Health and Safety Plan Rev.03

LRT JABODEBEK
Signaling System
Health and Safety Plan

(RS-03-GN-SG-HS-000180-03A)
Rev. 03
PT Len Industri (Persero)
DESIGN, MANUFACTURING, DELIVERY, INSTALATION, TESTING, &

COMMISSIONING, TRAINING PROVISION FOR SIGNALING SYSTEM
ACCELERATING THE IMPLEMENTATION OF INTEGRATED LIGHT RAIL TRANSIT

(LRT)
IN JAKARTA, BOGOR, DEPOK, AND BEKASI PROJECT

(LRT JABODEBEK)
2018
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Name Department Signature
Yanto Harisyanto
Author LEN
HSE Coordinator Corporate
M. Ichsan
Checked by LEN
Site HSE Coordinator
Aditya Maulana Pratama

Released by LEN
Document Control
Yadi Ramdani
Approved by LEN
Project Manager
Customer Ref Number: RS-MM-030006-2018-01-31-AK and Deliverable List
Revision/Version: 03
Status: Original
Release Date: September 26th,2018
Doc. No.: RS-03-GN-SG-HS-000180-03A

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 Document History
Revision Description Release Date Release Comments
Preliminary Initial release for the interface

00 February 06th,2018
Release workshop
First release for the document

01 First Release July 13 th,2018
Second release for the document

02 Second Release September 13 th, 2018
Third release for the document

03 Third Release September 26 th, 2018

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TABLE OF CONTENTS
TABLE OF CONTENTS ................................................................................................................ 3

1. GENERAL DESCRIPTION ........................................................................................ 4
1.1. Overview PT Len Industri (Persero) .......................................................................... 4
1.2. Project Overview ........................................................................................................ 4
2. LEADERSHIP AND COMMITMENT ......................................................................... 5
2.1. HSE Policy ................................................................................................................. 5
2.2. HSE Target................................................................................................................. 5
3. ORGANIZATIONAL STRUCTURE, RESPONSIBILITY, COMPETENCY................ 6
3.1. HSE Organization ...................................................................................................... 6
3.2. Jobdesc Personal HSE .............................................................................................. 6
3.3. Delimiter and lighting ................................................................................................ 13
3.4. Medical Wellfare and Drug Substance Abuse ........................................................... 13
4. HSE PLANNING ........................................................................................................ 14
4.1. HSE Safety Planning and Environmental Aspects .................................................... 14
4.2. Legal Identification And Requirement........................................................................ 15
5. COMPETENCY AND TRAINING .............................................................................. 17
6. COMMUNICATION / ORIENTATION PROGRAMS ................................................. 17
6.1. HSE Communications ................................................................................................ 17
6.2. Promotion and Engagement ...................................................................................... 18
7. OPERATIONAL.......................................................................................................... 19
7.1. Work Permit ............................................................................................................... 19
7.2. Use of the Equipment ................................................................................................ 19
8. REWARD AND PINALTY .......................................................................................... 20
8.1. Reward ....................................................................................................................... 20
8.1.1. Monthly Safety Role Model ........................................................................................ 20
8.1.2. Best Group Practice ................................................................................................... 20
8.2. Punishment and Warning Letter ................................................................................ 20
9. SAFETY MEETING AND AUDIT INSPECTION ....................................................... 21
9.1. Work at Height ........................................................................................................... 24
9.2. Subcontractor Control ................................................................................................ 24
9.3. Medical Check Up ...................................................................................................... 24
9.4. Coordination Among Companies ............................................................................... 25
9.5. LOTO (Lock Out & Tag Out) ...................................................................................... 25
9.6. Fire Prevention ........................................................................................................... 25
10. EMERGENCY STATE ............................................................................................... 25
11. MONITORING AND EVALUATION OF HANDLING APPLICATION HSE ............... 27
11.1. HSE Inspection .......................................................................................................... 27
11.2. HSE Audit ................................................................................................................... 28
12. HSE PERFORMANCE INDICATOR ......................................................................... 28
Appendix .................................................................................................................... 29

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1. GENERAL DESCRIPTION
The Project Health and Safety Plan is an overview (generally) of project safety preparation,
planning, engineering and execution process that will be applied and implemented at the
project site, to determine and ensure that all of safety activities are in accordance with and
under controlled of internal company needs and client requirement.
The importance and essence of this project HSE plan is guidance, monitoring and controlling
of project preparation stage, pre-execution and project execution stage of Safety activities at
the project site, in accordance with appearing high performance and team work coordination
internally within site management and Head office management.
The project HSE Plan is containing of Health, Safety & Environment work planning correlated
with scope of work.
1.1. Overview PT. Len Industri (Persero)
PT . Len Industri (Persero) (hereinafter referred to Len) is a State-Owned Enterprises (SOEs),

which develops business and products in the field of electronics for industry and infrastructure.
The business scope of Len Industri (Persero) includes EPC (Engineering, Procurement &
Construction) and manufacturing of EPC support products.
PT. Len Industri (Persero) implements a quality management system, K3 and Environment to
create a consistent service, satisfy customers, safe for worker health and safety, and
environmentally friendly in organizing corporate activities and perform a good documentation
process so as to meet user needs and in accordance with international standards that serve
as a reference.
Name Company : PT. Len Industri (Persero)
Company's address : Jl. Soekarno Hatta No. 442 Bandung 40254
No. Telp/Fax : +62-22-5202682, Fax +62-22-52026
Site Office address : Signature Park Grande
Jl. MT. Haryono Kav 20 MO/6 Jakarta Timur 13630
No. Telp : +62-21-8001897
1.2 Project Overview
Project Owner : PT Adhi Karya (Persero) Tbk.

: Accelerating the Implementation of Integrated Light Rail
Job Title
Transit in Jakarta, Bogor, Depok, and Bekasi Project
Scope Project : Signaling System Package
Execution time : December 2017 – December 2020
Job Location : Jakarta Bogor Depok Bekasi
Leader of Project : Yadi Ramdani, S.SiT.

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2. LE ADERSHIP AND CO MMIT MENT
2.1 HSE Policy
It is PT. Len HSE policy to provide and maintain a safe and healthy work environment at all
times. The goal of PT. Len management is to prevent occupational accidents, injuries,
illnesses, environmental issues and this will be achieved by management, who shall place
accident prevention and the protection of the health and safety of every employee and
environment, above any other consideration of job operation or administration. The ultimate
goal of PT. Len at every level of our organization shall be to ensure at all times, throughout
every phase of job operation, drug abuse, weapons and shines are something that is strictly
prohibited in the project, this is illegal and dangerous to work on.
HSE Policy can be seen at appendix 1.

Statement of Management Commitments can be seen at appendix 2.
Policy of Use of Drugs, Alcohol, Weapons and Shine can be seen at appendix 3.
2.2 HSE Target

No HSE Target Target
Lagging Indicator
1 Number of Fatality 0
2 Number of LTI 0
3 Number of First Aid 0
4 Number of Near Miss 0
Leading Indicator
1 Tool Box Meeting 95 %
2 HSE meeting 95 %
3 Inspeksi Patrol 95 %
4 HSE Reporting 100 %
5 HSE Management Visit 100 %
6 Closing Finding 100 %

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3. ORGANIZATIONAL STRUCTURE, RESPONSIBILITY, COMPETENCY

3.1 HSE Organization
For the implementation of the HSE work program in the project established the structure
responsible for the implementation of HSE in the project as follows:
Yadi Ramdani
Project Manager
Ketua
Fransisca A. Sirait
HSE Admin
Sekretaris
M. Ichsan Syahrul Mubarok Febby Rinaldi M.Dicky K Pinky SC

HSE Coordinator Technical Leader Site Leader QC Coordinator Human Capital &
Anggota Anggota Anggota Anggota General Affairs
Anggota
3.2 Jobdesc Personal HSE
STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

Project Manager a. Lead the entire pro- a. Responsible for overall site Project
ject from planning to management and project Management
implementation of the coordination between PT.
Len and PT Adhi Karya
project b. Establish and develop,
b. Ensure that all project through Project HSE
plans are imple- Coordinator, a systema-
mented tically step and procedure
c. Meets every Objec- related with safety accor-
ding to Occupational Sa-
tive and project requi- fety and Health PT. Adhi
rement such as: Karya Requirement.
quality, time as well
as HSE aspects app-
lied.
d. Conducting a meeting
or review and moni-
toring project cove-
ring technical as-
pects, quality include-
ing HSE perfor-
mance.

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e. Reporting on project
progress, schedule,
budget, risk including
HSE performance.
HSE Coordinator a. Manage and develop a. Maintain current know- a. AK3 Umum from
HSE Management ledge of Safety Literatures, Ministry of man-
Systems government and HSE power and trans-
b. Creating HSE Work Regulations and others, migration.
Plans and Work Prog- communications and Appendix 4
rams Manage and advises Project / Site b. AK3 Listrik from
monitor and evaluate Management of comp- Ministry of Man-
the implementation of liance and condition requi- power and Trans-
HSE work program ring attention. Provides job migration.
Appendix 5
Coordinate with the site with government,
HSE Officer and Client or provincial Safety
create an entire codes as necessary.
project HSE report b. Makes through analysis of
c. Investigate and com- statistical data inspection,
municate to interes- delineates problems areas,
ted parties and makes recom-
d. Manage project acti- mendations for solution.
vity related the elec- c. In special cases, where the
tricity appropriate with safety practices and work
HSE Requirements environment condition may
e. Collaboration with endanger personnel, visitor
enginer and site or equipment, Site HSE
leader to develope Coordinator may take the
electrical safe pra- actions to minimize, or stop
ctice. unsafe practice and or
condition by suspending
the work, till corrective
improvement action taken
by the work based
structure or totally suspend
the task till the practices
and condition complies
with the rules, regulations
and or standards
requirements.

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d. Collaborates with the
project / Project Manager
and all staff the
development of required
revision to existing pro-
cedures, rules and regu-
lation and submits pro-
posed changes.
e. Takes the part in the review
of all disabling injuries and
assists in the investigation
all accident and near
misses.
f. Serves all liaisons for the
PT. Len with governing
agencies and other groups
in related to HSE Require-
ment.
g. Establish contact with
subcontractor with the
objecttive of maintaining
good relation and coor-
dination of accident pre-
vention activities.
h. Review all accident and
investigative report, pro-
viding instruction and
guidance as needed
arrangements are made at
the start of each job and
ensure all government and
insurance are prepared,
distributed, and maintained
in a proper manner
i. Collaboration with
enginering team to
identifying and detecting
the hazards including
electricity.

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j. Collaboration with site
leader to reduce the risk of
harm due to the activity
including electrical work.
HSE Officer a. Examine the imple- a. Monitoring Work Permit AK3 Muda
mentation of the prog- and its validity. Konstruksi /
ram and the imple- b. Monitoring the comp-liance AK3 Umum /
mentation of HSE in
of Employees and Visitors. AK3 Migas
the project
b. Ensure project work c. To conduct emergency or
complies with and evacuation drill according
complies with safe to the schedule.
project procedures d. To conduct equipment
and safety practices. inspection including fire
c. Ensure that all per- protection equipment re-
sonnel at the project
gularly.
site act securely in
accor-dance with the e. Coordinates all HSE acti-
SOP and HSE rules vities as well as Emer-
d. Implement gency drills.
Communication, f. Investigates any accident
consultation and HSE or incident as required.
participation at the g. Prepares all reports as
project site to foster
required.
employee awareness
of HSE h. Conduct and report HSE
e. Ensure the imple- inspection / patrol at the
menttation of meeting project site
toolbox, safety meet- i. Supports investigations and
ing communicates to interested
f. Ensure that reports / parties.
findings of any unsafe j. Reguraly inspect related to
conditions / unsafe Hygiene Industries, (exp.
practices are promptly
Inspection for drinking
corrected.
g. Supports investiga- water)
tions and communi- k. Ensure collecting waste
cates to interested with correct segregation
parties. l. Implementation of proper
waste management system
to prevent pollution to the
environmental due to the
waste that is produced from
mechanical work.
m. Monitoring Management
for Hazardous Waste and

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collaboration with Related
company to handle Hazar-
dous waste.
HSE Admin a. Develop HSE Report a. Filling and collect the HSE AK3 Umum
b. Collaboration with document hard copy and
HSE Officer for Deve- soft copy.
lop Report and HSE
Documentation b. Filling the document of
(Photo, Hard Copy HSE Project.
and evidence) c. Provide report for client
c. Support all inspection d. Ensure the report is under
activity sign by Related personel
d. Collaboration with
HSE officer to e. Send the report which
organize Safety meet- required by client, and HSE
ing and General Safe- of head office
ty Talk. f. Collect the data from
e. Inventarization HSE project activities and data
Equipment
f. Record HSE Training from other department
and HSE Activity g. Preparation for all HSE
Project. activity.
HSE Man a. Ensure project work a. Patrol the site frequently Basic knowledge
complies with and ad- and inspect for unsafe Safety
here to Project Safety activities and unsafe work-
Procedures and safe ing condition.
working practices. b. Advise or instruct cons-
b. Suggest or direct the truction supervisor, Fore-
person in charge of man, and workers to
the project to improve remedy unsafe activities
unsafe working condi- and unsafe working condi-
tions or detected viola-
tions.
tions.
c. Maintain a log of any
c. Together with HSE
defects or violation obser-
officers conduct a
ved and notification of
'follow-up' to ensure
remedial action taken.
corrective action has
d. Compile a comprehensive
been taken immedi-
ately. list of all equipment and
d. The results of the tools incorporated in to the
patrol including advice site.
or corrective actions e. Monitor and assist, if
taken should be recor- necessary, construction
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ded in the 'Daily supervisor and foreman at
Report on Safety' and Tool Box Meeting to be
reported to the HSE held every morning or
Officer weekly depending on the
e. Ensure that reports / working status.
findings of any unsafe f. Assist the HSE Officer in
conditions / unsafe preparation of accident
practices are promptly reports. Encourage repor-
corrected. ting of near misses to the
f. Ensure that safety
HSE Officer.
aspects are applied
g. Prepare the Daily HSE
including, materials,
Report and report daily on
equipment permitted
major HSE activities and
to be taken to the
topics of the day to the
project site.
HSE Officer.
g. Assist HSE Officer in
conducting accident
/ incident investiga-
tion.
Operator Heavy a. Preparation for Heavy a. Appropriate heavy equip- SIO from Ministry of
Equipment equipment and lifting ment with material to be Manpower and trans-
gear to be used. lifted migration or Ministry
b. Check and Recheck b. Safely Lifting actifity of Energy and Mine-
document for Heavy c. Prepare Lifting Plan ral Recsources.
equipment and lifting d. Close communication with
gear are available. Rigger and All Crew.
c. Together with his crew e. Ensure Stabel ground for
to maintain condition Heavy Equipment and out
of Heave Equipment rigger
and Lifiting Gear. f. Always guided by Safe
d. Execute the lifting Working Load for all Lifting
activity with safe prac- Actifities
tice. g. Stop Activity if do unsafe.

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Rigger a. Colaboration with all a. Ensure Binding the object a. SIO from ministry
lifting crew to make with tight, strong and of Manpower and
Preparation for Lifting balanced transmigration or
activity b. Ensure Lifting do safely ministry of Ener-
b. Check surround lifting c. Stop Activity if unsafe gy Mineral Res-
radius on safe condi- d. Close communication with ources
tion. another liftine crew
c. Provide whistle and e. Clear and visible when
HT if necessary. giving the signal.
Employee b. Employee including a. Always conduct activities in Training based

employee of subcon- a way that is safe for on job task if
tractor and there all yourself and others who necessary
subcontractor shall may be affected by the
be personally activity.
responsible and b. Report to superiors if they
Comply with Adhi encounter any hazards or
HSE Requirement problems related to HSE.
c. Spesific Activity such as
c. Cooperate in case of Lifting, Rigging, etc shall
accident investiga- follow regulation apply.
tion, if necessary.
d. Not misuse all equip-
ment facilities or com-
ponents that should
only be used for
safety and health.
e. Understand and com-

ply with all safety and
health regulations
and other work rules.
Curiculum Vitae of HSE Personnel can be seen at appendix 6.
3.3 Delimiter and Lighting
Delimiter shall be established at the site p r ior to commencement of any site works
including construction of temporary facilities. This is to ensure that unauthorized personnel
are kept out of the project site and also to ensure that such personnel are not exposed to the

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hazards of construction related activities.

All safety helmets should have Len stickers to identify Len employees when working in the
field.
Delimiter shall be established for the following localized areas:
a. Working area,
b. Material storage area,
c. Camp area,
d. Office area,
e. Workshop and laydown area
Suitable and sufficient lighting shall be provided in the Site Office, and working night area job
ensure that Leader provide their employees with suitable and sufficient lighting to perform
works during night operations.
3.4 Medical Wellfare and Drug Substance Abuse
Pre-employment medical check-up to ensure worker health fitness before mobilization to

Site. Contractor shall ensure that all personnel coming into site have had Fit License from
doctor which shall determine in confidence the fitness for work of the prospective workforce
to the job offered.
Health services for all employees including management and employee of sub contractor
have been cover by BPJS. Regarding this, PT. Len have cooperation with the public health
center of Tebet to healthcare and treatment for employees. For hanlde minor injuries PT. Len
provide medical facilities, such as first aid box for office and first aid bag for site.
All personnel visiting or working at the Project Construction Site under the control of PT. Len
including employees of its Subcontractors and Vendors.
Prohibited drugs - marijuana, hashish, cocaine, hallucinogens, depressants, stimulants, and
medication not prescribed for current personal treatment by a licensed physician. in order to
maintain a safe and productive work environment.
List of First Aid Box and Its Contents can be seen at appendix 7.
List of First Aid Bag and Its Contents can be seen at appendix 8.
Letter of Cooperation with Public Health Center can be seen at appendix 9.
4. HSE PLANN ING

4.1 HSE Safety Planning and Environmental Aspects
PT Len identifies the hazards and aspects of the HSE in the workplace in order to eliminate
or at least reduce the risks or impacts that may result in injury / damage to both employees
and other company assets. Results of HSE identification and hazard aspects are listed in the
HIRADC document.

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The HIRADC document will be socialized to all employees involved and interested in the
project. The HIRADC document reviewed and updated if any changes to the process / activity
/ object. HSE hazards and environmental aspects at every stage of the process as well as the
current control projects execution have been identified, results can be seen in the Document
Identification Method Statement.
HIRADC (Hazard Identification, Risk Assessment, and Determining Control) is the process of
identifying hazards that can occur in routine or non-routine activities within the company, for
further assessment of the risks of these hazards. Those assessed in HIRADC are dangers or
risk of a job. The factors that are assessed are the probability and consequence of severity.
What is assessed to be revealed is not to the person but rather to the danger posed to the
extent that can be accepted by the company.
More comprehensive control methods include hierarchy of control, mitigation, and work
procedures. Control hierarchy is a system and risk control mechanism that is carried out in a
structured manner, from simple things to more complex ones. The control system should be
carried out in stages.
There are 5 control hierarchies as follows:

1) Elimination: Physically remove the hazard
Elimination is the first stage in the control hierarchy. Elimination is an effort to eliminate
the source of danger. Eliminating the source of danger is done by eliminating or
eliminating objects or jobs that are a source of danger.
2) Substitution: Replace the hazard

Substitution is the second stage in the control hierarchy. Substitution is the process of
replacing hazardous materials, processes and procedures with more harmless ones.
With this control system will be needed a redesign of a system or mechanism.
3) Engineering controls: Isolate people from the hazard

Engineering control is the third stage in the control hierarchy. Engineering controls are
physical changes to the work area or process that effectively minimize a worker's
exposure to hazards. Engineering is to do hazard separation to prevent risk. In
engineering this is usually done in the form of modifications such that the potential danger
can be minimized or even eliminated.
4) Administrative controls: Change the way people work

Administration is the fourth stage in the control hierarchy. In the hierarchy of control,
administration can also be used as a control tool that is from the side of the person who
does the work, that is by implementing procedures that are deemed necessary. With this
administrative control, it is expected that people who work around can comply and can
do the job safely. No physical changes, limits daily exposure to hazards by, and adjusting
work tasks or schedules. Examples: limited time exposure to hazards, written operating
procedures, work practices, and safety and health rules for employees.
5) Personal Protective Equipment: Protect the worker with PPE

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PPE is the fifth or final stage in the control hierarchy, and is the last 'defense' in minimizing
risk if the first four methods cannot be done. This used when hazards cannot be
eliminated through engineering or administrative controls, and must consider personal
protective equipment (PPE) necessary for employee protection. PPE is a tool used to
protect our body, or maybe even a certain object to protect themselves or the object from
a danger. In this APD technique is expected and able to reduce the level of risk of severity
due to danger from the surrounding environmental conditions.
HIRADC can be seen at appendix 10.
4.2 Legal Identification and Requirements
The HSE legislation that is directly related to the project scope is as follows:
NO. RULE NO. TITLE
A. Laws (UU) and Other Regulations Related to HSE
Law (UU):
Work Safety
1 UU No. 01 Thn 1970
Keselamatan Kerja
Manpower
2 UU 13 Tahun 2003
Ketenagakerjaan
Presidential Decree / Government Regulation:
Management of Hazardous and Toxic

2 PP No. 74 Tahun 2001 material
Pengelolaan bahan berbahaya dan beracun
Implementation of Health and Sfety
Peraturan Pemerintah Management Safety.
3
No.50/2012 Penerapan sisteim manajemen kesehatan
dan keselamatan kerja.
Decision / Regulation of Minister (Safety):
Permenaker RI No. Per. Lift and Transport

1
05/MEN/1985 Pesawat Angkat dan angkut
Permenakertrans RI No. Per- Fire extinguisher
2
04/MEN/1980 APAR
Permenakertrans No. 8 Tahun Personel Protective Equipment
3
2010 Alat Pelindung Diri
Permenakertrans No. 9 Tahun Opertor for Lift and Transport

4
2010 Operator petugas angkat dan angkut.

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NO. RULE NO. TITLE
Kepmenaker RI Management of Hazardous Chemical

5
No.Kep.187/Men/1999 Pengendalian Bahan kimia berbahaya
Regulation of the Minister of
Working at Height
6 Manpower of the Republic of
Pekerjaan pada ketinggian
Indonesia Number 9 Year 2016
Decision / Regulation of the Minister (Occupational Health):
Permenakertrans RI No. Per- Trechhold Value
1
13/MEN/X/2011 NAB – Nilai Ambang Batas
Inspection and reporting procedure
Permenaker RI No. Per-
2 Tata Cara Pelaporan dan Pemeriksaan
03/MEN/1998
kecelakaan di tempat kerja
Permenakertrans No. Per. Health Check
3
02/Men/1980 Pemeriksaan kesehatan
First aid
4 Permenaker 15/MEN/VIII/2008 Pertolongan Pertama pada kecelakaan di
tempat kerja
B. Laws (UU) and Other Environmental Related to Regulations
Law (UU)
Waste management
1 UU No. 18 Tahun 2008
Pengelolaan Sampah
Government Regulation
Hazardous material handling
1 PP RI No. 101 Tahun 2014 Pengelolaan limbah bahan berbahaya dan
beracun
Air Pollution controll
2 PP No.41 tahun 1999
Pengendalian pencemaran udara
Regulation of the State Minister of the Environment
Labeling Procedure for Hazardous Material
1 PerMen LH No. 03 Tahun 2008 Tata Cara Pemberian symbol dan label
Bahan Berbahaya dan Beracun
Decree of State Minister of Environment
Label and Symbol Hazardous material and
PerMen LH RI toxic.
1
No. 14 tahun 2013 Label dan Simbol limbah Bahan Berbahaya
dan beracun.
5. COMPETENCY AND TRAINING

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For competencies and trainings can be viewed or refer to point 3.2 job description
personalized.
6. COMMUNICATION / ORIENTATION PROGRAMS HSE

6.1 HSE Communications
HSE IMPLEMENTATION
DESCRIPTION
COMMUNICATION PLAN
HSE induction given to whole employees involved in

the project. The material given:
a. Management System Policy PT. Len Industri
(Persero)
b. HSE and Environmental Rules
c. Emergency handling procedures and personnel
d. Hazards that may occur related to the HSE as well Before the workers
HSE Induction
as the environment and the risk control plan enter the project site
implemented in the relevant unit in relation to the
type of work.
e. Management of cleanliness and tidiness during
work
f. The phone numbers are important
g. Accident reporting system.
Morning talk is provided to all workers and employees
with scheduled and documented materials.
HSE Morning
In the event of an accident that causes the day to
Talk/Safety Every day during the
disappear more than 2 days or there is an
Talk/Tool Box project
environmental pollution related event that causes the
Meeting (±10 Minutes)
public complaint then the HSE morning talk material
after the event should discuss the incident, handling and
prevention.
a. HSE meetings involving the responsible
construction and sub-contractors are implemented at
least once a month, may be combined with
construction coordination meetings but discuss
HSE materials
HSE Meeting
b. HSE meetings discuss HSE programs, HSE Each month
inspection results, HSE violations, HSE issues
and follow-up plans.
c. Minutes of HSE meetings are documented and
distributed to related functions (emails, boards etc.)
as well as monitored follow-up plans.
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HSE IMPLEMENTATION
DESCRIPTION
COMMUNICATION PLAN
Reports / HSE a. Every month, the HSE Coordinator reports to the

Each month
Reporting HSE Coordinator Center.
b. The HSE Officer immediately informs the

Communication occupational accident to the HSE Coordinator.
when Work c. The HSE coordinator PT. Len inform to HSE
Accident / Fire / Departement of PT. Adhi Karya Railway System. Every incident
Hazard d. Accident reports will be posted in monthly reports
Communication to support the accident reporting and statistics
system.
Giving appreciation to workers who are more
Customized
HSE Reward concerned and about aspects of health, safety and
Max: per 6 months
environmental.
HSE Induction also given to visitors and guests. The
material given:
Internal Visitor a. Management System Policy PT. Len Industri
Induction (Persero) At time of visit
(to be discuss) b. HSE and Environmental Rules
c. Emergency handling procedures and personnel.
d. Emergency Road and alert.
6.2 Promotion and Engagement

PT. Len seeks to build awareness and involvement of employees and workers in the project
by way of, among others:
a. Banner
b. Bulletin board
c. Poster Poster HSE
d. HSE Reward

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7. OPER AT ION AL
7.1 Work Permit
PT. Len will take care of the first letter prior to the commencement of work potentially result
in serious injury. PT. Len will apply for a work permit to PT Adhi Karya which is equipped with
JSA (Job Safety Analysis). As per legal and regulation apply.
JSA format can be seen in appendix 11.
7.2 Use of The Equipments
Before using the work tools and heavy equipment it is necessary to ensure that all equipment
that is required to be checked or tested, to meet the requirements. Use of the heavy
equipment such as cranes, forklifts, etc should meet the following requirements:
a. Operators and Rigger have a valid SIO (Surat Ijin Operasi) from ministry of Manpower
and Transmigration,
b. Heavy equipment already has a valid Special Permit or SILO (Surat Layak Ijin Operasi)
from ministry of Manpower and Transmigration before used,
c. Lifting Plan attached on Permit to work if necessary,
d. The heavy equipment is worthy of use and has passed the inspection covering the heavy
equipment itself include slings, and another lifting gear,
e. Inspection perform by dedicated persons by Subcontractor or Provider Heavy equipment,
f. Len HSE will ensure that all document of Heavy Equipment and operator are valid.
Heavy equipment shall be used for the intended purpose of the manufacturer. A copy manual
book or equipment manufacturer’s operation manual will be maintained on site by Site
management. No alterations or modifications shall be performed to the equipment without the
manufacturer’s approval that must be documented. Equipment will be operated within
capacity as outlined in the manufacturers operating manual.
The only modification which are required sometimes, and for which the above does not apply,
is when equipment is obtained from the manufacturer in an inadequately guarded condition.
Guards must then be fitted before the equipment may be used. All equipment will be provided
with necessary safety devices to prevent incidents. Inspection of these devices will be
included as part of the operators daily pre-operational inspection, as well in the formal
inspection. No equipment shall be operated with detective or missing safety devices.
All items that will be used in the project including heavy equipment must be inspected before
use. This aims to ensure that the item is safe to use.
Inspections are carried out every month. Inspection results will be recorded by HSE and the
inspector team. If any items that is damaged or not feasible is found, it will be recommended
not to be used again in the project.
After the inspection is carried out, the HSE will attach the sticker tag to the items. The tag
sticker used for the item is color code. The color code for the equipment before use will be
divided into two colors. Green sticker means that the equipment can be used, and the red

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sticker means it is rejected. The color code for monthly inspection is divided into three colors
and the color code will change every four months. Blue for inspection marks in January,
February, March, and April, yellow for inspection marks in May, June, July, and August, and
grey for inspection marks in September, October, November, and December. The tag sticker
will be installed on the device and placed in a place that is easy to find. In case if the items
failed of inspection or rejected, the HSE team will put a red sticker tag. This is indicated that
the equipments cannot be used.
List of Items Inspection Plan can be seen at appendix 12.

Color Code can be seen at appendix 13.
8. REWARD AND PINALTY
This programme is to promote safety consciousness, enthusiasm and interest in Safety and
Health in units and/or workers, this program also includes immediate positive reinforcement
personel the criteria of evaluation will be defined at site.
8.1 Reward
Generally, this awards programme is classified as follows.
8.1.1 Monthly Safety Role Model
This award given to workers are obedient with safety regulation. Compliance with PPE is one
of criteria in determining awarded. It is can be earned by Leader, worker or personnel from
Logistik Department. For this category, the winner gets cash or merchandise.
Monthly Safety Role Model can be seen in appendix 14.
8.1.2 Best Group Practice.
This program is reserved for group work unit assessed submissive regulatory safety. How
safe work and promote safety to the persons or group. This award will be given quarterly
rateable by safety team and aprooved by project manager. For those category, the winner
gets cash or merchandise.
Best Group Practice can be seen in appendix 15.
8.2 Punishment and Warning Letter
PT. Len Industri (Persero) / LRT Jabodebek Project has the right and will exercise to remove
any persons this right to remove the persons from the project for condoning, supporting or
instructing any employee to commit unsafe act. Work in unsafe or unhealthy conditition or
work with unsafe equipment. Employees that continuously ignore or disregard the project

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HSE requirements will be discipline. Employee has the right to refuse to do the job once an
unsafe condition is observed, such as working at height with no full body harness provided,
working in unstable platforme, etc.
If a subcontractor negelect their employee refusal. Contractor may issue warning letter/
disciplinary to subcontractor management it is management responsibility to find a safe way
to do the job.
Pinalty given to employee who violating safety regulation or work to harm himself and other.
It will be given Warning Letter.Warning Letter signed by worker, supervisor and HSE
Coordinator, and reported to Project Manager. To maintain the worker compliance with safety
regulation Pinalties for those violate will apply. Amercement realized on cash money.
Employee who violate safety regulations will be subjected to tiered sanctions. Some of
violation will arise Warning Letter. For example: violation is for disobedience wearing PPE,
activity without work permit, negligent use the required safety aids (example: full body
harness), and unsafe act that potentially risky to other workers and environment.
The step of Warning will be aplicated on 4 steps:

1. Verbal Warning
2. Warning Letter 1 and one punch hole given to employee who violate safety regulation
after received verbal warning in previous.
3. Warning Letter 2 and one another punch hole (total 2 holes) given to employee who violate
safety regulation after received warning letter 1.
4. Warning Letter 3 and one another punch hole (total 3 holes) given to employee who violate
safety regulation after received Warning Letter 2.
5. Dismissed Letter. The employee who still violates the safety regulations and after
receiving Warning Letter No. 3 will be released from the Project.
Warning Letter will be recorded and kept by HSE and Report to Project Manager.
Form of Warning Letter can be seen at appendix 16.
9. SAFETY MEETING AND AUDIT INSPECTION
Equipment including lifting gear upon arriving at the site shall be checked by a competent
person and witness by HSE Len designated before it is distributed to the LRT Jabodebek
Project.
The first entry equipment inspection shall be documented on the appropriate equipment
inspection form, copy of the most recent inspection report will be maintained on each piece
of equipment as well as in the HSE Department for the file.

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Safety meetings, audits and inspections
Safety Meetings
AGENDA ATTENDANCE PIC DURATION
Meeting prior to start of work All persons employed

Len Site Supervisor / 30 minutes /
Measures for the safe in the relevant working
Job Leader / HSE Daily (as per
performance of the work in the area / for the relevant
Officer condition)
next work shift contract section
Meetings on occupational 10 – 30
safety topics Incident / minutes
All persons working at Len Project Manager /
Accident or danger reports,
the construction site Leader 1 x weekly (as
HSE instruction topics, HSE
matters per condition)
Meetings on construction site

safety
The agenda of the meeting
will be agreed by the
committee and must include
at least the following items:
a. Initial assessment of
special health and
occupational safety topics
(risks)
b. Initial assessment of
special environmental
topics (aspects)
c. Definition and subsequent
supervision of the
Participants PT LEN Monthly
objectives and aims for
the construction site
d. Inspection of accidents
and incidents, which
occurred in the previous
period
e. Review and discussion of
possible changes of the
project-specific HSE plan
f. Review of audits and
inspections including any
outstanding corrective
measures
g. Emphasis on any
necessary instructions
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AGENDA ATTENDANCE PIC DURATION
h. Discussion about any

possible changes of laws,
international standards or
Len work instructions and
guidelines
i. Status of current
disciplinary proceedings
j. Installation of a
sitespecific productivity
bonus and disciplinary
system for HSE area
Audits and inspections
TYPE OF AUDIT / REGULAR

AREA PERFORMED BY
INSPECTION TURN
Internal :
Daily inspection of
construction site Construction Site HSE Officer Daily
HSE Patrol The relevant working areas, HSE Coordinator / HSE

Weekly
storage and lay-down areas Officer
Inspections for Line manager or Leader
The relevant working areas,
order and supervisors of Len and daily
storage and lay-down areas
cleanliness subcontractors
Contractor audit Activities and working areas and Len Site
As required
subcontractor as well HSE Coordinator
Self-assessment Len HSE Coordinator

Activities and working areas of
site office or Head As required
PT. Len and subontractors
Office.
HSE Post
assessment Activities and working areas of
External team As required
Documentation: Len and subcontractors
Audit report
Audit after incidents Working area or previously

unsafe practice of Len an Site HSE coordinator After incident
dsubcontractor

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TYPE OF AUDIT / REGULAR

AREA PERFORMED BY
INSPECTION TURN
External :
Implementation Activities and Fourth week

Site HSE Coordinator
HSE audit by LRT working areas of Len and of April,
PT. Len and HSE team
Department subcontractors including August,
of PT. Adhi Karya
Warehouse December
9.1 Work at height
PT. Len will take care of the permit before performing the work on the altitude. The terms of
working at altitude in general are as follows:
a. Worker conditions should be healthy and there is no fear or height trauma and use the
appropriate PPE,
b. Use barricades to prevent personal falling from edges or openings,
c. Training working at height will perform to all worker who will work on height and possibility
falling more than 2 meters.
d. Full Body Harness is required if there is a possibility of falling more than 2 meters.
9.2 Subcontractor Control
In general, prospective subcontractors prior to bidding or in the stage have been described
about the terms and conditions of the HSE system if later selected as subcontractors.
Specifically, prior to the execution of the work, it is ensured that all aspects of the HSE will be
implemented by the sub-contractor. Subcontractors are required to follow the rules specified
in the HSE Plan of this project. The HSE Officer project oversees all work performed in
accordance with applicable HSE rules or best practices including work performed.
9.3 Medical Check Up
PT. Len have responsible to Make sure that worker health fitness before mobilization tp site.
and during project ecxecution. PT. Len shall ensure that all personnel coming into Site have
healthy Letter from a doctor and Free Narkoba from related institution which shall determine
in confidence the fitness for work of the prospective workforce to the job offered.
Project Manager and Supervisor:

a. Responsible for ensuring that all employees are fit for task in accordance with this
program
b. Provide job title, together with HR as required
c. Provide medical check up result and Fitness for Work Result fo review

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d. Define Job and its hazard exposure that may require health surveillance (there may be
none), identify all individuals doing those job, get professional advice in instituting
appropriate health surveillance program, and ensure the implementation
e. Assure their staffs do not have health problems associated with the fitness for the job or
work.
9.4 Coordination among Companies

During the project work process from the design phase to the implementation of the project,
allowing conditions to coordinate with other subcontractors, All coordination, agreement and
decision shall be taken under the control and knowledge of PT Adhi Karya (Persero) Tbk.
9.5 LOTO (Lock Out & Tag Out)

LOTO is used to ensure the safety of personnel who work or are near equipment that is in the
bprocess of cleaning, servicing, repairing, modifying or replacing. In addition LOTO is used
To ensure that equipment and machinery under repair should not be operated before it is
completely safe and harmless to the worker. Persons who can use LOTO are subject to the
terms.
LOTO form can be seen at appendix 17.
9.6 Fire Prevention

Fire protection efforts fires in the project implemented under the following conditions:
a. Provision of fire facilities in the offfice, warehouse and hot work
b. Heat Work Permit for hot work, Follow Legal and regulation apply
c. Setting and management of Hazardous materials
d. Ascertaining the feasibility of the tool that uses electricity
e. Training of fire fighters team
10. EMERGENCY ST AT E
Emergency response plan is to give protection best for health and safety all employees in
proyek and other people nearby and also for keep workplace in an emergency. All activities
tactical must be taken based on on priority the following:
a. Save life other people
b. Secure society and environment.
c. Maintain security workplace, equipment, materials and important documents.
The Project Emergency Response Structure can be seen in appendix 18.

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The task and responsibilies of he Emergency Response Tean can be explained as follows.
STRUCTURE JOBDESC COMPETENCE
Basic HSE
Chairman of As the highest command holder during an
Emergency Response
TTD emergency
System
Handling and localizing emergencies

Fire brigade Fire Fighter
caused by fire
First Aid Team Carry out the functions of first aid in each
Basic HSE / First Aid
(P3K) case of accidents and emergencies
Carry out evacuation or security of

workers in times of emergency. To be
Evacuation
collected in the evacuation area and Basic HSE
Team
ensure all workers are actually saved
from the scene
PT. Len will provide equipment for emergencies during this project takes place such as: fire
extinguisher, first aid kit, and others required. PT. Len Industri will conduct inspection checks
against completeness and facilities of this emergency to ensure it is ready for use at the time
require.
In the case of an emergency, all workers should know the location of the assembly point and
evacuation access point. Designated assembly point will be provided by PT. Len. For
determine the location of assembly point, PT. Len will coordinate with HSE team of PT. Adhi
Karya LRT Department. PT. Len also provides an evacuation sign to make it easier for
workers to find the assembly point area.
Emergency Contact can be seen at appendix 19.

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INCIDENT REPORTING
START
ACCIDENT
REPORT TO HSE REPORT TO

OFFICER / PT ADHI KARYA
SUPERVISOR
TREATMENT
ACTION
HANDLE BY TREATMENT AT THE

HOSPITAL LOCATION BY HSE
PROJECT /FIRST AIDER
RECORD DATA ACCIDENTS
ENDS
11. MONITORING AND EVALUATION OF HANDLING APPLICATION HSE
11.1 HSE Inspection
Schedule of HSE Inspection :
NO. INSPECTION PIC PERIODIC

1 Daily HSE Officer/HSE man 1 time per day
2 Periodik HSE Coordinator Center Minimum 1 time project period
3 Management Direksi/GM/Manager Minimum 1 time project period

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HSE Man / Officer conducts HSE inspection everyday to ensure there are no unsafe or unsafe
conditions in the project environment, such examination parameters include:
a. Unsafe Action and Unsafe Condition,
b. Floor & Wall, Alley / Corridor, Window / Ventilation,
c. Lighting,
d. Machinery / Equipment,
e. Personal Protective Equipment,
f. Sign / Poster HSE,
g. Hazardous Material,
h. Light Fire Extinguishers,
i. First Aid Kit,
j. Trash can / Trash Bag.
In accordance with the specified schedule, the HSE Coordinator of the center conducts field
visits to conduct HSE inspections. In accordance with the specified schedule, the
representative of the management (Board of Directors / GM / Manager) conducts field visits
to conduct HSE inspections.
11.2 HSE Audit
HSE audit can be seen at point 9.0 about safety meeting and audit inspection.
Any accident will be investigated by HSE to find the root of the problem so that no similar
incidents will happen again.
12. HSE PERFORMANCE INDICATOR
The HSE performance indicator called KPI (Key Performance Indicator) for Occupational
Health and Safety Management System is important tools used by companies to measure
the effectiveness of their programs to reducing the opportunities and risk of occupational
health and safety. KPI is able to measure performance achievement. Is it appropriate or not
yet.
Induction Form can be seen at appendix 20.

KPI Form can be seen at appendix 21.
Training Matrix can be seen appendix 22.

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Appendix:
Appendix 1. HSE Policy .................................................................................................... 30

Appendix 2. Statement of Management Commitments ................................................ 31
Appendix 3. Policy of Use of Drugs, Alcohol, Weapons and Shine ............................ 32
Appendix 4. Certificate AK3 Umum................................................................................. 33
Appendix 5. Certificate AK3 Listrik ................................................................................. 34
Appendix 6. Curriculum Vitae of HSE Personnel ......................................................... 35
Appendix 7. List of First Aid Box and Its Contents ....................................................... 36
Appendix 8. List of First Aid Bag and Its Contents. ...................................................... 37
Appendix 9. Letter of Cooperation with Public Health Center ..................................... 38
Appendix 10. HIRADC ....................................................................................................... 39
Appendix 11. JSA .............................................................................................................. 40
Appendix 12. List of Items Inspection Plan.................................................................... 41
Appendix 13. Color Code ................................................................................................. 42
Appendix 14. Monthly Safety Role Model....................................................................... 43
Appendix 15. Best Group Practice .................................................................................. 44
Appendix 16. Warning Letter ........................................................................................... 45
Appendix 17. LOTO ........................................................................................................... 46
Appendix 18. Project Emergency Response Structure ................................................ 47
Appendix 19. Emergency Contact ................................................................................... 48
Appendix 20. Induction Form........................................................................................... 49
Appendix 21. KPI Form ..................................................................................................... 50
Appendix 22. Training Matrix ........................................................................................... 51
Appendix 23. Permit Form................................................................................................ 52

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Appendix 1. HSE Policy

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Appendix 2. Statement of Management

Commitments

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Appendix 3. Policy of Use of Drugs,

Alcohol, Weapons and Shine

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Appendix 4. Certificate AK3 Umum

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Appendix 5. Certificate AK3 Listrik

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Appendix 6. Curriculum Vitae of HSE

Personnel

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Appendix 7. List of First Aid Box and

Its Contents

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Appendix 8. List of First Aid Bag and

Its Contents

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Appendix 9. Letter of Cooperation with

Public Health Center

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Appendix 10. HIRADC

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Appendix 11. JSA

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Appendix 12. List of Items Inspection Plan

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Appendix 13. Color Code

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Appendix 14. Monthly Safety Role Model

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Appendix 15. Best Group Practice

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Appendix 16. Warning Letter

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Appendix 17. LOTO

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Appendix 18. Project Emergency

Response Structure

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Appendix 19. Emergency Contact

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Appendix 20. Induction Form

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Appendix 21. KPI Form

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Appendix 22. Training Matrix

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Appendix 23. Permit Form

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Health and Safety Plan Rev.03

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LRT JABODEBEK

Health and Safety Plan

PT Len Industri (Persero)

DESIGN, MANUFACTURING, DELIVERY, INSTALATION, TESTING, &

ACCELERATING THE IMPLEMENTATION OF INTEGRATED LIGHT RAIL TRANSIT

IN JAKARTA, BOGOR, DEPOK, AND BEKASI PROJECT

Name Department Signature

Aditya Maulana Pratama

Customer Ref Number: RS-MM-030006-2018-01-31-AK and Deliverable List

Release Date: September 26th,2018

Doc. No.: RS-03-GN-SG-HS-000180-03A

Revision Description Release Date Release Comments

Preliminary Initial release for the interface

First release for the document

Second release for the document

Third release for the document

Doc. No.: RS-03-GN-SG-HS-000180-03A

TABLE OF CONTENTS ................................................................................................................ 3

Doc. No.: RS-03-GN-SG-HS-000180-03A

1.1. Overview PT. Len Industri (Persero)

PT . Len Industri (Persero) (hereinafter referred to Len) is a State-Owned Enterprises (SOEs),

1.2 Project Overview

Project Owner : PT Adhi Karya (Persero) Tbk.

Doc. No.: RS-03-GN-SG-HS-000180-03A

2. LE ADERSHIP AND CO MMIT MENT

2.1 HSE Policy

HSE Policy can be seen at appendix 1.

2.2 HSE Target

Doc. No.: RS-03-GN-SG-HS-000180-03A

3. ORGANIZATIONAL STRUCTURE, RESPONSIBILITY, COMPETENCY

M. Ichsan Syahrul Mubarok Febby Rinaldi M.Dicky K Pinky SC

3.2 Jobdesc Personal HSE

STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

Doc. No.: RS-03-GN-SG-HS-000180-03A

STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

Doc. No.: RS-03-GN-SG-HS-000180-03A

STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

Doc. No.: RS-03-GN-SG-HS-000180-03A

STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

Doc. No.: RS-03-GN-SG-HS-000180-03A

STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

Doc. No.: RS-03-GN-SG-HS-000180-03A

STRUCTURE JOB DESCRIPTION RESPONSIBILITY COMPETENCY

Employee b. Employee including a. Always conduct activities in Training based

e. Understand and com-

Curiculum Vitae of HSE Personnel can be seen at appendix 6.

3.3 Delimiter and Lighting

Doc. No.: RS-03-GN-SG-HS-000180-03A

hazards of construction related activities.

3.4 Medical Wellfare and Drug Substance Abuse

Pre-employment medical check-up to ensure worker health fitness before mobilization to

4. HSE PLANN ING

Doc. No.: RS-03-GN-SG-HS-000180-03A

There are 5 control hierarchies as follows:

2) Substitution: Replace the hazard

3) Engineering controls: Isolate people from the hazard

4) Administrative controls: Change the way people work

5) Personal Protective Equipment: Protect the worker with PPE

Doc. No.: RS-03-GN-SG-HS-000180-03A

HIRADC can be seen at appendix 10.

4.2 Legal Identification and Requirements

NO. RULE NO. TITLE

A. Laws (UU) and Other Regulations Related to HSE