Hse Plan Example

Doc. No.
: 26071-100-G01-GHX-00002
Job No.: 26071 Rev.002
PROJECT HSE PLAN

PROJECT : Engineering, Procurement, Construction for Refinery Master
Plan (RDMP) RU V Balikpapan
LOCATION : Refinery Unit V Balikpapan, East Kalimantan, Indonesia
OWNER : PT. PERTAMINA (Persero)
___________
Djoko Koen Soewito
Chief Engineer (KTT)
PERTAMINA RDMP RU-V
RE-ISSUED FOR
002 28 Oct 19 YUZAR ISPRANTO Y.D.KIM
CONSTRUCTION
RE-ISSUED FOR
001 01 Oct 19 YUZAR ISPRANTO Y.D.KIM
CONSTRUCTION
ISSUED FOR
000 13 Aug 19 YUZAR ISPRANTO Y.D.KIM
CONSTRUCTION
00C 10 July 19 RE-ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM
00B 12 June 19 RE-ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM
00A 16 April 19 ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM
REV. DATE DESCRIPTION PREPARED CHECKED APPROVED

Doc. No.: 26071-100-G01-GHX-00002
Job No.: 26071 Rev.002
REVISION LOG
REV. NO. DATE PAGE DESCRIPTION
00A 16 April 19 - Issued for review

00B 12 June 19 - Re-Issued for Review
00C 10 July 19 - Re-Issued for Review
000 13 Aug 19 - Revised as PMC Comments
001 01 Oct 19 - Refer to Comment Resolution Sheet
002 28 Oct 19 - Refer to Comment Resolution Sheet
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Table of Contents
Table of Contents............................................................................................................................................. ii
List of Tables ................................................................................................................................................... vi
List of Figures .................................................................................................................................................. vi
1. INTRODUCTIONS ..................................................................................................................................... 1
2. PURPOSE ................................................................................................................................................. 1
3. SCOPE ...................................................................................................................................................... 1
4. DEFINITIONS AND ABBREVIATIONS ......................................................................................................... 2
5. REFERENCES ............................................................................................................................................ 4
6. LEADERSHIP AND COMMITMENT ............................................................................................................ 7

HSE POLICY ............................................................................................................................................ 7
STRATEGIC OBJECTIVES AND KPI’s ........................................................................................................ 7
ROLES AND RESPONSIBILITIES ............................................................................................................... 9
6.3.1. PROJECT DIRECTOR ...................................................................................................................... 9
6.3.2. PROJECT MANAGER ...................................................................................................................... 9
6.3.3. CONSTRUCTION MANAGER .......................................................................................................... 9
6.3.4. CONSTRUCTION DISCIPLINE SUPERINTENDENT ........................................................................... 9
6.3.5. HSE MANAGER ........................................................................................................................... 10
6.3.6. DEPUTY HSE MANAGER .............................................................................................................. 10
6.3.7. CHIEF HSE ................................................................................................................................... 11
6.3.8. HSE ENGINEER ............................................................................................................................ 11
6.3.9. INSPECTOR.................................................................................................................................. 11
6.3.10. HSE TRAINING COORDINATOR ................................................................................................... 11
6.3.11. SITE DOCTOR .............................................................................................................................. 12
6.3.12. HEALTH/MEDICAL ADVISOR ....................................................................................................... 12
6.3.13. PARAMEDIC ................................................................................................................................ 12
6.3.14. SUBCONTRACTOR/SUPPLIER/VENDORS ..................................................................................... 12
7. RISK MANAGEMENT .............................................................................................................................. 13

HIRAC .................................................................................................................................................. 13
JOB SAFETY ANALYSIS (JSA) ................................................................................................................. 14
JOB HAZARD ANALYSIS (JHA) .............................................................................................................. 16
8. MANAGEMENT OF CHANGE (MOC) ....................................................................................................... 16
9. PRE-MOBILIZATION MANAGEMENT ...................................................................................................... 19
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MANPOWER READINESS ..................................................................................................................... 19

EQUIPMENT / TOOLS / VEHICLES READINESS ..................................................................................... 19
DOCUMENTATION READINESS ............................................................................................................ 20
10. SUBCONTRACTOR MANAGEMENT......................................................................................................... 20
11. TRANSPORTATION MANAGEMENT ....................................................................................................... 22

VEHICLES ............................................................................................................................................. 22
PEDESTRIAN AREA ............................................................................................................................... 23
12. HEALTH MANAGEMENT ........................................................................................................................ 24

BIOLOGICAL HAZARDS ......................................................................................................................... 24
12.1.1. WILDLIFE ANIMAL ....................................................................................................................... 25
12.1.2. BLOOD-BORNE PATHOGENS ...................................................................................................... 25
DRINKING WATER ............................................................................................................................... 25
EXTENDED WORK AND SHIFT WORK ................................................................................................... 26
FITNESS TO WORK ............................................................................................................................... 26
HYGIENE AND OCCUPATIONAL HEALTH .............................................................................................. 27
12.5.1. CATERING PRACTICES ................................................................................................................. 27
12.5.2. FATIGUE MANAGEMENT ............................................................................................................ 27
12.5.3. HOUSEKEEPING .......................................................................................................................... 28
12.5.4. HEAT STRESS ............................................................................................................................... 28
12.5.5. HEARING PROTECTION ............................................................................................................... 28
12.5.6. RESPIRATORY PROTECTION ........................................................................................................ 30
12.5.7. RADIATION PROTECTION ............................................................................................................ 30
13. ENVIRONMENTAL MANAGEMENT ......................................................................................................... 31

HAZARDOUS WASTE MANAGEMENT .................................................................................................. 32
14. OPERATING PROCEDURES AND SAFETY STANDARDS ............................................................................ 32

ABRASIVE BLASTING ............................................................................................................................ 32
ASSURED GROUNDING ........................................................................................................................ 33
CAMERAS (SECURITY) .......................................................................................................................... 33
CHAIN BLOCKS AND COME-A-LONGS .................................................................................................. 33
CRANE AND LIFTING GEAR REQUIREMENTS ....................................................................................... 33
14.5.1. CRANE REQUIREMENTS .............................................................................................................. 33
14.5.2. LIFTING GEAR REQUIREMENTS................................................................................................... 34
14.5.3. LIFTING PLAN .............................................................................................................................. 34
14.5.4. CRANE OPERATOR QUALIFICATION ............................................................................................ 34
COMPRESSED GAS CYLINDERS ............................................................................................................ 34
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CONFINED SPACE ................................................................................................................................ 35

EXCAVATION AND TRENCHING ........................................................................................................... 38
ELECTRICAL SAFETY ............................................................................................................................. 39
FIRE PREVENTION AND PROTECTION .................................................................................................. 39
14.10.1. FLAMMABLE COMBUSTIBLE LIQUID STORAGE & HANDLING .................................................... 40
14.10.2. SMOKING AREA .......................................................................................................................... 41
14.10.3. MOBILE CELL PHONE .................................................................................................................. 42
14.10.4. FIRE EXTINGUISHER AND FIRE WATCHER ................................................................................... 43
FALL PREVENTION / PROTECTION ....................................................................................................... 43
FLOOR AND WALL OPENING ............................................................................................................... 44
HEAVY MOBILE EQUIPMENT ............................................................................................................... 45
HAZARDOUS CHEMICAL HANDLING .................................................................................................... 45
HYDROGEN SULFIDE (H2S) ................................................................................................................... 47
HAND AND POWER TOOLS .................................................................................................................. 47
LADDER USE AND INSPECTION ............................................................................................................ 48
LOCK OUT / TAG OUT – ENERGY ISOLATION ....................................................................................... 48
PERSONAL PROTECTIVE EQUIPMENT (PPE) ........................................................................................ 49
PNEUMATIC TOOLS ............................................................................................................................. 50
PEDESTAL, BENCH AND PORTABLE GRINDERS .................................................................................... 51
FALLING OBJECTS PROTECTION........................................................................................................... 51
SITE OFFICE, STORES, WORKSHOPS, LIVING ACCOMODATION AND CANTEEN FACILITIES ................. 52
14.23.1. WORKSHOP FACILITIES ............................................................................................................... 53
14.23.2. LIVING ACCOMODATION ............................................................................................................ 53
14.23.3. ABLUTION FACILITIES ................................................................................................................. 53
14.23.4. CANTEEN FACILITIES ................................................................................................................... 54
SIGNAGE & BARRICADES ..................................................................................................................... 54
SCAFFOLDING ...................................................................................................................................... 54
SIMOPS ................................................................................................................................................ 55
WELDING. CUTTING & GRINDING ....................................................................................................... 55
WORK PERMIT PROCEDURE ................................................................................................................ 56
15. TRAINING AND COMPETENCY ............................................................................................................... 56

HSE TRAINING REQUIREMENTS .......................................................................................................... 56
IIF® PROGRAMS ................................................................................................................................... 57
COMPETENCY ...................................................................................................................................... 58
TRAINING RECORD AND TRACKING METHOD ..................................................................................... 58
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TRAINING PROVIDER ........................................................................................................................... 58

TRAINING KEY PERFORMANCE INDICATOR (KPI) ................................................................................ 59
CONTRACTOR INTERNAL TRAINER ...................................................................................................... 59
SITE SPECIFIC ORIENTATION PROGRAMS ............................................................................................ 59
SHORT SERVICE EMPLOYEE PROGRAM (SSE) ...................................................................................... 60
16. COMMUNICATION................................................................................................................................. 60
TOOLBOX MEETING (TBM) .................................................................................................................. 60
PRE-JOB SAFETY MEETING (PJSM)....................................................................................................... 61
GENERAL SAFETY TALK ........................................................................................................................ 62
WEEKLY SITE HSE COORDINATION MEETING ...................................................................................... 62
PROJECT MANAGEMENT SAFETY COMMITTEE MEETING ................................................................... 63
MONTHLY HSE COMMITTEE MEETING................................................................................................ 63
HSE POSTER, SLOGAN, NOTICE BOARD ............................................................................................... 63
CONTRACTOR RADIO COMMUNCATION NETWORK ........................................................................... 64
17. STOP WORK AUTHORITY (SWA) ............................................................................................................ 64
18. EMERGENCY RESPONSE PROCEDURE .................................................................................................... 65

EMERGENCY RESPONSE DRILL ............................................................................................................ 65
EMERGENCY SIREN .............................................................................................................................. 66
MEDICAL FACILITIES AND MEDICAL SERVICES REQUIREMENTS .......................................................... 66
MUSTER POINT AND ASSEMBLY POINT ............................................................................................... 66
19. INCIDENT INVESTIGATION ..................................................................................................................... 67
20. PERFORMANCE EVALUATION ................................................................................................................ 68

AUDITS ................................................................................................................................................ 68
20.1.1. QUARTERLY HSE JOINT AUDITS BY CONTRACTOR AND OWNER ................................................ 68
20.1.2. EXTERNAL AUDITS ...................................................................................................................... 68
INSPECTIONS ....................................................................................................................................... 68
20.2.1. CONSTRUCTION OBSERVATION PROGRAM (e-COP) .................................................................. 68
20.2.2. DAILY/ROUTINE ASSESSMENT .................................................................................................... 68
20.2.3. WEEKLY SITE MANAGEMENT WALKDOWNS .............................................................................. 69
20.2.4. QUARTERLY ENVIRONMENTAL INSPECTIONS AND ASSESSMENT .............................................. 69
INCENTIVES AND CONSEQUENCES ...................................................................................................... 69
20.3.1. HSE INCENTIVE PROGRAMS ........................................................................................................ 69
20.3.2. HSE CONSEQUENCE PROGRAMS ................................................................................................ 70
21. ATTACHMENTS ...................................................................................................................................... 71
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Attachment 1. Project HSE Policy ..................................................................................................................... 71

Attachment 2. List of Regulations .................................................................................................................... 71
Attachment 3. HSE Matrix Training .................................................................................................................. 71
Attachment 4. CSMS Questionnaire ................................................................................................................. 71
Attachment 5. HSE Program............................................................................................................................. 71
Attachment 6. PPE Matrix ................................................................................................................................ 71
Attachment 7. Incident Process Flowchart ....................................................................................................... 71
Attachment 8. HSE Organization Chart ............................................................................................................ 71
Attachment 9. Change Management Request Form ........................................................................................ 71
Attachment 10. HIRAC Form ............................................................................................................................. 71
Attachment 11. JSA Form.................................................................................................................................. 71
Attachment 12. JHA Form ................................................................................................................................. 71
List of Tables
Table 1. HSE KPI’s .................................................................................................................................... 8
Table 2. MOC Risk Assessment Requirements...................................................................................... 17
Table 3. MOC Authorization Level Required......................................................................................... 18
Table 4. Listing of Personnel Included in the Hearing Conservation Program ..................................... 29
Table 5. Requirements for Respirable and Non-Respirable Confined Space........................................ 37
Table 6. Colour Code Period ................................................................................................................. 39
Table 7. List of Required Authority to Certify Heavy Mobile Equipment ............................................. 45
Table 8. Personal Protective Equipment (PPE) Standard ...................................................................... 50
Table 9. HT Radio Communication Channel ......................................................................................... 64
Table 10. Emergency Siren Tones ......................................................................................................... 66
Table 11. Disciplinary Action to be Taken up to The Penalty Points .................................................... 71
List of Figures
Figure 1. Probability/Severity Matrix .................................................................................................... 13
Figure 2. Risk Categories ....................................................................................................................... 13
Figure 3. Severity Definition.................................................................................................................. 14
Figure 4. CSMS Process Flow ................................................................................................................ 22
Figure 5. Calculation for Potential Fall Distance ................................................................................... 44
Figure 6. Lock, Tag and HASP for LOTO................................................................................................. 49
Figure 7. Out of Service Tag .................................................................................................................. 49
Figure 8. Muster Point Map .................................................................................................................. 67
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1. INTRODUCTIONS
Refinery Development Master Plan Project hereinafter RDMP Project is comprised of Revamp
of existing units, and construction of new licensed unit, non-licensed unit (for ISBL) as well as
new offsite and utilities (OS & US) in Pertamina RU V Balikpapan Located in Balikpapan, East
Kalimantan. The Project focuses on the need to modernize the refining configuration and
capabilities to produce more gasoline and other products by converting residue or fuel oil into
more valuable products, primarily gasoline and diesel. An Integrated Performance Management
System, as part of the ICSS, will be implemented to improve the quality of service and
production reliability of the Refinery.
This plan addresses the Health, Safety, and Environment requirements established by Owner,
as stated in exhibit H of the contract and enables the Contractor’s project teams to successfully
manage HSE throughout the project’s life cycle to achieve the goal of zero Lost Time Injury (LTI)
during the execution of the project. In the event of conflicts between Project HSE Plan,
Contractor standards, and applicable government rules & regulations, further discussion shall
be conducted with Owner (government rules and regulations over rules the other
requirements).
2. PURPOSE
The purpose of Project HSE Plan is a specific plan to ensure all job activities in this project has
complied with Owner standards, Contractor standards, and applicable government rules and
regulations in order to get the best quality for Health, Safety, and Environmental to prevent the
adverse (human, property, and environment) incident. In addition, Project HSE Plan described
the detail of HSE schedule (based on project requirements) to support all of project activities.
3. SCOPE
This Plan will be applied at boundary/demarcation of RDMP RU-V Project under control of
Contractor Management. The boundary area is limited to:
• In site fencing plant include ISBL and Offsites and Utilities (OS & US).
• Temporary facilities area (site office, warehouses, and lay down).
• Kariangau shop area.
Within the Brown field operation all Pertamina procedures and policies which are in line with
MIGAS requirements must be followed and are under the absolute authority of the Chief
Engineer (KTT).
The MIGAS regulations apply only to Brownfield areas (Oil and Gas Production facilities or
projects undertaken within the operating site).
In compliance with MIGAS regulations, the Greenfield area shall be clearly partitioned from
the Brownfield area, such that it is not possible for persons to arbitrarily cross between
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the greenfield/brownfield areas without passing through a strict security check point (Under
the scope of work Pertamina retain responsibility for security at all access points). Safety
rules in that area are the responsibility of Pertamina’s Chief Engineer (KTT), who must ensure
that adequate safety management is applied given the nature of the work.
4. DEFINITIONS AND ABBREVIATIONS

Accident : Unwanted or undesired event resulting from the occurrence of
one or more fault incident that have negative impact on the
system, product, equipment or personnel.
Brown Field The new build processing plant that running partially or overall,
or existing plant area where there a possibility of hydrocarbon,
process hazard or risk expose to human, machinery and
environmental surrounding.
Contractor : Joint Operation (JO)

DEPNAKER : Ministry of Manpower of Republic Indonesia
ESDM : Ministry of Energy and Mineral Resources
Simper Driver License only in RU V Pertamina

FAR : Fatality Accident Rate is number of fatal incidents that may
cause death.
Calculation: (Fatality / Total Man Hours) x 100,000,000
First Aid Case : First aid refers to the immediate treatment of an individual(s)
that is injured or ill. First aid is not a full medical treatment, but
something that can be done to stabilize a person so they can
be moved to a hospital for regular medical treatment, or to
preserve life while waiting for medical professionals.
Green Field : The new open work area which clearly demarcation, declared
by land Owner there are no process plant exposed to this area
and nor existing underground pipeline & power line.
Hazard : Dangerous condition, potential or inherent which either has

previously cause or could reasonably be expected to cause
personal injury or property damage.
HIRAC : Hazard Identification Risk Assessment and Control
Health/Medical : A medical expert doctor who focuses on prevention, diagnoses
Advisor and treats illness.
IIF : Incident and Injury Free
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SIMOPS : Simultaneous Operations, is two different or more activities

which have occurring in almost same time and area. Close
enough to each other that there is a risk of interference,
clashing, or risk transfer.
Incident : Work-related event(s) in which an injury or ill health
(regardless of severity) or fatality occurred, or could have
occurred.
JSA : Job Safety Analysis is one of the safety management tools that
can be used to define and control the hazards associated with
a certain process, job or procedure. The purpose of a JSA is to
ensure that the risk of each step of a task is reduced to ALARP
(As Low As Reasonably Practicable).
KPI’s : Key Performance Indicators
LTI : A work injury resulting disability and in which the injured
person is not able to work the next regularly scheduled shift.
Lost time injuries occur when the injured person (IP) unable to
work more than 2 x 24 hours since the final observation /
statement from doctor related to injured person (IP) condition
LTIFR : Lost Time Injury Frequency Rate is the number of injuries
causing lost time for employees and Contractors per million
hours worked.
Calculation: (Total LTI/Total Man Hours) x 1,000,000
LOTO System : Lock Out / Tag Out system is a procedure to ensure that
energized machines / equipment (such as mechanical static /
electrical / instrument equipment) / other process systems are
properly shut off and not started up again prior to the
completion of maintenance or servicing work.
MIGAS : Goverment agencies for Oil and Gas
Medical Treatment : A Medical Treatment Case is any recordable injury that involves
Case (MTC) neither Lost Workdays nor Restricted Workdays but which
requires treatment by, or under the specific order of, a
physician or could be considered as being in the province of a
physician.
Near miss : An incident where no property was damaged and no personal
injury was sustained, but where given a slight shift in time or
position, damage and/or injury easily could have occurred.
OWNER : PT Pertamina (Persero) RDMP RU-V Balikpapan
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PROJECT : RDMP Project

Permit System : Safe system of work for the control of activities in hazardous
area.
PPE : Personal Protective Equipment
Risk : Effect of uncertainty on objectives. It could refer to positive
consequences of uncertainty, as well as negatives one.
Restricted Work : When a person is injured such that they cannot perform their
Case (RWC) normal duties.
RDMP RU V : Refinery Development Master Plan Refinery Unit V Balikpapan
Balikpapan
SIKA (Surat Ijin : Permit To Work
Kerja Aman)
SDS : Safety Data Sheet
Subcontractor : Successful Bidder(s) appointed by Contractor to provide
services to Contractor
Site Doctor : A qualified medical practitioner who attends the project site.
TRIR : Total Recordable Incident Rate is number of total recordable
incidents per million hours worked.
Calculation: (Total Record Case / Total Man Hours) x 1,000,000
e-COP : Electronic Construction Observation Programs
Vendor : The manufacturer of the equipment or the manufacturers
agent Bidder(s) the Contractor which intended to bid or submit
the quotation for this work
Workplace : Any physical location in which work related activities are
performed under the control of the Contractor organization.
5. REFERENCES
Contractor shall implement HSE Management System refer to Government Regulations,
National & International Standard, Rules and others Regulation, such as but not limited:
1. Law No. 1/1970 regarding Occupational HSE (Consists of Health and Safety)
2. Law No. 23/1992 regarding Occupational Health
3. Law No. 32/2009 regarding Protection and Management of Life and Environment
4. Regulation of Indonesian Government No. 11/1979 regarding Work Safety at MIGAS
Refinery
5. Law No. 24/2011 regarding Social Security Organizing Body
6. Law No. 22/2001 regarding Oil and Gas
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7. Regulation of Indonesian Government No. 50 / 2012 regarding Implementation of

Occupational Health and Safety Management System Law No. 1/1970 regarding
Occupational Health
8. Regulation of Indonesian Government No. 101 / 2014 regarding Hazardous Waste
Management
9. Minister of Labour and Transmigration No. PER/01/MEN/1980 regarding Work Safety at
Construction
10. Regulation of Indonesian Government No. 81 / 2012 regarding Management of
Household Waste and Similar to Household Waste;
11. Regulation of Indonesian Government No. 74 / 2001 regarding Hazardous Material
Management
12. Regulation of Indonesian Government No. 41 / 1999 regarding Air Pollution Control;
13. Regulation of the Minister of Manpower and Transmigration No. 05/ 2018 regarding
Occupational Health and Safety of Workplace Environmental
14. Regulation of the Minister of Manpower No. 15/MEN/VIII/2008 regarding First Aid for
Workplace Accidents
15. Regulation of the Minister of Environmental No. 18/2009 regarding Guideline of
Hazardous Waste Management Permit
16. Regulation of the Minister of Environmental No. 14/2013 regarding Symbols and
Labelling of Hazardous Material and Toxic Waste
17. Regulation of the Minister of Environmental No. 13/2009 regarding Quality Standards for
Stationary Sources of Emissions and / or Activity Oil and Gas Business
18. Regulation of the Minister of Environmental No. 51 / 1999 regarding Decision of
Threshold Value for Physical Factors in the Workplace
19. Decree of the Minister of Health No. 492 / 2012 regarding Requirements for Drinking
Water Quality
20. Decree of the Minister of Health No 1096 / 2011 regarding Sanitation Hygiene
Requirements for Catering Services
21. Decree of the Minister of Health No. 70 / 2016 regarding Standard and Requirement of
Occupational Health Industrial Work
22. Decree of the Minister of Environmental No. 48/MENLH/11/1996 regarding Noise Level
Standard
23. Decree of the Minister of Environmental No.35/MENLH/10/1993 regarding Standard of
Vehicle Emissions
24. Decree of the Head of Environmental Impact Control Agency No. 255/BAPEDAL/08/1996
regarding Procedures and Requirements for Storage and Collection of Used Lubricating
Oil
regarding Procedures and Requirements for Storage and Collection of Hazardous Waste
regarding Hazardous Waste Manifest
regarding Technical Requirements of Hazardous Waste Management
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regarding Technical Guidelines for Air Pollution Control Stationary Sources.
29. Regulation of Manpower Ministry No. 09 Year 2016 regarding Working at Height
30. Regulation of Manpower Ministry No. 37 Year 2016 regarding Pressure Vessel and
Storage Tank
31. Regulation of Energy and Mineral Resources Ministry No. 18 Year 2018 regarding
Installation and Tools Inspection for Oil and Gas Activity
32. Local Regulation of East Kalimantan No. 02 Year 2011 regarding Water Quality
Management and Water Pollution Control
33. Local Regulation of Balikpapan No. 03 / 2012 regarding Permit for Building
34. Health, Safety, Security, and Environmental (HSSE) Plan Doc. No. 26070-203-G01-GHX-
J0001-000
35. Health, Safety, Security and Environmental (HSSE) Plan Document No. G01-GHX-J0001.
36. ISO 14001:2015 Environmental Management System – Requirements with guidance for
use.
37. ISO 45001:2018 Health and Safety Management System – Requirements with guidance
for use.
38. Regulation of the Minister of Manpower No. 01/MEN/I/2007 regarding Guidelines for
HSE Award.
39. Environmental Impact Analysis (EIA) of RDMP RU V Balikpapan Project.
40. Project HSE Management System Document No. 26071-100-G01-GHX-00008.
41. NFPA 30: Flammable and Combustible Liquids Code.
42. EN 397:2012 – Industrial Helmets.
43. ANSI Z89.1 – Safety Requirements for Industrial Head Protection.
44. EN 166 – Personal Eye Protection Specifications.
45. ANSI Z87.1 – American National Standard for Occupational and Educational Personal Eye
and Face.
46. ANSI Z88.2 – Practices for Respiratory Protection.
47. BS EN 4275 – Guide to Implementing an Effective Respiratory Protective.
48. BS EN 139 – Respiratory protective devices. Compressed air line breathing apparatus for
use with a full face mask, half mask or a mouthpiece assembly. Requirements, testing,
marking.
49. BS EN 137 – Specification for respiratory protective devices: self-contained open-circuit
compressed air breathing apparatus.
50. ANSI S3.19 – Noise Reduction Rating (NRR) Labelling
51. BS EN 420 – Protective gloves. General requirements and test methods.
52. BS EN 345-1 – Safety footwear for professional use. Specification.
53. ANSI Z.41 – Personal Protection - Protective Footwear.
54. ANSI A10.14 – Construction and Demolition Operations - Requirements for Safety Belts,
Harnesses.
55. BS 1139-1.1:1990 Metal Scaffolding, Tubes, Specification for Steel Tubes.
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6. LEADERSHIP AND COMMITMENT

HSE POLICY
Refer to Attachment 01 for Project HSE Policy.
Contractor’s HSE management system established for this project is centered on Contractor’s
top management commitment to execute the work in such manner that health, environment,
and property are protected in accordance with all applicable laws and regulations as well as HSE
policy of RDMP project (which is in line with Owner and Contractor HSE policy). To do so,
Contractor’s top management has strong commitment that throughout the execution of the
project:
1. Establish Health, Safety and Environment (HSE) as a priority in every work in order to
achieve the best level of quality and optimum time completion.
2. Provide safety and comfort in the work for client, employee, partner, and communities,
by maintain the best safety and security in every activity.
3. Increase the level of Health, Safety and Environment, in order to prevent all unsafe action
and / or condition, workplace accidents, and environment pollution in RDMP project.
STRATEGIC OBJECTIVES AND KPI’s

Contractor will implement a proper HSE programs and demonstrate leadership and
commitment to achieve the goal of zero harm to people, environment, and Zero Accidents.
The Strategic objective for the RDMP Project RU V Balikpapan is Zero Accident, which is defining
as:
a) Zero Lost Time Incident
b) Zero Total recordable incident
c) Zero significant environmental incident
d) Zero sabotage case
Contractor HSE Plan aligned with Owner’s Document 26070-203-G01-GHX-J0001 HSSE Plan to
minimize the gap between Contractor and Owner in terms of HSE Requirement including
Objectives, Target, and Program (OTP) that may be included in this HSE Plan.
To achieve project goals in HSE and minimize risks associated in the project activities, Contractor
will implement Incident Injury Free (IIF®) Programs covering all Contractor activities and
personnel. Contractor also set performance standards with the aim of eliminating and
controlling risks. The ultimate project specific HSE Performance Target as tabulated on the HSE
Objectives for this project in Table 1. HSE KPI’s Performance Target:
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NO ITEM KPI MEASUREMENT TARGET REMARKS
LAGGING INDICATOR
Total case number 0
1 Fatality
0
2 Lost Time Incident Total case number
Lost Time Incident Frequency Rate <1
3 Ratio
(LTIFR)
Lost Time Incident Severity Rate <1
4 Ratio
(LTISR)
Incident impacted to 0
5 Total case number
Environmental pollution
Incident impacted to fire / asset 0
6 Total case number
damage
Per million
7 Total Recordable Injury Rate (TRIR) Ratio <0.09
manhours
Total
8 First Aid Case Total case number 4% manpower
on board
LEADING INDICATOR
MoM / Attendant list Min. 1 / month
1 HSE Meeting
Attendant list Daily
2 HSE Talk / briefing / toolbox
Report submission Weekly
3 HSE Reporting
record
4 HSE Management Visit/ MWT MWT record Quarterly Level PMT
Follow up action 100% Closed
5 Closure Action
report
Audit/ Inspection Monthly
6 Inspection / audit
report
PPE compliance 100%
7 PPE Compliance
report
Compliance on Waste Waste management 100% Comply
8
Management report
Hygiene Industry 100% Comply
9 Compliance on Hygiene Industry
report
Comply to Good housekeeping e-COP & Audit 100% at the end
10
management Record of project
Table 1. HSE KPI’s
The progress of KPI and program shall be updated regularly. Contractor shall submit, on a
weekly basis, a formal report summarizing Contractor and Subcontractors’ HSE performance to
the Owner representative. The report will be including total man-hours, leading and lagging
indicator as stated on HSE Objectives, Target, Programs, and any related additional data.
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ROLES AND RESPONSIBILITIES

For Organization Chart refer to Attachment 8. HSE Organization Chart.
6.3.1. PROJECT DIRECTOR

• The Project Director acts as the overall Project leader for CMT. The Project
Director is responsible for communicating the safety expectations to the Project
team and with the PMC.
• Responsible for the project budget ensuring the resources necessary to carry
out the HSE Plan are made available.
• When onsite, the Project Director participates in safety observations, audits
and communicates safety enthusiasm to all levels.
6.3.2. PROJECT MANAGER

• Overall responsible for the implementation of deliverables in the HSE Plan.
• To lead Quarterly HSE Management Walkdowns.
• Provide sufficient resources for the implementation of this HSE plan.
• Ensure that all Contractor's HSE Plan and procedures are being well
implemented at RDMP project
• Achieve the HSE performance determined by Contractor's HSE policy for RDMP
project.
• Take necessary corrective and preventive action to gaps and weakness to
procedures and their implementations.
6.3.3. CONSTRUCTION MANAGER

• Responsible for the implementation of HSE Plan at site.
• To attend Project HSE Meetings.
• To attend Project HSE Committee Meeting.
• To attend Quarterly HSE Management Walkdowns.
• Ensure that all Contractor's HSE procedures are being well implemented at
project.
• Achieve the HSE performance determined by Contractor's HSE policy for
project.
• Ensure all construction activities are being done as per HSE requirements,
standards and codes, and all Contractor’s HSE procedures.
• Has authority to issue a Permit to Work.
6.3.4. CONSTRUCTION DISCIPLINE SUPERINTENDENT

Construction Discipline Superintendent are Superintendents responsible in
supervising and coordinating disciplines apart from HSE. E.g. Mechanical
Superintendent, Piping Superintendent, Civil Superintendent, etc. Their
responsibilities are:
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• Responsible to implement of HSE Plan at site.

• To attend daily toolbox meeting and other HSE meeting related with their
activities.
• Ensure the work team members under their supervision are aware of the
hazards associated with their work activities and required control measures to
eliminate or reduce the risks.
• Ensure effective instruction, training and supervision is given to the employees
under their supervision, particularly to inexperienced or new employees and
those of any Subcontractors.
• To develop safe work practices through method statements, work instructions
which applicable to their activities.
6.3.5. HSE MANAGER

• To attend Project HSE Meetings.
• To attend Project HSE Committee Meeting.
• To attend Quarterly HSE Management Walkdowns.
• Accountable for the implementation of Contractor's HSE management system
on the project site.
• Coordinate / communicate with Deputy HSE and JO HSE Team lead regarding
the implementation of HSE Management System.
• Ensure all corrective actions raised to all gaps and weakness found during HSE
inspections and/or audits are being implemented.
• Ensure all rules and regulations related to HSE are regularly reviewed and
updated.
• Ensure all project activities are conducted in a safe manner.
• Establish and maintain regular interface discussion with PMC HSE
representative.
• Ensure the HSE Inspector has a qualification or certified as Inspector for each
respective area. E.g. HSE Inspector for scaffolding shall be a qualified or certified
Scaffolding Inspector.
6.3.6. DEPUTY HSE MANAGER

• Assist HSEM (HSE Manager) to ensure the implementation of Contractor's HSE
management system.
• Coordinate / communicate with JO’s Chief HSE and each JO member regarding
the implementation of HSE Management System.
• Ensure all rules and regulations related to HSE are updated.
• Establish and maintain regular interface discussion with Owner's HSE
representative and others project members.
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6.3.7. CHIEF HSE

• Ensure all HSE activities at site are being implemented properly.
• Ensure procedures and other HSE related documents are being properly
implemented at project site.
• Develop HSE performance statistic at the workplace.
• Develop training and education program for all workers at project site.
• Conduct regular inspections at the workplace.
• Prepare project regular report (weekly report, monthly report, HSE project
overview) through HSE e-Board.
6.3.8. HSE ENGINEER

• Manage procedures and documentation on management system
implementation.
• Assist HSE Manager to implement and report of Contractor management
system.
• Assist HSE Manager regarding the web-based information system (HSE e-Board)
utilization.
• Assist HSE Manager in conducting CSMS Assessment, subcontractor selection,
and evaluation
• Assist HSE Manager to prepare proposal and programs.
• Collect, maintain, and analyse statistic data.
6.3.9. INSPECTOR
• Assist Chief HSE to inspect all scaffolding, construction electricity system, heavy
equipment, machineries, tools, vehicles, and other equipment will be used in
RDMP project as per competency
• Develop an inspection report and communicate it with Chief HSE.
• Conduct regular inspections at infrastructure facility area.
• Has a qualification or certified as Inspector for each respective area. E.g.
Inspector for scaffolding shall be a qualified or certified Scaffolding Inspector.
6.3.10. HSE TRAINING COORDINATOR

• To ensure the implementation of HSE Training programs are run properly at site
project.
• To ensure training database updated and well maintained.
• To provide approved training material and update it regularly as any changes
happen. E.g. MOC to HSE Procedure, Lesson Learn, etc.
• To ensure required training records are available and well documented.
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6.3.11. SITE DOCTOR

• Review & Verify MCU result, ensure worker are fit for job position.
• Conduct Health Education & Training for worker on site.
• Conduct Health assessment / inspection for onsite facility.
• Conduct Site Clinic to deliver primary medical care, minor surgery and
consultation.
• Prepare referral case, coordinate with hospital & conduct Medical evacuation.
• Conduct Occupational Health Management system, include Prior to work.
Medical Examination, Return to Work, Recording & Reporting.
• Prepare health matters for weekly and monthly report.
• Deliver Prompt Treatment for Emergency cases.
• Update medical evacuation procedure.
• Ensure drugs & medical equipment are sufficient for medical emergency
service. Update of skill of Clinic Personnel & First Aider.
• Ensure Clinic permit, Medical license, Medical record.
• Ensure Medical waste management are complying to local regulation.
6.3.12. HEALTH/MEDICAL ADVISOR

• Organize Health assessment for medical provider & health related suppliers.
• Organize Fitness for Work program.
• Coordinate with local government and medical service provider.
• Develop Health Management Plan & Health Surveillance.
• Review Medical Evacuation Procedure.
• Provide advice for Doctor, IH & Paramedic on site.
6.3.13. PARAMEDIC
• Respond immediately and deliver initial stabilization for injured / illness person
at the scene prior transfer to site clinic.
• Assist Site Doctor in implementation of health management programs,
• Assist Site Doctor to identify health hazards in the work place, implement
control and monitoring program
6.3.14. SUBCONTRACTOR/SUPPLIER/VENDORS
• Comply with minimum HSE requirement, procedures, and related HSE
agreement.
• Report accidents / incidents immediately direct to HSE committee /
representative.
• Assist in any accident / incident investigation in their area.
• Maintain good housekeeping and physical arrangements.
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7. RISK MANAGEMENT
HIRAC
Refer to Attachment 10. HIRAC Form
Contractor shall develop HIRAC (Hazard Identification, Risk Analysis and Control) throughout
project phase. HIRAC will be used as reference to develop JSA for specific activities at site.
At minimum HIRAC shall be consist of following stages:
• Hazard and Risk Identification Stage

Execution of Hazard Identification shall be conducted for all project stages.
• Hazard and Risk Assessment Stage
Risk assessment is based on identified hazards. Below Risk Assessment Matrix will be used
during this stage.
Figure 1. Probability/Severity Matrix
Figure 2. Risk Categories
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Figure 3. Severity Definition
• Hazard and Risk Implementation/Control Stage

Contractor shall determine required control measures based on the level of risks. Also the
monitoring to the implementation of control measures shall be done.
• Review and Update
HIRAC shall be reviewed and updated periodically to ensure any change or new hazards
introduced at site already incorporated into HIRAC.
JOB SAFETY ANALYSIS (JSA)

Refer to Attachment 11. JSA Form
Job Safety Analysis (JSA) relevant for the project in order to control risks of specific activities
which carried out at RDMP Project. Approved JSA shall be attached to the PTW.
JSA will be required for all jobs performed On or Off site. Construction Superintendent or
Supervisor shall be responsible to provide JSA and understood by all the work team member.
HSE are responsible to review the JSA. Normally during daily Tool Box Meeting (TBM). Employee
shall sign the JSA Attendance list and involving in any review of activity change. New hazard
identified in JSA shall be add on HIRAC register.
As minimum JSA shall described breakdown steps for the task and hazards identified for each
step including control measures.
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The JSA process flow to be done at site is as follows:
Step 1. Identify the job to be done.
Work Leader or Discipline Superintendent involved, shall identify the sequence of the job,
including HSE requirement for each of the sequence.
Step 2. Breakdown the job in to sequential steps.
Break the job down into sequential steps. Everyone should understand what is taking place and
where; what people are required; what equipment or plant is in use; and any other components
involved.
Step 3. Identify the hazards in each step.
To identify the potential hazards that could reasonably cause damage on each steps. Consider:
• Obvious hazards that can develop into an unwanted event

• Things that could go wrong. Discuss credible risks in terms of WHAT could happen, HOW it
could happen, and WHY it could happen
• Things that have been known to go wrong elsewhere (relevant incident reports)
• Weather conditions
• Day or night
• Experience of operators
• Other operations in the area
Step 4. Identify the control measures for each hazard.
A whole range of controls (elimination, substitution, etc.) should arise from such JSA, not just
procedural ones, as these are the least effective. Many of the non-procedural controls require
action before the job starts (E.g. purchasing of equipment (signs, harnesses etc), training and
certification of workers, re-design of equipment, installation of barriers, etc).
Step 5. Review the JSA with all workers on the works (Pre-Job Safety Meeting).
During Pre-Job Safety Meeting, work group will have a final discussion which includes HSE and
Discipline Superintendent review on the JSA then approval to proceed with the Work. Pre-job
Safety Meetings will be conducted at each work site prior to the start of job activities. During
these meetings the contents of the JSA will be discussed in detail in such a manner to meet the
expectations. In this meeting, The Supervisor or Crew Lead facilitates the JSA and asks specific
questions of multiple workers to obtain their input regarding planning and conducting Work
safely. Each crew member shall offer input, asks questions, and actively listens during the JSA
discussion. After completing final JSA discussion, all components of the JSA are accurately
documented on the appropriate project JSA form. The JSA is reviewed and signed by each crew
member, and signature approval is provided by the Supervisor or Crew Lead.
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Step 6. Ensure the JSA is reviewed periodically.
JSAs should be reviewed periodically but especially after changes in the work situation; after
related incidents; changes in legislation etc.
Generic JSAs should be reviewed each time they are used in a new work environment (E.g., a
JSA used by a Subcontractor to install scaffolding should be reviewed at the start of each job).
JOB HAZARD ANALYSIS (JHA)

Job Hazard Analysis will be focuses on following items:
1. Break the task down into a defined sequence of steps.

2. Identify the potential hazards which may come from the relationship between the worker,
the task, the tools, and the work environment.
3. Develop control measures to eliminate or reduce them to an acceptable risk.
Supervisor or Foreman shall be responsible to provide JHA and to ensure that the work crew
aware and understand all the associated hazards with the jobs they will be performing. and also
know what are the preventive measures to be taken to eliminate or reduce them into
acceptable risk.
Supervisor and Foreman need to conduct periodical review to JHA to ensures that it remains
relevant to reduce workplace incidents.
Supervisor and Foreman shall be deliver and discuss about JHA with their work crews just before
starting the work (Pre-Job Safety Meeting).
During Pre-Job Safety Meeting, Supervisor or Foreman and their work crew will have a final
discussion to review on the JHA then approval to proceed with the Work. Pre-job Safety
Meetings will be conducted at each work site prior to the start of job activities. During these
meetings the contents of the JHA shall be discussed and confirmation/check to ensure all
precaution already at place. After completing final JHA discussion, JHA are accurately
documented on the appropriate JHA form. The JHA is signed by each crew member, and
Supervisor or Crew Lead.
Refer to the Attachment 12. JHA Form
8. MANAGEMENT OF CHANGE (MOC)

MOC is required to provide a documented process for managing change in order to achieve an
acceptable level of risk. Change can be imposed from external and/or internal drivers and can
occur quickly or over a long period of time. Whatever form change takes, it must be properly
managed at the appropriate level so that unwanted risks do not evolve.
Change can be broadly defined as an alteration or modification, replacement, addition, revision

or deletion to any aspect of Contractor’s operations, systems or business. However, change as
it applies to this plan is limited to impacts on personal health & safety, environmental harm,
and regulatory compliance.
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Once a change or a need for future change is identified, it is necessary for that change to be
managed by the appropriate person which will be guided by the associated risk assessment as
to whether the proposed change(s) represents an acceptable level of risk.
The Change Management System consist of six (6) step process as follow:
Step 1 Change determination
Step 1 requires the Change Initiator to ask a series of questions with the aim of providing
clarification as to whether the change management process is required.
If “yes” is the response to any of the questions then the Change Initiator must move to the next
step.
Step 2 Risk Assessment
This Step need to determine the level of risk for a variety of change impact types.
The change impact types include:
• Impact on safety/harm to people.

• Impact to environment.
• Deviation from policy, procedures, compliance.
• Deviation from Government laws and/or regulations.
The Change Initiator is also required to make comment on the risks of undertaking and not
undertaking the proposed change.
Based on the level of risk identified, the following levels of risk assessment will be required to
be completed and details attached to the Change Management Request Form:
CHANGE RISK
RISK ASSESSMENT REQUIREMENTS
CATEGORY
1. JSA to be re-reviewed and re-written to incorporate
Low
with the change occur.
2. Requirements 1 and method statement may need to be
Medium
provided and approved.
3. Requirements 2, Conduct a Risk Assessment Workshop
High
and Prepare Action Plan.
Table 2. MOC Risk Assessment Requirements
Step 3 Details of the change
This step requires the Change Initiator to detail the following:
• Describe the reasons for change, providing hard evidence to support the need/opportunity.
• Describe the benefits of this change.
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• When does the change need to take place and why?
Step 4 Commitment and Application
This step requires the Change Initiator to detail the following:
• List any Technical Expert who needs to be consulted about / approve the proposed change.
• List the people / groups who need to be consulted on the proposed change.
• List systems, policies, procedures, plans, schedules, competencies, etc which affected by
these changes.
A Technical Expert is generally the person who may own legal obligation/business accountability
in the area covering the change and may not necessarily be the Change Authorizer.
The Change Initiator is required to seek approval from the Technical Expert for the proposed
change if the risk is deemed to be High.
Step 5 Action Plan
This step requires the Change Initiator to develop an Action Plan for the successful
implementation of the proposed change.
It is required to review the effectiveness of the change at an agreed period following the change.
Step 6 Approval
• The Risk Category for the requested change is the highest risk rating from Step 2. That is, if
one category has a risk rating of Medium, but another has a risk rating of High, the overall
risk rating is High.
• This step is break down into two stages. The first stage, if required, is the review and
approval by a Technical Expert. This shall apply for all High-risk changes.
• The second stage is the approval by the Change Authorizer. The Change Authorizer is
identified by completing Step 2 Risk Assessment of the Change Management Request
Form. The Change Authorizer depends on the level of risk as defined in the following table.
TYPE OF CHANGE AUTHORISATION LEVEL REQUIRED
Low Discipline Superintendent
Medium Construction Manager
High Project Manager, HSE Manager
Table 3. MOC Authorization Level Required
Changes that are High risk shall be subject to a Post Implementation Review. The date for review
and person responsible for organizing the review shall be detailed in the Action Plan.
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Contractor’s HSE will keep a register of all approved change management activities.
Refer to Attachment 9. Change Management Request Form.
9. PRE-MOBILIZATION MANAGEMENT
Premobilization inspections between Contractor and Subcontractor will be performed prior to
mobilization for agreed scopes of work to ensure readiness prior to mobilization. Subcontractor
shall fulfil all of premobilization readiness requirements before obtaining Contractor approved
and verified of workers SIML (Surat Ijin Masuk Lokasi= Site Entry Permit) and ID Badge and
Permit to Work. As a minimum, the scope of the inspection shall include but not limited to the
following:
MANPOWER READINESS
Requirements for Man Power Readiness that shall be submitted and followed by Subcontractor
are as follow:
• Copy of valid competence certificate (including driving license) for specific position such as
heavy and light vehicles driver, heavy equipment operator, welder, scaffolder, rigger, etc.;
• Copy Medical Check Up (MCU) result;
• Complete filled of man power register form (for each personnel);
• Formal photograph (3x4) with Red colour as a background;
• Copy of identity card (for each personnel);
• Copy of Kartu Keluarga (for each personnel);
• Copy of Surat Domisili (for each personnel);
• Copy of employment card / BPJS (for each personnel);
• Attend HSE induction and matrix training (based on work position).
A visitor is defined as Contractor / Subcontractor / Sub-Subcontractor / Vendor personnel who

will visit project site to conduct short inspections or walkthroughs or supervise as experts within
max 7 days.
Visitor shall be accompanied by an appointed Contractor person (user / host). Visitor shall also
complete the visitor SIML & ID Badge following requirement:
• Complete man power register form (for each personnel);

• Attend HSE induction and matrix training (based on work position).
All of man power data will be documented on a man power register web-based system called
HSE e-Board. This data could be accessed regularly in line with RFID card system.
EQUIPMENT / TOOLS / VEHICLES READINESS

Besides man power readiness, Subcontractor shall prepare and fulfil all requirements related to
equipment / tools / vehicles readiness. All of equipment / tools / vehicles shall pass a
premobilization inspection by Contractor (including heavy equipment, vehicles, generator set,
air compressor, and welding machine) prior to mobilize to project site.
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After mobilize to project site, Contractor will conduct gate inspection to have a final check prior
to use by Subcontractor. After Pass the inspection, sticker will be attached to the
equipment/tools/vehicles. The requirements related to equipment / tools / vehicles readiness
are as follow:
• Copy of valid equipment / tools / vehicles certificates (including KEUR, STNK, BPKB);
• Equipment / tools / vehicles manual book;
• Vehicle shall have Anti-lock Brake System, Air Bag System, safety belt for all passenger,
speed sensor attached, flame arrestor and safety accessories as per HSE requirement (back
up alarm, fire extinguisher, first aid kit).
• Vehicle shall not be older than 5 years for small vehicle and 10 years for truck and other
heavy vehicles.
DOCUMENTATION READINESS
Prior to conduct work at project site, Subcontractor shall prepare several documents as a
requirements of document readiness. Those documents are as follow:
• Working procedures (for each activity)/Method Statement;

• Job Safety Analysis (JSA) (for each activity);
• Job Hazard Analysis (JHA);
• Drawing / lifting plan / etc (related to activities).
• SIKA / Work Permit has been approved.
10. SUBCONTRACTOR MANAGEMENT

Contractor insists Subcontractors to be involved in the implementation of the Health, Safety
and Environmental Management Plan and to comply with requirements set within the
Contractor Project HSE Plan. To ensure Subcontractor’s compliance, project management team
shall conduct the following:
1. Project Manager, Procurement Manager and Construction Manager shall ensure that all
bidders for subcontracting passed the CSMS (Contractor Safety Management System)
before PQ (Pre-Qualification). CSMS scoring system not only based on documentation
(paper based) but also based on the scoring during shop visit in related Subcontractor
workshop. Refer to Attachment 4 CSMS Questionnaire and Flowchart of CSMS process
described in below Figure 4. CSMS Process Flow.
2. Contractor may sometimes conduct an audit to Subcontractors by prior appointment

arrangement. This audit will be carried out at least 7 days prior notice, and can be done
at Subcontractors Home Office or Project Office agreed. The results of this audit will be
determined as a reference for Subcontractors CSMS score validity.
3. Subcontractors shall responsible to Health, Safety, Security, and Environmental

performance within the project site area as appropriate to their relevant scope of work.
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4. Subcontractor shall meet the requirements of Contractor that contained in document

RDMP-SHRP000-S0-PRC-900-00039 HSE Minimum Requirement document. This
document covers all requirements that shall be met in carrying out RDMP project.
5. Subcontractor shall conduct HSE workshop to present their HSE management plan
including but not limited to man power plan (shall fulfil the requirements of 1 HSE
Coordinator + HSE Officer with ratio 1: 50 workers + First Aider with ratio 1:100 workers
+ Paramedic with ratio 1:250 workers).
6. Subcontractor shall provide their employees with proper equipment and skill certification
from relevant authorized government institution, provide adequate work tools and
provide all required personal protective equipment as required in the government rules
regulations and applicable industrial standard both national and international.
7. Subcontractor personnel shall be given a Health, Safety, and Environmental induction by

the Contractor HSE trainer or other appointed personnel at the workplace area.
8. All Subcontractors and outsource parties that contribute directly with Contractor is
obliged to provide health/safety and employment insurance facility to workers, both
individually and in groups.
9. A monthly KPI audit shall be conducted to all Subcontractors to measure the HSE
performance of the Subcontractors. Subcontractor that is actively working on the project
must be audited at least once a month to measure the performance of the Subcontractor
HSE, audit results in the form of Key Performance Indicator (KPI) HSE score will determine
whether to process Monthly Progress Report or not as a prerequisite of invoicing. Audit
findings listed in the KPI must be completed well within the allocated time, if not resolved
within the specified time, then the Monthly Progress Report Subcontractor approval will
be suspended until the findings resolved.
11. Upon the submission of the progress report, Subcontractors shall achieve a compliance
score (minimum 80 of 100) without any outstanding audit or inspection item from the
Subcontractor’s HSE Key Performance Indicator (KPI).
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Figure 4. CSMS Process Flow
11. TRANSPORTATION MANAGEMENT

VEHICLES
To minimize the risk and hazard during the transportation period, Contractor implement a
journey management system for vehicle operation included in Contractor’s area for supporting
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Contractor’s activities. All vehicles shall pass an inspection. Minimum requirements for drivers
are as follows:
• Have good physical, mental and psychological condition.

• Drivers/operators are experienced, are medically examined, completed driving tests.
• Have special skills such as terrain and climatic experience, and first aid knowledge.
• Have licenses both from the government and Contractor (SIMPER), and any relevant types
of cargo licenses.
• Have completed safety defensive driving training.
• Have completed induction on local area characteristics and regulations.
Vehicles shall be:
• The vehicle shall have Anti-lock Brake System, Air Bag System, and safety belt for all
passenger.
• Speed sensor attached in vehicle.
• Have valid gate pass.
• Completed with inspection record.
• Completed with safety accessories as per HSE requirement (reverse alarm, fire
extinguisher, first aid kit, flame arrestor).
The General Affair Department will be responsible to control driver alertness and fitness by:
• Scheduling driver’s trip plan for a week considering their enough time to rest.
• Pre- Briefing before starting work.
• Maximum duty hours of drivers shall be 15 hours.
• All driver 100 % should have attend Safe driving course provided by JO.
• Refreshment training for all driver at site will be conducted on yearly basis.
Refer to 26071-100-GPP-GHX-00007 Transportation and Journey Management Plan.
PEDESTRIAN AREA
• Contractor shall provide pedestrian walkways which capable to be used by employees to
move at site and office area by walk.
• At minimum dedicated pedestrian walkways shall provide with widths no less than 3 feet.
• Pedestrian way shall be clearly marked to show visible boundary between vehicle and
pedestrian access.
• Pedestrian crosswalk will have an interface with vehicles access. Contractor must treat
adequate control for this area such as put proper sign to stop their vehicles and give priority
to pedestrian to cross the road, provide dedicated signal man, speed limit, etc.
• Identified blind spot with potential crash between pedestrian and vehicles shall provide
with mirror and adequate safety sign. E.g. pedestrian walkways at warehouse, workshop.
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12. HEALTH MANAGEMENT

BIOLOGICAL HAZARDS
Biological hazard identification, control, and emergency handling response is detailed on
specific HIRAC/JSA, 26071-100-G01-GHX-00005 Health Management Plan and 26071-100-
GPP-GHX-00002 Project Emergency Handling Procedure.
Biological hazards refer to organisms or organic matters produced by these organisms that are
harmful to human health. These include parasites, viruses, bacteria, fungi and protein.
The main types of biological materials that workers were potentially exposed to in workplaces
were:
• Human bodily matter (blood, tissues, vomit, urine, faeces, saliva, breast milk)
• Animal product (meat, offal, skins, bones, blood, milk, eggs)
• Live animals (mammals, birds, fish, invertebrates and their urine or faeces)
• Biohazard waste, sewerage and rubbish
• Laboratory cultures
Occupation and workplaces where people may come into contact with biological hazards are:
• Medical staff, cleaning staff and laboratory technicians.

• Healthcare services.
• Cleaning services.
• Employees in environmental hygiene services such as sewage treatment or
wastewater plant and rubbish collection and disposal.
• Indoor workplaces where employees generally work in enclosed areas with central
air-conditioning: –Any microorganism breeding inside the air-conditioning system or
cooling towers may spread in the workplace through the air-conditioning system.
• Employees who work with animals.
Biological hazards likely to affect workers in specific workplaces will be vary according to the
type of occupation, the location, the weather, the nature of the work, species known to occur
in the region and the environment. Liaison with specialist advisors may be required to
document the type and extent of the Biohazards relevant to a workplace and to prepare a risk
assessment and mitigation plan based on that assessment.
Control of Biohazards requires systematic, analytical application of a hierarchy of control that

takes account of the nature of biohazards agent, the workplace, the nature of work, and the
workers.
If the contact with Biohazards cannot be prevented, the employees must use PPE and adhere
strictly to the practice of personal hygiene. PPE will be including masks, gloves, protective
clothing, eye shields (safety googles), face shields, and shoe covers.
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12.1.1. WILDLIFE ANIMAL

• Contractor shall identify potential wildlife will be encountered at project site and also
conflict handling with the wildlife. There is several wildlife could be encountered but not
limited to following animal:
- Mosquitos
- Bees
- Snake
- Sun bear
- Crocodile
- Orangutan
- Clouded leopard
• Contractor shall educate employees to prevent matters that can attract the presence of
wildlife. Such as food, rubbish, garbage, humidity, etc.
• Contractor shall ensure that employees are aware with the characteristic of wildlife at
their working area.
• Contractor may liaise with Government agency which is authorized to handle wildlife
conflict.
• Contractor shall provide emergency number for emergency case involving wild animal
attack or being bitten by animal.
12.1.2. BLOOD-BORNE PATHOGENS

Construction Manager will be responsible for the implementation of Blood-borne pathogens.
The program will include:
• Training to personnel employees whose responsibilities include medical emergencies,

first aid, CPR, etc., and such training will adhere to the all requirements outlined in
Contractor standard.
• Necessary PPE for employees mentioned above.
• Post exposure evaluation and follow up to personnel who have been exposed.
• Labelling and Sign.
• Response to accidental exposure to blood-borne pathogens.
DRINKING WATER
This provides guidance for the protection of site personnel from unsanitary and unhealthy
drinking.
• Contractor shall provide drinking water which comply with government water quality
standard for drinking water.
• It is prohibited to drink water directly from tap water, since tap water is often not
adequately treated. It is recommended to boil the water prior to drinking.
• Sampling of drinking water shall be conducted quarterly by Contractor HSE to ensure
drinking water supplies are health to consume.
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EXTENDED WORK AND SHIFT WORK

To speed up the work and to continue the work that cannot be stopped, the contractor will
overtime with extended working time and double shift. HSE requirement is recommended prior
start of work during night activities.
As with other health and safety hazards, the greater exposure to shift work and extended hours,
the more likely the risk of some harm. The risk of working with shifts and the amount of night
work can undermine long term shifts and long hours of work and safety, those who work them.
For that there are several mitigations that need to be considered among others but not limited
to:
• Plan an appropriate and varied workload.

• Offer a choice of permanent or rotating shifts and try to avoid permanent night shifts.
• Limit shifts to 12 hour including overtime.
• Encourage workers to take regular breaks and allow some choice as to when they are taken.
• Consider the needs of vulnerable workers, such as young or aging workers.
• Consider providing warm drinking & food (beverage) and proper feeding zone.
• Weather condition would be a consideration for providing clothes to keep body warm.
• Provide similar facilities as those available during daytime and allow night time workers
time for training and development.
• Ensure temperature and lighting is appropriate and preferably adjustable.
• Information on the risks of night time work and ensure the implementation of toolbox
meeting and briefing.
• Supervisors and management can recognize problems.
• Consider increasing supervision during periods of low alertness.
• Provide health assessment for night time workers.
• Ensure the workplace and surroundings are well it, safe and secure.
Detail of Night Out of Hours Work procedure is described on document 26071-100-GPP-GHX-

00023.
FITNESS TO WORK
Achieving good performance in doing the job or duty shall be equipped by fitness both physical
and mentally. Through this plan, Contractor needs to ensure that employees who working in
site area have to be in good condition to perform the job by conducting medical check-up
(MCU). Refer to attachment 1 Project HSE Policy.
The result of the medical check-up (MCU) will be reviewed by Site Doctor to determine the
fitness by considering to the job required by his/her supervisor. Only Fit to Work person shall
be obtained ID badges and enter the plant for work.
To be in line with Project HSE Policy, Contractor must conduct drug and alcohol test for the
employee. At minimum 1% of total number of employees per month shall be the target for the
test.
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Drug and Alcohol test will be carried out randomly. However, employee at high risk activities
will be the priority to participate in the test.
Detail of fitness for work please refer to 26071-100-G01-GHX-00005 Health Management Plan.
HYGIENE AND OCCUPATIONAL HEALTH

Contractor will implement and maintain hygiene and occupational health programs throughout
the duration of this project. At a minimum the Supervisor General Affair will ensure the
implementation and maintenance of the following areas:
12.5.1. CATERING PRACTICES

At a minimum the Supervisor General Affair will ensure the implementation and maintenance
of the following areas:
• Monthly Inspection lead by Medical Advisor. Owner will be requested to participate.

• Weekly Tool Box Meeting for Catering Crew led by General Affair assisted by Medical
Advisor.
• Provide worker complaint and suggestion box about catering service.
• Contractor must engage the services of a suitable pest control for insects, rats, etc.
• It is not recommended to keep leftover foods for the next day consumption.
• However, if it is not possible, contractor shall ensure that catering providers are
implement adequate food storage procedure.
• Medical Check Up for food handler personnel shall be done in accordance with the
national regulation.
• Catering provider should follow food and catering safety management standard in
accordance with the national regulation.
12.5.2. FATIGUE MANAGEMENT

• Contractor must provide adequate rest periods for employees. It is recommended that
rest periods between shifts be at least 10 hours. In the event that an employee is required
to work longer than the normal allocated, consideration should be given to their start
time for the next shift.
• Where employees are required to work an extended shift, (i.e.: greater than 12 hours),
consideration should be given to:
- Maximum overtime on site is 15 (fifteen hours) in one day work cycle.

- At least 10 hours break should be given taking into consideration travel time, eating,
socializing, relaxing and sleeping.
- Adequate rest breaks should be given during the work shift.
• Where an employee is required to change shift from day to night shift, and vice versa,
they should be given a full 24-hour rest period prior to commencing the new shift.
• All employees shall not work more than thirteen (13) days straight without taking a day
rest.
• To effectively manage fatigue caused by on call work, consideration is to be given to:
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- Limiting the number of consecutive 24-hour periods that an individual is on call.

- Rostering more than one person to be on call at any time so that someone who is
not well rested is not required to work.
- Make arrangements to have workers transported to and from site.
12.5.3. HOUSEKEEPING
• Housekeeping practices and clean-up of all project facilities will be maintained by
Construction Team.
• The work area shall be maintained to a high standard of cleanliness, and supervisors will
be expected to review and rectify their respective work areas as required on a daily basis.
• Waste material shall not be burned in site and shall be segregated when disposed of in
the bins.
12.5.4. HEAT STRESS

• Contractor shall implement Heat Stress Monitoring especially during hot weather and
conditions.
• Contractor must ensure that adequate supplies of cold water for drinking, together with
shaded rest areas, are provided around the work areas. Personnel will be permitted
reasonable access to water and rest, sufficient to prevent heat stress.
• All employees who are exposed or potentially exposed to heat stress will receive training
regarding heat stress-related injuries and prevention measures.
• Contractor shall ensure that all employee understand the early symptom of heat stress.
Detail of heat stress management refer to 26071-100-GPP-GHX-00008 Heat Stress Prevention

and Management Procedure.
12.5.5. HEARING PROTECTION

Hearing Protection programs is required to ensure personal noise exposure remains within
acceptable limits and to protect employees from permanent hearing loss.
Noise can be Continuous, Intermittent and Impulsive. Continuous noise is constant. For
example, ventilation fans are a source of continuous noise. Intermittent noise is a mix of quiet
and noisy periods. Most manufacturing noise is intermittent. Impulse noise is a short burst of
loud noise that lasts for short duration. They are associated with such sources as explosions,
impacts, and sonic booms.
Noise assessment will be made periodically by Contractor. Employees who work in areas with
noise levels greater than 85 dB shall wear hearing protection. Contractor will ensure that these
areas are adequately marked and communicated to personnel during safety meetings,
induction training and should be detailed within the relevant work task JSA.
Contractor shall monitor ambient noise or environmental noise that potential to cause
annoyance to surrounding areas during construction work. Contractor shall conduct noise
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measurement in affected surrounding areas in periodically or if needed. The noise threshold

for resident is 55 dB, or as required by local regulation.
When information indicates that any employee’s exposure may equal or exceed the Action
noise level, i.e. 8-hour TWA of 85 dB, Contractor must develop and implement noise
monitoring programs and to be carried out by Competent Person.
All personnel with potential exposure greater than the action noise level, will be enrolled in
the medical surveillance program and undergo a baseline audiogram in accordance with
current program requirements. Thereafter, annual audiograms will be compared with the
baseline exam.
All personnel enrolled in the audiometric testing portion of the medical Surveillance program
shall be identified on the “Listing of Personnel Included in the Hearing Conservation Program”.
Employee Name Employee ID # Area or Task Employee’s Supervisor
Table 4. Listing of Personnel Included in the Hearing Conservation Program
When a Standard Threshold Shift (STS) is noted between the last valid baseline and
the annual audiogram, the following steps will be taken:
1. A retest will be conducted within 30 days to confirm the STS. The employee will not be
exposed to workplace/hobby noise for 14 hours or will be provided with adequate
hearing protection prior to testing.
2. If the STS persists, ear protection will be upgraded to one with a greater Noise
Reduction Rating (NRR). The minimum NRR will be 26 dBA.
3. The employee will be counselled, and information will be obtained regarding the
employee's possible noise exposure away from the workplace or existing ear pathology.
4. Qualified medical personnel will review the audiograms. This group will determine the
need for a medical referral.
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5. The employee and employee’s supervisor will be notified of the shift in hearing
threshold in writing by HSE within 21 days of determination.
6. If the employee who has experienced an STS is exposed to 85 dBA for 8 hours or 80 dBA
for 12 hours, mandatory use of ear protection is required.
7. Temporary employees will receive audiograms during their exit physicals if they have
worked around heavy equipment or have received an exposure to noise levels in excess
of 85 dBAs.
12.5.6. RESPIRATORY PROTECTION

Detail of respiratory protection refer to 26071-100-G01-GHX-00005 Health Management
Plan.
• Contractor will comply with Owner and industry standards for the specification and
provision of respiratory protection.
• Supervisor will be responsible to provide Respiratory protection base on assessment of
the job. The respiratory protection type shall be in accordance with the PPE standard.
• Any employee who requires respiratory protection to perform the work shall be trained,
medically qualified, and fit-tested.
• Contractor must ensure that respiratory protection equipment cleaned and stored
properly
12.5.7. RADIATION PROTECTION

Radiation protection will be under Construction Manager’s responsibility. At the minimum,
the Construction Manager will ensure the following:
• Provide special room / bunker for Radioactive storage complete with sign and according
regulation and standard radiation storage system.
• Provide Sign, Barricade, Orange & Red rotary lamp and other equipment/tools to alert
that dangerous activity being conducted.
• Provide qualified personnel to conduct radiation activity. The personnel shall be certified
by BATAN for conducting the activity.
• NDT (RT) without collimators are prohibited.
• Emergency procedure for Radioactive shall be provided.
• Radiography organization structure for Sub-Contractor shall be established. At minimum
shall describe Radiography Operator, Radiography Specialist, and Personal Protection
Radiography (PPR).
Contractor shall ensure that the following basic rules for Radiography are strictly enforced:
• Sources of ionizing radiation shall not be left unattended.

• Required to use the film badge / dosimeter for all personal involved with radioactive
activities.
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• Area exposed by radioactive sources shall clearly marked at four direction (north, south,
east & west), given signs with rope or other effective means and mounted alert signs to
the radiation.
• Accepted doses for radioactive worker shall not exceed 5 Sv/H or 50 mSv/Y and, in project
site areas, the doses shall be as low as reasonably achievable and shall only be accepted
by the public not exceed 0.5 Sv/H or 5 mSv/Y.
• Contractor will ensure that radiation measuring devices in the workplace are provided.
• Ensure that all operating radiographic or X-ray equipment (inclusive survey meter)
possess a valid Government Radiographic License by The National Atomic Energy Agency
(BAPETEN). A copy of the license shall be submitted to Contractor’s HSE for review.
• Shall control that the radioactive work will not affect any system or operating process
and surrounding people, prior to commencing any radioactive work.
13. ENVIRONMENTAL MANAGEMENT

Environmental Management refer to 26071-100-G01-GHX-00004 Construction Environmental
Control Plan.
Contractor shall provide Environmental Monitoring programs and measurements in accordance

with Environmental Impact Analysis (EIA) of RDMP RU V Balikpapan Project (RKL-RPL).
All project activities of Contractor in RDMP RU V Balikpapan has been included in construction
phase Environmental Impact Analysis (EIA) of Owner. The potential impacts on the environment
of the Contractor activities on this project shall be assessed and stipulated with Owner’s and
Government regulations particularly environmental regulations.
Contractor shall provide Policy, Procedure, and other document in line with Owner’s
environmental management plan and EIA of Owner in construction phase.
The following environmental plan will be developed and implemented during the project by
Contractor:
• Comply with all applicable environmental laws, regulations, rules, and codes governing
environmental requirements.
• Provide all documentation required by all levels of governing authority concerning
environmental requirements.
Provide and maintain effective planning and field control measures for the following activities:
• Wastewater discharges to land, surface water, or groundwater,

• Spill prevention and response
• Erosion and sedimentation control
• Dust Control
• Noise control
• Waste & hazardous waste management
• Comply with EIA, Environmental Management Plan (RKL) & Environmental Monitoring Plan
(RPL).
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HAZARDOUS WASTE MANAGEMENT

Hazardous waste generated on site which meet the hazardous waste criteria are as follow:
• Flammable
• Combustible
• Reactive
• Toxic
• Infectious
• Corrosive
• Poisonous
Contractor shall ensure following requirements are implemented to manage waste of

hazardous chemical:
• Symbol and label shall be affixed on the hazardous chemical waste containers.
• The condition of the hazardous waste container/drum shall be inspected on a daily basis.
• Containers intended for hazardous waste disposal should not be used for other purpose.
• The waste should be kept at a proper temporary hazardous waste storage not more than
90 days.
• The hazardous waste temporary storage should be provided with license/permit from
authorized body.
• Contractor will provide third-party (who have license) to handle medical/clinic waste.
• Transfer of all hazardous wastes to a third-party should be accompanied by
manifest/document hazardous waste. Copies of document hazardous waste should be
maintained.
• Hazardous waste temporary storage shall comply with applied regulation and shall be
equipped with Fire extinguisher, PPE and spill kit equipment.
• Contractor shall provide Safety Data Sheet (SDS) for all waste of hazardous chemicals.
• Contractor will conduct basic waste management training periodically; this training must
be followed by personal who involved with waste of hazardous chemicals.
• Waste such as empty containers or drums with residue of flammable liquid should be
stacked in isolated area away from building and installation. Have notice displayed
forbidding smoking or naked lights. These containers should be thoroughly steam-
cleaned or washed before use.
14. OPERATING PROCEDURES AND SAFETY STANDARDS

ABRASIVE BLASTING
• The Supervisor will ensure the blast cleaning nozzle is equipped with an operating valve
which must be held open manually.
• The Supervisor will ensure the abrasive blasting equipment and the object being blast
cleaned is grounded to eliminate static electricity.
• The Supervisor will ensure appropriate respiratory protection is worn during the blasting
operation.
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• The Supervisor shall ensure the thickness of sand pot in good condition and inspect
periodically.
• No silica-based material will be allowed on site as storage or for use.
• Containment will be maintained at all times including during use, for 100% cleaning and
removal.
ASSURED GROUNDING
• Contractor shall ensure grounding system are provided to protect personnel and
installation against ground fault current, lightning and static discharge.
• Grounding system shall be installed and tested as per the standards.
• Only competence/certified person shall carry out electrical testing activities.
• PPE shall be used during working with electricity.
Contractor provides a written procedure 26071-100-GPP-GHX-00006 Electrical Equipment and

Assured Grounding Procedure for detail.
CAMERAS (SECURITY)
Detail of operational and deployment of CCTV camera is described on 26071-100-G01-GHX-
00003 Security Plan.
To increase surveillance of important and high-risk area within Contractor’s premises,

Contractor has allocated CCTV cameras that operate 24 hours per day, live view, fully recorded,
and can be accessed by authorized users.
CHAIN BLOCKS AND COME-A-LONGS

Refer to 26071-100-GPP-GHX-00011 Crane & Lifting Operation Procedure.
• Chain blocks and Come-a-longs shall have valid test certificate.

• Pre-use check for Chain blocks and Come-a-longs shall be done in daily basis by the rigger.
• Chain block shall never use for tensioning, pulling or anchoring loads.
• Chain block and Come-a-longs shall be inspected every three month and change the colour
code.
• It is prohibited to use rejected or out of service chain blocks and Come-a-longs. In case of
“out of service” for maintenance, chain blocks and Come-a-longs could be used only after
pass the inspection.
CRANE AND LIFTING GEAR REQUIREMENTS

Detailed procedure for crane and lifting refer to document 26071-100-GPP-GHX-00011 Crane
and Lifting Operation Procedure.
14.5.1. CRANE REQUIREMENTS

Contractor will ensure that all cranes used for this project either provided by
Subcontractor and/or directly by Contractor shall have valid certificate from MIGAS.
All cranes shall pass the Contractor’s standard and can only be used after get an
approval from Contractors.
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14.5.2. LIFTING GEAR REQUIREMENTS

All lifting gears will be inspected by qualified inspector from Contractor and have
valid MIGAS certification.
Lifting gears will be inspected regularly by Contractor Inspector and follow the colour
code inspection system.
14.5.3. LIFTING PLAN

Detailed procedure for lifting plan refer to document 26071-100-GPP-GHX-00011
Crane and Lifting Operation Procedure.
Lifting plan will be applicable for critical lifting; non-critical lifting will be required
only the lifting calculation.
Rigging engineer will develop and prepare lifting plan and method statement then
submit to Contractor Sr. Rigging Engineer for review. Lifting plan and method
statement will be attached in PTW. This lifting plan would be submitted at least two
days prior to work execution.
14.5.4. CRANE OPERATOR QUALIFICATION

All crane operator and rigger shall meet the requirements of Contractor’s standard
and mandatory to have valid SIO/ Operator License (Surat Ijin Operator) from MIGAS
which has to be verified by Contractor on originality of the MIGAS SIO by
crosschecking through MIGAS.
COMPRESSED GAS CYLINDERS

The use of compressed gas will follow Manpower Ministry standard (Regulation of Manpower
Ministry No. 37 Year 2016 regarding Pressure Vessel and Storage Tank) in terms of: how to
storage, how to handle, how to transport and use. Compressed gases are stored using the rack
and fastened using chain.
• Contractor must ensure that all gas cylinders are to be labelled to indicate the contents of
the cylinder.
• Flammable and oxygen cylinders shall be fitted with flashback arrestor (adjacent to the
regulator) and reverse flow check valve (at the torch).
• Contractor shall develop an inspection schedule of the gas cylinder.
• All compressed cylinders must be kept clear of oil, grease or other hydrocarbons.
• Cylinders must be inspected for leaks and/or defects prior to use.
• Cylinders must not be exposed to sparks, slag, flame or other heat sources.
• Cylinders must be secured in an upright position during use and storage. They must be
secured by the use of Chain, (never use barricade tape or rope).
• Protective caps must be in place over valve stems when cylinders are in storage or when
not in use.
• Cylinders must not be taken into confined spaces.
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• When cylinders are not in use, oxygen and fuel gas cylinders must be stored separately.
• Storage area for cylinders must be designated with signs stating” Oxygen Full or Empty,”
Acetylene Full or Empty,” etc.
The detail procedure related with welding and cutting activities using compressed gas cylinder
describe in Document No. 26071-100-GPP-GHX-00013 Cutting, Welding and Grinding
Procedure.
CONFINED SPACE
Confined Space means a space which:
• Is not intended as a regular workplace (i.e. continuous employee occupancy)

• Has restricted means of entry or exit;
• Is large enough and so configured that an employee can bodily enter and perform assigned
work and is at atmospheric pressure during occupancy.
• All excavation activities more than 1.5-meter depth
• Has limited air circulation
In addition, this space has at least one of these characteristics:
• It contains or has a potential to contain a hazardous atmosphere;

• It contains material (solid or fluid) that has potential for engulfing an entrant;
• It has an internal configuration such that an entrant could be trapped or asphyxiated by
inwardly converging walls or by a floor which slopes downward and tapers to a smaller
cross-section; or
• It contains any other recognized serious safety or health hazards, for example exposed
rotor blades, noise etc.
• Examples of confined spaces are:
• Process vessels and related equipment (vessel tower skirts and flare stacks), boilers, water
storage tanks, other tanks including pontoons on floating roof tanks, tank cars and trucks;
• Spaces located below ground or deck level, such as drain pits, sewage pits and associated
tunnels, ducts, trenches, wells, shafts, cellars, vaults and unventilated rooms which may be
considered confined spaces under specific circumstances.
Entry into a confined space shall only be contemplated as a last resort, after all other possible
options have been ruled out. Tasks to be carried out in a confined space shall be subject to a
Risk Assessment at the planning stage. If all other options for completing the work without
confined space entry are ruled out, task-specific controls shall be implemented to ensure it is
safe to carry out the work.
Before entering the confined space (sewer, drain, manhole, vessel, tank, or other enclosed area
with restricted entry and exit), workers must be trained and have an Entry into Confined Space
Permit.
Contractor shall identify the position(s) or person(s) responsible to coordinate entry operations
and permitting for the site(s). These people and their responsibilities shall be shown on the
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Confined Space list. As a minimum confined space activity should have these following position
(s) or role (s):
• Authorized entrants.
• Standby Man/Person.
• Authorize Gas Tester.
• Entry Supervisor.
Standby Man/Person responsibilities are:
• To monitor entrants during the job and during entry & exit to ensure their safety.
• The standby person may not abandon his post for any reason while personnel are in the
space. In case he/she need to leave, he/she MUST contact their supervisor/foreman to be
replaced by another trained standby person.
• To control access to the confined space.
• To summon emergency assistance as needed.
• To assess hazards in and around the space, and act on the same.
• To keep records of confined space work, such as air test results, personnel entry/exit.
• Standby person can ONLY watch one confined space at a time and shall have no other
duties.
Authorize Entrants responsibilities are:
• Understand the hazards involved with the job.

• Know the mode, signs and symptoms of exposure to chemicals hazards that could be
present.
• Use the required PPE correctly.
• To inform the standby person when noticing a warning indication of exposure to a hazard.
• Sign the entry log when entering or exiting the confined space.
• Will evacuate the space when any of the following conditions occur:
- An order to evacuate is given by the standby person
- Entrant recognizes a warning indication of hazard exposure
- The evacuation alarm is sounded
• To assure that the space has been adequately ventilated, isolated, emptied, or otherwise
made safe for entry.
• To immediately exit a space, without question, upon word of the standby person, no matter
what the reason.
• To follow all HSE rules and procedures that applies to the job.
All workers involved in confined space entry must be adequately trained to acquire the
understanding, knowledge, and skills necessary for the safe performance of the duties and to
ensure that safe work procedures are followed.
Contractor shall identify the training required to comply with this procedure and provide
training to ensure employees have the necessary understanding, knowledge, and skills to safely
perform Confined Space duties.
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This training as a minimum shall:
• Address safe work practices,

• Address roles and responsibilities of employees,
• Address the use of applicable safety equipment,
• Effectively communicate work conditions within the Confined Space and identified
potential and corrected hazards.
The training shall develop qualified employees and shall be continually improved to address
changes in the Confined Space program.
Confined space categorized as Gas Free/Respirable and Non-Gas Free/Non-Respirable Confined

Space. The conditions under which entry is permitted will depend primarily upon the results of
the atmospheric sampling using the table shown below.
NO Approved Entry Under Gas Approved Entry Under NON-Gas

Free/Respirable Condition Free/NON-Respirable Condition
1 Breathing Apparatus NOT required Breathing Apparatus required
2 OXYGEN: 20% TO 20.9% OXYGEN: <20% OR > 20.9%
3 LEL: <1% AND Toxic vapors ≤ 50% LEL: >1% but <10% AND/OR Toxic
of PEL vapors > 50% of PEL
4 Remarks – (a) Both conditions 2 & 3 Remarks – (a) For Inert conditions -
above must be met for entry without Refer to PTS 60.2110 Working in
BA (b) Typical gas detectors will Inert
provide reading for presence of Space (b) BA must be used if either
Oxygen, Flammables, CO and H2S. condition 2 or 3 is present (c)
Higher
presence of flammables indicates
presence of other gases which may
not
be detected using the typical gas
detector.
Table 5. Requirements for Respirable and Non-Respirable Confined Space
Pre-Entry requirements for Confined Space Entry are as following:
1. Carry out Risk Assessment.
2. Isolation of work area & surrounding.
3. Cleaning, draining, purging (if required).
4. Initial ventilation.
5. Pre-entry atmospheric testing.
6. Continuous ventilation.
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7. PPE & Tools.
8. Rescue Plan (for high risk confined space activity based on Risk Assessment).
9. Permit to Work.
A competent Rescue Team shall be available and on alert for high risk confined space entries
(based on Risk Assessment). Rescue Team members should have ready access to Breathing
Apparatus sets or airlines, harnesses, line rescue and any other equipment necessary for safely
retrieving injured or collapsed personnel from the confined space. The Rescue Team response
time must be considered during the Risk Assessment and Planning stages of the job preparation.
Specific Confined Space procedure with project site condition shall be provided to ensure all
Confined Space activities can be carried out safely.
EXCAVATION AND TRENCHING

Requirements of excavation are as follow:
• Design for excavation > 1.5 m (5 feet) (including protection system) shall be developed by
Civil Engineer.
• Where the trench excavation is benched, the height between benches should not exceed
1.2 m unless designed by a consultant engineer. The overall width of the benched
excavation should not be less than the safe slope.
• Soil and materials must be kept at least 2 m from the edge of the excavation or transport
to another place to avoid landslide.
• For permanent retaining walls, check the overload capacity first.
• Support systems should only be erected, altered or dismantled by competent workmen
under supervision.
• Safe access must be provided into all excavations by means of ladders, ramps or stairs.
• Access ladders or other means of access shall be placed at regular distances (max. 7.5m) so
that workers only have to travel a short distance to escape if there any emergency
situations.
• Access ladders shall be placed at least 1 m protruding over surfaces and must be tied off to
prevent any movements.
• Climbing into or out of excavations using the waling and struts is prohibited. In narrow
trenches use vertical ladders.
• Walkways, bridges or ramps with standard guardrails must be provided where workers or
equipment are required to cross over excavations or trenches.
• At the edges of all excavations where a worker fall could occur ≥ 1.2 m, rigid barriers must
be erected or the excavation covered and clearly visible.
• Particular care is required where the public are required to cross over excavations. In a case
such as a footbridge, rigid hand railing must be provided with appropriate warning signs
advising of the hazards.
• Dewatering is necessary if the water table is less than 0.5m from the bottom of the
intended maximum depth of the excavation (i.e. more than 1.7 m depth)
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• If the excavated pit or trench is deemed to be a Confined Space, the pit / trench shall be
treated as such and all Safe Working in a Confined Space shall be strictly adhered to.
Detailed of Excavation and Trenching refer to 26071-100-GPP-GHX-00024 Excavation and

Trenching Work Procedure.
ELECTRICAL SAFETY
Contractor provides a written procedure 26071-100-GPP-GHX-00006 Electrical Equipment and
Assured Grounding Procedure for detail.
• Contractor will ensure that all electrical tools such as portable tools, hand tools, and other
portable electrical apparatus, meet standard safety requirement.
• Contractor will use Ground Fault Circuit Interrupter (GFCI) and institute assured grounding
program.
• Temporary electrical installation including distribution boards, cabling, and switch gear
shall comply with the current wiring regulations. Hand lights carried into vessels shall not
exceed 12 volts, unless protection is provided by a Ground Fault Circuit Interrupter (GFCI).
• All required tests will be performed prior to first use and/or prior to the equipment is
returned to service following any repairs.
• Colour code standard will refer to Contractor standard in three months basis. Loose lifting
equipment shall be colour coded to indicate compliance with periodic inspection and / or
re-certification. The colour code will be affixed or painted onto the lifting gear.
• The following four colours, blue, orange, green and yellow will be used in rotation.
Colour Code Valid Period
Blue January – March
Orange April – June
Green July – September
Yellow October – December

Table 6. Colour Code Period
• Colour Coding System also will be applicable for:
- Lifting Gear (sling, shackle, etc.)

- Electrical Cable – Contractor will provide inspection tags
- Hand tools
- Powered tools
- Equipment
FIRE PREVENTION AND PROTECTION

Detail of fire prevention and protection is described on 26071-100-GPP-GHX-00005 Fire
Prevention and Protection Procedure.
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• All accidental fire on Contractor property, no matter how small, must be reported
immediately to the HSE Superintendent. The formal report should include all known or
reasonable summarized detail as an additional report may be required by government
agencies.
• The prevention of fires is of utmost importance. Good housekeeping and equipment
maintenance must be followed to keep fire hazards at a minimum.
• Contractor and Subcontractor shall provide gas detector if working in hazardous area, gas
detector that used will be calibrated annually.
• Contractor will conduct Fire Protection Training to employee. Storage and use of
flammable and combustible liquids will be per NFPA 30.
• All fire protection must be collected in designated area that are clearly identified with
appropriate marking. This equipment should be located near likely fire hazard but it must
also be accessible to operating personnel. The number type and location of extinguisher
must meet applicable standard.
• Partially used fire extinguisher must be discharger of pressure, recharged, or replace
immediately.
• All employee should be instructed in the proper use of available firefighting equipment.
14.10.1. FLAMMABLE COMBUSTIBLE LIQUID STORAGE & HANDLING

Following are the requirements for flammable combustible liquid storage:
• Since vaporization (the formation of vapor) increases when the temperature

is raised or when these liquids are more exposed to the air it is essential that
they are stored in a relatively cool place and in closed tanks, drums or cans.
Open containers should never be used for storing flammable and combustible
liquids.
• Storage in the open - in field conditions drums should be placed so that they
are not exposed to the direct rays of the sun, or any other source of heat.
• The storage area should have a warning sign clearly displayed indicating that
flammable and combustible liquids are stored there and that no smoking or
naked lights are permitted.
• A shallow trench or dike should be constructed around the storage area to
prevent any spillage or vapor spreading to lower ground areas where they
might contact a source of ignition and cause a flashback fire.
• The storage area must be at least 50 feet from any ignition source (e.g. open
fire, workshop area where grinding tools, or flame cutting equipment is used).
• Storage indoors - ideally, storage of flammable and combustible liquids should
be in a separate isolated building. If this is not possible, they should be stored
in a special room with fire resistant walls, doors, ceilings and floors.
• The storage indoor should be protected with an automatic fire-protection
system (sprinklers, foam, and carbon dioxide). The room should be well
ventilated, be equipped with explosion proof lighting and electrical fixtures
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and have a warning sign at the entrance indicating that no smoking or naked
lights are permitted.
• Any storage area, whether in the open or indoors, should have a portable fire
extinguisher (approved for Class B fires) available outside the entrance. This
extinguisher may be of the foam type, carbon dioxide type, dry chemical type
of liquefied gas (halon) type. Personnel must be trained in the use of the
extinguisher.
During flammable liquids are transferred from one container to another, there is a
possibility of static electricity build-up which is a dangerous ignition source. To
prevent build-up of static electricity, following requirements are required during
handling of flammable liquids:
• Flammable liquids storage shall be provided with grounding (earthing) and

bonding facility. This is to minimize potency of build-up static electricity during
transfer of flammable liquids.
• Grounding facility for storage must be periodically tested to ensure it is still
working properly.
• Safety glasses, protective gloves and long sleeves uniform should be worn if
there is any chance of skin contact. Liquids should be washed from the skin
with non-abrasive soap or hand cleaner. It is recommended to provide safety
shower facilities and/or proper water supply near to storage area.
• The liquids should be used only in well ventilated areas to avoid breathing
vapours and fumes. If ventilation is not possible (e.g. in confined spaces) an
approved respirator must be worn.
If any personnel are splashed with a harmful or burning liquid, they must be taken
to a source of running water immediately and the splashed area should be flushed
with water for at least 15 minutes. Contaminated clothing should be removed and
medical attention sought immediately.
14.10.2. SMOKING AREA

It is prohibited to have smoking shelter and do smoking in brownfield area. At
greenfield area, only when approved by the Kepala Teknik of Project RDMP RU V
Balikpapan, Contractor will provide smoking shelter with requirements as follow:
• Smoking shelter should not be near to:
- Live existing pipe line

- Gas Processing Plant
- Sewer
- Oil Catcher area
• Smoking shelter should be located in open area.

• Dimension of smoking shelter 5x5 m2 with approved design. It is
recommended to provide roof for the smoking shelter.
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• Smoking shelter wall may provide however it should not fully close until the
roof. This is to ensure proper ventilation will be achieved and to prevent
flammable gas accumulation inside smoking shelter.
• Contractor must provide sufficient number of fire extinguisher at smoking
shelter.
• Minimum distance 100 m from process facility, pipe line, server, oil catcher.
• Smoking sign will be put at place.
• However, if any indication of hydrocarbon leaking, smoking will be prohibited
in smoking shelter area. Smoking sign will be replaced with No Smoking sign.
• Smoking shelter should be kept clean and tidy at any time. Contractor must
provide proper bins and periodically pick up smoking shelter rubbish. Treated
and dumped as waste.
• There will be one lighter provided on the shelter and it will be secured by
security personnel.
• This smoking shelter will be monitored by security personnel which must
standby there.
• Contractor must conduct periodical inspection of smoking shelter to ensure
the safety condition of this shelter.
14.10.3. MOBILE CELL PHONE

It is prohibited to bring and use mobile phone at brownfield area. At greenfield
area, Contractor may bring and use mobile phone only if get approval from the
Kepala Teknik of Project RDMP RU V Balikpapan.
In case approved by the Kepala Teknik of Project RDMP RU V Balikpapan, strict

control of mobile phone shall be taken to prevent mobile phone moving from
greenfield to brownfield area. Following requirements shall be implemented as
control measures:
• Perimeter/boundary of brownfield area shall protect with proper fence to

limit the access to brownfield area.
• Contractor must provide security gate with security personnel on each access
to brownfield area.
• Security personnel must standby at security gate and do screening to
everyone with intention to go to inside the brownfield area. During this
screening mobile phone must be surrendered to security in power off mode.
Furthermore, the mobile phone will be kept at dedicated place under security
control.
• Mobile phone will be returned back to the owner of mobile phone once
he/she left the brownfield area. To ensure the phone owner could get his/her
phone back, he/she must leave the brownfield through the same security gate
when he/she entering the brownfield area.
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• It is recommended to provide effective identification method for each of

mobile phone kept by security. E.g. using ID number for mobile phone,
registration in log book, etc.
14.10.4. FIRE EXTINGUISHER AND FIRE WATCHER

• Fire extinguisher shall be inspected every month by HSE.
• Seal and Pin shall in place and not broken.
• Pressure Gauge is showing in the green acceptable levels.
• Hose on the extinguisher is not dry rotted or cracked.
• Check the body of the extinguisher are free from defects and corrosions.
• Work supervisor and Fire watcher are responsible to maintain the conditions
and requirements listed on the Hot Work permit.
• Work supervisor and Fire watcher must Stop the job if observe any condition
that you consider being hazardous.
• The fire watcher shall have no other duties. Do not leave the jobsite while
welding or spark-producing operations are in progress. If other duties
required to leave the jobsite, he/she must first stop the job.
• The fire watcher shall be provided with a Florescent Vest, and a 20lb. fire
extinguisher. If the fire extinguisher has been discharged, return it to the tool
room for replacement.
• The fire watcher shall continually survey the work area for combustible
materials.
• More than one fire watcher may be required depending on potential impact
on other areas, such as floors below the hot work activity.
• If there is a fire that the fire watcher cannot extinguish quickly and safely, the
emergency notification and evacuation shall be activated.
• A Fire Watcher shall remain in the area for 30 minutes after the Hot Work is
completed. He/she must ensure there is no potential of fire could happen at
his/her working area.
FALL PREVENTION / PROTECTION

• Working ≥ 1.8m is mandatory to use safety full body harness complete with double
lanyard.
• Shock absorber will be required to be attached to the full body harness by consider the
potential fall distance (with 3 ft safety factors). Below the picture illustration for the
calculation of potential fall distance.
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Figure 5. Calculation for Potential Fall Distance
• Workers who working above 10m should check by site paramedic to ensure the fitness’s
of workers (blood pressure, height consultation & others check) before commence the
works.
• Working at heights will not be permitted without supervision from authorized persons.
• When required a permit to work shall be issued under the authorization of Construction
Manager.
• Verification of job completion will be done by Project HSE Manager/ HSE Chief/ Site Safety
Superintendent.
FLOOR AND WALL OPENING

If openings are made in walls on overhead floors or if openings are created in floors and/or
walking surfaces of overhead structures, or if handrails are removed, the following
precautions must be taken:
• Barricade tape can be used to warn of the hazard as long as personnel working on the
opening/hole attend the opening/hole.
• Permanent and temporary floor openings must have warning tags and standard guard
railing.
• Grating Removal permit shall be obtained prior to removing (for any reason) any
permanent or temporary floor openings (Grating, Checker Plate, Floor Plate, Stair Tread
or any Temporary Hole Cover) or standard guardrail, handrail system.
• Grating Removal permits shall be issued after visual inspection to the openings and assure
that the proper precautions have been taken.
• Floor holes into which persons can accidentally walk must be guarded by either a
standard railing with standard toe-boards on all exposed sides, or a floor hole cover of a
minimum 3/4” plywood if one dimension is 18” or less; otherwise 2” lumber is required.
The covering shall be secured against accidental displacement and clearly labelled “Floor
Opening — Do Not Remove”. At any time DO NOT leaving open holes without covering.
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HEAVY MOBILE EQUIPMENT

All heavy mobile equipment used at worksites must be roadworthy and registered with the
appropriate authority, as per following table:
NO EQUIPMENT CERTIFICATION
1 Crane MIGAS / OIL & GAS (Government agency)
2 Truck Mounted Crane (TMC) MIGAS / OIL & GAS (Government agency)
3 Sky Lift MIGAS / OIL & GAS (Government agency)
4 Forklift MIGAS / OIL & GAS (Government agency)
5 Gondola MIGAS / OIL & GAS (Government agency)
6 Excavator DEPNAKER / MINISTRY OF MANPOWER
7 Dozer DEPNAKER / MINISTRY OF MANPOWER
8 Grader DEPNAKER / MINISTRY OF MANPOWER
9 Genset >200 KVA DEPNAKER / MINISTRY OF MANPOWER
10 Lifting gear such as webbing sling, chain, block, THIRD PARTIES
shackle, etc.
Table 7. List of Required Authority to Certify Heavy Mobile Equipment
• Vehicles shall not be older than 5 years for light vehicles and 10 years for trucks and
another heavy vehicle.
• All vehicles and heavy equipment’s must have reverse alarm installed.
• Contractor shall ensure that all vehicle drivers and heavy equipment operators are fit to
work and shall have a valid license for driving and/or operating issued by Government or
authorized institution.
• All heavy mobile equipment and vehicles must be in a safe operating condition at all
times. They are to be checked at the beginning of each shift. All heavy mobile equipment
and vehicles shall be attached by fire extinguisher, first aid equipment, seat belt and
flame/spark arrestor.
• The number of passengers of vehicles or equipment’s must follow the availability of seat
belt and it is prohibited to utilize the bed of truck and/or vehicles for passengers.
• Inspection to all heavy mobile equipment and vehicles will be done regularly. Inspection
Sticker will be attached to the heavy mobile equipment and vehicles after pass the
Inspection. With this sticker, equipment’s and/or vehicles permitted to be used at
greenfield and brownfield area.
• All heavy mobile equipment and vehicles to be used at RDMP JO will be manage to be
complied with RDMP JO Inspection procedure No. 26071-100-GPP-GHX-00026
Preventive Maintenance and Inspection Plant.
HAZARDOUS CHEMICAL HANDLING

Contractor will ensure that all substances classified as hazardous to health, which are
transported, used or created during activities, are controlled to minimise the risk to the health
and to the environment.
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• The list of Chemical and Hazardous Materials to be used shall be available including Safety
Data Sheet (SDS).
• Required PPE as mention in SDS shall be used during handling with the chemicals.
• Required equipment and tools as mention in SDS to control any accidental release of
hazardous chemicals shall be provided.
• Before beginning a task where a hazardous substance is to be used, the risks, the
precautionary measures to be taken and the actions to be taken in the event of a spillage
(if applicable) or injury will be explained during the Pre-Job Safety Meeting (PJSM).
• It is recommended to use less harmful substances to minimise the risk to health and to
the environment.
• Only trained personnel should handle hazardous materials using the precautionary
measure that have to be taken, as instructed in the SDS.
• Used containers of hazardous substances/chemical will be disposed of as hazardous
waste.
• Hazardous chemicals will be disposed as per the instructions available in the SDS. Never
litter, or scatter used/empty chemical containers or used it for other storage purpose or
handling as it may be harmful to life and environment.
• Contractor must provide adequate eye-wash, shower and first aid boxes with medicines
at locations were hazardous chemicals are stored and handled, if deemed necessary.
Also, to ensure that it is well maintained and inspected regularly for defects or
malfunctioning.
• Employees are to be given information with regards to working with hazardous
substances and use and maintenance of applicable PPE. At minimum this shall be given
as part of the individuals Induction Training.
Storage of Hazardous Substances/Chemical shall consider following requirements:
• All chemicals containers must be labelled.

• Contractors shall ensure that adequate storage cabinets/ store rooms are available for
the proper segregation and storage of different types of hazardous substances/
chemicals.
• Incompatible chemicals shall be stored separately.
• Hazardous substance storage areas are to be identified with the correct signage,
indicating contents of the storage area and ‘No Smoking’ signs.
• Spill kits shall be provided where hazardous substances are being stored or used.
• Hazardous substance storage areas will be well ventilated and kept in hygienic manner
at time.
• Appropriate portable fire extinguishers and safety shower shall be provided at the
storage facilities and employees will be trained to use them effectively during an incident
with hazardous substances/chemical.
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HYDROGEN SULFIDE (H2S)

• Contractor shall provide H2S Gas Detector to monitor the presence of H2S.
• Where H2S exists in concentrations greater than 10 ppm, employee protection shall be
ensured through following control:
- Engineering controls (ventilation, automatic tank gauging, etc.).
- A Hazard Assessment of the work to be performed including knowledge of the level
of hydrogen sulphide which may be encountered.
- An evaluation of the work area focusing on a means for egress, with respect to
conditions which may affect vapor migration, such as wind direction and speed.
- Use of a continuous personal monitor, that will provide an alarm when H2S
concentrations reach 10 ppm. The monitor shall be worn in the breathing zone.
- Supplied-air respirators shall be used
• Where H2S exposures exceed the IDLH level (100 ppm) or where H2S exposures are
unknown, SCBA’s or airline respirators that include escape provisions shall be used. In
addition, a standby person equipped with a SCBA and prepared to initiate rescue shall be
provided. Airline respirators are not approved for rescue from H2S atmospheres.
• Area with potential exposure of H2S shall be barricaded and informed with proper safety
sign.
• Contractor shall establish Emergency Response Procedure for H2S exposure.
• Contractor shall ensure that employee understand the hazards of H2S and know how to
response with H2S exposure.
HAND AND POWER TOOLS

• A portable hand and power tools shall be inspected prior to use. Contractor site
management shall ensure that all tools are maintained in a safe condition and used in a
safe manner by all personnel.
• Defective tools must be removed from service until repaired or replaced.
• Site Supervisor must ensure that workers understand how to use the tools correctly and
care about other workers.
• Machine Guarding must be checked to ensure that it can be operated effectively.
• Guards and safe protection of the devices must remain in place and in operable condition
on all tools. Wooden handles on tools must be free of cracks or other defects. Tape or
other coverings that will hide defects are not to be placed on these handles.
• The colour code must be posted on the device to determine the condition of the
equipment (Good or Not Good).
• Damaged or defects tools should not be used and removed from site. Re-inspection
should be done for these tools after repair.
• Daily checks shall be done by tools user to ensure that tools is in good condition and safe.
• Always use appropriate tools for every job. Do not use improvised or modified tools.
• Non-spark, explosion proof or intrinsically safe tools are mandatory to be used at several
hazardous or flammable area.
• Impact surfaces of tools including, but not limited to, hammers, wrenches, drift pins,
chisels must be kept free of mushroomed heads.
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LADDER USE AND INSPECTION

Access ladders or other means of access shall be placed at regular distances (max. 7.5m) so
that workers only have to travel a short distance to escape if there any emergency situations.
Access ladders shall be placed at least 1 m protruding over surfaces and must be tied off to
prevent any movements.
Contractor shall ensure to maintain portable ladders in safe condition. Ladders with the
following defects shall not be used, and shall either be tagged as unusable if kept on board, or
shall be removed from the site:
• Broken, split or missing rungs, cleats or steps;

• Broken or split side rails;
• Missing or loose bolts, rivets or fastenings;
• Defective ropes; or
• Any other structural defect.
Ladders shall be inspected for defects before each day's use, and after any occurrence, such
as a fall, which could damage the ladder.
Contractor will conduct a portable equipment inspection program for portable construction
equipment used in the work, including portable ladders. Inspection Schedule will be:
• Before mobilization to project site

• Upon delivery to site
• Daily at site (by user)
• Management joint safety patrol (Weekly)
• General inspection / internal audit (Monthly)
Frame ladders are possible to be used only with following criteria:
• No defects or structural damages.

• Only use ladders for their designed purpose and load capacity.
• Cannot use ladders near to power lines or electrical equipment’s.
• Maintain 3-point contact when climbing/descending ladders.
• Use barricade to keep traffic away from the ladder.
• Only put ladder on a stable and level surface that is not slippery.
• Implement buddy system when working with ladder.
• Cannot use ladder horizontally like a platform.
LOCK OUT / TAG OUT – ENERGY ISOLATION

• LOTO system shall implement before performing repairs, adjustment of electrical,
pneumatic, hydraulic, thermal, gravity and radiations equipment.
• Personal Danger Tag tagging and padlocked (Red colour) will be used for equipment that
is being repaired by someone.
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Figure 6. Lock, Tag and HASP for LOTO
Out of Service Tags (yellow colour) shall be attached to faulty equipment or out of service
equipment and shall be left attached until the equipment is repaired and ready for use.
Figure 7. Out of Service Tag
Detail of LOTO procedure is described on document 26071-100-GPP-GHX-00010 Lock Out and

Tag Out (LOTO) Procedure.
PERSONAL PROTECTIVE EQUIPMENT (PPE)

PPE mandatory is safety helmet with chin strap, clear safety glasses or goggle, ear plug,
coverall with high visibility reflector, and safety shoes. Employer also shall provide their
workers with others compulsory hand gloves PPE especially when working at height for
example. Inherent hazard when working at height and during night time could results in
unwanted fatal incident.
All personnel who work in RDMP project must be worn mandatory PPE. The standard PPE that
must be worn are:
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TYPE OF PPE STANDARDS

Head protection All head protection with chinstrap shall meet requirements set out in EN
397, ANSI Z89.1 – 2003
Colour requirements of safety helmet
Contractor’s Supervisor and above: White colour
Sub-contractor helmet: Yellow colour
Contractor & Sub-contractor HSE Personal: Red colour
Eye and face protection All eye and face protection shall meet the requirements set out
in EN 166, ANSI Z87.1 – 2003
Respiratory protection All respiratory protection shall meet the requirements set out in ANSI
Z88.2 – 1992, filter respirator set out in BS EN 4275, 1997;
Airline mask BS EN 139, 1995; Self Contained Breathing Apparatus
(SCBA) BS EN 137, 1993
Hearing protection All hearing protection shall meet the requirements set out in ANSI S3.19
– 1974, all type of hearing protective shall be used
appropriately depend on noise level to protect noisy as state limit
Hand protection All hand protection shall meet the requirements set out in BS
EN 420:2003 + A1 2009 and Super Duty gloves for specific activity
Body protection One-piece coverall (grey colour) with Contractor name and personnel
name
Foot protection All foot protection shall meet the requirements set out in BS EN
345, 1993 ANSI Z.41
Fall protection All fall protection shall meet the requirements refer to ANSI
A10.14
Table 8. Personal Protective Equipment (PPE) Standard
PNEUMATIC TOOLS
Pneumatic tools include Chippers, Drills, Hammers, and Sanders. Pneumatic power tools shall
be secured by proper clamps and whip checks.
In addition to mandatory PPE, eye protection (goggles) or a face shield (with safety glasses or
goggles), and hearing protection are required for working with pneumatic tools.
Pneumatic tools may be used only by employees who are properly instructed and familiar
with these tools.
Employees must follow safe practices for operating pneumatic tools, including the following:
• Before assembling the system, check all hoses for cuts, breaks, and loose connections.
• Blow out all hoses before hooking up the equipment. If the connector has a rubber seal.
Remove it before (and replace it after) blowing.
• When possible, run air lines through areas with little traffic. If possible, avoid laying lines
across roads. Protect air lines or hoses against trucks and pedestrians either by building
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runways over the hose or suspending the hose overhead with the lowest part of the hose
at least 7 feet (2 meters) above the ground.
• Tighten hammer-joint connections with a hammer. Do not tighten them by hand. Hoses
equipped with special connections require special tightening techniques or equipment.
One example is hammer-union connections, which must be tightened with a hammer.
Another example is spanner-wrench connections, who must be tightened with a spanner
wrench. Do not tighten these connections by hand.
• Do not turn on air valves until the hose connections are secure.
• Do not point an open-air hose at anyone.
• Compressed air shall not be used for cleaning purposes except where reduced to less
than 30 psi, and then only with effective chip guarding and proper personal protective
equipment.
• Unless the equipment has quick change connectors (with internal check valves), shut off
the air at the air supply valve ahead of the hose before breaking the connection.
PEDESTAL, BENCH AND PORTABLE GRINDERS

Machinery, such as grinders or buffers, must be secured to a work bench or pedestal and the
bench or pedestal, in turn, must be secured to the floor to prevent walking or moving.
Pedestal or bench mounted grinders shall have an emergency stop button and be fitted with
a properly adjusted tool rest. Pedestal grinders must be securely fixed to the floor to prevent
them from walking when in operation.
Detail is described in 26071-100-GPP-GHX-00013 Cutting, Welding and Grinding Procedure.
FALLING OBJECTS PROTECTION

The most effective way to eliminate/minimize the potential personnel exposure to falling
tools, materials and/or debris is to never allow employees to work and walk below others in
that are working at an elevated work area.
• Whenever possible, to secure below area of an elevated work location with barricade.
• Tools, equipment, material, etc., will be kept and arranged in an orderly manner and good
housekeeping will be practiced throughout the work day.
• Controlling/restricting the amount of material taken to the elevated work areas; only
stage/store what is needed to perform the task.
• Minimize hand carrying or handing material from person to person by hands.
• Use racks, baskets, containers, etc. to raise tools and materials.
• “Bundles” of long materials, such as scaffold tubes, will be banded together, rigged with
a minimum of two chokers/slings and will be kept horizontal.
• Loose material should be properly secured to prevent effect of wind.
• Scaffolding and work platforms shall require toe boards around the edge.
• Tools and equipment will be stored in appropriate containers/boxes to prevent dropped
objects.
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• Hot Work will not be performed overhead in areas where the potential for hot slags,
sparks or molten metal to contact employees working below without covering by fire
blanket or other similar protections.
• Tools, materials, will never be placed or stored on beams, pipes, valves unless they are
secured.
• Proper tool holsters shall be used when working at height/elevated area.
SITE OFFICE, STORES, WORKSHOPS, LIVING ACCOMODATION AND CANTEEN

FACILITIES
Contractor must ensure that site office, stores, workshop, accommodation block and canteens
are designed in manner which prevents injury, damage or loss.
• All such facilities shall contain adequate number of suitable fire extinguisher. Contractors
must conduct periodical inspection to ensure fire extinguisher and others emergency
equipment maintained in good condition.
• Each facility shall have evacuation procedure posted at regular interval throughout. Shall
ensure that the facility evacuation procedures remain in clear view to all.
• All facility occupants shall be made aware of the evacuation procedures and the relevant
assembly/muster points for that facility.
• Lightning protection shall be provided to all such facilities. The electrical installation of
such facilities shall be approved standard and comply with the Contractor’s policy on
electrical installation.
• All emergency exits, shall be clearly marked by an A4 sized poster/notice. All emergency
exits shall remain free from obstruction at all time. Any obstruction found shall be
removed immediately.
• At no time will rubbish, refuse and combustible materials be permitted to accumulate
within any facility. All rubbish, refuse and combustible shall be removed from yard to a
designated tipping area. Open burning of rubbish, refuse and combustible material
generated by such facilities will not be permitted at any location within project boundary.
• Contractor shall provide adequate number of rubbishes, refuse and combustible
materials bins.
• Contractor shall provide all the facilities with adequate ventilation and lighting to prevent
injury or damage.
• All facilities must be kept clean and tidy at all time. Any spillage shall be cleaned
immediately.
• Contractor will provide Prayer room located at field and office area. Design and number
of Prayer room will be decided based on need at site. The Prayer room will be provided
with sufficient water for ablution tap and toilet. Cleanliness, hygiene and tap condition
must be maintained in good condition.
• Contractor must provide safe and adequate transport to pick up people from living
accommodation to the working area and vice versa.
• Contractor shall provide proper and adequate number of toilet and sanitation system.
• Contractor shall ensure the cleanliness and waste management in accordance with the
national regulation.
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14.23.1. WORKSHOP FACILITIES

Prior to any site workshop becoming operational, risk assessment shall be
completed and all related personnel shall have addressed the following items:
• All equipment used shall be maintained in a safe working condition.

• Any cranes or lifting devices used have been certified by a recognized
authority and shall clearly state their Safe Working Load.
• The lifting of heavy plant and equipment, by the use of the hydraulically
operated plant, i.e. Excavators or pay loaders, shall be prohibited.
• Adequate and suitable fire extinguishers shall be provided throughout, with
additional extinguishers being provided around hot work areas such as
welding/burning areas.
• Adequate screens shall be placed around hot work areas to prevent eye flash.
• All personnel working within the workshops are mandatory to follow PPE
requirements.
• All generators shall be properly earthed.
• All electric within the site workshop shall be fused correctly.
• Guards shall be fitted stored in upright drums. The drums shall be stored in an
orderly manner and shall be clearly marked to show their contents. Additional
fire extinguisher shall be located adjacent to lubricant storage areas.
• Used lubricants and oils shall be disposed of at an approved temporary waste
storage area. All spillage shall be cleaned up immediately.
• All used batteries, containing acids, shall be stored in an upright position and
shall be removed to temporary waste storage as soon as possible.
• The workshop facility shall be maintained in safe working condition at all times
14.23.2. LIVING ACCOMODATION

Contractor shall ensure that all accommodation blocks shall be provided with an
adequate number of suitable fire extinguishers and that adequate lighting and
ventilation is provided. Fire Exits shall be indicated as mentioned above.
Evacuation procedures shall be advised to all personnel living/sleeping within the

blocks.
Such accommodation blocks shall be erected as far away from the permanent
works as possible.
Contractor must provide safe and adequate transport to pick up people from living
accommodation to the working area and vice versa.
14.23.3. ABLUTION FACILITIES

Contractor will ensure that all site ablution facilities are designed, constricted and
operated in accordance with all statutory regulations. All such facilities shall be
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maintained in a clean condition, at all times. Any defects found within the system
shall be rectified immediately
The user of each site ablution facilities shall discharge into a suitable designed
septic tank and soak way arrangement. All septic tank shall be designed to meet
demands from all site conditions. If at any time, septic tanks are found to be full or
overflowing they shall be pumped into a suitable tanker, immediately. The
resultant effluent shall be disposed of at an approved facility.
14.23.4. CANTEEN FACILITIES

Contractor must ensure that canteen facilities shall be maintained in a sanitary and
safe working condition at all time.
All Pressure Gas Cylinder (LPG) containers shall be stored outside the buildings,
except when in use.
Fly mesh shall be used at all window locations in an attempt to keep insects away
from the food preparation areas and the displayed food.
Food preparation areas shall be cleaned before and after each mealtime.
SIGNAGE & BARRICADES

Barricades Refer to 26071-100-GPP-GHX-00017 Barricading and Signboard Procedure.
• The boundaries of critical work areas, excavation and others hazard must be clearly
delineated by visible barricade and signage.
• Hazard signage shall be posted in conspicuous place to warn workers about any hazard
that is present in the surrounding areas.
• Contractor shall ensure that employees understand with safety sign, colour coding and
barricade.
• Signage shall be well illuminated so that it could serve its purpose. Broken signage shall
be replaced immediately and maintenance of all hazard signage shall be performed
accordingly.
• Excavation and floor openings shall be barricaded with hard barricades instead of
barricade tape.
SCAFFOLDING
Detail procedure for scaffolding refers to document 26071-100-GPP-GHX-00021 Scaffolding
Procedure.
• Installation, modification, and demolition of scaffolding shall be done by competent

persons (as common, in a team at least one person as a certified Scaffolder) and inspected
by certified Scaffolding Inspector (MIGAS Certificate)
• Employees shall not access scaffolds that have not been inspected and properly tagged.
• The standard of scaffolding that must be following: OSHA standard with material of the
frame scaffolding must be galvanized.
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• Work platforms must be equipped with standard guardrails, mid-rails and toe boards.
• Drop bars must be installed on all scaffolding deck/platform.
• Detail of scaffolding pipe specification and materials shall be followed Construction
Execution Plan (CEP) and in accordance with Contract.
• The uses of frame scaffolding for working at height platform are strictly prohibited.
• Movement of materials, tools, equipment, etc. to higher or lower levels will be affected
by hand line or hoist apparatus.
• Open sides and ends of platform 6 feet (1.8 meters) or more above will be guarded by
top rails, mid rails and toe boards with the top railing 42 inches (1.1 meters) above the
platform levels.
• Scaffolds must be erected plumb and on a solid foundation. Loose bricks, boxes, concrete
block, scrap lumber, etc. must not be used to level or support scaffolds or planks.
• All scaffolds must have an inspection tag placed at the point of access/egress by a
competent person.
• Employees, materials and tools must not ride on mobile scaffolds.
SIMOPS
SIMOPS is define as execution of 2 or more operations with potential interaction that could
lead to an increase of risk or introduction of new hazards to each other’s.
SIMOPS procedure and SIMOPS matrix should be established as a guideline to identify and
manage simultaneous activities. Construction will provide the SIMOPS procedure and SIMOPS
matrix with the participation of HSE and other required discipline.
Where there are major interfaces between Contractor, Sub-contractors and Operations, these
shall be managed by the Construction Management representative to ensure agreement and
clarity on SIMOPS.
Contractor need to arrange following but not limited to this meeting:
• 30 day and 90 day look ahead meeting.

• Daily plan of the day meeting: attended by discipline Superintendents/Supervisor, HSE,
Permit Coordinator and Project control teams.
• Meeting to coordinate and prioritize simultaneous activities.
WELDING. CUTTING & GRINDING

The detail procedure for welding, cutting & grinding describe in Document No. 26071-100-
GPP-GHX-00013 Cutting, Welding and Grinding Procedure.
Cutting Welding and Grinding or other flame or spark producing works are activities include
in hot work. All hot work activity shall be performed with hot work permit and job safety
analysis.
Hot work area shall be safe from flammable or explosive gases. Gas test shall be performed
before the job and continuously monitored until the job is completed.
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Area within 10-11 meter from hot work shall be free from combustible material such as dry
woods, rubbish, fuel, and chemicals.
All personnel that perform cutting, welding, and grinding, including welder, fitter, and helper
shall be properly trained.
WORK PERMIT PROCEDURE

Contractor will use Work Permit system for any activities consider as High Risk at green field
to comply with Regulation of Indonesian Government No. 50 / 2012 regardigng
Implementation of Occupational Health and Safety Management System Law No. 1/1970,
which mentioned to establish Work Permit for High Risk activities. Also, Regulation of
Indonesian Government No. 11/1979 regarding Work Safety at MIGAS Refinery, which
mentioned any specific Hot Work activities and conducted at hazardous area shall get written
permission from “Kepala Teknik” (Technical Manager).
At green field area, most of the routine and not high-risk activities will use general work permit
with area/discipline wise, however JSA will use activity wise and shall attached to the PTW.
The details of the Contractor Work Permit System for Green Field area will be described on
document 26071-100-GPP-GHX-00001 Work Permit Procedure.
If required, during pre-commissioning and commissioning (including start up and performance

test) phases, permit to work system will be modified / adjusted to the work conditions
(especially associated with specific hazards when conducting pre-commissioning and/ or
commissioning activities).
Contractor activities carried out at brownfield area will follow the Pertamina SIKA procedure
No. A-005/E15500/2016-S9.
15. TRAINING AND COMPETENCY

Contractor will provide Training Coordinators to administer all training requirement of
Contractor’s and subcontractor’s personnel.
Refer to 26071-100-GPP-GHX-00004 HSE Training Procedure. There are 26 topics of HSE

Trainings and will be delivered at project site regularly.
HSE TRAINING REQUIREMENTS

Following are HSE Training general requirements:
• Contractor must ensure all workers are competent for the job assigned and completed the
training programs as per Training Matrix.
• Contractor’s Trainer are responsible to maintain the Training Program as per Training
Matrix (refer to Attachment 2.HSE Training Matrix).
• Training schedule shall be developed to ensure it complies with the minimum requirement
and in line with the construction stage (schedule).
• Training shall be conducted at classroom or practice.
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• Contractor must submit the HSE Training material to PMC for their review and approval, in
order to have alignment with Owner’s regulation.
• All training material shall be provided in dual languages which are English and Indonesia.
IIF® PROGRAMS
Incident Injury Free (IIF) programs is a commitment-based approach to addressing safety issues.
This approach has been known to transform work cultures, leading to improved relationships,
improved communication and improved safety numbers.
Basic principle of IIF program is “the relationship is the foundation of the accomplishment”, in
which the more the relationship between employees are strengthened, and the better results
can be achieved. This concept is conveyed to the individual employee via IIF orientation
programs, which also provides training for the frontline supervisors, since frontline supervisors
are strategically the key players of the programs.
The purpose of IIF is prevent harm to plant, environment and people. The focus of IIF program
is on leadership and culture. To measure the effectiveness of IIF program will be as following:
1. IIF Leadership Team Members Participation:

Monthly participation on IIF Site walk throughs and meetings to demonstrate visible,
proactive safety leadership.
2. Listening Tour Action Items:
The number of “Closed” Action Items identified on Site walk-throughs. These
demonstrate management commitment and follow-through to rectifying site safety
concerns and hazards. This builds credibility and trust.
3. IIF Orientation Participation:
Track the number of workers participating in the IIF Orientation with a goal of 100%.
Typically combine IIF Orientation delivery with the project site induction.
4. Supervisors Trained in IIF Skills:
Track the number of supervisors participating in the IIF Supervisor Skills Training with
a goal of 100%.
5. TBT Quality Improvement metrics:
One focus of the IIF Supervisor Skill training is high-quality Tool Box Talks. An outcome
of the program is five specific areas to track and improve TBT metrics, including focus
on specific hazards, worker engagement and more.
6. Active IIF Champions:
The ratio of IIF champion per number of workers shall be decided with the
consideration of effective relation with the workers. Champions are volunteers from
the Contractor and Sub-contractor workforce who encourage and drive IIF actions in
their crews.
7. IIF Pulse Surveys:
IIF Pulse Surveys are an assessment tool for acquiring input, feedback and perceptions
from project team to establish new baselines on progress towards an IIF culture. IIF
pulse survey measurements will be:
• Trending of responses
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•Action items logged and closed

•Track cultural development from “Reactive to Legislative to Proactive to
Generative”.
8. e-COP observations achieved weekly or monthly.
To achieve the target and maintain the focus of IIF, following programs shall be delivered:
1. IIF Program kick-off meeting

2. IIF pulse survey
3. IIF commitment workshop
4. Supervising IIF in action (Train the Trainer)
5. IIF orientation (Train the Trainer)
6. IIF Champions program
7. IIF leadership team and monthly meeting
8. Quarterly on-site coaching
COMPETENCY
Contractor develop HSE Training Matrix based on required HSE competencies for each Job Task
at project site. Refer to Attachment 2. HSE Training Matrix for the detail.
To increase personnel awareness on working safely, Construction Manager with HSE Manager
are responsible to ensure that all personnel have completed all training required as per Training
Matrix.
Special skills/competency required for a specific job shall be certified by government

(Migas/Depnaker). E.g. Scaffolding, Crane Operator, Rigger, etc. In House (at site) training
deliver by Contractor in accordance with this special skills/competency only for refreshment
purpose.
TRAINING RECORD AND TRACKING METHOD

Following are Training record which shall be documented and made available for auditing
purpose:
• Training attendance record.

• Database of employees training record. Include a record to verify all personnel who have
successfully completed the training.
• Training assessment.
• Approved Training material.
Training Sticker will be given to the participant who pass the assessment and this sticker must
be attached to their helmets. Database of employees training record shall be maintained and
used to track employee’s compliance to follow the required training.
TRAINING PROVIDER
• Since contractor will have activities at brownfield area, Owner will conduct in house
training for transfer knowledge of HSE system and requirements to Contractor.
• Contractor have responsibilities to deliver required HSE Training at project site.
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• Incident Injury Free (IIF®) Orientation is delivered by licensed third party and/or
Contractor’s HSE Trainer which hold Training of Trainer (TOT) for IIF® and
authorize/certified by licensed third party (JMJ) to conduct IIF® Training.
• Others than IIF® Orientation will be delivered by Contractor’s Competence HSE Trainer
which hold Training of Trainer (TOT).
TRAINING KEY PERFORMANCE INDICATOR (KPI)

Contractor’s Weekly Report contain Key Performance Indicator (KPI) related to training.
Progress against these KPI’s will be reported by weekly to PMC.
CONTRACTOR INTERNAL TRAINER

Contractor shall provide qualified trainers.
• All Contractor’s HSE Trainer must Certified as Training of Trainer (TOT).

• Contractor will hire certified person to be assigned as HSE Trainer for the special
skills/competencies required training. i.e. Rigger, Crane Operator, Scaffolder refreshment
training.
Contractors will provide HSE Training centre to facilitate in house (at site) HSE Training. This
training centre will be located at Contractor’s temporary office and have capacity for 50
participants/trainee.
SITE SPECIFIC ORIENTATION PROGRAMS

• HSE Orientation Training (HSE Induction) and Incident Injury Free (IIF) are deemed
mandatory to be followed by all Contractor and Subcontractor personals before starting
their work activities at site.
• Contractor’s HSE will provide a project specific orientation (HSE Induction) to all
Contractor, Subcontractor personnel, including visitors and vendors. The content of
orientation should describe some items below but not limited to:
- Project HSE Policy.
- Project Prohibition of Alcoholic Drink, Drugs, and Carry Weapon Policy.
- Project Top Management HSE Commitment.
- Project HSE Golden Rules.
- HSE Rules and Requirements.
- HSE Communication System.
- Emergency Response Procedure.
- Transportation Procedure.
- Personal Protective Equipment.
- Environmental Condition.
- Hazards Identification and Mitigation (JSA) in Work Area.
• At the end of training, training participant will be required to sign a personal declaration
which mention they are aware with the HSE matter delivered in the training and will give
their commitment to follow the HSE requirements. Trainee should pass the post-test
assessment to ensure that trainee understood.
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• Training participants who pass the assessment will be given with RDMP JO sticker to be
attached at the front side of their safety helmet.
• Training participants required to fill out the attendance list. This list will be registered to
the training database.
In addition, Contractor / Subcontractor / Sub-Subcontractor / Vendor personnel who will visit

project site to conduct short inspection or walkthrough or supervise as expert within 1 – max 7
days, identified as a Visitor. Visitor who will enter project site shall be accompanied with
appointed Contractor personnel (user / host). Visitor shall also complete the visitor SIML & ID
Badge following requirement:
• Complete filled of man power register form (for each personnel);

• Attend HSE induction and matrix training based on work position.
SHORT SERVICE EMPLOYEE PROGRAM (SSE)

Contractor shall manage all Contractor, Subcontractor and Sub-subcontractor new &
inexperience hire employees through the SSE Program. After having passed the HSE Training
(Induction and Matrix training), all new employees will receive a New Employee Identification
Sticker and green colour tapes. This sticker and green colour tapes around the helmet will be
worn for the first 30 days of working at site.
Direct supervisor of new & inexperience hire employee shall be responsible to the
familiarization of the project requirement include, but not limited to:
• JSA.
• Project HSE Plan.
• Safe work procedures/practice.
• Location of designated assembly point, muster point, windsock, lunch/break areas/shelter,
smoking areas, routes to and from work areas, etc.
After 30 days of mentoring program, status may be removed at the discretion of the
Construction Manager, subject to the following criteria:
• The employee is deemed by their supervisor to have worked safely;

• The employee is deemed by their supervisor to have adhered to HSE policies; and
• The employee has no incidents attributable to him/her.
Personnel who have not met the above criteria in the specified period require written approval
from the Construction Manager for continued access to the site.
16. COMMUNICATION
TOOLBOX MEETING (TBM)
Toolbox Meeting will be conducted by Contractor and Subcontractor in daily prior to the start
the activities at site. Contractor Discipline Superintendent is responsible for these meeting and
will ensure that all members of supervisor/work leader and workers are briefed on the following
prior to the start of any work activities:
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• Today activities.
• Review for the tasks which have been carried out on previous day.
• Job distribution from each supervisor to all workers or team member. This is to prevent
misunderstanding and miss communication during execution of the job.
• HSE issues/concern, lesson learn, safety topics, etc. This is to remind and improve all the
members awareness concerning HSE aspects in their daily activities at site.
TBM shall be attended by:
• Work supervisor.
• Foreman.
• Discipline superintendent.
• Engineer.
• HSE.
• Workers.
TBM could be done per group to make it effective and efficient. For example, TBM for civil
group, TBM for mechanical group, etc.
PRE-JOB SAFETY MEETING (PJSM)

Pre-Job Safety Meeting is a meeting carried out soon after the TBM at working area just before
started the job/task. PJSM shall be followed by all team members involved in the job/task.
At minimum PJSM shall be attended by:
• Work Supervisor/Work Leader in charge for the job/task.

• Foreman in charge for the job/task.
• Discipline Superintendent in charge for the job/task.
• HSE in charge for the job/task.
• Workers in charge for the job/task.
PJSM will be focus to discuss about the JSA prepared for the job/task and ensure all the
precautions mention in the JSA already in place.
Considering the number of HSE personnel and Discipline Superintendent will be not enough to
attend each PJSM, they shall prioritize to attend PJSM for high risk job/task such as:
• Job/task covered with specific PTW (not general PTW). i.e. Confined space, critical lifting,
etc.
• Job/task at brownfield area.
• Job/task with any change of working conditions, such as changes in engine conditions,
weather, personnel, execution time and work methods.
• Etc.
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GENERAL SAFETY TALK

Safety talk will be conducted throughout the construction phase of the project. The agenda of
this activity shall include:
• Communication of general HSE issues.

• Socialization of procedure / requirements.
• Review of HSE issues from the previous week’s activities.
• Significant work planned for the current week, i.e. critical lifts, major equipment installs,
lockout tag outs being implemented, etc.
• Sharing of lesson learned from other projects.
• Review the previous week’s questions and concerns from the workforce and what was
done to address them.
• Session for a “Personal Safety Learning” or Guest Speaker.
• Rewards and recognition.
Site personnel (Contractor, Subcontractor, Sub-Subcontractor, and Owner) shall be in

attendance. All personnel in attendance will be required to sign the attendance sheet for each
meeting. Contractor Construction Manager is responsible to ensure the implementation of this
program.
General Safety Talk will be done in weekly basis. Venue for General Safety Talk shall be decided
by consider Site Project condition such as availability of space to be used by staff & workers.
Basically, it is preferred to carry out General Safety Talk at one place for all staff & workers.
However, at peak project stages, it seems not practicable to do it. In this case the most effective
and efficient method will be decided. It is recommended that General Safety Talk will be divided
into several big group at several work places or every week General Safety will be scheduled to
attended by different Sub-contractors.
WEEKLY SITE HSE COORDINATION MEETING

Weekly HSE Coordination Meeting shall be conducted weekly at project site with the following
agenda:
• Review HSE Program Implementation

• Review HSE Key Performance Indicator
• Review HSE Statistic
• Review HSE Issues
• Other business (if any)
HSE representative from Subcontractor & Contractor (coordinator level) shall attend this
meeting. Contractor HSE Chief shall chair this meeting. The agenda and result of the meeting
will be documented and distributed to all participants.
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PROJECT MANAGEMENT SAFETY COMMITTEE MEETING

Contractor’s PMT and Owner shall conduct this meeting on quarterly basis. Contractor shall use
this meeting as a means for reviewing recent HSE issues with Owner, developing corrective
action plans and identifying opportunities for improvement. Contractor’s Project Manager shall
chair this meeting.
Agenda for this meeting are as follow, but not limited to:
• Review HSE Programs.

• Review HSE Statistic.
• Safety Walkthrough
After the meeting, Contractor shall distribute meeting minutes to the following personnel:
• Owner and Contractor Project Manager

• Owner and Contractor HSE Manager
• Owner and Contractor Project Control Manager
• Owner and Contractor Procurement Manager
• Owner and Contractor Engineering Manager
• Owner and Contractor Construction Manager
• Owner and Contractor QC Manager
Minutes of meeting are subject to report to Owner.
MONTHLY HSE COMMITTEE MEETING

Contractor will implement Safety Committee meeting in monthly basis. All Contractor key
persons including Subcontractors and Sub-Subcontractor site management and key
representatives will participate as members of committee. Construction Manager is appointed
as Chairman on the committee, HSE Chief as secretary and Representative as observer of
committee.
Agenda of the meeting will include a communication of general HSE issues and requirements,
communication of any other pertinent information compiled from the previous month’s
activities, and sharing of lessons learned from other projects. All attendees will be required to
sign an attendance sheet for each meeting. Minutes of meeting shall be taken by Contractor.
HSE POSTER, SLOGAN, NOTICE BOARD

Posters, Rules of HSE, notices and HSE Policy shall be posted in key locations around the site to
maintain HSE awareness. HSE information will be issued to inform workforce about particular
issues and about progress in achieving objectives, results of inspections and lesson learn of Near
Miss and Incident.
HSE Information Boards will be used to display HSE Policy, slogans and other information as
statistics, awards, etc.
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CONTRACTOR RADIO COMMUNCATION NETWORK

Radio communication shall be provided by Contractor as means of communication at site to
ensure urgent issues are resolved immediately. 1 (one) radio frequency will be used for
communication purposes between Contractor and Project Team. Communications network will
be compatible with the site system and radio communications network must have government
certificate/permit, and must be intrinsically safe for Class 1 Div. II. Each radio channel will be
used for the following purpose:
CHANNEL PURPOSE
1 Contractor and Communication
2 Civil Discipline Communication
3 Piping Discipline Communication
4 Mechanical Discipline Communication
5 Instrument Discipline Communication
6 Electrical Discipline Communication
7 Lifting Activity
8 HSE Discipline Communication
9 Emergency
Table 9. HT Radio Communication Channel
Note:
The channels above can be changed and/or added depend on the situation at site
17. STOP WORK AUTHORITY (SWA)

The SWA should be initiated for conditions or behaviours that threaten danger or Imminent
Danger to person(s), equipment or the environment. Everyone who observe dangerous actions
and conditions could STOP the work and request for rectification before resume the work again.
Situations that warrant a SWA may include, but are not limited to the following:
• A modification or alteration that deviates from the way the job task is normally performed
may cause unsafe work actions or conditions.
• Unscheduled or unplanned event that distracts workers from the job task being performed.
• Observation with safety impact. Whenever a worker observes a condition or situation that
has an impact on safety.
• Incomplete understanding. Whenever a worker or co-worker does not completely
understand instructions, procedures or ongoing activities.
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• Relay information. Whenever a situation requires critical information to be relayed, an

unsafe work action or condition may occur. For example, shift change or employee
reassignment.
• Observing new hazards. Whenever a worker encounters risks that have not been addressed
during previous job safety analysis or risk assessments.
• Need to ask for help. Whenever a job requires additional people, or the experience level of
the person performing the job task requires support.
The affected area(s) will be reopened for work by personnel with restart authority. All affected
workers and contractors will be notified of what corrective actions were implemented and that
work will recommence.
No work will resume until all issues and concerns have been addressed.
18. EMERGENCY RESPONSE PROCEDURE

The site ERP will be in accordance with document 26071-100-GPP-GHX-00002 Project
Emergency Handling Procedure (PEHP).
In the event of emergency, Construction Manager will be the person in charge from the
Contractor site. The project site PEHP will be aligned with Owner existing site CEHP. PEHP will
be explained more detail in Bridging Document of PEHP.
Contractor will include a process for identifying and reviewing potential emergency situation
and the mitigation and control events. In the PEHP will include as minimum, but not limited to
an emergency plan for rescuing personnel at the work site for the following events:
• Medical emergency including Medical Evacuation

• Rescue Injured Person (IP) at high elevations
• Falls from high elevations.
Train personnel by conducting regular emergency drills and exercises to test response
effectiveness.
EMERGENCY RESPONSE DRILL

The Emergency Drill is one part of the Emergency Management Planning Process. This means
that the Emergency Response Plan, such as emergency communication flow, emergency
scenario, etc. must be tested to ensure that all existing provisions and guidelines can be
implemented and implemented properly.
In addition, the Emergency Response Guidelines are dynamic and must be renewed to maintain
their effectiveness in accordance with the developments and changes that exist.
Therefore, the Major Emergency Drill that involves all personnel must be carried out at least 1
(one) year. In addition, Minor Emergency Drill must be carried out at least 1 times per three
months.
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Emergency Response Plan provided by Contractor shall cover all area within scope/boundary of
RDMP RU-V Project.
EMERGENCY SIREN
Below table describe emergency siren tones which informed the emergency situation.
No Condition Siren Remark
1 Incident occurred 3 minutes wavy siren

3 min
6 minutes repetitive
2 Evacuation 6 min siren (Hi low tone)
3 Safe/normal condition Continuous siren

1 minute
Table 10. Emergency Siren Tones
MEDICAL FACILITIES AND MEDICAL SERVICES REQUIREMENTS

• In the event of medical evacuation, the IP (Injured Person) will be taken to Pertamina
hospital in Balikpapan for minor injury assessment and treatment.
• Contractor will provide the Ambulance and standby fulltime at site for emergency cases.
• Contractor will employ paramedics for site project. Paramedics will be assigned to assist
the Contractor’s site doctor. The paramedic will not be allowed to perform any medical
treatment without acknowledgement from the Contractor’s doctor. Paramedic will be
employed until final demobilization of all Contractor personnel. The Paramedic will be
assessed by Contractor’s Site Doctor or Medical Advisor.
MUSTER POINT AND ASSEMBLY POINT

When an emergency evacuation siren is activated, all employees gather to the nearest assembly
point. Assembly point as the first destination that is considered safe and becomes the pick-up
point for workers before heading to the muster point if needed.
Assembly points will be set at each point of work, if there are several work points in an area, it
will be agreed and marked as a flag with the initial’s "A" indicating the assembly point. Workers
and guests will be directed to the nearest muster point.
There are 3 muster points when an emergency occurs in the refinery area:
1. Gate V
2. Head Quarter Pertamina RU V
3. HSE Pertamina RU V Office
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Contractor shall provide and socialize to all employee the location of Assembly Point, Muster
Point and Wind sock. These location (map) shall be informed at HSE Notice board located at site
and office area.
Figure 8. Muster Point Map
19. INCIDENT INVESTIGATION

Incident, accident and near-miss which involved to all personnel of Contractor and Sub-
Contractor shall be reported, investigated and analysed to prevent recurrence and improve
performance accordance to standards & procedures of Contractor. Investigations focus on root
causes and/or management system failures. Corrective actions and preventive measures are
utilized to reduce future injuries and losses.
The comprehensive incident / accident / near-miss investigation and reporting procedure

developed by HSE Committees includes measurement of recordable injury and illness
experience, incident preparedness, actions to be taken immediately after an incident, urgent
notice, investigation procedure, analysis of incident causes, incident potential assessment,
recommendation, implementation of recommendations, reporting and records.
The site Incident reporting will be in accordance with document 26071-100-GPP-GHX-00019

Incident Investigation Reporting and document 26071-100-GPP-GHX-00025 Illness
Notification & Reporting Procedure.
Page 67 of 71
Doc. No.: 26071-100-G01-GHX-00002
Job No.: 26071 Rev.002
20. PERFORMANCE EVALUATION

AUDITS
Contractor shall conduct Audit programs to ensure HSE system are in place and effective. The
audit programs are defined as follows:
20.1.1. QUARTERLY HSE JOINT AUDITS BY CONTRACTOR AND OWNER

Involving both Contractor and Owner senior management and HSE team will be
participated in the audit and continued with HSE management system review, its
effectiveness and suitability in:
• Managing HSE risk

• Ensuring efforts to continually improve HSE performance
• Ensuring its continuing suitability and effectiveness
20.1.2. EXTERNAL AUDITS

The independent third party appointed by Contractor scheduled yearly to evaluate the
implementation in the project. HSE Audits are conducted to get information on how
HSE of the project are managed, the current shortcomings and concern and remedial
actions required to bring the situation to proper control and / or the risk to ALARP.
INSPECTIONS
Coordinated by Contractor HSE Chief, these inspections maybe conducted with assistance from
the Project Management team, Site Management team, Project HSE Committee team, etc.
20.2.1. CONSTRUCTION OBSERVATION PROGRAM (e-COP)

Contractor shall develop program for reporting unsafe action and unsafe condition
through e-COP card. Also, Contractor shall respond and take corrective action on Owner
recommendation of inspection result.
The cause and corrective action shall be determined on e-COP report. Corrective Action
request shall be created after the audit report signed by observer. All observation and
closing status shall be registered.
20.2.2. DAILY/ROUTINE ASSESSMENT

Performed by HSE personnel’s and supervisors who supervise the work activities carry
out at site. The topic of audit could be focused in:
• Electrical safety implementation

• Working at height & scaffolding
• Confined space entrant
• LOTO & live system safety implementation
• Lifting & rigging safety implementation
Page 68 of 71
Doc. No.: 26071-100-G01-GHX-00002
Job No.: 26071 Rev.002
Contractor Construction Manager has responsibility to ensure the audit attend by:
• Contractor & Subcontractor related discipline (refer the further topic and
schedule).
• Contractor & Subcontractor HSE.
The audit findings and recommendations will be reported to Contractor Construction

Manager and related discipline leader. If required it will be considered as attachment in
Subcontractor KPI HSE Performance.
20.2.3. WEEKLY SITE MANAGEMENT WALKDOWNS

In order to enforce safety rules, regulations and safety implementation at site on site
safe work practices, housekeeping, inspections, etc. Contractor has schedule of Site
Management Walkdowns in weekly basis. The Site Management Walkthrough is must
attend by:
• Owner Construction Manager

• Contractor and Subcontractor Construction Manager
• Contractor and Subcontractor Superintendent / Work Leader
• Contractor and Subcontractor HSE Chief
• Contractor and Subcontractor QC Coordinator
• Contractor and Subcontractor others Coordinator
During these programs, team members will do a walkdowns at worksite and observe
any unsafe action and condition. All team members shall take required immediate
action to close observed unsafe action and condition. Remaining issues which cannot
close at that time need to be registered into the findings list. The closing status for these
findings need to be updated to all team members regularly (e.g. every week).
20.2.4. QUARTERLY ENVIRONMENTAL INSPECTIONS AND ASSESSMENT

Performed by environmental superintendent and focus on environmental compliance
to ensure all applied environmental regulation from the government of Indonesia, local
government of East Kalimantan, International Standard, Company and Contractor rules
has been implemented. The HSE Manager will issue the report to Company as required.
INCENTIVES AND CONSEQUENCES

20.3.1.HSE INCENTIVE PROGRAMS
These programs will be expected to increase employee participation and they will be
more aware with HSE issues in their working environment.
HSE incentive programs will be rewarded to the following criteria:
• Displaying good/improvement initiative on HSE manner.
Page 69 of 71
Doc. No.: 26071-100-G01-GHX-00002
Job No.: 26071 Rev.002
• Setting a good example of safe work practices.

• A qualified hazards observation report – focusing on the work process/system
improvement – gives a beneficial input for work/process improvement.
• Influencing others in the working environment of positive/safe behaviour.
• Exceptional participation in HSE programs, PEKA, in terms of quantity and quality.
The detail of HSE Incentive Programs described in 26071-000-GPP-GHX-00029 Reward

and Punishment Procedure.
20.3.2.HSE CONSEQUENCE PROGRAMS

This procedure is designed to limit safety violations by imposing a set of measures that
would eventually lead to persistent violators being removed from the project to ensure
that all employees comply with HSE rules and requirements.
Contractor shall establish Consequence Management Committee which responsible to

decide the disciplinary action to be taken to the violators. The committee member shall
consist of following, but not limited to:
• Contractor’s Construction Manager.

• Contractor’s HSE Manager or Chief HSE.
• Sub-Contractor’s Construction Manager.
• Sub-Contractor’s HSE Coordinator.
• Contractor’s and Sub-contractor’s HR.
Disciplinary actions shall be applied to employees who violate safety rules and
requirements up to accumulated penalty points.
Penalty point are accumulated as per type of violations classified into 3 types as follows:
1. Minor offence (1 penalty point)

2. Major offence (2 penalty point)
3. Serious offence (6 penalty point)
Disciplinary action to be taken up to accumulated penalty points are referred to below

table:
Accumulated points Disciplinary actions to be taken
Verbal warnings are given to the offenders by Chief HSE

1 Point
/Officer.
Written warnings and re-trainings are given to the offenders

2 – 5 Points by Chief HSE /Officer. The training contains are specific
requirements related to that they had failed to comply with.
Page 70 of 71
Doc. No.: 26071-100-G01-GHX-00002
Job No.: 26071 Rev.002
A consequence management committee meeting (refer to 8.4)

convenes to determine disciplinary actions such as follows, but
not limited to;
> 5 Points
▪ Removal from project or
▪ Termination of employment or
▪ Temporary suspension of work or
▪ Temporary transfer to office work.
Table 11. Disciplinary Action to be Taken up to The Penalty Points
The detail of HSE Consequence Programs described in 26071-000-GPP-GHX-00029

Reward and Punishment Procedure.
21. ATTACHMENTS
Attachment 1. Project HSE Policy
Attachment 2. List of Regulations
Attachment 3. HSE Matrix Training
Attachment 4. CSMS Questionnaire
Attachment 5. HSE Program
Attachment 6. PPE Matrix
Attachment 7. Incident Process Flowchart
Attachment 8. HSE Organization Chart
Attachment 9. Change Management Request Form
Attachment 10. HIRAC Form
Attachment 11. JSA Form
Attachment 12. JHA Form
Page 71 of 71
ATTACHMENT 1. PROJECT HSE POLICY
PROJECT HSE POLICY
RDMP BALIKPAPAN JO Management is committed to:

1. Have the occupational health, safety and environment as a core value.
2. Continual improvement in HSE performance, based on legal requirement,
government regulation, and HSE Management System which is adjusted to
condition and risk level identified in project.
3. Prevent all injuries, job illness and property damages resulted from project
activities.
4. Prevent environmental pollution and environmental impact resulted from project
activities.
5. Have a commitment to comply with all applicable Pertamina HSE Procedures.
6. Provide workers who have understood / fulfilled the skill requirements in the HSE
aspect of the job.
7. Organize documentation, implementation and maintenance of HSE Management
System.
8. Prohibit the use of illegal drugs, liquor and firearms in the workplace.
9. Review HSE Management System periodically to ensure that it is remains
relevant and appropriate to project.
This policy should be supported, understood and conducted by management,

employees, vendors, and Subcontractors according to their role and responsibility
within this Project.
Jakarta, 27 February 2019
RDMP BALIKPAPAN JO
Project Manager
ATTACHMENT 2. LIST OF REGULATIONS
HSEMS
NO REGULATIONS AND OTHER REQUIREMENTS ELEMENT/ CLAUSE
SECTION
Requirements
26070-203-G01-GHX-J0001-000 Health, Safety, Security, And
1 4.6 All
Environmental (HSSE) Plan
26070-203-G80-GAX-J0001-B01 Scope of Work and Execution
2 8.2, All
Requirements
13.9
Environment
General
Undang-Undang No. 32 / 2009 – Perlindungan dan Pengelolaan 1, 2, 3, 4, 13, 14, 20, 21, 53,
1 1 – 13 54, 57, 58, 59, 60, 67, 68, 69
Lingkungan Hidup
2 Peraturan Pemerintah No. 27 Tahun 2012 – Ijin Lingkungan 5 Pasal 53
3 PP No. 70 Tahun 2009 – Konservasi Energi 5 Pasal 7, BAB 3
Permen LH No. 13 Tahun 2010 - UKL - UPL dan Surat
4 Pernyataan Kesanggupan Pengelolaan & Pemantauan Pasal 2 - 9
Lingkungan Hidup 5
Hazardous Material
6, 8, 9, 12, 13, 15, 16, 17,
Peraturan Pemerintah No. 74/2001 – Pengelolaan Bahan
5 5, 9 18, 19, 20, 22, 23, 25, 27, 28,
Berbahaya dan Beracun 29, 30, 31, 39
Hazardous Waste
3, 4, 5, 7, 8, 9, 10, 11, 13, 14,
Peraturan Pemerintah No. 101/2014 – Pengelolaan Limbah
6 2, 5, 9 16, 29, 30, 31, 54, 55, 56, 57,
Bahan Berbahaya dan Beracun 58, 59, 60, dst.
Peraturan Menteri Lingkungan Hidup No. 14/2013 – Simbol dan
7 2, 5, 9 Poin B dan C
Label Limbah B3
Peraturan Menteri Lingkungan Hidup No. 18/2009 – Tata Cara
8 2, 5, 9 1, 2, 3, 4,
PerIjinan Pengelolaan Limbah Bahan Berbahaya dan Beracun
Keputusan Kepala Bapedal No. 01 Tahun 1995 – Tata Cara dan 1, 2, 3, 4, 5, Lampiran 1 No.
9 Persyaratan Teknis Penyimpanan dan Pengumpulan Limbah 5, 9 1, 2.1, 2.2, 3.1, 3.2, 4, 4.1,
Bahan Berbahaya dan Beracun 4.2, 4.3, 4.4,
Keputusan Kepala Bapedal No. 02 Tahun 1995 – Dokumen 1, 2, 3, 4, 5, Lampiran 1 No.
10 5, 9 1, 2, 3, 4
Limbah Bahan Berbahaya dan Beracun
Peraturan Menteri Lingkungan hidup - Simbol dan Label Limbah
11 5, 9 2, Lampiran
Bahan Berbahaya Dan Beracun
Peraturan Menteri Negara Lingkungan Hidup No. 03 Tahun
12 2008 – Tentang Tata Cara Pemberian Simbol dan Label Bahan 5, 9 2,3, 4, dan Lampiran 1 No.
B3
Surat Edaran Nomor : 08/Se/02/1997 - Penyerahan Minyak
13 Pelumas Bekas 5, 9 1 s.d. 6
Radioctive
Peraturan Pemerintah No. 61/2013 – Pengelolaan Limbah 1, 5, 6, 12, 13, 14, 15, 16, 17,
14 5, 9 20, 26, 30, 35
Radioaktif
KEPBAPETEN No. 01/Ka-BAPETEN/V-99 - Ketentuan 5
15 Keselamatan Kerja Terhadap Radiasi BAB II dan BAB IV
Water Resources
16 Undang-Undang No.07/2004 – Sumber Daya Air 1 – 13 1, 7, 8, 9, 10
Peraturan Daerah Provinsi Kalimantan Timur No. 2/2011 -
17 5, 9 BAB IV - VII
Pengelolaan Kualitas Air dan Pengendalian Pencemaran Air
Peraturan Daerah Provinsi Kalimantan Timur No. 14/2012 –
18 Pengelolaan Air Tanah di Kalimantan Timur 5 BAB II dan BAB III
Liquid Waste
Peraturan Pemerintah No. 82/2001 – Pengelolaan Kualitas Air 7,8, 9, 10, 11, 12, 16, 17, 25,
19 2, 5, 9 26, 34, 35, 37, 38, 41, 42,
dan Pengendalian Pencemaran Air
Peraturan Menteri Lingkungan Hidup No. 19/2010 - Baku Mutu
20 Air Limbah bagi Usaha dan/atau Kegiatan Migas Serta Panas 5, 9 TBA
Bumi
Keputusan Menteri Lingkungan Hidup No. 51/1995 – Baku Mutu
21 Limbah Cair Bagi Kegiatan Industri 5, 9 1, 2, 5, 6, 8, Lampiran C
Keputusan Menteri Lingkungan Hidup No. 122/2004 –
22 Perubahan Atas KepMenLH No. 51/1995 tentang Baku Mutu 5, 9 Pasal 1, 2, dan Lampiran
Limbah Cair Bagi Kegiatan Industri
KepMenLH No. 112 Tahun 2003 - Baku Mutu Air Limbah
23 Domestik 5,9 4,6,8 dan lampiran
Air Pollution, Odor, and Noise

5, 9, 10, 20,22, 23, 24, 26,
Peraturan Pemerintah No. 41/1999 – Pengendalian Pencemaran
24 2, 5, 9 28, 30, 31, 34, 35, 36, 37,
Udara 41, 42, 48, 49, 50, 51
Peraturan MenteriLingkungan Hidup No. 05/2006 – Ambang
25 Batas Emisi Gas Buang Kendaraan Bermotor Lama 2, 5, 9 1, 2, 3, 4, 5, Lampiran No. B,
Keputusan Menteri Lingkungan Hidup No. 48/1996 – Baku
26 Tingkat Kebisingan 2, 5, 9 1, 2, 3, 5, 6, Lampiran 1, 2,
1, 2, 3, 5, 6, 7, Lampiran 1
Keputusan Menteri Lingkungan Hidup No. 49/1996 – Baku No, 1, 2, Lampiran 2 No. 1,
27 2, 5, 9
Tingkat Getaran 2, Lampiran 3, Lampiran 4,
Lampiran 5
Keputusan Menteri Lingkungan Hidup No. 50/1996 – Baku
28 2, 5, 9 1, 2, 4, 5, Lampiran 1
Tingkat Kebauan
Waste Management
29 Undang-Undang No. 18/2008 – Pengelolaan Sampah 1 – 13 1, 2, 22, 23
Occupational Health and Safety
30 UU No. 1/1970 – Keselamatan Kerja 1 – 13 1 s.d 18
31 UU No. 36/2009 – Kesehatan 1 1, 10, 28, 38,44, 46, 56
32 PERMENKESNo 269/Menkes/per/III/2008 Rekam Medis 2, 5, 11 Bab I – Bab V
Bagian ketiga (Pasal 49 –
33 UU RI No. 22 Tahun 2009 – Lalu Lintas dan Angkutan Jalan 5 56)
34 UU 03/1992 – JAMSOSTEK 1 3, 6, 8, 10, 17, 20
35 PP No. 53/2012 – JAMSOSTEK 1 Pasal 9, 22, dan 26
PER 02/MEN/1992 – Tata Cara Penunjukan Kewajiban dan
36 1 9, 10
Wewenang AK3
37 PER 05/MEN/1996 – Sistem Manajemen K3 1 1 s.d. 8
38 PP No. 50 Tahun 2012 – Penerapan SMK3 1 1 s.d. 22
39 PER 04/MEN/1987 – P2K3& Tata Cara Penunjukan AK3 1 2, 3, 12,
PER 02/MEN/1980 – Pemeriksaan Kesehatan Tenaga Kerja
40 dalam Penyelenggaraan Keselamatan Kerja 5 9
PER 01/MEN/1976 – Kewajiban latihan Hiperkes Bagi Dokter
41 Perusahaan 5 1
PER 01/MEN/1979 –Kewajiban Latihan Hygiene Perusahaan
42 Kesehatan dan Keselamatan Kerja Bagi Tenaga Para Medis 5 1
Perusahaan.
43 PER 02/MEN/82 – Kwalifikasi Juru Las di Tempat Kerja 5 3, 4 , 30, 31
PERMENAKERTRANS No.09 /2010 – Operator dan Petugas
44 Pesawat Angkat dan Angkut 5 5, 6, 10, 12
PER 03/MEN/1999 – Syarat – Syarat K3 Lift untuk
45 Pengangkutan Orang dan Barang 5 1, 3, 4, 5, 11, 12, 24, 27, 28
46 KEP 174/MEN/1986 – K3 pada Tempat Kegiatan Konstruksi 4 2

KEP 187/MEN/1999 – Pengendalian Bahan Kimia Berbahaya di
47 7 2, 4, 5, 9
Tempat Kerja
SK No. 261/MENKES/SK/II/1998 Persyaratan Kesehatan
48 5 BAB I. BAB II: A.1, B.1, C.1
Lingkungan Kerja
KEPMENKES 1405/2002 – Persyaratan Kesehatan Lingkungan
49 5 BAB VI: A, B. BAB XI
Kerja Perkantoran dan Industri
PERMENKES No. 492 / 2010 - Persyaratan Kualitas Air Minum
50 5 2, 6
PERMENKES No. 416 / 1990 – Syarat – syarat dan
51 5 2, 4, 9
Pengawasan Kualitas Air
PER 02/MEN/1980 – Pemeriksaan Kesehatan Tenaga Kerja
52 5 1
dalam Penyelenggaraan Keselamatan Kerja
PER 05/MEN/1985 – Pesawat Angkat dan Angkut 2, 3, 4, 7, 18, 19, 20, 27, 37,
53 5
55, 54, 55, 101
PER 09/MEN/2010 – Operator Pesawat Angkat dan Angkut
54 5 Bab 2 – 8
KEPRES 22/1993 – Penyakit Yang Timbul Karena Hubungan
55 7 2, 3
Kerja
KEPMENAKERTRANS No. 609/2012 - Pedoman Penyelesaian
56 5, 6 2, 3
Kasus Kecelakaan Kerja dan Penyakit Akibat Kerja
PER 04/MEN/1980 – Syarat – Syarat Pemasangan dan
57 7 3, 5, 11, 12
Pemeliharaan Alat Pemadam Api Ringan
PER 02/MEN/1983 Instalasi Alarm Kebakaran Automatik
58 7 Bab 1 - 6
PERMENAKERTRANS No. 13/2011 NAB - Faktor Fisika dan 4, 5, 12, 14, 15, 16, 17,
59 5, 6
Faktor Kimia di Tempat Kerja
Lampiran 1 dan 2
KEP 186/MEN/1999 – Unit Penanggulangan Kebakaran di
60 9 2, 3
Tempat Kerja
PER 01/MEN/1981-Kewajiban Melapor Penyakit Akibat Kerja
61 1 4
PER 03/MEN/1998 – Tata Cara Pelaporan dan Pemeriksaan
62 10 2
Kecelakaan
KEP 84/BW/1998 – Tata Cara Pengisian Formulir Laporan dan
63 10 1 s.d 11
Analisis Statistik Kecelakaan
Kep. 333/MEN/1989 – Diagnosis dan Pelaporan Penyakit Akibat
64 10 2
Kerja
PERMENAKER No. 15/MEN/VIII/2008 - P3K
65 5 2 s.d 11, lampiran I, II, dan III
PERMENAKER No. 8 /MEN/VII/2010 – APD
66 5 2,5,6,7,8
KEPMEN Pertambangan dan Energi No. 300.K/38/M.PE/1997 –
67 5 7,9,10,13
Keselematan Kerja Pipa Penyalur Minyak dan Gas Bumi
PER.11/MEN/VI/2005 - Pencegahan dan Penanggulangan
Penyalahgunaan dan Peredaran Gelap Narkotika, Psikotropika
68 1, 2, 5 2,3,4,5,6,7,8
dan Zat Adiktif Lainnya di Tempat Kerja
PER.02/MEN/1989 - Pengawasan Instalasi Penyalur Petir
69 5 Bab 2 -10
PER. 01/MEN/1982 - Bejana Tekanan
70 5 Bab 1 - 5
KEP.68/MEN/IV/2004 - Pencegahan dan Penanggulangan
71 5 2, 3, 4, 5
HIV/AIDS di Tempat Kerja
PER 01/MEN/1980 – K3 Pada Konstruksi Bangunan
72 2, 5, 9 1 - 105
PER07/MEN/1964 – Syarat Kesehatan , Kebersihan serta
73 5 5,6,8,11,14
Penerangan Dalam Tempat Kerja
PERMENKES No. 1096/MENKES/PER/VI/2011 – Higiene
74 5 Bab 1-3
Sanitasi Jasaboga
PP No. 55/2012 – Kendaraan
75 5 Bab 2-4
ATTACHMENT 3. HSE MATRIX TRAINING
I
N
T
S
Operator
R
Material Handling Operator

Logistic man / Warehouse
T
A
R
Electrical / Instrument
I FREQU
Light Vehicle Driver

No U
Carpenter / Mason
Security Personnel
N ENCY
Heavy Equipment
Mechanical Fitter
C
Superintendent
I
Administration
General Labor
T
N
Pipe Fitter
Supervisor
Rebarman
U
Scaffolder
Inspector
Manager
Foreman
Surveyor
Engineer
G
Welder
Riggers
Painter
R
Visitor
Chief
E
1 HSE Induction for JO Daily M M M M M M M M M M M M M M M M M M M M M M M M -
Employee (Level 1) HSE Trainer
2 HSE Induction for JO As - - - - - - - - - - - - - - - - - - - - - - - - M
Visitor (Level 1) HSE Trainer required
3 Basic First Aid for JO As - O M M M M M O O O O O - - - - O O O O O O O - -
Employee Doctor/ required
(Level 2) Paramedic
4 Basic Fire Fighting JO Bi- O O M M M M M O M M O O O O O - M M M M M M O M -
(Level 1) HSE Trainer weekly
5 Hand & Power Tools JO Monthly - O - - - M M - - - - - - - - - O O O O O O - O -
(Level 1) HSE Trainer
6 Permit to Work JO As O O M M - M M - - O O M - - - - - - - - - - - - -
(PTW) HSE Trainer Required
(Level 1)
7 Hazard Identification, JO Weekly O M M M M M M - - M M M M M M O M M M M M M M M -
Risk Assessment, JSA HSE Trainer
(Job Safety Analysis)

(Level 1)
8 Working at Height & JO Weekly O M M M M M M - O O O M M M M - M M M M M M M M -
Fall Protection HSE Trainer
I
N
T
S
Operator
R

T
A
R
I FREQU

No U
Carpenter / Mason
Security Personnel
N ENCY
Heavy Equipment
Mechanical Fitter
C
Superintendent
I
Administration
General Labor
T
N
Pipe Fitter
Supervisor
Rebarman
U
Scaffolder
Inspector
Manager
Foreman
Surveyor
Engineer
G
Welder
Riggers
Painter
R
Visitor
Chief
E
Equipment (Level 1)
9 Confined Space JO As O O O O M M - - - - M - - - - M O O - O - O O -
(Level 2) HSE Trainer Required M
10 Scaffolder Training JO Weekly - - - - M O - - - - - M - - - - - - - - - - - - -
11 PEKA/e-Construction JO Daily M M M M M M M M M M M M M M M M M M M M M M M M -
Observation Program HSE Trainer
(Level 1)
12 Respiratory JO Daily O M M M M M M - M O O O O O O O O O O O M O O M -
Protection HSE Trainer
(Level 1)
13 Safe Driving Course JO Quarterly O O O O O O O - O O O - - - - M - - - - - - - - -
14 HSE Leadership JO Monthly M M M M M M M - - O O - - - - - - - - - - - - - -
(Level 1) HSEM/Chief
15 Hot Work JO Monthly - - M O O M O - - - - - - - - - M M M - M O - O -
16 Slinging, Rigging & JO Monthly - - M O M M - - - - - - M M M - - - - - - - - - -
Lifting Refreshment HSE Trainer
Training
(Level 2)
I
N
T
S
Operator
R

T
A
R
I FREQU

No U
Carpenter / Mason
Security Personnel
N ENCY
Heavy Equipment
Mechanical Fitter
C
Superintendent
I
Administration
General Labor
T
N
Pipe Fitter
Supervisor
Rebarman
U
Scaffolder
Inspector
Manager
Foreman
Surveyor
Engineer
G
Welder
Riggers
Painter
R
Visitor
Chief
E
17 Incident Investigation JO Quarterly O M M M M M O - O O - - O - - - - - - - - - - - -
Training HSE Trainer
(Level 2)
18 Excavation Work JO Bi- - - M O - M M - - - - - - - - - - - - - - - - O -
(Level 1) HSE Trainer Weekly
19 Emergency JO Bi- O O M M M M M - M M M M M M M M M M M M M M M M -
Preparedness & HSE Trainer Weekly
Response
(Level 1)
20 Waste Management JO Bi- - O M O O M M - - - - - - - - - - - - - - - - - -
21 Electrical Safety JO Bi- - O M O O M M - - M - - - - - - - - - O M - - - -
22 Mechanical Safety JO Bi- - O M O O M M - - - - - - - - - - - M - - - - - -
23 Chemical & JO Bi- - O M O O M M - - M - - M - - - - - - - - - - - -
Hazardous Substance HSE Trainer Weekly
Handling
(Level 1)
24 Industrial Hygiene JO Quarterly - O M O O M M - - - - - - - - - - - - - - - - - -
(Level 1) Doctor/
Paramedic
25 Lock Out Tag Out JO As - O M O O M M - - - - - - - - - - - M - M - - - -
26
No
(IIF)
Note:
(LOTO)
O: Option
(Level 1)
(Level 1)
I
I
T
A
R
G
N
N
M: Mandatory
Incident Injury Free
I
E
T
T
S
R
C
R
U
U
N
3rd Party
HSE Trainer
Daily
ENCY
Required
FREQU
Manager
Chief
M M M
Superintendent
M
Engineer
M
Inspector
Supervisor
M M
Foreman
Administration
M M
Security Personnel
M

M
Surveyor
Scaffolder
M M

M
Heavy Equipment Operator
Riggers
M M

M
Welder
Pipe Fitter
M M
Mechanical Fitter
M
Carpenter / Mason
M
Rebarman
M M
Painter
M
General Labor
O
Visitor
ATTACHMENT 4. CSMS QUESTIONNAIRE
CONTRACTOR SAFETY MANAGEMENT SYSTEM QUESTIONNAIRE
1. Nama Perusahaan / Company Name :
2. Bidang Pekerjaan / Work Field :
3. Peralatan yang Digunakan / Equipments Used :
□ Perkakas Tangan / Hand Tools □ Mesin Las / Welding Machine □ Mesin Pilling / Pilling Machine
□ Alat Berat / Heavy Equipments (Dozer, Excavator, □ Tangga / Stairs □ Pompa / Pumps
Compactor, Grader)
□ Trailer, Lowboy □ Rigging/Hoisting □ Kapal Laut / Vessel
□ Truk / Truck □ Kompresor / Compressor □…
□ Crane □ Scaffolding □…
4. Material yang Digunakan / Materials Used :
□ Bahan Kimia Berbahaya / Hazardous Chemicals □ ...

□ Bahan Peledak / Explosive Materials □ ...
□ Bahan Radioaktif / Radioactive Materials □ ...
5. Lingkup Pekerjaan / Scope of Work :
Catatan: jika lebih dari satu jenis pekerjaan, maka pastikan Anda melampirkan dokumen CSMS yang diminta seperti prosedur, pelatihan, dan sertifikasi sesuai dengan
masing-masing jenis pekerjaan.
Note: if more than one kind of work, you shall to attached CSMS documents as requested such as procedure , training , and certification related to each kind of work
□ Fabricator □ Batching Plant □ Earth Work & Earth Moving

□ Forwarder □ Coating & Painting □ Chemical Cleaning
□ Offshore □ Concrete & Foundation Activity □ Electrical
□ Diving □ Drainage □ Cathodic Protection Activity
□ Pipe Laying □ Scaffolding □ Post Trenching
□ Trenching of Dredging □ Barge & Vessel Owner □ Weather Forecast Activity
□ Architectural Work □ Deepwell Activity □ HVAC Installation
□ Instrument □ Piling □ Steel Structure
□ Insulation □ Plumbing □ Temporary Facility
□ Land Clearing □ Portacamp Mob. & Lifting □ Topography
□ Logging □ Raw Water Intake Work □ Transportation Provider
□ Mechanical □ Roofing & Siding □…
□ Medical Services Provider □ Security Service □…
□ NDT - Radiography □ Soil Investigation □…
Catatan / Note : NO.1 s/d 5 harus diisi oleh Perusahaan yang mengajukan penilaian CSMS / No.1 to 5 shall be completted by Company who propose CSM S assessment
Perwakilan Perusahaan,
Company Representative,
Nama / Name :
Tgl / Date :
NO KUESIONER / QUESTIONNAIRE EVIDENCE / LAMPIRAN BUKTI NILAI / SCORE BOBOT / WEIGHT KETERANGAN / REMARK
I KEPEMIMPINAN & KEBIJAKAN K3LL / LEADERSHIP & HSE POLICY
Apakah perusahaan Anda memiliki kebijakan K3LL,
terdokumentasi & ditandatangani oleh pimpinan Salinan kebijakan K3LL perusahaan
1 perusahaan? 0 2
Does your company have HSE Policy, documented & approved
Copy of HSE policy
by Company Leader?
Bukti sosialisasi: daftar hadir dan materi

orientasi pekerja / tamu
Bagaimana cara perusahaan Anda mensosialisasikan
kebijakan K3LL?
(sebagai tambahan dapat melampirkan
2 poster kebijakan, banner) 0 2
Socialization evidences: attendance list and
orientation materials
How does your company socialize the HSE policy?
(in addition please attach poster, banner)
Riwayat kerja orang yang bertanggung

Siapakah orang yang bertanggung jawab dalam
jawab dalam penerapan sistem manajemen
penerapan sistem manajemen K3LL di perusahaan Anda?
K3LL di perusahaan
3 0 2
Who is the responsible person for implementing the HSE CV of the responsible person for implementing
management system at your company? the HSE management system at the company
Jelaskan bagaimana keterlibatan pemimpin perusahaan Notulensi rapat P2K3 mengenai peninjauan
Anda terkait dengan penerapan sistem manajemen K3LL? ulang sistem manajemen K3LL
4 0 2
Please, explain the involvement of your company leader P2K3 minutes of meeting about review of HSE
regarding HSE management system implementation? management system
NILAI TOTAL / TOTAL SCORE 0 8
II KEPATUHAN TERHADAP PERATURAN PERUNDANGAN K3LL / HSE REGULATION COMPLIANCE
Apakah perusahaan Anda memiliki organisasi P2K3 dan Struktur organisasi dilengkapi dengan
LL? nama
1 0 2
Does your company have HSE committee organization? Complete organization chart with name
Sebutkan tugas dan tanggung jawab masing-masing Tugas dan tanggung jawab masing-masing
personil dalam penerapan sistem manajemen K3LL di personil dalam penerapan sistem
perusahaan Anda? manajemen K3LL
2 0 2
Please, explain the job description of each personnel regarding Job description of each personnel in HSE
HSE management system implementation at your company? management system implementation
Apakah perusahaan Anda memiliki HSE personil yang

Riwayat pekerjaan serta sertifikasi
kompeten untuk memberikan panduan dalam program
(Depnaker / Migas) pimpinan HSE personil
3 K3LL? 0 3
Does your company have competent HSE personnel that drive CV and certification (Depnaker / Migas
the HSE program? certification) of HSE leader
Apakah perusahaan Anda melakukan pemeriksaan

Catatan hasil MCU dan rekapitulasi
kesehatan secara berkala?
4 0 2
Does your company carry out the Medical Check Up regularly? MCU record and recapitulation
Apakah perusahaan Anda memiliki program Jamsostek / Salinan kartu Jamsostek / asuransi
asuransi kesehatan dan kecelakaan? kesehatan dan kecelakaan
5 0 2
Does your company have Jamsostek / health and accident Copy of Jamsostek / health and accident
insurance program? insurance card
Riwayat pekerjaan dan sertifikasi keahlian

Apakah perusahaan Anda memiliki personel kunci yang
kerja (contoh: sertifikasi welder, SIO
kompeten sesuai lingkup pekerjaan?
peralatan berat, dll)
6 0 2
Does your company have competent key personnel related to CV and certification of job skills (e.g. welder
the scope of work? certification, heavy vehicle license, etc.)
Apakah perusahaan Anda mengelola peralatan operasi

Sertifikat alat berat, kalibrasi peralatan, atau
dengan mematuhi ketentuan dari pihak berwenang
lainnya
7 (sertifikasi, kalibrasi)? 0 2
Does your company manage operation equipments comply with Heavy vehicle certification, equipment
regulations (calibration, certification)? calibration or etc.
III PELATIHAN / TRAINING
Salinan prosedur pelatihan K3LL,matriks

pelatihan, daftar hadir, materi pelatihan
Apakah perusahaan Anda memiliki program dan
internal (contoh: pelatihan APD, Bekerja di
memberikan pelatihan K3LL secara internal / eksternal?
ketinggian, pelatihan pengelolaan bahan
1 0 4
kimia, HSE induksi, dll)
Attendance list, copy of HSE training procedure,

Does your company have program and give HSE internal /
and training materials (e.g. PPE training,
external training?
chemical handling, induction, etc.)
Apakah perusahaan Anda memberikan pelatihan kepada Matriks dan sertifikat pelatihan bidang
karyawan sesuai dengan lingkup pekerjaan? keahlian kerja
2 0 2
Does your company give training to employee related to the
Matrix and training certificate of work skill
scope of work?
IV MANAJEMEN SUBKONTRAKTOR / MANAGEMENT OF SUBCONTRACTOR
Bagaimana perusahaan Anda mengelola subkontraktor Salinan prosedur pengelolaan

yang dapat mendukung program K3LL perusahaan? subkontraktor / CSMS
1 0 2
How does your company manage subcontractor for support Copy of subcontractor management procedure /
company HSE program? CSMS
Bagaimana perusahaan Anda memastikan bahwa

Hasil evaluasi subkontraktor / dokumen
subkontraktor memahami dan melaksanakan program
kontrak yang memuat aspek K3LL
2 K3LL? 0 2
How does your company ensure that subcontractor understand Subcontractor evaluation result / contract
and implement HSE program? document that mention the HSE aspect
V HSE DALAM DESAIN, KONSTRUKSI, DAN KOMISIONING / HSE IN DESIGN, CONSTRUCTION, AND COMISSIONING
Apakah perusahaan Anda memiliki prosedur kerja sesuai Daftar dan salinan prosedur kerja sesuai
dengan lingkup pekerjaan? dengan lingkup pekerjaan
1 0 2
Does your company have working procedure related to the List and copy of working procedure related to
scope of work? the scope of work
Apakah perusahaan Anda memiliki rencana program

Salinan rencana program K3LL
2 K3LL untuk pelaksanaan proyek? 0 4
Does your company have HSE plan for project execution? Copy of HSE plan
Apakah perusahaan Anda memiliki prosedur identifikasi Salinan prosedur identifikasi bahaya dan
bahaya dan penilaian risiko? penilaian risiko (JSA, RA)
3 0 2
Does your company have hazard identification and risk Copy of hazard identification and risk
assesment procedure? assesment procedure (JSA, RA)
Apakah perusahaan Anda memiliki contoh JSA dan RA Contoh JSA dan RA sesuai dengan detail /
sesuai dengan detail / lingkup pekerjaan? lingkup pekerjaan
4 0 2
Does your company have an example of JSA and RA related to Example of JSA and RA related to the detail /
the detail / scope of work? scope of work
Apakah perusahaan Anda memiliki prosedur Izin Kerja

Salinan prosedur Izin Kerja Aman
5 Aman? 0 2
Does your company have Permit to Work procedure? Copy of Permit to Work procedure
Salinan prosedur APD (perawatan,
Apakah perusahaan Anda memiliki prosedur tentang APD penyimpanan, dll) dan daftar APD sesuai
dan membuat daftar APD sesuai spesifikasi lingkup dengan lingkup pekerjaan (jenis dan
pekerjaan? spesifikasi sesuai standar nasional /
6 internasional) 0 2
Copy of PPE procedure (maintenance, storage,
Does your company have PPE procedure and make a list of etc.) and list of PPE related to the scope of work
PPE and specification related to the scope of work? (type and specification according to national /
international standards)
Bagaimana perusahaan Anda memastikan APD telah

Catatan distribusi dan inventarisasi APD
diterima oleh karyawan sesuai dengan lingkup pekerjaan?
7 0 2
How does your company ensuring PPE accept properly by
PPE distribution record and inventory
worker related to the scope of work?
Apakah perusahaan Anda memiliki program Higiene

Laporan pengukuran Higiene Industri
Industri? (pencahayaan, debu, suhu, ergonomi, dll)
8 0 2
Does your company have Industrial Hygiene program?
Industrial Hygiene measurement report
(illumination, dust, temperature, ergonomic, etc.)
Apakah perusahaan Anda memiliki prosedur Salinan prosedur pengendalian tumpahan

pengendalian tumpahan bahan kimia? bahan kimia
9 0 2
Does your company have chemical spill handling procedure? Copy of chemical spill handling procedure
Apakah perusahaan Anda memiliki prosedur pengelolaan

Salinan prosedur pengelolaan limbah
limbah?
10 0 2
Does your company have waste management procedure? Copy of waste management procedure
Bagaimana cara perusahaan Anda menangani limbah

B3? (oli bekas, tumpahan minyak, material B3 kadaluarsa, Manifest limbah B3
11 pelarut, dll) 0 2
How does your company handle hazardous waste? (used oil, oil
Manifest of hazardous waste
spill, expired hazardous material, solvent, etc.)
VI MANAJEMEN PERUBAHAN / MANAGEMENT OF CHANGE
Apakah perusahaan Anda memiliki prosedur manajemen
Salinan prosedur manajemen perubahan
1 perubahan? 0 2
Does your company have management of change procedure? Copy of management of change procedure
Salinan form manajemen perubahan

Bagaimana cara perusahaan Anda melakukan (contoh: perubahan struktur organisasi
manajemen perubahan? perusahaan, perubahan penggunaan
2 peralatan di tempat kerja, dll) 0 2
Copy of management of change form (e.g.

How does your company perform management of change? organizational-structural change, equipment
change, etc.)
VII INSPEKSI / INSPECTION
Apakah perusahaan Anda melakukan inspeksi umum Bukti inspeksi K3LL (min: 2 periode
tempat kerja? inspeksi)
1 0 2
Does your company carry out the general workplace Evidence of HSE inspection (min: 2 inspection
inspection? periods)
Bagaimana cara perusahaan Anda untuk menindak lanjuti

Laporan tindak lanjut hasil temuan
temuan inspeksi?
2 0 2
How does your company follow up the inspection findings? Report of follow up inspection finding
Apakah peralatan kerja Anda diinspeksi sebelum dikirim

Bukti hasil inspeksi peralatan
ke lokasi proyek (mobilisasi)?
3 0 2
Does your company equipments inspected before sent to
Evidence of equipment inspection results
project site area (mobilization)?
Apakah perusahaan Anda melakukan inspeksi pada alat
Jadwal dan hasil inspeksi alat kerja
kerja yang digunakan?
4 0 2
Does your company do inspection for working equipments? Equipment inspection schedule and result

VIII KOMUNIKASI / COMMUNICATION
Apakah perusahaan Anda melakukan rapat toolbox / Daftar hadir dan materi rapat toolbox /
safety talk? safety talk
1 0 2
Does your company carry out toolbox / safety talk meeting Attendance list and materials of toolbox / safety
program? talk meeting
Apakah perusahaan Anda mengkomunikasikan Job

Daftar hadir komunikasi JSA / RA
Safety Analysis / Risk Assessment ?
2 0 2
Does your company communicate Job Safety Analysis / Risk
Attendance list JSA / RA communication
Assessment?
Apakah perusahaan Anda memiliki sarana komunikasi Contoh HSE news , HSE bulletin , HSE Alert
K3LL lainnya? (HSE news , HSE bulletin , HSE Alert dll) dll
3 0 2
Does your company have other HSE communication tool? (HSE Example of HSE news, HSE bulletin, HSE Alert
news, HSE bulletin, HSE Alert etc.) etc.
IX TANGGAP DARURAT / EMERGENCY RESPONSE
Apakah perusahaan Anda memiliki prosedur emergensi? Salinan prosedur emergensi

1 0 3
Does your company have emergency procedure? Copy of emergency procedure
Apakah perusahaan Anda melakukan pelatihan

Laporan pelatihan emergensi
emergensi secara berkala?
2 0 3
Does your company do the emergency drill regularly? Emergency drill report

PELAPORAN DAN PENYELIDIKAN KEJADIAN KECELAKAAN DAN PENCEMARAN LINGKUNGAN /
X
REPORTING AND INVESTIGATION OF INCIDENT AND ENVIRONMENTAL POLLUTION
Apakah perusahaan Anda memiliki prosedur pelaporan Salinan prosedur pelaporan kecelakaan
kecelakaan kerja? kerja
1 0 2
Does your company have incident reporting procedure? Copy of incident reporting procedure
Statistik kecelakaan tiga tahun terakhir

Apakah perusahaan Anda mencatat statistik kecelakaan
(jika ada, mohon lampirkan contoh laporan
dalam 3 tahun terakhir? (LTIFR, LTISR, dll)
investigasi kecelakaan)
2 0 2
Accident statistic report for last 3 years
Does your company record the accident statistic for last 3
(if available, please attach example of accident
years? (LTIFR, LTISR, etc.)
investigation report)
XI DOKUMENTASI / DOCUMENTATION
Kumpulan daftar dokumen, salinan
Bagaimana cara perusahaan Anda mendokumentasikan
prosedur pendokumentasian, dan lembar
dan memperbaharui program K3LL?
revisi
1 0 2
How does your company document and renew the HSE Master list of HSE document, copy of document
program? control prosedur, and historical sheet

XII EVALUASI / EVALUATION

Salinan prosedur evaluasi K3LL
1 0 3
Does your company have HSE evaluation procedure? Copy of HSE evaluation procedure
Jadwal dan laporan hasil internal audit
Apakah perusahaan Anda melakukan internal audit K3LL?
K3LL
2 0 3
Does your company carry out HSE internal audit? Schedule and report of HSE internal audit
Salinan sertifikat OHSAS 18001: 2007, ISO

Apakah perusahaan Anda memiliki sertifikat sistem
14001: 2004, SMK3, penghargaan jam kerja
manajemen K3LL dari pemerintah / badan sertifikasi?
3 aman, dll 0 3
Copy certificate of OHSAS 18001:2007, ISO
Does your company have HSE management system
14001: 2004, SMK3, reward for zero accident,
certification from government / certification agencies?
etc.)
XIII REWARD DAN PUNISHMENT / REWARD AND PUNISHMENT
Apakah perusahaan Anda memiliki prosedur tentang
Salinan prosedur promosi / reward HSE
promosi / reward HSE ?
1 0 2
How does your company have HSE promotion / reward
Copy of HSE promotion / reward procedure
procedure?
Salinan penghargaan atau pemberian
Bagaimana perusahaan Anda menerapkan program hadiah kepada pekerja
reward dan punishment HSE ? Salinan sangsi disiplin kepada pekerja
2 mengenai pelanggaran K3LL 0 2
Copy of reward for worker
How does your company implement HSE reward and
Copy of punishment for worker regarding HSE
punishment program?
violation
NILAI TOTAL KESELURUHAN / TOTAL SCORE OVERALL
0 100
Minimal Skor kelulusan Offshore 70
Minimal Skor kelulusan High Risk 60
Minimal Skor kelulusan Low Risk 50
(COMPANY NAME) HAS PASSED / NOT PASSED THE QUALIFICATION
Date:
Prepared by, Reviewed by,
(Name) (Name)
(Position) (Position)
ATTACHMENT 5. HSE PROGRAM
RDMP BALIKPAPAN JO
HEALTH & SAFETY PROGRAM
NO HEALTH & SAFETY ACTIVITY PLAN / PROCEDURE / APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY PRIMARY RESPONSIBILITY
EXPECTATION REFERENCE
Communicate HSEpolicy and procedures to all employees, sub-Contractors, COMPANY and other stakeholders as appropriate to ensure them
aware of their obligations with respect to Contractor’S operation.
1 Conduct orientation / induction for HSEManagement Plan and 1. Project All project Contractor Staff, Personal induction record New hire employees, CM, HSE Chief, HSEM
employees, SubContractors and visitors to CSMS Induction SubContractor Staff and visitor is maintained. Transferred
the site. Requirement Guideline. employees and visitor
2. Project Staff
Induction Record.
2 Conduct regular meetings with Contractor Project HSE Plan related Daily Tool Box A HSE discussion for each Record of Daily Tool Box Every starting of shift Site Supervisor, Discipline
staff, SubContractors and client to discuss Communication Procedure Meeting group on worker readiness, Meeting for attendance work Superintendent
HSE work plan for that day and and topics.
issues. possible JSA.
Site top management
have to attend this daily
tool box meeting
Weekly Construction progress Minutes of meeting Weekly Construction Manager
Construction coordination and discussion record with HSE as the
Meeting meeting, include HSE issues first agenda
Safety Committee Discuss HSE issues and Project Minutes of Meeting of Monthly Construction Manager
Meeting progress record and attendance
record
General safety A HSE discussion for All worker Make topics schedule and Weekly Construction Manager, HSE
talk on project record for Attendance list Manager
3 Ensure employees receive safety training Project HSE Plan Internal Training Training Nomination Form Form to signed off by Every time proposing General Superintendent /
appropriate to their task and Course must be filled out prior to any Project Manager prior to to attend a course Construction Manager
responsibility training taking place training taking place
Training Records have to be kept of all Training attendance sheet At every training Project HSE Admin. or HSE Chief
Attendance Sheet persons attending training completed course
Training Register Records have to be kept of all Training attendance sheet At every training Project HSE Admin. or HSE Chief
persons attending training completed course
4 Establish Health, Safety, and Project HSE Plan, HSE Safety Notice Display all policies, Safety Safety notice boards are Monthly Project HSE Admin. or HSE
Environmental promotional material to Communication and Board minute of meeting, review placed in each work areas Coordinator
improve the employee awareness Training Procedure result of inspection, incidents, and displaying
audits and others
RDMP BALIKPAPAN JO
4 Establish Health, Safety, and Project HSE Plan, HSE HEALTH & SAFETY PROGRAM
Environmental promotional material to Communication and
NO improve
HEALTHthe&employee
SAFETY ACTIVITY
awareness
PLAN / Training
PROCEDURE
Procedure
/ APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY PRIMARY RESPONSIBILITY
Safety Display project performance HSE performance board Update Weekly Project HSE Admin. or HSE
Performance review against its objective placed in front of REK Coordinator
Boards and target office and displaying
project performance
review result
Safety Alerts A Safety Alert shall be Safety Alerts produced Each occurrence PM, CM, HSE Chief or HSEM
produced for high actual or and displayed
potential incidents
Follow up all relevant Follow up action As Job condition PM, CM, HSE Chief or HSEM
corrective action of incoming incorporated into the require
safety alerts from other Project HSE Plan
projects
Cautionary and Develop and display relevant Cautionary and warning Once when it's CM, Discipline Superintendent
Warning Sign cautionary and warning sign signs developed and determined
(list of warning sign like tape displayed on the
barricade, etc.) hazardous work places
Comply with all applicable HSE laws, regulations, and statutory obligations.
5 Ensure that we are fully informed of all None Legal Gap Review all relevant legal Legal Gap Analysis is At start of project and CM, Discipline Superintendent
applicable health and safety laws, Analysis aspects project such as: developed and reviewed. as a result of any
regulations, statutory obligations and relevant statutory amendments to
Company Safety requirement and comply requirements, contractual Project procedures or legislations and client
with those laws and regulation requirements and Company working instruction may requirements
HSE requirements be developed to fill the
gap.
Ensure that health and safety management and practices are incorporated into all aspects of Contractor operations
6 We will analyze all areas of our activity Project HSE Plan and HSE JSA & Risk Identify all common hazards Conceptual Risk At start of project / Site Supervisor, Discipline
and identify the risk level Register Assessment and risks, which are associated Assessment is developed every starting of job Superintendent
with each project activity
7 Where those procedures are not Project HSE Plan and HSE Job Safety JSA must be completed for Completed JSA Prior to start of the Site Supervisor, Discipline
applicable or suitable develop, implement Register Analysis new jobs and high-risk jobs. jobs Superintendent
and maintain specific workplace
procedures to ensure operations are
conducted in such a manner that
eliminates the risk of injury, illness or
damage.
JSA Review Ensure all JSA's are suited to JSA Review report During the job in HSE Chief
jobs carried out progress
7 Where those procedures are not Project HSE Plan and HSE
applicable or suitable develop, implement Register
and maintain specific workplace
procedures to ensure operations are
conducted in such a manner that RDMP BALIKPAPAN JO
eliminates the risk of injury, illness or HEALTH & SAFETY PROGRAM
damage.
Workplace Carry out workplace hazard Checklist of workplace As per schedule Project Supervisor and HSE
Hazard Inspection inspection for each project hazard inspection is Chief
work area completed, followed up
and closed out
Seek to achieve the personal commitment of all employees, sub-Contractors and suppliers to HSE workplace practices.
8 Investigate a workforce safety Project HSE Plan Project Safety Safety Incentive criteria is Safety Performance is Monthly CM
performance incentive scheme Incentive Scheme established and communicated monitored and reviewed
by committee
9 Involve the workforce in the Project HSE Plan Project HSE Regular meetings, which Minutes of meetings is Monthly CM
implementation of the safety program Committee attended all member of produced and
through the formation of a workplace project safety committee. communicated
safety committee
Regular inspection, which are A checklist for this Monthly HSE Chief
to carried out by all member of inspection is developed
project safety committee. and completed
10 Provide Leadership on all issues of safety Project HSE Plan Workplace Carried out a workplace hazard A checklist of this Monthly Discipline Superintendent,
management Hazard Inspection inspection for their own area inspection is completed, Project Supervisor
of responsibility followed up and closed
out by relevant
signatories, 85 % close out
action
Project HSE All signatories take a part in Signatories attended on Monthly CM
Committee Project Safety Committee, if meeting and recorded.
appointed as a member of it Take a part on inspection
Tool Box Meeting All signatories involved in this Signatories attended on Daily Site Supervisor, Discipline
meeting on their own area of meeting and recorded. Superintendent
responsibility
Safety Talks All signatories involved in this Signatories attended Weekly CM, HSE Chief
meeting. meeting and record
Weekly All signatories involved in this Signatories attended on Weekly CM
Construction meeting, with "safety" as the meeting and recorded.
Meeting first agenda of meeting.
RDMP BALIKPAPAN JO
Provide HSE risk management systems and procedures that are relevant to the nature and scale of work undertaken
11 Ensuring that operations are carried out Project HSE Plan and HSE Standard Developing specific standard Standard Instruction is All works shall CM, HSEM
according to standard Contractor Register Instruction instruction or review existing developed, covered by standard
procedures or template standard communicated and instruction
instruction to be suited to the maintained
works
Permit to Work A restriction and limitation to Excavation Permit, As required CM, HSE Chief
personnel in carrying out the Working at Height Permit,
works known as a high risk Radiography Permit, Hot
Permit to Work, Entry Into
Confined Space Permit,
Electrical Permit to Work,
Crane Permit, Cold Permit
to Work
Job Safety JSA must be completed for Completed JSA (Job Safety Prior to Site Supervisor, Discipline
Analysis (JSA) new jobs, risk jobs, or jobs that Analysis) commencement of Superintendent
are not covered by SOP or the jobs
Standard Instruction prior to
commencement of the jobs
JSA Review Ensure all the jobs are carry JSA Review report, During the job in HSE Chief
out in accordance to JSA Updated JSA revision progress
number
12 Risks to health, safety and environment Project HSE Plan Pre-start Inspection of all equipment Checklist completed Before mobilize to site CM, HSE Chief
will be dealt with by elimination, or inspection must be carried out
removal, substitution, design, redesign, or
separation, administrative and personal
protection
Preventive All plant and equipment are Checklist completed As per Schedule Project GSI and Mechanical
Maintenance scheduled for maintenance Supervisor
Inspection
Workplace Carry out workplace hazard A checklist of this weekly Discipline Superintendent,
Hazard Inspection inspection regularly inspection is completed Project Supervisor
and closed out
13 Provide risk identification and Risk Register Job Safety JSA must be completed for Completed JSA Prior to Site Supervisor, Discipline
management in their work areas Analysis new jobs, risk jobs, or jobs that commencement of Superintendent
are not covered by SOP or the jobs
Standard Instruction.
RDMP BALIKPAPAN JO
13 Provide risk identification and Risk Register HEALTH & SAFETY PROGRAM
management in their work areas
JSA Review Ensure all the jobs are carry JSA Review report, During the job in HSE Chief
out suited to JSA Updated JSA revision progress
number
Hazard Reporting Supervisory staff to enforce Hazard report is Every Day Site Supervisor, Discipline
the reporting of hazards that produced. Superintendent, HSE
may arise before, during and Superintendent
after the works Hazard register is
maintained.
Corrective Action is
recorded.
14 Ensuring that operations are carried out Project HSE Plan Standard Developing environment Standard Instruction is All works shall CM, HSEM
according to environmental standard Instruction (SI) standard instruction or review developed, covered by standard
and Work existing or template communicated and instruction
Instruction (WI) environment standard maintained
instruction to be suited to the
works
Set measurable targets and seek to continually improve our HSE performance
15 Set the Safety Performance targets for the None To do better that the Safety Statistic Twice a Month CM
project corporate target: LTIFR <1, Performance, HSE
LTISR < 1.0, with Fatality=0, Evaluation
Medical Treatment =0
Property Damages =0,
Project Safety Environmental Damages = 0,
Performance HSE Performance min 90
Target (based on HSE Evaluation
Corporate HSE Audit Target is reviewed and As per schedule CM
compliance rate minimum 90 communicated
Audit internal project Target is reviewed and Monthly CM
minimum 1 sub- Contractor communicated
per month
RDMP BALIKPAPAN JO
Periodically review and revise our HSE Policy and procedure to maintain Contractor relevance
16 Conduct assessment and review of key None Assessment HSE Formal review of the Action plan from the Every 3 months or as HSEM
personal HSE in implementing HSE Management implementation HSE review required
Management System System Checklist Management System and
performance Project Manager
or HSE Chief
17 The Project will be audited regularly Project HSE Plan Corporate HSE Corporate HSE audit shall be Corporate Audit Report As per schedule CM
Audit conducted on a regular basis
Internal Safety Every workplace shall be Internal site HSE audit Monthly CM, HSE Chief, HSEM
Audit audited against the HSE plan
by internal audit
Prepared for emergencies and response quickly, effectively and with care to incidents resulting form Contractor operation
18 Undertake and establish Emergency Project HSE Plan Emergency Develop emergency response Plans are regularly Every Six-Month CM, HSE Chief
Preparedness Response Plan plan and maintain its reviewed. The
preparedness and equipment preparedness emergency
equipment is checked
regularly
Emergency Ensure all personnel involved ERP Training will be given Before project start HSEM, Owner HSEM
Response in Emergency Response Team to Site Project Team by
Training have been trained in ERP Owner
Emergency Practice the Plan by simulating A written emergency Quarterly PM, CM, HSE Chief or HSEM
Rehearsal an emergency situation rehearsal report
Site Medical First Aid Facilities to manned Medical Kit is maintained Every Week Paramedic
Services and per day (Working Hours) by and completed
Ambulance trained medic / paramedic
Rehabilitation Ensure that rehab plan is Completed Rehab Plan Every Rehabilitation CM, HSE Chief
Plan developed and agreed to by Case
employee
Prepared for Exercise Program
19 Conduct Exercise Program None Gym or Exercise All signatories involved in this Signatories attended this Weekly CM, PM, HSE Chief
Gym or Exercise Gym or Exercise
Rules and Regulations at Site
Safety Notice All contractor Staff, Result of Monitoring Monthly CM, HSE Chief
No smoking at office site and working
Board and Project SubContractor Staff and visitor
20 area, use drug and alcohol and carry Project HSE Plan
Induction
weapon
Drug Test Random drug test Drug test result Random (Weekly) HSE Chief & CM
RDMP BALIKPAPAN JO
Selection of SUBContractor
21 Conduct selection our Sub-Contractor Project HSE Plan HSE Questioner All sub-Contractor Result of questioner High Validity every 2 years Project Manager, Project
(CSMS) Risk Category > 60, 35 – Procurement Manager and
59 : Low Risk Category Project HSE Manager
Accident Investigation and Reporting

22 Conduct Accident Investigation Project HSE Plan Accident All Major Accident and Minor Completed Accident As per Event CM, HSE Chief
Investigation Accident (First Aid) Investigation Form
Form
23 Regular report Accident Project HSE Plan Accident All Major Accident and Car Completed Accident 1 x 24 Hours HSE Chief, Discipline
Reporting Form Accident Reporting Form Superintendent
Safety Awareness Program
24 In encourage Safety Behaviour Awareness, Project HSE Plan Unsafe Act and All unsafe act and unsafe Completed Unsafe Act Every Day All Project Team
will request to our employee to report all Unsafe Condition condition and Unsafe condition
unsafe act and unsafe condition Form Form
In monitoring implementation HSE None HSE Report Form Implementation HSE Completed HSE Report Monthly HSE Chief
Management System at project site. Management System, Man- Form
Request project team to provide HSE Hours, Man- power, Total
Report Accident for all employee of
Contractor and All
SubContractor
Health Program of RDMP Project
25 Conduct General Medical Check-up for all Project HSE Plan General Medical All employee of Contractor Result of General Medical As required Project Manager and
new employee of Contractor Check-up Form assigned to the Project Check-up Construction Manager, Health
Coordinator
26 Conduct General Medical Check-up for Project HSE Plan General Medical All employee of Sub Contractor Result of General Medical As require CM, Medical Advisor
Sub Contractor Supervisor to Up level Check-up Form Supervisor to Up level who Check-up
assign to the Project
27 Conduct General Medical Check-up for all Project HSE Plan General Medical All employee of All Sub Result of General Medical As require CM, Medical Advisor
Sub Contractor employee Contractor Check-up
Check-up Form
employee who assign to the
Project
28 Vital Check for high risk worker Project HSE Plan Vital Check Blood pressure check for high Daily check for high risk Daily Medical Advisor & HSE Chief
risk worker worker, no indication of
high blood pressure
Incident Injury Free® Program
RDMP BALIKPAPAN JO
29 To implement IIF® program to the entire Project HSE Plan IIF® Program Engage JMJ, start implement Activitities report as required (see PM, CM, HSE Chief or HSEM
EPC RDMP Balikpapan Project IIF ® Program at RDMP (Training attendees, attached table)
Balikpapan Project observation etc)
RDMP BALIKPAPAN JO
ENVRONMENTAL PROGRAM
NO ENVIRONMENTAL ACTIVITY PLAN / PROCEDURE / APPENDIX WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY PRIMARY RESPONSIBILITY
Control the schedule waste - Master List and inventory of As required CM, Discipline Superintendent,
management (Hazardous Chemical scheduled waste, - Storage of HSE Chief
Material) and provide MSDS at site. hazardous waste, - COMPANY
for handling waste schedule
must registered by
1 Waste Management Control Project HSE Plan
Government.
Control the non-schedule waste Weekly monitoring form Weekly HSE Chief, Discipline
through organic and non-organic completed Superintendent
waste
2 Liquid Spill Control Project HSE Plan Provide oil container and oil traps by Monitoring form completed Monthly CM, HSE Chief
the site drainage
3 Communicate Contractor Project HSE Plan All project Contractor staff, Induction record, Record As required CM, HSE Chief
Environmental Policy & Procedure SUBContractor staff and visitor daily tool box meeting,
minute of meeting and
attendance all HSE Meetings
4 Ensuring that operations are carried Project HSE Plan Developing environmental standard Standard instruction is All works shall covered Site Supervisor, HSE Chief
out according to environmental instruction or review existing or developed, communicated by standard instruction
standard template environmental standard and maintained
instruction to be suited to the work
5 Conduct accident investigation and Project HSE Plan All major and minor accident Complete accident and As per event for CM, Discipline Superintendent,
reporting investigation form investigation and 1 x 24 HSE Chief
hours for accident
reporting
6 Rules & Regulation at site: use drug Project HSE Plan All project Contractor staff, Result of monitoring Monthly CM, HSE Chief
and alcohol and carry weapon SUBContractor staff and visitor
7 Encourage behavior awareness Project HSE Plan All unsafe act and unsafe condition Complete unsafe act and Every Day All Project Team
unsafe condition form
ATTACHMENT 6. PPE MATRIX
PPE Minimum Welding Grinding Excavation Rigging Electrical Confined Space

ANSI Z89.1 - 2003, Type I ANSI Z89.1 - 2003, Type I class ANSI Z89.1 - 2003, Type I ANSI Z89.1 - 2003, ANSI Z89.1 - 2003, Type I
ANSI Z89.1 2003, Type I ANSI Z89.1 - 2003, Type I
Helmet (yellow color)
class G and E G and E class G and E Type I class G and E class G and E class E class G and E
Safety Glasses ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003
SNI Standard or ASTM F SNI Standard or ASTM F 2413- SNI Standard or ASTM F SNI Standard or ASTM SNI Standard or ASTM F
ASTM F 2413-2005 Impact SNI Standard or ASTM F
2413-2005 Impact 2005 Impact 2413-2005 Impact F 2413-2005 Impact 2413-2005 Impact Resistance Class 75 (I/75) 2413-2005 Impact
and Compression
Resistance Class 75 (I/75) Resistance Class 75 (I/75) and Resistance Class 75 (I/75) Resistance Class 75 Resistance Class 75 (I/75) Resistance Class 75 (I/75)
Resistance Class 75
and Compression Compression and Compression (I/75) and Compression and Compression and Compression
(C/75) with
Resistance Class 75 Resistance Class 75 Resistance Class 75 electrical protection such Resistance Class 75
Resistance Class 75 (C/75) Resistance Class 75 (C/75)
(C/75) (C/75) (C/75) as (C/75)
Safety Shoes
o Electric shock resistance
(EH) up to 14,000 V or
o Static Dissipative (SD),
106 ohms - 1010 ohms
or
o Conductive (CD), 0-
500,000 ohms
- ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for NRR - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for
NRR labeling labeling NRR labeling NRR labeling NRR labeling NRR labeling NRR labeling
Ear Plug
- ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for NRR - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for
NRR testing testing NRR testing NRR testing NRR testing NRR testing NRR testing
- ANSI S3.19 - 1974 for
NRR labeling
Ear Muff
- ANSI S12.6 – 1997 for
NRR testing
NIOSH Title 42 CFR 84-
Respiratory Protection NIOSH Title 42 CFR 84-1995
1995
ANSI Z87.1 - 2003 - High
Face Shield
Impact Level Protection
ANSI Z87.1 2003 - High Level
Welding Helmet
Protection
SCBA NIOSH Title 42-1995
SABA NIOSH Title 42-1995
ASTM D 120–2006
EN407–2004 for flammability, EN407–2004 for
Specification for Rubber
contact heat, flammability, contact heat,
Insulating
Hand Protection N/A convective heat, radiant heat, convective heat, radiant
Gloves (electrical)
small splashes heat, small splashes
molten metal or large splashes molten metal or large
of molten metal splashes of molten metal
ANSI Z359.1: Safety
Requirements for Personnel ANSI Z359.1: Safety Requirements for Personnel Fall
Fall
Fall Protection
Arrest Systems,
Subsystems and Arrest Systems, Subsystems and Components (MANDATORY ONLY FOR WORKING ABOVE 6 FEET)
Components
Coverall Coveralls Grey Color (100% cotton) with stripe scotchlight shall be worn by all worker and company Name (at front and back of coveralls)
ATTACHMENT 7. INCIDENT PROCESS FLOWCHART
INCIDENT TITLE: DATE OF INCIDENT: INCIDENT LEADER: INCIDENT NO:
1. VISIT SCENE 1. Check Investigator’s Safety All Wearing PPE, protect Information at scene, JSA of investigation site
Continue Collecting Evidence
1.
2. PROTECT 2. Gather evidence that might disappear from rain of work activities
2.
3. SELECT TEAM 3. Based on investigation team matrix
3.
4. Information Collection
People, Equipment, Environment, Systems:
Induction/training records Inspections / audit records Maintenance schedules and

procedures
4. COLLECT License/Certificates of Manufacturer equipment manual Operating manual
INFORMATION competency
Permits Purchasing records, warranties etc Procedures / rules
Checker MSDS Other authorities reports

(Police, client)
4.
5.a Incident Description,what happened , who Injured/Involved, time of incident,
5. SEQUENCE OF
EVENTS
5.a Incident description
5.b. Organize information collected to display full

Go back in time
of events
Review what else needs investigating Start thinking what contributed
5.b. Place Information on a whiteboard
6. Start with Stop when the information

“What Happened” is: Record realistic
Trivial causes
and repeatedly ask
Too timely & costly to Keep asking:
6. DEVELOP Y Why? Review list of
collect What has
TREE potential causes
Gone far enough to make a changed?
realistic recommendation Be specific
Scrap potential causes if Cross link causes
not supported
6.Place Information on a whiteboard

7. PLAN FURTHER 7. Investigate undecided/unknown items that are from the Sequence of Events and the Y Tree.
INVESTIGATION
7. What else needs investigating?
8. UPDATE SEQUENCE 8. Rearrange or add to sequence of events if required

& Y TREE
8.Update both Sequence and Y tree using “post it”
9. All answers on the Y Tree are contributing factors.
9. DETERMINE Must know determine which are the main factors to highlight in the report and undertake Corrective
CONTRIBUTING actions. Focus on those factors for which:
FACTORS The incident would not have happened if the factors were not present
There are practical actions to prevent recurrences
9. List contributing factors

10. Brainstorm ideas
§ Seek expert advise
10. ACTION FOR § Apply quick fixes until long term solutions are available
ADRESSING § Test the actions:
CONTRIBUTING Critically - Timing - Cost - University* - Responsibility - Alternatives
FACTORS (Each contributing factor must have one or more actions)
* When required third party consultation
10. List actions for each contributing factors and By Who? And By When?
11. Conduct review to ensure all the facts are correct and everyone is in agreement with the findings
11. SITE REVIEW
and proposed actions
11. List names of people in review
12. PRODUCE REPORT

1) Cover Page 5) Background 9) What controls were in
2) Executive Summary 6) InvestigationPlan place
3) Keyrecommendations 10) Action
4) Investigation team 7) Incident Description 11) Attachments
8) Incident Causes 12) Use standard headings
Attach photos, permits,
training records, etc
12.
ATTACHMENT 8. HSE Organization Chart
Change Management Request Form
ATTACHMENT 9. CHANGE MANAGEMENT REQUEST FORM

CHANGE MANAGEMENT REQUEST FORM
Describe the Proposed Change:
Company/Department: Date:
Change Initiator:
STEP 1: CHANGE DETERMINATION
No. Determine nature of the change. Does the proposed change: Y N N/A
1 Alter existing or introduce new plant and/or equipment?
2 Any change to a Contractors or Sub Contractors SoW?
3 Alter existing or introducing of a new Safe System of Work?
4 Modify material used (i.e. properties, composition, etc.)?
5 Introduction or Change to a fixed alarm and set point?
6 Alter the organisation structure, roles and responsibilities?
7 Any change to the operating controls or DCS logic philosophy?
Alter or add processes, plant or equipment requiring new skills, knowledge or
8
procedures.
9 Alter programmable electronic software and settings?
10 Alter the design/plan/layout of roads, excavations, services and facilities?
Alter the ergonomics specifications of the equipment, plant or activity (i.e. weight
11
to be lifted, pressure exerted, posture, etc.)?
12 Affect the emergency response and ability to raise alarm?
Increase levels of exposure to temperature, noise, dust, fumes, gas and/or
13
vibration generated?
14 Create new environmental emissions eg dust, noise, waste, sediment?
15 Alter land use (disturbance of mining, non-mining and rehabilitated areas)?
16 Alter energy use or greenhouse gas emissions?
17 Alter the impact to community (i.e. lighting, noise, dust, etc.)?
18 Require new or modified approvals, licenses or permits?
19 Be in conflict with any company or legislative requirements?
If one or more “yes” boxes are ticked, then the change management form is to be completed.
1 of 6
STEP 2: ASSESS THE RISK

· Using the ADVERSE IMPACT OF CHANGE MATRIX, rank each impact type:
Change Impact Type N/A Minor Serious Major

Impact on safety/harm to people
Environmental impact
Impact on Schedule
Cost Impact
Impact on Reputation
Impact on Community
Legal impact
Change Risk Category RISK ASSESSMENT REQUIREMENTS (Results to be attached)

1. JSA to be re-reviewed and re-written to incorporate with
LOW
the change occur.
2. Requirements 1 and method statement may need to be
MEDIUM
provided and approved.
3. Requirements 2, Conduct a Risk Assessment Workshop
HIGH
and Prepare Action Plan.
Comment on the risks of undertaking this change.
Comment on the risks of not undertaking this change.
STEP 3: DETAILS OF THE CHANGE

Describe the reasons for change, providing hard evidence to support the need/opportunity.
Describe the benefits of this change.
2 of 6
When does the change need to take place and why?
STEP 4: COMMITMENT AND APPLICATION
List any Technical Experts that need to be consulted on the proposed change.
List the people/groups that need to be consulted on the proposed change?
List the people that need to commit to the process.
List systems, policies, procedures, plans, schedules, competencies, etc this change effects.
3 of 6
STEP 5: ACTION PLAN

· See back of document for detailed action plan.
SUBMISSION
CHANGE INITIATOR:
Print name in full Signature Date
STEP 6: APPROVAL
STAGE 6.1
TECHNICAL EXPERT (HIGH RISK)

STAGE 6.2
CHANGE AUTHORIZER: (BASED ON THE LEVEL OF RISK)
DISCIPLINE SUPERINTENDENT (LOW RISK)

CONSTRUCTION MANAGER (MEDIUM RISK)

PROJECT MANAGER (HIGH RISK)
4 of 6
ADVERSE CONSEQUENCE OF CHANGE MATRIX
Change
Minor Serious Major
Consequence Type
Serious
Impact on safety/harm Single or multiple
Low level injury/permanent
to people Permanent loss of fatalities or
symptoms disability or
working ability, irreversible
requiring first aid impairment to one
irreversible impacts to multiple
treatment only. or more persons.
damage. Localised people.
Working conditions Serious reversible
outbreak of Widespread
causing discomfort health effects
infectious disease outbreak of
or strain. requiring medical
infectious disease.
treatment.
Localised medium
Environmental impact Wide spread /
Limited damage term damage to an
significant long Significant,
contained to a area of local value
term damage to extensive &
localised area, with reversible with
valued area, permanent impact.
no lasting impact. medium term
reversible with Loss of permit to
Nuisance local remediation.
long term operate. Loss of
impact (eg dust, Directive from
remediation. endangered
noise) with no regulator resulting
Suspension of species.
complaints. from nuisance
operations.
impacts.
Impact on Schedule < 1 day 1-4 weeks 4-12 weeks > 12 weeks
< $100,000 $500,000 to $5,000,000 to >$25,000,000

Cost Impact
$5,000,000 $25,000,000
Attention from
Impact on Reputation Significant
Minor technical media, negative
Prolonged negative
non-compliance local & regional negative attention,
international
resolved within one publicity. national publicity.
publicity.
week. Moderate or Reputation
Reputation
No media Serious breach of tarnished.
severely tarnished.
coverage. regulations with Legal action.
fine.
Ongoing social
Impact on Community Very serious social
issues.
Ongoing serious impacts.
Local public Aggressive
social issues. Irreparable damage
concern / community
Repairable damage to high value items
complaints. reaction.
to high value items of social
No compensation Suspension of
of social significance.
required. project works.
significance. Government
External arbitration
intervention.
required.
Serious breach of Significant
Legal impact Minor non-
regulation with Major breach of prosecution and
compliances and
prosecution or regulation. Major fines. Very serious
breaches of
moderate fine litigation. litigation including
regulations.
possible. class action.
LEGEND: LOW
MEDIUM
HIGH
5 of 6
ACTION PLAN
· All agreed actions are to be entered into Code No. for tracking.
· Each action plan is required to have an action to review the effectiveness of the change at an agreed period following the change.
# Change item Nature of item and change Action review effectiveness Who When Code No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
6 of 6
ATTACHMENT 10 HAZARD IDENTIFICATION RISK ASSESMENT & CONTROL (HIRAC)
HIRA Registration No. : Prepared by: Reviewed by: Reviewed by: Reviewed by: Approved by : Risk Category
Revision No. :
EXTREME HIGH RISK 15 - 30

Revision Purpose :
HIGH RISK 8 - 12
Project Name : RDMP Project MEDIUM RISK 4-6
Date : LOW RISK 1-3
Total Page Number :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Risk Identification Legal Initial Risk Value Residual Risk

Operation Potency of Major
Source of Introduction Incident
No Process / Activities Condition HS E No. Regulation Hierarcy of Control Existing Control Additional Control Planned PIC
Activity Hazard Category Tot Tot
(N/A/E) Consequency S P R S P R
Hazard/Aspect Detail Risk Explanation Consequency Category Hazard Code Score Score
H OS E PS Y/N Y/N Y/N
10
ATTACHMENT 11
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071

REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-
V BALIKPAPAN PROJECT JSA Number / NomorJSA : RDMP / JSA / ……………….. / …………………
Company : Prepared By Review by Approved by

Project : RDMP Balikpapan RU V SPV Chief/MGR HSE CM
Person in charge name : NAME
Position/ Title job : SIGNATURE
Job activity :
Date : DATE
Sequence of Basic Job Consequence / Risk Assessment* Result Risk*)

Hazard Risk Recommendation action
NO Steps severity
Bahaya Resiko PR SV RR Tindakan Pengendalian PR’ SV’ RR’
Tahapan pekerjaan Akibat
Risk Rangking (RR) Recommendation Action

Severity / consequence Tingkat Risiko TindakanPengendalian
Probability (PR) x =
Keparahan
Score Level Tingkat pengendalian Hierarchy of Control
Frequent =5 Catastrophic = 5 19-25 Extreme high E= 1+2+3+4+5 1= Eleminasi
Probable = 4 Major = 4 13-18 High H= 3+4+5 2= Substitusi
Occasional = 3 Moderate / serious = 3 6-12 Medium M= 4+5 3= REKIND technik
Unlikely = 2 Minor = 2 1-5 Low L=5 4= Administrasi
Improbable = 1 Negligible = 1 5= APD
Note : * : Without Control / Tanpa control *): With Control / Dengan control
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071

REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-
V BALIKPAPAN PROJECT JSA Number / NomorJSA : RDMP / JSA / ……………….. / …………………
DAFTAR PENJELASAN JSA

Tanda Tangan
No Nama Posisi
Tgl : Tgl : Tgl : Tgl : Tgl : Tgl : Tgl :
ATTACHMENT 12
JOB HAZARD ANALYSIS (JHA)
Job No.: 26071 Rev.000
Company : Job Location :

SV/Foreman Name : Job :
Position/ Title job : Description
Job Location :
Date : Approved by :
Revision : (SV/Foreman
Signature)
In case of emergency condition and/or incident, the following people will be

contacted:
1. SV/Foreman Name Phone No.:
2. Phone No.:
3. Phone No.:
Job Steps/Sequences Potential Hazard(s) Recommended Action
On what conditions, job changes or distraction will this activities temporarily stop?

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Doc. No.

Job No.: 26071 Rev.002

PROJECT HSE PLAN

LOCATION : Refinery Unit V Balikpapan, East Kalimantan, Indonesia

OWNER : PT. PERTAMINA (Persero)

00B 12 June 19 RE-ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM

00A 16 April 19 ISSUED FOR REVIEW YUZAR ISPRANTO Y.D.KIM

REV. DATE DESCRIPTION PREPARED CHECKED APPROVED

Job No.: 26071 Rev.002

REV. NO. DATE PAGE DESCRIPTION

00A 16 April 19 - Issued for review

Job No.: 26071 Rev.002

List of Tables ................................................................................................................................................... vi

List of Figures .................................................................................................................................................. vi

4. DEFINITIONS AND ABBREVIATIONS ......................................................................................................... 2

6. LEADERSHIP AND COMMITMENT ............................................................................................................ 7

7. RISK MANAGEMENT .............................................................................................................................. 13

8. MANAGEMENT OF CHANGE (MOC) ....................................................................................................... 16

9. PRE-MOBILIZATION MANAGEMENT ...................................................................................................... 19

Job No.: 26071 Rev.002

MANPOWER READINESS ..................................................................................................................... 19

10. SUBCONTRACTOR MANAGEMENT......................................................................................................... 20

11. TRANSPORTATION MANAGEMENT ....................................................................................................... 22

12. HEALTH MANAGEMENT ........................................................................................................................ 24

13. ENVIRONMENTAL MANAGEMENT ......................................................................................................... 31

14. OPERATING PROCEDURES AND SAFETY STANDARDS ............................................................................ 32

Job No.: 26071 Rev.002

CONFINED SPACE ................................................................................................................................ 35

15. TRAINING AND COMPETENCY ............................................................................................................... 56

Job No.: 26071 Rev.002

TRAINING PROVIDER ........................................................................................................................... 58

17. STOP WORK AUTHORITY (SWA) ............................................................................................................ 64

18. EMERGENCY RESPONSE PROCEDURE .................................................................................................... 65

19. INCIDENT INVESTIGATION ..................................................................................................................... 67

20. PERFORMANCE EVALUATION ................................................................................................................ 68

21. ATTACHMENTS ...................................................................................................................................... 71

Job No.: 26071 Rev.002

Attachment 1. Project HSE Policy ..................................................................................................................... 71

Job No.: 26071 Rev.002

Job No.: 26071 Rev.002

4. DEFINITIONS AND ABBREVIATIONS

Contractor : Joint Operation (JO)

Simper Driver License only in RU V Pertamina

Hazard : Dangerous condition, potential or inherent which either has

Job No.: 26071 Rev.002

SIMOPS : Simultaneous Operations, is two different or more activities

Job No.: 26071 Rev.002

PROJECT : RDMP Project

Job No.: 26071 Rev.002

7. Regulation of Indonesian Government No. 50 / 2012 regarding Implementation of

Job No.: 26071 Rev.002

Job No.: 26071 Rev.002

6. LEADERSHIP AND COMMITMENT

STRATEGIC OBJECTIVES AND KPI’s

a) Zero Lost Time Incident

b) Zero Total recordable incident

c) Zero significant environmental incident

d) Zero sabotage case

Job No.: 26071 Rev.002

NO ITEM KPI MEASUREMENT TARGET REMARKS

Job No.: 26071 Rev.002

ROLES AND RESPONSIBILITIES

6.3.1. PROJECT DIRECTOR

6.3.2. PROJECT MANAGER