(4210-GP-13-01) Prosedur CSMS_ Rev J.doc

PT. REKAYASA INDUSTRI

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CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

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Doc. No : 4210-GP-1301 Date : 1/2/2010

Rev : J Page : 1 o 38

C!RP!RA"E PR!CED#RE CONTRACTOR SAFETY MANAGEMENT SYSTEM

APPR!$ED %Y E&EC#"'$E $'CE PRES'DEN" P!R"(!)'!

CODDY SOERONO

RE$'E*ED %Y PR!JEC" SER$'CES $'CE PRES'DEN" DAFRIS DJINIK PREPARED %Y GENERA) +ANAGER QC-HSE DUDI GUNARDI

Revision Record Rev

Date

Responsible Person

! C D E F G ( I J

"#$%#&' %&#*#&+ $,#-#&+ %+#"#&+ $+#$#&. %*#-#&. %,#*#&" $,#+#&" 1/2/10

DADANG ASIKIN DUDI GUNARDI DUDI GUNARDI DUDI GUNARDI DUDI GUNARDI DUDI GUNARDI DUDI GUNARDI DUDI GUNARDI DUDI GUNARDI

Description o revision See See See See See See See See See

(istorical on Pa)e % (istorical on Pa)e % (istorical on Pa)e % (istorical on Pa)e % (istorical on Pa)e % (istorical on Pa)e % (istorical on Pa)e % (istorical on Pa)e % Historical on Page 2

Distrib/tion 0ist 1. Co,o,ate St,ateg G,o

. S%# Ree,  Pet,oce5ca6

2. 'te,a6 A7t  Co56ace G,o

8. S%# Po,to6o

3. S%# Geote,5a6

9. EPC !e,ato #t

4. S%# +e, +e,a6 a6 Ev,o Ev,o5e 5eta ta66 a7 a7 ',a;t ',a;t, ,ct ct,e ,e

<. P,o=ec P,o=ectt Se,v Se,vce; ce; #t #t

>. S%# Ga;

10. Sa,e7 Se,vce; #t

Controlled Copy Do Not D!plicate #nly

"or Internal Interna l Used


CORPORATE PROCEDURE


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Doc. No : 4210-GP-1301 Date : 1/2/2010


Document Change C hange History Histor y

Rev.

Date

A

3/06/05

Change Description

REV. A Initial Release This Document han!e "ecause o# chan!e st$uctu$e content content o# this %$oce&u$e' %$oce&u$e' (ast Re)ision *as Re)+A Doc. ,o -210++13+01 Date 3+6+2005 as an initial $elease.

B

9/12/05



20/3/0

A&& some *o$& an& uestione$ #o$ #a"$icato$. All the $e)ie* Italic o$&.

D

1-/3/0

Re)ie* in 4i!h Ris ate!o$ an& (o* Ris ate!o$ *ith Italic Boa$&.

E

2/9/0

A&& list o# $e#e$ence' $e)ie* #lo* cha$t #o$ 7 an& assessment %$ocess in %a!e 1 o# attachment 1' a&& stan&a$& sca##ol&in! on %a!e 3 o# attachment - an& a&& health $eui$ement on %a!e 6 o# attachment -. All the $e)ie* item *ith Italic o$&.



1/01/08

A&& A&& #a"$ #a"$ic icat ato$ o$ sco$ sco$in! in! sst sstem em on %a!e %a!e 5' a&& a&& some some clau clause se VI VI : VI VI in Atta Attachm chment ent+IV +IV 4;E 4;E Reu Reui$e i$eme ment nt o$ o$ ;u"c ;u"con ont$a t$act cto$ o$'' an& an& a&& a&& Atta Attachm chment ent 8 o$*a$&e$ 4;E 7uestione$ an& Attachment+9 o$*a$&e$ 4;E Bi& E)aluation. All the $e)ie* item *ith Italic o$&.



23/06/08

Re)ie* in Attachment+IV su" "a" -< A&& 1 sa#et man su%e$)ise 50 em%loees' su" "a" 9 E< mo$e than 2 m' *ea$in! #ull "o& ha$ness. The enti$e $e)ie* item *ith Bol& an& Italic o$&.

2-/03/09

Re)ie* in su" "a" VI' ;election $ocess' Re)ie* in attachment 3 su"cont$acto$ 4;E "i& e)aluation' Re)ie* Re)ie* in attachment - 4;E Reui$ement #o$ su"+cont$acto$ in su" "a" VII.-' V an& a&& su" "a" VII an& VIII' Re)ie* in attachment 6 a"$icato$ 4;E Bi& E)aluation an& attachment 9 a"$icato$ 4;E Bi& E)aluation. The enti$e item *ith Bol& an& Italic o$&.

I

22/06/09

han!e &ocument num"e$in! sstem "ecause o# chan!e attachment %a!e num"e$ "ase& on Doc. ,o. 1100++01+06 Re). Re). B. han!e =uncont$olle& co%> to =cont$olle& co%' &o not &u%licate> =;election %$ocess> to Rincian $ose&u$ a&& =#o$ inte$nal inte$nal use& use& onl>' onl>' a!e a!e num" num"e$ e$.. A&& Doc Doc ,um"e$ ,um"e$ in Re#e Re#e$en $ence ce an& Title Title o# o)e$nment Re!ulation.

J

1/2/10

Add Tools and Equipment requirement, page 20. List HSE Budget for Su!ontra!tor, page "# of atta!$ment 10. Add %%E requirement& Safet' (lasses, )otton (lo*e, Long Slee*es, page 1+.

4

han!e &ocument num"e$in! to a&o%t ne* o$!aniation co&in! num"e$ &ue to co$%o$ate $est$uctu$in! %$o!$am.




CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

PROJECT SERVICES

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Doc. No : 4210-GP-1301 Date : 1/2/2010


Document Change C hange History Histor y

Rev.

Date

A

3/06/05

Change Description

REV. A Initial Release This Document han!e "ecause o# chan!e st$uctu$e content content o# this %$oce&u$e' %$oce&u$e' (ast Re)ision *as Re)+A Doc. ,o -210++13+01 Date 3+6+2005 as an initial $elease.

B

9/12/05



20/3/0

A&& some *o$& an& uestione$ #o$ #a"$icato$. All the $e)ie* Italic o$&.

D

1-/3/0

Re)ie* in 4i!h Ris ate!o$ an& (o* Ris ate!o$ *ith Italic Boa$&.

E

2/9/0

A&& list o# $e#e$ence' $e)ie* #lo* cha$t #o$ 7 an& assessment %$ocess in %a!e 1 o# attachment 1' a&& stan&a$& sca##ol&in! on %a!e 3 o# attachment - an& a&& health $eui$ement on %a!e 6 o# attachment -. All the $e)ie* item *ith Italic o$&.



1/01/08

A&& A&& #a"$ #a"$ic icat ato$ o$ sco$ sco$in! in! sst sstem em on %a!e %a!e 5' a&& a&& some some clau clause se VI VI : VI VI in Atta Attachm chment ent+IV +IV 4;E 4;E Reu Reui$e i$eme ment nt o$ o$ ;u"c ;u"con ont$a t$act cto$ o$'' an& an& a&& a&& Atta Attachm chment ent 8 o$*a$&e$ 4;E 7uestione$ an& Attachment+9 o$*a$&e$ 4;E Bi& E)aluation. All the $e)ie* item *ith Italic o$&.



23/06/08

Re)ie* in Attachment+IV su" "a" -< A&& 1 sa#et man su%e$)ise 50 em%loees' su" "a" 9 E< mo$e than 2 m' *ea$in! #ull "o& ha$ness. The enti$e $e)ie* item *ith Bol& an& Italic o$&.

2-/03/09

Re)ie* in su" "a" VI' ;election $ocess' Re)ie* in attachment 3 su"cont$acto$ 4;E "i& e)aluation' Re)ie* Re)ie* in attachment - 4;E Reui$ement #o$ su"+cont$acto$ in su" "a" VII.-' V an& a&& su" "a" VII an& VIII' Re)ie* in attachment 6 a"$icato$ 4;E Bi& E)aluation an& attachment 9 a"$icato$ 4;E Bi& E)aluation. The enti$e item *ith Bol& an& Italic o$&.

I

22/06/09

han!e &ocument num"e$in! sstem "ecause o# chan!e attachment %a!e num"e$ "ase& on Doc. ,o. 1100++01+06 Re). Re). B. han!e =uncont$olle& co%> to =cont$olle& co%' &o not &u%licate> =;election %$ocess> to Rincian $ose&u$ a&& =#o$ inte$nal inte$nal use& use& onl>' onl>' a!e a!e num" num"e$ e$.. A&& Doc Doc ,um"e$ ,um"e$ in Re#e Re#e$en $ence ce an& Title Title o# o)e$nment Re!ulation.

J

1/2/10

Add Tools and Equipment requirement, page 20. List HSE Budget for Su!ontra!tor, page "# of atta!$ment 10. Add %%E requirement& Safet' (lasses, )otton (lo*e, Long Slee*es, page 1+.

4

han!e &ocument num"e$in! to a&o%t ne* o$!aniation co&in! num"e$ &ue to co$%o$ate $est$uctu$in! %$o!$am.




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Doc. No : 4210-GP-1301 Date : 1/2/2010


TABLE OF CONTENT

a!e I.

?R@;E

-

II.

;@E

-

III.

DEI,ITI@,

-

IV. IV.

REERE,E

-

V.

RE;@,;IBI(IT

-

VI.

DETAI(ED R@ED?RE

-

ATTA4E,T< I.

(@ 4ART R@E;; RE+7?A(IIATI@, / A;;E;;E,T

6

I I.

;?B@,TRAT@R 4;E RE+7?A(IIATI@, / A;;E;;E,T 7?E;ITI@,ER



III .

;?B@,TRAT@R 4;E BID EVA(?ATI@,

11

IV.

4;E RE7?IREE,T @R ;?B@,TRAT@R

13

V.

ABRIAT@R 4;E RE+7?A(IIATI@, / A;;E;;E,T 7?E;TI@,ER

2-

VI.

ABRIAT@R 4;E BID EVA(?ATI@,

28

VII. VII.

;?B@ ;?B@,TR ,TRAT AT@R @R 4;E CE ER@R ER@RA A,E ,E I,DI I,DIA AT@ T@R R %lea %lease se $e#e $e#e$$ to 4;E #o$m Doc ,o. 4;E++.1F

VIII.

@RARDER 4;E RE+7?A(IIATI@, / A;;E;;E,T 7?E;TI@,ER

30

I.

@RARDER 4;E BID EVA(?ATI@,

3-

.

4;E B?DET @R ;?B@,TRAT@R

36




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I.

Doc. No : 4210-GP-1301 Date : 1/2/2010

Rev : J Page : - o 38

!RO"E

This %$oce&u$e is a sstem #o$ selectin! a su"+cont$acto$ in te$ms o# 4;E sstem. The main o"Gecti)e o# this %$oce&u$e is to select an& choose a su"+contacto$ *hich has a %$o%e$ 4;E sstem' so that the %$o"a"ilities o# all in&s o# acci&ents that *ill a##ect %$o%e$ties' en)i$onment' an& %e$sonnel &u$in! eHecution o# *o$ can "e $e&uce&. II.

"COE

This %$oce&u$e *ill "e im%lemente& #o$ selectin! a su"+cont$acto$ #o$ eHecutin! a s%eci#ic *o$ %aca!e in an E %$oGect such as< i%in!' echanical' ;teel ;t$uctu$e' Elect$ical' Inst$ument' Insulation' ilin!' hemical leanin!' ,DT' +Ra' 4ea) A**a$& @)e$sie 4A@F' Dan!e$ous a$!o T$ans%o$t' Roo#in! an& ;i&in!' encin!' i)il' aintin!' a)ement' Dee% ell o$ an& ene$al a$!o T$ans%o$t. III.

DEFINITION

All lea$. I#.

REFERENCE

+

o$%o$ate olic ene$a%an ;istem anaGemen Ceselamatan' Cesehatan Ce$Ga &an (in&un!an (in!un!an . Doc. ,o -200+(+13

+

$oce&u$e o# Bi&&e$ (ist ;election. Doc. ,o -220++--+0-

+

?? ,o.1 190 ?n&an! ?n&an! tentan! Ceselamatan Ce$Ga

+

@4;A; 18001<1999

+

an%o*e$ iniste$ ente$i Tena!a Ce$GaF Re!ulation ,o. e$.02/E,/1980.

#.

RE"ON"IBILIT$

The $ocu$ement ene$al ana!e$ an& 7+4;E ene$al ana!e$ shall "e $es%onsi"le #o$ im%lementation o# this %$oce&u$e in co$%o$ate. The $oGect ana!e$' Ven&o$ ana!ement ana!e$' an& 4;E ana!e$ shall "e $es%onsi"le in assistin! the $ocu$ement ene$al ana!e$ an& 7+4;E ene$al ana!e$ #o$ im%lementation o# this %$oce&u$e in e)e$ %$oGect. VI.

DETAILED ROCED!RE

All su"+cont$acto$ an& #a"$icato$ must %ass the %$e+uali#ication / assessment %$ocess "e#o$e ente$in! the technical an& comme$cial assessment %$ocesses. The %$e+uali#ication %$ocess sta$ts #$om #illin! the 4;E $e+ 7uali#ication / Assessment 7uestione$ #o$m ;ee in Attachment 1' 2 an& 5F. 6.1

;u"+cont$acto$ ;co$in! ;stem

The minimum sco$e that must "e achie)e& " each su"+cont$acto$ to %ass the 4;E $e+7uali#ication / assessment is< Controlled Copy Do Not D!plicate #nly

"or Internal Used


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Doc. No : 4210-GP-1301 Date : 1/2/2010


 60< 4i!h Ris ate!o$ i%in! o$' echanical o$' ;teel ;t$uctu$e o$' Elect$ical an& Inst$ument' Insulation' ilin!' hemical leanin!' ,DT' +Ra' Roo#in! J ;i&in!' 4i!h Ris Buil&in! mo$e than 2 loo$F' EHca)ation' ommissionin! J $e+commissionin!' Blastin! J aintin!F. 35 : 59 < (o* Ris ate!o$ encin!' Dee% ell um%' Roa& a)ement' Tem%o$a$ ;ite @##iceF. a su"+cont$acto$' *hich &oes not %ass this assessment %$ocess can "e $e+a%%l minimum 3 month. 6.2

a"$icato$ ;co$in! ;stem

The minimum sco$e that must "e achie)e& " #a"$icato$ to %ass the 4;E $e+uali#ication / assessment is minimal 50. The )ali&it o# this assessment is t*o ea$s. 6.3

o$*a$&e$ ;co$in! ;stem

The minimum sco$e that must "e achie)e& " #o$*a$&e$ to %ass the 4;E $e+uali#ication / assessment is  50< 4ea) (i#t' Dan!e$ous a$!o T$ans%o$t' Inte$national o$*a$&e$K 35+50< (ocal T$ans%o$te$' an& ene$al a$!o T$ans%o$te$. The )ali&it o# this assessment is t*o ea$s.

6.-

Reco$& ;stem

All ;; $eco$& *ill "e $eco$&e& " 4;E o$%o$ate an& the )ali&it o# the assessment is 2 t*oF ea$s.


"or Internal Used


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Doc. No : ,%$&1GP1$*1 &$ Date : 1/2/2010


ATTA)HE-T 1& L )HAT  %E34AL55)AT5- / ASSESSE-T %)ESS


"or Internal Used


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Rev : J Page :  o 38

Start

$e%a$e 7uestione$ J ;ent to Ven&o$ ana!ement Attachment 2 / 5F B 4;E

Dist$i"ute to ;u"cont$acto$ / a"$icato$ Ven&o$ ana!ement

om%lete 7uestione$ J ;ent Bac to Ven&o$ ana!ement

;u"cont$acto$ / a"$icato$

Recei)e 7uestione$ J ;ent Bac to 4;E

Ven&o$ ana!ement

$e%a$e Bi& E)aluation Attachment 3 / 6F 4;E

Cee% @$i!inal 4;E

Do ,ot ass

Re)ie* in 3 month %e$io&


o% to Ven&o$ ana!ement 4;E Dist$i"ute to ;u"cont$acto$ / a"$icato$ Ven&o$ ana!ement

ass $eui$ement sco$e

Recommen&e& Bi&&e$ (ist

"or Internal Used


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ATTACH%ENT & "!BCONTRACTOR'" "AFET$( HEALTH AND EN#IRON%ENT )H"E* RE+,!ALIFICATION - A"E""%ENT ,!E"TIONNAIRE

$oGect

<

;u"cont$acto$Ls ,ame

<

;ection I 4;E olic an& (ea&e$shi% 1.

Does ou$ com%an ha)e an 4;E %olic &ocumentM A%aah %e$usahaan an&a mem%unai Ce"iGaan Ceselamatan Ce$Ga' Cesehatan &an (in!un!anM es

,o

I# es' %lease attach / Nia a' silahan untu &ilam%i$an. 2.

ho has o)e$all an& #inal $es%onsi"ilit #o$ 4;E in ou$ o$!anisationM ;ia%a an! "e$tan!!un! Ga*a" te$ha&a% Ceselamatan Ce$Ga' Cesehatan &an (in!un!an &i%e$usahaan an&aM

3.

ho is the most senio$ %e$son in the o$!anisation $es%onsi"le #o$ this %olic "ein! ca$$ie& out at the %$emises an& on site *he$e his em%loees a$e *o$in!M ;ia%a senio$ sta## &i %e$usahaan an&a an! "e$tan!!un! Ga*a" &alam im%lementasi e"iGaan ini &i %$oGect tem%at an&a "ee$GaM

;ection II ene$al @ $!anisation + ana!ement ; t$uctu$e / @$!anisation -.

ho has ultimate $es%onsi"ilit #o$ 4;E mana!ement in ou$ o$!anisationM ;ia%a an! "e$tan!!un! Ga*a" te$ha&a% mana!ement C3 &i %e$usahaan an&aM ,ame<

No" Title<

5.

lease attach a cu$$ent o$!anisation cha$t sho*in! $e%o$tin! $elationshi%s #$om ou$ hie# EHecuti)e @##ice$ to lo*est line mana!e$ / ;ilahan lam%i$an st$utu$ o$!anisasi %e$usahaan an&a mulai &a$i Di$etu$ ?tama sam%ai e ana!e$ @$!aniation cha$t attache&M es ,o

6.

Does a #ull time 4;E De%a$tment eHist in ou$ o$!anisationM A%aah De%a$tement C3 te$se&ia &i %e$usahaan an&aM es ,o

.

I# ans*e$ to 6 a"o)e is es' &o ou ha)e Go" &esc$i%tions #o$ the %e$sonsF em%loe& in ou$ 4;E De%a$tmentM Nia Ga*a"an no 6 a' A%aah %e$usahaan an&a mem%unai Go" &esc$i%tion te$ha&a% a$a*an &i De%a$tement C3.

8.

es ,o I# es' lease !i)e &etail the %osition an& $es%onsi"ilities Nia a' silahan lam%i$an &etail &a$i %osisi masin!+masin! a$a*an &an $es%onsi"ilitina. I# the ans*e$ to item  a"o)e is no' *ho is $es%onsi"le #o$ %$o)i&in! sa#et a&)ice an& monito$in! the im%lementation o# 4;E ana!ement ;stem at ou$ *o$ sites an& *hat is thei$ uali#icationM


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Nia Ga*a"an no. Ti&a a&a' sia%a an! "e$tan!!un! Ga*a" &alam mem"e$ian a$ahan C3 &an melauan monito$in! te$ha&a% im%lementasi C3 mana!ement sstem &item%at %e$usahaan an&a "ee$Ga &an a%a uali#iasi o$an! te$se"utM e$son Res%onsi"le < OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO 7uali#ication <

;ection III @$!anisin! #o$ 4;E + 4;E lannin! 9.

Do ou %$o&uce an 4;E lan #o$ each $oGectM A%aah an&a menia%an $encana %elasanaa C3 &an (in&un!an (in!un!an &i %$oGect iniM es ,o

10.

I# ans*e$ to 7uestion 9 a"o)e *as no' "$ie#l &esc$i"e ho* ou ensu$e that the $eui$e& 4;E ;stems a$e communicate& an& im%lemente& on time. Nia Ga*a"an an&a Ti&a' Nelasan "a!aimana an&a memastian C3 &an (in&un!an (in!un!an an! &isa$atan &a%at te$omuniasi &an &ilasanaan &en!an "ai.

;ection IV @$!anisin! #o$ 4;E + 4;E T$ainin! 11.

Do ou ha)e a 4;E T$ainin! at$iH #o$ ou$ em%loeesM A%aah %e$usahaan an&a mem%unai $encana t$ainin! C3 &an (in&un!an (in!un!an untu a$a*an an&aM es ,o

12.

I# the ans*e$ to 7uestion 11 a"o)e *as no' "$ie#l &esc$i"e ho* ou i&enti# an& im%lement 4;E T$ainin! #o$ ou$ sta##. Nia Ga*a"an no 11 Ti&a a&a' Nelasan "a!aimana an&a men!i&enti#iasi &an men!im%lementasi e"utuhan t$aininin! C3 &an (in&un!an (in!un!an untu a$a*an an&a.

13.

Do ou ha)e a #o$mal t$ainin! %$o!$amsF #o$ ;u%e$)iso$s thei$ $es%onsi"ilities in 4;E ana!ement as ;u%e$)iso$sM A%aah %e$usahaan an&a mem%unai %$o!$am t$ainin! untu sa#et su%$)iso$ M es

,o

1-.

I# the ans*e$ to item 13 a"o)e is es' "$ie#l &esc$i"e this %$o!$am an& *ho con&ucts this t$ainin!. Nia Ga*a"an no 13 a' Nelasan "a!aimana %$o!$am ini "e$Galan &an sia%a an! melauan t$ainin! te$se"ut.

15.

Do ou ha)e a #o$mal 4;E @$ientation $o!$amme #o$ ne* em%loeesM A%aah %e$usahaan an&a mem%unai $o!$am ;a#et @$ientation untu a$a*an "a$uM

es ;ection V @$!anisin! #o$ 4;E + 4;E $oce&u$e 16.

,o

Does ou$ om%an ha)e *$itten 4;E %$oce&u$esM A%aah %e$usahaan an&a mem%unai %$oce&u$e C3 &an (in&un!an (in!un!anM


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,o

I# ans*e$ to 7uestion 16 *as es' %lease attach 4;E $oce&u$e that ou ha)e. Nia Ga*a"an no.16 a' ;ilahan lam%i$an %$oce&u$e C3 &an (in&un!an (in!un!an an! %e$usahaan an&a %unai.

;ection VI ana!in! 4;E + Acci&ent e$#o$mance easu$ement 18.

Do ou measu$e en)i$onmental %e$#o$manceM A%aah %e$usahaan an&a men!uu$ %e$#o$mance lin!un!anM es

,o

I# es' state *hat an& ho* Nia a' Nelasan a%a an! &i uu$ &an Ba!aimana hatM 4o*M 19.

Do ou ee% Acci&ent/Inci&ent ;tatistics #o$ ou$ Em%loeesM A%aah %e$usahaan an&a menim%an statistic ecelaaan te$ha&a% a$a*an an&aM es ,o

20.

I# the ans*e$ to item 19 a"o)e is es' "$ie#l &esc$i"e the Acci&ent/Inci&ent ;tatistics ou ee% an& the analsis ou %e$#o$m on these. Nia Ga*a"an no 19 a' Gelasan Genis ecelaaan an! an&a muat &i statistic te$se"ut.

21.

Do ou ee% Acci&ent/Inci&ent ;tatistics on ou$ ;u"cont$acto$sM A%aah %e$usahaan an&a mem%unai statistic ecelaaan te$ha&a% su"cont$acto$ an&aM es ,o ;ection VII ana!in! 4;E + onito$in! an& Im%$o)ement 22.

Do ou$ ;enio$ ana!ement use an 4;E Au&it an& Ins%ection %$ocess at the *o$ siteM A%aah senio$ mana!ement an&a melauan au&it C3 &an (in!un!an &an melauan ins%esi te$ha&a% tem%at an&a melasanaan %ee$GaanM es

,o

;ection VIII u$$ent 4;E ;tatistical In#o$mation 23

lease %$o)i&e the #ollo*in! in#o$mation< AF

;ection I

lease %$o)i&e ou$ statistical 4;E e$#o$mance #o$ 3 last ea$s< (am%i$an statistic ecelaaan C3 &an (in!un!an untu 3 tahun te$ahi$

e$sonnel $otecti)e Eui%ment

2-.

Do ou %$o)i&e a%%$o%$iate %e$sonal %$otecti)e eui%ment EF #o$ ou$ em%loeesM lease %$o)i&e a listin! o# the E #o$ the sco%e o# this *o$M A%aah %e$usahaan an&a menia%an alat %elin&un! &i$i untu a$a*an %e$usahaan an&aM ;ilahan list alat %elin&un! &i$i an! aan an&a sia%an untu %ee$Gaan iniM

25.

Do ou ha)e a %$o!$am to ensu$e that E is im%acte& an& maintaine&M


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A%aah %e$usahaan an&a mem%unai %$o!$am %emeliha$aan alat %elin&un! &i$iM ;ection 

4aa$&s an& E##ect En)i$onmental ana!ement

26.

lease %$o)i&e the num"e$ o# acci&ent $esultin! in en)i$onmental &ama!e in the amount !$eate$ than P 50'000 #o$ the last 2- months. Attach co%ies o# an !o)e$nmental $e%o$ts su"mitte& (am%i$an ecelaaan lin!un!an an! %e$usahaan an&a te$ima &en!an Gumlah e$u!ian le"ih &a$i R%. 500.000.000 untu &ua tahun te$ahi$.

2.

ho is the %e$son in cha$!e #o$ coo$&inatin! en)i$onment matte$ an& *hat is he/she eH%e$ienceM ;ia%a an! "e$tan!!un! Ga*a" &alam men!han&le untu melauan %e$lin&un!an lin!un!an &i%e$usahaan an&a &an a%a %en!alaman o$an! te$se"utM

;ection I 28.

Do ou ha)e a &$u!s an& alcohol %olic in ou$ o$!anisationM I# es %lease attach. I# ,o' ho* &o ou ensu$e that ou$ em%loees &o not use &$u!s an& alcohol &u$in! %$oGect. A%aah %e$usahaan an&a mem%unai e"iGaan %ela$an!an men!!unaan o"at &an minuman te$la$an!M Nia a silahan lam%i$an. Nia Ti&a' "a!aimana %e$usahaan an&a memastian a$a*an an&a ti&a men!!unaan o"at &an minuman te$la$an! selama %$oGect "e$Galan.

;ection II 29.

D$u!s an& Alcohol

;a#et Achie)ement o$ A*a$&s

lease %$o)i&e an si!ni#icant achie)ements o$ a*a$&sM (am%i$an %en!ha$!aan sa#et an! %e$nah &i&a%at.Gia a&a.

I un&e$stan&' #ollo* all the $eui$ement an& all the ans*e$ a"o)e is co$$ectl an& honest' ;aa men!e$ti' men!iuti semua %e$sa$atan &an menGa*a" semua %e$tanaan &iatas &en!an GuGu$ &an "ena$. ;i!ns'

 F Tittle< Di$ecto$ / Di$etu$ Date<


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ATTACH%ENT 

SU!CON2RAC2OR (SE !ID E3A0U2ION No 1

2

3

4

>



8 9

Eval/ation Ite4 HSE Po6c  )ea7e,; 1.1 HSE Po6c 1.2 (a6 Re;o;?6t 1.3 Seo, Pe,;o  !,ga@ato "ota6 +aage5et St,ct,e / !,ga@ato 2.1 Re;o;?6e o, HSE +aage5et 2.2 !,ga@ato Ca,t 2.3 HSE Dea,t5et 2.4 Jo? De;c,to  HSE Dea,t5et 2.> Re;o;?6e o, ;aet a7vce  5oto,g "ota6 HSE P6ag 3.1 P,o7ce HSE P6a 3.2 '56e5et 6a o, HSE "ota6 HSE ",ag 4.1 HSE +at, ",ag 4.2 '7et a7 56e5et HSE ",ag 4.3 ",ag P,og,a5 o, Se,v;o, 4.4 P,og,a5  Co7ct HSE ",ag 4.> HSE !,etato "ota6 HSE P,oce7,e >.1 *,tte P,oce7,e >.2 Attac5et HSE P,oce7,e "ota6 Acc7et Pe,o,5ace +ea;,e5et .1 +ea;,e Ev. Pe,o,5ace .2 Kee o Acc7et Stat;tc o E56oee .3 De;c,?e o te Acc7et Stat;tc .4 Kee o Acc7et Stat;tc o S?-cot "ota6 +oto,g a7 '5,ove5et 8.1 Seo, +aage5et ;e o HSE A7t ';ecto "ota6 HSE Stat;tc 'o,5ato 9.1 HSE Stat;tc Pe,o,5ace o, 3 6a;t ea, "ota6

Eval/ation Res/lt 6a7 Aceve5et Score

Re4ar5s * (P) = < 5 (G) = 5 - 10 (E) = > 10

$'

* (P) = < 5 (G) = 5 - 8 (E) = > 8 $& * (P) = < 5 (G) = 5 - 8 (E) = > 8 $& * (P) = < 5 (G) = 5 - 8 (E) = > 8 $& * (P) = < 5 (G) = 5 - 8 (E) = > 8 $& * (P) = < 2 (G) = 2 - 3 (E) = > 3 ' * (P) = < 5 (G) = 5 - 8 (E) = > 8 $& * (P) = < 2 (G) = 2 - 3 (E) = > 3 '


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10

11 12

Doc. No : 4210-GP-1301 Date : 1/2/2010

Pe,;oa6 P,otectve EB5et <.1 );t o PPE <.2 +ateace PPE P,og,a5 "ota6 Ev,o5eta6 +aage5et 10.1 Acc7et o Ev,o5eta6 10.2 Pe,;o  coo,7atg ev,o5eta6 "ota6 D,g; a7 A6coo6 P,og,a5 11.1 D,g a7 A6coo6 Po6c "ota6 Saet Aceve5et o, Aa,7; 12.1 Aa,7 Aceve5et "ota6

Rev : J Page : 13 o 38 * (P) = < 5 (G) = 5 - 8 (E) = > 8

$& * (P) = < 2 (G) = 2 - 3 (E) = > 3 ' * (P) = < 2 (G) = 2 - 3 (E) = > 3 ' * (P) = < 2 (G) = 2 - 3 (E) = > 3 '

$&&

2otal Score SU66ARY

PASS / FAILED

Ris5 cate)or8 HIGHT / LOW

Reco55e7ato:

Note / "core achievement/ 6 #0& Hig$ is7, "8 9 8:& Lo; is7

$Criteria Score% Poor &P' Good &G' .cellence &.' P,ea,e7 % : Na5e : "tt6e o Jo? : Sg : Date : ,@TE< and

6

#0

"8 9 8:

Can not ans(er t)e *!estion and can not gi+e attac),ent Can -e ans(er t)e *!estion -!t can not gi+e attac),ent Can -e co,plete t)e *!estion

&

&

Hig$ is7 )ategor' <%iping or7, e!$ani!al or7, Steel Stru!ture or7, Ele!tri!al 5nstrument, 5nsulation, %il ing, )$emi!al )leaning, -=T, >a', oofing ? Siding, Hig$ is7 Building

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ATTACH%ENT 0 H"E RE,!IRE%ENT FOR "!BCONTRACTOR I.

CO%%IT%ENT AND OLIC$

;u"+cont$acto$ st$on!l $euest to *$ite 4;E olic *hich is si!n " ;u"+cont$acto$ Di$ecto$s. This 4;E olic must "e socialiin! to all em%loees *ho *ill assi!n in this %$oGect. This olic shoul& "e in En!lish o$ In&onesia.

II.

LE1AL RE,!IRE%ENT" AND RE1!LATION"

;u"cont$acto$ shall com%l *ith all a%%lica"le sa#et la*s inte$national' national' $e!ional' o$ localF' $e!ulations inclu&in! *o$ %e$mit sstemF' an& a&&itional sa#e o%e$atin! stan&a$&s. ;u"cont$acto$ shall tae all necessa$ %$ecautions to %$otect the *o$ #$om un+sa#e *o$ an& un+sa#e con&ition' an& %$otect all %e$sonnel' the en)i$onment' an& %$o%e$t o# @*ne$' Reaasa' ;u"cont$acto$' an& all thi$& %a$ties #$om acci&ent. III.

"!BCONTRACTOR H"E LAN

Sub-contractor shall issue its HSE Plan as a part of the bid proposal. 4;E lan &ocument shall "e esta"lishe& " ;u"+ont$acto$' &e#inin! all the 4;E $eui$ements a%%lica"le' ho* the a$e im%lemente& an& monito$e& #o$ com%liance.

A#te$ a%%$o)al " 4;E ana!e$ T. Reaasa In&ust$i' the a!$ee& )e$sion o# its 4;E lan must "e %$o%ose "e#o$e the ic+o## meetin!. Be#o$e 4;E lan a%%$o)e& " 4;E ana!e$ T. Reaasa In&ust$i' su"+ cont$acto$ &oes not allo* to sta$t *o$. The a!$ee& 4;E lan must "e communicate& to an in)ol)e& %e$sonnel "e#o$e the *o$s sta$t e##ecti)el on site. The content o# 4;E lan as minimum is< + u$%ose + ;co%e o# o$ + Res%onsi"ilit each %e$sonal in team %$oGect $elate& to 4;E + lannin! o# 4;E %e$sonal / coo$&inato$ $esou$ces + 4ealth lan + e$sonal $otecti)e Eui%ment an& i$e EHtin!uishe$ lan + Eme$!enc Res%onse lan + ;ecu$it lan + onst$uction / ommissionin! Acti)ities lan.

;am%le o# onst$uction Acti)ities lan< ,o

onst$uction Acti)ities

A%%lica"le $oce&u$e

hatQs To Be Done

4o* Do e hec

$euenc

e$son Res%onsi"ilit


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EHca)ation

$oce&u$e ,um"e$ / ,one

2

Install i%e


3

Built Tem%o$a$ ;ite $oce&u$e @##ice ,um"e$ / ,one

-

E$ection Vessel

I#.


$e%a$e o$ e$mit' N;A an& ;a#e @%e$atin! $oce&u$e

o$ e$mit' N;A an& ;a#e @%e$atin! $oce&u$e must "e com%lete& $e%a$e o$ o$ e$mit' N;A e$mit' N;A an& ;a#e an& ;a#e @%e$atin! @%e$atin! $oce&u$e $oce&u$e must "e com%lete& $e%a$e o$ o$ e$mit' N;A e$mit' N;A an& ;a#e an& ;a#e @%e$atin! @%e$atin! $oce&u$e $oce&u$e must "e com%lete& $e%a$e o$ o$ e$mit' N;A e$mit' N;A an& ;a#e an& ;a#e @%e$atin! @%e$atin! $oce&u$e $oce&u$e must "e com%lete&

Rev : J Page : 15 o 38

Be#o$e sta$t the *o$

$oGect ;u%e$)iso$







"!B+CONTRACTOR H"E RERE"ENTATI#E

;u"+ont$acto$ shall assi!n one 4;E oo$&inato$' *ith 1 ea$ #o$ (o* Ris an& 3 ea$s eH%e$ience #o$ 4i!h Ris in 4;E $elate& to this acti)it. @ne 4;E oo$&inato$ must "e su%%o$te& " one o$ mo$e ;a#et ans' *ith $atio 1 sa#et man *ill "e su%e$)isin! 50 em%loees. 1 sa#et man< 50 em%loeesF. T. Reaasa *ill con&uct inte$)ie* #o$ su"+cont$acto$ 4;E oo$&inato$ that *ill assi!ne& to the %$oGect site on technical cla$i#ication o$ ic o## meetin! "e#o$e su"+cont$acto$ mo"ilie the sta##. ;u"+cont$acto$ 4;E oo$&inato$ *ill "e "ecomes co$$es%on&ent #o$ mana!in! the &a to &a 4;E matte$s $elatin! to ;u"+ont$acto$ acti)ities. 4e *ill ee% close contact *ith the T. Reaasa In&ust$i site 4ealth' ;a#et an& En)i$onment %e$sonnel. @ne 4;E man $atio to su%e$)ise em%loee *o$ at site is 1<50. #.

TER%INATION AND "!"EN"ION

An unsa#e con&ition an& unsa#e *o$' *hich &one " su"cont$acto$ an& i&enti#ie& " Reaasa th$ou!h eithe$ Gointl o$ se%a$atel " @*ne$ an&/o$ Reaasa. Reaasa has the $i!ht to sto% all o$ an %a$t o# the *o$' until co$$ecti)e action taen " su"+cont$acto$. #I.

!BLIC RELATION


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;u"cont$acto$ shall %$om%tl tae such ste%s as necessa$ to maintain !oo& $elations *ith the %u"lic an& local autho$ities *ith *hom the *ill come into contact *ith &u$in! the cou$se o# the *o$. ;u"cont$acto$ shall also $eui$e all em%loees to con&uct themsel)es in a sa#e an& cou$teous manne$. hene)e$ necessa$' Reaasa ma assist ;u"cont$acto$ in the maintenance o# !oo& %u"lic $elations. #II.

"AFET$ RE1!LATION

VII.1 Res%onsi"ilit #o$ 4;E Reaasa *ill $eui$e su"cont$acto$ to a##i$m that all mana!e$s' 4;E $e%$esentati)es' an& em%loees a$e $es%onsi"le #o$ ensu$in! that the *o$ is %e$#o$me& in acco$&ance *ith all a%%lica"le sa#et $ules' $e!ulations' an& !oo& *o$in! %$actices. VII.2 Acci&ent / Inci&ent Re%o$tin! ;u"cont$acto$ shall #ollo* an acci&ent $e%o$tin! sstem o# T. Reaasa In&ust$i stan&a$&s. An haa$&ous acci&ent' nea$ miss in)ol)in! @*ne$' Reaasa' ;u"+cont$acto$ em%loees' an thi$& %a$tQs %e$sonnel' %lant' an& eui%ment shall "e imme&iatel $e%o$te& to T. Reaasa In&ust$i *ithin 2- hou$s. VII.3 4;E eetin!s ;u"cont$acto$ is $es%onsi"le #o$ maintainin! an& enhancin! the 4;E a*a$eness o# its %e$sonnel. In %$inci%le' mana!ement su"cont$acto$Qs mem"e$s shoul& atten& a 4;E meetin! that a$$an!e " T. Reaasa In&ust$i. ;u"cont$acto$ shall ensu$e that no em%loee o# its su"cont$acto$ shall ca$$ out *o$' until the ha)e $ecei)e& "asic 4;E in#o$mation ;a#et In&uction o$ ;a#et @$ientationF' *hich con&uct " 4;E T. Reaasa In&ust$i. VII.- ;ca##ol&in! ;ca##ol&in! that *e !i)e %e$mit is %i%e tu"e sca##ol&in! #o$ *o$in! in mechanical *o$' %i%in! *o$' steel st$uctu$e an& %$e+cast e$ection *o$' elect$ical an& inst$ument *o$ an& insulation *o$. $ame sca##ol&in! onl allo*e& usin! in o##ice "uil&in! *o$ an& an acti)it insi&e o##ice "uil&in! Gust #o$ ci)il *o$' elect$ical an& inst$ument. The stan&a$&s o# %i%e tu"e sca##ol&in! a$e !al)anie& tu"e an& steel tu"e' *hich must "e #ollo*in!< A; 156.3.1995 *ith< Reui$ement o# al)anie& Tu"e< @utsi&e Diamete$/Diamete$ (ua$< -8.3 mm 0.5 tole$anceFK inimum all Thicness/inimum Te"al tF< 3.2 mm 0.-8 tole$anceFK ei!ht %e$ mete$/Be$at %e$ mete$< 3.56 !/m.

Reui$ement o# ;teel Tu"e< @utsi&e Diamete$/Diamete$ (ua$< -8.3 mm 0.5 tole$anceFK inimum all Thicness/inimum Te"al tF< -.0 mm 0.5 tole$anceFK ei!ht %e$ mete$/Be$at %e$ mete$< -.3 !/m. ate$ial ;teel Tu"e must "e %ainte& to eliminate the co$$osion o# the steel tu"e. The stan&a$& o# #$ame sca##ol&in! that must "e #ollo*in!< @;4A stan&a$& *ith< ate$ial o# the #$ame sca##ol&in! must "e !al)anie&. The #$ame sca##ol&in! s%eci#ication< (e!s< -0.8 mm 0.5 tole$anceF @D @utsite Diamete$/ Diamete$ (ua$F Tu"e Diamete$ / Diamete$ i%a  2.mm 0.5 tole$anceF all Thicness / Cete"alan i%a. $oss B$aces< 25.3 mm @D @utsi&e Diamete$ / Diamete$ (ua$F Tu"e Diamete$ / Diamete$ i%a.


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;u"cont$acto$ must "e %$o)i&in! sca##ol& su%e$)iso$ that ha)in! a license& #$om De%nae$ to "uil& the sca##ol&in! at site' *ith minimal eH%e$ience 1 ea$. VII.5 o$ e$mit ;stem ;u"+cont$acto$ must #ollo* the o$ e$mit $oce&u$e T. Reaasa In&ust$i. ;u%e$)iso$ must "e $es%onsi"le to mae an& %$ocess the *o$ %e$mit. VII.6 Eui%ment / ate$ial ;u"+cont$acto$ shall ensu$e that all its eui%ment an& mate$ials on T. Reaasa In&ust$i site' must meet the 4;E stan&a$& $eui$e& " T. Reaasa In&ust$i an& @*ne$ an& liste& in the ;u"+cont$acto$ 4;E lan. ;u"+cont$acto$ shall ensu$e that an eui%ment an& mate$ials un&e$ these stan&a$&s calle& =su"+stan&a$&> a$e $emo)e& #$om the %$oGect site. VII. Ins%ection T. Reaasa In&ust$i *ill con&uct ins%ection $e!ula$ at site an& "e#o$e mo"ilie to site #o$ all machine$ eui%ment' tools' c$anes' t$ucs an& ca$s "e#o$e mo"ilie to site. VII.8 Re%o$tin! ;stem ;u"+cont$acto$ shall $e%o$t &ail to 4;E T. Reaasa In&ust$i the &ata $esultin! #$om its health' sa#et an& en)i$onmental monito$in! acco$&in! to T. Reaasa In&ust$i #o$m. #III.

EN#IRON%ENT

VIII.1 ene$al ;u"cont$acto$ shall %a &ue $e!a$& to the en)i$onment " actin! to %$ese$)e ai$' *ate$' animal an& %lant li#e #$om a&)e$se e##ects o# ;u"cont$acto$ acti)ities' an& minimie an nuisance' *hich ma a$ise #$om such o%e$ations. ;u"cont$acto$ shall a&he$e to eHistin! national statuto$ $e!ulations conce$nin! en)i$onmental &ama!e $esultin! #$om the %e$#o$mance o# the o$ an& in %a$ticula$ an s%eci#ic en)i$onmental $eui$ements' *hich ma a%%l to the %$oGect site an& its su$$oun&in!s. ;u"+cont$acto$ $eui$es %$o%e$ %lannin! an& sa#e *o$ to ensu$e thei$ no en)i$onmental &ama!e &u$in! const$uction an& commissionin!. VIII.2 4ouseee%in! an& ;ite Resto$ation ;u"cont$acto$ shall "e $es%onsi"le #o$ maintainin! !oo& houseee%in! continuousl th$ou!hout the &u$ation o# the *o$ *ith &ue $e!a$& "ein! %ai& to ti&iness' ensu$in! that access *as an& eme$!enc eHits a$e e%t clea$ at all times an& *ithout eHce%tion. ;u"+cont$acto$ shall $emo)e an eui%ment' mate$ial' an& *aste #$om the *o$+site "e#o$e lea)e the %$oGect site. ;u"+cont$acto$ &oes not allo* &est$oin! the sc$a% an& $u""ish mate$ial at %$oGect site an& su$$oun&in! " "u$nin!. VIII.3 ;a#e 4an&lin! o# 4aa$&ous ate$ial


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;u"cont$acto$ shall "e $es%onsi"le #o$ the cont$ol an& sa#e han&lin! o# all su"stances %otentiall haa$&ous to health' sto$e& on its #acilities. ;u"cont$acto$ shall maintain an u% to &ate #ile o$ &ata"ase o# all such su"stances an& thei$ ate$ial ;a#et Data ;heets ;D;F. ;u"cont$acto$ shall also su%%l to Reaasa *ith co%ies o# these ;D; as soon as the a$e &is%atche& to location. ;D; *ill contain the #ollo*in! in#o$mation as a minimum< a. hemical i&enti#ication an& &ata ". i$e an& eH%losion lash %oint tem%e$atu$e' #lamma"le limit $an!e' auto i!nition tem%e$atu$eF c. 4ealth as%ects natu$e o# haa$&s T(V+;TE(' T(V+TAF &. Eme$!enc $oce&u$e i$e i!htin!' a!ent' s%illa!e' %e$sonnel eH%osu$e' #i$st+ai&F e. En)i$onmental emissions to atmos%he$e' s%illa!e' neut$alie$ %$oce&u$e' *aste &is%osalF #. T$ans%o$tation %$oce&u$e !. e$sonnel %$otecti)e eui%ment to "e *o$n h. ;to$a!e $eui$ements ;u"cont$acto$ shall ha)e in %lace a suita"le means o# communicatin! the sa#et $eui$ements #o$ han&lin! all su"stances that ha)e the %otential to "e health haa$& an& *ill ensu$e that a%%$o%$iate han&lin! eui%ment' an& e$sonal $otecti)e Eui%ment' as a&)ise& " the ;D;' is a)aila"le an& use& each time such su"stances a$e han&le&. ;u"cont$acto$ shall ensu$e that all su"stance is sto$e& in com%liance *ith its ;D;. VIII.- (ocal ustoms' ultu$al an& Reli!ious onsi&e$ations ;u"cont$acto$ shall ensu$e that all local customs' cultu$al an& $eli!ious $eui$ements a$e $es%ecte& an& those suita"le #acilities a$e a)aila"le #o$ the o"se$)ance o# these " (ocal em%loees. I2.

ER"ONAL ROTECTI#E E,!I%ENT

The minimum e$sonal $otecti)e Eui%ment that must "e %$o)i&e& #o$ all em%loees at site a$e< + ;a#et ;hoes< ollo* Eu$o%ean 4a$monie ;tan&a$& B;E, 3-5<1993 o$ eui)alent an& #o$ ci)il *o$ must "e *ea$in! sa#et $u""e$ "oot. + ;a#et 4elmet< ollo* A,;I ;tan&a$& ,o. 89.1 199o$ eui)alent< ;A In&onesia. + ull "o& ha$ness &ou"le lana$&s must "e *o$n " an em%loee' *ho shall *o$ on an ele)ate& a$ea hi!he$ than to 2 m a"o)e !$oun& le)el / #loo$< A,;I stan&a$&. + ;a#et !lasses < ollo* A,I.8.1 o$ eui)alent + All em%loees must "e *ea$in! cotton !lo)es an& lon! slee)es. An othe$ E that $eui$e &u$in! %$oGect is su"+cont$acto$ cost $es%onsi"ilities. 2.

3OB "AFET$ ANAL$"I" 4 RI"5 A""E""%ENT

;u"+cont$acto$ shall %$o&uce a No" ;a#et Analsis an& Ris Assessment #o$ all acti)it. o$ its e)aluation o# the N;A an& Ris Assessment associate& *ith %e$#o$min! the *o$s' ;u"cont$acto$ shall $e)ie* *ith the T. Reaasa In&ust$i "e#o$e sta$t the Go". ;u%e$)iso$ must "e $es%onsi"le to mae the No" ;a#et Analsis an& Ris Assessment. 2I.

ALCOHOLIC( DR!1( CARR$ 6EAON( AND NO "%O5IN1 OLIC$

;u"+cont$acto$ shall ensu$e that the %$ohi"ition o# the alcoholic consum%tion an& / o$ the use o# &$u!s' ca$$ *ea%on an& smoin! *ithin the T. Reaasa In&ust$i %$emises a$e st$ictl #ollo*e&< + on the *o$ sites' &u$in! the *o$in! an& non+*o$in! hou$s + *hen t$a)elin! #$om / to home : *o$ site + *hen &$i)in! at lan&' at sea o$ in the ai$.


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Insi&e at o##ice site. A!DIT" 4 IN"ECTION B$ T. RE5A$A"A IND!"TRI

T. Reaasa In&ust$i *ill "e ca$$in! out 4;E ins%ection an& au&its at an time to ensu$e that the 4;E $eui$ements a$e "ein! com%lie& *ith 13 elements 4;E ana!ement ;stem T. Reaasa In&ust$i. 2III.

CORRECTI#E ACTION

;u"+cont$acto$ shall "e #ollo*in! u% an $ecommen&ation &u$in! ins%ection an& au&it into a co$$ecti)e action. 2I#.

EC %EA-)E 5-=5)AT

T. Reaasa In&ust$i *ill con&uct monthl e)aluation to the su"+cont$acto$ %e$#o$mance an& it *ill a##ect to the su"+cont$acto$ monthl %$o!$ess $e%o$t. lease see #lo* cha$t "ello* #o$ the %$ocess. Tool< 4;E++.1 ATTA4E,T F

;ta$ t

;u"cont$acto$ 4;E e$#o$mance In&icato$ hie# 4;E

Recei)e Document $o!$ess Re%o$t

;u"mit monthl %$o!$ess $e%o$t

hie# onst$uction ont$ol

;u"cont$acto$ Do ,ot $ocee&

E)aluate 4;E e$#o$mance

;u"mit to  to "e

In&icato$ o$m

#ollo*+u% " su"cont$acto$

4;E De%a$tment ;ite $ocee& ;en& "ac to  to %$o!$ess $e%o$t

2#.

HEALTH RE,!IRE%ENT

Base& on ?? ,o.1 190' @4;A; 18001<1999 $eui$ement an& an%o*e$ iniste$ ente$i Tena!a Ce$GaF Re%u"li In&onesia Re!ulation ,o.e$.02/E,/1980' su"+cont$acto$ shall con&uct "asic me&ical chec+u% #o$ thei$ e %e$sonal sta$t #$om su%e$)iso$F *ho *ill assi!n to %$oGect an& it shall "e $e%eate& once a ea$.


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The lists o# la"o$ato$ checs #o$ "asic me&ical chec+u% a$e< 4ematolo!< (ED' 4"' 4t' (euosit hite Bo& ellF' T$om"osit' Di##' VER' 4ER' C4ERK unction o# (i)e$< ;@T' ;RK unction o# Ci&ne< ?$eum' C$eatinimK Ca$"ohi&$at< ula Da$ah ;e*atu Bloo& lucose *ithout #astin!FK ?$ine om%lete< BG;%ecies $a)itF' %4' Al"umin' luosa' Bili$u"in' ?$o"ilina!en' Ceton' ,it$it' Da$ah ;ama$Bloo& T$ans%a$entF' ;e&imen an& &$u! an& alcohol test. o$ le)el o$e$s "elo* ;u%e$)iso$ must "e attach lette$ #$om &octo$ o$ hos%ital to in&icate that the *o$e$s #it #o$ *o$. The lists o# la"o$ato$ checs #o$ o$e$s "elo* ;u%e$)iso$ a$e< ;@T' ;T an& EC. The $esult o# the me&ical chec+u% must "e consulte& to &octo$ occu%ational me&icine to no* *hethe$ the #it to the Go" assi!nment o$ not. >D5. L5T5-( %EAT5-

(i#ts utiliin! c$anes' hoists' o$ othe$ mechanical li#tin! &e)ices *ill not commence unless< + + + + + + +

+

An assessment o# the li#t has "een com%lete& an& the li#t metho& an& eui%ment has "een &ete$mine& " com%etent %e$sons. @%e$ato$s o# %o*e$e&' li#tin! &e)ices a$e t$aine& an& ce$ti#ie& #o$ that eui%ment. Ri!!in! o# the loa& is ca$$ie& out " a com%etent %e$sonsF. (i#tin! &e)ices an& eui%ment has "een ce$ti#ie& #o$ use *ithin the last 12 months at a minimumF. (oa& &oes not eHcee& &namic an&/o$ static ca%acities o# the li#tin! eui%ment. An sa#et &e)ices installe& on li#tin! eui%ment a$e o%e$ational. All li#tin! &e)ices an& eui%ment ha)e "een )isuall eHamine& "e#o$e each li#t " a com%etent %e$sonsF o$ manu#actu$e ce$ti#icate. *i$e $o%e slin!' man+ma&e #i"$e& slin!' chain slin!' s%$ea&e$ "eam' li#tin! clam' hoos an& #ittin!' s*i)els' shacles' ee"olts' $i!!in! sc$e*tu$n"uclesF' *e&!e socets' %late clam%s' %e$sonnel "aset' #all a$$est &e)ices an& simila$ eui%mentF. $ane' T' o$li#t' EHca)ato$' Doe$ shall ha)e ce$ti#icate #$om i!as/De%nae$/ine$"a%um *hich &e%en& on the a$ea o# the %$oGect.

2#II. %ECHANICAL E,!I%ENT OERATION

;u"+cont$acto$ shall ensu$e that onl t$aine& com%etent ce$ti#icate&F %e$son o%e$ates all mechanical eui%ment i!as/De%nae$/ine$"a%a"umF &e%en& on the a$ea o# the %$oGect. The eui%ment *ill inclu&e "ut ma not "e limite& to the #ollo*in!< + $ane + o$ li#t + ;el# (oa&in! T$uc + T$aile$ an& $ime o)e$s + om%$esso$ + Tem%o$a$ Elect$ical Dist$i"ution Boa$&s + ;ca##ol&in! Eui%ment + Ri!!in! Eui%ment + Ae$ial o$ lat#o$m 2#III. TOOL" AND E,!I%ENT

;u"+cont$acto$ shall ensu$e that a ;u"+cont$acto$Qs machine$' tools an& eui%ment' #acilities' an& othe$ items associate& *ith the *o$s *hethe$ %u$chase& o$ $ente& a$e maintaine& in a sa#e con&ition an& to "e o%e$ate& " com%etent o%e$ato$s. Tools shall onl "e use& #o$ the Go" the *e$e &esi!nate& to %e$#o$m *ith consi&e$in! the %$esence o# h&$oca$"ons at *o$site.


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All !ua$&s must "e #itte& an& shall "e in !oo& con&ition at all times. el&in! machine an& ene$ato$ ;et must "e eui%%e& *ith &ist$i"ution %anel an& eme$!enc sto%. All !$in&in! &iscs must "e chece& #o$ co$$ect sie an& s%ee& %$io$ to #ittin! $%m s%ee& o# !$in&in! &isc is eual o$ mo$e than $%m s%ee& o# !$in&in! machineF Elect$icall %o*e$e& tools shall meet the haa$&ous one $eui$ement *he$e a%%lica"le. All elect$ical ca"les an& connecto$ must "e *ate$ %$oo# mate$ial an& in&ust$ial t%es. ?se o# &omestic elect$ical ca"le is %$ohi"ite&. ;u"+cont$acto$ shall $e%ai$ o$ $e%lace &e#ecti)e tools an& eui%ment at ;u"+cont$acto$ cost. A%%$o%$iate %e$sonal %$otecti)e eui%ment must "e *o$n at all times *hen usin! an tool o$ eui%ment.

2I2. CO%RE""ED 1A" C$LINDER

;u"+cont$acto$ shall ensu$e that< + om%$esse& !as clin&e$s a$e sto$e&' t$ans%o$te& o$ use& shall "e in an u%$i!ht %osition an& secu$e& to some su"stantial o"Gect o$ st$uctu$e " a chain o$ othe$ suita"le means ca%a"le o# su%%o$tin! the *ei!ht o# clin&e$. This a%%lies to all clin&e$s' *hethe$ em%t o$ #ull. +

lin&e$ )al)es shall "e close& an& hoses &e%$essu$ie& *hen clin&e$ a$e not in use.

+

lin&e$s shall ha)e %$otecti)e )al)e ca%s in %lace *hile the a$e "ein! t$ans%o$te& / sto$e&.

+

lin&e$s shall "e $etu$ne& %$om%tl to a suita"le sto$a!e a$ea a#te$ use. The shall not "e le#t at an site. lin&e$ sto$a!e a$eas shoul& "e e%t a*a #$om !ene$al t$a##ic %aths an& must not "e a&Gacent to )ehicle %aths.

+

lamma"le !ases an& oH!en clin&e$s must not "e sto$e& in close %$oHimit unless se%a$ate& " a non+com"usti"le *all.

+

lin&e$ ma onl "e hoiste& *hen enclose& in an a%%$o)e& "oH o$ c$a&le *ithin *hich the a$e secu$el #astene&.

+

lin&e$s must "e i&enti#ie& " a colo$ co&e in acco$&ance *ith $es%ecti)e national stan&a$&s.

+

as *el&in! clin&e$s shall ha)e hose chec )al)e non+$etu$n )al)esF' *hich allo* !ases to the "lo*%i%e' "ut not "ac #$om it. lash"ac a$$esto$s shall "e installe& to uench #lash"ac #lames an& cut o## the !as #lo* automaticall' in "oth oH!en an& #uel !as outlet lines.

22. ELECTRICAL "AFET$ - O6ER LINE"

All elect$ical $ece%tacles shall "e o# in&ust$ial !$a&e an& com%l *ith a$ea classi#ication $eui$ement. ,o %a$t o# an li#tin! &e)ices o$ an eui%ment o%e$ate& a$oun& %o*e$ lines is close$ than "elo*< o*e$ (ine 150 : 50V 50 + 50V 50 : 250V @)e$ 250V

in. (i#tin! lea$ance 2.0 m 3.0 m -.5 m 6.0 m


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The a"o)e clea$ance a%%lies in all &i$ections. All o)e$hea& lines shall "e i&enti#ie& *ith a hi!hl )isi"le si!n %lace&  m #$om "oth si&es o# the lines' 1.8m a"o)e !$oun&. A $est$iction !ua$& %ole connecte& *ith $o%es shall "e installin! to $est$ict clea$ance close to %o*e$ lines. 22I. H"E BRIEFIN1 - TOOLBO2 %EETIN1

;u"+cont$acto$ shall %e$#o$m &ail 4;E "$ie#in!/tool "oH meetin! %$io$ to sta$t o# each *o$in! &a. Re%$esentati)e #$om ana!ement shall a&&$ess the *o$e$s on the $otational "asis. ;u"+cont$acto$ shall ensu$e that his a%%ointe& o$ ;u%e$)iso$s hol& tool "oH meetin! #o$ a"out 5 : 10 minutes &ail o$ %$io$ to commencement o# *o$. ;%eci#ic to%ics shall inclu&e haa$&s i&enti#ie& in the No" ;a#et Analsis $ele)ant to the cu$$ent *o$' e$mit to o$ $eui$ements' an& $e)ie* o# acci&ents' nea$ misses an& an ne* eui%ment o$ machine$. ;u"+cont$acto$ shall maintain $eco$& o# atten&ances an& su"mit to @,TRAT@R as &ail "asis. 22II. !"E OF !BLIC ROAD

;u"+cont$acto$ shall ee% %u"lic $oa& #$ee #$om its &e"$is &ue to )ehicle mo)ement to an& #$om site. ;u"+ cont$acto$ shall %$o)i&e t$e+*ashin! #acilities at site. In the e)ent o# s%illa!e onto the $oa&' su"+ cont$acto$ shall un&e$tae the cleanin! acti)ities at su"+cont$acto$ cost. 22III. H"E A6ARENE""

;u"+cont$acto$ shall at its o*n eH%ense %$o)i&e continuous 4;E a*a$eness to thei$ em%loee th$ou!h "ut not limite& to the #ollo*in!< + + +

4;E Bulletin Boa$&' *hich locate& at st$ate!ic location o# site an& u%&ate& $e!ula$l. 4;E Banne$s' *hich st$un! at ent$ance an& st$ate!ic location at site an& chan!e& %e$io&icall. 4;E ;i!n Boa$&' *hich locate& at st$ate!ic location at site an& u%&ate& $e!ula$l.

22I#.RADIO1RAH$

;u"+cont$acto$ shall ensu$e that all $a&io!$a%hic' su"+cont$acto$ "e a%%ointe& is in %ossession o# )ali& o%e$atin! license issue& " ,uclea$ Ene$! Re!ulato$ A!enc BAETE,F. ;u"+cont$acto$ shall o"tain a %e$mit to *o$ #o$ $a&io!$a%h *o$. EHt$a %$ecaution shall "e taen to ee% a*a all non $ele)ant %e$sonnel #$om the a$ea. The a$ea shall "e isolate& " )isi"le "a$$ica&es' si!ns' *a$nin! li!hts etc. The sou$ce shall "e sto$e& acco$&in! to a%%$o)e& %$oce&u$e. ;u"+cont$acto$ shall em%lo onl uali#ie& $a&io!$a%h o%e$ato$s #o$ the Go". $o%e$l cali"$ate& $a&iation su$)e must "e a)aila"le. Each $a&io!$a%h technician shall "e su%%lie& *ith a %e$sonal "ee%e$. 22#. AIR HO"E

Ai$ hose connection shall "e eui%%e& *ith anti *hi%%in! &e)ice to %$e)ent acci&ental &isconnection. Ai$ hose shoul& not "e use& to clean an %a$t o# the "o& o$ clothin! o$ use to "lo* o## &i$t on the #loo$. om%$esso$ su%%lin! ai$ shall %osses a )ali& ce$ti#icate o# #itness an& eui%%e& *ith automatic $elie# )al)e. The $elie# )al)e must ca$$ a cu$$ent cali"$ation ta!. 22#I.6OR5IN1 AT HEI1HT

All *o$ at ele)ate& a$eas in the eHcess o# t*o 2F mete$s shall $eui$e the use o# #ull "o& ha$ness &ou"le lana$&s.


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hen *o$in! at hei!ht mo$e than .5 mete$s' su"+cont$acto$ shall %$o)i&e suita"le sa#et nets' *hich eHten&s 2.5 mete$s "eon& the e&!e o# *o$ le)el. The nets shall "e su##icientl ancho$e& usin! steel hoos o$ shacle. The net shall "e ins%ecte& &ail.

22#II. ETROL "TATION

Diesel an& %et$ol a$e haa$&ous !oo&s an& the$e#o$e shall "e sto$e& an& su%%lie& to use$s *ith %$ecaution. acilities shall "e e%t clean an& in !oo& con&itions. A&euate *a$nin! si!ns shall "e &is%lae& an& #i$e#i!htin! eui%ment shall "e a)aila"le in imme&iate )icinit. ;to$a!e an& #illin! #acilities shall "e eui%%e& to collect an lea *hich coul& a##ect the en)i$onment. 22#III. ER"ONNEL BA"5ET Desi!n o# %e$sonnel "asets shall "e su%%o$te& " a com%$ehensi)e calculation note. Thei$ #a"$ication shall "e onl un&e$taen " uali#ie& *el&e$s. e$sonnel "asets shall "e ce$ti#ie& " an in&e%en&ent ce$ti#ication @A,. The shall "e chece& an& ins%ecte& " a com%etent %e$son %$io$ an use.


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ATTACH%ENT 7 FABRICATOR'" "AFET$( HEALTH AND EN#IRON%ENT )H"E* RE+,!ALIFICATION - A"E""%ENT ,!E"TIONNAIRE

$oGect

<


<


Does ou$ com%an ha)e an 4;E %olic &ocument M A%aah %e$usahaan an&a mem%unai Ce"iGaan Ceselamatan Ce$Ga' Cesehatan &an (in!un!anM es

,o

I# es' %lease attach / Nia a' silahan untu &ilam%i$an. -.


5.

ho is the most senio$ %e$son in the o$!anisation $es%onsi"le #o$ this %olic "ein! ca$$ie& out at the %$emises an& on site *he$e his em%loees a$e *o$in!M ;ia%a senio$ sta## &i %e$usahaan an&a an! "e$tan!!un! Ga*a" &alam im%lementasi e"iGaan ini &i tem%at an&a "ee$GaM



No" Title<

5.


6.

Does a #ull time 4;E De%a$tment eHist in ou$ o$!anisationM A%aah De%a$tement C3 te$se&ia &i %e$usahaan an&aM es ,o

.

I# ans*e$ to 6 a"o)e is es' &o ou ha)e Go" &esc$i%tions #o$ the %e$sonsF em%loe& in ou$ 4;E De%a$tmentM Nia Ga*a"an no 6 a' A%aah %e$usahaan an&a mem%unai Go" &esc$i%tion te$ha&a% a$a*an &i De%a$tement C3. es ,o I# es' lease !i)e &etail the %osition an& $es%onsi"ilities Nia a' silahan lam%i$an &etail &a$i %osisi masin!+masin! a$a*an &an $es%onsi"ilitina.


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I# the ans*e$ to item  a"o)e is no' *ho is $es%onsi"le #o$ %$o)i&in! sa#et a&)ice an& monito$in! the im%lementation o# 4;E ana!ement ;stem at ou$ *o$ sites an& *hat is thei$ uali#icationM Nia Ga*a"an no. Ti&a a&a' sia%a an! "e$tan!!un! Ga*a" &alam mem"e$ian a$ahan C3 &an melauan monito$in! te$ha&a% im%lementasi C3 mana!ement sstem &item%at %e$usahaan an&a "ee$Ga &an a%a uali#iasi o$an! te$se"utM e$son Res%onsi"le < OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO 7uali#ication <

;ection III @$!anisin! #o$ 4;E + 4;E lannin! 9.

Do ou %$o&uce an 4;E lan in ou$ *o$%laceM A%aah an&a menia%an $encana %elasanaa C3 &an (in&un!an (in!un!an &i tem%at an&a "ee$GaM es ,o

10.

I# ans*e$ to 7uestion 9 a"o)e *as no' "$ie#l &esc$i"e ho* ou ensu$e that the $eui$e& 4;E ;stems a$e communicate& an& im%lemente& on time. Nia Ga*a"an an&a Ti&a' Nelasan "a!aimana an&a memastian C3 &an (in&un!an (in!un!an an! &isa$atan &a%at te$omuniasi &an &ilasanaan &en!an "ai.


Do ou ha)e a 4;E T$ainin! at$iH #o$ ou$ em%loeesM A%aah %e$usahaan an&a mem%unai $encana t$ainin! C3 &an (in&un!an (in!un!an untu a$a*an an&aM lease attach the 4;E t$ainin! mat$iH / ;ilahan lam%i$an 4;E t$ainin! mat$uH es ,o

12.

I# the ans*e$ to 7uestion 11 a"o)e *as no' "$ie#l &esc$i"e ho* ou i&enti# an& im%lement 4;E T$ainin! #o$ ou$ sta##. Nia Ga*a"an no 11 Ti&a a&a' Nelasan "a!aimana an&a men!i&enti#iasi &an men!im%lementasi e"utuhan t$aininin! C3 &an (in&un!an (in!un!an untu a$a*an an&a.

13.

Do ou ha)e a #o$mal t$ainin! %$o!$amsF #o$ ;u%e$)iso$s thei$ $es%onsi"ilities in 4;E ana!ement as ;u%e$)iso$sM A%aah %e$usahaan an&a mem%unai %$o!$am t$ainin! untu sa#et su%$)iso$ M es

,o

1-.

I# the ans*e$ to item 13 a"o)e is es' "$ie#l &esc$i"e this %$o!$am an& *ho con&ucts this t$ainin!. Nia Ga*a"an no 13 a' Nelasan "a!aimana %$o!$am ini "e$Galan &an sia%a an! melauan t$ainin! te$se"ut.

15.

Do ou ha)e a #o$mal 4;E @$ientation $o!$amme #o$ ne* em%loeesM A%aah %e$usahaan an&a mem%unai $o!$am ;a#et @$ientation untu a$a*an "a$uM I# es' lease attach / Nia a' silahan lam%i$an es

;ection V @$!anisin! #o$ 4;E + 4;E $oce&u$e

,o


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Page : 26 o 38

Does ou$ om%an ha)e *$itten 4;E %$oce&u$esM A%aah %e$usahaan an&a mem%unai %$oce&u$e C3 &an (in&un!an (in!un!anM es

1.

Rev : J

,o

I# ans*e$ to 7uestion 16 *as es' %lease attach 4;E $oce&u$e that ou ha)e. Nia Ga*a"an no.16 a' ;ilahan lam%i$an %$oce&u$e C3 &an (in&un!an (in!un!an an! %e$usahaan an&a %unai.


Do ou measu$e en)i$onmental %e$#o$manceM A%aah %e$usahaan an&a men!uu$ %e$#o$mance lin!un!anM es

,o

I# es' state *hat an& ho* Nia a' Nelasan a%a an! &i uu$ &an Ba!aimana hatM 4o*M 19.

Do ou ee% Acci&ent/Inci&ent ;tatistics #o$ ou$ Em%loeesM

A%aah %e$usahaan an&a menim%an statistic ecelaaan te$ha&a% a$a*an an&aM es 20.

,o

I# the ans*e$ to item 19 a"o)e is es' "$ie#l &esc$i"e the Acci&ent/Inci&ent ;tatistics ou ee% an& the analsis ou %e$#o$m on these. Nia Ga*a"an no 19 a' Gelasan Genis ecelaaan an! an&a muat &i statistic te$se"ut.

;ection VII ana!in! 4;E + onito$in! an& Im%$o)ement 22.

Do ou$ ;enio$ ana!ement con&uct $e!ula$ 4;E Au&it an& Ins%ectionM A%aah senio$ mana!ement an&a melauan au&it C3 &an (in!un!an &an melauan ins%esi ;eca$a $e!ula$M I# es' %lease attach sam%le / Nia a silahan lam%i$an "uit &a$i %elasanaan es

,o

;ection VIII u$$ent 4;E ;tatistical In#o$mation 23


;ection I

lease %$o)i&e ou$ statistical 4;E e$#o$mance #o$ 3 last ea$s< (am%i$an statistic ecelaaan C3 &an (in!un!an untu 3 tahun te$ahi$ e$sonnel $otecti)e Eui%ment

2-.

Do ou %$o)i&e a%%$o%$iate %e$sonal %$otecti)e eui%ment EF #o$ ou$ em%loeesM lease %$o)i&e a listin! o# the E #o$ the sco%e o# this *o$ M A%aah %e$usahaan an&a menia%an alat %elin&un! &i$i untu a$a*an %e$usahaan an&aM ;ilahan list alat %elin&un! &i$i an! aan an&a sia%an untu %ee$Gaan iniM

25.

Do ou ha)e a %$o!$am to ensu$e that E is im%acte& an& maintaine&M A%aah %e$usahaan an&a mem%unai %$o!$am %emeliha$aan alat %elin&un! &i$iM


CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

PROJECT SERVICES

QC-HSE

;ection 

Doc. No : 4210-GP-1301 Date : 1/2/2010

Rev : J Page : 2 o 38


26.


2.

ho is the %e$son in cha$!e #o$ coo$&inatin! en)i$onment matte$ an& *hat is he/she eH%e$ienceM ;ia%a an! "e$tan!!un! Ga*a" &alam men!han&le untu melauan %e$lin&un!an lin!un!an &i%e$usahaan an&a &an a%a %en!alaman o$an! te$se"utM

;ection I 28.


;ection II 29.

D$u!s an& Alcohol


lease %$o)i&e an si!ni#icant achie)ements o$ a*a$&sM (am%i$an %en!ha$!aan sa#et an! %e$nah &i&a%at.Gia a&a.

I un&e$stan&' #ollo* all the $eui$ement an& all the ans*e$ a"o)e is co$$ectl an& honest' ;aa men!e$ti' men!iuti semua %e$sa$atan &an menGa*a" semua %e$tanaan &iatas &en!an GuGu$ &an "ena$. ;i!ns'



CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

PROJECT SERVICES

QC-HSE

Doc. No : 4210-GP-1301 Date : 1/2/2010

Rev : J Page : 28 o 38

ATTACH%ENT 8

FA!RICA2OR9S (SE !ID E3A0U2ION No 1

2

3

4

>



8 9



Re4ar5s * (P) = < 5 (G) = 5 - 10 (E) = > 10

$'



CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

PROJECT SERVICES

QC-HSE <

10

11 12

Doc. No : 4210-GP-1301 Date : 1/2/2010

Pe,;oa6 P,otectve EB5et <.1 );t o PPE <.2 +ateace PPE P,og,a5 "ota6 Ev,o5eta6 +aage5et 10.1 Acc7et o Ev,o5eta6 10.2 Pe,;o  coo,7atg ev,o5eta6 "ota6 D,g; a7 A6coo6 P,og,a5 11.1 D,g a7 A6coo6 Po6c "ota6 Saet Aceve5et o, Aa,7; 12.1 Aa,7 Aceve5et "ota6

Rev : J Page : 29 o 38 * (P) = < 5 (G) = 5 - 8 (E) = > 8

$& * (P) = < 2 (G) = 2 - 3 (E) = > 3 ' * (P) = < 2 (G) = 2 - 3 (E) = > 3 ' * (P) = < 2 (G) = 2 - 3 (E) = > 3 '

$&&

2otal Score SU66ARY

PASS / FAILED


Note / "core achievement/

$Criteria Score% Poor &P' Good &G' .cellence &.' P,ea,e7 % : Na5e : "tt6e o Jo? : Sg : Date :

89/ ass the H"E re:uirement


ATTACH%ENT ; FOR6ARDER'" "AFET$( HEALTH AND EN#IRON%ENT )H"E* RE+,!ALIFICATION - A"E""%ENT ,!E"TIONNAIRE

$oGect

<



CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

Doc. No : 4210-GP-1301 Date : 1/2/2010

PROJECT SERVICES

QC-HSE


Rev : J Page : 30 o 38

<


Does ou$ com%an ha)e an 4;E %olic &ocument M A%aah %e$usahaan an&a mem%unai Ce"iGaan Ceselamatan Ce$Ga' Cesehatan &an (in!un!anM es

,o

I# es' %lease attach / Nia a' silahan untu &ilam%i$an. 2.


3.

ho is the most senio$ %e$son in the o$!anisation $es%onsi"le #o$ this %olic "ein! ca$$ie& out at the %$emises an& on site *he$e his em%loees a$e *o$in!M ;ia%a senio$ sta## &i %e$usahaan an&a an! "e$tan!!un! Ga*a" &alam im%lementasi e"iGaan ini &i tem%at an&a "ee$GaM



No" Title<

5.


6.

lease %$o)i&e 4;E (ea&e$ #o$ this *o$s / o%e$ationM
;ection III Ris I&enti#ication .

lease %$o)i&e ou$ Ris I&enti#ication #o$ $oute th$ou!h su$)e #o$ this Go" o$ %$oGectM A%aah an&a menia%an $encana %elasanaa C3 &an (in&un!an (in!un!an &i tem%at an&a "ee$GaM


Do ou ha)e a 4;E T$ainin! at$iH #o$ ou$ e m%loeesM
A%aah %e$usahaan an&a mem%unai $encana t$ainin! C3 &an (in&un!an (in!un!an untu a$a*an an&aM lease attach the 4;E t$ainin! mat$iH / ;ilahan lam%i$an 4;E t$ainin! mat$uH


CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

Doc. No : 4210-GP-1301 Date : 1/2/2010

PROJECT SERVICES

QC-HSE es 9.

10.

Rev : J Page : 31 o 38

,o

I# the ans*e$ to uestion no.8 *as no' "$ie#l &esc$i"e ho* ou i&enti# an& im%lement 4;E t$ainin! #o$ ou$ sta##M Nia Ga*a"an no.11 ti&a a&a' Gelasan "a!aimana an&a men!in&enti#iasi &an men!im%lementasi e"utuhan t$ainin! C3 &an lin&un!an lin!un!an untu a$a*an an&a.

Do ou ha)e a #o$mal 4;E @$ientation $o!$amme #o$ ne* em%loeesM
A%aah %e$usahaan an&a mem%unai $o!$am ;a#et @$ientation untu a$a*an "a$uM I# es' lease attach / Nia a' silahan lam%i$an es

,o

;ection V @$!anisin! #o$ 4;E + 4;E $oce&u$e 11.

Does ou$ om%an ha)e *$itten ;a#et %$oce&u$es
12.

,o

I# ans*e$ to 7uestion 16 *as es' %lease attach ;a#et an& En)i$onmental $oce&u$e that ou ha)e. Nia Ga*a"an no.16 a' ;ilahan lam%i$an %$oce&u$e C3 &an (in&un!an (in!un!an an! %e$usahaan an&a %unai.


Do ou measu$e en)i$onmental %e$#o$manceM
,o

I# es' state *hat an& ho* Nia a' Nelasan a%a an! &i uu$ &an Ba!aimana hatM 4o*M 1-.

Do ou ee% Acci&ent/Inci&ent ;tatistics #o$ ou$ Em%loeesM

A%aah %e$usahaan an&a menim%an statistic ecelaaan te$ha&a% a$a*an an&aM es 15.

,o

I# the ans*e$ to item 19 a"o)e is es' "$ie#l &esc$i"e the Acci&ent/Inci&ent ;tatistics ou ee% an& the analsis ou %e$#o$m on these.


CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

Doc. No : 4210-GP-1301 Date : 1/2/2010

PROJECT SERVICES

QC-HSE

Rev : J Page : 32 o 38

Nia Ga*a"an no 19 a' Gelasan Genis ecelaaan an! an&a muat &i statistic te$se"ut. ;ection VII ana!in! 4;E + onito$in! an& Im%$o)ement 16.

Do ou$ ana!ement con&uct 4;E Au&it an& Ins%ection at the *o$ siteM
A%aah senio$ mana!ement an&a melauan au&it C3 &an (in!un!an &an melauan ins%esi ;eca$a $e!ula$M I# es' %lease attach sam%le / Nia a silahan lam%i$an "uit &a$i %elasanaan es

,o

;ection VIII u$$ent 4;E ;tatistical In#o$mation 1.


lease %$o)i&e ou$ statistical 4;E e$#o$mance #o$ 3 last ea$s<
(am%i$an statistic ecelaaan C3 &an (in!un!an untu 3 tahun te$ahi$ ;ection I

e$sonnel $otecti)e Eui%ment

18.

Do ou %$o)i&e a%%$o%$iate %e$sonal %$otecti)e eui%ment EF #o$ ou$ em%loeesM lease %$o)i&e a listin! o# the E #o$ the sco%e o# this *o$ M A%aah %e$usahaan an&a menia%an alat %elin&un! &i$i untu a$a*an %e$usahaan an&aM ;ilahan list alat %elin&un! &i$i an! aan an&a sia%an untu %ee$Gaan iniM

19.

Do ou ha)e a %$o!$am to ensu$e that E is im%acte& an& maintaine&M A%aah %e$usahaan an&a mem%unai %$o!$am %emeliha$aan alat %elin&un! &i$iM

;ection 


20.


21.

ho is the %e$son in cha$!e #o$ coo$&inatin! en)i$onment matte$ an& *hat is he/she eH%e$ienceM
;ia%a an! "e$tan!!un! Ga*a" &alam men!han&le untu melauan %e$lin&un!an lin!un!an &i%e$usahaan an&a &an a%a %en!alaman o$an! te$se"utM

;ection I 22.


;ection II 23.

D$u!s an& Alcohol


lease %$o)i&e an si!ni#icant achie)ements o$ a*a$&sM


CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

PROJECT SERVICES

QC-HSE

Doc. No : 4210-GP-1301 Date : 1/2/2010

Rev : J Page : 33 o 38

(am%i$an %en!ha$!aan sa#et an! %e$nah &i&a%at.Gia a&a. I un&e$stan&' #ollo* all the $eui$ement an& all the ans*e$ a"o)e is co$$ectl an& honest' ;aa men!e$ti' men!iuti semua %e$sa$atan &an menGa*a" semua %e$tanaan &iatas &en!an GuGu$ &an "ena$. ;i!ns'



CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

PROJEC2 SER3ICES QC-HSE

Doc. No : 4210-GP-13-01

Rev : J

Date

Page : 3- o 38

: 1/2/2010

ATTACH%ENT <

"#RARD.R HS. ID .A3U4I#N No 1

2

3

4

>



8 9



Re4ar5s * (P) = < 5 (G) = 5 - 10 (E) = > 10

$'



CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM

PROJEC2 SER3ICES QC-HSE <

10

11 12

Doc. No : 4210-GP-13-01

Rev : J

Date

Page : 35 o 38

: 1/2/2010

* (P) = < 5 (G) = 5 - 8 (E) = > 8

Pe,;oa6 P,otectve EB5et <.1 );t o PPE <.2 +ateace PPE P,og,a5 "ota6

$& * (P) = < 2 (G) = 2 - 3 (E) = > 3

Ev,o5eta6 +aage5et 10.1 Acc7et o Ev,o5eta6 10.2 Pe,;o  coo,7atg ev,o5eta6 "ota6

' * (P) = < 2 (G) = 2 - 3 (E) = > 3

D,g; a7 A6coo6 P,og,a5 11.1 D,g a7 A6coo6 Po6c "ota6

' * (P) = < 2 (G) = 2 - 3 (E) = > 3

Saet Aceve5et o, Aa,7; 12.1 Aa,7 Aceve5et "ota6

'

$&&

2otal Score

PASS / FAILED

SU66ARY



Note: Score ac;ieve4ent: < -&: (eav8 0it= Dan)ero/s Car)o 2ransport= International For>arder? *' @ '": 0ocal 2ransporter and General Car)o 2ransport

$Criteria Score% Poor &P' Good &G' .cellence &.' P,ea,e7 % : Na5e : "tt6e o Jo? : Sg : Date :


ATTACH%ENT =9

(SE !UDGE2 FOR SU!CON2RAC2OR 0OCA2ION O PROJEC2 ES2I6A2ED 6ANPOBER REK ES2I6A2ED PROJEC2 DURA2ION

NO

(SE EUIP6EN2

: : :

SPECIFICA2ION

2Y

UNI2

PRICE

2O2A0

RE6ARKS


CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM


Doc. No : 4210-GP-13-01

Rev : J

Date

Page : 36 o 38

: 1/2/2010 PRICE

A

2

PERSONA0 PRO2EC2I3E E2 Saet He65et  C St, Saet G6a;;e;

3 4

(ace Se67 Ea, P6g

ea ea

> 

ea ea

< 10 11 12 13

Ea, + (66 (ace +a;  Ca;te, Re;,ato, D;t +a; / Kava; Cotto G6ove; FPa65 Dotte7 )eate, G6ove; R??e, G6ove; Saet Soe; *ea, Pac Saet R??e, %oot;

,; ,; ,; ,; ,;

14 1>

Ra Coat; SC%A / E)SA

ea ea

1

*o, $e;t

ea

!

6ASS PRO2EC2I3E E2 (66 %o7 Ha,e;; c/ 6aa,7 Saet Net; Saet Roe; Saet "ae; / %a,,ca7e; Saet Coe; Yoo F(66 %6oc A,,e;to, Saet )e )e

1

8 9

1 2 3 4 >  8 C 1 2 3 4 >  8 9 < D

SAFE2Y SIGNS= POS2ERS= etc Saet Sg; c/ ;ta7 Saet Po;te, c/ ,a5e Saet %ae, FSa7 *7 Soc %e7e,a K3 %e7e,a Pe,;aaa %e7e,a +e,a Pt %e7e,a +;te, Pot Stce,;

1

FIRE PRO2EC2ION EUIP6EN2 (,e Etg;e,;

2

(,e Etg;e,;

3

(,e %6aet (?,e

4

(,e Etg;e,; C!2 te (,e Ho;e; 2> 5t, Jet-S,a No@@6e; Y-Pece / Dv7g ?,eecg

>  8

+SA  CHA'N S"R'P

ea ea

ea ,;

Aa?6a eca ;?- cot a=? 5e ggat #t ee,=aa cg 7a 7eat 7ega g,7a 7a e67g Seta ee,=aa g,7a #t ?ee,=a 7e?;ga 5e6e? 90 7? ;e6a5a 9 =a5 (o, Co55;;og (o, Co55;;og

Se5a ee,=a a=? 5eggaa a7 g6ove #t e67g g,7a (o, Co55;;og Seta ;at ta ;ea6 a=? 7gat (o, Co55;;og #t ee,=aa cv6 Fecavato ee,a=aa 5g ce5et ?6a =a ?6a 7e,6a t ee,=aa coe7 ;ace a=? t ?ee,=a 7ata; a,

t ee,=aa 7ata; 1 5

Do?6e )a7 Ya,7

t 5egcove, ee,=aa 7etgga

#t ee,=aa 7ata; > 5 7a6a5 o7; ve,ta6 7a 6a77e, g ve,ta6 7ata; 3 5 P,ote; ?ee,=a 7etgga

S6g/"a6 "a5?ag

0 c5  90 c5 A655 Pat o cava;

30 40 40 > > > > >

Ca. 20 )?; A%C Po7e, Ca. 10 )?; A%C Po7e, Ca.  )?;

#t ;eta e67g 5ace t,ao ge;et 77a6a5 ato, o,;o 7a 5ace, ag 6a ag a7a 76aaga t ;eta ecavato, e7a,aa 7o@e, c,ae t5c ;eta ?oto6 ?e,teaa ag a7a 76aaga t ee,=aa 7 e;tg a,ea 7eat 7ega e6ect,ca6 eB5et #t 7 e;tg a,ea #t 7 e;tg a,ea #t 7 e;tg a,ea


CORPORATE PROCEDURE


CONTRACTOR SAFETY

REKAYASA

MANAGEMENT SYSTEM


E 1 2

6EASURE6EN2 EUIP6EN2 +6t6e Ga; Detecto, !2 Ga; Detecto,

3

Ka6?,a; 7a Rea,

F 1

(EA02( EUIP6EN2 (,;t a7; Kt ;et  ER Set +e7ca6 Cec #

2

G 1 2 ( 1

EN3IRO6EN2 EUIP6EN2 Po,ta?6e "o6et So6a, 7a !6 Sto,age CO66UNICA2ION EUIP6EN2 Ha7 "a6

I 1

SCAFFO0DING "e e t?e toe?oa,76a77e,

J 1

SER2IFIKASI C,ae

2

"+C

3

Scao67e,

4 > 

Rgge, Ge;et !e,ato, C,ae

8

!e,ato, "+C

9

Ecavato, Do@e,

K

S0ING= 2ACK0E= C(AIN !0OCK

0 1

PRESSURE !O220E (6a; %ac A,,e;to,

2 3 4

Reg6ato, C6a5 Se6ag Rac %oto6 %e,teaa

6 1

(SE 6ANPOBER HSE Coo,7ato,

2

HSE S$

Date

Doc. No : 4210-GP-13-01

Rev : J

Date

Page : 3 o 38

: 1/2/2010

Aa6og/Dgta6 Aa6og/Dgta6

#t ee,=aa 7e;tg

SN' Sta7a,7 t 7ata; >0 o,ag

#t 7o,;o 7a ato, ;?cot,acto,

#t ee,=aa 7e;tg 7a coe7 ;ace

S,at ete,aga ;eat t ;eta ee,=a ;e7aga t a,aa o,gac o66o CS+S ,oce7,e Reaa;a '7;t,.

1:>0 ee,=a Coc,ete (6oo,

#t ea5ga ;o6a, 7a o6

Ga; P,oo "e o, e;tg

t ;eta HSE Coo,7ato, ;?cot,acto, g co5at?6e 7ega Reaa;a

tce;; 5 2.> 55 =a c6et 5e;a,ata 6e? 5aa ;?-cot a,; 5e5at. +ate,a6 ga6va@e7

t ee,=aa 7ata; 1 5

!6 a7 Ga; F+ga; Se,tat Se6a t Deae, ;e,tat !6 a7 Ga; F+ga; Se,tat Se6a t Deae, ;e,tat Deae, Se,tat

Scao67e, S$ ;eta c,e

Deae, Se,tat Deae, Se,tat

 200 Kva

!6 a7 Ga; F+ga; Se,tat Se6a t Deae, ;e,tat !6 a7 Ga; F+ga; Se,tat Se6a t Deae, ;e,tat Deae, Se,tat

Ha,; 5e5a ;e,tcate 5aact,e

!2 Acte6e 7a A,go

eggaa 76aaga 7a a,eo;e

Seta ;?-cot,acto, a=? 5ee7aa 1 o,ag HSE Coo,7ato, 7ega ega6a5a e,=a 55a6 4 ta 7 o6 7a ga; 5e5a egetaa K3 7a 55a6 ?e,7a D3 6e? ?a D3 !HS "ota6 HSE S$ a7a6a 1 : >0 ee,=a

:

(4210-GP-13-01) Prosedur CSMS_ Rev J.doc

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