SOP 07-700 Appendix 5

HSE EVALUATION OF BIDER

Contractor PT.Supraco Lines
PRVISION OF DREDGING SERVICES
Service Dredging Scope Of Work
FOR MAHAKA WEST AREA
Div. / Dep.
Tender No SZ0800089A-DSTNK
Assesed by team
Date 01 Maret 2022

Max
Weighted
Weighting score Score
No Criteria factor WFi Zi=3 x Xi
score Yi Comments
=Xi x WFi
WFi

1 HSE 01 – Respect of Laws and Regulations

1.1 System to follow up any change in local regulation 2 6 1 2 “Attached F-ISM-QSHE-1401-01-
Tinjauan Kesesuaian Peraturan””
“Attached M-ISM-SPL-14-Identification
of Legal and Requirements”
“Attached P-ISM-QSHE-1401-
Identification of Legal and
Requirements”
Compliance with International Standard (ISO, OHSAS, “Attached DOC SPL”
1.2 2 6 2 4
IMO,SMK3 etc) “Attached SMC SP1 2023”
“Attached SMC SPL Mahakam 2023”
HSE 02 – Responsibilities of Management
2
Corporate HSE Organisation?
2.1 Established Corporate and project HSE Organisation 1 3 2 2 “Attached M-ISM-SPL-02-Struktur
Organisasi Manajemen Keselamatan”
“Attached Company ORG-SPL”
“Attached Jobdesc Direktur-SPL”
“Attached QSHE-SPL-SPL(ID 56578)”
“Attached QSHE HO Officer(ID 93053)”
“Attached QSHE Operation
Dept.Head(ID 93049)”
2.2 Corporate HSE policy and socialization evidence 1 3 2 2 “Attached Policy SPL Kebijakan
Manajemen Keselamatan dan
Perlindungan Lingkungan”
“Attached Policy Drug and Alcohol”
“Attached Policy SPL SWA”
“Attached Absensi Sosialisasi Policy”
Procedure , program and evidence of implementation for “Attached P-ISM-QSHE-1501-
2.3 2 6 1 2
communication & consultation ? Communication(ID 3516)”
“Attached Evidence of Toolbox Meeting,
Prejob Meeting, Bulletin Board and
Monthly Meeting”
2.4 Updated Coorporate HSE Objectives 2019 & 2020 2 6 1 2 “Attached Objective Target QSHE SPL
2019”
“Attached Objective Target QSHE SPL
2020”
“Attached SPL-QSHE Management
Program 2022”
3 HSE 03 - Operational responsibilities
3.1 Work permit procedure and its implementation 2 6 1 2 “Attached IK-HSE-013-IJIN KERJA”
“Attached Evidence of Audit Permit – 07
Oktober 2020”
“Attached Evidence of Audit Permit – 23
Oktober 2020”
Site personnel, their HSE Roles & responsibilities defined, “Attached JD, Fire Patrol, Daily
3.2 1 3 1 1
known, implemented Checklist, Inspection Report”
3.3 Record/list of operational procedure 1 3 1 1 “Attached Daftar Dokumen Internal SPL”

4 HSE 04 - Risk evaluation and management

4.1 Contractual HSE Plan including the management of risks 1 3 2 2 “Attached HSE PLAN DSPS000579-
TDD TECHNICAL FRAMEWORK
CONTRACT OF DREDGING
SERVICE”
“Attached KPI QSHE 2021-CB SPLM &
CB SP-1”
“Attached SPL-QSHE Management
Program Office 2022”
“Attached Draft HSE Program”
“Attached F-ISM-QSHE-0501-HIRA”
Evidence of JRA implementation and its socialization to worker ?
4.2 2 6 2 4 “Attached P-ISM-QSHE-0501-Prosedur
Penilaian Resiko”
“Attached Hazard Mapping, Hazard
Register”
“Attached JRA, JSA”
“Attached Risk Assessment Overhaul
Genset”
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 SOP 07-700 Appendix 5
“Attached PHM JRA-SPU-CST-OFF-003
Dredging Activity”

Worksite Housekeeping & Industrial Hygine Procedure, record of “Attached IK-HSE-006-Housekeeping”

4.3 implementation and its follow up at Barge such as hiegine 2 6 2 4 “Attached IK-HSE-012-Industrial
inspection on Barges Hygiene”
“Attached Record of Implementation”
Safety and emergency equipment inspection and test procedure , “Attached IK-HSE-002-Inpection”
program , record of implementation and its follow up ( minimum for “Attached Record of Implementation”
4.4 life raft, smoke & heat detector,SOPEP,SCBA, life bouy,fire pump 2 6 2 4
& fire water canon
& Hidrant, fire alarm )
Procedure to manage lifting gear inspection & certification and “Attached P-ISM-OPS-0509- Prosedur
4.5 2 6 2 4 Pengoperasian Towing”
evidence of implementation
“Attached P-ISM-OPS-0511-Lifting”
“Attached evidence of implementation”
Procedure to manage marine fleet compliance ,record of “Attached F-ISM-OPS-0701-02
4.6 2 6 2 4
implementation and its follow up ? SPLM”
“Attached F-ISM-OPS-0701-03
PIONEER”
“Attached P-ISM-OPS-0505
Prosedur Pengoperasian AHT (ID
3138)”
“Attached P-ISM-OPS-0701
Instruksi Perawatan Kapal
Perusahaan (ID 2904)”
“Attached P-ISM-OPS-0703
Prosedur Perawatan Kapal
Terencana (ID 3144)”
“ Attached P-ISM-OPS-0706
Prsosedur Perawatan Peralatan Kritis
(ID 3147)”
“Attached P-ISM-OPS-0705
Perawatan Mesin - mesin Penting
(ID 3146)”
5 HSE 05 - Respect for the environment
Waste management procedure and evidence of “Attached IK-HSE-007-Pembuangan
5.1 2 6 2 4
implementation Sampah”
“Attached M-ISM-SPL-06-
Perlindungan Lingkungan”
“Attached evidence of
implementation”
6 HSE 06 - Safeguarding of health
Procedure to manage the occupational risks for healthincluding “Attached M-ISM-SPL-04- M-ISM-SPL-
6.1 managing COVID 19 pandemic and its 2 6 2 4 04 Pengawakan Personil Kapal (ID
implementation ? 2958)”
“Attached P-ISM-HRD-0406
Pemeriksaan Karyawan Rev. 1 Signed
(ID 49191)”
“Attached evidence of implementation”
6.2 Programme for personnel medical assessment and follow up 2 6 1 2 “Attached hasil MCU+TMT”

Procedure of hazardous substances management on site and “Attached IK-HSE-010 Material Safety
6.3 1 3 1 1 Data Sheet _MSDS”
its implementation
“Attached evidence of implementation”
6.4 Procedure to manage PPE on site and implementation 2 6 2 4 “Attached IK-HSE-005 Personnel
Protective Equipment Rev 3”
“Attached evidence of implementation”
6.5 Adequate site first aid facilities & qualified support personnel 2 6 2 4 “Attached Certificate First Aid &
qualified support personel”
HSE 07 - Management of sub-contractors and
7
suppliers (SC & S)
7.1 Procedure to assess sub contractor HSE performance 1 3 1 1 “Attached P-PRC-002 Pengadaan Barang
Jasa (ID 47073)”
“Attached P-PRC-003 Vendor
Management System (ID 47070)”
Procedure and evidence implementation how to evaluate “Attached P-PRC-003 Vendor
7.2 2 6 1 2
competency of sub-contractors personnel? Management System (ID 47070)”
“Attached Evaluasi sub-contractors”
8 HSE 08 - Competence and training of personnel
HSE & Competence personnel training matrix and evidence of “Attached 2. P-ISM-HRD-1201-
8.1 2 6 2 4 Pelatihan dan Kompetensi”
implementation in 2019 & 2020
“Attached evidence of
implementation

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 SOP 07-700 Appendix 5

Max
Weighted
Weighting score Score
No Criteria factor WFi Zi=3 x Xi
score Yi Comments
=Xi x WFi
WFi

Evidence of personnel competence for Barge Master position,Rigger “Attached CV & Sertifikat of Personnel
8.2 2 6 2 4 Competence”
and Crane Operator and food handler ?
9 HSE 09 - Emergency preparedness
9.1 Emergency Response Plan procedure 2 6 2 4 “Attached P-ISM-QHSE-0902 Latihan
Keadaan Darurat di Kapal”
“Attached P-ISM-QSHE-0901 Prosedur
Menghadapi Keadaan Darurat di Kapal”
“Attached F-ISM-QHSE-0801-01 Nomor
- nomor yang Dihubungi Saat Keadaan
Darurat”
Exercises used to validate emergency procedures and to train “Attached Emergency Drill, Training
9.2 2 6 2 4
personnel AFA, and Drill”
9.3 Qualified fire-fighting and SAR intervention teams? 2 6 1 2 “Attached Qualified fire-fighting and
SAR intervention teams”
10 HSE 10 - Incident analysis
10.1 Procedure of Anomaly/incident management 2 6 2 4 “Attached F-ISM-QHSE-1002-01 Acc-
Ins Report (ID 3513)”
“Attached F-ISM-QHSE-1002-02 Acc-
Inc Follow up report (ID 3514)”
“Attached F-ISM-QHSE-1002-03 SCAT
Chart (ID 58874)”
“Attached P-ISM-QHSE-1002 Report
INCIDENT & Accident Rev. 01 (ID
3511)”
10.2 Evidence of Anomaly/incident report 2 6 2 4 “Attached Evidence of Anomaly/incident
report”
A system to set up and follow up the associated corrective “Attached P-ISM-QHSE-1001 CAR
10.3 2 6 2 4
action plans PAR. rev1 (ID 3226)”
11 HSE 11 - Audits and inspections
Procedure and implementation for internal HSE audits and “Attached P-ISM-QHSE-1102 Internal
11.1 2 6 2 4
inspections Audit di Kapal (ID 3210)”
“Attached implementation for internal
HSE audits and
Inspections”
11.2 Documented evidence of associated corrective action plans 2 6 1 2 “Attached Documented evidence of
associated corrective action plans”

12 HSE 12 - Performance improvement

12.1 Procedure to review and improve HSE performances 1 3 2 2 “Attached P-ISM-QHSE-1701
Pemantauan & Pengukuran (ID 34077)”
“Attached HSE Performance Report SPL
2021”
Evidence of regular meeting of corporate HSE board “Attached MR Complete 2019”
12.2 (Management Review Meeting on 2019 & 2020 ) to define 2 6 2 4 “Attached MoM Management Review
improvement targets 2020”
13 HSE 13 Societal Commitment
Procedure related to societal issues and evidence of implementation “Attached SKDK-031-RUI-IX-
13.1 (local employment, claim handling issues, 1 3 1 1 2018_Corporate Social Responsibility
CSR etc) (CSR) (ID 88600)”
“Attached evidence of implementation”
14 HSE 14 Security
14.1 Procedure related to security and evidence of implementation 1 3 1 1 “Attached P-ISM-QSHE-0801-Prosedur
Tanggap Darurat”
“Attached evidence of implementation”
15 List of Must Have Requirement
“Attached the statement letter”
Legal commitment letter to provide PPE as per company
15.1 requirement in SOP MHK-COMP-TKO-HSE-MTH-0005 last 3 9 3 9
revision for all project personnel
“Attached the statement letter”
Legal commitment letter to provide medically fit personnel
15.2 proven by valid MCU (as per SOP MHK-ENTY-SOP-HSE- 3 9 3 9
MED-0005 last revision)
“Attached the statement letter”
Legal commitment letter to fulfill PHM HSE training requirement
15.3 3 9 3 9
to support operation for all project personnel

“Attached the statement letter”

Statement letter to provide First Aid Equipment as per company
15.4 regulation (SI/MED/001-FIRST AID, MHK-COMP-SOP-HSE- 3 9 3 9
MTH-0012 last revision Guide 06 MED)

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 SOP 07-700 Appendix 5
“Attached SERTIFIKAT-AK3U-
HSE Coordinator / Manager holding AK3 Umum certificateand DepNaKerTrans RI-YAYAT-S”
completed with valid: “Attached Yayat's CV”
" Surat Penunjukan Ahli K3 Umum mentioning designated
company where the HSE Coordinator is working at from
15.5 3 9 3 9
Kementerian Tenaga Kerja; and
** Updated CV of propose HSE Coordinator for this project which
mentioning his/her experience of minimum 3 years working at the
same position.

Total: Prepared By: Approved by:

Maximum Score (Z) 237
Audit result (Y) 151

Percentage SCORE (Y/Z)*100 63.71

Must Have Requirement (MHR) Score 100 Yayat Suyatman Chrismon Djajadi

Note:
- WFi = 3 is a Must Have Requirement ( MHR),

- MHR Score = 3 mean 100% meet expectation MHR Score 100

Overall Score 63.71

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