for Exercise Program

Periodically review and revise our HSE Policy and procedure to maintain Contractor relevance

Prepared for emergencies and response quickly, effectively and with care to incidents resulting form Contractor operation

Rules and Regulations at Site

17 The Project will be audited regularly Project HSE Plan


EXPECTATION


REFERENCE


RDMP BALIKPAPAN JO


21 Conduct selection our Sub-Contractor Project HSE Plan HSE Questioner

(CSMS)

All sub-Contractor Result of questioner High

Risk Category > 60, 35 –

59 : Low Risk Category

Validity every 2 years Project Manager, Project

Procurement Manager and

Project HSE Manager

22 Conduct Accident Investigation Project HSE Plan Accident

Investigation

Form

All Major Accident and Minor

Accident (First Aid)

Completed Accident

Investigation Form

As per Event CM, HSE Chief

23 Regular report Accident Project HSE Plan Accident

Reporting Form

All Major Accident and Car

Accident

Completed Accident

Reporting Form

1 x 24 Hours HSE Chief, Discipline

Superintendent

In encourage Safety Behaviour Awareness,

will request to our employee to report all

unsafe act and unsafe condition

Project HSE Plan Unsafe Act and

Unsafe Condition

Form

All unsafe act and unsafe

condition

Completed Unsafe Act

and Unsafe condition

Form

Every Day All Project Team

In monitoring implementation HSE

Management System at project site.

Request project team to provide HSE

Report

None HSE Report Form Implementation HSE

Management System, Man-

Hours, Man- power, Total

Accident for all employee of

Contractor and All

SubContractor

Completed HSE Report

Form

Monthly HSE Chief

25 Conduct General Medical Check-up for all

new employee of Contractor

Project HSE Plan General Medical

Check-up Form

All employee of Contractor

assigned to the Project

Result of General Medical

Check-up

As required Project Manager and

Construction Manager, Health

Coordinator

26 Conduct General Medical Check-up for

Sub Contractor Supervisor to Up level


Check-up Form

All employee of Sub Contractor

Supervisor to Up level who

assign to the Project


Check-up

As require CM, Medical Advisor

27 Conduct General Medical Check-up for all

Sub Contractor employee


Check-up Form

All employee of All Sub

Contractor

employee who assign to the

Project


Check-up

As require CM, Medical Advisor

28 Vital Check for high risk worker Project HSE Plan Vital Check Blood pressure check for high

risk worker

Daily check for high risk

worker, no indication of

high blood pressure

Daily Medical Advisor & HSE Chief

Incident Injury Free® Program

Selection of SUBContractor

Health Program of RDMP Project

24

Accident Investigation and Reporting

Safety Awareness Program


EXPECTATION


REFERENCE


RDMP BALIKPAPAN JO


29 To implement IIF® program to the entire

EPC RDMP Balikpapan Project

Project HSE Plan IIF® Program Engage JMJ, start implement

IIF ® Program at RDMP

Balikpapan Project

Activitities report

(Training attendees,

observation etc)

as required (see

attached table)

PM, CM, HSE Chief or HSEM

NO ENVIRONMENTAL ACTIVITY PLAN /

EXPECTATION


REFERENCE

WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY PRIMARY RESPONSIBILITY

Control the schedule waste

management (Hazardous Chemical

Material) and provide MSDS at site.

- Master List and inventory of

scheduled waste, - Storage of

hazardous waste, - COMPANY

for handling waste schedule

must registered by

Government.

As required CM, Discipline Superintendent,

HSE Chief

Control the non-schedule waste

through organic and non-organic

waste

Weekly monitoring form

completed

Weekly HSE Chief, Discipline

Superintendent

2 Liquid Spill Control Project HSE Plan Provide oil container and oil traps by

the site drainage

Monitoring form completed Monthly CM, HSE Chief

3 Communicate Contractor

Environmental Policy & Procedure

Project HSE Plan All project Contractor staff,

SUBContractor staff and visitor

Induction record, Record

daily tool box meeting,

minute of meeting and

attendance all HSE Meetings

As required CM, HSE Chief

4 Ensuring that operations are carried

out according to environmental

standard

Project HSE Plan Developing environmental standard

instruction or review existing or

template environmental standard

instruction to be suited to the work

Standard instruction is

developed, communicated

and maintained

All works shall covered

by standard instruction

Site Supervisor, HSE Chief

5 Conduct accident investigation and

reporting

Project HSE Plan All major and minor accident Complete accident and

investigation form

As per event for

investigation and 1 x 24

hours for accident

reporting

CM, Discipline Superintendent,

HSE Chief

6 Rules & Regulation at site: use drug

and alcohol and carry weapon

Project HSE Plan All project Contractor staff,

SUBContractor staff and visitor

Result of monitoring Monthly CM, HSE Chief

7 Encourage behavior awareness Project HSE Plan All unsafe act and unsafe condition Complete unsafe act and

unsafe condition form

Every Day All Project Team

RDMP BALIKPAPAN JO

ENVRONMENTAL PROGRAM

Waste Management Control1 Project HSE Plan

ATTACHMENT 6. PPE MATRIX

PPE Minimum Welding Grinding Excavation Rigging Electrical Confined Space

Helmet (yellow color) ANSI Z89.1 - 2003, Type Iclass G and E

ANSI Z89.1 - 2003, Type I classG and E

ANSI Z89.1 - 2003, Type Iclass G and E

ANSI Z89.1 - 2003,Type I class G and E


ANSI Z89.1 2003, Type Iclass E


Safety Glasses ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003SNI Standard or ASTM F2413-2005 Impact

SNI Standard or ASTM F 2413-2005 Impact

SNI Standard or ASTM F2413-2005 Impact

SNI Standard or ASTMF 2413-2005 Impact


ASTM F 2413-2005 ImpactResistance Class 75 (I/75)


Resistance Class 75 (I/75)and Compression

Resistance Class 75 (I/75) andCompression


Resistance Class 75(I/75) and Compression


and CompressionResistance Class 75(C/75) with


Resistance Class 75 (C/75) Resistance Class 75 (C/75) Resistance Class 75(C/75)

Resistance Class 75(C/75)


electrical protection suchas


o Electric shock resistance(EH) up to 14,000 V or

o Static Dissipative (SD),106 ohms - 1010 ohmsoro Conductive (CD), 0-500,000 ohms

- ANSI S3.19 - 1974 forNRR labeling

- ANSI S3.19 - 1974 for NRRlabeling






- ANSI S12.6 – 1997 forNRR testing

- ANSI S12.6 – 1997 for NRRtesting






- ANSI S3.19 - 1974 forNRR labeling- ANSI S12.6 – 1997 forNRR testing

Respiratory Protection NIOSH Title 42 CFR 84-1995 NIOSH Title 42 CFR 84-1995

Face Shield ANSI Z87.1 - 2003 - HighImpact Level Protection

Welding Helmet ANSI Z87.1 2003 - High LevelProtection

SCBA NIOSH Title 42-1995SABA NIOSH Title 42-1995

EN407–2004 for flammability,contact heat,

EN407–2004 forflammability, contact heat,

ASTM D 120–2006Specification for RubberInsulating

convective heat, radiant heat,small splashes

convective heat, radiantheat, small splashes Gloves (electrical)

molten metal or large splashesof molten metal

molten metal or largesplashes of molten metal

ANSI Z359.1: SafetyRequirements for PersonnelFallArrest Systems,Subsystems andComponents

Coverall Coveralls Grey Color (100% cotton) with stripe scotchlight shall be worn by all worker and company Name (at front and back of coveralls)

Fall Protection

ANSI Z359.1: Safety Requirements for Personnel Fall

Arrest Systems, Subsystems and Components (MANDATORY ONLY FOR WORKING ABOVE 6 FEET)

Hand Protection N/A

Safety Shoes

Ear Plug

Ear Muff

ATTACHMENT7.INCIDENTPROCESSFLOWCHART

INCIDENTTITLE: DATEOFINCIDENT: INCIDENTLEADER: INCIDENTNO:

1.VISITSCENE 1. Check Investigator’s Safety All Wearing PPE, protect Information at scene, JSA of investigation site

Continue Collecting Evidence

1.

2.PROTECT 2. Gather evidence that might disappear from rain of work activities

2.

3.SELECTTEAM 3. Based on investigation team matrix

3.

4.COLLECTINFORMATION

4. Information CollectionPeople, Equipment, Environment, Systems:

Induction/training records Inspections / audit records Maintenance schedules andprocedures

License/Certificates ofcompetency

Manufacturer equipment manual Operating manual

Permits Purchasing records, warranties etc Procedures / rules

Checker MSDS Other authorities reports(Police, client)

4.

5.SEQUENCEOFEVENTS

5.a Incident Description,what happened , who Injured/Involved, time of incident,

5.a Incident description

5.b. Organize information collected to display fullof events

Go back in time

Review what else needs investigating Start thinking what contributed

5.b. Place Information on a whiteboard

6.DEVELOPYTREE

6. Start with“What Happened”and repeatedly askWhy?

Stop when the informationis:TrivialToo timely & costly tocollectGone far enough to make arealistic recommendationScrap potential causes ifnot supported

Keep asking:

What haschanged?

Record realisticcauses

Review list ofpotential causes

Be specific

Cross link causes

6.Place Information on a whiteboard

7.PLANFURTHERINVESTIGATION

7. Investigate undecided/unknown items that are from the Sequence of Events and the Y Tree.

7. What else needs investigating?

8.UPDATESEQUENCE&YTREE

8. Rearrange or add to sequence of events if required

8.Update both Sequence and Y tree using “post it”

9.DETERMINECONTRIBUTINGFACTORS

9. All answers on the Y Tree are contributing factors.

Must know determine which are the main factors to highlight in the report and undertake Correctiveactions. Focus on those factors for which:

The incident would not have happened if the factors were not present There are practical actions to prevent recurrences

9. List contributing factors

10.ACTIONFORADRESSINGCONTRIBUTINGFACTORS

10. Brainstorm ideas§ Seek expert advise§ Apply quick fixes until long term solutions are available§ Test the actions:Critically - Timing - Cost - University* - Responsibility - Alternatives

(Eachcontributingfactormusthaveoneormoreactions)*Whenrequiredthirdpartyconsultation

10. List actions for each contributing factors and By Who? And By When?

11.SITEREVIEW 11. Conduct review to ensure all the facts are correct and everyone is in agreement with the findingsand proposed actions

11. List names of people in review

12.PRODUCEREPORT1) Cover Page2) Executive Summary3) Keyrecommendations4) Investigation team

5) Background6) InvestigationPlan7) Incident Description8) Incident Causes

9) What controls were inplace

10) Action11) Attachments12) Use standard headings

Attach photos, permits,training records, etc

12.

ATTACHMENT 8. HSE Organization Chart

Change Management Request Form

1 of 6

ATTACHMENT 9. CHANGE MANAGEMENT REQUEST FORM

CHANGE MANAGEMENT REQUEST FORM

Describe the Proposed Change:

Company/Department: Date:

Change Initiator:

STEP 1: CHANGE DETERMINATION

No. Determine nature of the change. Does the proposed change: Y N N/A

1 Alter existing or introduce new plant and/or equipment?2 Any change to a Contractors or Sub Contractors SoW?3 Alter existing or introducing of a new Safe System of Work?4 Modify material used (i.e. properties, composition, etc.)?5 Introduction or Change to a fixed alarm and set point?6 Alter the organisation structure, roles and responsibilities?7 Any change to the operating controls or DCS logic philosophy?

8 Alter or add processes, plant or equipment requiring new skills, knowledge orprocedures.

9 Alter programmable electronic software and settings?10 Alter the design/plan/layout of roads, excavations, services and facilities?

11 Alter the ergonomics specifications of the equipment, plant or activity (i.e. weightto be lifted, pressure exerted, posture, etc.)?

12 Affect the emergency response and ability to raise alarm?

13 Increase levels of exposure to temperature, noise, dust, fumes, gas and/orvibration generated?

14 Create new environmental emissions eg dust, noise, waste, sediment?15 Alter land use (disturbance of mining, non-mining and rehabilitated areas)?16 Alter energy use or greenhouse gas emissions?17 Alter the impact to community (i.e. lighting, noise, dust, etc.)?18 Require new or modified approvals, licenses or permits?19 Be in conflict with any company or legislative requirements?

If one or more “yes” boxes are ticked, then the change management form is to be completed.


2 of 6

STEP 2: ASSESS THE RISK

· Using the ADVERSE IMPACT OF CHANGE MATRIX, rank each impact type:

Change Impact Type N/A Minor Serious MajorImpact on safety/harm to peopleEnvironmental impactImpact on ScheduleCost ImpactImpact on ReputationImpact on CommunityLegal impact

Change Risk Category RISK ASSESSMENT REQUIREMENTS (Results to be attached)

LOW 1. JSA to be re-reviewed and re-written to incorporate withthe change occur.

MEDIUM 2. Requirements 1 and method statement may need to beprovided and approved.

HIGH 3. Requirements 2, Conduct a Risk Assessment Workshopand Prepare Action Plan.

Comment on the risks of undertaking this change.

Comment on the risks of not undertaking this change.

STEP 3: DETAILS OF THE CHANGE

Describe the reasons for change, providing hard evidence to support the need/opportunity.

Describe the benefits of this change.


3 of 6

When does the change need to take place and why?

STEP 4: COMMITMENT AND APPLICATION

List any Technical Experts that need to be consulted on the proposed change.

List the people/groups that need to be consulted on the proposed change?

List the people that need to commit to the process.

List systems, policies, procedures, plans, schedules, competencies, etc this change effects.


4 of 6

STEP 5: ACTION PLAN

· See back of document for detailed action plan.

SUBMISSION

CHANGE INITIATOR:

Print name in full Signature Date

STEP 6: APPROVALSTAGE 6.1TECHNICAL EXPERT (HIGH RISK)

Print name in full Signature DateSTAGE 6.2CHANGE AUTHORIZER: (BASED ON THE LEVEL OF RISK)DISCIPLINE SUPERINTENDENT (LOW RISK)


CONSTRUCTION MANAGER (MEDIUM RISK)


PROJECT MANAGER (HIGH RISK)



5 of 6

ADVERSE CONSEQUENCE OF CHANGE MATRIX

ChangeConsequence Type Minor Serious Major

Impact on safety/harmto people Low level

symptomsrequiring first aidtreatment only.Working conditionscausing discomfortor strain.

Seriousinjury/permanentdisability orimpairment to oneor more persons.Serious reversiblehealth effectsrequiring medicaltreatment.

Permanent loss ofworking ability,irreversibledamage. Localisedoutbreak ofinfectious disease

Single or multiplefatalities orirreversibleimpacts to multiplepeople.Widespreadoutbreak ofinfectious disease.

Environmental impact Limited damagecontained to alocalised area, withno lasting impact.Nuisance localimpact (eg dust,noise) with nocomplaints.

Localised mediumterm damage to anarea of local valuereversible withmedium termremediation.Directive fromregulator resultingfrom nuisanceimpacts.

Wide spread /significant longterm damage tovalued area,reversible withlong termremediation.Suspension ofoperations.

Significant,extensive &permanent impact.Loss of permit tooperate. Loss ofendangeredspecies.

Impact on Schedule < 1 day 1-4 weeks 4-12 weeks > 12 weeks

Cost Impact < $100,000 $500,000 to$5,000,000

$5,000,000 to$25,000,000

>$25,000,000

Impact on Reputation Minor technicalnon-complianceresolved within oneweek.No mediacoverage.

Attention frommedia, negativelocal & regionalpublicity.Moderate orSerious breach ofregulations withfine.

Significantnegative attention,national publicity.Reputationtarnished.Legal action.

Prolonged negativeinternationalpublicity.Reputationseverely tarnished.

Impact on Community

Local publicconcern /complaints.No compensationrequired.

Ongoing socialissues.Aggressivecommunityreaction.Suspension ofproject works.External arbitrationrequired.

Ongoing serioussocial issues.Repairable damageto high value itemsof socialsignificance.

Very serious socialimpacts.Irreparable damageto high value itemsof socialsignificance.Governmentintervention.

Legal impact Minor non-compliances andbreaches ofregulations.

Serious breach ofregulation withprosecution ormoderate finepossible.

Major breach ofregulation. Majorlitigation.

Significantprosecution andfines. Very seriouslitigation includingclass action.

LEGEND: LOW

MEDIUM

HIGH


6 of 6

ACTION PLAN· All agreed actions are to be entered into Code No. for tracking.

· Each action plan is required to have an action to review the effectiveness of the change at an agreed period following the change.

# Change item Nature of item and change Action review effectiveness Who When Code No.1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

: Approved by ::

EXTREME HIGH RISK 15 - 30

HIGH RISK 8 - 12

: MEDIUM RISK 4 - 6

: LOW RISK 1 - 3

:

1 2 3 4 6 7 8 9 10 11 12 13 17 18

H OS E PS Y/N Y/N

1

2

3

4

5

6

7

8

9

10

S PTot

ScoreRHazard/Aspect

Hazard CategoryDetail Risk Explanation Consequency Consequency Category Hazard Code

Residual Risk

Additional Control Planned PICHS ES P

Tot

ScoreR

No. Regulation

Initial Risk Value

Potency of Major

Incident Hierarcy of Control Existing Control

Y/N

No Process / Activities

Operation

Condition

(N/A/E)

Source of Introduction

Activity

Risk Identification Legal

5 14 15 16

Project Name RDMP Project

Date

Total Page Number

Revision Purpose :

HAZARD IDENTIFICATION RISK ASSESMENT & CONTROL (HIRAC)

HIRA Registration No. Prepared by: Reviewed by: Reviewed by: Reviewed by: Risk CategoryRevision No.

wayan_sanbudi

Text Box

ATTACHMENT 10

JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

ENGINEERING PROCUREMENT CONSTRUCTION FOR

REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-

V BALIKPAPAN PROJECT

HSE Job No. : 26071

JSA Number / NomorJSA : RDMP / JSA / ……………….. / …………………

Company : Prepared By Review by Approved by

Project : RDMP Balikpapan RU V SPV Chief/MGR HSE CM

Person in charge name : NAME

Position/ Title job : SIGNATURE

Job activity :

Date : DATE

NO

Sequence of Basic Job

Steps

Tahapan pekerjaan

Hazard

Bahaya

Risk

Resiko

Consequence /

severity

Akibat

Risk Assessment* Recommendation action

Tindakan Pengendalian

Result Risk*)

PR SV RR PR’ SV’ RR’

Probability (PR) x Severity / consequence

Keparahan =

Risk Rangking (RR)

Tingkat Risiko

Recommendation Action

TindakanPengendalian

Score Level Tingkat pengendalian Hierarchy of Control

Frequent =5 Catastrophic = 5 19-25 Extreme high E= 1+2+3+4+5 1= Eleminasi

Probable = 4 Major = 4 13-18 High H= 3+4+5 2= Substitusi

Occasional = 3 Moderate / serious = 3 6-12 Medium M= 4+5 3= REKIND technik

Unlikely = 2 Minor = 2 1-5 Low L = 5 4= Administrasi

Improbable = 1 Negligible = 1 5= APD

Note : * : Without Control / Tanpa control *): With Control / Dengan control

ATTACHMENT 11

JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

ENGINEERING PROCUREMENT CONSTRUCTION FOR

REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-

V BALIKPAPAN PROJECT

HSE Job No. : 26071

JSA Number / NomorJSA : RDMP / JSA / ……………….. / …………………

DAFTAR PENJELASAN JSA

No Nama Posisi Tanda Tangan

Tgl : Tgl : Tgl : Tgl : Tgl : Tgl : Tgl :

JOB HAZARD ANALYSIS (JHA)

Job No.: 26071 Rev.000

Company : Job Location :

SV/Foreman Name : Job

Description

:

Position/ Title job :

Job Location :

Date : Approved by

(SV/Foreman

Signature)

:

Revision :

In case of emergency condition and/or incident, the following people will be

contacted:

1. SV/Foreman Name Phone No.:

2. Phone No.:

3. Phone No.:

Job Steps/Sequences Potential Hazard(s) Recommended Action

On what conditions, job changes or distraction will this activities temporarily stop?

ATTACHMENT 12

project hse plan - EXIM.GOV

Documents

Transcript of project hse plan - EXIM.GOV