Schedule 10 – Health and Safety

10 HEALTH & SAFETY

Policy  As appropriate

10.1 Safety Yes No

Does your company agree to work under the PTAMNT Safety
Management System and/or Safety Procedures?
10.2 Does your company have a Safety Management System and/or Safety Yes No
Procedures?
If “Yes”, does the system comply with any standards?
10.3 Identify the standard:
OHSAS 18001 ISO45001
SMKP Manual (Indonesian DEMR) Other (describe) : SMK3 PP.50/2012
10.4 Yes No
Does your company prepare site-specific safety plans?
If “No”, attach explanation of how your company proposes to control
safety on this project. (This will be subject to review by The Client for
suitability)

If “Yes”, has your company’s system been certified by a Third Party?

Attach a copy of the current certificate

10.5 Does your company have a documented Safety Policy? Yes No

If "Yes", attach policy to this questionnaire
Give a brief overview of how this policy is communicated to all
employees and implemented.

10.6 Statistics
For your company, give the following details as per Minister Decree DEMR 1827 K/30/MEM/2018
for the preceding three years.

Year N-1 N-2 N-3

2019 2018 2017
Permanent Disability or Fatality 0 0 0
(events and number of employees, if any, attach details
to this questionnaire).
Number of Lost Time Injuries
(number of events and number of employees) 2 2 2
Total Lost Time Injury Frequency Rate
(12 month rolling) 1.09 2.99 5.95
Total Recordable Injury Frequency Rate
(12 month rolling) 1.64 1.00 2.45
Total employees working hours 3657920 3014888 2857889
If no LTI or above, describe total manhours without

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 LTI up to now and how many years (if data recorded)
10.7 Workers’ Compensation
What is the Supplier's/Subcontractor’s gazette workers compensation premium?

Under which industry has the Supplier’s/subcontractor's gazette rate been determined?

10.8 Is the premium subject to claims experience penalty/discount? Yes No

10.9 What is the penalty/discount?

10.10 Is the Supplier/Subcontractor willing to allow The Client to verify the Yes No
above with the insurer?

10.11 Workers' Rehabilitation Yes No

Does your company have a rehabilitation programmed for your
injured employees?
10.12 Breaches Yes No
Has your company received any notices/breaches from your local
Workplace Health and Safety in the last 2 years? If "Yes", state
number of the following:

Improvement Notices:

Prohibition Notices:

10.13 Prosecutions Yes No

Has your company ever been prosecuted for breach of Safety and
Health Acts or Regulations?
If "Yes", provide a brief description or attach details.

10.14 First Aid/Training Yes No

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 What percentage of your employees are holders of occupational
first aid certificates? (current within three (3) years).
Have the supervision/management received Safety and Health training
and certified as a competent?
If "Yes", attach details to this Questionnaire. Please refer to below;
- There are 3 first aider personnel and the Company does first aid refresh

to first aider candidates before conducting external training.

- Supervision and management received Safety and Health training and also

certified as a competent. (See attachment)

10.15 Operational Control Yes No

Are risk assessments/hazard analyses undertaken, documented and
records kept on file?
If "Yes", provide a brief description or attach details example(s).

10.16 Are Safe Work Methods/Job Safety Analyses developed and Yes No
communicated within the workforce?

10.17 Does your company hold regular pre-shift/toolbox or safety meetings Yes No
with its employees?
If "Yes", at what frequency?
- Every section always do toolbox meeting before work.

- HSE Department do safety meeting regulary minimum once a week.

10.17 Does your company hold regular general safety inspection in the Yes No
workplace ?
If "Yes", at what frequency?
- Safety inspector conduct inspections every day.
- HSE Department and management conduct safety inspections together

once a month.

10.18 Are internal/external reviews or process audits of safety practices Yes No

taken and records held on file?
For external reviews, state by whom and what were the outcomes?

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 Schedule 11 – Environmental Management

11 ENVIRONMENTAL MANAGEMENT
Policy  As appropriate
11.1 Yes No
Does your company have an environmental policy statement?
If "Yes", please attach to this questionnaire.

11.2 Give a brief overview of how this policy is communicated to all employees and implemented.
By conducting socialization through P2K3 meetings, email, safety talk, and also conveyed
during safety induction.

11.3 Management System Yes No

Does your company have an environmental management system?
If “Yes”, does the system comply with any standards? Yes No
Identify the standard: ISO 14001 Other

11.4 Does your company prepare site-specific environmental plans? Yes No

If “No”, attach explanation of how your company proposes to control
environmental on this project. (This will subject to review by The Client for
suitability
- We control the environment by measuring the work environment every 2 times a year.

to ensure the measurement results are below the Threshold Value.

- Treat hazardous and toxic waste according to regulations

- Include environmental issues in HIRARC

If “Yes”, has your company’s system been certified by a Third Party?

Yes No
Attach a copy of the current certificate.
If not certified, are records of inspection and other environmental activities Yes No
maintained?

11.5 Does your company undertake internal environmental system audits? Yes No
If your company does not have formal environmental management system or
programmed, you are expected to use The Client systems
11.6 Incidents/Breaches

Identify the number of environmental incidents that have occurred and required reporting to the
EPA or other Authority:

There is no number of environmental incidents that have occurred.

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11.7 Prosecutions. Yes No
Has your company ever been prosecuted for breaches of Acts or Regulations
that relate to the environment?
If “Yes”, provide a brief description or attach details
____________________________________________________________
____________________________________________________________

11.8 Has your company ever received any Environmental Penalty Notices? Yes No
If "Yes", provide a brief description or attach details.

11.9 Licences Yes No

Has your company have current Environmental Licence, Environmental
Management Licenses, LB3 Management Licences applicable for
works?
If "Yes", provide a brief description and attach evidence/details
The company has several licneses related to the environment and
waste Hazardous and toxic materials.

11.10 Risk Management

Provide an overview of your procedure for managing environmental issues and risks or aspects and
impacts.

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