Doc. No. : 26071-100-VSC-BD3.

1-00011

Job No. : 26071 Rev.00A

WORK METHOD STATEMENT FOR ANCHOR BUILDING

WORK PACKAGE BD3.1 OSBL OR ISBL AREA

PROJECT : Engineering, Procurement and Construction (EPC) Inside

Battery Limits (ISBL) and Outside Battery Limits (OSBL)
for the Refinery Development Master Plan (RDMP) Project
RU V Balikpapan
LOCATION : Refinery Unit V Balikpapan, East
Kalimantan,Indonesia OWNER : PT. Pertamina
PO. NO : RDMP-P-SC-BD-003.1

NANANG WESLEY PUJO

00A 05 Apr 22 ISSUED FOR REVIEW
TARYANA P. SIBUEA WIYATNO
REV. DATE DESCRIPTION PREPARED CHECKED APPROVED

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REVISION LOG

REV. NO. DATE PAGE DESCRIPTION

00A 05 Apr 22 - ISSUED FOR REVIEW

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Table of Contents

1. PURPOSE.............................................................................................................................4

2. SCOPE OF WORK..............................................................................................................4

3. DEFINITION........................................................................................................................4

4. REFERENCE.......................................................................................................................5

5. ROLE AND RESPONSIBILITIES....................................................................................5

6. GENERAL SAFETY & QUALITY REQUIREMENT....................................................7

7. WORK PREPARATION..................................................................................................10

8. METHODE OF EXECUTION.........................................................................................12

9. WORKING AREA.............................................................................................................14

10. ATTACHMENTS..............................................................................................................15

10.1 Attachment.1 : Flowchart Anchor Bolt Installation Works........................................................................15

10. 2 Attachment.2: Emergency Response Team Organization Chart...............................................................19

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1. PURPOSE

The purpose of this Construction Method Statement is to describe and establish HSE and
Construction requirements for Anchor Bolt Installation Procedure to be executed by
Subcontractor for Construction Inside Battery Limits (ISBL) and Outside Battery Limit
(OSBL) for The Refinery Development Master Plan (RDMP) Project RU V Balikpapan
(hereinafter referred to as PROJECT).

2. SCOPE OF WORK

This Construction Method Statement covers for all the activities related to Structure works of
Building Work Package BD3.1 OSBL Area on specifically 341-SS(ISH)-103, 341-SS(ISH)-
105 and 341-SS-113.

3. DEFINITION

Terms Definition

PROJECT Engineering, Procurement and Construction (EPC) Inside

Battery Limits (ISBL) and Outside Battery Limit (OSBL) for
The Refinery Development Master Plan (RDMP) Project RU V
Balikpapan

OWNER PT. Pertamina

IPMT Integrated Project Management Team consists of a combination

of OWNER Personnel and third-party personnel appointed by
OWNER

CONTRACTOR RDMP Balikpapan JO

JO Joint Operation, Joint Operation (JO) Body

SUBCONTRACTOR PT. Agcia Pertiwi

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4. REFERENCE

Doc. No
26071-100-3SS-E13-00002
26071-100-D0-000-00007
26071-100-GQI-GAQ-00004
26071-100-GQI-GAQ-00005
Title
Specification for Concrete Work and Grout
Structural Concrete Standard Drawing Anchor Bolts &
Sleeves
Insepectioon Measuring and Test Equipment Control
Procedure
Site Inspection and Test Procedure

26071-100-GQI-GAQ-00009 Material Receiving Inspection Procedure

26071-100-GQP-GAQ-00002 Project Quality Plan

26071-100-3DR-000-00001 Design Criteria for Civil & Structure Works

26071-100-3SS-E13-00001 Specification for Furnishing and Delivery of Concrete

26071-100-3SS-E15-00003 Specification for Galvanized Steel

26071-100-GQI-GCQ-00009 Inspection and Test Plan for Civil

26071-100-GQI-GCQ-00015 Inspection and Test Plan for Structural Steel Work

5. ROLE AND RESPONSIBILITIES

The responsibilities of the key personnel are as follows;

5.1. Project Manager

The Construction Manager is overall responsible for the implementation of method

statement of anchor bolts fixation and ensures that his team of Engineers and foremen are
aware of this method statement and all resources – human, material and equipment are
available to carry out the work as planned and without any delay

5.2. Project Engineer / QAQC

5.2.1. Submit all permit, RFI and Inspection checklist of the works
5.2.2. Provide the site engineer with approved drawings
5.2.3. Follow up the site team to use approved materials

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5.2.4.Check the fixed anchor bolts in the template are as per approved drawings such as
diameter, number, location and the space between each anchor bolt.
5.2.5.Check with surveyor the required level for the anchor bolts during fixation stage.
5.2.6.Check the alignment and level of the anchor bolts.
5.2.7. Ensure that anchor bolts are covered properly after fixing and approval before
concrete
5.2.8.Ensure the level of anchor bolts after casting the pedestals
5.2.9.Preparing the equipment and man power are available on site.

5.3. Surveyor

5.3.1.Surveyor setting out the axis of anchor bolts per approved drawing
5.3.2. Checked the bolts before,during and after concrete placement
5.3.3. Prepare survey report as described in the inspection and test plan

5.4. Safety Supervisor

5.4.1. Ensure that all equipment are properly maintained and in safe working conditions.
5.4.2. Follow up all the safety precautions during anchor bolts preparation and fixing
such as wearing helmet, safety shoes, overalls, gloves, and vests.
5.4.3. Ensure that the working area is protected during the work.
5.4.4. Always coordination with the site supervisor to make sure the activity follow the
Risk Assessment provided.

5.5. Site Engineer

5.5.1. To coordinated with designated personnel representative from Contractor in

order to en sure that anchor bolts installation is according to the latest revision
drawing and specifications.
5.5.2. Follow up and ensure anchor bolt alignment and level are according to the
latest drawing and specifications.
5.5.3. Preparing the daily report of the complete area of anchor bolt fixing to the
Project Engineer.

5.6. Site Supervisor

5.6.1.Coordinate the foreman and workers and supervise works activities.

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5.6.2. Instruct the workers to following the anchor bolt fixing works
instructions and drawing from Site Engineer.

5.6.3. Leading daily tool box meeting

5.6.4. Controlling the implementation of project operations

5.6.5. Carry out project operational activities in accordance with quality

requirements and safety regulations

5.6.6. Planning a work schedule for workers in accordance with the master
schedule

5.6.7. Planning and calculating the needs and placement of materials and labor

5.7. Foreman

5.7.1. Following the instructions from the Site Supervisor.

5.7.2. Distribute the labors for the site works as per needed.
5.7.3. Supervise the labors productivity and their works
5.7.4. Verifiy the alignment and the level of anchor bolts.
5.7.5. Prepare all the required tools for the fixing.

5.8. QC/QA Coordinator

5.8.1. Asuring quality of Building

5.8.2. Coordinating with spv and client for support progress

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6. GENERAL SAFETY & QUALITY REQUIREMENT

6.1. Equipment & Man Power :

Equipment
No Name Of Tools Function Remark
1 Total Station Survey Works 1 set
2 Level Machine Survey Works 1 set
3 Spanner Bolt Fixing As per needed
4 Water Level Survey Works 1 unit
5 Line Dory / Nylon Chord Axis Benchmark/Survey As per needed
6 Masking Tape Anchor Bolts Cover As per needed
7 Cutting Wheel / Steel Cutter Bar/Plate Cutting 1 unit
8 Welding Set Bottom Template Tack Weld 1 set
9 Drilling Machine Drilling Bolt Hole 1 unit
Face Shield, Welding Face Bottom
10 Shield Template As per needed
Fabrication
11 PPE Safety Equipment As per needed

Manpower
No. Description Remark
a. Project Manager 1 person
b. Project Engineer/QAQC Supervisor 1 person
c. Surveyor 1 person/ as per needed on field
d. Surveyor Assistant 1 person/ as per needed on field
e. Safety Supervisor 1 person/ as per needed on field
f. Site Engineer 1 person
g. Site Supervisor 1 person/ as per needed on field
i. Foreman 1 person/ as per needed on field
j. Welder 1 person/ as per needed on field
k. Labor 2 person/ as per needed on field

The number of the above equipment and man power shall be adjust in accordance with

site conditions, requirements, and availability at the time of execution.

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6.2. Material Specification :

All permanent material shall submit for owner approval prior to purchase

6.2.1. Anchor Bolt Type “A” & “AS”

 The specification of concrete material is in accordance with the document 26071-100-

3SS-E13-00001 Specification for Furnishing and Delivery Of Concrete

 Fabricated or all thread bolt shall conform to ASTM F1554/F1554M Grade 36

 Machine Bolts may be substituted where the required size and lengths are
available and shall conform to ASTM A307/A307M

 Nuts shall be in accordance with ASTM A563/A563M Heavy Hex Nut Grade A

6.2.2. Anchor Bolt Type “B” & “BS”

 The specification of concrete material is in accordance with the document 26071-100-

3SS-E13-00001 Specification for Furnishing and Delivery of Concrete

 Bolt material shall conform to ASTM F1554/F1554M Grade 105

 Nuts shall be in accordance with ASTM A563/A563M Heavy Hex Nut Grade DH

 Circular plates shall be fabricated from ASTM A36/A36M steel unless

noted otherwise . Holes in the plates shall be 2 mm larger than bolt diameter.

6.2.3. One washer required for each bolt unless noted otherwise. Washer shall conform to
ASTM F436/F436M circular type 1 unless noted otherwise.

6.2.4. Threads shall conform to ANSI/ASME B1.1 having A Class UNC 2A tolerance
for bolts and A Class UNC 2B tolerance for nuts

6.2.5. Bolts, nuts and washers shall be hot-dip galvanized in accordance with ASTM
F2329, unless noted otherwise.

6.2.6. Excess galvanizing material shall be removed from the threaded portion of the
anchor bolts by the use of a centrifuge or mechanical chasing of the threads.

6.2.7. The fit of the nuts on threads of anchor bolt shall be verified

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6.2.8. Tack weld in shop with 3 mm fillet (3 places) to prevent release or backing off

6.2.9. Two nuts shall be provided above grip for anchor bolts securing vibrating equipment

Coupling nuts for type “AS” and “BS” shall be supplied with a standard hex bolt to

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6.2.10. be used to temporarily fill the coupler during concrete placement.

6.3. Hazard Identification :

Description of Potential Harmed
Control Measures
Job Step Hazard/Risk Object
Material - Material - Use PPE (Personal
Handling Protective Equipment).
Handling Bag
(Delivery, Workers Pay attention to handle the
Broken.
Storage) material not to tear the bag
- Back Injury
- Proper manual lifting method

- Use PPE (Personal

Protective Equipment).
- Material Scattered.
- Use Qualified Worker.
- Damage to eyes
Wooden plate
- Inspect tool prior to working
/ hearing / other
cutting for anchor Workers - Using safety glass and dust
body parts.
template
mask
- Injured by plywood
- Following the work
saw
instructions / procedure
- Use PPE (Personal
- Material Scattered.
Protective Equipment).
Drilling the - Damage to eyes
- Use Qualified Worker.
wooden template / hearing / other
- Inspect tool prior to working
body parts. Workers
for anchor holes - Using safety glass and dust
- Injured by drilling
mask
tool.
- Following the work
instructions / procedure
Bottom template - Burned by welding - Use PPE (Personal
fabrication or cutting spark Protective Equipment).
- Electric shock - Use Qualified Worker.
- Noise hazard - Inspect tool and power line
Workers
- Fire hazard prior to working
- Exposure to UV and - Use helmet with welding
IR radiation shield

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Description of Potential Harmed

Control Measures
Job Step Hazard/Risk Object
- Use respirator
- Exposure to Fume
and Gases - Use fire resistant clothing
- Use ear protection
- Clean the working area from
flammable materials
- Use PPE (Personal
Anchor - Stabbing hazard.
Protective Equipment)
placement & - Finger pinched
Workers - Use Qualified Worker
template fixing hazard
- Following the
- Scratched by rebar
work instructions / procedure
- Use PPE (Personal
- Finger pinched
Protective Equipment)
Bolt and nut
hazard Workers - Use Qualified Worker
fixing - Scratched by rebar
- Following the
work instructions / procedure

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7. WORK PREPARATION

7.1. General

7.1.1. All the personnel working in the field will be given relevant safety orientation
training and formal site induction. All the personnel will be made aware of
safety procedure and requirements to be ensured on the entire task to be
executed on site.
7.1.2. Daily toolbox tasks will be held at the site prior to commence of work
activities. All the personnel working in the site shall wear the appropriate
PPE.
7.1.3. Isolate the area with warning tape and warning signs in order to control
access to the work area by unauthorized workers.
7.1.4. Proper barricade must be provided and maintained around working area at all
times.
7.1.5. Supervisor shall conduct inspection for all equipment to ensure good
equipment conditions at site.
7.1.6. Housekeeping shall be carried out in proper way and the waste shall be
disposed in the designated place allocated by CONTRACTOR.
7.1.7. Job risk assessment shall be done daily by supervisor and workers and
potential hazards shall be highlighted during Tool Box Meeting.

7.1.8. Before work start, education (training) of the work sequences will be
provided to all workers, who are involved in this work.

7.2. Personal Protective Equipment(PPE)

The usage of the following PPE is mandatory during the construction work.
7.2.1. Safety helmet
7.2.2. Safety shoes
7.2.3. Safeguard (Coverall)
7.2.4. Hand gloves
7.2.5. Safety glasses

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7.2.6. Dust mask

7.3. Work Permit (PTW : Permit To Work)

7.3.1. To start the work SUBCONTRACTOR will follow approved permit to work
procedure along with the approved WMS, Risk Assessment (or Job Safety
Analysis) and the related drawings showing the working proposal shall be
submitted to CONTRACTOR/OWNER.
7.3.2. Before work starts, ensure that all work permits have been obtained from
CONTRACTOR/OWNER, for Brown field and SHRP for Green field.
7.3.3. Permit Box shall be available & all the permits shall be displayed in the Permit
Box on site.

7.4. Night Work & Day Shift Extended Hours

7.4.1. Prior approval shall be obtained from OWNER to work outside the normal
working hours.
7.4.2. Area lighting Shall procedure an overall level of illumination adequate for
personnel and equipment to move around safety to carry out work activities
without risk.
7.4.3. All exits, pathways and muster points shall be clearly illuminated.
7.4.4. Ladder accesses and egrees shall be clearly illuminated.
7.4.5. Generator provided shall be checked prior to use to ensure that they meet
site requirements, if applicable.
7.4.6. Cable provided for temporary lighting shall be routed ensure that they do
not present a trip hazard or other obstruction.

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7.5. Emergency Response Plan (ERP)

7.5.1. Emergency Response Plan must be developed and all personnel acquainted
with the relevant provisions and know what to do in case of any emergency.
7.5.2. PT. Agcia Pertiwi shall have stably trained fire watch man among his crew at
all time during onsite operations.
7.5.3. PT. Agcia Periwi shall display emergency evacuation procedures at strategic
location on the site and ensure arrangements are in place to call for outside help if
need to assist in any emergency associated with the Work on Site.
7.5.4. PT. Agcia Pertiwi shall at all-time keep update with list of addresses and telephone,
numbers of the PT. Agcia Pertiwi and OWNER staffs who are responsible for
organizing emergency responses at site.
7.5.5. In case any emergency happens during night activities, PT. Agcia Pertiwi shall
follow project emergency handling procedure doc.No. 26071-100-GPP-GHX-
00002. As an example, for general and fire emergency response flowchart could
be seen below. (Attachment Sheet)

8. METHODE OF EXECUTION

8.1. Preparation
8.1.1. Prepare the latest revision drawings for anchor bolt details.
8.1.2. Prepare the materials, man power and equipment as per needed.
8.1.3. The Supervisor held a pre work meeting to explain the job instructions and safety
procedure.

8.2. Preparing the Anchor Bolt Template

8.2.1. Cut the wooden plank or plywood into rectangular shape (unless required otherwise)
with the dimension depend on the bolts positions and distances and pedestal size.
8.2.2. Mark the wooden plate to specify drilling point according to bolts positions and
distances.
8.2.3. Drill the plate with the drill bit diameter fit to the anchor bolt diameter.
8.2.4. Cut the bar or plate according to standart drawing and anchor bolt requirement.

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8.2.5. Arrange the anchor bolt according to its position and distance,then place the bottom
template.
8.2.6. Bottom template welded tack weld is prohibited without qualified welder type to
anchor bolt in order to stabilized the bolts position and distance into a rigid form
and prevent the bolts from shifting, rotating or any other movement.

8.3. Template and Anchor Bolt Fixing

8.3.1. Surveyor setting out the axis with total station and prepare the axis line or marking
on the top of the pedestals.
8.3.2. Place the bolts to the temporary plate and fix it.
8.3.3. After survey works, start fixing the temporary wooden plate with the anchor bolts
in the top of the pedestals.
8.3.4. Insert the bottom part of the anchor bolts inside the pedestals as per approved
drawings.
8.3.5. Adjust the bottom template in order to prevent the bottom template or bolts
attached to pedestals rebar.
8.3.6. After fixing the temporary wooden plates align, level and fix properly the
anchor bolts as per approved drawings.
8.3.7. The surveyor has to check the alignment and the level of the anchor bolts after
fixing and prepare the survey report.
8.3.8. The QC Inspector shall check the anchor bolts after fixing.
8.3.9. After QC Inspector approval cover the anchor bolts with masking tape protection
before concreting.

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9. WORKING AREA

SS-103

SS-105

SS-113

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10. ATTACHMENTS

10.1 Attachment.1 : Flowchart Anchor Bolt Installation

STAR
T B
Y
CLEANING AND
WORK AREA
PREPARATION
SM / SE
NO

CHECKIN
G SM / SE
REBAR QC INS / QC
ENG
OK

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SM / SE
SURVEY
SURVEY
MARKING OUT
OR

PLACING & ALIGN

TEMPLATE &
ANCHOR BOLT
SM /
SE

NO

ALIGNMENT & SM / SE
LEVEL QC INS / QC
CHECK ENG
SURVEYOR
NO
O
K

REQUEST FOR QC INS / QC

INSPECTION ENG

INSPECTION FROM QC SM / SE
& CLIENT QC INS /QC
ENG
CLIENT

CONCRETE
POURING
SM /
SE

END

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10.2 Attachments. 4 : Emergency Respond Team Organization Chart

ORGANIZATION CHART PT. AGCIA PERTIWI

PACKAGE BD3.1
RDMP RU V BALIKPAPAN
DATE : 05-Mar-22
REVISI : 01

PROJ ECT MANAGER

PUJO WIYATNO

PROJ ECT ENGINEER SURVEYOR COORDI NATOR QC COORDINATOR CM 1 0 3 -1 0 5 CM 1 1 3 HSSE COORDI ANTOR PROJ ECT FI NANCE

E. MIRIANO LATIEF FRANSYAH KUSTIYA N RUDI HASCARYO WESLEY SIBUEA NANANG TARYANA NUR FAMILIANSYAH BAMBANG IRAWAN
AREA 103

SURVEYOR QC INSPECTOR SUPERVISOR SAFETY MAN DRIVER

FRANSYAH KUSTIYA N EDGAR YOGI HERMAWAN RAGIL MOCHAMAD FIKRI CHAMDAN RACHMADAN SELDY
AREA 105

SURVEYOR QC INSPECTOR SUPERVISOR SAFETY MAN DRIVER

MOCH. IRFAN MUHAMMAD ARDIANSYAH ADIGUNA DARMA SOEDJA MAHFUZH ABU HUMAIDI RONNIE
AREA 113

SURVEYOR QC INSPECTOR SUPERVISOR SAFETY MAN DRIVER

SANDY RUDIANA LILIS KUSUMA WARDANI FATAR HUSNUS SAWAB RIFKY

ENGINEERING PROJ ECT CONTROL ADMIN QC PARAMEDI C PROCUREMENT

NANANG TARYANA E. MIRIANO LATIEF SANDY TRI TBA PANITRA

QUANTITY SURVEYOR DOKUMEN CONTROL HSSE ADMIN ADMINISTRASI KEUANGAN

ANDY DAS NUR HIDAYANI RIZKY SITI ANISYAH LARASATI PANGESTU

DRAFTER COST CONTROL PERMI T HOLDER ADMINI STRASI LOGISTI C

FAJAR SIDIK PUJO WIYATNO M TAJUL ARIFIN DEDI ARDIANSYAH

DRAFTER PLANNING CONTROL EXTERNAL LOGISTI C

BINTANG DWIPUTRA E. MIRIANO LATIEF ROMI SISWANDRI

ADM PROJ ECT INTERNAL LOGISTIC

RUKMAYANTI AGUSMAN

DRI VER EXT

SABILAL M
EDIYANTO

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