JOB NO. DOCUMENT NO. REV.

PT. BIOMASS SEMESTA INDONESIA

21Z08 CON-CVL-HSP-001 0A
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HSE PLAN
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SOIL TEST WORK

PROJECT

PT. BIOMASS SEMESTA INDONESIA

BALING PRESS MACHINE

NGAWI, EAST JAVA

Prepared By Reviewed By Approved By

Date: Date: Date: Date: Date:

Vony Krisbiantara Dionisius Indra P. Akhmad Rizky Tofan Richard Chandra Joannes Tarigan
Operational Manager HSE Site Coordinator HSE Manager Deputy Head of Project Head of Project
Manager Management

REV. DATE DESCRIPTION

0A July 8th, 2021 Issued for Approval
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1. PURPOSE AND OBJECTIVES

The purpose of this Project HSE Plan is to document the HSE philosophy, procedures and
processes that will be implemented by the Project Management Team (PMT) and Construction
Team (CT). It is to ensure that facilities are designed, manufactured, constructed, installed, and
commissioned without incident, and that they are handed over to company operation in a safe
manner, and in line with company HSE policy. The Objectives of the Project HSE PLAN are:

 To ensure, through regular top-down not only communications but implemented

regarding HSE Rules and Policy, amongst all project personnel.
 To undertake specific occupational health, safety and environmental activities at each
stage of the project to ensure that superior performance will be achieved.
 To ensure that the relevant aspects of the contract risk assessment and any other HSE
aspect of the contract are communicated, understood and implemented by all parties
prior to implementation of the contract.
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 To monitor, review and audit performance throughout the project in an effort to ensure
quality and identify opportunities for continuous improvement.
This document describes the Health, Safety & Environmental Plan (HSEP) in place for All Our
Clients.

2. APPLICATION

PT. GZ Rancang Bagus Guna will responsible for the HSE performance of its agents,
personnel, Subcontractor and Sub-subcontractor personnel engaged in the Work.

PT. GZ Rancang Bagus Guna will develop, implement and maintain a systematic process for
managing HSE requirements in relation to the Work. All HSE requirements in relation to the
Work shall be defined in PT. GZ Rancang Bagus Guna HSE Plan.

The contract holder and the contractor are jointly responsible for the implementation and
improvement of the HSE Plan. Successful implementation of the HSE Plan will be determined
by the achievement of monitoring, evaluating and conducting corrective actions.

2.1 HSE OPERATION STANDARDS

2.1.1 Safety Rules

This Standard operation communicated and shared to all personnel by internal
induction, and state in manual safety book and induction flyer, Operation standard
include:
a. Identify hazard area and unsafe conditions
b. Wear proper PPE
c. Use appropriate tools and equipment
d. Report any unsafe conditions and incident/accident
e. Do stop work authority for all personnel when there is unsafe condition.
f. Follow relevant Standard Operation Procedure

2.1.2 General Safety Rules

a. Any injury sustained at your place of work whilst working or during recreations
periods, shall be reported immediately to your supervisor who will investigate
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the accident/incident and issue a report to management and copy to HSE

department within 24 hours
b. An employee shall immediately report any incident (including Oil Spill,
Equipment Damage and Fire/Explosion), near miss incidents, unsafe conditions
or practices to your supervisor, and copy to HSE Department, and take any
necessary actions to correct
c. All fires, whether extinguished or not, shall be immediately reported to the
Supervisor/Superintendent in charge of that area
d. Fighting and horseplay are strictly prohibited on the all work area
e. No equipment shall be operated unless the operator has received proper
training
f. No work shall be started on any unit or equipment without a work permit or
without the knowledge and consent of the person responsible for that area
g. When ascending or descending stairways, use the handrail and take one step at
a time

2.2 AWARENESS, TRAINING AND COMPETENCY Safety Induction

Employees conducting this project are to be given Safety Induction Training/Orientation

Program. This induction shall cover in particular, organization, hazard identification & control,
safe working practices, safety equipment and facilities, incident reporting, procedure for first
aid and emergency response plan and areas. All potential hazards and other HSE issues
identified during the kick-off meetings must be well communicated during this orientation.

3. PLANNING AND PROCEDURE

The main objective of this plan are to ensure the project activities are organized, controlled and
effectively discharged to minimize accident and harm to the environment. Conform with
Indonesian law and regulation, and used as the basis for managing HSSE on project.

3.1 SAFETY REQUIREMENT ON TOOLS & EQUIPMENT AND OPERATING STANDARDS

3.1.1 Tools and Equipment

Accidents associated with tools can be prevented with following :
a. Always use the right tool for the job. A permit to work will be issued where
appropriate
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b. Keep and maintain all tools in good condition, particularly safety devices such as
emergency stop button, etc.
c. Disconnect electric pneumatic and hydraulic tools from their power source when
adjusting, servicing, or when not in use, Perform LOTO procedure
d. Documented procedures shall be in place to ensure proper use dead man switch
and maintenance of powered equipment such as pedestal and portable hand held
grinders, drills, power saws, needle guns, lathes, etc
e. Employee training in proper use of equipment is provided, documented and
made available for audit purposes
f. Serviceable work bench and safety guards are in place and in good working order
g. Safety devices (stop buttons, etc) must be checked prior to use
h. Ensure adequate lighting is provided
i. Proper storage of abrasive wheels/discs in sealed waterproof bags in a dry place
j. Examination and correct mounting of abrasive wheel/discs by a competent person
prior to use
k. Correct use of designated tool for replacing used and/or worn wheels.
l. Pre-use check for tools
m. Use of proper PPE – fit for purpose

ensure equipment and tools shall only be operated by competent personnel.

ensure that all machinery, equipment, facilities and other items associated with or
utilized in the Work are maintained in a safe, sound and proper condition, and
comply with laws, regulations and the Company’s requirement.
PT. GZ ensure that all tools and equipment and temporary facilities and other items
used in the services, weather purchased, rented or otherwise provided by PT. GZ
shall ensure that all in safe, sound and good condition and are capable of
performing the function for which they are intended. If any tool and item of
equipment is in the judgement of Company unsafe or incapable of performing the
work for which it is intended, PT. GZ shall repair and/or replace such defective tools
and equipment used in the services at PT. GZ’s own expense.
PT. GZ ensure that all rotating or moving parts of all tools and equipment are
adequately guarded to prevent accidental contract by personnel. Every power-
driven machine should be provided with adequate means, immediately accessible
and readily identifiable to the operator, of stopping it quickly, and preventing it being
started again.
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3.1.2 Hand Tools

PT. GZ ensure that all tools supplied are in good condition and fit for their intended
use. Damaged tools which are unfit for use must be removed from service
immediately and if they cannot be repaired, they must be scrapped. Not allowed to
use handmade or hand tool modify brass hammers are used for work related to
products.

3.1.3 Confined Space work

Only experienced, trained and competent personnel shall be assigned as confined
space work, gas detectors are only carried out by authorized personnel. Worker
shall be subjected to Company medical fitness requirement and records of the
examination shall be made available to Company when requested. Tool that used
in Confined space work do by the PT. GZ must be inspected (including all
associated safety equipment such as gas detector, blower, etc.) by a qualified
certifying agent accordance with an approved certifying agency procedure in
accordance with the schedule stated. Safety on confined space detailed in HSSE
procedure.

3.1.4 LOTO
Hazardous energy associated with work activity is identified and assesses, this
includes temporary equipment. Integrity check on isolation devices are conducted,
verified (Log, Tag, Try) and isolated by competence person for the relevant hazard.
Energy isolation procedures are clearly defined and understood by all personnel
involved. Permit to work and isolation list are used to control work around
hazardous energy. Isolation authorise are operation team

3.1.5 System Testing

Due to the potential for catastrophic release of energy associated with pneumatic
testing, the procedures, size of test system and barrier management for this type of
test are pre-approved by client. Minimize the number of people in the area either by
restricting access or by performing testing activities during time when the general
workforce is not present, such as at night.
Provide a work procedure on the system preparation and test that include:
- Permit To Work requirement
- Hazard Identification and Risk Assessment (HIRA)
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- Job Safety Analysist (JSA)

- Approved test plan with required inspection and verification of hazard control
(pressure testing, energy isolation, etc)

3.1.6 Barricades System

It is forbidden to enter or pass through an area barricaded with warning sign,
without approval from entry attendant or supervisor. Opening hole must be covered
and installed barricade around with warning sign. Barricades requirement in PT. GZ
use barricade tape system that introduced with proper stands for effective
barricade. List below are the colour codes for the rope barricade system : BLACK -
YELOW : General, hot work, temporary storage, housekeeping, manual rigging
scaffolding erection and dismantling. (General working) RED - WHITE : lifting using
lorry cranes or mobile cranes work that is more than 3 days must be done
permanent barricade

3.1.7 Fatigue Management

Fatigue management is setting work time to prevent fatigue in workers resulting in
loss of concentration, decrease in health conditions that trigger harm while working.
within one day the maximum worker is allowed to work for 12 hours within 1 week
(Monday-Friday) 14 hours maximum overtime. in 1 week there must be 1 day off on
the basis of the above rules, PT. GZ regulates working time per person. if the work
requires 1 week to work without a day off, then PT. GZ must provide additional
numbers of workers fatigue management report will be documented and submitted
to client.

3.1.8 Personal Protective Equipment

All employees PT. GZ will comply with company Personal Protective Equipment in
determining the requirement and the type of PPE to be used at the work site
The minimum PPE requirement are as follows:
• Head protection ( hard hat complete with chin strap) (ANSI Z89.1)
• Eye protection ( safety glasses or goggles) (ANSI Z87), Wearing of dark glasses
are prohibited unless approval given by HSSE.
• Hearing protection ( earplug or earmuffs) (ANSI/ASA S12.6-2016 or EN 352-2)
• Foot protection (ankle high, steel toe capped and non-slip soles) (ASYM)
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• Protective clothing long-sleeved coverall

• Hand gloves (minimum leather gloves and specific based on activity)
Depending on the type of the work being performed, other required PPE (fall
protection harness compliance with ANSI EN.354 & EN 355 standard, masker, etc).
Respiratory protective devices shall be properly selected depends on the toxic
substance encountered, condition of exposure, human capability and equipment fit.
PT. GZ will be required to provide PPE for all relevant workforces. A list of PPE
shall be developed by the PT. GZ, describing the type, the standard reference and
client standards..

3.1.9 Inspection and Maintenance of Personal Protective Equipment

1. The Company shall ensure that the PPE provision to the workers is properly
maintained in good working condition.
2. The Company will conduct checking of personal protective equipment
accordingly. 3. All torn, damaged and unsafe equipment shall be replaced with a
good one.

PPE of poor condition should be discarded.

4. Equipment’s to be checked include helmet, earplug, safety glass, safety harness,

hand gloves, safety shoes, etc.
5. Records of the PPE inspection programme should be maintained for reference.
Required Personal Protective Equipment (PPE) and how to use them properly must
be known in the work operations. If in doubt, ask your Supervisor/ Superintendent.
The Supervisor/Superintendent is responsible for ensuring that all personnel under
his supervision are trained, understand and comply with the PPE policy/guidelines
specifically apply to their work environment. Supervisors/Superintendents shall
maintain appropriate surveillance of work area conditions and degree of personnel
exposure.

3.1.10 Safety Equipment and Fire Protection

PT. GZ will at its own expense provide sufficient fire extinguishers min. 6Kg, and
other safety equipment, approved to ISO or equivalent standards, as may be
specified in connection with this document, and shall maintain this equipment in a
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professional manner as prescribed by legal and industry standards. In addition, PT.

GZ shall keep up-to-date records of all said equipment and its maintenance.

3.1.11 Vehicle Requirements

1. The vehicle is fit for purpose, and has been maintained in safe working order,
with seatbelts installed and functional.
2. The number of passengers does not exceed manufacturer’s specification for the
vehicle
3. Loads are secure and do not exceed manufacturer’s specification and legal limits
for the vehicle.
4. Pick up vehicle not allowed to carry passenger
5. Operational Vehicle equipped by safety belt for all seats, speed management
device
6. Vehicle should be equipped by first aid kits and portable fire extinguisher

3.1.12 Driver Requirements

1. The driver is appropriately assessed, trained, valid driving license and medically
fit to operate the vehicle.
2. Drivers are appropriately rested and alert.
3. Drivers do not use mobile phone or other two-way communication device while
operating the vehicle.
4. In specific high-risk countries, risks of the journey have been assessed and
journey risk management plans in place.
5. Seatbelts are worn by all occupants at all times whenever a vehicle is in motion.
6. Drivers are not under the influence of alcohol or drugs, or any other substance or
medication that could impact their ability to drive.
7. Safety helmets are worn by rider and passengers of motorcycles, and similar
types of vehicle.

3.1.13 Smoking Policy

Smoking is not permitted in any Company premises except for the
“designated smoking area”. PT. GZ will provide the designated smoking area in PT.
GZ premises. PT. GZ are responsible for the enforcement of this smoking policy,
failure to do so will constitute a violation of the policy (especially in Company
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premises) and may lead to disciplinary action under the Company’s disciplinary
procedures.

3.1.14 Permit To Work

Permit to Work (PTW) hold by trainer permit holder. The purpose of the Permit to
Work system is to ensure that the controls necessary are available to provide safe
performance for work against specific range of potentially hazardous task. PTW is
the generic term that refers to documents for controlling work. These documents
are design to cover different work activities.
There may still be the requirement for some local rules covering sitespecific
logistical/administrative arrangements and local variations in responsibilities to
reflect differences in organizational arrangements. These local rules should not
deviate from the core processes. Permit to Work system tasks are divided into one
of the following categories:
- Soil Investigation & topography

The permit to work should all information about specific activities and hazard
associated with the work and is located at the work site prior to start of any work.

3.1.15 General
PT. GZ will pay due regard to the environment by acting to preserve air, water,
land, animal and plant life from adverse effects of PT. GZ’s activities, and to
minimize any nuisance which may arise from such operations.

3.1.16 Housekeeping
PT. GZ will be responsible for maintaining good housekeeping continuously
throughout the duration of the Work with due regard being paid to tidiness, ensuring
that access ways and emergency exits are kept clear at all times and without
exception.

3.1.17 Supervisory and Employee HSE Communication

Contractor’s supervisors or employees ensure that the jobs they are performing are
not hazardous either to themselves, others, other contractors. The contractor
should ensure that the contractor’s employees are able to communicate any related
HSE issues to their management.
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3.1.18 SAFETY MEETING

PT. GZ is responsible for maintaining and enhancing the HSE awareness of
contractor group personnel and shall participate in relevant training/emergency
drills. In principle, all PT. GZ personnel should attend on HSE meeting and
participate in a relevant emergency drill. PT. GZ will ensure that all group personnel
shall not commence to carry out services, or part thereof, until they have received
basic HSE information. This, as a minimum shall consist of an introductory briefing
explaining the nature of the work, the general hazards which may be encountered
during the work, the particular hazards attached to their own function within the
work, the methods of controlling these hazards and the relevant emergency
procedures to be followed, if required. This process will be repeated each time the
mode of operation substantially changes.
• The meeting shall be at least 30 minutes and not to exceed 90 minutes.
• One or some of the suggested Topics may be propagated or discussed.

3.2 COVID-19 PROTOCOLS AND ERP

PT. GZ will implement COVID-19 protocols and procedure as prevention at working area.

4. RULES AND OPERATIONS INTEGRITY

4.1 FALL PROTECTION

Any person on a walking/working surface with an unprotected side which is 1,8 meters or
more above a lower level or less than 1,8 meters but may suffer injury if falling shall be
protected from falling by the use of guard rails or a personal fall arrest system.
A personal fall arrest system includes a full body harness, shock absorbing lanyard or self-
retracting lifeline, anchoring connector and anchoring support such as a beam or support
structure. A safety lanyard shall not be secured by connecting the lanyard to itself. Only
locking type snap hooks shall be used on safety lanyards.
Personal fall arrest systems shall be inspected prior to each use for wear, damage, and other
deterioration. Any defective components shall be removed from service and may no longer be
used. For work on roofs or other similar surfaces with a slope of less than 1 in 4 (vertical to
horizontal) where the anchoring system and lanyard length will not permit a vertical fall, body
positioning belts (safety belts) may be used.
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• All loads are to be put down and placed as practical as possible using minimum assistance
from the Rigger.
• Tag line must be used in accordance with approved Risk Assessment.
• Lifting team must be always standby in-site during lifting process until crane engines is
stopped.
• All lifting gears (sling, shackle, hook, etc) shall refer to the marked SWL.
• Mandatory PPE, special additional for rigger and signal man use leather gloves minimum.

4.2 MANUAL HANDLING

For any operation involving the use of manual handling, lifting aids such as trolleys, barrel
lifters, etc. should be used wherever possible. For all lifts in excess of 25 kg, it will be
necessary to use a lifting aid or a minimum TWO-person lift.
1. Ask for help to lift any object which is difficult to lift. Always recognize and know your lifting
capacity. Both muscular and skeletal injuries can result from improper material handling.
2. Inspect the areas and routes prior to transferring materials. Ensure routes and storage
areas are unobstructed and free from slipping and tripping hazards.
3. Check objects which may have sharp edges, protruding nail points, or other hazards that
could cause injury when moving and take appropriate precautions.
4. Use of Medical aid like pallet jack and trolley carry out when it more than one object need
to move
5. . Apply the basic principles of lifting:
- Use the muscles in the legs to lift rather than the weaker back muscles.
- Ensure you have secure footing.
- Bend at the knees and get close to the object.
- Keep your back straight and bend slightly from the hips.
- Take a firm, balanced grip.
- Lift gradually by straightening the legs and keeping the back straight, not arched.
- Do not twist your body while under strain. Shift your feet and turn your whole body.
6. Medical preconditions:
During normal work pre-planning/Task Risk Assessment preparation involving activities
such as manual handling, lifting, stretching, twisting, entry in confined spaces, working at
extreme height, restricted access etc., care must be taken to ensure that medical
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precondition such as back/lumber problems, claustrophobia, fear of heights etc. are

identified and appropriate planning and control measures applied in order that such
preconditions are not exacerbated and risk the possibility of serious injury whilst carrying
out the task. Proactive prevention measures can help identify and prevent the potential for
serious injury/DAFWC.
7. Where possible, do not carry loads up and down stairways on your own. Obtain
assistance and ensure that one hand is maintained free for the handrail, at all times.

5. HSE REFERENCE STANDARD

1. International Association of Oil and Gas Producers (IOGP)

2. Construction Site Standarisation in Project (CSSS Standards)
3. UU No 1 tahun 1970 tentang Keselamatan Kerja
4. PERMENAKER RI No. Per-08/MEN/2020 tentang Keselamatan dan Kesehatan Kerja
Pesawat Angkat dan Pesawat Angkut
5. PERMENAKER RI No. Per-01/MEN/1989 tentang Kwalifikasi dan Syarat-syarat Operator
Keran Angkat
6. PUIL 2011 Instalasi Listrik
7. ANSI Z.87
8. ANSI Z.88
9. ANSI Z.89
10. ANSI Z.41
11. ANSI Z.359
12. ANSI S3.19 or ANSI S12.6
13. BSEN 345 : 1993 standard
14. PERMENAKER RI No. Per-04/MEN/1980 tentang Syarat-syarat Pemasangan dan
Pemeliharaan Alat Pemadam Api Ringan
15. PERMENAKER RI No. Per-02/MEN/1982 tentang Kwalifikasi Juru Las
16. PERMENAKER RI No. Per-03/MEN/1998 tentang Tata Cara Pelaporan dan Pemeriksaan
Kecelakaan
17. KEPMEN RI No. Kep-186/MEN/1999 tentang Penanggulangan Kebakaran di Tempat Kerja
18. KepPres RI No 22 tahun 1993 tentang Penyakit yang Timbul karena Hubungan Kerja
19. PERMENAKER RI No. Per-02/MEN/1980 tentang Pemeriksaan Kesehatan Tenaga Kerja
dalam Penyelenggaraan Keselamatan Kerja
20. PERMENAKER RI No. Per-01/MEN/1981 tentang Kewajiban Melapor Penyakit Akibat Kerja
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21. PERMENAKER RI No. Per-01/MEN/1998 tentang Penyelenggaraan Pemeliharaan

Kesehatan Bagi Tenaga Kerja dengan Manfaat Lebih Baik dari Paket Jaminan Pemeliharaan
Dasar Jaminan Sosial Tenaga Kerja.
22. PERMENAKER RI No. Per-147/MEN/1998 tentang Pemanfaatan Pelayanan
Kesehatan Bagi Program Jaminan Pemeliharaan Kesehatan Jaminan Sosial Tenaga Kerja
23. KEPMENAKER RI No Kep-187/MEN/1999 tentang Pengendalian Bahan Kimia Berbahaya
24. PERMENAKER RI No. 8/MEN/VII/2010 tentang Alat Pelindung Diri
KepPres RI No 22 tahun 1993 tentang Penyakit yang Timbul karena Hubungan Kerja

Appendix A – Policies and Regulation

 HSE Policies
 Regulation and Legislation List

Appendix B – Organization, Responsibilities, Contractor Management, and Standard

 Organization Chart (Merge with BECIS Personnel)

 HSE Qualified Personnel CV
 Personnel Certificate (First Aider, Fire Fighters, Operator, etc)
 HSE Meetings (Scheduled Plan, Meeting Attendance List Form, etc)
 Safety Talk (Topics, Safety Talk Form, etc)

Appendix C – HSE Program

 Training (Training Matrix, Training Material, Training Attendance List Form, etc)
 Health (Covid Monitoring, etc)
 Environmental (Hazardous, Waste Segregation, etc)

Appendix D – Hazard and Risk Management

 HIRA
 JSA
 Method Statement
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 Equipment Readiness Assurance (List of Equipment e.g. crane, hand tools,

scaffolding, etc, Equipment Control e.g. Inspection Plan, Inspection Form, etc)
 Emergency Preparedness (ERT, ERP, Emergency Contact, Emergency Equipment, etc)
 PPE (PPE Standard, PPE Matrix, PPE minimum Stock, PPE Monitoring, etc)
 HSE Sign (Follow ANSI535 Standard and Bilingual)

Appendix E – Planning and Procedures

 Safety Patrol (Planning, Inspection Form, etc)

 HSE Communication
 Procedures (Working at Height, CSE, Incident Report, etc)
 Inspection (Form, Timeline, etc)

Appendix F – HSE Management System Implementation

 KPI