EPC OF LAWE-LAWE FACILITIES RDMP

RU-V BALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 007
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 1 / 154

ENGINEERING, PROCUREMENT AND CONSTRUCTION (EPC)

OF LAWE-LAWE FACILITIES RDMP RU-V
BALIKPAPAN

PROJECT HSSE PLAN

Djoko Koen Soewito

Chief Engineer (KTT)
PERTAMINA RDMP RU-V

007 03-Feb-21 Reissued for Construction Rivan R Hajir Cui Guojun

006 17-Jan-21 Reissued for Construction Rivan R Hajir Cui Guojun

005 19-Dec-20 Reissued for Construction Rivan R Hajir Cui Guojun

004 30-Nov-20 Reissued for Construction Rivan R Hajir Cui Guojun

003 31-Aug-20 Reissued for Construction Bimo HP Hajir Cui Guojun

002 27-Apr-20 Reissued for Construction Hajir Aris W Cui Guojun

001 06-Mar-20 Reissued for Construction Hajir Aris W Cui Guojun

000 06-Feb-20 Issued for Construction Hajir Aris W Cui Guojun

00C 19-Dec-19 Reissued for Review Hajir Aris W Cui Guojun

00B 22-Nov-19 Reissued for Reviews Hajir Aris W Cui Guojun

00A 06-Nov-19 Issued for Review Hajir Aris W Cui Guojun

Rev. Date Description Prepared By Reviewed By Approved By

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REVISION LOG
REV. NO DATE PAGE DESCRIPTION

00A 06-NOV-19 - ISSUED FOR REVIEW

00B 22-NOV-19 - REISSUED FOR REVIEW, REFER TO COMMENT RESOLUTION

SHEET 00A

00C 19-DEC-19 - REISSUED FOR REVIEW, REFER TO COMMENT RESOLUTION

SHEET 00B

000 06-FEB-20 - ISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 00C

001 11-MAR-20 - REISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 000

002 27-APR-20 - REISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 001

003 31-AUG-20 - REISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 002

004 30-NOV-20 - REISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 003

005 19-DEC-20 - REISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 004

006 17-JAN-21 - REISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 005

007 03-FEB-21 - REISSUED FOR CONSTRUCTION, REFER TO COMMENT

RESOLUTION SHEET 006
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TABLE OF CONTENT
1.0 GENERAL..................................................................................................................... 10
2.0 DEFINITION ................................................................................................................. 10
3.0 ACRONYMS................................................................................................................. 15
4.0 REFERENCE DOCUMENT .............................................................................................. 16
5.0 SCOPE ......................................................................................................................... 20
6.0 PURPOSE .................................................................................................................... 21
7.0 PROJECT HSSE PHILOSOPHY ........................................................................................ 21
8.0 LEADERSHIP AND COMMITMENT ................................................................................ 21
9.0 TEAM LEADER OBJECTIVES .......................................................................................... 22
10.0 POLICY, OBJECTIVES AND KPI’S ................................................................................... 22
10.1 HSSE Policy .............................................................................................................22
10.2 Strategic Objectives and KPI’s ................................................................................23
11.0 HSSE GOLDEN RULES AND NO TOLERANCE.................................................................. 26
11.1 Golden Rules for Life Saving ...................................................................................26
11.2 Golden Rules for Safe Driving .................................................................................26
11.3 Zero Tolerance........................................................................................................27
12.0 HSSE ORGANIZATION AND RESPONSIBILITY ................................................................ 27
12.1 Organization ...........................................................................................................27
12.2 Responsibility .........................................................................................................28
12.2.1 Project Manager .................................................................................................... 28
12.2.2 HSSE Manager ....................................................................................................... 28
12.2.3 Engineering Manager ............................................................................................ 30
12.2.4 Procurement Manager .......................................................................................... 30
12.2.5 Construction Manager........................................................................................... 30
12.2.6 Construction Discipline Superintendent or Supervisor ......................................... 31
12.2.7 Pre-Commissioning and Commissioning Manager ............................................... 31
12.2.8 Discipline Leads ..................................................................................................... 32
12.2.9 Deputy HSSE Manager ........................................................................................... 33
12.2.10 Chief HSSE / HSSE Superintendent ........................................................................ 33
12.2.11 HSSE Engineer........................................................................................................ 33
12.2.12 Enviromental Engineer .......................................................................................... 34
12.2.13 Inspector ................................................................................................................ 34
12.2.14 HSSE Training Coordinator .................................................................................... 34
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12.2.15 Site Doctor ............................................................................................................. 34

12.2.16 Paramedic .............................................................................................................. 35
12.2.17 SUBCONTRACTOR/Supplier/Vendors .................................................................... 35
13.0 HSSE RISK MANAGEMENT ........................................................................................... 35
13.1 Engineering HSSE Risk Management......................................................................35
13.2 Hazard Identification Risk Assessment and Control (HIRAC) .................................36
13.3 Job Safety Analysis (JSA) and Work Method Statement ........................................36
13.4 Job Hazard Analysis (JHA) .......................................................................................38
13.5 Toolbox Talk / Safety Task Analysis Risk Reduction Talk (STARRT) ........................38
13.6 Pre-Construction HSSE Activities ............................................................................38
14.0 MANAGEMENT OF CHANGE (MOC) ............................................................................. 39
15.0 CLASSIFICATION AREA ................................................................................................ 41
16.0 PRE MOBILIZATION MANAGEMENT ............................................................................ 44
16.1 Manpower Readiness .............................................................................................45
16.2 Equipment / Tools / Vehicles Readiness ................................................................45
16.3 Documentation Readiness .....................................................................................45
17.0 TRANSPORTATION MANAGEMENT ............................................................................. 46
17.1 Vehicles...................................................................................................................46
17.2 Pedestrian Area ......................................................................................................46
18.0 HEALTH MANAGEMENT .............................................................................................. 47
18.1 Health Goals and Objectives ..................................................................................47
18.2 Biological Hazards...................................................................................................47
18.2.1. Wildlife Animal ...................................................................................................... 48
18.2.2. Blood-Borne Pathogens......................................................................................... 49
18.3 Fitness to Work.......................................................................................................50
18.4 Hygiene and Occupational Health ..........................................................................50
18.4.1. Catering Practices .................................................................................................. 50
18.4.2. Fatigue Management ............................................................................................ 51
18.4.3. Housekeeping ........................................................................................................ 51
18.4.4. Heat Stress............................................................................................................. 52
18.4.5. Hearing Protection ................................................................................................ 52
18.4.6. Respiratory Protection .......................................................................................... 53
18.4.7. Radiation Protection.............................................................................................. 53
18.5 Hazardous Materials...............................................................................................54
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18.6 Water and General Sanitation ................................................................................55

18.7 Pest and Vector Control .........................................................................................55
18.8 Eye Protection ........................................................................................................55
18.9 Medical Services and Medical Treatment ..............................................................55
18.10 First Aid ...................................................................................................................56
18.11 Return to Work .......................................................................................................56
18.12 Extended Work and Shift Work ..............................................................................56
18.13 Prevention the spread of Corona Virus Disease (Covid-19) for Workers, Partners
and Families. ...........................................................................................................57
19.0 HSSE MANAGEMENT SYSTEMS ................................................................................... 61
19.1 Planning ..................................................................................................................61
19.2 HSSE Management System ....................................................................................62
20.0 OPERATING PROCEDURES AND SAFETY STANDARD ................................................... 62
20.1 Personal Protective Equipment..............................................................................62
20.2 Safety Sign, Color Coding and Barricade ................................................................63
20.3 Chain Blocks and Come-A-Longs ............................................................................64
20.4 Lifting and Rigging ..................................................................................................65
20.4.1 Crane Requirements .............................................................................................. 65
20.4.2 Lifting Gears Requirements ................................................................................... 65
20.4.3 Lifting Plan ............................................................................................................. 66
20.4.4 Operator Requirements ........................................................................................ 67
20.4.5 Rigger Requirements ............................................................................................. 67
20.5 Heavy Mobile Equipment .......................................................................................68
20.6 Working at Height /Fall Protection ........................................................................69
20.7 Scaffolding ..............................................................................................................70
20.8 Falling Objects Protection ......................................................................................71
20.9 Floor and Wall Opening ..........................................................................................72
20.10 Excavation and Trenching ......................................................................................72
20.11 Confined Spaces Entry ............................................................................................73
20.12 Lock-Out and Tag Out Procedure (LOTO) – Energy Isolation .................................76
20.13 Portable Ladders.....................................................................................................78
20.14 Radiography............................................................................................................79
20.15 Welding, Cutting and Grinding ...............................................................................79
20.16 Pedestal, Bench and Portable Grinders .................................................................80
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20.17 Manual and Mechanical Handling ..........................................................................80

20.18 Permit to Work .......................................................................................................81
20.19 Cameras (Security) .................................................................................................82
20.20 Hand and Power Tools ...........................................................................................82
20.21 Pneumatic Tools .....................................................................................................83
20.22 Compressed Gas Cylinder .......................................................................................84
20.23 Electrical Works ......................................................................................................84
20.24 Hot Work ................................................................................................................86
20.25 Hazardous Material ................................................................................................86
20.26 Hydrogen Sulfide (H2S) ..........................................................................................87
20.27 Site Office HSSE ......................................................................................................88
20.28 Fire Prevention and Protection ..............................................................................88
20.28.1 Flammable Combustible Liquid Storage & Handling............................................. 89
20.28.2 Smoking Area......................................................................................................... 91
20.28.3 Mobile Cell Phone ................................................................................................. 91
20.28.4 Fire Extinguisher and Fire Watcher ....................................................................... 92
20.29 Traffic Safety ...........................................................................................................92
20.30 Blasting and Painting ..............................................................................................93
20.31 Marine Safety .........................................................................................................93
20.32 SIMOPS ...................................................................................................................95
20.33 Site Office, Stores, Workshops, Living Accommodation and Canteen Facilities ....95
20.33.1 Workshop Facilities ............................................................................................... 96
20.33.2 Living Accommodation .......................................................................................... 96
20.33.3 Ablution Facilities .................................................................................................. 97
20.33.4 Canteen Facilities................................................................................................... 97
21.0 COMPENTECES, AWARENESS AND TRAINING .............................................................. 97
21.1 HSSE Training Requirements ..................................................................................97
21.2 Competency............................................................................................................98
21.3 Training Record and Tracking Method ...................................................................98
21.4 Training Provider ....................................................................................................98
21.5 Training Key Performance Indicator (KPI) ..............................................................98
21.6 CONTRACTOR Internal Trainer ...............................................................................98
21.7 Site Specific Orientation Programs.........................................................................99
21.8 Short Service Employee Program (SSE) ..................................................................99
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22.0 COMMUNICATION .................................................................................................... 100

22.1 Languages .............................................................................................................100
22.2 Communication Mediums ....................................................................................100
22.3 Meetings ...............................................................................................................101
22.4 Records and Reports.............................................................................................102
23.0 STOP WORK AUTHORITY (SWA) ................................................................................ 103
24.0 EMERGENCIES AND EVACUATION ............................................................................. 103
24.1 Emergency Response Plan....................................................................................104
24.2 Emergency Response Drill ....................................................................................104
24.3 Emergency Siren ...................................................................................................104
24.4 Medical Facilities and Medical Services Requirements .......................................105
24.5 Equipment ............................................................................................................105
24.6 Muster Point and Assembly Point ........................................................................105
25.0 SECURITY .................................................................................................................. 106
25.1 Security Control Areas ..........................................................................................106
25.2 Site Entry ..............................................................................................................107
25.3 Security Personnel Duties ....................................................................................107
25.4 Material Exit .........................................................................................................108
26.0 ENVIRONMENT ......................................................................................................... 108
26.1 General Environmental Requirement ..................................................................108
26.2 Environmental Control .........................................................................................109
26.2.1 Environmental Standards .................................................................................... 109
26.2.2 Environmental Hazard Mitigations...................................................................... 109
26.2.3 Spill and Waste Management ............................................................................. 109
26.2.4 Hazardous Waste Management .......................................................................... 110
26.2.5 AMDAL ................................................................................................................. 111
27.0 PERFORMANCE EVALUATION.................................................................................... 111
27.1 Audits....................................................................................................................111
27.1.1 Quarterly HSSE Joint Audits by CONTRACTOR and Owner ................................. 111
27.1.2 External Audits .................................................................................................... 112
27.2 Inspections............................................................................................................112
27.2.1 Construction Observation Program (e-COP) ....................................................... 112
27.2.2 Daily / Routine Assessment ................................................................................. 112
27.2.3 Weekly Site Management Walkdowns ............................................................... 112
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27.2.4 Quarterly Environmental Inspections and Assessment ...................................... 113

27.3 Incentives and Consequences ..............................................................................113
27.3.1 HSSE Incentive Programs..................................................................................... 113
27.3.2 HSSE Consequence Programs .............................................................................. 113
28.0 REPORTING/INVESTIGATING OF INCIDENT AND ACCIDENT ....................................... 114
29.0 SUBCONTRACTOR MANAGEMENT ............................................................................ 116
29.1 Pre-approved SUBCONs .......................................................................................116
29.2 CSMS Process Flow ...............................................................................................116
30.0 RECORDS AND REPORTS ........................................................................................... 119
30.1 Safety Performance Indicators data.....................................................................119
30.2 Registers ...............................................................................................................119
30.3 Authorizations ......................................................................................................119
31.0 MANAGEMENT REVIEW MEETING ............................................................................ 119
32.0 ATTACHMENTS ......................................................................................................... 120
Attachment 1.a. CONTRACTOR HSSE Policies ..................................................................121
Attachment 1.b. Environmental CONTRACTOR Policy .....................................................122
Attachment 1.c. Prohibition Drug, Alcohol and Weapon CONTRACTOR Policy...............123
Attachment 2 List of Regulations .....................................................................................124
Attachment 3 HSSE Matrix Training .................................................................................127
Attachment 4 CSMS Questionnaire..................................................................................130
Attachment 5 HSSE Program ............................................................................................136
Attachment 6 PPE Matrix .................................................................................................144
Attachment 7 Incident Process Flowchart .......................................................................145
Attachment 8 HSSE Organization Chart ...........................................................................149
Attachment 9 Change Management Request Form ........................................................150
Attachment 10 Hazard Identification Risk Assessment & Control (HIRAC) .....................155
Attachment 11 Job Safety Analysis (JSA)..........................................................................156
Attachment 12 Job Hazard Analysis (JHA)........................................................................159
Attachment 13 Penalty System ........................................................................................160
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List of Tables
Table 1. HSSE Key Performance Indicators.................................................................. 25
Table 2. MOC Risk Assessment Requirements............................................................. 40
Table 3. MOC Authorization Level Required................................................................ 41
Table 4. Classification of Work Areas.......................................................................... 41
Table 5. Matrix Approval Authority Greenfield-Brownfield Onshore & Offshore............ 43
Table 6. Personal Protective Equipment (PPE) Standard............................................... 57
Table 7. List of Required Authority to Certify Heavy Mobile Equipment......................... 63
Table 8. Requirements for Respirable and Non-Respirable Confined Space................... 70
Table 9. Colour Code Period....................................................................................... 79
Table 10. Records and Reports Retentions Periode........................................................ 96
Table 11. Emergency Siren Tones................................................................................. 98
Table 12. Disciplinary Action to be Taken up to The Penalty Points ................................. 107

List of Figures
Figure 1. Classification of Work Areas.......................................................................... 42
Figure 2. Calculation for Potential Fall Distance............................................................ 64
Figure 3. Danger Tag tagging and padlocked (Red colour) ............................................. 71
Figure 4. Out of Service Tags (yellow colour) ............................................................... 72
Figure 5. Distribusi muster point and Assemble Point................................................... 100
Figure 6. CSMS Process Flow....................................................................................... 111
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1.0 GENERAL
PT PERTAMINA (PERSERO), hereinafter referred to as the OWNER, places prime importance
health, safety and environmental issues and shall require the CONTRACTOR Subscribe to and
actively pursue the highest standards of Health, Safety, Security, and Environment in the course
of project execution.
CONTRACTOR shall therefore observe, adhere to and comply with HSSE provisions as required by
this HSSE document and applicable local HSSE Laws and Regulations.
This Project HSSE Plan is established to provide all CONTRACTOR Management and employees,
SUBCONTRACTORs, visitors, and other persons involved in the project a clearly defined plan to
ensure that CONTRACTOR takes every possible action to protect Health, Safety, Security and
Environment.
All CONTRACTOR management and employees and SUBCONTRACTOR personnel shall be familiar
with their responsibilities to Health, Safety, Security and Environment. For this purpose, this
Project HSSE Plan and other documents required such as OWNER’s HSSE Guidance, if any, will be
located at work areas and be readily available to all personnel.

2.0 DEFINITION
Unwanted or undesired event resulting from the occurrence of
ACCIDENT one or more fault incident that have negative impact on the
system, product, equipment or personnel.
Siren is a sign with a certain sound and duration for emergency or
ALARM
unsafe condition
is a study of the major and significant impacts of a business and /
or planned activity on the environment required for the decision-
AMDAL
making process regarding conducting business and / or activities in
Indonesia.
Assembly point are considered safe place to congregate the
ASSEMBLY POINT
workers or the third parties in case of evacuation
A systematic and independent review of a HSSE system or element
for its compliance, effectiveness and degree of implementation to
AUDIT
the system undertaken by a person other than those who have a
responsibility within the activity being audited
A property team, project team or SUBCONTRACTOR who are
AUDITEE
executing an activity
Persons of EPC Of Lawe-Lawe Facilities RDMP Ru-V Balikpapan
AUDITOR Project who have proper qualification (National/ International
certified) and authorization to perform a HSSE audit
Employees of CONTRACTOR, Pertamina or any of its
SUBCONTRACTOR or Vendors, Who are scheduled for work or has
AUTHORIZED PERSONNEL other official business on site. Authorized personnel may also
include non employees who have been formally invited to the
project or who have been formally invited to the project or who
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have obtained prior written permission to enter the site.

Goverment officials on official business to site
means an unpowered, flat bottomed, shallow draft vessel
BARGE including river barges, scows, car floats, and lighters. It does not
include ship shaped or deep draft barges.
BARREL A volume of 42 U.S. gallons.
Training in addition to Induction Training to ensure that all
BASIC TRAINING personnel permanently working on site have sufficient knowledge
to meet HSSE requirements while performing their basic tasks
Project area located and in direct contact with existing plants /
BROWNFIELD
refineries
CARDIO PULMONARY a combination of artificial respiration (mouth to mouth) and
RESUSCITATION artificial circulation (external cardiac compression)
is a person who has the highest position in the Oil & Gas
organizational structure that leads and is responsible for carrying
CHIEF ENGINEER (KTT)
out Oil & Gas operations in accordance with good Oil & Gas
engineering principles. Development Director - KPB
Is any work that is not included in the category of work that USES
COLD WORK
or GETS a source of fire or heat.
A space that:
- Is large enough and so configured that an employee can bodily
enter and perform assigned work; and
CONFINED SPACE - Has limited or restricted means for entry or access (for
example, tanks, vessels, silos, storage bins, hoppers, vaults and
pits are spaces that may have limited means of entry) and;
Is not designed for continuous employee occupancy
Organization to which PERTAMINA awards the EPC Scope of Work
CONTRACTOR for the PROJECT. Joint Operation by China Petroleum Pipeline
E. Co and PT. Hutama Karya (CPPHK)
Training in addition to Basic Training, to ensure that all craft
CRAFT TRAINING working on site have sufficient knowledge to meet HSSE
requirements while performing their specialty tasks.
Lifting devices that are capable of being dynamically loaded when
CRANES lifting, loading or shifting loads by means of a projecting and/or
swinging boom and movable lifting blocks
DEPNAKER Ministry of Manpower of Republic Indonesia
Emergency is an abnormal condition includes fire, oil spill, gas leak,
EMERGENCY power failure, or hazards that threaten safe operation of the
refinery, the company’s assets, the human soul, and environment
ESDM Ministry of Energy and Mineral Resources
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Evacuation is an act to keep away from the scene of emergency to

EVACUATION safer place with consideration the condition can be wider to life
threatening of workers and residents around the incident/refinery.
Fatality Accident Rate is number of fatal incidents that may cause
FATALITY ACCIDENT RATE death.
Calculation: (Fatality / Total Man Hours) x 100,000,000
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
FIRST AID CASE (FAC) 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.
Gas leak is the uncontrollable of gas or vapors exposure and can
GAS LEAK
be dangerous to human and environment
The new open work area which clearly demarcation, declared by
GREENFIELD land Owner there are no process plant exposed to this area and
nor existing underground pipeline & power line.
A condition or action that has the potential for an unplanned
HAZARD release of, or unwanted contact with, an energy source that may
result in harm or injury to people, property or the environment.
includes materials contaminated with hydrocarbon solvents,
HAZARDOUS WASTE (B3) chemically treated lumber, fuels, paints, coatings, residue, heavy
metals, and similarly toxic materials
are remains or excesses from a task and / or activity which contains
dangerous and / or poisonous Substances which because of the
HAZARDOUS AND TOXIC characteristics and / or concentration and / or quantity of the
WASTE (B3 WASTE) Substances may directly or indirectly pollute and / or endanger and
/ or destroy the environment and / or well being of mankind and
other life forms.
HEALTH/MEDICAL A medical expert doctor who focuses on prevention, diagnoses and
ADVISOR treats illness.
A hoist (including pneumatic-powered lifting equipment, lever
hoists) is a chain or electric lifting device, usually attached to a
HOIST trolley, which travels along a monorail or bridge crane. A hoist may
also be a chain or electric lifting device that is affixed to a
stationary point.
Is any type of work related to the use of ignition sources or that
HOT WORK
can cause an open flame / spark
Work-related event(s) in which an injury or ill health (regardless of
INCIDENT
severity) or fatality occurred, or could have occurred.
Training to ensure that all personnel entering the site are aware of
INDUCTION TRAINING and can meet general HSSE requirements, to enable them to move
around Safety without an escort
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Integrated Project Management Team consists of a combination of

INTEGRATED PROJECT OWNER personnel and PMC. Communication between OWNER
MANAGEMENT TEAM and CONTRACTOR to be executed through IPMT as representative
of OWNER. The PMC is represented by Worley
Job Safety Analysis is one of the safety management tools that can
be used to define and control the hazards associated with a certain
JOB SAFETY ANALYSIS 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).
An auditor who has proper qualification (National/ International
LEAD AUDITOR
certified) and authorization to manage a HSSE audit
A work injury resulting disability and in which the injured person is
not able to work the next regularly scheduled shift. Lost time
LOST TIME INJURY 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
Lost Time Injury Frequency Rate is the number of injuries causing
LOST TIME INJURY lost time for employees and CONTRACTORs per million hours
FREQUENCY RATE worked.
Calculation: (Total LTI/Total Man Hours) x 1,000,000
Lock Out / Tag Out is a procedure to ensure that energized
machines / equipment (such as mechanical static / electrical /
LOCK OUT / TAG OUT
instrument equipment) / other process systems are properly shut
(LOTO)
off and not started up again prior to the completion of
maintenance or servicing work.
cases are more serious than first aid cases. Essentially, medical
treatment refers to management and care of persons to combat
MEDICAL TREATMENT
disease or disorder and excludes visits for observation or
counseling and conduct of diagnostic procedures.
A Medical Treatment Case is any recordable injury that involves
MEDICAL TREATMENT neither Lost Workdays nor Restricted Workdays but which
CASE requires treatment by, or under the specific order of, a physician
or could be considered as being in the province of a physician.
Master area is a safe area that has been designated as a main
MUSTER AREA congregate (center) to accommodate the refugees from the
assembly point
An incident where no property was damaged and no personal
NEAR MISS injury was sustained, but where given a slight shift in time or
position, damage and/or injury easily could have occurred.
includes untreated lumber, medical waste, solid sewage waste,
NON-HAZARDOUS WASTE scrap metals, waste oils, lubricants and other waste not designated
as hazardous by ANDAL, RKL, and World Bank standards
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OFFSHORE WORK is practices of work conducted under, on, over and near water.
a doctor who was accomplished and located at the site project of
ON SITE DOCTOR a particular activity or concern on site medical treatment for
accident victim
OWNER PT PERTAMINA (Persero) RDMP RU-V Balikpapan
PERMIT SYSTEM Safe system of work for the control of activities in hazardous area.
is entry or inclusion or organism, Substance, energy and/or other
component into environment by human activity, result the quality
POLLUTION
decreased to a certain level and caused the environment
malfunction
Engineering, Procurement and Construction (EPC) for the scope of
PROJECT work for the Lawe-Lawe Storage Terminal defined within and in
referenced documents and drawings (RDMP Lawe-Lawe Project)
RDMP RU V Balikpapan Refinery Development Master Plan Refinery Unit V Balikpapan
RESTRICTED WORK Where the employee cannot fulfill his normal work, the day
ACTIVITY CASES following an incident.
Effect of uncertainty on objectives. It could refer to positive
RISK
consequences of uncertainty, as well as negatives one.
Safety Task Analysis Risk Reduction Talk A meeting conducted
SAFETY TASK ANALYSIS RISK before a task between field supervisors/PA and their work crew
REDUCTION TALK which focuses methodically on the hazards of the task and its
associated precautionary measures
SUBCONTRACTORs/ CONTRACTOR's employee engaged in the
SCAFFOLDER
erection and dismantling of scaffolds.
Simultaneous Operations, is two different or more activities which
SIMULTANEOUS have occurring in almost same time and area. Close enough to
OPERATIONS each other that there is a risk of interference, clashing, or risk
transfer.
SITE is Project Location where the facilities will be installed
SITE DOCTOR A qualified medical practitioner who attends the project site.
SPECIFICATION is technical requirement which has not been included in standards
the base used for prayer, in the form of carpets etc. small in size,
PRAYER MAT
approximately 80 x 120 cm
Person or persons, firm, partnership, corporation or combination
thereof engaged by the CONTRACTOR, (not being the employee of
SUBCONTRACTOR
CONTRACTOR, (not being the employee of CONTRACTOR) for
supplying services to CONTRACTOR
All sudden, suspicious, unexpected, unexplained and accidental
death or missing person (presumed dead). It can be classified at
SUDDEN DEATH
the work place or in an area other than the workplace i.e.
accommodation, travel, smoking area, etc.
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Total Recordable Incident Rate is number of total recordable

TOTAL RECORDABLE
incidents per million hours worked.
INCIDENT RATE
Calculation: (Total Record Case / Total Man Hours) x 1,000,000
is movement of vehicles, mobile equipment, animals, pedestrians
TRAFFIC
on roads
Any person from the general public who does not have any offial
UNAUTHORIZED
business with CONTRACTOR, Pertamina or any of its
PERSONNEL
SUBCONTRACTORs or vendors
The manufacturer of the equipment or the manufacturers agent
VENDOR/MANUFACTURER Bidder(s) the CONTRACTOR which intended to bid or Submit the
quotation for this work
WASTES are remains or excesses from a task and/or activity.
Any physical location in which work related activities are
WORKPLACE
performed under the control of the CONTRACTOR organization.

3.0 ACRONYMS
ALARP As Low as Reasonably Practicable
Analisis dampak lingkungan / Analisis mengenai dampak
AMDAL
lingkungan (Environmental Impact Analysis)
BAPETEN The Nuclear Energy Supervisory Agency is a non-ministerial
government institution that is under and responsible to the
President
BATAN The National Nuclear Energy Agency (BATAN) as a Non-
Departmental Government Institution carrying out tasks in the
field of research, development and utilization of nuclear energy in
accordance with the provisions of the applicable laws and
regulations intends to hold a 2015 Nuclear Science and
Technology Seminar.
BBSO Behavior Based Safety Observation
CFCs Chlorofluorocarbons
COSHH Control of Substance Hazardous to Health
CPR CARDIO PULMONARY RESUSCITATION (CPR)
Joint Operation of China Petroleum Pipeline Engineering co., ltd.
CPPHK
and PT. Hutama Karya (Persero)
CPR Cardio Pulmonary Resuscitation
CSMS CONTRACTOR Safety Management System
CTR CONTRACTOR
DAFW Days Away from Work Cases
e-COP Electronic Construction Observation Programs
EMS Environmental Management System
ERT Emergency Response Team
FAC First Aid Case
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FAR Fatality Accident Rate

HALON Halomethane fire extinguishing systems
HIRAC Hazard Identification Risk Assessment and Control
HK PT. Hutama Karya (Persero)
HSSE Health, Safety, Security, Environment
IPMT Integrated Project Management Team
JSA Job Safety Analysis
KPI’s Key Performance Indicators
LTI Lost Time Injury
LTIFR Lost Time Injury Frequency Rate
MCK Mandi, Cuci, Kakus (Bath – Wash - Toilet)
MOC Management of Change
MTC Medical Treatment Case
NDT Non-Destructive Test
ODP Orang Dalam Pemantauan (People In Monitoring)
OTG Orang Tanpa Gejala (People Without Symptoms)
PCBs polychlorinated biphenyls
PDP Pasien Dalam Pengawasan (patient under surveillance)
PPE Personal Protective Equipment
PPU Penajam Paser Utara (Regency in East Kalimantan)
PTW Permit to Work
RDMP PERTAMINA RU V Refinery Development Master Plan PERTAMINA Refinery Unit V
RWC Restricted Work Case
SDS Safety Data Sheet
SIMOPS Simultaneous Operations
STARRT Safety Task Analysis Risk Reduction Talk
SWA Stop Work Authority
SWL Safe Working Load
TBM Toolbox Meeting
TRIR Total Recordable Incidents Rate

4.0 REFERENCE DOCUMENT

 RI – Law No. 1 / 1970: Occupational HSSE (Consists of Health and Safety)
 RI – Law No. 32 / 2009 Protection and Management of Life Environment
 RI- Law No. 44 Prp. 1960 About: Oil and Gas Mining
 RI - Law No. 23/1992 regarding Occupational Health
 RI - Law No. 24/2011 regarding Social Security Organizing Body
 RI - Law No. 22/2001 regarding Oil and Gas
 Government Regulation No. 11 Year 1979, about Occupation on Oil and Gas Purification and
Refinery
 Government Regulation No. 27 of 2012 regarding Environmental Permit
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 Government Regulation No. 101 of 2014 regarding Management of Hazardous and Toxic Waste
Materials
 RI-Goverment Regulation No. 17 Year 1974 about Supervision Of Implementation Of Oil
Exploration And Exploitation And Earth Gas In The Beach Regions
 Regulation of Indonesian Government No. 50 / 2012 regarding Implementation of
Occupational Health and Safety Management System Law No. 1/1970 regarding Occupational
Health
 Regulation of Indonesian Government No. 81 / 2012 regarding Management of Household
Waste and Similar to Household Waste;
 Regulation of Indonesian Government No. 74 / 2001 regarding Hazardous Material
Management
 Regulation of Indonesian Government No. 41 / 1999 regarding Air Pollution Control;
 RI - Labor and Transmigration Minister Regulation No. PER/01/MEN/1980 about Safety and
Health on Building Construction
 Minister of Labor Regulation No. 2 Year 1992, about the Procedures for Appointment of
Obligations and Authority of Occupational Safety and Health Experts
 Decree No. 51/MEN/1999 Ministry of Manpower regarding the physical threshold values at
work sites
 Regulation of the Minister of Manpower and transmigration No. Per.03/Men/1982, on Medical
Services
 Manpower Ministry standard No. 37 Year 2016 Pressure Vessel and Storage Tank
 Minister of Environment Decree No.127/2002, Environmental Evaluation Performance
Program
 Minister Regulation No. PER. 05/ MEN/ 96 about Occupational Health and Safety Management
System.
 Minister of Environment Decree No.42/1994, General Guidance for the Implementation of
Environment Audit
 Minister of Energy an Mineral Resources Regulation No. 26 of 2018 Concerning Good
Implementation of Mining Rules and Supervision of Mineral and Coal Mining
 Decree of the Minister of Energy and Mineral Resources Number 1827 K /30 /MEM /2018
Concerning Guidelines for Implementing Good Mining Engineering Rules
 Decree of the Minister of Energy and Mineral Resources No. 1457K/38/MEM/2002 regarding
Technical Guidelines on Environmental Management in the Mines and Energy Field
 Decision of the Minister of Manpower, No. KEP-612/MEN/1989 regarding the supply of data
on dangerous Substances affecting occupational safety and Health.
 Minister of Manpower Decree No.05/1996, Health Management System
 Head of Police RI Regulation No. 24 year 2007 about Organization Security Management
System, Company and or Government Institute.
 Decree of the Chairman of BAPEDAL No. Kep-01/BAPEDAL/09/1995 regarding Procedures and
technical Requirements for Storing and Collecting of Hazardous and Toxic Waste Materials
 Regulation of the Minister of Manpower and Transmigration No. 05/ 2018 regarding
Occupational Health and Safety of Workplace Environmental
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 Regulation of the Minister of Manpower No. 15/MEN/VIII/2008 regarding First Aid for
Workplace Accidents
 Regulation of the Minister of Environmental No. 18/2009 regarding Guideline of Hazardous
Waste Management Permit
 Regulation of the Minister of Environmental No. 14/2013 regarding Symbols and Labelling of
Hazardous Material and Toxic Waste
 Regulation of the Minister of Environmental No. 13/2009 regarding Quality Standards for
Stationary Sources of Emissions and / or Activity Oil and Gas Business
 Regulation of the Minister of Environmental No. 51 / 1999 regarding Decision of Threshold
Value for Physical Factors in the Workplace
 Decree of the Minister of Health No. 492 / 2012 regarding Requirements for Drinking Water
Quality
 Decree of the Minister of Health No 1096 / 2011 regarding Sanitation Hygiene Requirements
for Catering Services
 Decree of the Minister of Health No. 70 / 2016 regarding Standard and Requirement of
Occupational Health Industrial Work
 Decree of the Minister of Environmental No. 48/MENLH/11/1996 regarding Noise Level
Standard
 Decree of the Minister of Environmental No.35/MENLH/10/1993 regarding Standard of Vehicle
Emissions
 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
 Decree of the Head of Environmental Impact Control Agency No. 02/BAPEDAL/09/1995
regarding Hazardous Waste Manifest
 Decree of the Head of Environmental Impact Control Agency No. 03/BAPEDAL/09/1995
regarding Technical Requirements of Hazardous Waste Management
 Decree of the Head of Environmental Impact Control Agency No. 205/BAPEDAL/07/1996
regarding Technical Guidelines for Air Pollution Control Stationary Sources.
 Regulation of Manpower Ministry No. 09 Year 2016 regarding Working at Height
 Regulation of Manpower Ministry No. 37 Year 2016 regarding Pressure Vessel and Storage
Tank
 Regulation of Energy and Mineral Resources Ministry No. 18 Year 2018 regarding Installation
and Tools Inspection for Oil and Gas Activity
 Regulation of the Minister of Manpower No. 01/MEN/I/2007 regarding Guidelines for HSSE
Award.
 Environmental Impact Analysis (EIA) of RDMP RU V Balikpapan Project.
 Local Regulation of East Kalimantan No. 02 Year 2011 regarding Water Quality Management
and Water Pollution Control
 Local Regulation of Balikpapan No. 03 / 2012 regarding Permit for Building
 Guidelines of CONTRACTOR Safety Management System (CSMS), A-001/ K00100/2015-S9 Rev-
3, June 2015.
 Pertamina HSSE Plan Project Guidelines No. A-002 / V00100 / 2018-S9.
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 Environmental Impact Assessment (AMDAL) EPC Lawe-Lawe Facilities Project, RDMP RU V

requirement, which consist of the following: ANDAL (Environmental Impact Assessment), RKL
(Environmental Management Plan), RPL (Environmental Monitoring Plan).
 HSSE Rewards & Consequences Implementation No. 525/C00000/2017-S8
 Guideline of Fit to Work Health Check Standard in Assignment Part of Work Execution by
Supporting Service Company Number A-001/S00000/2018-S9 rev 0
 Decree of Director Processing No. Kpts-099/E0000/98-S0 date 1 July 1998 on Guidelines for
Disaster Management Directorate Processing of Central Level.
 ISO 9001:2015 Requirements for a Quality Management System
 ISO 14001:2015 Environmental management systems — Requirements with guidance for use
 ISO/IEC 27002:2013 Information Security Controls to Personal Data Protection Controls:
Guidelines for GDPR Compliance
 ISO 31000:2018 Risk management — Guidelines
 ISO 45001:2018 Occupational health and safety management systems — Requirements with
guidance for use
 ISO 19011:2018 Guidelines for auditing management systems
 OSHA 29 CFR 1926.451 Scaffolding
 JIS A 8951:1995 (Tubular Steel Scaffolds)
 BS 5975:2019 is latest version (Code of Practice for Scaffold Design)
 BS EN 12811-1:2003: Temporary works equipment. Scaffolds. Performance requirements and
general design
 OSHA 3122-06R 2004 Principal of Medical Emergency Response and Preparedness of
Occupational Safety and Health Administration
 OSHA Hazard Communication Standard (29CFR 1910.1200)
 ANSI / NFPA 704 Classifying hazards by Labeling
 OSHA 29 CFR 1926 Subpart P regarding Excavation
 OSHA, 29 CFR 1910.146, Permit Required Confined Spaces
 OSHA, 29 CFR 1910.146, App B. Procedures for Atmospheric Testing
 OSHA, 29 CFR 1910.146, App D. Confined Space Pre-Entry Checklist
 NFPA 326. Standard for the Safeguarding of Tanks and Containers for Entry, Cleaning, or Repair.
2010. Edition.
 OSHA 1910.28” Safety Requirement for Scaffold”
 OSHA 1926 Subpart L. Scaffold
 OSHA 1926.450 to 454. Scaffold
 OSHA 1915.71. Scaffold or Staging
 OSHA 29 CFR 1910.29, Manually Propelled Mobile Ladder Stands and Scaffolds (Towers).
 OSHA 29 CFR 1910.118, Fixed Ladders.
 OSHA 29 CFR 1926.502, Fall Protection Systems Criteria and Practices.
 OSHA 29 CFR 1926.452, Additional Requirements Applicable to Specific Type of Scaffolds.
 OSHA 29 CFR 1926.552, Material Hoists, Personnel Hoists, and Elevator.
 29 CFR OSHA 1926.1053, Ladders.
 OSHA 29CFR 1910 SUB part D: Walking- Working Surface.
 OSHA 29 CFR 1910.27, Fixed Ladders.
 OSHA 29 CFR 1910.28, Safety Requirement for Scaffolding.
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 NFPA 780 Standard for the Installation of Lightning Protection System.

 NFPA 495. Explosive Material Code. 2010 Edition.
 OSHA 1960.28. Employee reports of unsafe or unhealthful working conditions.
 NFPA 30 Flammable and Combustible Liquid Code.
 NFPA 101 Life Safety Code.
 EN 397:2012 – Industrial Helmets.
 ANSI Z89.1 – Safety Requirements for Industrial Head Protection.
 EN 166 – Personal Eye Protection Specifications.
 ANSI Z87.1-2020 – American National Standard for Occupational and Educational Personal Eye
and Face.
 ANSI Z88.2 – Practices for Respiratory Protection.
 BS EN 4275 – Guide to Implementing an Effective Respiratory Protective.
 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.
 BS EN 137 – Specification for respiratory protective devices: self-contained open-circuit
compressed air breathing apparatus.
 ANSI S3.19 – Noise Reduction Rating (NRR) Labelling
 BS EN 420 – Protective gloves. General requirements and test methods.
 BS EN 345-1 – Safety footwear for professional use. Specification.
 ANSI Z.41 – Personal Protection - Protective Footwear.
 ANSI A10.14 – Construction and Demolition Operations - Requirements for Safety Belts,
Harnesses.
 BS 1139-1.1:1990 Metal Scaffolding, Tubes, Specification for Steel Tubes.

5.0 SCOPE
This document defines the Health, Safety, Security, and Environment (hereinafter referred to as
“HSSE”) requirements that CONTRACTOR shall apply during the execution of the Project.
The Project HSSE Management System implementation activities described in this plan apply to
the Project Management, Procurement, Construction, Commissioning, Start-up and operations
take and take-over, and HSSE functions performed by CONTRACTOR.
CONTRACTOR shall take all necessary action steps to ensure all employees including
SUBCONTRACTORs comply with all applicable HSSE Regulation and guidance from OWNER’s HSSE
Regulation.
This document shall apply to all project activities carried out by the CONTRACTOR and its
SUBCONTRACTORs
This document shall be revised and updated as necessary to reflect any changes to the project
scope of work.
Within the Brownfield 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).
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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

6.0 PURPOSE
The purpose of Project HSSE 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 HSSE Plan described
the detail of HSSE schedule (based on project requirements) to support all of project activities. It
is a working document, Subject to ongoing review, and possible revision during the lifetime of the
project.

7.0 PROJECT HSSE PHILOSOPHY

The Project HSSE philosophy is based on the following concepts, and this philosophy shall be
applied to CONTRACTOR’s and SUBCONTRACTOR’s performance of all project phases and to all
HSSE related programs:
 Management leadership is the utmost importance in planning, developing HSSE Management
system and its effective implementation during the project execution
 HSSE is led by management and supported by HSSE team
 Creating safe culture caring individual workforce is management responsibility
 The proactive concept that prevention is better than cure
 Every individual in organization are responsible for project HSSE performance
 Systematic and structured effort shall result in a better HSSE performance
 Zero accidents/incidents are achievable through continuous improvement practices,
commitment and delegation
 High visibility awareness of HSSE is a requirement throughout the project, with a particular
focus in housekeeping
 A safe site is a productive site
 In order to maximize and integrate the efforts made by all parties involved including OWNER,
CONTRACTOR and SUBCONTRACTOR, all parties shall conceptually form a one team for HSSE
implementation with one goal

8.0 LEADERSHIP AND COMMITMENT

CONTRACTOR Management (Directors, Project, Site and Construction Managers, Department and
Functional Managers) will demonstrate commitment to all project phases in manner that is
uncompromising on issues of health, safety, and environment.
Senior Management will personally practice HSSE leadership, demonstrate visible commitment to
the project’s HSSE Policy and strategic objectives, and provide resources to foster a project culture
that embraces and accepts nothing but optimal HSSE behavior. The Project Manager will ensure
that HSSE management requirements are given equal status other managerial requirements. The
Project Manager also lead and attend weekly safety management walk downs.
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9.0 TEAM LEADER OBJECTIVES

 Provide safe system of work
 Promote HSSE objectives as a constant value while executing work
 Strive to eliminate all occupational injuries and illnesses
 Spread Ownership for HSSE Program effectiveness throughout the CONTRACTOR’s
Organization.
 Enhance employee awareness and participation in the HSSE Program
 Increase employees’ consistent use of safe practices in their daily work activities
 Optimize the use of continuous improvement practices as the basis of Zero Accident
Performance initiatives
 Select SUBCONTRACTORs with proven backgrounds of excellent safety performance and who
are committed to “Zero Incident Performance”.
 Participate in the site HSSE Leadership Program

10.0 POLICY, OBJECTIVES AND KPI’s

10.1 HSSE Policy
Primary CONTRACTOR management is committed to providing a safe and healthful workplace in
all of CPPHK facilities, offices and work sites and to making every effort towards eliminating or
minimizing any environmentally adverse effects of CPPHK operations.
To meet this commitment, Joint Operation of China Petroleum Pipeline Engineering Co., Ltd. and
PT. Hutama Karya (Persero) in carrying out its operations, will in all cases, abide by the following
principles:
 Place the highest priority on the health and safety of personnel and on the preservation and
protection of the environment.
 Give authority to all employees and workers to stop work due to unsafe behavior, unsafe
conditions, and involve them in the decision-making process in matter of safety, occupational
health and environmental protection.
 Provide plans that meet the highest standards for safety and operation, and place the
minimum burden on the environment.
 Plan and perform work in accordance with the HSSE Management System.
 Hold employees, including those of Vendors and SUBCONTRACTORs, responsible for their own
HSSE and that of their colleagues.
 Prohibit the usage of illegal drugs, alcohol and firearms
 Provide HSSE training for personnel to improve workers' HSSE understanding and competence
through socialization and training and implementation of the HSSE program (Employs
employee who understood/fulfill HSSE skill requirement for such works)
 Implement a Reward and Punishment system related to HSSE aspects
 Review, monitor and measure HSSE performance for continual improvement (Continual
improvement to HSSE performance)
 Creating and maintaining harmonious relationships with the surrounding environment
and stakeholders
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To achieve the above commitments, the CONTRACTOR Management, SUBCONTRACTORS and

every personnel involved in the work must be aware of their contents and implement all the
statements in the Policy above for each of their work activities. Project Manager responsible for
Policies. HSSE Policy can be shown on Attachment 1 – CONTRACTOR HSSE POLICY
10.2 Strategic Objectives and KPI’s
CONTRACTOR will implement a proper HSSE program 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:
 Zero Case of Lost Time Incident
 Zero Occupational Illness
 Zero Significant environmental incident
 Zero Fire Incident
 Zero Property Damage
 Zero Health issues in camps and canteens, onshore and offshore
 Zero sabotage case
CONTRACTOR HSSE Plan aligned with Owner’s Document 26070-203-G01-GHX-J0001 HSSE Plan
to minimize the gap between CONTRACTOR and Owner in terms of HSSE Requirement including
Objectives, Target, and Program (OTP) that may be included in this HSSE Plan.
To achieve project goals in HSE and minimize risks associated in the project activities,
CONTRACTOR will implement “Safety Leader and Awareness training” which equivalent Incident
Injury Free (IIF®) Programs covering all CONTRACTOR activities and personnel. CONTRACTOR also
set performance standards with the aim of eliminating and controlling risks.
CONTRACTOR HSSE KPI is Used as Data to measure and monitor CONTRACTOR’s achievement in
implementing HSSE during the execution of the CONTRACTOR work. The CONTRACTOR shall set-
up HSSE KPI as a commitment to HSSE Plan implementation during execution of contracted work
which is stated in the form of HSSE performance achievement indicator value. This HSSE
Performance indicator consists of lagging and leading indicator which include:
1. Lagging indicator
An indicator that shows final performance result of HSSE/ultimate achievement during
execution of contracted work based on number of incident / finding cases which happen during
the execution of the work
2. Leading indicator.
An indicator that shows the achievement of HSSE programs implemented during the execution
of contracted work.
HSSE CONTRACTOR Key Performance Indicator (KPI) both Lagging Indicator and Leading Indicator
are shown in Table 1. The ultimate project specific HSSE Performance Target as tabulated on the
HSSE Objectives for this project in Table 1. HSSE Key Performance Indicators:
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Table 1. HSSE Key Performance Indicators

No. ITEM KPI MEASUREMENT TARGET REMARKS

LAGGING INDICATOR
1 Fatality Total case number 0
2 Lost Time Incident Total case number 0
Lost Time Incident Frequency Ratio
3 <1
Rate (LTIFR)
Lost Time Incident Severity Ratio
4 <1
Rate (LTISR)
Incident impacted to
5 Total case number 0
Environmental pollution
Incident impacted to fire /
6 Total case number 0
asset damage
Total Recordable Injury Rate
7 Ratio < 0.15
(TRIR)
Total manpower
8 First Aid Case Total case number 4%
on board

9 Nearmiss Total Case Number Reported

LEADING INDICATOR
1 HSSE Meeting MoM / Attendant list Min. 1 / month
2 HSSE Talk / briefing / toolbox Attendant list Daily
Report Submission
3 HSSE Reporting Weekly
record
4 HSSE Management Visit/ MWT MWT record Quarterly Level PMT
Follow up action
5 Closure Action 100% Closed
report
Audit/ Inspection
6 Inspection / audit Monthly
report
PPE compliance
7 PPE Compliance 100%
report
Compliance on Waste Waste management
8 100% Comply
Management report
Compliance on Hygiene Hygiene Industry 100% Comply
9
Industry report
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Comply to Good housekeeping e-COP & Audit

10 100% comply
management Record
Attendance List &
11 HSSE Training 100% Comply
Resume
Behavior Base Safety BBSO Card, Data 2 finding /
12
Observation / BBSO target recapitulation person / month

The progress of KPI and program shall be updated regularly. CONTRACTOR shall submit, on a
weekly basis, a formal report summarizing CONTRACTOR and SUBCONTRACTORS HSSE
performance to the Owner representative. The report will be including total man-hours, leading
and lagging indicator as stated on HSSE Objectives, Target, Programs, and any related additional
data.
To achieve the above mentioned HSSE objectives and KPIs, the following actions will be taken in
terms of Safety, Health, Environment and Security:
Occupational Safety:
 Effective leadership and accountability for the performance of own and SUBCONTRACTOR
/vendors’ personnel
 Identification, safety risk assessment and appropriate controls of the project’s unique hazards
 Ongoing behavior and observation based training and education, including sustainable
development
 Provision of safe systems of work and risk-free facilities.
 Establishment of barrier-free communication system
 Establishment of a “blame-free” culture
 Establishment of emergency preparedness and incident reporting procedures
 Application of incident/accident investigation and analysis for recurrence prevention
 Monitoring and auditing with management participation
 Establishment of safety promotion schemes
Occupational health and hygiene
 Conduct health risk assessment
 Supply appropriate site medical staff/facilities and emergency vehicle(s)
 Provide a suitable and adequate amount of fresh water
 Supply of sufficient number of site toilets
 Provision of site resting shed
 Prevention of heat stress
 Protection from any epidemics
Environmental:
 Conservation of natural resources
 Minimization of adverse environmental impact
 Fostering of waste reduction, reuse, and recycling
 Open communication with public and local community
 Awareness of “zero emission initiatives”
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Security:
 Strict management of goods, materials, vehicles, equipments and personnnel movement on
and off the RDMP Lawe-lawe Project
 Ensure that all personnel entering the project site have valid ID or are issued with a visitor ID
 Review relevant management plans for continual improvement
 Promote compliance with the project 8 Golden Rules and the Golden Rules for Safe Driving Full
compliance with the Site Security Regulation

11.0 HSSE GOLDEN RULES AND NO TOLERANCE

11.1 Golden Rules for Life Saving
In the interest of preserving life and preventing serious incident personnel must comply with the
“12 Golden Rules for Life Saving” at all times, these being:
1. Ensure Permit to Work complete and valid prior to start work.
2. Ensure tools and equipment are in good condition worth using well maintained and in
accordance with Occupation. Ensure the facility has been inspected, testing and
maintenance in accordance with procedures and regulations.
3. Ensure lifting operations planned, supervised and conducted by competent personnel.
4. Working at Height above 1.8 m require standard scaffolding, ladder, wear full body harness,
and sampling for blood pressure check-up prior to work.
5. Do not walk on suspended load. Only authorized person entry within working radius during
equipment operation. Ensure rigging plan is available for all the lift work (Ensure you work
in the safe area and at safe position).
6. Prohibited to bring ignition source to the hazardous area (Follow PTW).
7. Ensure LOTO is available on pressurized or energized equipment and only authorized person
can performed the LOTO. Make sure the energy has been isolated before do work, by
implementing Log Out, Tag Out and Discharge Test. Ensure you get permission and
authorization before overriding / bypassing or disable / disabling safety critical equipment
8. Ensure you meet the requirements medical and fit to work accordingly your work task
9. Confirm all the confined space requirement is complete and obtain authorization before
entering the confined space area. Ensure you have authorization and valid work permit
before entering in confined space
10. Ensure the floatation device is used when work in areas that have potential danger of
drowning
11. Keep the traffic safety rule in the project area by wear seat belt, do not use mobile phone,
and do not exceed speed limits. Maintain safety while driving
12. Keep the good housekeeping in the work area and protect environment from the pollution
11.2 Golden Rules for Safe Driving
Drivers must comply with the “7 Golden Rules for Safe Driving” all times, they are:
 Conduct pre-trip vehicle check
 Do not drive unless all passenger is wearing seat belts
 Do not drive in excess of the posted speed limit and drive in a safe manner
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 Never make a call and/or wear ear phone as well as smoking while driving
 Do not drive when tired and do not allow an unfit driver to drive
 Do not drive at night unless authorized to do so
 Warn drivers of safety concerns or unsafe behavior
All drivers will be received the “7 Golden Rules for Safe Driving” after completion of
CONTRACTOR Defensive Driving Training
11.3 Zero Tolerance
A “Zero Tolerance Policy” for designated HSSE violations will be strictly enforced, ANY person
who knowingly and intentionally violates the Zero Tolerance Policy will be TERMINATED from
working at the RDMP Lawe-lawe. Zero tolerance offences shall include but not be limited to the
following:
 Under influence of Alcohol and Consumption of Prohibited drugs
 Fighting
 Stealing
 Gambling (cash money)
 Using ID of another person to gain site access
 Willful damage to equipment of property belonging to the Project
 Not 100% tie off when working at height 1.8m above (double hook)
 Without fall protection system when working at height
 Unauthorized entry into confined space
 Driving without accreditation card (inside project area)
 Violation red tags on scaffolding working platform
7 Golden Rules for Safe Driving and Zero Tolerance Policy will be prominently displayed at the
project site in English and language understood by the majority of workers i.e. Bahasa Indonesia.
List Penalty System can be seen on Attachment 4 – PENALTY SYSTEM

12.0 HSSE ORGANIZATION AND RESPONSIBILITY

12.1 Organization
HSSE organization is established by CONTRACTOR and all SUBCONTRACTORs involved in the
Project. CONTRACTOR and SUBCONTRACTORs will fulfill the ratio of 1/50 of HSSE Personnel to
All Personnel. 1/50 ratio may required to be reviewed in JSA and JHA based on how the project
is sped out. CONTRACTOR & SUBCONTRACTOR HSSE personnel will work together with
CONTRACTOR & SUBCONTRACTOR supervisors to ensure that all HSSE requirements are
followed by the project organization. CONTRACTOR HSSE personnel will supervise all
SUBCONTRACTOR HSSE personnel to implement all HSSE programs.
The overall CONTRACTOR organization chart for the Project covering all disciplines including
HSSE is described in the Project Execution Plan. The specific HSSE Organization Chart is as
attached in Attachment 8.
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12.2 Responsibility
The responsibility of Key Personnels are refer to 26076-110-G01-GAM-00001 “Project Execution
Plan”.
12.2.1 Project Manager
The Project Manager has overall responsibility for HSSE management and performance
of the project covering engineering, procurement, construction, pre-commissioning
and commissioning throughout the project execution period.
His/her major roles and responsibilities for HSSE management are to:
1) Establish the project HSSE Policies and targets.
2) Establish the project organization and assign competent personnel to the
organization.
3) Define and assign individual’s roles and responsibilities.
4) Participate in setting up the project HSSE strategy just after project award
5) Arrange necessary resources of people, things and funds
6) Incorporate the requirements of HSSE into the SUBcontracting scheme.
7) Be responsible for the selection of SUBCONTRACTORS according to their attitude
toward HSSE, past record of HSSE performance, etc., as well as their experience and
ability to do the work, proposed price and conditions.
8) Propose to assign HSSE Manager, Engineering Manager, Procurement Manager,
Construction Manager, Pre-commissioning & Commissioning Manager and other
managerial personnel who are competent and highly experienced in their designated
roles and responsibilities.
9) Encourage the HSSE Manager, Engineering Manager, Procurement Manager,
Construction Manager, Pre-commissioning & Commissioning Manager and other
managerial personnel to establish and/or to implement HSSE management strategy,
programs and procedures for the project.
10) Visit the site, as frequently as possible, to confirm and evaluate the HSSE
management status and performance as well as the construction status.
12.2.2 HSSE Manager
General
1) Represent Project Manager (PM) in socialization, implementation, maintenance
and continual improvement of this Project HSSE Plan including its associated
reference documents refer to ISO 45001: 2018 and ISO 14001:2015 requirements
including OWNER’S, CONTRACTOR’S quality manual and other applicable
requirements
2) Represent Project Manager (PM) in socialization, implementation, maintenance
and continual improvement of the HSSE Key Performance Indicators (KPI)
contained in HSSE Monthly Report in cooperation with the project SUB-
organizations to ensure the Project HSSE Plan including its associated reference
documents for the engineering, procurement, construction and commissioning
are well socialized, implemented, maintained and continually improved.
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3) Assist Project Manager (PM) in reviewing HSSE Procedures / Work Instructions

and represent Project Manager (PM) in socialization, implementation,
maintenance and continual improvement of the HSSE Procedures / Work
Instructions as well as Laws and Regulations for construction site.
4) Develops, socializes, maintains and continually improves additional procedures /
work instructions needed for construction site (if any).
5) Take role as the focal point for OWNER for HSSE Management System issues and
serves as the Field HSSE Management Representative as required by ISO 45001:
2018 and ISO 14001:2015 at site.
Specific
1) Coordinating site HSSE efforts between OWNER, CONTRACTOR and
SUBCONTRACTOR HSSE personnel.
2) Keeping site management aware of the progress of the HSSE Program and making
recommendations for site-related HSSE improvements.
3) Administering site HSSE policies and procedures within the framework of the
Project HSSE Plan with particular emphasis on potentially hazardous operations.
4) Proposing Programs to implement the accomplishment of short and long term site
HSSE objectives and to initiate the motivation for employee participation needed
to obtain these objectives.
5) Preparing and distributing all relevant HSSE reports, which will include accident,
incident and near miss details.
6) Maintaining a continuing inspection Program and reporting the findings and
recommendations to the appropriate supervisor or SUBCONTRACTOR for prompt
remedial action.
7) Conducting and participating in HSSE meetings.
8) Supervising HSSE training in accordance with the Project HSSE Plan.
9) Coordinating the site first aid and rescue services.
10) Investigating all accidents, injuries, fires, property damage, and other HSSE-
related incidents and completing relevant reports.
11) Being responsible for the classification of occupational injuries/illness and
following up on the control and management of all cases. Assisting
SUBCONTRACTORs with their HSSE Programs to meet government, OWNER and
CONTRACTOR site HSSE requirements.
12) Evaluating the need for, and requisitioning of, HSSE, first aid, and fire protection
equipment needed at each job location, and ensuring that HSSE equipment meets
appropriate standards and is maintained in good condition.
13) Effectively displaying and maintaining publicity material on site bulletin /
equivalent (if any), boards, posters, HSSE signs and banners and distributing HSSE
literature.
14) Monitoring the site hazardous waste program and reporting the amount of
hazardous waste (per month) and calculation per 6 months.
15) Monitoring the site radiation HSSE Program.
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16) Maintaining knowledge of current state-of-the-art concepts of accident

prevention and continually contributing to upgrading the site HSSE effort.
17) Ensuring, by adequate practical means and "follow-up" methods, that all
directions and advice is understood and acted upon.
18) Pursuing improvements in HSSE performance.
19) Monitoring the effect of the construction activities on the environment.
12.2.3 Engineering Manager
Manage engineering to ensure:
1) The Engineering related HSSE Management System is suitable, engineering
requirements are identified, and adequate resources are allocated to meet
requirements
2) Monitoring of OWNER satisfaction issues and direction of the engineering work
process OWNERs with respect to improving pertinent Engineering related HSSE
Management System elements
3) Review and confirmation of technical data in the Project Specification
4) Other design input, e.g. battery limit conditions
5) Engineering HSSE Risk Management through HAZID, HAZOP, SIL, Plot Plan & 3D
Model, PFD, QRA, PSSR and / or others as applicable)
6) Engineering change control and revisions
7) HSSE control of Seller supplied Materials
12.2.4 Procurement Manager
Manage procurement to ensure:
1) The Procurement related HSSE Management System is suitable, procurement
requirements are identified, and adequate resources are allocated to meet
requirements
2) Monitoring of OWNER satisfaction issues and direction of the procurement work
process OWNERs with respect to improving pertinent Procurement related HSSE
Management System elements
3) Procurement HSSE control in cooperation with HSSE discipline
4) Use of inspection vendors in cooperation with HSSE discipline
12.2.5 Construction Manager
The Construction Manager is responsible for the implementation of the Project HSSE
Plan within construction scope.
Specifically, the Construction Manager shall be the driving force behind the Project
HSSE Program and shall take the following responsibilities:
1) Assume full responsibility for HSSE activities within construction scope and maintain
liaison with the Construction Manager as well as with the CONTRACTOR Construction
Management Department Manager in Head Office, Jakarta.
2) In cooperation with HSSE Manager direct the HSSE Program for construction scope.
3) Promote full support of the HSSE Program by enthusiastically advocating the
Program.
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4) Delegate responsibilities for the various HSSE functions and authority for
departmental and craft HSSE promotion.
5) Require full HSSE compliance by all involved disciplines of CONTRACTOR and all of its
SUBCONTRACTORs.
6) Establish and/or encourage to implement the job HSSE rules with special attention
to unusual operations and HSSE requirements of OWNER.
7) Establish and/or encourage to implement the disciplinary action necessary to
develop an efficient, functioning HSSE Program.
8) Plan for prompt accident investigations, ensuring that adequate, informative reports
are completed and their distribution is accomplished.
9) Be directly concerned with the planning for those operations which have a potential
loss or hazard above that of normal construction activities.
10) Pursue improvements in HSSE performance. Prevent damage to the environment by
construction activities
12.2.6 Construction Discipline Superintendent or Supervisor
Construction Discipline Superintendent are Superintendents responsible in supervising
and coordinating disciplines apart from HSSE. E.g. Mechanical Superintendent, Piping
Superintendent, Civil Superintendent, etc. Their responsibilities are:
o Responsible to implement of HSSE Plan at site.
o To attend daily toolbox meeting and other HSSE meeting related with their
activities.
o 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.
o 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.
12.2.7 Pre-Commissioning and Commissioning Manager
The Pre-commissioning and Commissioning Manager is responsible for the
implementation of the Project HSSE Plan within pre-commissioning and commissioning
scope.
Specifically, the Pre-commissioning and Commissioning Manager shall be the driving
force behind the Project HSSE Program and shall take the following responsibilities:
1) Assume full responsibility for HSSE activities within pre-commissioning and
commissioning scope and maintain liaison with the Construction Manager as well as
with the CONTRACTOR Construction Management Department Manager / Process
Department Manager in Head Office, Jakarta.
2) In cooperation with HSSE Manager direct the HSSE Program for pre-commissioning
and commissioning scope.
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3) Promote full support of the HSSE Program by enthusiastically advocating the

Program.
4) Delegate responsibilities for the various HSSE functions and authority for
departmental and craft HSSE promotion.
5) Require full HSSE compliance by all involved disciplines of CONTRACTOR and all of its
SUBCONTRACTORs.
6) Establish and/or encourage to implement the job HSSE rules with special attention
to unusual operations and HSSE requirements of OWNER.
7) Establish and/or encourage to implement the disciplinary action necessary to
develop an efficient, functioning HSSE Program.
8) Plan for prompt accident investigations, ensuring that adequate, informative reports
are completed and their distribution is accomplished.
9) Be directly concerned with the planning for those operations which have a potential
loss or hazard above that of normal pre-commissioning and commissioning activities.
10) Pursue improvements in HSSE performance. Prevent damage to the environment by
pre-commissioning and commissioning activities
12.2.8 Discipline Leads
Discipline Leads are directly responsible for the control and activities of craft
employees in the project. They play a key role in the execution and maintenance of an
effective job HSSE Program.
The HSSE Program are implemented by all Leads for their scope in cooperation with
HSSE discipline. The actual performance of the HSSE Program is a prime responsibility
of the Discipline Leads who has direct contact with the crafts. The Discipline Leads’
ability to instill an HSSE attitude of the crafts is a direct reflection of their talents.
The specific HSSE responsibilities of Discipline Leads shall include, but will not be
limited to the following:
1) Reviewing all work and all new personnel for HSSE requirements. Complete
familiarization with HSSE requirements is an integral part of the total job
responsibility.
2) Continual monitoring of the HSSE attitudes of employees, their responsibilities
toward the HSSE of their crafts, and their participation in the job HSSE effort.
3) Insist on compliance with all established HSSE legal & other requirements during
performance of the work.
4) Communicating work steps, hazards, risks and preventive actions through Tool Box
Meeting and other.
5) Conduct HSSE inspections and make recommendations on a daily basis.
6) Hold HSSE meetings and other activities to perpetuate HSSE consciousness
7) Ensure that proper craft HSSE training is provided.
8) Initiate plans prior to the start of work to supply the personnel; tools materials, and
equipment necessary to complete the job safely.
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9) Assist accident investigations to ensure proper reporting and documentation and

ensure prompt corrections are made following an accident or incident to eliminate
recurrences.
10) Coordinate planning and work activities with other supervisory personnel
performing work within, or adjacent to, their assigned work areas.
11) Ensure that this Project HSSE Plan is implemented by SUBCONTRACTORs.
12) Cooperate in conductiing safety induction for new worker or visitor when entry the
site to share of all risk and hazard
12.2.9 Deputy HSSE Manager
o The HSSE Subject Matter Expertise of all the Offshore Activities. He shall support
the HSSE Manager by visiting each active Offshore Jobsite daily and ensure
compliance with all HSSE requirements (contractual preamble for HSSE Manager
approval)
o Assist HSSEM (HSSE Manager) to ensure the implementation of CONTRACTOR's
HSSE management system.
o Coordinate / communicate with CPPHK’s Chief HSSE and each CPPHK member
regarding the implementation of HSSE Management System.
o Ensure all rules and regulations related to HSSE are updated.
o Establish and maintain regular interface discussion with Owner's HSSE
representative and others project members.
12.2.10 Chief HSSE / HSSE Superintendent
o Ensure all HSSE activities at site are being implemented properly.
o Ensure procedures and other HSSE related documents are being properly
implemented at project site.
o Develop HSSE performance statistic at the workplace.
o Develop training and education program for all workers at project site.
o Conduct regular inspections at the workplace.
o Prepare project regular report (weekly report, monthly report, HSSE project
overview) through HSSE e-Board.
12.2.11 HSSE Engineer
o Manage procedures and documentation on management system implementation.
o Assist HSSE Manager to implement and report of CONTRACTOR management
system.
o Assist HSSE Manager regarding the web-based information system (HSSE e-Board)
utilization.
o Assist HSSE Manager in conducting CSMS Assessment, SUBCONTRACTOR selection,
and evaluation
o Assist HSSE Manager to prepare proposal and programs.
o Collect, maintain, and analyze statistical data
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12.2.12 Enviromental Engineer

o Provide technical support in developing and implementing environmental
programs in project.
o Generate environmental reports as per regulations.
o Stay updated with air, water and waste regulations as defined by laws.
o Review and recommend improvements to existing environmental programs to
reduce environmental damages (AMDAL).
o Oversee waste management and pollution control activities (AMDAL).
o Perform regular site surveys for environmental compliances.
o Assess potential environmental risks and develop mitigation plans.
o Provide assistance and job trainings to team members as needed.
o Analyze root causes of environmental incidents and propose corrective action
plans.
o Prepare and maintain environmental documentations for reference purposes.
o Assist in environmental audits and implement audit recommendations.
o Assist in getting and maintaining environmental permits for industries.
12.2.13 Inspector
o Assist Chief HSSE/HSSE Superintendent to inspect all scaffolding, construction
electricity system, heavy equipment, machineries, tools, vehicles, and other
equipment will be used in RDMP project as per competency
o Develop an inspection report and communicate it with Chief HSSE.
o Conduct regular inspections at infrastructure facility area.
o Has a qualification or certified as Inspector for each respective area. E.g. Inspector
for scaffolding shall be a qualified or certified Scaffolding Inspector.
12.2.14 HSSE Training Coordinator
o To ensure the implementation of HSSE Training programs are run properly at site
project.
o To ensure training database updated and well maintained.
o To provide approved training material and update it regularly as any changes
happen. E.g. MOC to HSSE Procedure, Lesson Learn, etc.
o To ensure required training records are available and well documented.
12.2.15 Site Doctor
o Review & Verify MCU result, ensure worker are fit for job position.
o Conduct Health Education & Training for worker on site.
o Conduct Health assessment / inspection for onsite facility.
o Conduct Site Clinic to deliver primary medical care, minor surgery and consultation.
o Prepare referral case, coordinate with hospital & conduct Medical evacuation.
o Conduct Occupational Health Management system, include Prior to work. Medical
Examination, Return to Work, Recording & Reporting.
o Prepare health matters for weekly and monthly report.
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o Deliver Prompt Treatment for Emergency cases.

o Update medical evacuation procedure.
o Ensure drugs & medical equipment are sufficient for medical emergency service.
Update of skill of Clinic Personnel & First Aider.
o Ensure Clinic permit, Medical license, Medical record.
o Ensure Medical waste management are complying to local regulation.
o Provide advice for Doctor, IH & Paramedic on site (Doctor for Offshore and Onshore
required HYPERKES, Advance Cardiac Live support (ACLS), Advance Trauma Life
Support (ATLS).
o Inspect and maintain drugs and medical equipment including medivac
transportation periodically
o Organize and conduct in house health training periodically as CPR, broken bone case
etc.
o Must be managing the lowest possible risk related to the spreads of COVID-19 and
to handle prevention the spread of COVID-19
12.2.16 Paramedic
o Respond immediately and deliver initial stabilization for injured / illness person at
the scene prior transfer to site clinic.
o Assist Site Doctor in implementation of health management programs,
o Assist Site Doctor to identify health hazards in the work place, implement control
and monitoring program
o Paramedic for Offshore and Onshore required Hyperkes and Basic Trauma
Cardiac Live Support (BTCLS).
12.2.17 SUBCONTRACTOR/Supplier/Vendors
o Comply with minimum HSSE requirement, procedures, and related HSSE
agreement.
o Report accidents / incidents immediately direct to HSSE committee /
representative.
o Assist in any accident / incident investigation in their area.
o Maintain good housekeeping and physical arrangements.

13.0 HSSE RISK MANAGEMENT

13.1 Engineering HSSE Risk Management
The Engineering HSSE Risk Management shall be implemented by Engineering Discipline according
to Engineering HSSE Plan.
CONTRACTOR as part of its standard practices will conduct an integrated multi-discipline design
review, which also used to ensure HSSE Concepts are transmitted across design disciplines.
Multi-discipline Design reviews will include the following:
 P&ID Review
 Plot Plan Review
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 HAZOP and SIL

 3D Model Review
13.2 Hazard Identification Risk Assessment and Control (HIRAC)
Refer to document no. 26076-110-GPP-GHX-00001 “HIRAC Procedure”
The HIRAC shall be implemented before commencing the project, periodically at least once per
year and in case of any relevant significant change refers to the referenced HIRAC Procedure.
Before commencing any new construction activity, the SUBCONTRACTORs concerned will prepare
a comprehensive work method statement and then make a suitable and sufficient HIRAC
 Identify the HSSE hazards/aspects of its activities, products, services and facilities included in
the project
 Identify risks/impacts of the hazards/aspects
 Assess the potential of the hazards/aspects
 Determine the significant hazards/aspects
 Determine the control for the significant hazards/aspects as well as for the other hazards /
aspects
 Implement the control
 Monitor, measure, and evaluate the determined control to reduce the significant
hazards/aspects to a level that is as low as reasonably practicable (ALARP) or until
corrective/preventive actions are completed
13.3 Job Safety Analysis (JSA) and Work Method Statement
Refer to document no. 26076-110-GPP-GHX-00026 “Job Safety Anaysis Procedure” and
Attachment 11.
Before commencing any new construction activity, the SUBCONTRACTOR / Vendors concerned
will prepare a comprehensive method statement and then make a suitable and sufficient
assessment of:
1) The risks to the health and safety of his employees to which they are exposed and
2) The risks to the health and safety of person not in his employment who may be affected by
their undertakings
CONTRACTOR will incorporate a risk assessment procedure that is essentially are as follows:
 Select the job and JSA participants
 Break the job into steps
 Identification of hazards and risks
 Evaluation of the risks
 Measures to control the risks
 Record and distribute JSA
 Review on a yearly basis after serious incident or change of work/operation, etc.
SUBCONTRACTORs / vendors will use JSA as an aid to the pre-task planning process known as
Toolbox Talk / STARRT.
Job Safety Analysis (JSA) relevant for the project in order to control risks of specific activities which
carried out at RDMP Lawe-Lawe Project. Approved JSA shall be attached to the PTW.
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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. HSSE
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.
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 HSSE 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 HSSE 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
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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.
13.4 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
13.5 Toolbox Talk / Safety Task Analysis Risk Reduction Talk (STARRT)
Refer to document no. 26076-110-GPP-GHX-00041 “Toolbox Meeting Procedure / STARRT
Meeting”
The supervisor or Foreman shall use the STARRT process, with participation from his entire crew,
to identify potential hazards associated with the task, immediately prior to its commencement.
The STARRT process shall be used at the beginning of every shift and prior to starting any new
task. Supervisors shall ensure that their employees understand the purpose of, and participate in
the JSA and STARRT processes and shall use them as primary planning and lessons learnt tools.
Records of attendees will be retained.
13.6 Pre-Construction HSSE Activities
Where pre-construction work activities exist in CONTRACTOR’s scope of work such activities shall
be performed after the relevant Method Statements and JSA. These documents shall be
completed and approved. After the process completed, PTW will be issued by Approving
Authority. For Brownfield Approves by IPMT (PMC and Owner) and For Greenfield by
CONTRACTOR.
a) Site Visit
- Personnel visiting the Project site shall be briefed on the relevant HSSE issues and
thereafter shall fully comply with the requirements of OWNER and the project HSSE
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procedures including the use of PPE. Visitors will be issued with a temporary site access
badge and in most cases will be accompanied by personnel with permanent
CONTRACTOR ID badge.
b) Temporary Facilities
CONTRACTOR will ensure that adequate office, welfare and accommodation facilities are
provided by themselves and by all SUBCONTRACTORs/vendors on the project.
These will include:
- Installation of facilities in a manner that recognizes access, egress and fire prevention
requirements;
- Providing utilities with special regard to the protection of underground and above
ground services;
- Consideration of adjacent process operations;
- Maintenance of standards of cleanliness and order;
- Ensuring that personnel are aware and are complying with the requirements of the fire
plan, and that adequate fire extinguishers have been provided
- Reporting any defect to relevant personnel;
- Ensuring that hazardous (e.g. flammable, etc) materials are stored and used in a
controlled manner, and adhering to electrical regulations
c) Site Preparation
Before commencing activities such as ground clearing, installation of temporary facilities, and
erection of batching plant CONTRACTOR will ensure that all relevant documents, including
Government licenses and Permits have been obtained. CONTRACTOR to issue Camp /
Canteen food health & safety plan

14.0 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.
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.
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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:
o Impact on safety/harm to people.
o Impact to environment.
o Deviation from policy, procedures, compliance.
o 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 with the
Low
change occur.
2. Requirements 1 and method statement may need to be
Medium
provided and approved.
3. Requirements 2, Conduct a Risk Assessment Workshop and
High
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:
o Describe the reasons for change, providing hard evidence to support the need/opportunity.
o Describe the benefits of this change.
o 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:
o List any Technical Expert who needs to be consulted about / approve the proposed change.
o List the people / groups who need to be consulted on the proposed change.
o 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
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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
o 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.
o 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.
o 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.

Table 3. MOC Authorization Level Required

TYPE OF CHANGE AUTHORISATION LEVEL REQUIRED
Low Discipline Superintendent

Medium Construction Manager

High Project Manager, HSSE Manager

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.
CONTRACTOR’S HSSE will keep a register of all approved change management activities.
Refer to Attachment 9. Change Management Request Form.

15.0 CLASSIFICATION AREA

The classification of Greenfield and Brownfield areas is the fundamental for PTW issuance. The
implementation of PTW must be in accordance with the classification of the area that has been
determined and agreed with the OWNER for the sake of orderliness in the implementation of
work, coordination, and administration, which ultimately impacts on the achievement of Safety.
The division of greenfield and brownfield areas in the Lawe-Lawe RDMP project is shown in the
table below.
Table 4. Classification of Work Areas
CLASSIFICATION OF WORK AREAS

No. WORK AREA

WORK LOCATION BROWNFIELD GREENFIELD
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1 Pig Receiver 20” (RU V Balikpapan) √

2 Offshore Pipeline 20 " √

3 Launcher & Receiver 20” √

4 Onshore Pipeline 20 " √

5A Lawe-Lawe Facilities √

5B Tanked Area √

6 Receiver 52” √

7 Site Office √

8 Onshore Pipeline 52" √

9 Offshore 52" √

10 SPM & PLEM √

PENAJAM Pigging station. Greenfield outside existing bund-wall and Brownfield inside

Figure 1. Classification of Work Areas

The detailed location can be shown on 26076-110-G3-GHX-00001 Plot Plan Greenfield &
Brownfield Area Lawe Lawe Terminal. Including GREENFIELD areas such as Area 1, 2, 3, 4 Incl. Deep
Well area, 7 and 8 and all between gate 3 and 3A as well as all OFFSHORE project facilities and
construction sites / barges / vessels etc. Also, transportation or pedestrian moving between Area
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8 (gate 3A) and areas 1, 2, 3,4 incl. Deep Well and area 7 is GREENFIELD areas. While the others
are BROWNFIELD areas (for example Area 5, 6, etc.). In BROWNFIELD areas, CONTRACTOR shall
follow all the rules and requirements of PERTAMINA RDMP and RU V as well as compulsory full
PPE according to the work activities carried out.
Following are JO CPPHK General Rules in the site greenfield areas:
Gate 3:
- Security Check is required
- Must use ID Badge (Greenfield)
- For all workers who will carry out HSSE Induction shall have received complete personal
equipment from CPPHK or subcontractor.
- Cellphone is allowed
- Cigarette and matches is allowed
- Weapons, drugs and alcohol not allowed
Gate 3A:
- Security Check is required
- Must use ID Badge (according to the destination area, Greenfield or Brownfield)
- PPE Mandatory is required (Coverall, Safety Helmet with chinstrap, Safety Shoes, Safety
Glasses, and hand gloves). Used special PPE for specific activities.
- Cellphone is not allowed
- Matches is not allowed
- Diesel fuel vehicles, equipped with flame arrestor, fire extinguisher & first aid kit, SIMPER /
IMDK and Vehicle must have pass entry sticker.
Gate 3B :
- Security Check is not required
- Must use ID Badge (Greenfield)
- PPE Mandatory is required (Coverall, Safety Helmet with chinstrap, Safety Shoes, Safety
Glasses, and hand gloves). Used special PPE for specific activities.
- Cellphone is not allowed
- Matches is not allowed
Site Office (Area 8):
- Must use ID Badge (Greenfield)
- For every working/maintenance activies refer to 26076-110-GPP-GHX-00016-000 Permit to
Work Procedure
- Inspection for camera and PC is not required.
Warehouse/Workshop and Genset area:
- Must use ID Badge (Greenfield)
- PPE mandatory is required
- For every working/maintenance activities, 26076-110-GPP-GHX-00016-000 Permit to Work
Procedure
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Tabel 5. Matrix Approval Authority Greenfield-Brownfield Onshore & Offshore

GREENFIELD BROWNFIELD
No DESCRIPTION
ONSHORE OFFSHORE ONSHORE
1 PTW Implementation:
a. Issuing authority (GSI)/ Asset KPB Lawe-Lawe
CPPHK CPPHK
Holder
b. Performing authority (Ahli KPB Lawe-Lawe
CPPHK CPPHK
teknik)
c. Authorized Gas Tester (AGT) CPPHK CPPHK KPB Lawe-Lawe
2 Entry Permit:
a. ID Badge CPPHK CPPHK CPPHK
b. Visitor CPPHK CPPHK CPPHK
c. Vehicle Entrance Permit (IMK) CPPHK CPPHK CPPHK
d. Vehicle Temporary Entrance CPPHK CPPHK CPPHK
Permit (IMK)
e. Equipment and Tools Safety CPPHK CPPHK CPPHK
Tag
3 Other Requirement Safety
a. Safety Induction CPPHK CPPHK CPPHK
b. HSSE Passport CPPHK CPPHK CPPHK
c. Emergency Response Plan CPPHK CPPHK CPPHK
(Responder I)
The application of the Greenfield area can be done by considering the following:
1. All construction, fabrication, warehouse and workshop areas must use a complete PPE
including coverall.
2. Availability of physical facilities such as a fence separating the operating process area, two
security check points on the "IN & OUT" track and access control
3. Greenfield area permit can be revised, corrected and amended when a violation of the
commitments that have been agreed upon.

16.0 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:
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16.1 Manpower Readiness

Requirements for Man Power Readiness that shall be Submitted and followed by
SUBCONTRACTOR are as follow:
o 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.;
o Copy Medical Check Up (MCU) result include Covid-19 Clearance as requested by owner;
o Complete filled of man power register form (for each personnel);
o Formal photograph (3x4) with Red colour as a background;
o Copy of identity card (for each personnel);
o Copy of Kartu Keluarga (for each personnel);
o Copy of Surat Domisili (for each personnel);
o Copy of employment card / BPJS (for each personnel);
o Attend HSSE 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:
o Complete man power register form (for each personnel);
o Attend HSSE 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 HSSE
e-Board. This data could be accessed regularly in line with RFID card system.
16.2 Equipment / Tools / Vehicles Readiness
Besides manpower readiness, SUBCONTRACTOR shall prepare and fulfil all requirements related
to equipment/ tools / vehicles readiness. All of the 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. Inspection shall be done
by competent and certified person per qualification.
After mobilize to project site, CONTRACTOR will conduct gate inspection to have a final check prior
to use by SUBCONTRACTOR. After passed the inspection, sticker will be attached to the equipment
/ tools /vehicles. The requirements related to equipment / tools / vehicles readiness are as follow:
o Copy of valid equipment / tools / vehicles certificates (including KIR, STNK, BPKB);
o Equipment / tools / vehicles manual book;
o Vehicle shall have Anti-lock Brake System, Air Bag System, safety belt for all passenger, flame
arrestor and safety accessories as per HSSE requirement (fire extinguisher and first aid kit).
o Vehicle shall not be older than 5 years for small vehicle and 10 years for truck and other heavy
vehicles.
16.3 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:
o Working procedures (for each activity)/Method Statement);
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o Job Safety Analysis (JSA) (for each activity);

o Job Hazard Analysis (JHA);
o Drawing / lifting plan / etc. (related to activities).
o SIKA / Work Permit has been approved.

17.0 TRANSPORTATION MANAGEMENT

17.1 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
CONTRACTOR’S activities. All vehicles shall pass an inspection. Minimum requirements for drivers
are as follows:
o Have good physical, mental and psychological condition.
o Drivers/operators are experienced, are medically examined, completed driving tests.
o Safety belts shall be worn at all times inside construction areas and in public areas by driver
and passenger. Driver is responsible to ensure all inside vehicle (LV or HV) are wearing safety
belts while driving
o Have special skills such as terrain and climatic experience, and first aid knowledge.
o Have licenses both from the government and CONTRACTOR (SIMPER), and any relevant
types of cargo licenses.
o Have completed safety defensive driving training.
o Have completed induction on local area characteristics and regulations.
Vehicles shall be:
o The vehicle shall have Anti-lock Brake System, Air Bag System, and safety belt for all
passenger.
o Have valid gate pass.
o Completed with inspection record.
o Completed with safety accessories as per HSSE requirement (reverse alarm, fire
extinguisher and first aid kit, flame arrestor).
The General Affair Department will be responsible to control driver alertness and fitness by:
o Scheduling driver’s trip plan for a week considering their enough time to rest.
o Pre- Briefing before starting work.
o Maximum duty hours of drivers shall be 15 hours.
o All driver 100 % should have attend Safe driving course provided by CPPHK.
o Refreshment training for all driver at site will be conducted on yearly basis.
Refer to 26076-110-GPP-GHX-00015 Traffic Safety Rules Procedure.
17.2 Pedestrian Area
o CONTRACTOR shall provide pedestrian walkways which capable to be used by employees to
move at site and office area by walk.
o At minimum dedicated pedestrian walkways shall provide with widths no less than 3 feet.
o Pedestrian way shall be clearly marked to show visible boundary between vehicle and
pedestrian access.
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o 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.
o 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.

18.0 HEALTH MANAGEMENT

As comprehensive implementation other than below, refer to Document No.26076-110-GPP-GHX-
00012 “Occupational Health and Welfare Procedure”
18.1 Health Goals and Objectives
All employees will undergo pre-employment medical checks to confirm fitness for duty, in line
with local government regulations and OWNER requirement as well.
The primary goal is to provide a healthy workforce and workplaces that is, as far as reasonably
practicable (ALARP), free from recognized workplace health hazards by:
- Implementation of Health Hazard Evaluation (HHE) and Hazard Control. Elimination or
reduction of hazards by risk assessment.
- Control of Substances hazardous to health (COSHH) procedures.
- Implementation of required standards of camp accommodation and site canteen facilities
- Readiness for activation of medical and emergency response equipment.
- Maintaining First Aid and minor ailments records for assessment purposes.
- Implementation of a Drugs and Alcohol Policy.
- Management of working in hot climates.

18.2 Biological Hazards

Biological hazard identification, control, and emergency handling response is detailed on specific
HIRAC/JSA, 26076-110-GPP-GHX-00012 Occupational Health and Welfare Procedure and 26076-
110-GPP-GHX-00006 Emergency Response 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:
o Human bodily matter (blood, tissues, vomit, urine, faeces, saliva, breast milk)
o Animal product (meat, offal, skins, bones, blood, milk, eggs)
o Live animals (mammals, birds, fish, invertebrates and their urine or faeces)
o Biohazard waste, sewerage and rubbish
o Laboratory cultures
Occupation and workplaces where people may come into contact with biological hazards are:
o Medical staff, cleaning staff and laboratory technicians.
o Healthcare services.
o Cleaning services.
o Employees in environmental hygiene services such as sewage treatment or wastewater
plant and rubbish collection and disposal.
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o 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.
o 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.

18.2.1. Wildlife Animal

o 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
o CONTRACTOR shall educate employees to prevent matters that can attract the presence of
wildlife. Such as food, rubbish, garbage, humidity, etc.
o CONTRACTOR shall ensure that employees are aware with the characteristic of wildlife at
their working area.
o CONTRACTOR may liaise with Government agency which is authorized to handle wildlife
conflict.
o CONTRACTORS must be able to coordinate with the nearest hospital that refers to the
emergency number, in the event of a wild animal attack or being bitten by an animal.
Crocodiles are large-bodied reptiles that live in water. Scientifically, crocodiles include all species
of the Crocodylidae tribe. Crocodiles generally inhabit freshwater habitats such as rivers, lakes,
swamps and other wetlands, but some live-in brackish water such as estuarine crocodiles. The
main food of crocodiles is vertebrate animals such as fish, reptiles and mammals, sometimes
also prey on mollusks and crustaceans depending on the species.
Crocodiles are ancient animals, which have only changed little because of evolution since the
time of the dinosaurs. Crocodiles can move very quickly at short distances, even outside water.
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This animal has a very strong jaw, which can bite with extraordinary strength, making it the
animal with the greatest bite strength
Crocodiles prey on fish, birds, mammals, and sometimes other crocodiles that are smaller and
even the bodies of adult crocodiles. These reptiles are ambush predators, it waits for its prey
land animals or fish to approach, then pounces it abruptly. As cold-blooded animals, these
predators can survive long enough without food, and rarely really need to move to hunt their
prey. Although it seems slow, crocodiles are the top predators in their environment, and some
species have been observed to attack and kill sharks. The exception is the Egyptian plover, which
is known to have a symbiotic relationship with crocodiles.
Snake bites can occur while working, especially when working in fields where there is still a lot
of grass
 Ensure medical facility have appropriate anti venom available.
 All people who are bitten by a snake must be transported to a medical facility immediately
 Stomach aches, vomiting, headaches, are often the first symptoms.
 Signs of muscle weakness due to bite (envenomation) may only occur after 24 hours
 The most important thing is to stop the spread of poison from the bite site
That must be done immediately
 Do not let the patient move - carry the transport to the patient
 Try to keep the patient calm and not moving.
 Do not wash the bite marks. Maybe a special test will be done to find out the type of snake
that has bitten the patient, based on the poison left in the skin.
 Wrap / wrap all limbs, use the same pressure as for a sprained ankle
 Wrap the arms or legs so they cannot move at all.
If the bite is on the body or on the head, give bandages only on the bite marks.

18.2.2. Blood-Borne Pathogens

Construction Manager will be responsible for the implementation of Blood-borne pathogens
program will include:
o 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.
o Necessary PPE for employees mentioned above.
o Post exposure evaluation and follow up to personnel who have been exposed.
o Labelling and Sign.
o Response to accidental exposure to blood-borne pathogens.
CONTRACTOR shall provide all its employees with a general overview of the hazards associated
with blood borne pathogens, possible means of exposure, and proper control method.
Provisions (if applicable) will be made for proper disposal of hazardous medical waste and a sign
posted in the treatment area warning of biohazards. A “needles” container, acceptable to
OWNER, will be maintained in the site clinic for the secure disposal of used needles and similar
medical waste. Proper sterilization method and materials shall be used
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18.3 Fitness to Work

The CONTRACTOR shall have a process for assuring the fitness to work of all CONTRACTOR
PERSONNEL including SUBCONTRACTORS in accordance with applicable legislation.
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).
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 HSSE 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.
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 26076-110-GPP-GHX-00012 Occupational Health and
Welfare Procedure.
18.4 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:

18.4.1. Catering Practices

At a minimum the Supervisor General Affair will ensure the implementation and maintenance
of the following areas:
o Monthly Inspection lead by Site Doctor. OWNER will be requested to participate.
o Weekly Tool Box Meeting for Catering Crew led by General Affair assisted by Medical
Advisor.
o Provide worker complaint and suggestion box about catering service.
o CONTRACTOR must engage the services of a suitable pest control for insects, rats, etc.
o It is not recommended to keep leftover foods for the next day consumption.
o However, if it is not possible, CONTRACTOR shall ensure that catering providers are
implement adequate food storage procedure.
o Medical Check Up for food handler personnel shall be done in accordance with the national
regulation.
o Catering provider should follow food and catering safety management standard in
accordance with the national regulation.
Employees shall take breaks and eat in designated areas only. These areas shall be free from
hazardous materials and other possible contaminants. Food shall not be consumed by the
workforce in areas where they do not have facilities to wash beforehand.
Food shall be prepared, handled, stored and supplied to the workforce in a safe and hygienic
condition. If meals are being transported to work areas, hygienic containers shall be provided.
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All food handlers shall be rigorous in matters of personal hygiene, washing hands before
touching food after having touched something else. All food handlers shall wear fresh and clean
uniforms with aprons, head cover and safety shoes. They shall maintain a clean, neat and tidy
appearance, with short finger nails and hair. The wearing of jewelry, especially rings, whilst
working is strictly prohibited.
The HSSE Manager shall implement a system of monthly checks and inspections of the catering,
food storage and preparation areas to ensure compliance with hygiene standards.
18.4.2. Fatigue Management
o 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.
o 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.
o 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.
o All employees shall not work more than thirteen (13) days straight without taking a day rest.
o To effectively manage fatigue caused by on call work, consideration is to be given to:
- 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.

18.4.3. Housekeeping
o Refer to document no. 26076-110-GPP-GHX-00033 “Housekeeping Procedure”
o A planned, clean, orderly project site is mandatory. Worksites, shop areas and lay down
areas shall be kept clear of scrap and unnecessary materials. Materials necessary for work
shall be properly stacked and kept out of roadways to allow proper access for firefighting
equipment. Lay down areas shall be planned and laid out in sections with access roadways
adequate for fire-fighting and materials handling equipment.
o Housekeeping practices and clean-up of all project facilities will be maintained by
Construction Team.
o 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.
o Waste material shall not be burned in site and shall be segregated when disposed of in the
bins.
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18.4.4. Heat Stress

o CONTRACTOR shall implement Heat Stress Monitoring especially during hot weather and
conditions.
o 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.
o All employees who are exposed or potentially exposed to heat stress will receive training
regarding heat stress-related injuries and prevention measures.
o CONTRACTOR shall ensure that all employee understand the early symptom of heat stress.
Detail of heat stress management refer to 26076-110-GPP-GHX-00012 Occupational Health
and Welfare Procedure.
18.4.5. 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 or 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
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”.
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.
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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.
5. The employee and employee’s supervisor will be notified of the shift in hearing threshold
in writing by HSSE 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.
18.4.6. Respiratory Protection
- CONTRACTOR will comply with industry standards for the specification and provision of
respiratory protection. Disposable respirators for nuisance dust shall comply with BS or
ANSI standard
- Where a Risk Assessment identifies the need, CONTRACTOR and SUBCONTRACTORs will
ensure the provision and use of appropriate respiratory protective equipment,
manufactured to a recognized international standard.
- Appropriate training shall be provided to the wearers on the inspection, use, sanitary care,
and limitations of the equipment. Records of such training shall be maintained by
CONTRACTOR
- 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
18.4.7. Radiation Protection
Radiation protection will be under Construction Manager’s responsibility. At the minimum, the
Construction Manager will ensure the following:
o Provide special room / bunker for Radioactive storage complete with sign and according
regulation and standard radiation storage system.
o Provide Sign, Barricade, Orange & Red rotary lamp and other equipment/tools to alert
that dangerous activity being conducted.
o Provide qualified personnel to conduct radiation activity. The personnel shall be certified
by BATAN for conducting the activity.
o NDT (RT) without collimators are prohibited.
o Emergency procedure for Radioactive shall be provided.
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o 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:
o Sources of ionizing radiation shall not be left unattended.
o Required to use the film badge / dosimeter for all personal involved with radioactive
activities.
o 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.
o 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.
o CONTRACTOR will ensure that radiation measuring devices in the workplace are provided.
o 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 HSSE for review.
o Shall control that the radioactive work will not affect any system or operating process and
surrounding people, prior to commencing any radioactive work.
18.5 Hazardous Materials
Refer to document no. 26076-110-GPP-GHX-00013 “Hazardous Material Control Procedure”
- All construction CONTRACTORs are responsible to ensure that only approved hazardous
material are purchased for use at its worksite.
- SUBCONTRACTORs will minimize the quantities of hazardous materials stored and consumed
on site. SUBCONTRACTORs/vendors will obtain prior approval from CONTRACTOR for
hazardous materials brought to site and Submit to CONTRACTOR Material Safety Data Sheets
(SDS) for each hazardous Substance. All SDS must be displayed at site and explained to all
workers through daily Tool-box Talk.
- The need to share during TBM on the familiarization on the CONTRACTOR/OWNER plant entry,
emergency facilities, eye wash, safety shower and spill kit.
- Materials arriving at site without SDS shall be quarantined and not released until the SDS is
received and approval received from CONTRACTOR. CONTRACTOR will ensure that each
SUBCONTRACTOR maintains an inventory of hazardous material on site.
- CONTRACTOR will ensure that employees are trained in the recognition, proper handling and
use of hazardous Substances. HSSE Induction training will include introductory training on the
topic of hazardous Substances. However, SUBCONTRACTORs will provide specific hazardous
material training for its Project employees whose work involves the use of any hazardous
material under its control. Such training will be properly documented, filed and made available
to OWNER.
- SUBCONTRACTORs will properly label all hazardous Substances and/or chemicals that have
been transferred from the manufacture’s container into a secondary container. Inspection will
be made and documented by CONTRACTOR to ensure that adequate labeling occurs
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18.6 Water and General Sanitation

- All eating and sanitary facilities will be maintained in a clean and sanitary condition at all times.
CONTRACTOR and SUBCONTRACTORs/vendors will provide necessary resources to accomplish
this, including adequate washing facilities with soap and deposable towels and whatever labor
is required to clean and maintain a reasonably high level of sanitation.
- CONTRACTOR and SUBCONTRACTORs will ensure the provision of clean potable drinking water
for own employees in a safe hygienic manner at desire locations within the project site.
However, OWNER approval on such allocation shall be obtained prior to implementation.
- Unless specified elsewhere in the subcontract, CONTRACTOR will provide and maintain its own
sanitary toilet facilities for own employees. The daily facility cleaning, and maintenance, and
method and location of waste disposal shall be to a standard acceptable to OWNER
- This provides guidance for the protection of site personnel from unsanitary and unhealthy
drinking.
o CONTRACTOR shall provide drinking water which comply with government water quality
standard for drinking water.
o 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.
o Sampling of drinking water shall be conducted quarterly by CONTRACTOR HSSE to ensure
drinking water supplies are health to consume.
18.7 Pest and Vector Control
CONTRACTOR will engage the services of a suitable pest control SUBCONTRACTOR
18.8 Eye Protection
- Eye protection will be mandatory in all areas of the construction site, lay-down areas and
workshops. Safety glasses will be required at all times on site and in associated workshops/lay-
down areas. For specific activities the type of eye protection will depend on the task and
Subsequent risk assessment.
- Safety glasses can be of clear or slightly tinted lens type. Dark lens could only be used upon
job hazard recommendation as stated in JHA for specific task.
18.9 Medical Services and Medical Treatment
Appropriate First Aid and medical facilities will be provided for personnel working at the worksite.
Medical facilities will comply with OWNER requirements.
CONTRACTOR and/or SUBCONTRACTORs must have the supported of trained First Aiders at site,
drawn from all sections of the project establishment. Ensure first aid boxes are installed at the
site office of CONTRACTOR and SUBCONTRACTORs
First aiders will administer minor injuries before sending the injured to a recognized medical clinic
for further review. Major injuries suffered by the injured will be sent to clinic by respective
supervisor immediately for medical treatment
SUBCONTRACTOR/vendors will be prohibited from establishing their own medical facilities
without assessment and approval by CONTRACTOR/OWNER, other than basic first aid with
trained First Aiders and first aid boxes.
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18.10 First Aid

- Rules on first aid will refer to the Contract Document
- CONTRACTOR in cooperation with SUBCONTRACTORs will provide First Aid Room with nurses
& facilities or use OWNER’s facilities when agreed by the OWNER, first aid boxes and their
contents, first aiders and other related matters as required in the RI Government Regulation
and First Aid Procedures Refer to document no.26076-110-GPP-GHX-00007 “First Aid
Procedure”
18.11 Return to Work
CONTRACTOR’s HSSE representative will review all return-to-work orders and inform OWNER.
CONTRACTOR and SUBCONTRACTOR’s employees injured on the Project and returned for light
duty (restricted workday case injury) shall have a treatment record and report to the Industrial
nurse who will in turn inform CONTRACTOR’s HSSE Manager.
18.12 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. HSSE 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:
o Plan an appropriate and varied workload.
o Offer a choice of permanent or rotating shifts and try to avoid permanent night shifts.
o Limit shifts to 12 hour including overtime.
o Encourage workers to take regular breaks and allow some choice as to when they are taken.
o Consider the needs of vulnerable workers, such as young or aging workers.
o Consider providing warm drinking & food (beverage) and proper feeding zone.
o Weather condition would be a consideration for providing clothes to keep body warm.
o Provide similar facilities as those available during daytime and allow night time workers
time for training and development.
o Ensure temperature and lighting is appropriate and preferably adjustable.
o Information on the risks of night time work and ensure the implementation of toolbox
meeting and briefing.
o Supervisors and management can recognize problems.
o Consider increasing supervision during periods of low alertness.
o Provide health assessment for night time workers.
o Ensure the workplace and surroundings are well it, safe and secure.
If some work is unavoidable to be performed in the night, CONTRACTOR shall Submit methods
statement including lighting type / numbers and allocation map, on the ground and/or at height,
and JSA to PT PERTAMINA for review and approval. See Work at Night Procedure No.: 26076-110-
GPP-GHX-00048.
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CONTRACTOR must provide sufficient and adequate illumination for night work activities.
Illumination intensities shall comply with minimum requirement as defined in OSHA Safety &
Health Regulation for Construction, Subpart D, and Standard Number 1926.56(a) table D3.
Perform lifting activities that classified as critical lift is not allowed at night.
According to the construction condition of RDMP Lawe lawe Project that the high intensity of the
construction activity become trigger the need to accommodate the work at night. Especially for
critical activities at night must be equipped with a checklist (as attached in attachment 13) who is
reviewed and approved by the RDMP Lawe lawe Manager on duty.
Recommendations regarding the requirements that must be met before the start of critical
activities at night including monitoring for work and sometime after the work are completed. This
includes night time critical works, such as:
 Working at height
 Critical lifting work
 Working aboard a barge
 Confined space
 Equipment repair work
 Hot works
 Etc.
Next, we have to make sure the checklist work at night consistently implemented seriously and
responsibly. The checklist is part of the Permit To Work (PTW) document for night work.
Detail of Working at Night Procedure is described on document 26076-110-GPP-GHX-00048.
18.13 Prevention the spread of Corona Virus Disease (Covid-19) for Workers, Partners and Families.
JO CPPHK must be managing the lowest possible risk according to the spreads of COVID-19 in all
lines of the operational activities of EPC Lawe-Lawe Facilities Project and to ensure the operational
activities runs well in order to complete the project on schedule. Work mechanism will be arranged
by JO CPPHK to handle prevention the spread of COVID-19 which includes the following details:
1. Daily checkup (Body temperature) using thermogun for all workers when entering the work
areas and the result will be reported.
2. If the body temperature >37.5°C and with the symptoms like Cold / Cough / sore throat /
shortness of breath shall be taken to nearest hospital immediately for further checking
according to the applicable government procedures.
3. Provide prevention facilities, includes:
a. Wash Hands Facilities including clean water and soap.
b. Hand sanitizer on site.
c. Provide drinking water and maximizing to use personal tumblers or disposable glasses.
d. Provide face masks.
e. Distribute vitamins and supplements for maintain immune and stamina.
4. Daily education to all workers including subcontractors with conducting Toolbox Meeting,
General Safety Talk, and Posters / Banners to increase personal awareness (workers &
families) against the transmission of COVID-19 through the following efforts, such as:
1) Avoid crowds (Public Area)
2) Avoid direct interaction between personnel, such as: Handshaking, hugging, etc.
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3) Improve Clean and Healthy Life Behavior (PHBS) as follows:

I. Washing hands with 7 steps before eating, after go outside and before entering
mess, and before doing activities in the office.
II. Routinely clean desks, laptops and surface or objects that may be frequently
touched by other people.
III. Avoid touching face and handshaking frequently.
IV. Use a mask and replace regularly and dispose of dirty masks.
V. Implement coughing and sneezing etiquette and keep a distance min 1.5 meters
from other people.
VI. Maintain stamina with regular exercise, balanced nutrition and rest well.
5. Limits and suspend all gathering / meeting / workshop activities related to the current
project and maximize media such a teleconference meeting. If the meeting unavoidable,
please arrange for a maximum the (10) participants with a minimum distance 1.5 m.
maximum
6. Limiting the number of passengers on vehicle, minimum 50% of vehicle capacity.
As a mitigation for preventing the spread of Corona Virus Disease (COVID-19) for workers, work
partners and families, facilities and activities in the workplace and related joint facilities are
managed, including:
A. General Management
 Covid Rangers are available to supervising compliance to the Covid-19 Protocol.
 Communication facilities / tools are available to implementation COVID-19 Protocol and
placed at location that are easily to seen by workers (especially in public facilities).
 Ensure assigned personnel to carry out activities that needs to be physically contact with
other people, handling cleaning activities are equipped with PPE to prevent spreading of
COVID-19.
 Conducting disinfection and cleaning of all work areas, reception, apartments, elevators,
work spaces, meeting rooms, pantries, bedrooms, public facilities and surfaces or subjects
that may be frequently touched by other people routinely.
 Ensure that all personals at work areas wearing long sleeves and masks.
 Security Patrol are available in place to ensure compliance Covid-19 Protocol
B. Lobby & Receptionists Area Management
 Provide personnel and facilities are available for body check temperature.
 Assigned personnel must be equipped and use standard PPE to prevent spreading of
Covid-19
 Ensure availability and implementation of queue body check temperature before entering
work area.
 Ensure that personnel who will work in Office (WFO) has been rapid tested.
 Ensure that personnel can be WFO (Non-comorbid, breastfeeding, ODP, OTG, PDP, and
positive) and running well.
 Ensure the availability of hand washi facilities and hand sanitizer.
 Availability and has been applied marking for keeping a distance minimum 1.5 meters
(especially at area where there are queues).
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 Availability and has been applied standing area marking on lift by considering the safe
distance between user (not facing each other, the space is sufficient according to the
physical distancing protocol).
 Ensure that provided seats has been complied for physical distancing requirements
(separate and 1.5 meters minimum distance and has been marked).
 Ensure that all personnel use masks properly
 Disinfection 7 cleaning of work spaces in the lobby and reception area must be carried out.
C. Receiving package from outside Management
 Ensure the body temperature of couriers has been checked an passed physical checking.
Couriers may not allow to entering the gate, and package placed at the drop off point.
 Ensure on every package that entering JO CPPHK work area has sprayed with disinfectant.
 Ensure the package that has been sterilized is delivered by internal personnel to the
recipient.
 Ensure the body temperature of couriers has been checked a passed physical checking.
Couriers may not allow to entering the gate, and package placed at the drop off point.
D. Workspace and Meeting Management
 Ensure that tables and chairs in work spaces and meeting room comply with physical
distancing requirements (minimum distance of 1.5 meters which can be marked with a
marker, workers are not allowed to face each other, or there is a dividing bulkhead, the
maximum occupancy of the meeting room).
 Provide the sign or a text stating "the maximum number of occupancies in the meeting
room" and "maximum duration of 60 minutes".
 Make sure the meeting conducted using by MS. Team. Attempted to avoid face-to-face
meetings.
 The worker must be do physical / social distancing.
 Workspaces and meeting rooms are cleaned (at least 2 times a day) and disinfected (once
a week) on a regular basis.
 Make sure the workers always wear a mask.
E. Management of Breakout / Pantry / Canteen / Mess Area
 Ensure all places has implemented physical distancing
 Ensure that tables and chairs in breakout/pantry comply with physical distancing
requirements (minimum distance of 1.5 meters which can be marked with a marker,
workers are not allowed to face each other, or there is a dividing bulkhead).
 The worker has been informed to bring their own tableware.
 The worker should be worn mask properly, Chef and the food presenters also use gloves
and mask properly.
 Ensure to provide wash basin facilities and hand sanitizer
 Proper trash bins are available.
F. Public Facility Management
 Public facilities (smoking area, musholla, toilet, parking area etc.) comply with physical
distancing requirements (minimum distance of 1 meter which can be marked with a
marker, workers are not allowed to face each other, or there is a dividing bulkhead).
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Note: For musholla management, every worker must bring their own prayer mat. The
public facilities to be used interchangeably.
 The workers use their own prayer mat and do not left it in the musholla
G. Toilet Management
 Must provide soap for hand washing and tissue.
 Proper trash bins are available.
 Toilet users always wear a mask
H. Trash Management
 Plastic bag bins must be provided and always closed.
I. Drop Off point Management
 Availability facility and drop off point protocol for catering, food and stuff delivery.
J. Pool and shuttle Point to Point Management
 Vehicle must be disinfected and cleaned regularly before it used.
 Shuttle point to point must be provided for the transportation of workers and partners.
 Passengers must be limited to a capacity of 50% capacity, and apply the concept of
physical distancing and other health protocols (must wearing a mask and washing hands
also using a hand sanitizer).
 Availability vehicles must be suitable for workers who do not use private vehicles
 Drivers and passengers who are WFO must have had the Rapid Test and the results are
Non-reactive.
 Driver and passengers must use masks.
 Personnel no longer use public transportation.
 Provide hand wash facility and hand sanitizer at the parking area
K. Arrival Workers from their Origin Management (Mess)
 Ensure workers from outside mess, must pass the Rapid Test (internal Balikpapan) or
SWAB Test (for those from outside Balikpapan)
L. Entering Mess Protocol
 Provide a place to put shoes, sandals before entering the house.
 Provide laundry basket.
 Provide hand sanitizer in every strategic place at the mess (living room, dining room, etc.).
M. Bedroom Management at the Mess
 The Limitation on the number of occupants. The distance between the beds is 2 meters. 1
room does not exceed 10 peoples.
 Do not allowing the guests to come during pandemic
 Provide the special room for self-isolation or quarantine and its occupants are limited.
 There is sufficient distance between isolation rooms and another room.
Daily needs of people in the isolation room (food, drink. MCK) are separated from people
in another room and be served.
N. COVID-19 Prevention Inside Vehicles Requirements
Regarding the COVID-19 Prevention Program in All CPPHK Operational Vehicles, Ensure:
 COVID-19 prevention barriers on vehicles are installed
 Hand sanitizer and cleaning wipes are available in each compartment
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 All passengers have cleaned their self before entering the vehicle and wiped their seats
when exiting
 Air conditioning must not be used during occupation of the vehicle and all windows shall
remain open during driving and occupation for full ventilation
O. Protocol for New Comer Employee or After Temporary Leaving Site
New Worker, after business trip, or after temporary leaving site for holiday need to be get
Medical Clearance from Doctor on Site, as for the requirements as follows:
1. Active Workers (Have ID Badge)
 From Outside EAST Kalimantan:
- PCR/Swab Test
- Rapid Test  Self Quarantine (min. 14 days)  Rapid Test
 From EAST KALIMANTAN, Outside Balikpapan & PPU:
- PCR/Swab Test
For every worker that used public transportation.
- Rapid Test
For every worker that used private transportation
 Protocol as above applies also to every worker that have ID Badge and have traveled
from outside Balikpapan or PPU (Example: Business trip to Head Office, Survey/Visit
Vendor, etc.).
*NOTE:
 PCR/Swab Test and Rapid Test Result need to be clearance by Doctor on Site.
 PCR/Swab Test and Rapid Test Result valid for 14 days after result announced.
 Workers can return to work after get Medical Clearance from Doctor on Site.
2. New Workers (Have no ID Badge)
 From Local Balikpapan & PPU:
- Valid MCU and attached Screening Covid-19 Letter from Clinic/Hospital.
 From Outside Balikpapan & PPU:
- Valid MCU and attached the Result of PCR/Swab Test
- If attached Rapid Test Result must be Self quarantine (min.14 days) and fulfilled
Self Quarantine Form.

19.0 HSSE MANAGEMENT SYSTEMS

19.1 Planning
The main objectives of this plan are to ensure that the project activities are organized, controlled,
and effectively discharged to minimize accidents, incidents and harm to the environment.
To achieve the objectives stated above, the Project will implement HSSE Policy included in
Attachment 1 and conform to the Indonesian laws and regulations, which are listed in the
Applicable Codes and Standards.
This Plan will be used as the basis for managing HSSE on the Project. All project team members
have the responsibility and authority to identify conditions adverse to HSSE, and initiate
recommend corrective action.
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19.2 HSSE Management System

CONTRACTOR HSSE Management Systems are used as a basis and benchmark for The Project HSSE
Management Systems.
Project HSSE Documents consist of Plans and Procedures.
The HSSE Manager assure that the HSSE Management system meets requirements of ISO 45001,
ISO 14001, and ISO/IEC 27002:2013 and applicable requirements of health, safety, security and
environment.
Any deviation of practices and procedures required by Contract will be identified and Submitted
to OWNER for approval.
The Project HSSE Management system plans and procedures will be maintained and apply during
all phases of the project
1) Engineering
Construction/Commissioning in Design Activities
Construction/commissioning personnel will participate in a number of HSSE reviews, where
required, to provide input on HSSE matters. And, Pre-start up safety reviews will be
implemented.
Health
A central Safety Data Sheet (SDS) file will be maintained. The Senior Engineering Manager or
the Discipline Lead Engineers will keep this central file. All vendors will be required to provide
SDS sheets. New vendor data will be inserted into central file, replacing any existing SDS
sheets
Environmental
Emissions, land and water conservation, and noise levels will meet the technical
requirements and the applicable requirements of Indonesian Laws and regulations as well as
the requirements of AMDAL and/or permits. CONTRACTOR will assist OWNER by providing
an updated emissions inventory.
2) Procurement
While HSSE objectives extent the procurement activities, CONTRACTOR has no direct control
over vendor activities in their fabrication shops, or the expertise to monitor compliance to
laws and regulations that apply locally. In keeping with the intent of the Project HSSE Policy,
CONTRACTOR therefore includes the following statement in its requisitions:
“The Vendor shall establish and maintain a Health, Safety, and Environment Management
system that meets local laws and regulations for the workplace, and implement it for
activities related to the order.

20.0 OPERATING PROCEDURES AND SAFETY STANDARD

20.1 Personal Protective Equipment
Refer to document no. 26076-110-GPP-GHX-00003 “Personal Protective Equipment (PPE)
Procedure”
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
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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 Lawe-Lawe project must be worn mandatory PPE. The standard
PPE that must be worn are:
Table 6. Personal Protective Equipment (PPE) Standard

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 HSSE 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

PPE inside Gate 3 Lawe-Lawe are Safety Helm, Safety Shoes & Two Piece. PPE Inside Gate 3A Lawe-
Lawe are Safety Helm, Safety Shoes, Coverall, Safety Glasses and Gloves. Used special PPE for
specific activities.
20.2 Safety Sign, Color Coding and Barricade
Refer to 26076-110-GPP-GHX-00034 Barricade Procedure, 26076-110-GPP-GHX-00010 HSSE
Inspection Procedure, 26076-110-GPP-GHX-00004 HSSE Sign and Color-Coding 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.
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 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.
CONTRACTOR and SUBCONTRACTORs/vendors will ensure that employees understand and
comply with barricade and barrier procedures (i.e. prohibited entry into barricaded or taped
areas).
No road shall be closed off without CONTRACTOR approval (OWNER when required).
20.3 Chain Blocks and Come-A-Longs
Refer to 26076-110-GPP-GHX-00024 Lifting and Erection 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.
The use of Chain Blocks and lever blocks must pay attention to the following matters:
 Make sure the lever / chain block is attached to the beam using standard shackle and lifting
lugs.
 Be sure to use pad eyes made specifically for connecting hooks from the lever / chain block.
 It is forbidden to swing a load that is hanging or pulling against the floor.
 Do not use a lever / chain block if the hook has changed shape. (crooked or wide open)
 Do not use a lever / chain block if the name plate is unclear or missing.
 Make sure to place the top and bottom hooks at a standard lifting point.
 Be sure to use webbing sling to tie the pipe and hook it to the hook.
 Make sure the lever / chain block is neatly stored in the storage area.
 Ensure that annual inspections and load capacity tests of the levers / chain blocks are carried
out routinely.
 Make sure the lever / chain block has a number
 Serial and WLL (working load limit) & the availability of valid certificates.
 Make sure the lever / chain block color code (quarterly) is still valid.
 Do not be under the load position of the chain block
 It is forbidden to use a chain lever / chain block as a binder / binding material.
 It is prohibited to link the lever / chain block in the scaffolding pipe as a point of lifting.
 Do not use a lever / chain block if the chain is damaged, elongated or bent.
 Do not use levers / chain blocks that do not have safety latches or conditions are damaged.
Immediately replace the safety latch with a new one.
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 Do not lift loads beyond the capacity (SWL) specified in the chain / lever block.
 It is prohibited to build a load on the end of the hook lever / chain block.
 Hook lever / chain block is prohibited from being connected to the beam.
20.4 Lifting and Rigging

Detailed procedure for crane and lifting refers to document 26076-110-GPP-GHX-00024 Lifting
and Erection Procedure.
20.4.1 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.
All lifting Crane shall have:
- Valid MIGAS certification in line with the lifting requirements
- Its identification numbers
- Safe Working Load (SWL) marking
- Current color code, transit slings are permitted to be of a different color to that in
use during the current color period. This is to identify them as “transit slings” which
is less confusing
- Load chart put in the cabin
- An adequate safety factors
- The current color code must be posted and all slings with different color must be
moved from the location
- Certification of Lifting Crane shall be managed.
In case of intending to use lifting crane in an unusual way, suitability must be indicated by
the manufacturer / supplier and the advice sought before any change of use is attempted.
20.4.2 Lifting Gears 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.
All lifting gears shall have:
- Valid MIGAS certification in line with the lifting requirements
- Its identification number
- Safe Working Load (SWL) marking
- Current color code, transit slings are permitted to be of a different color to that in
use during the current color period. This is to identify them as “transit slings” which
is less confusing.
- Regular inspection by CONTRACTOR inspector before change color code
- An adequate safety factor
- The current color code must be posted and all slings with different color must be
moved from the location
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- The use of home-made lifting gears is strictly prohibited.

- Certification of Lifting gears shall be managed.
- In case of intending to use lifting gears in an unusual way, suitability must be
indicated by the manufacturer / supplier and the advice sought before any change of
use is attempted.
- Pre-use inspection done
20.4.3 Lifting Plan
Detailed procedure for lifting plan refer to 26076-110-GPP-GHX-00024 Lifting and Erection
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.
Specific Lifting Operation Plan is required for any Complicated and Complex lifting
operations refer to CONTRACTOR Construction Procedure.
If a documented lifting plan already exists, it should be re-used but only after review to
ensure that provisions are made for any change in circumstances.
The competent person should have adequate practical and theoretical knowledge and
experience. The plan must address the risks identified by the risk assessment and propose
appropriate control measures.
The plan considers the operation in a logical sequence that includes at least:
1. Assessment of the size and weight of the load (including rigging). The weight of
rigging hardware, blocks, slings, jibs, etc. must be considered and included in the
overall calculations
2. Selection of the right equipment for the job, lifting method, right rigging.
3. Checking of anticipated path for obstacles, access, headroom, working radius. Load
dimension must be reviewed to ensure the load does not hit an obstruction or the
boom, and to determine effects of wind loading.
4. Preparation of suitable area to set load down
5. Making the lift safely (trial lift may be required to confirm load’s gravity center).
Centre of gravity must be determined to provide stable rigging
6. Safe release of equipment from load to set down
7. Clearing up to leave area free from hazards. Survey of above ground obstruction is
essential
8. Weather conditions
9. Appropriate level of permit required
The plan should be prepared in writing and consists of at least the following:
1. Valid work permits
2. Valid certificates (copies or where to find them out) / SIA from Government
3. Organizations of the lifting operations
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4. Schedule of the lifting operations

5. List of lifting equipment
6. Layout of the site with crane positions
7. Layout of the lifting equipment moves
8. Calculations of the loads
9. Layout of access to lifting site
10. Original or certified copy of any obtained exemption
11. Contingency and emergency procedures, escape ways, alert codes, etc.
12. Standard of calculating safe working loads
13. Operator must have License Operated Equipment (SIO) from Government
The lifting operation plan shall be approved by the Competent Person and determined
approvers.
20.4.4 Operator Requirements
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.
Operator must have License Operated Equipment (SIO) from MIGAS and have the ability
to:
- To carry out daily inspection of the condition of crane and lifting tools to ensure those
equipment are safe to use
- Have a clear view of loads or be directly by a certified rigger by clear visual contact or
other communication way
- All operations of the crane to be done in a safe and steady manner, abide the duty of
crane
- Obey any stop signal at all times
- Report any fault or malfunction immediately to supervisor
- Never leave crane controls whilst a load is slung
- Be aware of the personnel within the vicinity of crane operations
- Ensure any potential for dropped object including loose items are removed
- The crane operator has the final say on all lifts activities, and if the operator hesitates
they shall not proceed.
20.4.5 Rigger Requirements
- Rigger must have License from MIGAS
- Appointed Slingers (also known as riggers or load handlers)) must ensure that the
loads are properly attached to the lifting equipment
- The rigger job has undergone a thorough training.
- Signalers/Riggers are appointed to ensure that clear and precise commands are given
to the operator of the lifting equipment, either in carrying out of the lifting operation
or when the equipment is being move. Signalers / slinger / rigger have the ability to:
 Relaying signals to the equipment operator and for initiation and direction of
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safe movement of the lifting equipment and hook load,

 Directing the safe movement of the equipment and its load to maintain the
safety of all personnel,
 Being thoroughly trained in a hand-signaling system,
 Attaching, detaching slings to and from the load,
Reviewing and understanding the complicated and complex lifting operations to be
performed.
Detailed description refers to document no. 26076-100-GPP-GHX-00024 “Lifting and
Erection Procedure”.
CONTRACTOR and SUBCONTRACTORs/vendors will provide the resources necessary for
inspection and maintenance of rigging and lifting equipment and will monitor all lifts to
ensure that acceptable lifting practices are followed. Tag lines shall be used on all lifts.
All Lifting works will require a lifting plan for approval prior to performing the lift. In the
lift is over than 50 metric tons or classified as critical (exceeding 80% of crane capacity
chart, any two-crane lift or any lift over operating occupied facilities, process pipe racks
or near power lines), the SUBCONTRACTOR/vendor will Submit detailed rigging plan with
all applicable supporting calculations to CONTRACTOR or OWNER for approval prior to the
lift.
CONTRACTOR will designate a qualified supervisor (Rigging Supervisor) to determine the
methods and develop plans for rigging operations to ensure safe lifts. CONTRACTOR will
specify the responsibilities of the supervisor. This shall include approving lift plans and
monitoring lifting operations, overseeing the processes for selecting competent operators
and riggers, and inspection and maintenance procedure.
SUBCONTRACTORs/vendors will ensure that the equipment operators are adequately
qualified and informed of their responsibility to operate their equipment within design
limit.
20.5 Heavy Mobile Equipment
All heavy mobile equipment used at worksites must be roadworthy and registered with the
appropriate authority, as per following table:

Table 7. List of Required Authority to Certify Heavy Mobile Equipment

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

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7 Dozer DEPNAKER / MINISTRY OF MANPOWER

8 Grader DEPNAKER / MINISTRY OF MANPOWER

9 Genset > 200 KVA DEPNAKER / MINISTRY OF MANPOWER

Lifting gear such as webbing sling,
10 THIRD PARTIES
chain, block shackle, etc.

 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 Lawe-Lawe CPPHK will be manage
to be complied with RDMP Lawe-Lawe CPPHK Inspection procedure No. 26076-110-GPP-GHX-
00010 HSSE Inspection Procedure.
20.6 Working at Height /Fall Protection
Refer to document no. 26076-110-GPP-GHX-00020 “Working at Height Procedure”
 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 2. 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 HSSE Manager/ HSSE Chief/ Site Safety
Superintendent.
Maximum use will be made of primary fall protection systems, such as scaffolds, aerial lifts,
personnel hoist, etc. Workers who working above 10m should check blood pressure, by site
paramedic.
CONTRACTOR will adopt a “100% fall protection policy” that makes provision for secondary fall
protection (full body harness complying with BS or ANSI standard) for all employees who are
working or travelling more than 1.8 meters above ground. All fall protection devices shall be
manufactured and used in accordance with recognized international standard. Fully supervisor
during WAH is a requirement.
Irrespective of the type of platforms or safety nets a full-body safety harness with double lanyards
must always be worn while working over, or adjacent to, water. Prevention of the danger of falling
into the water when doing activities offshore, including: Scaffolding Platforms, Safety Nets and
Safety Harnesses and Lanyards
20.7 Scaffolding
Detail procedure for scaffolding refers to document 26076-110-GPP-GHX-00018 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.
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 The standard of scaffolding that must be following: OSHA standard with material of the frame
scaffolding must be galvanized.
 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.
 Ensure toe boards are in place and secured down to prevent tools and materials from falling
off and provide buckets/boxes to store small material
 Ensure safe access to and from the scaffold is provided with no obstruction.
 Keep the platform tidy and remember only LIMITED materials are allowed on the platform.
 NEVER modify components of a scaffold for your job, only SCAFFOLD CREW is authorized to
modify the scaffold.
 Visually inspect the scaffold at all points to ensure safety every time you are planning to use
it.
 Weekly inspections of scaffolds are done to ensure the scaffold is still safe for use. Scaffold
Tags identifies the condition of the scaffold
 Regarding scaffolding platforms for offshore activities:
- Where practicable, a scaffold is the best method of ensuring safe offshore activities.
- The scaffold should be designed for the task so that it is stable and of sufficient size for the
proposed work.
- Guardrails and toe boards should be fitted to prevent falls of persons or materials
20.8 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.
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 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.
 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.
20.9 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.
20.10 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.
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 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)
 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. 26076-110-GPP-GHX-00019 “Excavation and
Trenches Procedure”.
20.11 Confined Spaces Entry
Refer to document no. 26076-110-GPP-GHX-00021 “Confined Space Procedure”
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;
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 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
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.
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 To immediately exit a space, without question, upon word of the standby person, no matter
what the reason.
 To follow all HSSE 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.
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.

Approved Entry Under Gas Free / Approved Entry Under NON-Gas Free /
NO
Respirable Condition NON-Respirable Condition
1 Breathing Apparatus NOT required Breathing Apparatus required
2 OXYGEN: 20% TO 20.9% OXYGEN: <20% OR > 20.9%
LEL: <1% AND Toxic vapors ≤ 50% of LEL: >1% but <10% AND/OR Toxic vapors >
3
PEL 50% of PEL
Remarks – (a) For Inert conditions - Refer to
Remarks – (a) Both conditions 2 & 3 PTS 60.2110 Working in Inert Space (b) BA
above must be met for entry without must be used if either condition 2 or 3 is
4 BA (b) Typical gas detectors will provide present (c) Higher presence of flammables
reading for presence of Oxygen, indicates presence of other gases which
Flammables, CO and H2S may not be detected using the typical gas
detector.
Table 8. 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.
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6. Continuous ventilation.
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.
The CONTRACTOR and SUBCONTRACTORs will ensure that all employees have the CONTRACTOR
in-house training regarding the hazards of confined spaces and the procedures to be followed.
Special training shall be provided to all entry supervisors, entrants, and attendants. The
CONTRACTOR will ensure that entry supervisors know, understand and execute their full
responsibilities
Assigned AGT (Authorized Gas Tester) will examine each confined space before initial entry to
evaluate the specific hazards and SUBCONTRACTOR’s safety precautions.
Prior to each entry into a confined space SUBCONTRACTORs will ensure, and the CONTRACTOR
will verify, that:
- Proper ventilation equipment is used to purge and/or supply air to the confined space
- All electrical services have been Earth Leakage Protection Device (ELPD) or Ground Fault
Circuit Interpreter (GFCI) protected
- No AC current equipment or lightings to be used within confined space.
- Adequate access/egress from the confined space is provided,
- A task specific rescue plan has been developed and reviewed with all involved employees,
and
- All external sources of atmospheric contamination are isolated.
- Ensure periodical gas check to be performed at all times of the confined space activity and
Subsequent gas test will be by the CONTRACTOR and all data must be recorded on the
permit.
The CONTRACTOR and SUBCONTRACTORs will evaluate each confined space for possible heat
stress conditions.
SUBCONTRACTORs will ensure that all personnel who will be responsible for safety watchers
(confined space attendants) are easily identified, properly trained and aware of the duties
associated with each emergency situation that may occur within the confined space.
The CONTRACTOR and SUBCONTRACTORs will ensure that an emergency response plan is
available for all confined space entries and that all employees know how to summon assistance.
20.12 Lock-Out and Tag Out Procedure (LOTO) – Energy Isolation
Refer to document no. 26076-110-GPP-GHX-00017 “Lock Out and Tag Out (LOTO) Procedure”
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CONTRACTOR will ensure that all employees receive instruction on the specific lock-out/tag-out
procedure and comprehension testing shall be conducted to verify knowledge and understanding
of the procedure. Records of training and testing shall be retained.
Worker supervisor, SUBCONTRACTOR HSSE officer, CONTRACTOR disciplines supervisor in charge
and CONTRACTOR HSSE supervisor shall utilize and control their personnel key log and worker to
ensure that entire worker or work area have safe during LOTO working execution and termination
period.
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.

Figure 3. Danger Tag tagging and padlocked (Red colour)

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.
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Figure 4. Out of Service Tags (yellow colour)

Detail of LOTO procedure is described on document 26076-110-GPP-GHX-00017 Lock Out and Tag
Out (LOTO) Procedure.
20.13 Portable Ladders
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.
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 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.
Refer to document no. 26076-110-GPP-GHX-00036 “Ladders Procedure”
The CONTRACTOR will inspect portable ladders and step-ladders and apply quarterly color coding
system. The uses of homemade ladder are strictly prohibited.
The CONTRACTOR will monitor ladders to ensure all ladders used on the Project are commercially
constructed, have non-slip feet, and no wooden ladders are allowed. Self-made ladders are
prohibited to be use on site at all times. All workers must use the 3-point contact method while
using any access ladders on site.
20.14 Radiography
Refer to document no. 26076-110-GPP-GHX-00022 “Radiography Procedure”
The CONTRACTOR prepares Radiography Procedure based on the CONTRACTOR and Local
Government Regulations and existing HSSE Procedures of the NDT companies engaged to carry
out the work.
Radiography work shall be performed under the CONTRACTOR/OWNER issued Permit to Work
and only by SUBCONTRACTORs possessing the proper licenses and certificates. This procedure will
address as a minimum the following:
- Storage and transportation of radioactive sources
- Use and handling procedure
- Emergency procedures
Where laboratories are used to analyze samples, the laboratories shall be acceptable to the
CONTRACTOR/OWNER. The CONTRACTOR will instruct employees on the potential for radioactive
hazards during radiography and precautions to be followed in the event of an emergency.
20.15 Welding, Cutting and Grinding
The detail procedure for welding, cutting & grinding describe in Document No. 26076-110-GPP-
GHX-00037 Welding and Cutting Procedure and 26076-110-GPP-GHX-00038 Grinders 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.
Area within 10 meters 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.
1) Welding machines
- Welding sets shall be in good condition, maintained and inspected by the CONTRACTOR
as per CONTRACTOR/OWNER procedures, and to include into the CONTRACTOR Daily
Check List before start of work, and earthed. All mobile generators and welding machines
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must be equipped with a drip tray to contain any accidental leak. The daily inspection
check list shall be kept for recording purposes.
- Isolation switches for machines and equipment shall be readily accessible.
- Terminals and live components shall be adequately protected and cables shall be
frequently inspected to ensure that insulation is intact.
- The welding return cable shall be secured onto the work piece, or as near as is practically
possible
- Approved cable connectors shall be used when connecting runs of cables and cables must
not be allowed to lie in water
2) Cutting and Grinding Works
- SUBCONTRACTORs shall ensure that any of their employees authorized to change abrasive
wheels have attended the vendor approved course of training, carried out by in-house
personnel, or have been appointed in writing by their Construction Manager. This
certificate must be with the employee at all times while on site. Training will include the
following: Grades, types and marking of wheels, the use, hazards, speeds, storage,
handling, inspection, testing, dressing, adjustments, and the functions of associated
components such as flanges, bushes, locking nuts etc.
- Details of each employee trained shall be entered in an Abrasive Wheels register retained
at site by each SUBCONTRACTOR. Machines used to drive abrasive wheels shall be in good
condition, inspected daily and properly guarded.
- 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
20.16 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 26076-110-GPP-GHX-00037 Welding and Cutting Procedure and 26076-110-
GPP-GHX-00038 Grinders Procedure.
20.17 Manual and Mechanical Handling
Refer to document no. 26076-110-GPP-GHX-00030 “Manual and Mechanical Handling Procedure”
Conduct manual duties referring to the related work procedures / work instructions and pay
attention to the HSSE Aspects determined during conducting HSSE aspect identification,
assessment, and control or job safety analysis.
When manually moving materials, personnel should seek help when:
 The load is so bulky it cannot be properly grasped of lifted
 They cannot see around or over it
 Use mechanical devices/equipment when the loads are very heavy
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During manual handling, personal should be wear required PPE (appropriate gloves, eye
protection, safety shoes and safety helmet), when use lumber must have protruding nails
removed before handling and prior to handling hazardous materials, make certain that a SDS is
reviewed and understood
Conduct mechanical duties referring to each equipment Operation Manual and pay attention to
the HSSE Aspects determined during conducting HSSE aspect identification, assessment, and
control or job safety analysis.
20.18 Permit to Work
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 regarding 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 26076-110-GPP-GHX-00016 Permit To Work 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.
Any construction activity under the general or hazardous work procedure category, when
conducted under non-routine or other jeopardizing conditions, will be performed under PTW. All
project and SUBCONTRACTOR personnel will abide by the project PTW program and its affiliate
procedure. PTW-covered activities will not commence unless an accurately completed authorized
PTW is in effect. CONTRACTOR PTW system will be applied at Greenfield area. PERTAMINA’s PTW
system will be applied at existing (Brownfield) area.
The work permit system will incorporate checks and authorizations that are consistent with risk
or hazards involved.
The following points are contained in the permit system:
- The Permit to Work system contains pre-start checks to ensure that the work site is safe, that
necessary isolations are performed and verified, necessary bypasses are performed, and the
work does not present a hazard to other work in progress or planned. Those affected by the
work must be informed of the work and the possible affects upon their work, and appropriate
communication and coordination meetings are held and key decisions recorded.
- Work Permits are approved for a specific duration.
- Senior operations/construction management is responsible for ensuring an effective work
permit system and verifying that it is used correctly.
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- The type of work and work conditions that are managed with work permits are defined for
each site based on the risks involved.
- Each work permit has a description of the work to be performed and details specific
precautions to protect personnel, environment and equipment from potential hazards.
- Permit procedures require closeout checks to be performed at completion of the work to
ensure that: (a) the work was performed satisfactorily, (b) isolations and bypasses are
restored, (c) workplace and processes are returned to a safe condition, and (d) completion of
work is communicated to affected personnel.
- The authority to approve and closeout work permits is clearly designated and approved by
Head of Purification and Refinery. PTW shall be documented at each site.
- All personnel issuing or using work permits are trained in the application of the work permit
procedure.
- Work permit system and training effectiveness is audited periodically and results documented.
Work permits and records are retained to facilitate assessment.
- The JSA shall be provided in detail for each activity. The Supervisor will discuss the hazards of
the job with his/her employees while completing the JSA and determine all the appropriate
mitigations required to perform the job which will be implemented before the job is
authorized to start. Workers will use the JSA process at the commencement of each shift and
new work task.
All Construction work within live plant areas, or as dictated by OWNER, will be Subjected to
OWNER’s PTW Procedures. Ensure PTWs shall be prominently displayed at work area at all times.
20.19 Cameras (Security)
Detail of operational and deployment of CCTV camera is described on 26076-110-GPP-GHX-00025
Security Procedure.
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.
20.20 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).
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 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.
Refer to document no. 26076-110-GPP-GHX-00035“Tools Procedure”
SUBCONTRACTORs will provide and ensure that all tools are used in accordance with the
manufacturers’ recommendations, have required guards in place, and are maintained in good
working order.
All job made tools shall be Subject to inspection for approval by the CONTRACTOR HSSE Section
prior to use. A sticker after pass inspection should be implemented periodically. Generally,
handmade tools shall be prohibited on the project. All tools and equipment shall be used and
maintained in accordance with manufacturers’ recommendations. If exceptions to this rule are
needed (e.g. spreader beams), they will be brought to the OWNER attention for review and
acceptance prior to use.
20.21 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
runways over the hose or suspending the hose overhead with the lowest part of the hose at
least 2.1336 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.
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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.
20.22 Compressed Gas Cylinder
Refer to document no. 26076-110-GPP-GHX-00039 “Gas Cylinder Procedure”
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.
 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. 26076-110-GPP-GHX-00037 Welding and Cutting Procedure.
SUBCONTRACTORs will provide cradles and/or cages for lifting compressed gas cylinders and
ensure that cylinders being transported are secured and in the upright position.
SUBCONTRACTORs will ensure that cylinders are provided with protective systems to prevent
damage to valves. This may include caps or protective collars.
Safety device such as a suitable flashback arrestor or any suitable device which prevent flame
flashback should be fitted at the pressure regulatory outlet of each gas cylinder.
A suitable check valve, non-return valve or any similar device which prevents the backflow of gas
into the hose should be fitted between each gas torch inlet and gas hose.
20.23 Electrical Works
Refer to document no. 26076-110-GPP-GHX-00023 “Electrical Work Procedure” and 26076-110-
GPP-GHX-00010 HSSE Inspection Procedure.
The CONTRACTOR will implement, and SUBCONTRACTORs will fully comply with, the Government
Electrical Equipment Inspection requirements, which include quarterly color code changes and
shall use Earth Leakage Protection Devices (ELPD) or Ground Fault Circuit Interrupters (GFCI) on
all temporary electrical applications.
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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.
The CONTRACTOR or SUBCONTRACTOR will employ an Electrical Safety Supervisor (Usually
supported by Electrical Construction Section) to undertake and supervise SUBCONTRACTORs’
electrical inspections. The CONTRACTOR and SUBCONTRACTORs will maintain records of all
construction tools / equipment inspections. Colour Coding System need to be implemented for
electrical & power tools, equipment and also lifting gear as per inspection period.
The CONTRACTOR will ensure all tools are checked for electrical continuity after repairs are made.
The CONTRACTOR and SUBCONTRACTORs will ensure that personnel are isolated from electrical
distribution centers. This may include fencing and locking of transformers.
SUBCONTRACTORs will provide details in method statements prior to commencing Underground
and Overhead Electrical Installations.
CONTRACTOR will ensure that all electrical tools such as portable tools, hand tools, and other
portable electrical apparatus, meet standard safety requirement.
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 monthly 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 9. 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
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Equipment
20.24 Hot Work
Refer to document no. 26076-110-GPP-GHX-00027 “Hot Work Procedure”
Hot work refers to any task uses (or could create) a flame, spark or other energy discharge that
might in turn ignite a fire or explosion. It is normal practice to consider two types of hot work:
High energy (open flame), Lower energy (spark potential)
Hot work shall be Subject to a JSA at the planning stage and task-specific controls implemented to
ensure that:
o all combustible materials within 15,24 meters have been removed, isolated, and/or protected
from the source(s) of ignition
o where relevant, control measures are in place to keep oxygen levels and flammable vapour
within acceptable limits
o in hazardous areas, the atmosphere affected by the hot work is regularly tested by a competent
person as often as the Risk assessment requires
o Suitable fire-fighting equipment is readily available and accessible at the hot work site.
A fire watcher must be present to monitor the work area while fire and gas system are inhibited
for naked flame hot work, e.g., welding and burning. The fire watcher is responsible for ensuring
that:
o He is in possession of a radio for immediate emergency communication, or he is aware of the
location of the nearest radio point for communicating with the facility control point.
o Fire fighting equipment is available and ready for immediate use
o He is trained and able to demonstrate his competence in handling relevant fire fighting
equipment
o Flammable materials are cleared away from the work site
o Drains remain covered and sealed
o Sparks and welding spatter are contained (by the use of fire blankets, water sprays etc.)
o The alarm is raised where a fire of gas release occurs in the area
o Upon completion of the task, all relevant fire fighting equipment is returned to its appropriate
storage location.
20.25 Hazardous Material
CONTRACTOR will ensure that all Substances classified as hazardous to health, which are
transported, used or created during activities, are controlled to minimize the risk to the health
and to the environment.
o The list of Chemical and Hazardous Materials to be used shall be available including Safety Data
Sheet (SDS).
o Required PPE as mention in SDS shall be used during handling with the chemicals.
o Required equipment and tools as mention in SDS to control any accidental release of hazardous
chemicals shall be provided.
o 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).
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o It is recommended to use less harmful Substances to minimize the risk to health and to the
environment.
o Only trained personnel should handle hazardous materials using the precautionary measure
that have to be taken, as instructed in the SDS.
o Used containers of hazardous Substances/chemical will be disposed of as hazardous waste.
o 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.
o 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.
o 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:
o All chemicals containers must be labelled.
o CONTRACTORs shall ensure that adequate storage cabinets/ store rooms are available for the
proper segregation and storage of different types of hazardous Substances/ chemicals.
o Incompatible chemicals shall be stored separately.
o Hazardous Substance storage areas are to be identified with the correct signage, indicating
contents of the storage area and ‘No Smoking’ signs.
o Spill kits shall be provided where hazardous Substances are being stored or used.
o 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.
No hazardous Substances or materials shall be brought and used on the site before a suitable
COSHH assessment has been carried out by a suitably trained person. In addition to the
assessment, approval to use the hazardous Substances on site shall be sought from CONTRACTOR.
The hazards of the Substance shall be described and shall be obtained from the SDS. In
circumstances where the work involves exposure to more than one Substance hazardous to
health, the risk presented by exposure to each Substance in combination shall be assessed.
Control measures to be implemented shall be based on the principal of hierarchy of controls
where elimination is the most preferential method of prevention and personal protective
equipment shall be used as a last resort for control. Exposure shall be controlled to below the
relevant exposure limits. All control measures shall be maintained in an efficient state, in efficient
working order, in good repair and in a clean condition.
20.26 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.).
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- 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.
20.27 Site Office HSSE
Refer to document no. 26076-110-GPP-GHX-00040 “Office HSSE Procedure”
CONTRACTOR and SUBCONTRACTORs/Vendors will ensure that temporary facilities fully conform
to project fire prevention and night work standards.
20.28 Fire Prevention and Protection
Detail of fire prevention and protection is described on 26076-110-GPP-GHX-00008 “Fire
Prevention and Protection Procedure”.
 All accidental fire on CONTRACTOR property, no matter how small, must be reported
immediately to the HSSE 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.
1) Fire Prevention and Protection Plan
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This will include all areas of the construction site and temporary facilities. CONTRACTOR will
include plans to ensure that fire protection equipment is placed and maintained in proper
location as work progress.
Prevention of fire is a goal. Identification of potential fire hazards and prevention and
protection will be an important factor in the job HSSE analysis performs for each specific
activity.
Fire prevention and fighting training will emphasize planning work in such a way that
potential fire hazards are removed or reduced to the greatest extent possible. Particular
emphasis will be on hot work permits, control of flammable gas, liquids and other material,
proper electrical wiring, and proper removal and storage of waste materials.
Refueling of mobile equipment and vehicles whilst running is prohibited.
The use of gasoline powered equipment such as dewatering pumps, concrete vibrators,
temporary lights is restricted and Subject to CONTRACTOR/OWNER approval prior to use.
Where temporary welding enclosures are required to prevent sparks flying or falling,
CONTRACTOR and SUBCONTRACTORs/vendors will ensure that these enclosures are
constructed with flame resistant materials (such as fire blanket)
CONTRACTOR will establish a smoking Policy for the Project as OWNER requirements. This
shall restrict smoking to designated areas.
Office areas shall be monitored to reduce and control storage of combustible materials.
CONTRACTOR and SUBCONTRACTOR’s/vendors personnel whose work tasks are in the
vicinity of fire cabinets and equipment, fire hydrants, and fire lanes shall keep them clear
and unobstructed.
CONTRACTOR and SUBCONTRACTORs/vendors will ensure that all combustible waste
containers are emptied regularly, equipment, tables, and floors are free from oil or oily rags
and oily rag containers are kept covered and emptied regularly. Janitor/storage closet shall
be maintained in an orderly condition and shall not be used to store quantities of hazardous
or toxic chemicals. Electrical, mechanical, and telegraphic rooms shall be kept in order and
free of combustible storage materials. Cable tray and raceways shall be free of combustible
material, debris, or trash.
2) Equipment
CONTRACTOR and SUBCONTRACTORs/vendors will ensure the provision of all fire protection
and prevention equipment necessary for their operations.
Each SUBCONTRACTOR/vendor will provide an adequate number of fire extinguishers of the
correct size and type for its work activities. Extinguishers shall be maintained per
manufactures recommendations, inspected monthly, and tasted annually.
Employees will be trained in the proper use of fire extinguisher.
The frames of arc-welding and cutting machines that incorporate a power outlet will be
adequately grounding.
20.28.1 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
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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 15,24 meters 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 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.
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20.28.2 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 m with approved design. It is recommended to provide
roof for the smoking shelter.
 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.
20.28.3 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.
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 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.
 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.
20.28.4 Fire Extinguisher and Fire Watcher

 Fire extinguisher shall be inspected every month by HSSE.

 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 9 kg. 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.
20.29 Traffic Safety
Refer to document no. 26076-110-GPP-GHX-00015 “Traffic Safety Rules Procedure”
This document covers Road Safety Policy as well.
A driver or operator of vehicles including passenger car, or mobile equipment entering of working
at EPC Lawe-Lawe Facilities Project, RDMP RU V project site shall obey this traffic rules and the
specific OWNER’s rules. At public roads, the local traffic law and regulations shall be observed. All
drivers/car holder, passenger, shall follow the 7 Golden Rules for Safe Driving. Driver will adjust
their speed to the specific road conditions (climate, traffic conditions, etc.) in order to drive safely.
Any deviation from the established minimum safety standards or procedures for drivers and
vehicles must be properly risk assessed and suitable measures put in place to reduce the risk to
“As Low As Reasonable Practicable”.
PERTAMINA 12 life saving Rules for Save Driving shall be adhered to at all times by all drivers and
passenger.
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Journey Management Plan consist of all work necessary to provide turn the safe transportation
on the hazof personnel and materials between workshop and site, material and/or
lamp)"equipment transportation between harbor and site, including material and/or equipment
loading and offloading, movement of vehicle and protection of person and property at harbor as
well as construction sites.
20.30 Blasting and Painting
Refer to document no. 26076-110-GPP-GHX-00029 “Abrasive Air Blasting Cleaning and Painting”
Abrasive air blasting means propelling a stream of abrasive material at high speed against a
surface using compressed air to clean, abrade, etc. or otherwise change the original appearance
or condition of the surface.
Abrasive blasting operations can generate a variety of hazards to those directly involved, persons
in the vicinity and to the environment. Common hazards include dusts, hazardous chemicals and
risks associated with the use of plant and equipment.
Persons performing blasting works shall wear air supplied blasting helmets, blasting suits (heavy
canvas or leather), overall with hoods, gauntlet type leather gloves, safety boots, goggles, leather
aprons and hearing protection devices. Blasting helmets shall be positive air pressure type and
shall be rigged and used in accordance to the manufacturer’s recommendations.
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.
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.
In this context, painting refers to spray painting. Spray painting is a process by which a liquid
coating of paint is converted into a mist of aerosol and applied onto an object or surface. The
Subsequent identify the minimum controls that need to be implemented to mitigate the hazards
inherent to spray painting operations which include:
 Exposure to hazardous Substances contained in the paint
 Fire and explosion
 Noise and
 Manual handling
Persons performing spray painting operations shall be provided and are required to wear airline
respirators of the right type or half face particulate respirators, safety glasses for eye protection,
hearing protectors, hand gloves, overalls and loose fitting hoods. Painters shall be trained on the
correct use, fitting and maintenance of PPE.
20.31 Marine Safety
Working in an offshore facility is known as one of the high-risk jobs. Potential hazards include
when traveling from / to facilities (helicopter crashes, vessel collisions, fires, natural conditions,
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etc.) and when working at facilities (gas escapes / explosions, mechanical / structural failures,
natural conditions, etc.). The offshore activities covering survey activities, pipe laying, installation
of SPM / PLEM, piling, landfall, accommodation, transport, training requirements etc. There are
three hazards in the sea (offshore) that can threaten human lives, namely:
 Drowning
 Exposure to natural elements
 Exposed back to the initial hazard
Any boat or small craft used to convey a person to and from a place of work must provide for his
safe transport and be suitably constructed, properly maintained and in the charge of a competent
person. Sea survival training for offshore workers are mandatory. Competent persons properly
qualified and experienced in their respective duties for safe and reliable BARGE operation shall
man the BARGE. The minimum qualification and experience standards for all crew members shall
be those set by the Marine Department of the BARGE’S flag state.
If there is any risk of persons falling into water and drowning, suitable steps should be taken to
prevent falling, and to ensure that suitable rescue equipment is provided
Where there is a risk of falling from an edge of adjacent land, a structure, scaffolding or a floating
stage, etc. guardrails or fencing must be provided. These can be removed temporarily for the
movement of materials but must be replaced promptly Safety nets can be used where it is not
possible to provide a proper scaffold or gangway with handrails and toe boards, provided that
everything practicable has been done in respect of providing a suitable platform
Full body safety harnesses with double lanyards can be used instead of nets provided that secure
anchorage points exist and the harness is constantly worn and attached.
Irrespective of the type of platforms or safety nets a full-body safety harness with double lanyards
must always be worn while working over, or adjacent to, water.
Although every effort should be made to prevent people falling into water, the risk of this
happening remains. In the event of a casualty, two things are of paramount importance:
 The person must be kept afloat
 Location and rescue must be achieved as quickly as possible
Regular practice drills so that the best method of rescuing, securing and landing a potential
casualty is known in advance.
All personnel working over or near water must wear some form of lifejacket or buoyancy aid. Both
are designed to keep the wearer afloat, there are, however, some important differences.
Buoyancy Aids are intended to provide a conscious person with enough extra buoyancy to stay
afloat. Lifejackets are designed to support an unconscious person face upwards, either by built-in
buoyancy or when fully inflated. Inflation may be by mouth or CO2 cartridge, activated manually
or automatically.
Where safety harnesses are worn in addition to floatation equipment, it is important to ensure
that each of these items functions effectively and will not interfere with the other.
Lifebuoys must be available wherever people are working on, over, or near water Standard 760
mm diameter lifebuoys with rope or cord lifelines (usually 30 meter) attached should be placed in
conspicuous positions near the water’s edge.
All diving operations shall follow PERTAMINA RU-V Permit as stipulated in TKO Under Water
Permit.
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The minimum requirement for the diver is shall have certificate of SCUBA Diver or Open Water
Diver which issued by LEMIGAS / IMCA / ADCI.
The minimum requirement for the standby diver is shall have certificate of Rescue Diver which
issued by LEMIGAS/IMCA/ADCI.
All employees who are assigned as divers or may be exposed to hyperbaric conditions shall have
successfully completed a physical examination and valid medical record by a licensed physician
prior to any diving or exposures.
20.32 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 HSSE and other required discipline.
Where there are major interfaces between CONTRACTOR, SUBCONTRACTORs 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, HSSE,
Permit Coordinator and Project control teams.
 Meeting to coordinate and prioritize simultaneous activities.
20.33 Site Office, Stores, Workshops, Living Accommodation 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.
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 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.
20.33.1 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
20.33.2 Living Accommodation
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.
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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.
20.33.3 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 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.
20.33.4 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.

21.0 COMPENTECES, AWARENESS AND TRAINING

CONTRACTOR will provide Training Coordinators to administer all training requirement of
CONTRACTOR’s and SUBCONTRACTOR’s personnel.
Refer to 26076-110-GPP-GHX-00043 HSSE Competence, Awareness and Training Procedure. There
are 38 topics of HSSE Trainings and will be delivered at project site regularly.
21.1 HSSE Training Requirements
Following are HSSE 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.HSSE 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.
 CONTRACTOR must Submit the HSSE 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.
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21.2 Competency
CONTRACTOR develop HSSE Training Matrix based on required HSSE competencies for each Job
Task at project site. Refer to Attachment 2. HSSE Training Matrix for the detail.
To increase personnel awareness on working safely, Construction Manager with HSSE 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.
21.3 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.
21.4 Training Provider
 Since CONTRACTOR will have activities at brownfield area, Owner will conduct in house training
for transfer knowledge of HSSE system and requirements to CONTRACTOR.
 CONTRACTOR have responsibilities to deliver required HSSE Training at project site.
21.5 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 IPMT (PMC and Pertamina RDMP RU V).
21.6 CONTRACTOR Internal Trainer
CONTRACTOR shall provide qualified trainers.
 All CONTRACTOR’s HSSE Trainer must Certified as Training of Trainer (TOT).
 CONTRACTOR will hire certified person to be assigned as HSSE Trainer for the special
skills/competencies required training. i.e. Rigger, Crane Operator, Scaffolder refreshment
training.
CONTRACTORs will provide HSSE Training centre to facilitate in house (at site) HSSE Training. This
training centre will be located at CONTRACTOR’s temporary office and have capacity for 50
participants/trainee.
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21.7 Site Specific Orientation Programs

 HSE Orientation Training (HSE Induction) and Safety Leader and Awareness which equivalent
with 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 HSSE will provide a project specific orientation (HSSE Induction) to all
CONTRACTOR, SUBCONTRACTOR personnel, including visitors and vendors. The content of
orientation should describe some items below but not limited to:
- Project HSSE Policy.
- Project Prohibition of Alcoholic Drink, Drugs, and Carry Weapon Policy.
- Project Top Management HSSE Commitment.
- Project HSSE Golden Rules.
- HSSE Rules and Requirements.
- HSSE 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 HSSE matter delivered in the training and will give
their commitment to follow the HSSE requirements. Trainee should pass the post-test
assessment to ensure that trainee understood.
 Training participants who pass the assessment will be given with RDMP CPPHK 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 HSSE induction and matrix training based on work position.
21.8 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 HSSE 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.
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 Project HSSE 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 HSSE 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.

22.0 COMMUNICATION
Refer to document no. 26076-110-GPP-GHX-00005 “HSSE Communications Procedure”
22.1 Languages
It is CONTRACTOR policy that the major HSSE-related project publications, bulletins and general
communication notices will be printed in both English and the language of the base country. In
addition, for verbal communication purposes, an adequate number of bilingual (English and
Bahasa Indonesia) staff will be employed in the work area to facilitate communication between
the work force, CONTRACTOR, SUBCONTRACTORs/vendors and OWNER.
All HSSE Training and education for the local workforce, including training material and booklets,
will be languages understood by the workers. All multi-national meetings will be facilitated by an
interpreter(s) and the record of minutes will be produced in bilingual (English-Bahasa Indonesia)
format as necessary.
CONTRACTOR will produce a multilingual HSSE handbook for participants who successfully
complete the project HSSE orientation course.
22.2 Communication Mediums
CONTRACTOR recognizes that HSSE objectives can be achieved with effective communication.
CONTRACTOR will utilize numerous mediums to educate, raise HSSE awareness, motivate and
stimulate participation. There may include all or some of the following:
 HSSE Training
 Bulletins and posters
 Sign boards and banners
 HSSE handbook
 HSSE committees
 HSSE awareness campaign
 Toolbox meeting/STARRT
 Submission of reports
 Others
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22.3 Meetings
a) CONTRACTOR-business partners kick off meeting
Kick off meeting of CONTRACTOR and business partners (OWNER / SUBCONTRACTORs /
priority vendors) is intended to ensure that business partners clearly understand the Project
HSSE requirements. It shall be conducted prior to start work, lead by relevant leads and
attended by related Sub-organization representatives
b) JSA Meeting
JSA meeting is a meeting for each construction job such as: heavy lift rigging, steel erection,
high elevation work, confined space work, hot work and any other works that need work
permit. This meeting shall be conducted by each group of SUBCONTRACTOR, lead by their
group leaders and attended by their group members to discuss HSSE aspect of the job. Job
sequences, accident prevention plan and safe work methods shall discuss in this meeting.
Each JSA group should not be more than 20 members in order to make effective two ways
communication and should not be more than 20 minutes. JSA records shall be prepared,
effectively used during the meeting, and field accordingly. Attendants’ list/equivalent shall
be maintained.
In accordance with Risk Assessment process, the high risk job may require the JSA meeting
as OWNER’s request.
c) Daily Group Toolbox Meeting
Daily Group TBM is a meeting for each SUBCONTRACTOR discussing hot issue specific to the
SUBCONTRACTOR or planned Subjects. This TBM shall be conducted by each
SUBCONTRACTOR, lead by their Site Manager/Equivalent and attended by all of their
members before starting their work on the day. Speakers of the TBM should be scheduled in
turn representing all disciplines and TBM reports & attendants’ list/equivalent shall be
maintained.
d) Weekly General Toolbox Meeting (General TBM)
Weekly General TBM is a meeting for all CONTRACTORs, SUBCONTRACTORs and other related
site parties members discussing hot issue specific to the project or planned Subjects. This
TBM shall be conducted by CONTRACTOR, lead by CONTRACTOR Site Manager/Equivalent
and attended by all site members on a scheduled day. Speakers of the TBM should be
scheduled by the Construction Manager (assisted by CONTRACTOR HSSE Manager) in turn
representing all disciplines (of CONTRACTORs, SUBCONTRACTORs, related parties) and TBM
reports & attendants list / equivalent shall be maintained by CONTRACTOR HSSE Manager.
The end of Week in every Month will become The General Monthly Toolbox Meetings with
OWNER’s involvement and the opportunity to held HSSE awards.
e) Weekly HSSE Coordination Meeting
Weekly HSSE coordination meeting is a meeting for all HSSE representatives of CONTRACTOR,
SUBCONTRACTORs and related parties discussing gaps between HSSE Lagging & Leading KPI
versus project requirements and its implementation. This meeting shall be conducted by
CONTRACTOR, lead by HSSE Manager/Equivalent and attended by CONTRACTOR and
SUBCONTRACTOR HSSE & Management representatives refer on a scheduled day. MOM and
attendants list of the meeting shall be maintained by CONTRACTOR HSSE Manager.
f) Monthly HSSE Coordination Meeting
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Monthly HSSE Coordination meeting is a meeting for all discipline representatives of

CONTRACTOR, SUBCONTRACTORs, OWNER and related parties discussing:
- Results from internal audits and evaluations of compliance with legal and other
requirements
- The results of participation and consultation
- Relevant communication from external parties, including complaints
- The HSSE performance of the CONTRACTOR’s organization
- The extent to which the objectives have been met
- The status of incident investigations, corrective and preventive actions
- Follow-up actions from previous management reviews
- Changing circumstances, including developments in legal and other requirements related
to HSSE
- Recommendations for improvement
This meeting shall be conducted by CONTRACTOR, lead by Construction Manager/Equivalent and
attended by CONTRACTOR, SUBCONTRACTOR, OWNER (optional) and related party discipline
representatives on an agreed schedule. MOM and attendants list of the meeting shall be
maintained by CONTRACTOR HSSE Manager/Relevant.
22.4 Records and Reports
a) HSSE Daily report
- Data is supplied by SUBCONTRACTORs’ HSSE Personnel
- Prepared by CONTRACTOR HSSE Manager
- Combined in the Project Daily Report
- Distributed to all Disciplines’ Representatives
b) HSSE Weekly report
- SUBCONTRACTORs’ HSSE Weekly Reports is prepared by its SUBCONTRACTOR’s HSSE
Personnel
- Project HSSE Weekly Report is prepared by CONTRACTOR HSSE Manager
- Distributed to all Disciplines’ Representatives
c) HSSE Monthly report
- Data is sourced from HSSE Weekly Report
- Prepared by CONTRACTOR HSSE Manager
- Distributed to all Disciplines’ Representatives, CONTRACTOR Corporate HSSE
Department and Management, and OWNER Representative(s)
The HSSE report will address HSSE progress, incidents, issues requiring attention, look ahead
items, and status for the period of agreed Leading Indicators and Key Performance Indicators
(KPI’s).
Minutes of meetings will be prepared by nominated personnel and given wide distribution.
HSSE records will be retained either by CONTRACTOR HSSE Manager or by individual
SUBCONTRACTORs/vendors or both.

TYPE RETENTION PERIOD

Training Job duration
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Accident/incident/near miss Indefinitely

Permits to work 4 weeks after close-out. In case of incident
retain indefinitely
Construction equipment inspection Site life equipment
HSSE Inspections and audits Job duration
Minutes of meetings Job duration
First Aid register Indefinitely
Table 10. Records and Reports Retentions Periode

All Project HSSE records shall be archived in accordance with OWNER’s Safety and Health
procedures. The CONTRACTOR HSSE Manager shall insure that records to be maintained
throughout project life, training records, inspection reports, testing records, etc.

23.0 STOP WORK AUTHORITY (SWA)

The SWA should be initiated for conditions or behaviors 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.
 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.
24.0 EMERGENCIES AND EVACUATION
The site ERP will be in accordance with document 26076-110-GPP-GHX-00006 Emergency
Response Procedure.
In the event of emergency, Construction Manager will be the person in charge from the
CONTRACTOR site.
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:
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 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.
24.1 Emergency Response Plan
Refer to document no. 26076-110-GPP-GHX-00006 “Emergency Response Procedure”
CONTRACTOR’s “Emergency Response Procedure”, will be developed prior to start of
construction activities. This Procedure will be closely aligned with OWNER Emergency Response
Procedure.
CONTRACTOR and SUBCONTRACTORs will provide sufficient trained personnel as Emergency
Response Team (ERT), emergency equipment and supplies to support the work at each work
location.
The plan will address emergency evacuation, medical emergencies, civil unrest, natural disasters,
etc. The plan will include emergency alarm system, assembly and evacuation points, an employee
head count process, and provisions for employee training before entering the Jobsite as a part of
Safety Induction Training course. Drills will be conducted at minimum of once a year or for cause.
CONTRACTOR will also develop a procedure for adverse weather conditions, including lightning
and typhoons, and specify other occasions when work will be suspended due to adverse weather
conditions.
Although every effort should be made to prevent people falling into water, the risk of this
happening remains. In the event of a casualty, two things are of paramount importance:
- The person must be kept afloat
- Location and rescue must be achieved as quickly as possible
In case of man over board, the witness and/or watchman must make attempt of prompt actions
for rescue operations as referred to Emergency Response Procedure 26076-110-GPP-GHX-00006
24.2 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.
Emergency Response Plan provided by CONTRACTOR shall cover all area within scope/boundary
of RDMP Lawe-Lawe RU-V Project.
24.3 Emergency Siren
Below table describe emergency siren tones which informed the emergency situation.
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Table 11. Emergency Siren Tones

No. Condition Siren Remarks

3 min
1 Incident occurred 3 minutes wavy siren

6 min 6 minutes repetitive siren

2 Evacuation
(Hi low tone)

Safe / normal
3 1 minute Continuous siren
condition

24.4 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.
24.5 Equipment
Emergency equipment will be inspected at regular frequencies as determined by the inspection
program. Records of inspections will be retained by CONTRACTOR HSSE Section. All marine and
heavy equipment certification are required as per MIGAS standard.
24.6 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 is one muster point when an emergency occurs in the Lawe-Lawe area that is Gate 3.
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 HSSE Notice board located at site
and office area. For HSSE Notice Board reference to standard drawing No.: xxxx.
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Figur 5. Distribusi muster point and Assemble Point

25.0 SECURITY
Refer to document no. 26076-110-GPP-GHX-00025 “Site Security Procedure”
25.1 Security Control Areas
- Security control within SUBCONTRACTORs assigned areas and temporary lay-down facilities
etc. shall be the sole responsibility of each SUBCONTRACTOR.
- Security personnel engaged outside the OWNER Plant by the CONTRACTOR will only be
responsible for site office guardhouse/gate control and security in areas not assigned to
individual SUBCONTRACTORs. However, the CONTRACTOR security reserves the right to
enter/check construction CONTRACTOR’s assigned areas at any time, particularly during
routine site security patrols.
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- Plant gate will be manned by the OWNER security

25.2 Site Entry
- Those persons who are continuously engaged in construction activities will be issued with a
site I.D. badge by the CONTRACTOR/OWNER Security department on successful completion of
the HSSE Induction Training Course. On entering site all personnel must show their project I.D.
badge and all necessary training and documentations when upon request to the gate security
guard in order to gain access to the facility and again at the construction area temporary fence
access.
- Visitors to site will be issued with a temporary visitors I.D. badge by CONTRACTOR following
application by their host, approval by the CONTRACTOR Representative. The temporary I.D.
badge will only be issued in exchange for an official identification document e.g. passport,
driving license, National I.D. card.
- Delivery persons/vehicles will be issued with temporary visitors I.D. badges on production of
valid delivery documents and provided that the vehicle is in good condition. The driver must
hand over an official identification document in exchange for a temporary I.D. badge which will
be returned on leaving site.
- Visitors shall always and all the time while on site be accompanied by a permanent ID badge
holder. Visitors are not allowed to free roaming on the construction site as they may not have
obtained all the required training and detailed inductions
25.3 Security Personnel Duties
Prior assignment to brownfield areas, all CONTRACTOR personnel will need to be
screen/interview by OWNER head of security. Duties will include, but not limited to:
- Prevent unauthorized entry of persons and vehicles to site.
- Issue/check security passes.
- Conduct searches.
- Prohibit illegal/unlawful activities.
- Check/monitor material movements in and out of site.
- Ensure correct documentation for the movement of hazardous materials.
- Conduct routine and “spot” security patrols.
- Check security of site boundary fences.
- Control gates, locks and keys.
- Assist police, customs and other government bodies.
- Assist with the coordination of Emergency Response Procedures including practice and
evacuation drills.
- Assist medical personnel in case of accident /emergency.
- Prevent unauthorized access to scenes of accidents until instructed by CONTRACTOR Site
Manager.
- Enforce site traffic/parking regulations and inspect drivers’ and vehicle documents.
- Report/investigate/follow-up security infringements
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25.4 Material Exit

Material exit pass – OWNER or CONTRACTOR provided forms shall be used and requires the
approval from OWNER or CONTRACTOR authorized signatories. Records of CONTRACTOR copies
shall be kept by CONTRACTOR. Any waste or excavated material that requires be disposing or
delivering outside OWNER requires to be witnessed by OWNER security prior to on load these
materials.
This entire section needs to be discussed with OWNER before finalized in this procedure. It makes
no sense in it's present form. CONTRATOR shall control all in/out of Gate 3 and Gate 3A. There's
designated dump sites/disposal areas where CONTRACTOR shall dispose of certain types of
surplus materials

26.0 ENVIRONMENT
Environmental Management refer to 26071-100-G01-GHX-000014 Environmental Control
Procedure.
CONTRACTOR shall provide Environmental Monitoring programs and measurements in
accordance with Environmental Impact Analysis (EIA (AMDAL)) 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:
o Comply with all applicable environmental laws, regulations, rules, and codes governing
environmental requirements.
o 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:
o Wastewater discharges to land, surface water, or groundwater,
o Spill prevention and response
o Erosion and sedimentation control
o Dust Control
o Noise control
o Waste & hazardous waste management
o Comply with EIA (AMDAL), Environmental Management Plan (RKL) & Environmental
Monitoring Plan (RPL).
26.1 General Environmental Requirement
The project shall be constructed and commissioned in accordance with the following:
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All applicable legal requirements, regulatory constraints and recommendations for

environmental protection specified by local laws (i.e. National Regulations, Provincial Regulations
and local standards) shall be complied with;
- All HSSE standards generally accepted in the petrochemical/oil and gas industry
- The reduction of hazards and adverse environmental impacts to a level “As Low As
Reasonably Practicable” (ALARP)
- The use of the “precautionary principle” in applying strict standards wherever feasible, where
existing conditions are likely to be close to natural levels, and where impacts on a sensitive
environment are not fully understood;
- No Halon, CFCs, PCBs or asbestos shall be used on the project for any purpose.
26.2 Environmental Control
Refer to document no. 26076-110-GPP-GHX-00014 “Environmental Control Procedure” and
document no. 26076-100-GPP-GHX-00032 “Waste Control Procedure”
26.2.1 Environmental Standards
To protect the quality of environment during construction period, the CONTRACTOR shall
refer to RI – Law No. 32 Year 2009 on Protection and Management of Life Environment
and all associated applicable laws and regulations.
26.2.2 Environmental Hazard Mitigations
All works shall be thoroughly planned such that all possible hazards to the environment
can be identified and furthermore the risk associated with the hazards can be managed
not to endanger life thereby.
26.2.3 Spill and Waste Management
Spill and or waste material shall be controlled thoroughly so as to not cause damage to
environment nor to endanger life thereby, following to guidelines set forth below:
- Report any spillage damaging or having the potential damage to the environment
- Material shall be identified into its classification, as hazardous or non-hazardous
Substance.
- Removal and disposal of all non-biodegradable waste used during the construction
work or recycle them at local facility if exists.
- Hazardous waste shall be treated and handled following to applicable laws and
regulations, under supervision of the qualified personnel specific to the type of
material.
o Hazardous waste shall be identified into below classification:
o Ignition waste (oil soaked, alcohol, etc.)
o Corrosive material (acid, alkali, etc.)
o Reactive materials (cyanide, sulfide, etc.)
o Toxic/Harmful Substance (organic solvent, etc.)
o Radioactive (alpha/beta particles, gamma or X- rays).
o Biohazards (etiologic materials, used injectors, carcinogenic, etc.).
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- Sewage system shall be designed adequate to handle the sanitary waste of all project
personnel, with treatment facility according to the regulations.
- Regular inspection shall be conducted to ensure that waste management has been
done appropriately and not to cause any damage nor hazards to environment in the
area including it downstream up to the reasonable extent.
26.2.4 Hazardous Waste Management
Hazardous waste generated on site which meet the hazardous waste criteria are as follow:
o Flammable
o Combustible
o Reactive
o Toxic
o Infectious
o Corrosive
o Poisonous
CONTRACTOR shall ensure following requirements are implemented to manage waste of
hazardous chemical:
o Symbol and label shall be affixed on the hazardous chemical waste containers.
o The condition of the hazardous waste container/drum shall be inspected on a daily
basis.
o Containers intended for hazardous waste disposal should not be used for other
purpose.
o The waste should be kept at a proper temporary hazardous waste storage not more
than 90 days.
o The hazardous waste temporary storage should be provided with license/permit from
authorized body.
o CONTRACTOR will provide third-party (who have license) to handle medical/clinic
waste.
o 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.
o Hazardous waste temporary storage shall comply with applied regulation and shall be
equipped with Fire extinguisher, PPE and spill kit equipment.
o CONTRACTOR shall provide Safety Data Sheet (SDS) for all waste of hazardous
chemicals.
o CONTRACTOR will conduct basic waste management training periodically; this training
must be followed by personal who involved with waste of hazardous chemicals.
o 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.
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26.2.5 AMDAL
- Environmental Impact Analysis (in Indonesia, known as AMDAL) is a study of the major
and significant impacts of a business and / or planned activity on the environment
required for the decision-making process regarding conducting business and / or
activities in Indonesia.
- CONTRACTOR shall provide Environmental Monitoring programs and measurements
in accordance with Environmental Impact Analysis (EIA (AMDAL)) 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.
- Provide and maintain effective planning and field control measures for Comply with
EIA (AMDAL), Environmental Management Plan (RKL) & Environmental Monitoring
Plan (RPL).
- Environmental management issues shall be raised in the management review meeting
in finding the best solutions to address the problems. The achievement construction
environmental management performance also is associated with waste management
and it should be discussed through the Management Review Meeting to ensure all the
targets can be achieved
- All documented information of environmental management will be recorded and
tracked by CONTRACTOR and reported periodically to OWNER as required, includes
documentation of EIA (AMDAL) Monitoring as RKL / RPL report, every 6-monthly
- Air and water quality monitoring as the consequence of project activities include
waste management activities on site will be conducted at least every three (3) months.
Monitoring of hazardous waste balance in the temporary storage and reporting to the
project management include reporting to local government shall be conducted every
month

27.0 PERFORMANCE EVALUATION

27.1 Audits
CONTRACTOR shall conduct Audit programs to ensure HSSE system are in place and effective. The
audit programs are defined as follows:
27.1.1 Quarterly HSSE Joint Audits by CONTRACTOR and Owner
HSSE audits are part of the assurance program across the project, and shall be determined
by a risk-based process towards the areas and topics to be audited. The program should
follow the project phase, key activities on site, and the higher risk tasks being performed.
Involving both CONTRACTOR and Owner senior management and HSSE team will be
participated in the audit and continued with HSSE management system review, its
effectiveness and suitability in:
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 Managing HSSE risk

 Ensuring efforts to continually improve HSSE performance
 Ensuring its continuing suitability and effectiveness
27.1.2 External Audits
The independent third party appointed by CONTRACTOR scheduled yearly to evaluate the
implementation in the project. HSSE Audits are conducted to get information on how HSSE
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.
27.2 Inspections
Coordinated by CONTRACTOR HSSE Chief, these inspections maybe conducted with assistance
from the Project Management team, Site Management team, Project HSSE Committee team, etc.
27.2.1 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.
27.2.2 Daily / Routine Assessment
Performed by HSSE 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
CONTRACTOR Construction Manager has responsibility to ensure the audit attend by:
 CONTRACTOR & SUBCONTRACTOR related discipline (refer the further topic and
schedule).
 CONTRACTOR & SUBCONTRACTOR HSSE.
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 HSSE Performance.
27.2.3 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:
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 OWNER Construction Manager

 CONTRACTOR and SUBCONTRACTOR Construction Manager
 CONTRACTOR and SUBCONTRACTOR Superintendent / Work Leader
 CONTRACTOR and SUBCONTRACTOR HSSE 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).
27.2.4 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 HSSE Manager will issue the report to Company as required.
27.3 Incentives and Consequences
27.3.1 HSSE Incentive Programs
These programs will be expected to increase employee participation and they will be more
aware with HSSE issues in their working environment.
HSSE incentive programs will be rewarded to the following criteria:
 Displaying good/improvement initiative on HSSE manner.
 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 behaviors.
 Exceptional participation in HSSE programs, PEKA, in terms of quantity and quality.
The detail of HSSE Incentive Programs described in 26076-110-GPP-GHX-00011 HSSE
Award and Incentive Procedure.
27.3.2 HSSE 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 HSSE 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 HSSE Manager or Chief HSSE.
 SUB-CONTRACTOR’s Construction Manager.
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 SUB-CONTRACTOR’s HSSE 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:
Table 12. Disciplinary Action to be Taken up to The Penalty Points

Accumulated points Disciplinary actions to be taken

1 Point Verbal warnings are given to the offenders by Chief HSSE

/Officer.
2 – 5 Points Written warnings and re-trainings are given to the offenders by
Chief HSSE /Officer. The training contains are specific
requirements related to that they had failed to comply with.
> 5 Points A consequence management committee meeting convenes to
determine disciplinary actions such as follows, but not limited to;
▪ Removal from project or
▪ Termination of employment or
▪ Temporary suspension of work or
▪ Temporary transfer to office work.

The detail of HSSE Consequence Programs described in 26076-110-GPP-GHX-00011 HSSE Discipline,

Award and Incentive Procedure.

28.0 REPORTING/INVESTIGATING OF INCIDENT AND ACCIDENT

Incident, accident and near-miss which involved to all personnel of CONTRACTOR and SUB-
CONTRACTOR shall be reported, investigated and analyzed 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 HSSE 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.
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The site Incident reporting will be in accordance with document 26076-110-GPP-GHX-00009

Incident Report and Investigation Procedure
Incidents are unplanned events or chain of events that have, or could have, resulted in injury or
illness or damage to assets, the environment or company reputation. This section describes the
process of determining if an incident is work related and then goes on to describe the various
types of impact resulting from incidents.
All personnel including SUBCONTRACTORs working on the Lawe-Lawe Terminal Facilities RDMP
RU-V Balikpapan project shall report all accidents / incidents, either verbally or via Radio channel,
to the Site Manager, Construction Manager, and HSSE Manager immediately. Formal reporting,
shall be done within 24 hours or by the end of the work shift whichever comes earlier.
The HSSE Manager shall then verbally report the incident to the OWNER HSSE Representative as
soon as it is made known to him.
In the event of serious incidents, the Emergency Response Team (ERT) from existing facilities shall
be mobilized (as requested by OWNER Representative) to assist in the rescue and recovery efforts.
HSSE Manager shall notify Construction Manager and Contraction Manager formally notifies
OWNER Representative of all incidents on site by way of a simple email within eight hours of its
occurrence.
Investigation of accidents / incidents is a line responsibility. All investigations shall be led or
sponsored by a line manager or supervisor. HSSE representatives and other specialists shall be
employed in a support or facilitating role.
Incidents occurring during activities by SUBCONTRACTORs controlled by CONTRACTOR shall be
investigated by the relevant SUBCONTRACTOR, supported by CONTRACTOR HSSE and other
specialist advisers.
The incident investigation report Submitted by the SUBCONTRACTOR shall be reviewed and
agreed by CONTRACTOR site management.
The HSSE Manager shall facilitate all in depth investigations using the Root cause Analysis
Investigation into accidents / incidents shall be carried out as soon as possible after an incident as
the quality of evidence will deteriorate rapidly with time. The investigation shall include the
following activities:
• Conducting interviews
• Inspecting the location and gathering physical evidence
• Collecting background information.
• Fact finding
• Reviewing records and procedures
• Conducting specialist studies
• Resolving conflicts in evidence
Competency in accident / incident investigation is a key requirement in ensuring that line
management is able to conduct accident / incident investigations effectively. Therefore, all line
management representatives including field supervisors of the Lawe-Lawe Terminal Facilities
RDMP RU-V Balikpapan project shall be progressively trained in accident and incident techniques
as stipulated in The Training Plan.
It shall be the responsibility of the investigation team leader to present the investigation findings,
analysis and action plan in a formal investigation report. The incident report shall be reviewed at
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the appropriate management level as a check on the completeness and quality of the investigation
and to obtain agreement to the proposed actions.
All corrective actions listed in the incident investigation report shall be closed in a timely manner.
The report shall remain in the ‘open status’ until it is closed. A corrective action tracking register
shall be established to track the closure of all action items and issues that remains in the ‘open
status’ shall be Subjected to discussion and resolution in the Site HSSE Committee Meeting.
A copy of the investigation report shall be forwarded to the OWNER and a copy sent to the
CONTRACTOR Home Office.
The HSSE Manager shall maintain a log of all incidents on the project in an up to date manner.
Incidents shall be updated into the Incident/accident log.
In addition, all investigation reports including witness statements shall be maintained by the HSSE
Manager till the completion of the project.

29.0 SUBCONTRACTOR MANAGEMENT

29.1 Pre-approved SUBCONs
Potential candidates are informed of the Project HSSE requirements and invited to Submit the
following information for evaluation during the ITB stage:
a) HSSE Organization
b) Their own HSSE program which shall dovetail with this HSSE Plan
c) Availability and qualification of HSSE and other Key Personnel
d) Past HSSE records and commitment to promote and maintain their HSSE program
e) The quality, condition and availability of equipment and tools.
Note: Detailed HSSE requirements for SUBCONTRACTORs are included in each contract inquiry
package.
Based on these and other externally obtained information, final decisions on SUBCONTRACTOR
selection will be determined.
29.2 CSMS Process Flow

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 HSSE 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 6. CSMS Process Flow.
2. CONTRACTOR shall 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.
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3. SUBCONTRACTORs shall responsible to Health, Safety, Security, and Environmental

performance within the project site area as appropriate to their relevant scope of work.
4. SUBCONTRACTOR shall meet the requirements of CONTRACTOR that contained in document
RDMP-SHRP000-S0-PRC-900-00039 HSSE Minimum Requirement document. This document
covers all requirements that shall be met in carrying out RDMP project.
5. SUBCONTRACTOR shall conduct HSSE workshop to present their HSSE management plan
including but not limited to man power plan (shall fulfil the requirements of 1 HSSE
Coordinator + HSSE 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 HSSE 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 HSSE
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 HSSE, audit results in the form of Key Performance Indicator (KPI) HSSE
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.
10. 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 HSSE Key Performance Indicator (KPI).
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CSMS Process Flow

START

Prepare Questionnaire & Sent to Vendor

Management

By HSE

Preparation
Completed
Distribute to Subcontractor / Fabricator /
CSMS in 25
Forwarder
days
Vender Management

Complete Questionnaire & Sent Back to

Vendor Management

Subcontractor / Fabricator / Forwarder

Receive Questionnaire & Sent Back to HSE

Vender Management Process

Prepare Bid Evaluation in 5 work days

HSE

Keep Original Copy to Vendor Management

HSE HSE

Distribute to Subcontractor / Fabricator /

Forwarder

Vendor Management

Not Pass Pass

Clarification Recommended
Bidder List

Figure 6. CSMS Process Flow

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30.0 RECORDS AND REPORTS

30.1 Safety Performance Indicators data
The following data will be reported and recorded:
- Near-misses
- First Aid Case Injuries
- Medical Treatment Case Injuries
- Restricted Workday Case Injuries
- Lost Workday Case Injuries
- Fatalities

30.2 Registers
The following registers will be retained on site:
- Personnel medical records
- Inspection of Excavations.
- Inspections of Lifting Gear
- Inspection of Electrical Powered hand tools
- Inspection of Pressure Vessels (e.g. air receivers)
- Scaffolding
- Inspection of Cranes and Lifting machines.
- Explosive Powered tools
- Pre-inspection of plant & equipment
- Vehicle inspection

30.3 Authorizations
The following persons shall be required to carry a site authorization card at all times while on
site:
- Crane Operators
- Riggers
- Drivers/Operators of mobile plant (mechanically propelled vehicles).
- Drivers of cars, trucks, vans, pick-ups
- Scaffolders
- Electricians
- Explosive Powered Tools Operators.
- Permit To Work Holders/Acceptors
- Confined Space Watcher
- Hot Work Fire Watchers
- First Aiders

31.0 MANAGEMENT REVIEW MEETING

The CONTRACTOR establishes, socializes, implements, maintains and continually improves
procedure(s) for management review to ensure that:
- The CONTRACTOR top management (at planned intervals) reviews the HSSE management
system, to ensure its continuing suitability, adequacy and effectiveness
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- The review includes assessing opportunities for improvement and the need for changes to the
HSSE Management System, including the HSSE Policy and HSSE objectives
- The inputs to management review include:
o Results from internal audits and evaluations of compliance with legal and other
requirements
o The results of participation and consultation
o Relevant communication from external parties, including complaints
o The HSSE performance of the CONTRACTOR’s organization
o The extent to which the objectives have been met
o The status of incident investigations, corrective and preventive actions
o Follow-up actions from previous management reviews
o Changing circumstances, including developments in legal and other requirements related
to HSSE
o Recommendations for improvement
- The outputs from the management review include decisions and actions related to possible
changes to the HSSE policy, objectives, resources, HSSE performance and other elements of
the HSSE management system, and consistent with the commitment to continual
improvement
- The records of the management reviews are retained and made available for communication
and consultation

32.0 ATTACHMENTS
Attachment 1 CONTRACTOR HSSE Policies
Attachment 2 List of Regulation
Attachment 3 HSSE Matrix Training
Attachment 4 CSMS Questionnairre
Attachment 5 HSSE Program
Attachment 6 PPE Matrix
Attachment 7 Incident Process Flowchart
Attachment 8 HSSE Organization Chart
Attachment 9 Change Management Request Form
Attachment 10 Hazard Identification Risk Assesment & Control (HIRAC)
Attachment 11 Job Safety Analysis (JSA)
Attachment 12 Job Hazard Analysis (JHA)
Attachment 13 Penalty System
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Attachment 1.a. CONTRACTOR HSSE Policies

HEALTH, SAFETY AND ENVIRONMENT

CONTRACTOR POLICY

Primary CPPHK’s management is committed to providing a safe and healthful workplace in all of
CPPHK’s facilities, offices and work sites and to making every effort towards eliminating or minimizing
any environmentally adverse effects of CPPHK’s operations.

Thus, CPPHK will, promote the highest standards, health, safety and environmental preservation by
establishing and implementing an HSE Management System , in all of its operations and in all locations
where work is being carried out under its control, as well as , maintaining an HSE Management System that
will include such elements as targets and standards for HSE performance, HSE education programs and
motivational incentives, and assessments and accountability for achievement those targets and standards.

To meet this commitment, Joint Operation of China Petroleum Pipeline Engineering Co., Ltd. and PT.
Hutama Karya (Persero) in carrying out its operations, will in all cases, abide by the following principles:
1. Place the highest priority on the health and safety of personnel and on the preservation and
protection of the environment.
2. Give authority to all employees and workers to stop work due to unsafe behavior, unsafe
conditions, and involve them in the decision making process in matter of safety, occupational
health and environmental protection.
3. Provide plans that meet the highest standards for safety and operation, and place the minimum
burden on the environment.
4. Plan and perform work in accordance with the HSE Management System.
5. Hold employees, including those of Vendors and Subcontractors, responsible for their own HSE
and that of their colleagues.
6. Prohibit the usage of illegal drugs, alcohol and firearms
7. Provide HSE training for personnel to improve workers' HSE understanding and competence
through socialization and training and implementation of the HSE program
8. Implement a Reward and Punishment system related to HSE aspects
9. Review, monitor and measure HSE performance for continual improvement
10. Creating and maintaining harmonious relationships with the surrounding environment
and stakeholders

To achieve the above commitments, the CONTRACTOR Management, Sub-Contractors and every
personnel involved in the work must be aware of their contents and implement all the statements in the
Policy above for each of their work activities.

Jakarta, September 26, 2019

CONTRACTOR
CPPHK

Cui Guojun
( Project Manager CPPHK )
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Attachment 1.b. Environmental CONTRACTOR Policy

ENVIRONMENTAL CONTRACTOR POLICY

As Joint Operation of China Petroleum Pipeline Engineering Co., Ltd. and PT. Hutama Karya
(Persero) which creates a more prosperous future for humans and the earth, CPPHK sets the
following environmental policies to contribute to the protection of the earth's environment.
1. To build, maintain and work through periodic reviews for continuous improvement of the
Environmental Management System that clearly states and provides for the implementation
of environmental targets for office operations and project implementation that contribute to
the prevention of environmental pollution.
2. To use our technical expertise to give our clients access to services that contribute to the
protection of the earth's environment.
3. To fully comply with environmental laws and regulations made to protect the environment
and with related agreements reached with clients and stakeholders.
4. To minimize the burden on the environment from office operations by reducing waste,
promoting reuse and recycling and limiting energy consumption.
5. To strictly pay attention to the following principles in carrying out engineering, procurement
and construction work for our projects.
 In our design work for projects we must strive to minimize adverse impacts on the
environment through these steps including limiting the consumption of resources and
energy, and working to prevent air, water and soil pollution.
 In procurement, we will encourage vendors who show a positive attitude towards the use
of environmentally friendly manufacturing policies.
 In construction, we must minimize the use of resources and waste production, promote
recycling, and strive to protect the environment through the prevention of air, water and
soil pollution.

Jakarta, September 26, 2019

CONTRACTOR
CPPHK

Cui Guojun
( Project Manager CPPHK )
 EPC OF LAWE-LAWE FACILITIES RDMP
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Attachment 1.c. Prohibition Drug, Alcohol and Weapon CONTRACTOR Policy

PROHIBITION DRUG, ALCOHOL AND WEAPON

CONTRACTOR POLICY

Joint Operation of China Petroleum Pipeline Engineering Co., Ltd. and PT. Hutama Karya
(Persero) is committed to creating a safe, healthy and productive workplace for employees. The
CPPHK stipulates that the abuse of alcohol, illegal drugs, other addictive substances and weapon
is illegal and can endanger yourself and others, disrupt the productivity, efficiency and
performance of workers, business partners and business partners.

The CPPHK strictly prohibits and takes firm action, namely Termination of Employment to
anyone who while working in the activities of CPPHK:

1. Consuming alcohol, illegal drugs and other addictive substances which are prohibited by
the law
2. Circulating or selling alcohol, illegal drugs and other addictive substances within CPPHK
3. Abusing legal drugs or knowingly owning, distributing, selling drugs available in Health
Facilities and first aid kits provided by the CPPHK
4. It is strictly forbidden to carry any weapon for any reason inside the job site and office.
People who are suspected carrying any weapon should be suspended from the job site and
shall be prosecuted by the law.

The CPPHK will not provide health facilities for all health consequences due to the abuse and
dependence on illegal drugs, alcohol and other addictive substances.

All employees and worker of CPPHK are responsible for implementing and complying with HSE
policies and evaluating for continuous improvement.

Jakarta, September 26, 2019

CONTRACTOR
CPPHK

Cui Guojun
( Project Manager CPPHK )
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Attachment 2 List of Regulations

LIST OF REGULATIONS

HSEMS
NO REGULATIONS AND OTHER REQUIREMENTS ELEMENT / CLAUSE
SECTION
Requirements

1 26076-110-G90-GHX-00001 Project HSSE Plan 4.6 All

2 26076-110-G01-GAM-00001 Project Execution Plan 8.2,13.9 All

Environment
General
Undang-Undang No. 32 / 2009 – Perlindungan dan Pengelolaan 1, 2, 3, 4, 13, 14, 20, 21, 53,
1 1 – 13
Lingkungan Hidup 54, 57, 58, 59, 60, 67, 68, 69
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 Pernyataan
4 5 Pasal 2 - 9
Kesanggupan Pengelolaan & Pemantauan Lingkungan Hidup
Hazardous Material
6, 8, 9, 12, 13, 15, 16, 17, 18,
Peraturan Pemerintah No. 74/2001 – Pengelolaan Bahan Berbahaya
5 5, 9 19, 20, 22, 23, 25, 27, 28, 29,
dan Beracun
30, 31, 39
Hazardous Waste
3, 4, 5, 7, 8, 9, 10, 11, 13, 14,
Peraturan Pemerintah No. 101/2014 – Pengelolaan Limbah Bahan
6 2, 5, 9 16, 29, 30, 31, 54, 55, 56, 57,
Berbahaya dan Beracun
58, 59, 60, dst.
Peraturan Menteri Lingkungan Hidup No. 14/2013 – Simbol dan Label
7 2, 5, 9 Poin B dan C
Limbah B3
8 Peraturan Menteri Lingkungan Hidup No. 18/2009 – Tata Cara PerIjinan 2, 5, 9 1, 2, 3, 4,
Keputusan Kepala Bapedal No. 01 Tahun 1995 – Tata Cara dan 1, 2, 3, 4, 5, Lampiran 1 No. 1,
9 Persyaratan Teknis Penyimpanan dan Pengumpulan Limbah Bahan 5, 9 2.1, 2.2, 3.1, 3.2, 4, 4.1, 4.2,
Berbahaya dan Beracun 4.3, 4.4,
Keputusan Kepala Bapedal No. 02 Tahun 1995 – Dokumen Limbah 1, 2, 3, 4, 5, Lampiran 1 No. 1,
10 5, 9
Bahan Berbahaya dan Beracun 2, 3, 4
Peraturan Menteri Lingkungan hidup - Simbol dan Label Limbah Bahan
11 5, 9 2, Lampiran
Berbahaya Dan Beracun
Peraturan Menteri Negara Lingkungan Hidup No. 03 Tahun 2008 –
12 5, 9 2,3, 4, dan Lampiran 1 No.
Tentang Tata Cara Pemberian Simbol dan Label Bahan B3
Surat Edaran Nomor : 08/Se/02/1997 - Penyerahan Minyak Pelumas
13 5, 9 1 s.d. 6
Bekas
Radioctive
1, 5, 6, 12, 13, 14, 15, 16, 17,
14 Peraturan Pemerintah No. 61/2013 – Pengelolaan Limbah Radioaktif 5, 9
20, 26, 30, 35
15 KEPBAPETEN No. 01/Ka-BAPETEN/V-99 - Ketentuan Keselamatan
15 5 BAB II dan BAB IV
Kerja Terhadap Radiasi
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 - Pengelolaan
17 5, 9 BAB IV - VII
Kualitas Air dan Pengendalian Pencemaran Air
Peraturan Daerah Provinsi Kalimantan Timur No. 14/2012 – Pengelolaan
18 5 BAB II dan BAB III
Air Tanah di Kalimantan Timur
Liquid Waste
Peraturan Pemerintah No. 82/2001 – Pengelolaan Kualitas Air dan 7,8, 9, 10, 11, 12, 16, 17, 25,
19 2, 5, 9
Pengendalian Pencemaran Air 26, 34, 35, 37, 38, 41, 42,
Peraturan Menteri Lingkungan Hidup No. 19/2010 - Baku Mutu Air
20 5, 9 TBA
Limbah bagi Usaha dan/atau Kegiatan Migas Serta Panas Bumi
21 Keputusan Menteri Lingkungan Hidup No. 51/1995 – Baku Mutu
21 5, 9 1, 2, 5, 6, 8, Lampiran C
Limbah Cair Bagi Kegiatan Industri
Keputusan Menteri Lingkungan Hidup No. 122/2004 – Perubahan Atas
22 KepMenLH No. 51/1995 tentang Baku Mutu Limbah Cair Bagi Kegiatan 5, 9 Pasal 1, 2, dan Lampiran
Industri
23 KepMenLH No. 112 Tahun 2003 - Baku Mutu Air Limbah Domestik 5,9 4,6,8 dan lampiran
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LIST OF REGULATIONS

HSEMS
NO REGULATIONS AND OTHER REQUIREMENTS ELEMENT / CLAUSE
SECTION
Air Pollution, Odor, and Noise
5, 9, 10, 20,22, 23, 24, 26, 28,
24 Peraturan Pemerintah No. 41/1999 – Pengendalian Pencemaran Udara 2, 5, 9 30, 31, 34, 35, 36, 37, 41, 42,
48, 49, 50, 51
Peraturan MenteriLingkungan Hidup No. 05/2006 – Ambang Batas Emisi
25 2, 5, 9 1, 2, 3, 4, 5, Lampiran No. B,
Gas Buang Kendaraan Bermotor Lama
Keputusan Menteri Lingkungan Hidup No. 48/1996 – Baku Tingkat
26 2, 5, 9 1, 2, 3, 5, 6, Lampiran 1, 2,
Kebisingan
1, 2, 3, 5, 6, 7, Lampiran 1 No,
Keputusan Menteri Lingkungan Hidup No. 49/1996 – Baku Tingkat 1, 2, Lampiran 2 No. 1, 2,
27 2, 5, 9
Getaran Lampiran 3, Lampiran 4, Lampiran
5
Keputusan Menteri Lingkungan Hidup No. 50/1996 – Baku Tingkat
28 2, 5, 9 1, 2, 4, 5, Lampiran 1
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
33 UU RI No. 22 Tahun 2009 – Lalu Lintas dan Angkutan Jalan 5 Bagian ketiga (Pasal 49 – 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 Wewenang
36 1 9, 10
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 dalam
40 5 9
Penyelenggaraan Keselamatan Kerja
41 PER 01/MEN/1976 – Kewajiban latihan Hiperkes Bagi Dokter Perusahaan 5 1
PER 01/MEN/1979 –Kewajiban Latihan Hygiene Perusahaan Kesehatan
42 5 1
dan Keselamatan Kerja Bagi Tenaga Para Medis Perusahaan
43 PER 02/MEN/82 – Kwalifikasi Juru Las di Tempat Kerja 5 3, 4 , 30, 31
PERMENAKERTRANS No.09 /2010 – Operator dan Petugas Pesawat
44 5 5, 6, 10, 12
Angkat dan Angkut
PER 03/MEN/1999 – Syarat – Syarat K3 Lift untuk Pengangkutan Orang
45 5 1, 3, 4, 5, 11, 12, 24, 27, 28
dan Barang
46 KEP 174/MEN/1986 – K3 pada Tempat Kegiatan Konstruksi 4 2
KEP 187/MEN/1999 – Pengendalian Bahan Kimia Berbahaya di Tempat
47 7 2, 4, 5, 9
Kerja
SK No. 261/MENKES/SK/II/1998 Persyaratan Kesehatan Lingkungan
48 5 BAB I. BAB II: A.1, B.1, C.1
Kerja
KEPMENKES 1405/2002 – Persyaratan Kesehatan Lingkungan Kerja
49 5 BAB VI: A, B. BAB XI
Perkantoran dan Industri
50 PERMENKES No. 492 / 2010 - Persyaratan Kualitas Air Minum 5 2, 6
PERMENKES No. 416 / 1990 – Syarat – syarat dan Pengawasan
51 5 2, 4, 9
Kualitas Air
PER 02/MEN/1980 – Pemeriksaan Kesehatan Tenaga Kerja dalam
52 5 1
Penyelenggaraan Keselamatan Kerja
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LIST OF REGULATIONS

HSEMS
NO REGULATIONS AND OTHER REQUIREMENTS ELEMENT / CLAUSE
SECTION
2, 3, 4, 7, 18, 19, 20, 27, 37, 55,
53 PER 05/MEN/1985 – Pesawat Angkat dan Angkut 5
54, 55, 101
54 PER 09/MEN/2010 – Operator Pesawat Angkat dan Angkut 5 Bab 2 – 8
55 KEPRES 22/1993 – Penyakit Yang Timbul Karena Hubungan Kerja 7 2, 3
KEPMENAKERTRANS No. 609/2012 - Pedoman Penyelesaian Kasus
56 5, 6 2, 3
Kecelakaan Kerja dan Penyakit Akibat Kerja
PER 04/MEN/1980 – Syarat – Syarat Pemasangan dan Pemeliharaan
57 7 3, 5, 11, 12
Alat Pemadam Api Ringan
58 PER 02/MEN/1983 Instalasi Alarm Kebakaran Automatik 7 Bab 1 - 6
PERMENAKERTRANS No. 13/2011 NAB - Faktor Fisika dan Faktor Kimia 4, 5, 12, 14, 15, 16, 17,
59 5, 6
di Tempat Kerja Lampiran 1 dan 2

60 KEP 186/MEN/1999 – Unit Penanggulangan Kebakaran di Tempat Kerja 9 2, 3

61 PER 01/MEN/1981-Kewajiban Melapor Penyakit Akibat Kerja 1 4
62 PER 03/MEN/1998 – Tata Cara Pelaporan dan Pemeriksaan Kecelakaan 10 2
KEP 84/BW/1998 – Tata Cara Pengisian Formulir Laporan dan Analisis
63 10 1 s.d 11
Statistik Kecelakaan
64 Kep. 333/MEN/1989 – Diagnosis dan Pelaporan Penyakit Akibat Kerja 10 2
65 PERMENAKER No. 15/MEN/VIII/2008 - P3K 5 2 s.d 11, lampiran I, II, dan III
66 PERMENAKER No. 8 /MEN/VII/2010 – APD 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
68 Penyalahgunaan dan Peredaran Gelap Narkotika, Psikotropika dan Zat 1, 2, 5 2,3,4,5,6,7,8
Adiktif Lainnya di Tempat Kerja
69 PER.02/MEN/1989 - Pengawasan Instalasi Penyalur Petir 5 Bab 2 -10
70 PER. 01/MEN/1982 - Bejana Tekanan 5 Bab 1 - 5
KEP.68/MEN/IV/2004 - Pencegahan dan Penanggulangan HIV/AIDS di
71 5 2, 3, 4, 5
Tempat Kerja
72 PER 01/MEN/1980 – K3 Pada Konstruksi Bangunan 2, 5, 9 1 - 105
PER07/MEN/1964 – Syarat Kesehatan , Kebersihan serta Penerangan
73 5 5,6,8,11,14
Dalam Tempat Kerja
PERMENKES No. 1096/MENKES/PER/VI/2011 – Higiene Sanitasi
74 5 Bab 1-3
Jasaboga
75 PP No. 55/2012 – Kendaraan 5 Bab 2-4
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Attachment 3 HSSE Matrix Training

HSE MATRIX TRAINING

Material Handling Operator

Heavy Equipment Operator

Logistic man / Warehouse

Electrical / Instrument
Deputy Manager/Chief

Light Vehicle Driver

Security Personnel

Carpenter / Mason
Mechanical Fitter
Superintendent
N o TRAINING INSTRUCTURE FREQUENCY

Administration

General Labor
Supervisor

Rebarman
Pipe Fitter
Scaffolder
Inspector

Surveyor
Engineer

Foreman
Manager

Riggers

Painter
Welder

Visitor
HSE Induction for CPPHK
1 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 T rainer
HSE Induction for Visitor CPPHK
2 As required - - - - - - - - - - - - - - - - - - - - - - - - M
(Level 1) HSE T rainer
Basic First Aid for CPPHK Doctor
3 As required - O M M M M M O O O O O - - - - O O O O O O O - -
Employee (Level 2) /Paramedic
Basic Fire Fighting CPPHK
4 Biweekly 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 T rainer
Hand & Power T ools CPPHK
5 Monthly - O - - - M M - - - - - - - - - O O O O O O - O -
(Level 1) HSE T rainer
Permit to Work (PT W) CPPHK
6 As required O O M M - M M - - O O M - - - - - - - - - - - - -
(Level 1) HSE T rainer
Hazard Identification,
Risk Assessment, JSA CPPHK
7 Weekly O M M M M M M - - M M M M M M O M M M M M M M M -
(Job Safety Analysis) HSE T rainer
(Level 1)
Working at Height & Fall
CPPHK
8 Protection Equipment Weekly O M M M M M M - O O O M M M M - M M M M M M M M -
HSE T rainer
(Level 1)
Confined Space CPPHK
9 As required O O M O O M M - - - - M - - - - M O O - O - O O -
(Level 2) HSE T rainer
Scaffolder T raining CPPHK
10 Weekly - - - - M O - - - - - M - - - - - - - - - - - - -
(Level 2) HSE T rainer
BBSO/e-Construction
CPPHK
11 Observation Program 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 -
HSE T rainer
(Level 1)
Respiratory Protection CPPHK
12 Daily O M M M M M M - M O O O O O O O O O O O M O O M -
(Level 1) HSE T rainer
Safe Driving Course CPPHK
13 Quarterly O O O O O O O - O O O - - - - M - - - - - - - - -
(Level 2) HSE T rainer
CPPHK HSEM/
14 HSE Leadership (Level 1) Monthly M M M M M M M - - O O - - - - - - - - - - - - - -
DEPUT Y /Chief
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HSE MATRIX TRAINING

Material Handling Operator

Heavy Equipment Operator

Logistic man / Warehouse

Electrical / Instrument
Deputy Manager/Chief

Light Vehicle Driver

Security Personnel

Carpenter / Mason
Mechanical Fitter
Superintendent
No TRAINING INSTRUCTURE FREQUENCY

Administration

General Labor
Supervisor

Rebarman
Pipe Fitter
Scaffolder
Inspector

Surveyor
Engineer

Foreman
Manager

Riggers

Painter
Welder

Visitor
CPPHK
15 Hot Work (Level 1) Monthly - - M O O M O - - - - - - - - - M M M - M O - O -
HSE T rainer
Slinging, Rigging & Lifting
CPPHK
16 Refreshment T raining Monthly - - M O M M - - - - - - M M M - - - - - - - - - -
HSE T rainer
(Level 2)
Incident Investigation CPPHK
17 Quarterly O M M M M M O - O O - - O - - - - - - - - - - - -
T raining (Level 2) HSE T rainer
Excavation Work CPPHK
18 Bi-Weekly - - M O - M M - - - - - - - - - - - - - - - - O -
(Level 1) HSE T rainer
Emergency Preparedness CPPHK
19 Bi-Weekly O O M M M M M - M M M M M M M M M M M M M M M M -
& Response (Level 1) HSE T rainer
Waste Management CPPHK
20 Bi-Weekly - O M O O M M - - - - - - - - - - - - - - - - - -
(Level 1) HSE T rainer
Electrical Safety CPPHK
21 Bi-Weekly - O M O O M M - - M - - - - - - - - - - M - - - -
(Level 1) HSE T rainer
Mechanical Safety CPPHK
22 Bi-Weekly - O M O O M M - - - - - - - - - - - M - - - - - -
(Level 1) HSE T rainer
Chemical & Hazardous
CPPHK
23 Substance Handling Bi-Weekly - O M O O M M - - M - - M - - - - - - - - - - - -
HSE T rainer
(Level 1)
Industrial Hygiene CPPHK Doctor
24 Quarterly - O M O O M M - - - - - - - - - - - - - - - - - -
(Level 1) /Param edic
Lock Out T ag Out CPPHK
25 As required - O M O O M M - - - - - - - - - - - M - M - - - -
(LOT O) (Level 1) HSE T rainer
Safety Leader and CPPHK
26 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 O
Awareness (Level 1) HSE T rainer
Basic Sea Survival
27 3rd Party As required M M M M M M M M M M M M M M M M M M M M M M M M O
(Level 1)
Working Above Water CPPHK
28 As required O O O O O O O O O O O O O O O O O O O O O O O O O
(Level 1) HSE T rainer
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HSE MATRIX TRAINING

Material Handling Operator

Heavy Equipment Operator

Logistic man / Warehouse

Electrical / Instrument
Deputy Manager/Chief

Light Vehicle Driver

Security Personnel

Carpenter / Mason
Mechanical Fitter
Superintendent
No TRAINING INSTRUCTURE FREQUENCY

Administration

General Labor
Supervisor

Rebarman
Pipe Fitter
Scaffolder
Inspector

Surveyor
Engineer

Foreman
Manager

Riggers

Painter
Welder

Visitor
CPPHK
29 SIMOPS (Level 1) As required O O M O O M M - - - O O O M M - O O O - O - - - -
HSE Trainer
H2S / Hazard Gas CPPHK
30 As required O O M O O M M - O - O O O O O O O O O O O O O O -
Awareness (Level 1) HSE Trainer
Banksman / Flagman CPPHK
31 As required - - - - - - O - - - - - O O O O - - - - - - - - -
(Level 1) HSE Trainer
CPPHK
32 STARRT (Level 1) As required O O M M - M M - - O O M - - - - - - - - - - - - -
HSE Trainer
CPPHK
33 Grating Activity (Level1) As required - O M O O M M - - - - M - - - - O O O - O - - - -
HSE Trainer

Note:
M: Mandatory
O: Option
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Attachment 4 CSMS Questionnaire

CSMS 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 Activit 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 CSMS assessment
Perwakilan Perusahaan,
Company Representative,

Nama / Name : :
Tgl / Date : :
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CSMS QUESTIONNAIRE

NILAI / BOBOT / KETERANGAN

NO. KUESIONER / QUESTIONNAIRE EVIDENCE / LAMPIRAN BUKTI
SCORE WEIGHT / REMARK
I KEPEMIMPINAN & KEBIJAKAN K3LL / LEADERSHIP & HSE POLICY
Apakah perusahaan Anda memiliki kebijakan Salinan kebijakan K3LL perusahaan
K3LL, terdokumentasi & ditandatangani oleh
1 pimpinan perusahaan? 0 2
Does your company have HSE Policy, Copy of HSE policy
documented & approved by Company
Leader?
Bagaimana cara perusahaan Anda Bukti sosialisasi: daftar hadir dan
mensosialisasikan kebijakan K3LL? materi orientasi pekerja / tamu
(sebagai tambahan dapat
melampirkan poster kebijakan,
2 0 2
How does your company socialize the HSE banner)
Socialization evidences: attendance
policy? list and orientation materials
(in addition please attach poster,
banner)
Siapakah orang yang bertanggung jawab Riwayat kerja orang yang
dalam penerapan sistem manajemen K3LL di bertanggung jawab dalam
perusahaan Anda? penerapan sistem manajemen K3LL
3 di perusahaan 0 2
Who is the responsible person for CV of the responsible person for
implementing the HSE management system implementing the HSE management
at your company? system at the company
Jelaskan bagaimana keterlibatan pemimpin Notulensi rapat P2K3 mengenai
perusahaan Anda terkait dengan penerapan peninjauan ulang sistem manajemen
sistem manajemen K3LL? K3LL
4 0 2
Please, explain the involvement of your P2K3 minutes of meeting about
company leader regarding HSE management review of HSE management system
system implementation?
NILAI TOTAL / TOTAL SCORE 0 8
II KEPATUHAN TERHADAP PERATURAN PERUNDANGAN K3LL / HSE REGULATION COMPLIANCE
Apakah perusahaan Anda memiliki organisasi Struktur organisasi dilengkapi dengan
P2K3 dan LL? nama
1 0 2
Does your company have HSE committee Complete organization chart with
organization? name
Sebutkan tugas dan tanggung jawab masing- Tugas dan tanggung jawab masing-
masing personil dalam penerapan sistem masing personil dalam penerapan
manajemen K3LL di perusahaan Anda? sistem manajemen K3LL
2 0 2
Please, explain the job description of each Job description of each personnel in
personnel regarding HSE management HSE management system
system implementation at your company? implementation
Apakah perusahaan Anda memiliki HSE Riwayat pekerjaan serta sertifikasi
personil yang kompeten untuk memberikan (Depnaker / Migas) pimpinan HSE
3 panduan dalam program K3LL? personil 0 3
Does your company have competent HSE CV and certification (Depnaker /
personnel that drive the HSE program? Migas certification) of HSE leader
Apakah perusahaan Anda melakukan Catatan hasil MCU dan rekapitulasi
pemeriksaan kesehatan secara berkala?
4 0 2
Does your company carry out the Medical MCU record and recapitulation
Check Up regularly?
Apakah perusahaan Anda memiliki program Salinan kartu Jamsostek / asuransi
Jamsostek /asuransi kesehatan dan kesehatan dan kecelakaan
5 kecelakaan? 0 2
Does your company have Jamsostek / health Copy of Jamsostek / health and
and accident insurance program? accident insurance card
Apakah perusahaan Anda memiliki personel Riwayat pekerjaan dan sertifikasi
kunci yang kompeten sesuai lingkup keahlian kerja (contoh: sertifikasi
pekerjaan? welder, SIO peralatan berat, dll)
6 0 2
Does your company have competent key CV and certification of job skills (e.g.
personnel related to the scope of work? Welder certification, heavy vehicle
license, etc.)
 EPC OF LAWE-LAWE FACILITIES RDMP
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Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 132 / 154

CSMS QUESTIONNAIRE

NILAI / BOBOT / KETERANGAN

NO. KUESIONER / QUESTIONNAIRE EVIDENCE / LAMPIRAN BUKTI
SCORE WEIGHT / REMARK
Apakah perusahaan Anda mengelola Sertifikat alat berat, kalibrasi
peralatan operasi dengan mematuhi peralatan, atau lainnya
ketentuan dari pihak berwenang (sertifikasi,
7 kalibrasi)?
Does your company manage operation Heavy vehicle certification,
equipments comply with regulations equipment calibration or etc.
(calibration, certification)?
NILAI TOTAL / TOTAL SCORE 0 15
III PELATIHAN / TRAINING
Apakah perusahaan Anda memiliki program Salinan prosedur pelatihan
dan memberikan pelatihan K3LL secara K3LL,matriks pelatihan, daftar hadir,
internal / eksternal? materi pelatihan internal (contoh:
pelatihan APD, Bekerja di ketinggian,
pelatihan pengelolaan bahan kimia,
1 HSE induksi, dll) 0 4

Does your company have program and give Attendance list, copy of HSE training
HSE internal / external training? procedure, and training materials
(e.g. PPE training, chemical handling,
induction, etc.)
Apakah perusahaan Anda memberikan Matriks dan sertifikat pelatihan
pelatihan kepada karyawan sesuai dengan bidang keahlian kerja
2 lingkup pekerjaan? 0 2
Does your company give training to Matrix and training certificate of work
employee related to the scope of work? skill
NILAI TOTAL / TOTAL SCORE 0 6
IV MANAJEMEN SUBKONTRAKTOR / MANAGEMENT OF SUBCONTRACTO
Bagaimana perusahaan Anda mengelola Salinan prosedur pengelolaan
subkontraktor yang dapat mendukung subkontraktor / CSMS
program K3LL perusahaan?
1 0 2
How does your company manage Copy of subcontractor management
subcontractor for support company HSE procedure /CSMS
program?
Bagaimana perusahaan Anda memastikan Hasil evaluasi subkontraktor /
bahwa subkontraktor memahami dan dokumen kontrak yang memuat
melaksanakan program K3LL? aspek K3LL
2 0 2
How does your company ensure that Subcontractor evaluation result /
subcontractor understand and implement HSE contract document that mention the
program? HSE aspect
NILAI TOTAL / TOTAL SCORE 0 6
V HSE DLM DESAIN, KONSTRUKSI, DAN KOMISIONING / HSE IN DESIGN, CONSTRUCTION, AND COMISSIONING
Apakah perusahaan Anda memiliki prosedur Daftar dan salinan prosedur kerja
kerja sesuai dengan lingkup pekerjaan? sesuai dengan lingkup pekerjaan
1 0 2
Does your company have working procedure List and copy of working procedure
related to the scope of work? related to the scope of work
Apakah perusahaan Anda memiliki rencana Salinan rencana program K3LL
program K3LL untuk pelaksanaan proyek?
2 0 4
Does your company have HSE plan for Copy of HSE plan
project execution?
Apakah perusahaan Anda memiliki prosedur Salinan prosedur identifikasi bahaya
identifikasi bahaya dan penilaian risiko? dan penilaian risiko (JSA, RA)
3 0 2
Does your company have hazard Copy of hazard identification and risk
identification and risk assesment procedure? assesment procedure (JSA, RA)
Apakah perusahaan Anda memiliki contoh JSA Contoh JSA dan RA sesuai dengan
dan RA sesuai dengan detail / lingkup detail / lingkup pekerjaan
4 pekerjaan? 0 2
Does your company have an example of JSA Example of JSA and RA related to
and RA related to the detail / scope of work? the detail /scope of work
Apakah perusahaan Anda memiliki prosedur Salinan prosedur Izin Kerja Aman
Izin Kerja Aman?
5 0 2
Does your company have Permit to Work Copy of Permit to Work procedure
procedure?
 EPC OF LAWE-LAWE FACILITIES RDMP
RU-V BALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 133 / 154

CSMS QUESTIONNAIRE

NILAI / BOBOT / KETERANGAN

NO. KUESIONER / QUESTIONNAIRE EVIDENCE / LAMPIRAN BUKTI
SCORE WEIGHT / REMARK
Apakah perusahaan Anda memiliki prosedur Salinan prosedur APD (perawatan,
tentang APD dan membuat daftar APD penyimpanan, dll) dan daftar APD
sesuai spesifikasi lingkup pekerjaan? sesuai dengan lingkup pekerjaan
(jenis dan spesifikasi sesuai standar
nasional /internasional)
Does your company have PPE procedure and Copy of PPE procedure
6 0 2
make a list of PPE and specification related to (maintenance, storage, etc.) and list
the scope of work? of PPE related to the scope of work
(type and specification according to
national /(type and specification
according to national /international
standards)
Bagaimana perusahaan Anda memastikan Catatan distribusi dan inventarisasi
APD telah diterima oleh karyawan sesuai APD
dengan lingkup pekerjaan?
7 0 2
How does your company ensuring PPE accept PPE distribution record and inventory
properly by worker related to the scope of
work?
Apakah perusahaan Anda memiliki program Laporan pengukuran Higiene Industri
Higiene Industri? (pencahayaan, debu, suhu,
ergonomi, dll)
8 0 2
Does your company have Industrial Hygiene Industrial Hygiene measurement
program? (illumination, dust, temperature, report
ergonomic, etc.)
Apakah perusahaan Anda memiliki prosedur Salinan prosedur pengendalian
pengendalian tumpahan bahan kimia? tumpahan bahan kimia
9 0 2
Does your company have chemical spill Copy of chemical spill handling
handling procedure? procedure
Apakah perusahaan Anda memiliki prosedur Salinan prosedur pengelolaan limbah
pengelolaan limbah?
10 0 2
Does your company have waste Copy of waste management
management procedure? procedure
Bagaimana cara perusahaan Anda Manifest limbah B3
menangani limbah B3? (oli bekas, tumpahan
minyak, material B3 kadaluarsa, pelarut, dll)
11 0 2
How does your company handle hazardous Manifest of hazardous waste
waste? (used oil, oil spill, expired hazardous
material, solvent, etc.)
NILAI TOTAL / TOTAL SCORE 0 24
VI MANAJEMEN PERUBAHAN / MANAGEMENT OF CHANGE
Apakah perusahaan Anda memiliki prosedur Salinan prosedur manajemen
manajemen perubahan? perubahan
1 0 2
Does your company have management of Copy of management of change
change procedure? procedure
Bagaimana cara perusahaan Anda melakukan Salinan form manajemen perubahan
manajemen perubahan? (contoh: perubahan struktur
organisasi perusahaan, perubahan
penggunaan peralatan di tempat
2 kerja, dll) 0 2

How does your company perform Copy of management of change

management of change? form (e.g. organizational-structural
change, equipment change, etc.
NILAI TOTAL / TOTAL SCORE 0 4
VII INSPEKSI / INSPECTION
Apakah perusahaan Anda melakukan inspeksi Bukti inspeksi K3LL (min: 2 periode
umum tempat kerja? inspeksi)
1 0 2
Does your company carry out the general Evidence of HSE inspection (min: 2
workplace inspection? inspection periods)
 EPC OF LAWE-LAWE FACILITIES RDMP
RU-V BALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 134 / 154

CSMS QUESTIONNAIRE

NILAI / BOBOT / KETERANGAN

NO. KUESIONER / QUESTIONNAIRE EVIDENCE / LAMPIRAN BUKTI
SCORE WEIGHT / REMARK
Bagaimana cara perusahaan Anda untuk Laporan tindak lanjut hasil temuan
menindak lanjuti temuan inspeksi?
2 0 2
How does your company follow up the Report of follow up inspection finding
inspection findings?
Apakah peralatan kerja Anda diinspeksi Bukti hasil inspeksi peralatan
sebelum dikirim ke lokasi proyek (mobilisasi)?
3 Does your company equipments inspected Evidence of equipment inspection 0 2
before sent to project site area results
(mobilization)?
Apakah perusahaan Anda melakukan inspeksi Jadwal dan hasil inspeksi alat kerja
pada alat kerja yang digunakan?
4 0 2
Does your company do inspection for working Equipment inspection schedule and
equipments? result
NILAI TOTAL / TOTAL SCORE 0 8
VIII KOMUNIKASI / COMMUNICATION
Apakah perusahaan Anda melakukan rapat Daftar hadir dan materi rapat
toolbox /safety talk? toolbox /safety talk
1 0 2
Does your company carry out toolbox / Attendance list and materials of
safety talk meeting program? toolbox / safety talk meeting
Apakah perusahaan Anda Daftar hadir komunikasi JSA / RA
mengkomunikasikan Job Safety Analysis /
2 0 2
Risk Assessment
Does your company? communicate Job Safety Attendance list JSA / RA
Analysis / Risk Assessment? communication
Apakah perusahaan Anda memiliki sarana Contoh HSE news , HSE bulletin ,
komunikasi K3LL lainnya? (HSE news , HSE HSE Alert dll
bulletin , HSE Alert dll)
3 0 2
Does your company have other HSE Example of HSE news, HSE bulletin,
communication tool? (HSE news, HSE bulletin, HSE Alert etc.
HSE Alert etc.)
NILAI TOTAL / TOTAL SCORE 0 6
IX TANGGAP DARURAT / EMERGENCY RESPONSE
Apakah perusahaan Anda memiliki prosedur Salinan prosedur emergensi
emergensi?
1 0 3
Does your company have emergency Copy of emergency procedure
procedure?
Apakah perusahaan Anda melakukan Laporan pelatihan emergensi
pelatihan emergensi secara berkala?
2 0 3
Does your company do the emergency drill Emergency drill report
regularly?
NILAI TOTAL / TOTAL SCORE 0 6
X PELAPORAN DAN PENYELIDIKAN KEJADIAN KECELAKAAN DAN PENCEMARAN LINGKUNGAN /
REPORTING AND INVESTIGATION OF INCIDENT AND ENVIRONMENTAL POLLUTION
Apakah perusahaan Anda memiliki prosedur Salinan prosedur pelaporan
pelaporan kecelakaan kerja? kecelakaan kerja
1 0 2
Does your company have incident reporting Copy of incident reporting procedure
procedure?
Apakah perusahaan Anda mencatat statistik Statistik kecelakaan tiga tahun
kecelakaan dalam 3 tahun terakhir? (LTIFR, terakhir (jika ada, mohon lampirkan
LTISR, dll) contoh laporan investigasi
kecelakaan)
2 0 2
Does your company record the accident Accident statistic report for last 3
statistic for last 3 years? (LTIFR, LTISR, years (if available, please attach
etc.) example of accident investigation
report)
NILAI TOTAL / TOTAL SCORE 0 6
 EPC OF LAWE-LAWE FACILITIES RDMP
RU-V BALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 135 / 154

CSMS QUESTIONNAIRE

NILAI / BOBOT / KETERANGAN

NO. KUESIONER / QUESTIONNAIRE EVIDENCE / LAMPIRAN BUKTI
SCORE WEIGHT / REMARK
XI DOKUMENTASI / DOCUMENTATION
Bagaimana cara perusahaan Anda Kumpulan daftar dokumen, salinan
mendokumentasikan dan memperbaharui prosedur pendokumentasian, dan
program K3LL? lembar revisi
1 0 2
How does your company document and Master list of HSE document, copy
renew the HSE program? of document control prosedur, and
historical sheet
NILAI TOTAL / TOTAL SCORE 0 2
XII EVALUASI / EVALUATION
Apakah perusahaan Anda memiliki prosedur Salinan prosedur evaluasi K3LL
evaluasi HSE?
1 0 3
Does your company have HSE evaluation Copy of HSE evaluation procedure
procedure?
Apakah perusahaan Anda melakukan internal Jadwal dan laporan hasil internal audit
audit K3LL? K3LL
2 0 3
Does your company carry out HSE internal Schedule and report of HSE internal
audit? audit
Apakah perusahaan Anda memiliki sertifikat Salinan sertifikat OHSAS 18001:
sistem manajemen K3LL dari pemerintah / 2007, ISO 14001: 2004, SMK3,
badan sertifikasi? penghargaan jam kerja aman, dll
3 0 3
Does your company have HSE management Copy certificate of OHSAS
system certification from government / 18001:2007, ISO 14001: 2004,
certification agencies? SMK3, reward for zero accident, etc.
NILAI TOTAL / TOTAL SCORE 0 9
XIII REWARD DAN PUNISHMENT / REWARD AND PUNISHMENT
Apakah perusahaan Anda memiliki prosedur Salinan prosedur promosi / reward
tentang promosi / reward HSE? HSE
1 0 2
How does your company have HSE Copy of HSE promotion / reward
promotion / reward procedure? procedure
Bagaimana perusahaan Anda menerapkan Salinan penghargaan atau pemberian
program reward dan punishment HSE? hadiah kepada pekerja
Salinan sangsi disiplin kepada pekerja
2 mengenai pelanggaran K3LL 0 2
How does your company implement HSE Copy of reward for worker
reward and punishment program? Copy of punishment for worker
regarding HSE violation
NILAI TOTAL / TOTAL SCORE 0 4

NILAI TOTAL KESELURUHAN / TOTAL SCORE OVERALL

Minimal Skor kelulusan Offshore 70
0 100
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)
 EPC OF LAWE-LAWE FACILITIES RDMP
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Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 136 / 154

Attachment 5 HSSE Program

HSE PROGRAM
RDMP LAWE-LAWE CPPHK
HEALTH & SAFETY PROGRAM
PROCEDURE / PRIMARY
HEALTH & SAFETY ACTIVITY PLAN
NO APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY RESPONSIBILI
/EXPECTATION
REFERENCE TY
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 1. Project All project Contractor Staff, Personal induction record is New hire CM, HSE Chief,
employees, SubContractors and visitors to and CSMS Requirement Induction SubContractor Staff and maintained. employees, HSEM
the site. Guideline. visitor T ransferred
2. Project Staff employees
Induction and visitor
Record.
2 Conduct regular meetings with Contractor Project HSE Plan related Daily T ool Box A HSE discussion for each Record of Daily T ool Box Every starting Site Supervisor,
staff, SubContractors and client to discuss Communication Meeting group on worker readiness, Meeting for attendance and of shift work Discipline
HSE issues. Procedure work plan for that day and topics. Superintendent
possible JSA. Site top management have
to attend this daily T BM
Weekly Construction progress Minutes of meeting record Weekly Construction
Construction coordination and discussion with HSE as the first agenda Manager
Meeting meeting, include HSE issues
Safety Discuss HSE issues and Minutes of Meeting of Monthly Construction
Committee Project progress record and attendance Manager
Meeting record
General safety A HSE discussion for All Make topics schedule and Weekly CM, HSE Manager
talk worker on project record for Attendance list
3 Ensure employees receive safety training Project HSE Plan Internal T raining T raining Nomination Form Form to signed off by Every time General
appropriate to their task and responsibility Course must be filled out prior to Project Manager prior to proposing to Superintendent /
any training taking place training taking place attend course CM
T raining Records have to be kept of T raining attendance sheet At every Project HSE
Attendance all persons attending training completed training Admin. or HSE
Sheet course Chief
T raining Records have to be kept of T raining attendance sheet At every Project HSE
Register all persons attending training completed training Admin. or HSE
course Chief
4 Establish Health, Safety, and Project HSE Plan, HSE Safety Notice Display all policies, Safety Safety notice boards are Monthly Project HSE
Environmental promotional material to Communication and Board minute of meeting, review placed in each work areas Admin. or HSE
improve the employee awareness T raining Procedure result of inspection, and displaying Coordinator
incidents, audits and others
Safety Display project performance HSE performance board Update Project HSE
Performance review against its objective placed in front of REK office Weekly Admin. or HSE
Boards and target and displaying project Coordinator
performance review result
 EPC OF LAWE-LAWE FACILITIES RDMP
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Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 137 / 154

HSE PROGRAM
RDMP LAWE-LAWE CPPHK
HEALTH & SAFETY PROGRAM
PROCEDURE / PRIMARY
HEALTH & SAFETY ACTIVITY PLAN
NO APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY RESPONSIBILI
/EXPECTATION
REFERENCE TY
Safety Alerts A Safety Alert shall be Safety Alerts produced and Each occurrence PM, CM, HSE
produced for high actual or displayed Chief or HSEM
potential incidents
Follow up all relevant Follow up action incorporated As Job condition PM, CM, HSE
corrective action of incoming into the Project HSE Plan require Chief or HSEM
safety alerts from other
projects
Cautionary and Develop and display relevant Cautionary and warning Once when it's CM, Discipline
Warning Sign cautionary and warning sign signs developed and determined Superintendent
(list of warning sign like tape displayed on the hazardous
barricade, etc.) 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 CM, Discipline
applicable health and safety laws, Analysis aspects project such as: developed and reviewed. project and as a Superintendent
regulations, statutory obligations and relevant statutory Project procedures or result of any
Company Safety requirement and comply requirements, contractual working instruction may be amendments to
with those laws and regulation requirements and Company developed to fill the gap. legislations and
HSE requirements client
requirements
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 and Project HSE Plan and JSA & Risk Identify all common hazards Conceptual Risk Assessment At start of Site Supervisor,
identify the risk level HSE Register Assessment and risks, which are is developed project /every Discipline
associated with each project starting of job Superintendent
activity
7 Where those procedures are not applicable Project HSE Plan and Job Safety JSA must be completed for Completed JSA Prior to start of Site Supervisor,
or suitable develop, implement and HSE Register Analysis new jobs and high-risk jobs. the jobs Discipline
maintain specific workplace procedures to Superintendent
ensure operations are conducted in such a JSA Review Ensure all JSA's are suited to JSA Review report During the job in HSE Chief
manner that eliminates the risk of injury, jobs carried out progress
illness or damage. Workplace Carry out workplace hazard Checklist of workplace As per schedule Project Supervisor
Hazard inspection for each project hazard inspection is and HSE Chief
Inspection 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 established and monitored and reviewed by
Scheme communicated committee
 EPC OF LAWE-LAWE FACILITIES RDMP
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PROJECT HSSE PLAN
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HSE PROGRAM
RDMP LAWE-LAWE CPPHK
HEALTH & SAFETY PROGRAM
PROCEDURE / PRIMARY
HEALTH & SAFETY ACTIVITY PLAN
NO APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY RESPONSIBILI
/EXPECTATION
REFERENCE TY
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 inspection Monthly HSE Chief
to carried out by all member is developed and completed
of project safety
committee.
10 Provide Leadership on all issues of safety Project HSE Plan Workplace Carried out a workplace A checklist of this inspection Monthly Project Supervisor
management Hazard hazard inspection for their is completed, followed up Discipline
Inspection own area of responsibility and closed out by relevant Superintendent,
signatories, 85 % close out
action
Project HSE All signatories take a part in Signatories attended on Monthly Monthly
Committee Project Safety Committee, if meeting and recorded.
appointed as a member of it Take a part on inspection
Tool Box All signatories involved in this Signatories attended on Daily Site Supervisor,
Meeting meeting on their own area meeting and recorded. Discipline
of responsibility Superintendent
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 meeting and recorded.
Meeting the first agenda of meeting.

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 Standard Developing specific standard Standard Instruction is All works shall CM, HSEM
according to standard Contractor HSE Register Instruction instruction or review existing developed, communicated covered by
procedures or template standard and maintained standard
instruction to be suited to instruction
the works
Permit to Work A restriction and limitation Excavation Permit, Working As required CM, HSE Chief
to personnel in carrying out at Height Permit,
the works known as a high Radiography Permit, Hot
risk Permit to Work, Entry Into
Confined Space Permit,
Electrical Permit to Work,
Crane Permit, Cold Permit to
Work
 EPC OF LAWE-LAWE FACILITIES RDMP
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PROJECT HSSE PLAN
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HSE PROGRAM
RDMP LAWE-LAWE CPPHK
HEALTH & SAFETY PROGRAM
PROCEDURE / PRIMARY
HEALTH & SAFETY ACTIVITY PLAN
NO APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY RESPONSIBILI
/EXPECTATION
REFERENCE TY
Job Safety JSA must be completed for Completed JSA (Job Safety Prior to Site Supervisor,
Analysis (JSA) new jobs, risk jobs, or jobs Analysis) commencement Discipline
that are not covered by of the jobs Superintendent
SOP or Standard Instruction
prior to commencement of
JSA Review Ensure all the jobs are carry JSA Review report, Updated During the job in HSE Chief
out in accordance to JSA JSA revision number progress
12 Risks to health, safety and environment Project HSE Plan Pre-start Inspection of all equipment Checklist completed Before mobilize CM, HSE Chief
will be dealt with by elimination, or removal, inspection must be carried out to site
substitution, design, redesign, or Preventive All plant and equipment are Checklist completed As per Schedule Project GSI and
separation, administrative and personal Maintenance scheduled for maintenance Mechanical
protection Inspection Supervisor
Workplace Carry out workplace hazard A checklist of this inspection Weekly Discipline
Hazard inspection regularly is completed and closed out Superintendent,
Inspection Project Supervisor
13 Provide risk identification and management Risk Register Job Safety JSA must be completed for Completed JSA Prior to Site Supervisor,
in their work areas Analysis new jobs, risk jobs, or jobs commencement Discipline
that are not covered by of the jobs Superintendent
SOP or Standard Instruction.
JSA Review Ensure all the jobs are carry JSA Review report, Updated During the job in HSE Chief
out suited to JSA JSA revision number progress
Hazard Supervisory staff to enforce Hazard report is produced. Every Day Site Supervisor,
Reporting the reporting of hazards Hazard register is Discipline
that may arise before, maintained. Corrective Sprntndnt, HSE
during and after the works Action is recorded. Superintendent
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 developed, communicated covered by
and Work review existing or template and maintained standard
Instruction (WI) environment standard instruction
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 None Project Safety T o do better that the Safety Statistic T wice a Month CM
the project Performance corporate target: LT IFR <1, Performance, HSE
T arget LT ISR < 1.0, with Fatality = Evaluation
0, Medical T reatment =0,
Property Damages =0,
Environmental Damages =
0, HSE Performance min 90
(based on HSE Evaluation)
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HSE PROGRAM
RDMP LAWE-LAWE CPPHK
HEALTH & SAFETY PROGRAM
PROCEDURE / PRIMARY
HEALTH & SAFETY ACTIVITY PLAN
NO APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY RESPONSIBILI
/EXPECTATION
REFERENCE TY
Corporate HSE Audit T arget is reviewed and As per schedule CM
compliance rate minim. 90 communicated
Audit internal project T arget is reviewed and Monthly CM
minimum 1 sub- Contractor communicated
per month
Periodically review and revise our HSE Policy and procedure to maintain Contractor relevance
16 Conduct assessment and review of key None Assessment Formal review of the Action plan from the review Every 3 months HSEM
personal HSE in implementing HSE HSE Mngmnt implementation HSE or as required
Management System System Mngmnt System and
Checklist performance PM / HSE Chief
17 T he 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,
Audit audited against the HSE plan HSEM
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 PlanProject Emergency Develop emergency Plans are regularly reviewed. Every Six-Month CM, HSE Chief
Preparedness HSE Plan Response Plan response plan and maintain T he preparedness
its preparedness and emergency equipment is
equipment checked regularly

Emergency Ensure all personnel involved ERP T raining will be given to Before project HSEM, Owner
Response in Emergency Response Site Project T eam by Owner start HSEM
T raining T eam have been trained in
ERP
Emergency Practice the Plan by A written emergency Quarterly PM, CM, HSE
Rehearsal simulating an emergency rehearsal report Chief or HSEM
situation
Site Medical First Aid Facilities to manned Medical Kit is maintained and Every Week Paramedic
Services and per day (Working Hours) by completed
Ambulance trained medic / paramedic

Rehabilitation Ensure that rehab plan is Completed Rehab Plan Every CM, HSE Chief
Plan developed and agreed to by Rehabilitation
employee Case
Prepared for emergencies and response quickly, effectively and with care to incidents resulting form Contractor operation
19 Conduct Exercise Program None Gym or Exercise All signatories involved in this Signatories attended this Weekly CM, PM, HSE
Gym or Exercise Gym or Exercise Chief
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HSE PROGRAM
RDMP LAWE-LAWE CPPHK
HEALTH & SAFETY PROGRAM
PROCEDURE / PRIMARY
HEALTH & SAFETY ACTIVITY PLAN
NO APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY RESPONSIBILI
/EXPECTATION
REFERENCE TY
Rules and Regulations at Site
20 No smoking at office site and working Project HSE Plan Safety Notice All contractor Staff, Result of Monitoring Monthly CM, HSE Chief
area, use drug and alcohol and carry Board and SubContractor Staff and
weapon Project visitor
Induction
Drug Test Random drug test Drug test result Random HSE Chief & CM
(Weekly)
Selection of SUBContractor
21 Conduct selection our Sub-Contractor Project HSE Plan HSE Questioner All sub-Contractor Result of questioner High Validity every 2 PM, Project
(CSMS) Risk Category > 60, 35 – years Procurement Mgr
59: Low Risk Category and Project HSEM
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,
Reporting Form Accident Reporting Form Discipline
Superintendent
Safety Awareness Program
24 In encourage Safety Behaviour Project HSE Plan Unsafe Act and All unsafe act and unsafe Completed Unsafe Act and Every Day All Project Team
Awareness, will request to our employee to Unsafe condition Unsafe condition Form
report all unsafe act and unsafe condition Condition Form
In monitoring implementation HSE None HSE Report Implementation HSE Completed HSE Report Form Monthly HSE Chief
Management System at project site. Form Management System, Man-
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
new employee of Contractor Check-up Form assigned to the Project Check-up and Construction
Manager, Health
Coordinator
26 Conduct General Medical Check-up for Sub Project HSE Plan General Medical All employee of Sub Result of General Medical As require CM, Medical
Contractor Supervisor to Up level Check-up Form Contractor Supervisor to Up Check-up Advisor
level who assign to the
Project
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HSE PROGRAM
RDMP LAWE-LAWE CPPHK
HEALTH & SAFETY PROGRAM
PROCEDURE / PRIMARY
HEALTH & SAFETY ACTIVITY PLAN
NO APPENDIX TOOLS WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY RESPONSIBILI
/EXPECTATION
REFERENCE TY
Rules and Regulations at Site
27 Conduct General Medical Check-up for all Project HSE Plan General Medical All employee of All Result of General Medical As require CM, Medical
Sub Contractor employee Check-up Form SubContractor employee Check-up Advisor
who assign to the Project

28 Vital Check for high risk worker Project HSE Plan Vital Check Blood pressure check for Daily check for high risk Daily Medical Advisor &
high risk worker worker, no indication of high HSE Chief
blood pressure
Incident Injury Free® Program
To implement IIF® program to the entire Project HSE Plan IIF® Program Engage JMJ, start Activitities report (Training as required (see PM, CM, HSE
EPC RDMP Lawe-Lawe Project implement IIF ® Program attendees, observation etc) attached table) Chief or HSEM
at RDMP Balikpapan Project
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HSE PROGRAM
RDMP LAWE-LAWE CPPHK
ENVRONMENTAL PROGRAM
PROCEDURE /
HEALTH & SAFETY ACTIVITY PLAN PRIMARY
NO APPENDIX WHAT’S TO BE DONE? HOW DO WE CHECK? FREQUENCY
/EXPECTATION RESPONSIBILITY
REFERENCE
1 Waste Management Control Project HSE Plan Control the schedule waste - Master List and inventory of As required CM, Discipline
management (Hazardous scheduled waste, - Storage of Superintendent, HSE
Chemical Material) and provide hazardous waste, - COMPANY Chief
MSDS at site. for handling waste schedule must
registered by 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 Monitoring form completed Monthly CM, HSE Chief
by the site drainage

3 Communicate Contractor Environmental Project HSE Plan All project Contractor staff, Induction record, Record daily As required CM, HSE Chief
Policy & Procedure SUBContractor staff and visitor tool box meeting, minute of
meeting and attendance all HSE
Meetings

4 Ensuring that operations are carried out Project HSE Plan Developing environmental Standard instruction is developed, All works shall Site Supervisor, HSE
according to environmental standard standard instruction or review communicated and maintained covered by Chief
existing or template standard
environmental standard instruction
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
reporting investigation form investigation and 1 Superintendent, HSE
x 24 hours for Chief
accident reporting

6 Rules & Regulation at site: use drug and Project HSE Plan All project Contractor staff, Result of monitoring Monthly CM, HSE Chief
alcohol and carry weapon SUBContractor staff and visitor

7 Encourage behavior awareness Project HSE Plan All unsafe act and unsafe Complete unsafe act and unsafe Every Day All Project Team
condition condition form
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Attachment 6 PPE Matrix

PPE MATRIX
PPE Minimum Welding Grinding Excavation Rigging Electrical Confined Space
ANSI Z89.1 - 2003, ANSI Z89.1 - 2003, T ype I ANSI Z89.1 - 2003, T ype I ANSI Z89.1 - 2003, ANSI Z89.1 - 2003, ANSI Z89.1 2003, T ype ANSI Z89.1 - 2003,
Helmet (yellow color)
T ype I class G and E class G and E class G and E T ype I class G and E T ype I class G and E I class E T ype I 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 SNI Standard or AST M F SNI Standard or AST M F SNI Standard or SNI Standard or AST M F 2413-2005 SNI Standard or
AST M F 2413-2005 2413-2005 Impact 2413-2005 Impact AST M F 2413-2005 AST M F 2413-2005 Impact Resistance Class AST M F 2413-2005
Impact Impact Impact 75 (I/75) Impact
Resistance Class 75 (I/75) Resistance Class 75 (I/75) Resistance Class 75
Resistance Class 75 and Compression and Compression Resistance Class 75 Resistance Class 75 (C/75) with electrical Resistance Class 75
(I/75) and (I/75) and (I/75) and protection such as (I/75) and
Safety Shoes Compression Resistance Class 75 (C/75) Resistance Class 75 (C/75) Compression Compression o Electric shock Compression
resistance (EH) up to
Resistance Class 75 Resistance Class 75 Resistance Class 75 14,000 V or Resistance Class 75
(C/75) (C/75) (C/75) o Static Dissipative (SD), (C/75)
106 ohms - 1010 ohms
or
o Conductive (CD), 0-
- ANSI S3.19 - 1974 - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 - ANSI S3.19 - 1974 - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974
for NRR labeling NRR labeling NRR labeling for NRR labeling for NRR labeling NRR labeling for NRR labeling
Ear Plug
- ANSI S12.6 – 1997 - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 - ANSI S12.6 – 1997 - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997
for NRR testing NRR testing NRR testing for NRR testing for NRR testing NRR testing for NRR testing
- ANSI S3.19 - 1974
for NRR labeling
Ear Muff
'- ANSI S12.6 – 1997
for NRR testing
NIOSH T itle 42 CFR NIOSH T itle 42 CFR 84-
Respiratory Protection
84-1995 1995
ANSI Z87.1 - 2003 - High
Face Shield
Impact Level Protection
ANSI Z87.1 2003 - High
Welding Helmet
Level Protection
SCBA NIOSH T itle 42-1995
SABA NIOSH T itle 42-1995
EN407–2004 for EN407–2004 for AST M D 120–2006
flammability, contact heat, flammability, contact heat, Specification for Rubber
convective heat, radiant convective heat, radiant Insulating
Hand Protection N/A
heat, small splashes molten heat, small splashes molten Gloves (electrical)
metal or large splashes of metal or large splashes of
molten metal molten metal
ANSI Z359.1: Safety
Requirements for ANSI Z359.1: Safety Requirements for Personnel Fall
Fall Protection Personnel Fall Arrest
Systems, Subsystems Arrest Systems, Subsystems and Components (MANDAT ORY ONLY FOR WORKING ABOVE 6 FEET )
and 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)
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Attachment 7 Incident Process Flowchart

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

2. PROTECT 2. Gather evidence that might disappear from rain of work activities

3. SELECT TEAM 3. Based on investigation team matrix

4. Information Collection
People, Equipment, Environment, Systems:

Induction/training records Inspections / audit records Maintenance schedules and

procedures

License/Certificates of Manufacturer equipment Operating manual

4. COLLECT
competency manual
INFORMATION

Permits Purchasing records, Procedures / rules

warranties etc

Checker MSDS Other authorities reports

(Police, client)

4
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INCIDENT PROCESS FLOWCHART

5. SEQUENCE OF 5.a Incident Description,what happened , who Injured/Involved, time of incident,

EVENTS

5.a Incident description

5.b. Organize information collected to Go back in time

display full of events

Review what else needs investigating Start thinking what contributed

5.b. Place Information on a whiteboard

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

6.Place Information on a whiteboard

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INCIDENT PROCESS FLOWCHART

7. PLAN FURTHER 7. Investigate undecided/unknown items that are from the Sequence of Events and the
INVESTIGATION Y Tree.

7. What else needs investigating?

8. UPDATE 8. Rearrange or add to sequence of events if required

SEQUENCE & Y
TREE

8.Update both Sequence and Y tree using “post it”

9. DETERMINE 9. All answers on the Y Tree are contributing factors.

CONTRIBUTING
FACTORS Must know determine which are the main factors to highlight in the report and
undertake Corrective actions. Focus on those factors for which:
The incident would not have happened if the factors were not present
There are practical actions to prevent recurrences

9. List contributing factors

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INCIDENT PROCESS FLOWCHART

10. ACTION FOR 10. Brainstorm ideas

ADRESSING ▪ Seek expert advise
CONTRIBUTING ▪ Apply quick fixes until long term solutions are available
FACTORS ▪ Test the actions:
Critically - Timing - Cost - University* - Responsibility - Alternatives
(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. SITE REVIEW 11. Conduct review to ensure all the facts are correct and everyone is in agreement
with the findings and proposed actions

11. List names of people in review

12. PRODUCE 1) Cover Page 5) Background 9) What controls were in

REPORT 2) Executive Summary 6) InvestigationPlan place
3) Keyrecommendations 7) Incident Description 10) Action
4) Investigation team 8) Incident Causes 11) Attachments
12) Use standard headings
Attach photos, permits,
training records, etc

12
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Attachment 8 HSSE Organization Chart

HSE ORGANIZATION CHART

CPPHK HSSE MANAGER

Aris Wahyudiono

DEPUTY HSSE MANAGER

2 PERSONS

HSE SUPERINTENDENT/CHIEF HSE

4 PERSONS

HSE ENGINEER

2 PERSONS

HSE SUPERVISOR S/I

PERMIT CONTROL HSE INSPECTOR ADMIN HSE HSE TRAINER SITE DOCTOR
(S/I) ENVIRONMENTAL

2 PERSONS 8 PERSONS 4 PERSONS 2 PERSONS 4 PERSONS 2 PERSONS 1 PERSON

PARAMEDIC
/NURSE

4 PERSON
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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?

8 Alter or add processes, plant or equipment requiring new skills, knowledge or 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 to be lifted,
11
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 vibration
13
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.
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CHANGE MANAGEMENT REQUEST FORM

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)

LOW 1. JSA to be re-reviewed and re-written to incorporate with the change occur.

MEDIUM 2. Requirements 1 and method statement may need to be provided and approved.

HIGH 3. Requirements 2, Conduct a Risk Assessment Workshop 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.

When does the change need to take place and why?

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CHANGE MANAGEMENT REQUEST FORM

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.

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 )

Print name in full Signature Date

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

Print name in full Signature Date

CONSTRUCTION MANAGER (MEDIUM RISK)

Print name in full Signature Date

PROJECT MANAGER (HIGH RISK)

Print name in full Signature Date

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CHANGE MANAGEMENT REQUEST FORM

ADVERSE CONSEQUENCE OF CHANGE MATRIX

Change
Minor Serious Major
Consequence Type
Impact on safety/harm to Low level Serious Permanent loss of Single or multiple
people symptoms injury/permanent working ability, fatalities or
requiring first aid disability or irreversible irreversible impacts
treatment only. impairment to one damage. Localised to multiple people.
Working conditions or more persons. outbreak of Widespread
causing discomfort Serious reversible infectious disease outbreak of
or strain. health effects infectious disease.
requiring medical
treatment.

Environmental impact Limited damage Localised medium Wide spread Significant,

contained to a term damage to an /significant long extensive &
localised area, area of local value term damage to permanent impact.
with no lasting reversible with valued area, Loss of permit to
impact. Nuisance medium term reversible with long operate. Loss of
local impact (eg remediation. term remediation. endangered species.
dust, noise) with Directive from Suspension of
no complaints. regulator resulting operations.
from nuisance
impacts.

Impact on Schedule < 1 day 1-4 weeks 4-12 weeks > 12 weeks

Cost Impact < $100,000 $500,000 to $5,000,000 to >$25,000,000

$5,000,000 $25,000,000

Impact on Reputation Minor technical Attention from Significant negative Prolonged negative
non-compliance media, negative attention, national international
resolved within local & regional publicity. publicity. Reputation
one week. No publicity. Moderate Reputation severely tarnished.
media coverage. or Serious breach tarnished. Legal
of regulations with action.
fine.

Impact on Community Local public Ongoing social Ongoing serious Very serious social
concern issues. Aggressive social issues. impacts. Irreparable
/complaints. No community Repairable damage damage to high value
compensation reaction. to high value items items of social
required. Suspension of of social significance.
project works. significance. Government
External arbitration intervention.
required.

Legal impact Minor non- Serious breach of Major breach of Significant

compliances and regulation with regulation. Major prosecution and
breaches of prosecution or litigation. fines. Very serious
regulations. moderate fine litigation including
possible. class action.

LEGEND : LOW
MEDIUM
HIGH
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CHANGE MANAGEMENT REQUEST FORM

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.

No. 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
16
17
18
19
20
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Attachment 10 Hazard Identification Risk Assessment & Control (HIRAC)

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 Lawe-Lawe 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

Legal Init ial Risk Value Residual Risk

Risk Ident ificat ion Pot ency of Major
Operat ion
Source of Int roduct ion No. Incident Hierarcy of Addit ional
No Process / Act ivit ies Condit ion HS E Exist ing Cont rol PIC
Act ivit y Hazard Cat egory Consequency Hazard Regulat ion Tot Cont rol Tot Cont rol Planned
(N/A/E) Hazard/Aspect Det ail Risk Explanat ion Consequency S P R S P R
Cat egory Code Score Score
Y/N Y/N
H OS E PS Y/N

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25
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Attachment 11 Job Safety Analysis (JSA)

JOB SAFETY ANALYSIS (JSA)

24-Sep-19

JSA JSA Team Members

CPPHK
( Job Safety Analysis )
Engineering, Procurement, Construction Approval Position Names Date Signature
Tanggal Pelaksanaan Pekerjaan
Prepared Subcontractor SPV / Foreman
Job Execution Date

Pelaksana Pekerjaan
Checked Contractor SPV / Lead Eng
Job Responsible Person

Lokasi Pekerjaan
Approved Site Controller
Job Location

Aktivitas Pekerjaan JSA Team, confirm that the risks for the task described have been reviewed and the
control which are recomended reduce the risk to ALARP and they consider it is safe so
Job Activities
the task can proceed & confirm that a work site visit has been conducted prior to the
completion of the risk assessment.

JSA No :

Risk Rank = Probability Likelihood x Severity Consequence

Score Level Probability / Likelihood Description Severity Index Description

The event is expected to Death, Permanent serious environmental damage, multiple fatalities damage, toxic
13 -25 High 5 - Frequent 5 - Catastrophic release of site, huge financial loss.
occur in most circumstance

Lost time icident, permanent/partial disability, non permanent environmental damage,

6 - 12 Medium 4 - Probable Will occur frequently 4 - Major
high financial loss.

Medical treatment required/work restriction, high financial loss, on site release contained
1-5 Low 3 - Occasional Will occur several time 3 - Moderate
with outside assistance
Unlikely, but it can
2 - Unlikely reasonable be expected to 2 - Minor First aid treatment, on site release immediately contained medium financial loss
occur
Unlikely to occur but
1 - Improbable 1 - Negligible No affecting work performance, No injury, low financial loss.
possible
Note : * : Without Control / Tanpa control ; *): With Control / Dengan control Remark :
Our Objectives are Zero Illness, Zero Injury, Zero Property Demage/Loss and Zero Environmental Damage

ASSESSMENT AND CONTROL

IDENTIFICATION
Initial Ris k Re s idual Ris k
Pe rs on In
No. Activity Hazard / As pe ct Effe ct / Impact P S R* Control Me as ure P S R*) ALARP ? Status
Charge
 EPC OF LAWE-LAWE FACILITIES RDMP
RU-V B ALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 157 /154

JOB SAFETY ANALYSIS (JSA)

ASSESSMENT AND CONTROL

IDENTIFICATION
Initial Risk Re sidual Risk
Pe rson In
No. Activity Hazard / Aspe ct Effe ct / Impact P S R* Control Me asure P S R*) ALARP ? Status
Charge

NOTE : IN EVENT OF EMERGENCY, STOP ALL ACTIVITY, TURN OFF ALL EQUIPMENT AND MAKE SAFE AND GO TO MUSTER POINT.
E : Elim ination Control Mn : Im pact to the pers on or hum an
S : Subs titution Control Fc : Im pact to the facilities or property dam age
G : Engineering Control En : Im pact to the environm ent
A : Adm inis tration Control
P : PPE control
 EPC OF LAWE-LAWE FACILITIES RDMP
RU-V B ALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 158 /154

JOB SAFETY ANALYSIS (JSA)

24-Sep-19
JSA HSE Job No. :
CPPHK ( Job Safety Analysis )

JSA No :

DAFTAR PENJELASAN JSA

Tanda Tangan
No Nama Posisi
Tgl : Tgl : Tgl : Tgl : Tgl : Tgl : Tgl :
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
 EPC OF LAWE-LAWE FACILITIES RDMP
RU-V B ALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 159 /154

Attachment 12 Job Hazard Analysis (JHA)

JOB HAZARD ANALYSIS (JHA)

Company : Job Location :

SV/Foreman Name : Job Description :

Position/ Title job :

Job Location :

Date : Approved by :
(SV/Foreman
Revision : Signature)

In case of emergency condition and/or incident, the following people will be contacted:

SV/Foreman Name Phone No.

1 Phone No. :
2 Phone No. :
3 Phone No. :

No. Job Steps/Sequences Potential Hazard(s) Recommended Action

10

11

12

On what conditions, job changes or distraction will this activities temporarily stop?
 EPC OF LAWE-LAWE FACILITIES RDMP
RU-V B ALIKPAPAN
Doc. No. : 26076-110-G90-GHX-00001 Rev No. : 006
PROJECT HSSE PLAN
Job No. : 26076 Page No. : 160 /154

Attachment 13 Penalty System

EPC LAWE-LAWE FACILITIES PROJECT
RDMP RU V – BALIKPAPAN
PENALTY SYSTEM
PENALTY
No. FOUL (DESCRIPTION) POINT
OUT
Work in progress IMMEDIATELY stop and Workers are terminated from the project DIRECTLY:
1 Working or driving under the influence of alcohol or drugs 3-OUT 6
2 Working without work permit 3-OUT 6
3 Smoking in hazardous areas (such as: inside plant, near fuel storage) 3-OUT 6
4 Remove Lockout/Tag out device without permission from authorized person 3-OUT 6
5 Operate permanent equipment without written permission from CPPHK operation 3-OUT 6
6 Dismantle and modify scaffolding without authorization 3-OUT 6
7 The misuse of legitimate drugs, alcohol and any weapon both use or carry to project site 3-OUT 6
8 Physical harassment and fight with other at site 3-OUT 6
9 Thief and other criminal act that violate the law 3-OUT 6
10 Sex Harassment 3-OUT 6
Work in progress IM M EDIATELY stop and Workers are subject to disciplinary action:
1 Carry out work when do not have the right tools for the job and the environment 2-OUT 2
2 Access installations or perform work without wearing general or task-specific PPE 2-OUT 2
3 Performing work without a valid work permit 2-OUT 2
4 Walking or standing under a load while lifting is taking place 2-OUT 2
5 Entering a confined space before obtain authorization 2-OUT 2
6 Working at height without a safety harness when there is no collective protective equipment (> 1.8 m) 2-OUT 2
7 Entering restricted areas without permission 2-OUT 2
8 Not wearing proper PPE in the work area 2-OUT 2
9 Industrial acetylene & oxigen cylender in the field without being equipped with flash back arrestors 2-OUT 2
10 Unauthorized persons entering or near the heavy equipment during equipment operation 2-OUT 2
11 Open new area / make a hole / remove the barrier without safety protection 2-OUT 2
12 Operated the equipment without a permit or license (machine) / unqualified person 2-OUT 2
13 Excavation without safety protection 2-OUT 2
14 Dismantling the safety facilities without permission 2-OUT 2
15 The person who are caused the near miss happen 2-OUT 2
16 Disobey HSE team instructions in order to improve safety on site 1-OUT 1
17 Sleep on working area / rest near working area 1-OUT 1
18 Driving on the site above the maximum speed limit / wrong parking / wrong direction of the road 1-OUT 1
19 Dumping or stacking the material not in the right place 1-OUT 1
20 Electrical equipment not being equipped with earthing / grounding / ELCB / double insulation cable 1-OUT 1
21 Using lifting tool / tackle without being equipped with certificate / certificate expired 1-OUT 1
22 Ignored housekeeping 1-OUT 1
23 Communication using mobile phones on prohibited area 1-OUT 1
24 Use work equipment with substandard (as per international regulation) 1-OUT 1
25 Continually instruct or execution of unsafe work 1-OUT 1
26 Not providing adequate equipment to workers during activity 1-OUT 1
27 Intentionally not attended Tool Box M eeting on time 1-OUT 1
Verbal warning, the ID Card will be pounched on a green circle : 1-OUT Minor offence
Discuss with HSE team and written warning, the ID cards will be punched on yellow circle, that person should
: 2-OUT Major offence
attended training by contractor and the person can work after training done
Terminated from the Lawe-lawe Project : 3-OUT Serious offence