Small Project PHSSER

Small Project PHSSER Form

This is a Tool for conducting a brief Health Safety Security and Environment Review for any proposed change that might occur.
This document is an abbreviated form of the PHSSER objectives and is designed to trigger consideration of potential Operational & HSSE impacts from any
proposed change to plant, infrastructure, equipment, materials, substances, organisation, work controls, work conditions, procedures or any other aspects of the
business operation.
Use the following questions as a guide only and complete the document in electronic format.
Let your consideration of the potential risks and hazards associated with a proposed change be limited only by your imagination. Ensure that risks that are real and
tangible can be mitigated / managed to the satisfaction of the PHSSER owner before commencement of the change.
For complex changes, this form may not be sufficient. The outcome of this Form (or any other associated documentation) must be documented and reported.

SITE: SPBU BP AKR IMAM BONJOL DATE: 4 APRIL 2022

ADDRESS:
PSR OWNER:
PRINCIPLE CONTRACTOR:
PSR TEAM MEMBERS:
DESCRIPTION OF WORKS:
FINAL SIGN OFF (PSR Owner):
Jl. Imam Bonjol No.21, RT.002/RW.006, Bojong Jaya,Kec. Karawachi, Kota Tangerang, Banten
Hendra Gunawan
Zero Accident
Proyek Pembangunan SPBU BP AKR Imam Bonjol
To be signed off when complete only,

STEP 1 – 2 – 3

1. Consider the impact and affect of your project

2. Review the Golden Rules and ensure they are being addressed in your project
3. Prepare you mitigation / action plan (Then manage your plan)

RESPONSIBILITIES

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1. The following responsibilities apply to the person proposing the change or co-ordinating the project:
• Complete the PHSSER and oversee the implementation of all agreed control measures for each stage of the project.
• Engage the relevant stakeholders to participate in the PHSSER to ensure all relevant risks and hazards are identified. This may include
representatives from HSSE, Operations, Maintenance, Logistics, Engineering, Project Management, Construction and any other subject matter
experts or stakeholder that this change may impact.
• Update the PHSSER and communicate the changes at review at any time there is a major change to the scope.
2. The following responsibilities apply to any person who is designated as the person responsible for the implementation of a control:
Implement the agreed control by in the timeframe agreed in the PHSSER. If this is not possible you must notify the PHSSER owner or your Line
Manager by as soon as possible.
3. The PHSSER Owner has the overall accountability for ensuring the implementation of all controls as per the actions identified in the PHSSER
and the safety of the site. Accountability for ensuring the implementation of all controls as per the PHSSER will be as specified in the PHSSER and
will usually be managed by the Senior Project Manager accountable for delivering the project.
4. A Risk Assessment (PHSSER) will need a person on the PHSSER team who is Competent in risk management. The risk assessor need not be a
separate person; you just need to make sure that someone in the team has been trained.

STEP 1 – HOW WILL THE PROJECT AFFECT OR IMPACT:

1. The HEALTH of Consideration of Impacts (Please write any mitigations in Step 3 below)
Customers N/A
Staff and Operators Air pollution (ISPA), Water pollution/sanitation (diarrhea/poisoning), Sleep disturbances/insomnia, Changes in
diet (gastritis/diabetes), Covid-19 transmission, Temporary hearing loss/deafness, Eye irritation
(conjunctivitis), Muscle injury / LBP
Public Air pollution (ISPA), Water pollution/sanitation (diarrhea/poisoning), Disturbed sleep patterns/insomnia
(interrupted with work activities), Covid-19 transmission, Traffic jams (stress)
Contractors Air pollution (ISPA), Water pollution/sanitation (diarrhea/poisoning), Sleep disturbances/insomnia, Changes in
diet (gastritis/diabetes), Covid-19 transmission, Temporary hearing loss/deafness, Eye irritation
(conjunctivitis), Muscle injury / LBP
Project Engineering Staff Air pollution (ISPA), Water pollution/sanitation (diarrhoea/poisoning), Fatigue/work stress (hypertension),
Sleep disturbances/insomnia, Changes in diet (gastritis/diabetes), Covid-19 transmission
Maintenance or Service Staff Air pollution (ISPA), Water pollution/sanitation (diarrhoea/poisoning), Fatigue/work stress (hypertension),
Sleep disturbances/insomnia, Changes in diet (gastritis/diabetes), Covid-19 transmission
Others Angina pectoris

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Could the change cause undue fatigue and stress to staff No

and operators?

2. The SAFETY of Consideration of Impacts (Please write any mitigations in Step 3 below)
Customers N/A
Staff and Operators ▪ Physical/Mechanical/Gravity/Motion: Being crushed/pinched by material or heavy equipment,
scratched/cut by sharp objects/materials/work equipment, electrocution, falling from a height,
falling, tripping, fire, extreme weather (Rain: struck by lightning, Heat:
dehydration/hypovolemic shock/fatigue), hit/hit a vehicle/worker, stabbed, knocked, noise,
lighting.
▪ Biology: stung by poisonous animals (snakes, wasps, centipedes etc.), viral/bacterial
infections, transmission of Covid-19, Bring pets,
▪ Ergonomics / Biomechanics: overloaded lifting (manual handling), wrong lifting position,
inappropriate design / workplace (muscle injury / LBP / HNP)
▪ Socio-Psychological: Repetitive work, miss communication

Public ▪ Physical/Mechanical/Gravity/Motion: Disruption of pedestrian activity/vehicle traffic caused by

narrowing of the road, pedestrian access/traffic scattered on the ground
(falling/running/vehicle/traffic accident, Taking photos of work area without permission,
entering area without permission, taking photos without permission, carrying sharp weapons
Contractors ▪ Physical/Mechanical/Gravity/Motion: Struck / pinched by material, scratched / cut by sharp
objects / materials / work equipment, electrocution, falling from a height, falling, tripping, fire,
extreme weather (Rain: lightning strike, Heat: dehydration / shock hypovolemic/fatigue),
hit/hit a vehicle/worker, stabbed, knocked, noise, lighting.
▪ Chemical : Material / material / liquid / gas / dust / vapor is dangerous, toxic, reactive,
explosive, flammable / flammable, irritant, corrosive.
▪ Biology: stung by poisonous animals (snakes, wasps, centipedes etc.), viral/bacterial
infections, transmission of Covid-19, bringing pets to the work area
▪ Ergonomics / Biomechanics: overloaded lifting (manual handling), wrong lifting position,
inappropriate design / workplace (muscle injury / LBP / HNP)

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▪ Socio-Psychological: Repetitive work, miss communication

Project Engineering Staff ▪ Physical / Mechanical / Gravity / Motion: Scratched by sharp objects / materials / work
equipment, electrocution, falling from a height, falling, tripping, extreme weather (Rain: struck
by lightning, Heat: dehydration / hypovolemic shock / fatigue), hit / hit a vehicle /worker,
stabbed, knocked, noise, lighting.
▪ Biology: stung by poisonous animals (snakes, wasps, centipedes etc.), viral/bacterial
infections, transmission of Covid-19
▪ Socio-Psychological: Repetitive work, miss communication
Maintenance or Service Staff ▪ Physical / Mechanical / Gravity / Motion: Scratched by sharp objects / materials / work
equipment, electrocution, falling from a height, falling, tripping, extreme weather (Rain: struck
by lightning, Heat: dehydration / hypovolemic shock / fatigue), hit / hit a vehicle /worker,
stabbed, knocked, noise, lighting.
▪ Biology: stung by poisonous animals (snakes, wasps, centipedes etc.), viral/bacterial
infections, transmission of Covid-19
▪ Socio-Psychological: Repetitive work, miss communication

Others
Does the change comply with each of the eight Golden Yes
Rules of Safety?

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3. SECURITY of Consideration of Impacts (Please write any mitigations in Step 3 below)

Customers N/A
Operators Staff Damage / loss of vehicle / property / assets.
Products Delivery Wrong product placement when loading / loading, Parking is not in the right place Damage / loss of
vehicle / property / assets, Product damage due to weather.
Goods Delivery Wrong placement of goods when loading / loading, parking is not in the right place, Damage / loss of
vehicle / property / assets, Product damage due to weather.
Stock Misplacement, counting and summing related to stock, Damage / loss of property / assets, Product
damage due to weather.

Assets Placement of assets is not in the right place, damage / loss of property / assets, Error in counting /
summing related to stock, Damage to assets due to weather.
How will the change impact any other aspect of security? Yes,

4. The ENVIRONMENT Consideration of Impacts (Please write any mitigations in Step 3 below)
Discharge to Air Mobilization of heavy equipment will affect air pollution around the project area. Excavation also has
the potential to release flammable gases. The construction process will also cause silica dust to fly
around the project area.
Discharge to Water Land clearing that using clean water without going through the process can cause sediment to form
in rivers due to water-borne materials. If there are chemical materials carried in the waste water, it
can also cause river / surface water to be polluted. Excavation also has the potential to contaminate
local groundwater.
Discharge to Land Land clearing and excavation can cause changes in soil fertility levels, potentially disrupting the local
ecosystem.
Odour Odour pollution may occur when certain gases appear in the excavation area. Odor pollution can also
occur if there is a septic tank in the excavation area.
Waste Every step of the project, there will be potential to generate the waste. The waste that will be
generated includes unused soil, rocks, certain remaining materials and residue from demolition of the
land.
Noise / Dust Because of the use of heavy equipment, it will certainly produce noise in the project area. This work
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also has the potential to generate dust from the material as well as due to the mobilization of heavy
equipment.
Are there any existing environmental concerns? There is no any existing environmental concerns in the area project.
How else could the environment be impacted? No.

5. ACCESS for Consideration of Impacts (Please write any mitigations in Step 3 below)
Customers Pedestrian exit/entrance door
Operators / Staff Pedestrian exit/entrance door
Product Delivery Vehicle exit/entrance door
Goods Delivery Vehicle exit/entrance door
Emergency Services Vehicle exit/entrance door
Project Engineering Staff Pedestrian exit/entrance door
Contractors Vehicle exit/entrance door
The Public Pedestrian exit/entrance door
Utilities Customized unit dimensions
Others

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6. OPERABILITY Consideration of Impacts (Please write any mitigations in Step 3 below)

Can the facility be operated to achieve its aims?
Is there any special training required for operators?
Is the facility serviceable?
Can the changed facility / operation be maintained without undue
HSSE risk?
Can the changed facility / operation be sustained without undue
HSSE risk?
Have you got the necessary human resources to cope with the
change?
Have you got the necessary physical resources to cope with the
change?
Yes
Yes, internal and external company training
Toilet, Musholla, First Aid Room, Wastafel
Yes
Yes
Yes, Certified Welder, Certified Scaffolder, Certified Safety Team
Yes, internal and external company training

7. Brand Values Consideration of Impacts (Please write any mitigations in Step 3 below)
Is the proposed change Legal, Morally Acceptable, compliant with N/A
APR’s Policies, Brand Values and What we Stand For?
How will APR people perceive this change? Review on going process
How will external agencies perceive this change? Review on going process
How will the public perceive this change? Review on going process
How will our customers perceive this change? Review on going process
How will our contractors and suppliers perceive this change? Review on going process

8. CONSTRUCTION Consideration of Impacts (Please write any mitigations in Step 3 below)

What are the requirements for personal protective protection BPJS Kesehatan/ Insurance, HSSE Plan
Is sediment from the site controlled? Visual check, Milesheet, Hasil Test
Have appropriate insurances been attained and sighted? Yes, attachment file
Have Work Method Statements been written and sighted? Yes, attachment file
Has traffic management been considered and mitigated? Yes, Prepared traffic signs, Rotary lights, Flag Man, safety cone/stick cone, stick lamp
Have flammable vapour impacts been considered and mitigated? Yes, Gas detector check
Is there a Contractor / Supplier induction process Yes, Safety induction and accreditation
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Are all HSSE requirements of the Contract and scope of work in Yes,
place?
Other

STEP 2 – GOLDEN RULES: Consider the Golden Rules and include mitigations in STEP 3 below.

9. Golden Rules Please consider when identifying potential hazards and associated risks:
Permit to Work Before conducting work that involves confined space entry, work on energy systems, ground disturbance in locations where buried
hazards may exist, or hot work in potentially explosive environments, a permit must be obtained that:

❑ defines the scope of work and its duration

❑ identifies hazards and assesses risk
❑ establishes control measures to eliminate or mitigate hazards
❑ links the work to other associated work permits or simultaneous operations
❑ is authorized by the responsible person(s)
❑ communicates above information to all involved in the work
❑ ensures adequate control over the return to normal operations

Energy isolation Any isolation of energy systems; mechanical, electrical, process, hydraulic and others, cannot proceed unless:

❑ the method of isolation and discharge of stored energy are agreed and executed by a competent person(s)
❑ any stored energy is discharged
❑ a system of locks and tags is utilized at isolation points
❑ a test is conducted to ensure the isolation is effective
❑ isolation effectiveness is periodically monitored

Ground disturbance Work that involves a man-made cut, cavity, trench or depression in the earth's surface formed by earth removal cannot proceed unless:

❑ a hazard assessment of the work site is completed by the competent person(s)

❑ all underground hazards, i.e. pipelines, electric cables, etc., have been identified, located and if necessary, isolate

Where persons are to enter an excavation:

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❑ a confined space entry permit must be issued if the entry meets the confined space definition
❑ ground movement must be controlled and collapse prevented by systematically shoring, sloping, benching, etc., as appropriate
❑ ground and environmental conditions must be continuously monitored for change

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Confined space entry Entry confined space cannot proceed unless:

❑ all other options have been ruled out

❑ permit is issued with authorization by a responsible person(s)
❑ permit is communicated to all affected personnel and posted, as required
❑ all persons involved are competent to do the work
❑ all sources of energy affecting the space have been isolated
❑ testing of atmospheres is conducted, verified and repeated as often as defined by the risk assessment
❑ standard-by person is stationed
❑ unauthorised entry is prevented

Working at heights Working at heights of 1.8 metres (6 feet) or higher above the ground cannot proceed unless:

❑ a fixed platform is used with guard or hand rails, verified by a competent person, or.
❑ fall arrest equipment is used that has:
o a proper anchor mounted preferably overhead
o full body harness using double latch self locking snap hooks at each connection
o synthetic fibre lanyards
o shock absorber
❑ fall arrest equipment will limit free fall to 1.8 metres (6 feet) or less
❑ a visual inspection of the fall arrest equipment and system is completed and any equipment that is damaged or has been
activated is taken out of service
❑ person(s) are competent to perform the work

Lifting operations Lifts utilizing cranes, hoists, or other mechanical lifting devices will not commence unless:

❑ an assessment of the lift has been completed and the lift method and equipment has been determined by a competent person(s)
❑ Operators of powered lifting devices are trained and certified for that equipment.
❑ rigging of the load is carried out by a competent person(s)
❑ lifting devices and equipment have been certified for use within the last 12 months (at a minimum)
❑ load does not exceed dynamic and/or static capacities of the lifting equipment
❑ any safety devices installed on lifting equipment are operational
❑ all lifting devices and equipment have been visually examined before each lift by a competent person(s)

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Driving safety All categories of vehicle, including self-propelled mobile plant, must not be operated unless:

❑ vehicle is fit for the purpose, and has been maintained in safe working order, with seatbelts installed and functional
❑ number of passengers does not exceed manufacturer's specification for the vehicle
❑ Loads are secure and do not exceed manufacturer’s specification and legal limits for the vehicle
❑ seat belts are installed and worn by all occupants
❑ safety helmets are worn by riders and passengers of motorcycles, bicycles, and similar types of vehicle.

Drivers must not be authorized to operate the vehicle unless:

❑ they are trained, certified and medically fit to operate the class of vehicle
❑ they are not under the influence of alcohol or drugs, and are not suffering from fatigue
❑ they do not use a hand-held cell phones and radios while driving (best practice is to switch off all phones and two-way radios
when driving)

Management of Work arising from temporary and permanent changes to organization, personnel, systems, process, procedures, equipment, products,
change materials or substances, and laws and regulation cannot proceed unless a Management of change process is completed, where
applicable, to include:

❑ a risk assessment conducted by all impacted by the change

❑ development of a work plan that clearly specifies the timescale for the change and any control measure to be implemented
regarding:
o equipment, facilities and process
o operations, maintenance, inspection procedures
o training, personnel and communication
o documentation
❑ authorisation of the work plan by the responsible person(s) through completion

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STEP 3 - Mitigation / Action Plan

This procedure applies to all activities, products and services conducted by BP AKR to ensure that all health, safety, security, environmental, quality, business and
financial hazards are identified, risks are assessed, and appropriate risk reduction measures are determined and implemented.
Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
Survey : Pengukuran dan - Manual handling F 4 L - Penggunaan SM, SPV, HSE Selama aktivittas 28 March - 4 April
Pengambilan Data Pencahayan untuk pekerjaan 2022
pekerjaan di malam
hari
- Pengawasan
(SPV/Safety Man)
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker

Hand tools H 3 L - Penerapan 5 R SM, SE, SPV, HSE Selama aktivitas 6 April - 9 July 2022
- Inspeksi area kerja pekerjaan
- Pengawasan
(SPV/Safety Man)
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, full
body harness
(disesuaikan)

Cuaca extreme E 5 L - Safety Briefing / TBM SM, SPV, HSE Selama aktivitas 6 April - 9 July 2022
(hujan dan petir) - Stop aktifitas pekerjaan pekerjaan
- Mematikan semua
peralatan yang
mengandung muatan
listrik,
- Menjauhi pepohonan di
sekitar area kerja,
- Berlindung dalam

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Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
ruangan atau gedung,
hindari berlindung di
tempat istirahat
(shelter) dan bangunan
tinggi, menara dan
tiang listrik,
- Atur jarak dengan
pekerja (hindari
berteduh secara
bergerombol),
- Pengawasan
(SPV/Safety Man)
- APD : Helmet, vest,
safety shoes, safety
gloves,
Site set up : Loading - Mobile crane/ truck E 4 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6 - 12 April 2022
unloading material, crane Pencahayan untuk pekerjaan
peralatan kerja,kontainer pekerjaan di malam
hari
- Safety Induction
- Safety Briefing / TBM
- Pengawasan
(SPV/Safety Man)
- Inspeksi Alat Berat (uji
kelayakan,
kelengkapan SIA/SILO,
SIO dikirimkan H-3
paling lambat)
- Inspeksi area kerja
(form ceklist)
- Barricade area
pekerjaan
(pemasangan safety
line, safty sign, stick
cone/safety cone/stick
lamp)
- Buddy Sistem / 3 point
of contactr
- Penggunaan HT untuk
komunikasi (Operator,

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 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
Riggers/signalma,
SPV/HSE)
- APD : Helmet, vest,
safety shoes, safety
gloves, masker
- Manual handling F 4 L - Penggunaan SM, SPV, HSE Selama aktivitas 6 April - 9 July 2022
Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Pengawasan
(SPV/Safety Man)
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker
-
Hand tools H 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6 April - 9 July 2022
Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Pengawasan
(SPV/Safety Man)
- Barricade area
pekerjaan
(pemasangan pipe
pembatas, safety line,
safty sign)
- Buddy Sistem / 3 point
of contact
- Penerapan 5 R
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, full
body harness
(disesuaikan)

Cuaca extreme E 5 L - Safety Briefing / TBM SPV, HSE Selama aktivitas 6 April - 9 July 2022
(hujan dan petir) - Stop aktifitas pekerjaan
pekerjaan/ aktifitas

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 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
crane, lipat boom pada
crane.
- Mematikan semua
peralatan yang
mengandung muatan
listrik,
- Menjauhi pepohonan di
sekitar area kerja,
- Berlindung dalam
ruangan atau gedung,
hindari berlindung di
tempat istirahat
(shelter) dan bangunan
tinggi, menara dan
tiang listrik,
- Atur jarak dengan
pekerja (hindari
berteduh secara
bergerombol),
- Pengawasan
(SPV/Safety Man)
- Prokes 3m (Menjaga
jarak, Memakai
masker, Mencuci
tangan)
- Informasikan bahaya
covid pada saat tbt
briefing
- APD : Helmet, vest,
safety shoes, safety
gloves,
Covid-19 E 5 L - Prokes 3m (Menjaga SM, SPV, SE MEP, Selama aktivitas Schedule full
jarak, Memakai HSE pekerjaan project
masker, Mencuci
tangan)
- Informasikan bahaya
covid pada saat tbt
briefing
- Swab test by medical
and test result

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Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
- APD : Helmet, vest,
safety shoes, safety
gloves,
Installasi listrik Installasi panel, E 5 L - Teknisi listrik SM, SPV, SE MEP, Selama aktivitas 20 May - 12 June
Genset berkompeten HSE pekerjaan 2022
- Inspeksi area kerja
(material dan alat kerja
layak pakai)
- Pengawasan
(SPV/Safety Man)
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves (anti static),
masker

Under Ground Tank Penggunaan mesin E 5 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 9 - 27 April 2022
Pemasangan pancang pancang Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Safety Briefing / TBM
- Inspeksi Alat Berat (uji
kelayakan,
kelengkapan SIA/SILO,
SIO)
- Inspeksi area kerja
(form ceklist)
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker

Cuaca extreme E 5 L - Safety Briefing / TBM Selama aktivitas 9 - 27 April 2022

(hujan dan petir) - Stop aktifitas pekerjaan
pekerjaan/ aktifitas
pancang
- Mematikan semua

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 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
peralatan yang
mengandung muatan
listrik,
- Menjauhi pepohonan di
sekitar area kerja,
- Berlindung dalam
ruangan atau gedung,
hindari berlindung di
tempat istirahat
(shelter) dan bangunan
tinggi, menara dan
tiang listrik,
- Atur jarak dengan
pekerja (hindari
berteduh secara
bergerombol),
- Pengawasan
(SPV/Safety Man)
- APD : Helmet, vest,
safety shoes, safety
gloves,
Penggalian Menggunakan alat E 4 M - Safety Briefing / TBM SM, SE, SPV, HSE Selama aktivitas 22-25 April 2022
berat - Pengawasan pekerjaan
(excavator/backhoe) (SPV/Safety Man)
- Inspeksi Alat Berat (uji
kelayakan,
kelengkapan SIA/SILO,
SIO)
- Inspeksi area kerja
(form ceklist)
- Barricade area
pekerjaan
(pemasangan pipe
pembatas, safety line,
safty sign, stick
cone/safety cone/stick
lamp)
- Buddy Sistem / 3 point
of contact
- Helper / signalman

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 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
- Pengawasan
(SPV/Safetyman)
- APD : Helmet, vest,
safety shoes, safety
gloves, masker
Hand tools H 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 22-25 April 2022
Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Pengawasan
(SPV/Safety Man)
- Barricade area
pekerjaan
(pemasangan pipe
pembatas, safety line,
safty sign)
- Buddy Sistem / 3 point
of contact
- Penerapan 5 R
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, full
body harness
(disesuaikan)

Struktur Bawah UGT : Manual handling & H 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 25 April -8 May
Pembesian Hand tools Pencahayan untuk pekerjaan 2022
pekerjaan di malam
hari
- Pengawasan
(SPV/Safety Man)
- Pemasangan safety
sign/safety line
- Penerapan 5 R
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker

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Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
Cutting, welding, grinding Electrical equipment F 2 L - Penggunaan SM, SPV, HSE Selama aktivitas 25 April -8 May
Pencahayan untuk pekerjaan 2022
pekerjaan di malam
hari
- Opertaor weder
(berkompeten/bersertifi
kat)
- Inspeksi Pekerjaan Hot
Work
- Penyediaan APAR dan
Fire blanket
- Inspeksi peralatan
kerja
- Pengawasan
(SPV/Safety Man)
- Pemasangan safety
sign/safety line
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker,
welding mask/welding
glasses, apron, welding
gloves, ear plug,
faceshield
Pengecoran Penggunaan truck H 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6 April - 9 July 2022
mixer / Concrete Pencahayan untuk pekerjaan
Pump (CP) pekerjaan
- Safety Briefing / TBM
- Pengawasan
(SPV/Safety Man)
- Inspeksi Alat Berat (uji
kelayakan,
kelengkapan SIA/SILO,
SIO)
- Inspeksi area kerja
(form ceklist)
- Barricade area
pekerjaan

BP AKR Fuels Retail Page 19 of 27

Form Paper Copies are Uncontrolled

 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
(pemasangan pipe
pembatas, safety line,
safty sign, stick
cone/safety cone/stick
lamp)
- Buddy Sistem / 3 point
of contact
- Helper / signalman
- Pengawasan
(SPV/Safetyman)
- Instalasi Shower /
westafel / Eye Wash
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, safety
glasses
Manual handling & 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6 April - 9 July 2022
Hand tools
H Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Pengawasan Sertifikat scaffolder
(SPV/Safety Man) terlampir
- Penerapan 5 R
- Buddy Sistem / 3 point
of contact
- Pemasangan safety
sign
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, safety
glasses
- Menyediakan
scaffolder bersertifikat
selama melakukan
pekerjaan ketinggian di
proyek.

Pemadatan/penimunan - Penggunaan alat G 2 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 26 April - 4 June
tanah tanah (backfill) Stemper jumper Pencahayan untuk pekerjaan 2022
- Hand tools pekerjaan di malam

BP AKR Fuels Retail Page 20 of 27

Form Paper Copies are Uncontrolled

 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
hari
- Operator berkompeten
/ berpengalam / sudah
mendapatkan training
- Inspeksi peralatan
kerja
- Pengawasan
(SPV/Safety Man)
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, safety
glasses, ear plug

Baby Roller F 2 L - Inspeksi Alat Berat (uji SM, SPV, HSE Selama aktivitas 26 April - 4 June
kelayakan, pekerjaan 2022
kelengkapan SIA/SILO,
SIO)
- Inspeksi area kerja
(form ceklist)
- Buddy Sistem / 3 point
of contact
- Helper / signalman
- Pengawasan
(SPV/Safetyman/Helpe
r/signalman)
- APD : Helmet, vest,
safety shoes, safety
gloves, masker

BP AKR Fuels Retail Page 21 of 27

Form Paper Copies are Uncontrolled

 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
Lifting and - Mobile crane/ truck E 4 H - Penggunaan SM, SE, SPV, HSE Selama aktivitas 9 May 2022
crane Pencahayan untuk pekerjaan
placement of tank
pekerjaan di malam
BP-AKR hari
- Safety Induction
- Safety Briefing / TBM
- Pengawasan
(SPV/Safety Man)
- Inspeksi Alat Berat (uji
kelayakan,
kelengkapan SIA/SILO,
SIO)
- Inspeksi area kerja
(form ceklist)
- Barricade area
pekerjaan
(pemasangan safety
line, safty sign, stick
cone/safety cone/stick
lamp)
- Buddy Sistem / 3 point
of contactr
- Penggunaan HT untuk
komunikasi (Operator,
Riggers/signalma,
SPV/HSE)
- APD : Helmet, vest,
safety shoes, safety
gloves, masker

Cuaca extreme E 5 L - Safety Briefing / TBM SPV, HSE Selama aktivitas 9 May 2022
(hujan dan petir) - Stop aktifitas pekerjaan
pekerjaan/ aktifitas
crane, lipat boom pada
crane.
- Mematikan semua
peralatan yang

BP AKR Fuels Retail Page 22 of 27

Form Paper Copies are Uncontrolled

 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
mengandung muatan
listrik,
- Menjauhi pepohonan di
sekitar area kerja,
- Berlindung dalam
ruangan atau gedung,
hindari berlindung di
tempat istirahat
(shelter) dan bangunan
tinggi, menara dan
tiang listrik,
- Atur jarak dengan
pekerja (hindari
berteduh secara
bergerombol),
- Pengawasan
(SPV/Safety Man)
- APD : Helmet, vest,
safety shoes, safety
gloves,
Hydrostatic test pressurized pump G 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 16 May 2022
Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Safety briefing
- Inspeksi peralatan dan
area kerja
- Pemasangan barricade
dan safety sign
- Pengawasan
(SPV/Safety Man)
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, safety
glasses, ear plug

Struktur Atas UGT : Manual handling & H 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6-13 June 2022
Pembesian Hand tools Pencahayan untuk pekeraan
BP AKR Fuels Retail Page 23 of 27

Form Paper Copies are Uncontrolled

 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
pekerjaan di malam
hari
- Pengawasan
(SPV/Safety Man)
- Pemasangan safety
sign/safety line
- Penerapan 5 R
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker
Cutting, welding, grinding Electrical equipment F 2 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6-13 June 2022
Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Opertaor weder
(berkompeten/bersertifi
kat)
- Inspeksi Pekerjaan Hot
Work
- Penyediaan APAR dan
Fire blanket
- Inspeksi peralatan
kerja
- Pengawasan
(SPV/Safety Man)
- Pemasangan safety
sign/safety line
- Buddy Sistem / 3 point
of contact
- APD : Helmet, vest,
safety shoes, safety
gloves, masker,
welding mask/welding
glasses, apron, welding
gloves, ear plug,
faceshield
Pengecoran Penggunaan truck H 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6-13 June 2022
mixer / Concrete Pencahayan untuk pekerjaan
BP AKR Fuels Retail Page 24 of 27

Form Paper Copies are Uncontrolled

 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
Pump (CP) pekerjaan
- Safety Briefing / TBM
- Pengawasan
(SPV/Safety Man)
- Inspeksi Alat Berat (uji
kelayakan,
kelengkapan SIA/SILO,
SIO)
- Inspeksi area kerja
(form ceklist)
- Barricade area
pekerjaan
(pemasangan pipe
pembatas, safety line,
safty sign, stick
cone/safety cone/stick
lamp)
- Buddy Sistem / 3 point
of contact
- Helper / signalman
- Pengawasan
(SPV/Safetyman)
- Instalasi Shower /
westafel / Eye Wash
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, safety
glasses
Manual handling & 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 6-13 June 2022
Hand tools
H Pencahayan untuk pekerjaan
pekerjaan di malam
hari
- Pengawasan
(SPV/Safety Man)
- Penerapan 5 R
- Buddy Sistem / 3 point
of contact
- Pemasangan safety
sign
- APD : Helmet, vest,

BP AKR Fuels Retail Page 25 of 27

Form Paper Copies are Uncontrolled

 Small Project PHSSER

Activity Hazard Risk assessment – see table below for details Risk Control to be Who is By when? Initial and date
implemented responsible? when complete.
Consequence Likelihood Risk Rating
(H/M/L)
safety shoes, safety
gloves, masker, safety
glasses

Tank sump, vent pipe Manual handling & H 3 L - Penggunaan SM, SE, SPV, HSE Selama aktivitas 16 May - 6 June
Hand tools Pencahayan untuk pekerjaan 2022
pekerjaan di malam
hari
- Inspeksi area kerja
- Pemeriksaan gas
detector
- Pengawasan
(SPV/Safety Man)
- Penerapan 5 R
- Buddy Sistem / 3 point
of contact
- Pemasangan safety
sign
- APD : Helmet, vest,
safety shoes, safety
gloves, masker, safety
glasses

Risk Rating Matrix

Consequence

Likelihood Very Likely Likely Unlikely Highly unlikely

Fatality High High High Medium

Major injuries High High Medium Medium

BP AKR Fuels Retail Page 26 of 27

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 Small Project PHSSER

Minor Injuries High Medium Medium Low

Negligible injuries Medium Medium Low Low

BP AKR Fuels Retail Page 27 of 27

Form Paper Copies are Uncontrolled