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KEGIATAN : Pekerjaan Pengadaan, Pemasangan dan Pemeliharaan Peralatan Tol

Pada Jalan Tol Bakauheni – Terbanggi Besar (Gerbang Bakauheni –
Kalianda dan Lematang – Kota Baru)

LOKASI : Bakauheni – Terbanggi Besar

Tanggal Pengesahan : 10 Oktober 2016

Dibuat, Diperiksa, Disetujui,

(Ali Khumaidi) Stelarius Baura Ir. Bayu Wicaksono

HSE Officer HSE Manager Direktur

PT. DELAMETA BILANO ensure the fulfillment of the requirements and customer
satisfaction and continually improve the effectiveness of the Quality Management System
and Management System Health and Safety at Work, provides a framework for establishing
and reviewing the goals of quality and K3, communicated and understood within the
organization, and reviewed for suitability of kelanjutannyamelalui System Health & Safety
management (SMK3) by:
a) Set a goal, plan, implement and evaluate the objectives and programs of Health & Safety
(K3) on a regular basis in order to align both with the development of the company's
condition, applicable regulations or standards and expectations Costomer.
b) Comply with legislation and other requirements relating to K3, and integrate it into all
aspects of the operations of PT. DELAMETA BILANO.
c) To identify hazards appropriate to the nature and scale of risk - the risk of K3 in the PT.
d) Provide procedures for establishing and reviewing work sasaranK3.
e) Provide sufficient resources to implement K3 Management System (SMK3).
f) To document, implement and maintain K3 Management System.
g) Maintain Environmental Protection program of the activities in all the locations working
h) Communicate and instill awareness of this policy to all personnel on a regular basis.
i) Manage and handle all materials, whether hazardous or harmless, including control
potential hazards are in the working environment PT. DELAMETA BILANO.
j) To enhance the competence of workers in accordance with the duties and responsibilities.
k) Review the management aspects of the K3 PT. DELAMETA BILANO periodically to keep
it relevant to the legislation in force.

List of Laws and Regulations and Requirements K3L used as a reference in implementing

1 Undang-Undang/UU No. 18 Tahun 1999 About Construction Services
2 Undang-Undang/UU No. 1 Tahun 1970 About Occupational Health and Safety
3 Peraturan Pemerintah/PP No. 50 Tahun 2012 About the Management System Occupational
Health and Safety
4 OHSAS 18001 : 2007 Occuptional Health and Safety Management
System Specification
5 ISO 9001 : 2008 About Manjaemen Quality System
6 PERMENNAKERTRANS No 01/Men/1980 About K3 in Building Construction
7 PERMENNAKERTRANS No 02/Men/1980 About Health Check in the Implementation of
Labor Occupational Safety
8 PERMENNAKERTRANS No 04/Men/1980 About Terms Installation & Maintenance
9 PERMENNAKERTRANS No 01/Men/1981 Obligation to Report on Occupational
10 PERMENNAKERTRANS No 03/Men/1982 Occupational Health Services
11 PERMENNAKER No 04/Men/1987 About P2K3 and Procedure for Appointment
of Expert K3
12 KepMen No 1135/MENNAKER/1987 About Flag K3
13 PERMENNAKER No 04/Men/1988 About Safety of Electrical Installation in the
14 Instruksi MenNaker No 1/MEN/1988 About Enhancing Procurement Monitoring &
Control of the Company's Diner & Toilet
15 KepMen No 147/MENNAKER/1989 About Health Care Utilization for JPK
Jamsostek Program
16 KepMen No 333/MENNAKER/1989 TentangDiagnosis & Reporting Occupational
17 KepPres No 51/1989 Changes magnitude President Order No.
28/1988 On Accident Insurance Death
Benefit Social Insurance & Labor
18 PERMENNAKER No 02/Men/1992 On Procedures for appointment, Obligations
and Privileges Ahli K3
19 KepPres No 22/1993 Disease Occur Because Of Employment
20 PerMenNaker No 04/MEN/1993 About Work Accident Insurance
21 KepMenNaker No 51/Men/1999 About Threshold Limit Values for Physical
Factors in the Workplace
22 KepMenNaker No 187/Men/1999 About Control of Hazardous Chemical
Substances in the Workplace
23 KepMen No 186/MENNAKER/1999 About Fire Fighting Unit in the Workplace
24 PerMenNaKerTrans No 11/Men/VI/2005 On the Prevention and Combating Drug
Abuse & Illicit Traffic in Narcotic Drugs,
Psychotropic Substances Additives & Others
in the Workplace
25 Surat Edaran Menakertrans No About Diligence Implementation K3
117/Men/PPK/III/2005 Shopping Center, Building Storey & Other
Public Places


Head of Unit K3 (Management
1. Approve the project-specific
1. Establish a work program work instructions 1. Ahli K3 Umum
and perform all safety and 2. Perform periodic inspection 2. OHSAS 18001:2007
health activities at the project site 3. Training ERP
site / office. 4. ISO 9001:2008
5. Awareness SMK3
2. Provide briefings and
training in project K3 / office

3. Supervise the work.

Unit Secretary K3

1. Responsible for 1. Represents Head of Unit K3 1. Ahli K3 Umum

Occupational Health and Safety in touch with external parties in 2. OHSAS 18001:2007
(K3) and provide technical relation to SMK3 3. Training ERP
support and guidance on safety 4. ISO 9001:2008
and health (K3) for each activity 5. Awareness SMK3
Occupational Health and Safety 6. Fire Fighting
(K3) to employees. 7. First Aid
2. Responsible for promoting
and introducing Management
System Occupational Health
and Safety (K3) to employees,
the owner of the project, sub-
contractors and suppliers.
3. Assess and monitor the
implementation of the
Occupational Health and Safety
(K3) in the project.
4. Reporting to the head of the
unit for the performance K3
5. Ensuring the implementation
of the improvement of the
implementation of K3
continuously at the project site.

1. Develop a Safety Plan.

2. Conduct Training K3
3. Organize. Consultation and
4. Hold meetings K3
5. Documentation, document
control and recording.
6. Organize Personal
Protective Equipment (PPE).
7. Permits and Work
Instructions High Risk Jobs
8. Inspection K3
9. Organize monitoring,
performance measurement K3
10. Conduct an internal audit


Chairman of the Emergency
Response Team 1. Announced emergencies.
2. referral to the nearest 1. Ahli K3 Umum
1. Lead and be responsible hospital. 2. OHSAS 18001:2007
for all kejiatan in the event of 3. Answering questions from 3. Training ERP
an emergency. the relevant agencies 4. ISO 9001:2008
2. Report the incident to his 5. Awareness SMK3
3. Ask for help to the fire
department and police
station nearby
Vice Chairman of the
Emergency Response Team

1. Assist Leaders tasks 1. Replace the head when the 1. Ahli K3 Umum
related to emergency head of the task is not present, 2. OHSAS 18001:2007
Emergency Response 3. Training ERP
2. Monitor the development 4. ISO 9001:2008.
of the state of emergency 5. Awareness SMK3
and report to Chairman
3. Coordinate the activities of
the entire team coordinator.
Team ERT (Emergency
Response Team)
1. Understand the evacuation 1. As the task of implementing 1. OHSAS 18001:2007
work instructions, the behest of Chairman of the 2. ISO 9001:2008
emergency stairs, emergency Emergency Response Team 3. Training ERP
exits, gathering place and
communication techniques.

2. Understand the clear

layout and usage procedures
of small fire extinguisher
(APAR), alarm system,
evacuation provisions, and
3. Ensure that all employees
in the area of its
responsibility to leave a
dangerous area.

Team Coordinator small fire

extinguisher (APAR)

1. Understand clearly 1. Provide a report on the 1. OHSAS 18001:2007

Procedures Emergency situation APAR 2. Fire Fighting
Preparedness and Response, 3. Training ERP
emergency door, emergency 4. ISO 9001:2008
stairs, and others.
2. Understand the clear
layout and usage procedures
of small fire extinguisher
(APAR), alarm systems,
evacuation conditions, etc.
3. Ring the nearest fire alarm
(break glass) currently find
their fire or smell smoke.
4. Extinguish the flame if it is
safe to do.
5. Ensure that all employees
have left the area.
Evacuation Team

1. Evacuate all employees to 1. OHSAS 18001:2007

the place of assembly (Muster 2. Fire Fighting
1. Collecting state and local POINT) 3. Training ERP
keryawan number. 4. ISO 9001:2008
2. Ensure that employees in
the area have to understand
work instructions

3. At the time of emergency,

responsibility for collecting
all employees in the area of
its responsibility and take
him to get to Muster POINT
(gathering place).

4. Report To Chairman Tim

Tam \ nggap Emergency

Team Coordinator First Aid


1. Monitor all employees 1. Make reference to the 1. OHSAS 18001:2007

were evacuated in a hospital when needed. 2. Fire Fighting
gathering place 3. Training ERP
4. ISO 9001:2008
2. Provide first aid if no 5. First Aid
employees were injured yan
Coordinator of the
Communication and
1. Using the communication 1. OHSAS 18001:2007
tools available 2. Fire Fighting
1. Receiving the report, 2. Closing the entrance except 3. Training ERP
submit a report, contact the the exit toward the gathering 4. ISO 9001:2008
relevant parties on the orders point in the event of an
of the head of Tim
3. Anticipate crime.
2. Notify the incident to all
employees about the
3. Secure the scene of the
fire and provide the location
of a gathering place.

4. Assist the role of team

tasks that require fire.

5. Set up a place to put the

fire truck.

6. Set the state to ease traffic

1. Induction Form K3
2. Form Job Safety Analysis
3. Accident Report and Treatment
4. Letter of Warning
5. accident report, Investigation and Settlement
6. Report of Inspection Equipment
7. Inspection Report K3 Cleanliness
8. Inspection Report K3

Project leaders review the implementation of the project every day, and regularly every week
through the Weekly Report and once a month through the Monthly Report to ensure continuing
suitability, adequacy and effectiveness continues includes assessing opportunities for improvement
and the need for changes such as the policy SMI & sasaran.Input Overview Repeat performance
includes information on:

1. The results of the investigation and evaluation of compliance with legal requirements and more.

2. Communication of internal and external stakeholders, including complaints and customer


3. Suitability of product quality and performance, processes, products & K3

4. The level of target achievement.

5. Status of corrective and preventive actions.

6. Follow-up results Revisited previous performance.

7. Changes in circumstances that affect the system as technological developments, changes in
international standards and changes in the legal and other requirements related to quality and K3.

8. Suggestions / recommendations for improving the system.

Output of reviews include any decisions and actions related consistent with continuing
improvements to:

1. Improvement of the effectiveness of the system.

2. Changes in policy, targets or other elements of the system.

3. Improvement of product related to customer requirements.

4. Improving the performance of K3

5. The need for the necessary resources to increase system performance


1. REPORT incompatibility K3 (LK-K3)

2. Daily Report

3. Weekly Report

4. Monthly Report

5. Reports Safety Meeting