HSE

Onshore LNG
Tangguh Expansion Project
Indy Bintaro Office, 7th Floor

JI. Boulevard Bintaro Jaya Blok B7/A6 Sektor VII CBD Bintaro Jaya,
Tangerang Selatan - 15224, Indonesia
SECTION B.05 HEALTH, SAFETY & ENVIRONMENTAL (HSE) MANAGEMENT
XXX-XXX-003 Pre-Qualification Questionnaire
Page 1 of 16
Onshore LNG Feed

Please note that responses to all questions under Section B.05 are mandatory.
B.05.1 - Safety Record
What is your companys safety record, both for the current year and for the last five years?
Please input your data below.
Alamanda Tower, 3rd Floor

JI. TB. SimatupangKav. 23-24, Cilandak Barat
Jakarta 12430, Indonesia
Tel: +6221 3002 2100
B.05.2 - HSE Management System

a)
Does your company operate an HSE management system complying with ISO 14000, OHSAS
18001 or a similar recognized standard?

JI. Boulevard Bintaro Jaya Blok B7/A6 Sektor
VII CBD Bintaro Jaya,Tangerang Selatan 15224, Indonesia
Onshore LNG
Yes
No
Include copies of the following:
Your HSE Policy

The cover page and contents page of your corporate HSE Management System Manual
Your current HSE-related accredited certification
Your accredited certification: please check as appropriate:

ISO 140001
OHSAS 18001
HACCP
Other ( ISO 9001
b) Provide a summary and include examples of established HSE performance goals that are supported
by senior management. Describe any established programs to increase worker HSE awareness and
motivate workers to be actively involved in HSE activities
For the Program and HSE activities can found at : Attached in Training data follow up matrix
B.05.3 - Safety Manuals & Procedures
a)
b)
c)
d)
e)
f)
Does your company have a Safety Manual and Safety Procedures?

Yes
No
If yes, please provide the list of documents complete with the revision states and the date issuance.
Is a dedicated Safety Professional appointed to manage HSE?
Yes
No
If yes, how many years experience he gained in HSE? 3 years experience
Please provide your company HSE organization chart and explain the roles and responsibilities for
each positions.
Describe any established fitness for duty program, which address medical screening, physical
condition and substance abuse consideration.
Please comment below or by separate attachment.
Tingkat kesehatan karyawan kami menjadi yang utama, kami menerapkan jam kerja normal 8 jam sesuai
peraturan yang ada. Makan teratur disesuaikan jam kerja dan untuk tetap menjaga tingkat kesehatan setiap
karyawan kami.
The health level of our employees to be the main one, we apply the normal working hours of 8 hours in
accordance with existing regulations. Eating regularly adjusted working hours and to maintain the level of
health of each of our employees.
Provide with Summary MCU and example MCU one of other our employee
g) Is safety training part of your company policy?

Yes
No
h) Describe your documented SHE training and orientation program. Provide a listing of available
training modules and indicate the frequency and duration of each session. Include examples of
completed training records for workers.
Duration HSE training program duration is 15 to 30 minutes along with a safety briefing every morning,
training materials related to HSE and discuss work to be performed.
However, if the HSE training materials, requires a long duration, usually ask for time off work to provide
the training operation.
Page 4 of 16
Onshore LNG
i)
j)

Are Craft and safety competency training records available?

Yes
No
Describe any established incident management procedures and emergency response plans. Provide
a copy of these procedures.
SPT-QHSE-QP-022 (Incident Procedure)

SPT-QHSE-QP-020 (Emergency Response)
k) Is your company prepared to allow safety audits to be conducted? Yes
l)
No
Does your company have disciplinary Procedure addressing life threatening relations?
Yes No
m) Describe any established hazard assessment programs, which recognizes, evaluates and controls
HSE-related hazards associated with your operations. Describe any periodic HSE-focused
inspections and walkthroughs of your work sites. Summarize these efforts and include at least one
example of a completed hazard assessment and one example of a completed inspection or
walkthrough.
Hazard assessment programs that exist and the appropriate operation of our company, lighting inspection,
noise inspection, inspection work climate, work area inspection, the inspection period ie once a month.
n) Describe any established SHE guidelines used when screening, selecting and monitoring
subcontractors. Provide a summary of these applicable guidelines.
Each of our subcontractors in screaning and selected to give a special document "QHSE and Evaluation
Quetionnaire" concerning which there are questions regarding the involvement of HSE in every job.
B.05.4 - Environmental Management System & Sustainability

a) Does your company have an environmental management program?
Yes
No
b) When purchasing raw materials, does your company inquire about potential harmful effects of the
materials, or their origins?
Yes
No
c) Is there a segregation area for hazardous materials?
Yes
No
d) Are personnel aware of environmental issues?
Yes
No
e) If yes, how do you assure that?
By providing socialization Impact Of Company 's business field to the Environment.
Always socialize as well as regulatory and compliance systems of companies and workers against the
regulation.
The Company IS ALSO implementing a program of separation of waste by type , to preserve the
Page 5 of 16

Onshore LNG
environment.
For The Appendix is : .
f)
Are there any products, goods or services provided by you that

could cause harmful or toxic pollutants?
g) Does your company consider itself to be environmentally aware?
Yes
No
Yes
No
h) Does your company have experience in executing construction work with due regard toward
sustainability of the environment in advanced countries and in remote and environmentally
sensitive project locations?
Yes
No
Please provide examples below, (or on a separate sheet), from your previous projects.
On progress- sedang mengerjakan konstruksi VCO CROSS OVER BRIDGE
SECTION B.06 QUALITY MANAGEMENT SYSTEM

Please note that responses to all questions under Section B.06 are mandatory.
B.06.1 - Does your company have a documented Quality Management System for QA Manual and procedures
(NCR procedure, Audit procedure, CAR, PAR, NCR and Document Control procedure)?
Yes
No
If yes, please provide Quality Manual and Procedures list
Procedur list and Appendix:
a. QHSE Manual Control (SPT-QHSE-QP-002)
b. Document and Data Control (SPT-QHSE-QP-005)
c. Control of Non-Conformance (SPT-QHSE-QP-008)
d. Corrective and Preventive Action (SPT-QHSE-QP-009)
e. QHSE Records (SPT-QHSE-QP-010)
f. Internal Audit (SPT-QHSE-QP-011)
B.06.2 - Does your company have dedicated function to the Quality department in its Organization Chart?
Yes
No
If yes, please fill the following table and provide the updated organization chart with names
QA/QC Manager name and surname:
Roman Zerr
QA/QC /Manager contact person
031-7341401
Specify if you use external Companies

for tests and inspections
No
Our Company is Inspection services.
Page 6 of 16

Onshore LNG
B.06.3 - Does your company have periodic improvement program such as Process Objective or KPI as part of
the Quality Management System?
Yes
No
If yes please provide recently KPI which related to QA/QC
Attachedment: CSS (Customert Satisfaction Survey) and MO (Mission Order)
B.06.4 - Has the subcontractor produced Inspection Testing Plan (ITP)?
If yes please provide the sample of ITP related to SOW or services
Yes
No
B.06.5 Does your company have ISO 9001:2008 QMS Certificate?

Yes
No
If your answer is Yes, please fill the following table and provide the copy of the certificate
ISO 9001:2008 Certificate No.
Fs 601773
Scope of Certification
The provision of inspection, certification, non

destructive testing, maintenance and technical
supplier seruices
Certifying Agency
BSI
Actual Certification release date
11/10/2013
Expire Certification date
10/10/2016
If your answer is No please state below how quality is controlled:

-
SECTION B.07 INDUSTRIAL RELATIONS, GOVERNEMENT RELATIONS

AFFAIRS, LABOR RELATIONS AND WORKFORCE STABILITY
AND
PUBLIC
B.07.1 - Industrial Relations

Does your company have experience in industrial relations in workshop and construction site
environments, including dealing with appropriate local and national authorities and trades unions?
Yes
No
Please provide examples below, (or on a separate sheet), from your previous projects.
-
B.07.2 - Describe the history of any substantial work you have performed within the governmental boundary of
the proposed site location for this CSTS JO project or in locations nearby or similar. Describe also
your experience with public and community affairs in this area.
Page 7 of 16
Onshore LNG

Our Project under BP Indonesia In site location for this CSTS JO

Our team experience for all permit to work and communicate with public in this area always
underBP Indonesia, and our team just perform to work. For all our team activity cover with BP
Indonesia. Compaitable with SOP and Permit with BP Indonesia.
B.07.3 - Describe your experience with public and community affairs in this area
Same with before question
B.07.4 - LABOR RELATIONS AND WORKFORCE STABILITY

a) Describe the labor agreements in place at your company that are applicable to work in the location
of the described CSTS JO project. Provide details and the expiration date of such agreements.
Not yet have agreements with CSTS JO
b) Relative to work in the location of the described CSTS JO project, list any labor strikes or other
work stoppages at your company or on a project you were associated with during the last five years. If
stoppages have occurred during the past two years, identify what action has been taken to avoid
similar stoppages in the future.
We do not have any problem with labor strikes or other work stoppages at our company, Good
communication with all employees.
c) For working in the location of the described CSTS JO project, describe how labor relations are
managed by your company.
Page 8 of 16
Onshore LNG

SECTION B.08 INFORMATION TECHNOLOGY

B.08.1 - Information Technology
a)
Does your company utilize computer hardware and software programs for engineering and project
management, including procurement and construction management?
Yes
No
In Progress
Please check all items that apply:
i. Engineering
Engineering & Design
ii.Project Execution
Planning & Scheduling
Procurement & Logistics
Other (
)
Other (
)
Other (
)
iii.
Construction
Construction Progress Monitoring

Heavy Lift & Transportation Planning
Material Control
Personnel Gate Control
Pipe Spool & Structural Steel Status Tracking
Pipe Welding & Inspection Control
Turnover & Completion
Other (
)
Other (
)
Other (
)
b) Please provide details of the IT systems that your company utilizes under the above headings:
-
Page 9 of 16

Onshore LNG
Annex I
(Work History & Current Projects)
(Page 1 of 2)
(Work History)
Company Name:
Location:
Projects Completed
Client
PT. Bureau
Veritas
Indonesia
T. Vantage
Drilling
Company
Indonesia
Name of Project
Location
Work Category
BP Tangguh Papua
Contract
Value
(US$)
41,231.87
Topaz Rig Vantage,

Madura
15,000.00
Scope
of
Work
Provision of
Lifting
Inspector
Competence
Person 2015
6
Montly
Lifting Gear
Inspection &
Drilling Tools
NDT
on
Boards
and
Onshore
Type
of
Contract
Yearly
Lump
Sum
Year
Completed
Peak
Manpower
2015
Inspector
2016
Inspector
PT. Bonne
Batam
23,363.07 QAQC OCTG Per Day
2016
Inspector
Indoteknik
PT. Petronas Lamongan Shorebase 13,703.00 NDT Test of Per Unit
2016
Inspector
Carigalli
Lifting Gears
Indonesia
Notes:
i. If you have no work experience with CSTS JO, please provide the names and contact details of persons to
contact with your other clients for reference purposes.
ii.In entering data in the above table please use the following abbreviations:
Scope of Work
E: Engineering
P: Procurement
C: Construction
O: Other
Type of Contract
L: Lump Sum
C: Cost Plus
U: Unit Price
Annex I
(Work History & Current Projects)
(Page 2 of 2)
(Current Projects)
Company Name:
Location:
Projects under Construction
Client
Project Name
Contract
Scope
Type
Construction Schedule
Peak
Page 10 of 16

Onshore LNG
Location
Work Category
Value
(US$)
of
Work
PT.
Bourbon
Indonesia
335,362.78
Construc
tion
work
agreeme
nt
PT.
Bourbon
Indonesia
2,719,45
PT. COSL Indo
23,884.32
5,112.78
PT.
Eastern
Logistics
PT. ELNUSA
1,315.78
OEG
3,520.00
PT. Prasadha
Pamunah
Limbah
Industri
PT.
Bureau
Veritas
Indonesia
2,233.08
Samudra
Marine
Project
PRV &
Preassur
e Gauge
Inspectio
n
Lifting
Gears
MPI
CCU
MPI
CCU
MPI
DCB
Provisio
n of
Lifting
Inspector
Compete
nce
Person
2016
80,542.32
of
Contra
ct
Lump
Sum
Start
Peak
Finish
Manpower
Jun 16
Sub Cont
Lump
Sum
Jun 16
Inspector
Lump
Sum
Jun 16
Inspector
Per
Unit
Per
Unit
Per
Unit
Per
Unit
May 16
Inspector
Jun 16
Inspector
Jun 16
Inspector
May 16
Inspector
Per
Day
Jan 16
Dec 16
Inspector
Notes:
Scope of Work
E: Engineering
P: Procurement
C: Construction
O: Other
Type of Contract
L: Lump Sum
C: Cost Plus
U: Unit Price
Annex II
(Construction Equipment)
Company Name:
Location:
List of Construction Equipment
Page 11 of 16

Onshore LNG
Equipment Type
Bulldozer:
Capacity
D6 & above
Under D6
370 cfm & above
150 cfm & above
10 Ton & above
Under 10 Ton
300 A & above
300 kVA & above
200 kVA & above
100 kVA & above
Compressor:
Dump Truck:
Engine Welder:
Generator:
Heavy Equipment Lifter:

(Ginpole and/or Gantry)
Mobile Crane:
800 Ton & above

400 Ton & above
100 Ton & above
50 Ton & above
20 Ton & above
Under 20 Ton
Shovels:
(Power-Shovel, Back Hoe, etc.)
Tractor/Trailer:
50 Ton & above

20 Ton & above
20 Ton & above
10 Ton & above
Truck:
Other (
):
Quantity Owned
Average Age
Annex III
(Estimated Future Workload)
Company Name:
Location:
Estimated Future Workload
Page 12 of 16

Onshore LNG
Client
Name of Project
Location
Work Category
Contract
Value
(US$)
Scope
of
Work
Type
of
Contract
Year
Completion
Peak
Manpower
Notes:
Scope of Work
E: Engineering
P: Procurement
C: Construction
O: Other
Type of Contract
L: Lump Sum
C: Cost Plus
U: Unit Price
Annex IV
(Productivity: Overall)
Company Name:
Location:
Please indicate your companys productive man-hours for the various categories of work stated below for the
last full year for which you have records available. You should also indicate the breakdown of your figures (as
percentages both in terms of project types and locations) in the boxes provided.
a)
Overall Work Volumes and Man-Hours

You should provide the work volumes and man-hours expended per work category specified in the table
below for the last full year for which you have figures available (please indicate the year in the box
provided):
Year of Data:
Overall Work Volumes and Man-Hours per Work Category for Full Year
Work Category
Unit
Work Volume
Piling:
Number (piles)
Civil Works:
m3 (concrete)
Buildings:
m2 (floor area)
Furnace Steel:
Ton (steel)
Man-Hours
Page 13 of 16

Onshore LNG
Structural Steel: Pre-Fabrication:
Structural Steel: Installation:
Equipment Installation:
Piping: Pre-Fabrication:
Piping: Installation:
Electrical Installation:
Instrumentation Installation:
Painting:
Insulation:
Ton (steel)
Ton (steel)
Ton (equipment)
Dia. Inch (pipe)
Dia. Inch (pipe)
Linear Meter (cable)
m2 (painting)
m2 (insulation)
b) Project Type & Project Location

You should provide a breakdown of the work that the above figures represent as percentages per project
type and project location:
Project Type
Chemical Plant:
Gas Plant (LNG / NGL):
Power Plant:
Petrochemical Plant:
Petroleum Refinery:
Other Industrial Plant:
Industrial Building:
Commercial Building:
Land Infrastructure:
Marine Infrastructure:
Other Infrastructure:
Total:
Percentage
100%
Page 14 of 16

Onshore LNG
Annex V
(Productivity: Individual Projects)
(PLEASE FILL THIS FORM FOR EACH PROJECT)
Company Name:
Location:
Please indicate your companys productive man-hours for the various categories of work stated below for the
last five completed projects for which you have records available. You should also indicate the project type and
location in the appropriate boxes.
a) Project #1
i. Please indicate the project name and construction period:
Project Name:
Start (month/year):
Finish (month/year):
ii.Please indicate the project type:
Chemical Plant
Gas Plant (LNG/NGL)
Power Plant
Petrochemical Plant
Petroleum Refinery
Other Industrial Plant (
Industrial Building
Commercial Building
Land Infrastructure
Marine Infrastructure
Other Infrastructure (
Other Construction (
)
)
iii.
Please provide the work volumes and man-hours expended per work category specified in the
table below for the above project:
Overall Work Volumes and Man-Hours per Work Category for the Project
Work Category
Unit
Work Volume
Piling:
Number (piles)
Civil Works:
m3 (concrete)
Buildings:
m2 (floor area)
Furnace Steel:
Ton (steel)
Structural Steel: Pre-Fabrication:
Ton (steel)
Structural Steel: Installation:
Ton (steel)
Equipment Installation:
Ton (equipment)
Piping: Pre-Fabrication:
Dia. Inch (pipe)
Piping: Installation:
Dia. Inch (pipe)
Electrical Installation:
Instrumentation Installation:
Painting:
m2 (painting)
Insulation:
m2 (insulation)
-
Man-Hours
-
Page 15 of 16
Onshore LNG

QUESTIONNAIRE COMPLIANCE CHECKLIST
Form/Attachment
Questionnaire
Parent Company Guarantee (If required)
Bank References
Audited financial statement for the last 3 (three) years period.
Company Organization Chart
HSE Policy
HSE Management System Manual
Current HSE related accredited certification
HSE Organization Chart
Quality Manual and Procedures list
Quality Organization Chart
Recently KPI which related to QA/QC
Sample of ITP
Current Copy of quality related accredited certification ISO 9001: 2008
Other Certificate related to QA/QC
Annex I work volumes and productive man-hours
Annex II work volumes and productive man-hours for the various categories of
works for the last five completed projects.
Annex III Work History and current projects
Annex IV Construction Equipment List
Annex V Estimated Future Workload
Page 16 of 16

HSE

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

HSE

Uploaded by

Copyright:

Available Formats

Onshore LNG

Tangguh Expansion Project

Indy Bintaro Office, 7th Floor

SECTION B.05 HEALTH, SAFETY & ENVIRONMENTAL (HSE) MANAGEMENT

XXX-XXX-003 Pre-Qualification Questionnaire

Onshore LNG Feed

Alamanda Tower, 3rd Floor

B.05.2 - HSE Management System

Indy Bintaro Office, 7th Floor

Include copies of the following:

Your HSE Policy

Your accredited certification: please check as appropriate:

Does your company have a Safety Manual and Safety Procedures?

g) Is safety training part of your company policy?

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

Are Craft and safety competency training records available?

SPT-QHSE-QP-022 (Incident Procedure)

B.05.4 - Environmental Management System & Sustainability

Indy Bintaro Office, 7th Floor

Are there any products, goods or services provided by you that

SECTION B.06 QUALITY MANAGEMENT SYSTEM

QA/QC /Manager contact person

Specify if you use external Companies

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

B.06.5 Does your company have ISO 9001:2008 QMS Certificate?

The provision of inspection, certification, non

Actual Certification release date

Expire Certification date

If your answer is No please state below how quality is controlled:

SECTION B.07 INDUSTRIAL RELATIONS, GOVERNEMENT RELATIONS

B.07.1 - Industrial Relations

Indy Bintaro Office, 7th Floor

Our Project under BP Indonesia In site location for this CSTS JO

B.07.4 - LABOR RELATIONS AND WORKFORCE STABILITY

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

SECTION B.08 INFORMATION TECHNOLOGY

Construction Progress Monitoring

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

Topaz Rig Vantage,

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

PT. COSL Indo

Indy Bintaro Office, 7th Floor

Heavy Equipment Lifter:

800 Ton & above

50 Ton & above

Indy Bintaro Office, 7th Floor

Overall Work Volumes and Man-Hours

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

b) Project Type & Project Location

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

XXX-XXX-003 Pre-Qualification Questionnaire

Indy Bintaro Office, 7th Floor

QUESTIONNAIRE COMPLIANCE CHECKLIST

XXX-XXX-003 Pre-Qualification Questionnaire

You might also like