Apendiks F / Appendix F

Bagian 2 – Persyaratan Pengajuan / Part 2 – Submittal Requirements

APENDIKS F
APPENDIX F

PERSYARATAN KESEHATAN, KESELAMATAN KERJA DAN LINDUNGAN LINGKUNGAN (K3LL)

HEALTH, SAFETY AND ENVIRONMENT (HSE) REQUIREMENTS

CALON PESERTA TENDER harus memberikan tanggapan terhadap persyaratan K3LL dalam
Apendiks F dari Bagian 2 iniPOTENTIAL BIDDER shall provide response to HSE requirements under
Appendix F of Part 2 hereto.Apabila diperlukan, PERUSAHAAN dapat meminta CALON PESERTA
TENDER untuk menyediakan data-data dan/atau dokumen tambahan dan melakukan kunjungan
terhadap fasilitas-fasilitas dan kantor-kantor CALON PESERTA TENDERIf required, COMPANY may
request POTENTIAL BIDDER to provide additional data and/or documents and conduct site visit to
POTENTIAL BIDDER’s facilities and offices.

Qualification HSE Questionnaire

HEALTH, SAFETY AND ENVIRONMENT – HSE QUESTIONNAIRE

General Information

HSE Contact :

Name : WISNU HADI SAPUTRA

Title : HSE DEPARTMENT HEAD PT SURYA DARMA PERKASA

Phone : 0813-8052-8338

E-mail : wisnu.hadi@hartonorentcar.com

Section 1 – Leadership and Commitment

1.1Commitment of HSE Aspects Through Leadership

aHow senior managers are personally involved in HSE management, for example objective-
setting and monitoring?
b- General Manager have routine review related HSE performance with HSE Dept.
c- Objective Target Program approved by General Manager

aProvide evidence of commitment at all levels of the organization.

b- Commitment shown by attendance weekly review meeting all department and HSE
present Problem Identification and Corrective Action

aHow do you promote a positive culture towards HSE matters?

b- By Safety meeting, By Safety Bulletin

Section 2 – HSE Policy and Strategic Objectives

1.1HSE Policy Documents

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aDoes your company have an HSE policy document? If the answer is YES please attach a
copy?
bYes, PT Surya Darma Perkasa have HSE Policy (attached file)

aWho has overall and final responsibility for HSE in your organization?
bTop responsibility by Owner PT Surya Darma Perkasa and monitor by General
Manager and maintain – control by HSE Dept.

aWho is the most senior person in the organization responsible for this policy being carried
out at the premises and on site where his/her employees are working? Provide name and
title.
bGeneral Manager Operation and Marketing
cMr Anggoro Widodo

aItemize the methods by which you have drawn your policy statements to the attention of all
your employees.
bBy meeting, By put on Driver Safety Book

aWhat are your arrangements for advising employees of changes in the policy?
bDuring safety meeting we always made discussion session to take input from
employee so that could be point to revise or change the policy as actual as current
condition.

1.1HSE Contract Strategic Objectives

aDoes your company have strategic HSE objectives? If the answer is YES please attach a
copy.
bYes, we have HSE Objective Target Program (Attached file)

aItemize the methods by which you have communicated your strategic HSE objectives to the
attention of all your employees.
bBy meeting all department, safety meeting to employee

Section 3 – Organization, Responsibilities, Resources, Standards and Documentation

1.1Organizational Structure for HSE Management

aHow is your organization structured to manage and communicate HSE effectively?

HSE Dept report to General Manager Ops Marketing, and have a review weekly to
report problem identification corrective action. HSE Dept divided by HSE field and
HSE admin.

aDo HSE meetings promote HSE awareness?

bYes, HSE meeting share HSE awareness

aDo client and contractor meet regularly to discuss and act upon any interface situations?
bYes, example performance review with Customer

aWhat provision does your company make for HSE communication meetings? Please
provide an organization chart.
bProvision : at least conduct once monthly, and review management by weekly
cAttached Organization Structure.
d
e

1.1HSE training of managers, supervisors and HSE critical position holders

aHave the managers and supervisors at all levels who will plan, monitor, oversee, and carry

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out the work received formal HSE training in their responsibilities with respect to conducting
work to HSE requirements?Do HSE meetings promote HSE awareness?
bManagers and Spv join HSE training regularly in HSE meeting. HSE Meeting always
sharing HSE material which relevant for job task each section.

aIf YES please give details. Where the training is given in-house, please describe the content
and duration of courses. Please provide an example of training matrix.

aHow have you identified areas of your company’s operations where specialized training is
required, for instance training related to health hazard such as radiation, asbestos and
chemicals?
bRelated with our business, HSE training related with safety on drive (Defensive
Driving Training).

1.1General HSE training

aWhat arrangements does your company have to ensure new employees have knowledge of
basic industrial HSE, and to keep this knowledge up to date?
bWe conduct HSE induction, HSE Training

aWhat arrangements does your company have to ensure new employees also have
knowledge of your HSE policies, practices and company requirements?
bWe conduct HSE induction.

aWhat arrangements does your company have to ensure new employees have been
instructed and have received information on any specific hazards arising out of the nature of
the activities?
bWe conduct HSE induction

NB) for (a), (b) & (c): if training is provided in-house, please give details of the content.

1.1Competence Assurance

aDoes your organization have a competence system in place? If YES, please describe the
scope and content of your competence system.
bYes, for monitoring safety transportation we use In Vehicle Monitoring System.
cScope of this system for tracking all vehicle in SDP. We could track location, fuel
management, velocity, harsh brake, accelerate.

aWhat arrangements does your company have to ensure existing staff’s HSE knowledge is
up to date?
bBy conducting internal training related with HSE aspect (file attached for example)

1.1Contractor Management Process (Not Applicable)

aDoes your company have a contractor management process or system? If yes, provide an
outline of the process.No

aHow do you assess contractors, HSE competence or HSE performance? Still not yet
conduct.

aWhere do you define the company standards you require your contractors to meet?
bStill not yet conduct.

aHow do you ensure these standards are met and verified?We still develop and will launch
for 2017.

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1.1HSE Standards

aHow do you identify new industry or regulatory standards that may be applicable to your
activities?
By keep update our legal compliance with our related business industry (by
browsing internet, by information from customer).

aIs there an overall structure for producing, updating and disseminating standards?
bYes, by Legal Department

aAre your company standards aligned with OGP/industry guidelines or recommended practices? If
yes, state which one.
bYes, as transportation company we comply with UU no.22/2009 (for example)

Section 4 – Risk Management

1Risk Assessment and Control

aHow does your company identify hazards, assess risk, control and mitigate consequences,
to a level as low as reasonably practicable?
bWe have procedure Hazard Identification and example Risk Assessment to assess
risk (file attached).

1.14.2 Health Hazards

aDo you have specific policies and programs on specific health hazards, e.g. substance
abuse, blood borne pathogens, malaria pandemic diseases etc.?
bYes, we have program Drug Alcohol test (example) and also Drug Policy

aWhat types of health hazards (chemical, vibration, noise, radiation, etc.) are associated with
the scope of your services? Explain how occupational health hazards are identified,
assessed and controlled.
bAs Provider Transport Service, type health hazard will arise for example blind color,
fatigue
cWe conduct Medical Check Up regularly for all our driver, the result will analyze and
communicate with Customer. Driver on result 'Unfit' will replaced with 'fit' driver.

aWhat systems are in place to control these hazards and monitor the effectiveness of these
controls? Is worker’s regular exposure monitoring part of these systems?
bWe review medical check up regularly and report to customer and Customer will
issued a letter of acknowledge. Driver on result 'Unfit' will replaced with 'fit' driver.

1.1Safety Hazards

aWhat types of safety hazards (mechanical guarding, work at height, lifting and hoisting,
confined space entry, explosive atmospheres, etc.) are associated with the scope of your
services?
bDriving hazard.

aWhat systems are in place to control these hazards and monitor the effectiveness of
these controls?
bWe have Driving Golden Policy for all driver, we have safety driving standar which
already made in Driving Safety Book.
cwe conduct driver assesment and we conduct regular defensive driving training
(example file attached).
d

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1.1Logistics Hazards

aWhat types of logistics hazards (land transport, air transport, marine transport, materials
handling etc.) are associated with the scope of your services?
bNot Applicable

aWhat systems are in place to control these hazards and monitor the effectiveness of
these controls?
b Not Applicable

1.1Environmental Hazards

aWhat types of environmental hazards (chemical spill, atmospheric emissions, waste

disposal etc.) are associated with the scope of your services?
bAtmospheric emission

aWhat systems are in place to control these hazards and monitor the effectiveness of
these controls?
bOne of our program is conduct emission test for our vehicle (example attached).

1.1Security Hazards

aWhat types of security hazards (terrorism, hostage taking, robbery, hostile local
population etc.) are associated with the scope of your services? Not yet Developed

aWhat systems are in place to control these hazards and monitor the effectiveness of
these controls?
bNot yet Developed.

1.1Social responsibility hazards

aWhat types of social hazards are associated with the scope of your services?Not yet
developed.

aWhat systems are in place to control these hazards and impacts and monitor the
effectiveness of these controls?Not yet developed.

Section 5 – Planning and Procedures

1HSE Operations Manual

aDo you have a company HSE-MS manual (or operations manual with integrated HSE
requirements) which describes in detail your company approved HSE working practices
relating to your work activities? If the answer is YES, please attach a copy of an index and
relevant supporting documentation.
bYes, we HSE Manual (Attached File).
c

1.1Infrasturcture and Equipment Integrity

aHow do you ensure that infrastructure, plant and equipment used within your operations
(own premises, client site, or at other locations) are correctly certified, registered, controlled
and maintained in a safe working condition?
bFor Vehicle, we maintain well as per manufacture standard. We provide driver daily
safety checklist to inspect the vehicle.

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1.1Management of Change

aHow do you manage changes and assess associated risks, e.g. personnel, equipment,
processes, documentation?
bIn SDP, if there are change related with personnel we conduct induction for new
personnel, for equipment (vehicle) we have handover form.

1.1Emergency Planning and Response

aWhat arrangements does your company have for emergency planning and response?
bFor emergency response, we develop procedure emergency response, we conduct
training related emergency response.
c(File attached for example)

aWhich emergency situations are included?

b- Fire
c- Earthquake
d- Driving on Rain

Section 6 – Implementation and Preformance Monitoring

1HSE-MS Implementation and Active Performance Monitoring of Work Activities

aWhat arrangements does your organization have for monitoring the implementation of your
HSE-MS?
bWe have regular meeting on weekly basis to review implementation of HSE MS.
cFor external, we also sent performance report on monthly basis and we also present
to Customer our achievement on HSE aspect.
d(File attached for example)

aHow does your company assure the implementation of work procedures within your work-
site operations (e.g. compliance with procedures, toolbox meetings, safety meetings,
supervision, job observations)?
bBy Inspection on site (File attached for example)

aHow do you monitor employee HSE performance (e.g. hazard identification systems, HSE
participation)?
bBy control monthly report and performance review (example)

aWhat active HSE monitoring is performed (i.e. where no incident has occurred)?
bTo prevent and minimize risk of accident, we provide In Vehicle Monitoring System
to ensure all vehicle motion, for example if driver overspeeding we could know by
SMS so we could direct give warning to driver.

aHow do you report and correct deficiencies identified?

bWe have Problem Identification and Corrective Action Method. We identify the
problem and solve by Man, Machine, Method, Material and Environment aspect.

aHow do you communicate the results of active performance monitoring to relevant

personnel?
bWe communicate performance in HSE meeting that conduct regular on monthly
basis.

1.16.2 Safety Performance Indicators

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aPlease provide the following statistics for each year for the last five years:

20122013201420152016
·Number of Fatalities

00000

·Number of Lost Time Injuries

00000
·Number of Lost Workday Cases

00000
·Number of Restricted Work Day Cases

00000
·Number of Medical Treatment Cases

00000
·Number of First Aid Cases

00000

·Number of Near-Miss Incidents

00000
·Fatal Accident Rate (per 100 milion hours worked)

00000
·Lost Time Injury Frequency (per million hours worked)

00000
·Total Recordable Incident Rate (per million hours worked)

00000
NOTE: If not using the OGP definitions (refer to the OGP safety performance indicators
report), please include the definitions used at your company.

1.16.3 HSE Performance Monitoring

aHow is health performance monitored and recorded?

bWe recap all data after MCU for employee, and we inform to relevant section if found
nonconformity from MCU result.

aHow is environmental performance monitored and recorded?

bUntil now, SDP not monitor and record this item.

aHow is security performance monitored and recorded?

bUntil now, SDP not monitor and record this item.

aHow and what near-miss incidents are reported?

bNear miss report we used observation card and by monthly we review it.

aHow often is HSE performance reviewed? By whom?

bWeekly basis at internal, and monthly basis at Customer

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aHow is logistics performance monitored and reported?

bUntil now, SDP not monitor and record this item.

aDo you record vehicle incidents?

bYes, example of report incident vehicle at 2015

1.16.4 HSE Incident Investigation and Follow-Up

aWhat types of HSE incident are investigated?

bFatality, Lost Time, Property Damage, Medical Aid, First Aid

aWhat process is used to investigate HSE incidents?

bWe Use 4M 1E methods

aWho conducts HSE incident investigations?

bHSE dept and related Dept

aHow are the findings of an incident investigation followed up to ensure effective prevention
of recurrence?
bBy tracking from HSE department communicate to related dept. Reminder by
continuously before due date. Reported to Superior.

aHow is incident learning communicated to all relevant personnel?

bWe conduct stand Down meeting for communicate
1.16.5 Statutory Notifiable Incidents or Non-Compliance Notices

aHas your company suffered any statutory notifiable incidents in the last five years (safety,
occupational health and environmental)? Provide answers with details including dates,
country and location, summary of incident and follow-up preventative measures taken
bNo

Section 7 – HSE Auditing and Management Review of HSE-MS

1Audits

aDo you have a written procedure for HSE auditing? If yes, please attach a copy.
bYes, attached file

aWho is involved in conducting HSE audits? How are audit team members selected to have
specific expertise and be independent from the activities being audited? What are the
qualifications required for auditors?
bMostly HSE Dept incharge for HSE Audit. HSE Dept had qualification as internal
auditor for OHSAS 18001:2007

aHow does your company schedule HSE audits and what scope of auditing is covered? (e.g.
internal, regulatory compliance, supplier/contractor, HSE management system
implementation).
bAs per HSE plan and requirement from Customer

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aHow does management follow up on audit findings and ensure effective close out of action
items?
bGive important attention, and always check regular bassis by review weekly

1.1Management Review and Follow Up

aDo you have a written procedure for management review of the HSE-MS? If yes, please
attach a copy.
Yes, attached file for procedure review management

aHow often are HSE-MS reviews conducted and who is involved in the process?
bSDP conduct review for HSE as per procedure at Cross Department Meeting, all
Department join and involve for this meeting. General Manager as leader of meeting
always give input related with HSE performance.

aHow are identified actions and improvement efforts recorded and tracked to effective
completion?
bWe have PICA (Problem Identification and Corrective Action) format. All non
conformity input in PICA format and tracked from HSE Department.

Section 8 – HSE Management – Additional Features

1Certification of Your HSE-MS

aPlease provide information on any certification which you have received from certification
bodies.
bPT SDP still not certified for Safety Management System (example, OHSAS, or ISO).
cThis project will establish at HSE plan 2017.

1.1Memberships of Associations

aDescribe the nature and extent of your company’s participation in relevant industry, trade,
and governmental organizations.
b SDP join Asosiasi Perusahan Rental Indonesia (File Attached)
c

1.1Additional Features of Your HSE-MS

aDoes your organization (globally, regionally or locally) have any HSE features or
arrangements not described elsewhere in your response to the questionnaire?
bWe already received HSE Recognition award from other Oil Gas Company
(Exxonmobil, Conoco Philips for example)

Section 9 – Company Specific Information

l壱HSE Contract Responsible for the Answers of this Questionnaire

Name : WISNU HADI SAPUTRA

Title : HSE DEPARTMENT HEAD

Phone : 0813 – 8052 -8338

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E-mail : wisnu.hadi@hartonorentcar.com

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