(4210-GP-13-01) Prosedur CSMS - Rev J

PT.
REKAYASA INDUSTRI CORPORATE PROCEDURE

REKAYASA
ENGINEERING & CONSTRUCTION CONTRACTOR SAFETY
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
PROJECT SERVICES 01
QC-HSE Date : 1/2/2010 Page : 1 of 38
CORPORATE PROCEDURE
CONTRACTOR SAFETY MANAGEMENT SYSTEM
APPROVED BY
EXECUTIVE VICE
PRESIDENT CODDY SOERONO
PORTFOLIO
REVIEWED BY
PROJECT SERVICES
VICE PRESIDENT
DAFRIS DJINIK
PREPARED BY
GENERAL MANAGER
QC-HSE
DUDI GUNARDI
Revision Record
Rev Date Responsible Person Description of revision
B 9/12/05 DADANG ASIKIN See Historical on Page 2
C 20/3/07 DUDI GUNARDI See Historical on Page 2
D 14/6/07 DUDI GUNARDI See Historical on Page 2
E 27/9/07 DUDI GUNARDI See Historical on Page 2
F 17/1/08 DUDI GUNARDI See Historical on Page 2
G 23/6/08 DUDI GUNARDI See Historical on Page 2
H 24/3/09 DUDI GUNARDI See Historical on Page 2
I 14/7/09 DUDI GUNARDI See Historical on Page 2
J 1/2/10 DUDI GUNARDI See Historical on Page 2
Distribution List
1. Corporate Strategy Group 6. SBU Refinery & Petrochemical
2. Internal Audit & Compliance Group 7. SBU Portfolio
3. SBU Geothermal 8. EPC Operation Unit
4. SBU Mineral, Environmental and Infrastructure 9. Project Services Unit
5. SBU Gas 10. Shared Services Unit
Controlled Copy, Do Not Duplicate For Internal Used

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PT. REKAYASA INDUSTRI CORPORATE PROCEDURE
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Document Change History
Rev. Date Change Description
A 3/06/05 REV. A Initial Release
This Document Change because of change structure content of this procedure, Last
Revision was Rev-A Doc. No 4210-GP-13-01 Date 3-6-2005 as an initial release.
B 9/12/05
Change document numbering to adopt new organization coding number due to
corporate restructuring program.
C 20/3/07 Add some word and questioner for fabricator. All the review Italic Word.
D 14/3/07 Review in High Risk Category and Low Risk Category with Italic Board.
Add list of reference, review flow chart for PQ and assessment process in page 1 of
E 27/9/07 attachment 1, add standard scaffolding on page 3 of attachment 4 and add health
requirement on page 6 of attachment 4. All the review item with Italic Word.
Add fabricator scoring system on page 5, add some clause XVI XXVI in
F 17/01/08 Attachment-IV HSE Requirement For Subcontractor, and add Attachment 8
Forwarder HSE Questioner and Attachment-9 Forwarder HSE Bid Evaluation. All
the review item with Italic Word.
Review in Attachment-IV sub bab 4: Add 1 safety man supervise 50 employees, sub
G 23/06/08 bab 9 PPE: more than 2 m, wearing full body harness. The entire review item with
Bold and Italic Word.
Review in sub bab VI, Selection Process, Review in attachment 3 subcontractor HSE
bid evaluation, Review in attachment 4 HSE Requirement for sub-contractor in sub
H 24/03/09 bab VII.4, XV and add sub bab XXVII and XXVIII, Review in attachment 6
Fabricator HSE Bid Evaluation and attachment 9 Fabricator HSE Bid Evaluation.
The entire item with Bold and Italic Word.
Change document numbering system because of change attachment page number
based on Doc. No. 1100-GP-01-06 Rev. B. Change uncontrolled copy to
I 22/06/09 controlled copy, do not duplicate Selection process to Rincian Prosedur add for
internal used only, Page number. Add Doc Number in Reference and Title of
Government Regulation.
Add Tools and Equipment requirement, page 20. List HSE Budget for
J 1/2/10 Subcontractor, page 36 of attachment 10. Add PPE requirement: Safety Glasses,
Cotton Glove, Long Sleeves, page 18.

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TABLE OF CONTENT
Page
I. PURPOSE 4
II. SCOPE 4
III. DEFINITION 4
IV. REFERENCE 4
V. RESPONSIBILITY 4
VI. DETAILED PROCEDURE 4
ATTACHMENT:
I. FLOW CHART PROCESS PRE-QUALIFICATION / ASSESSMENT 6
II. SUBCONTRATOR HSE PRE-QUALIFICATION / ASSESSMENT QUESITIONER 7
III. SUBCONTRACTOR HSE BID EVALUATION 11
IV. HSE REQUIREMENT FOR SUBCONTRACTOR 13
V. FABRICATOR HSE PRE-QUALIFICATION / ASSESSMENT QUESTIONER 24
VI. FABRICATOR HSE BID EVALUATION 28
VII. SUBCONTRACTOR HSE KEY PERFORMANCE INDICATOR (please refer to
HSE form Doc No. HSE-FF-Z.1)
VIII. FORWARDER HSE PRE-QUALIFICATION / ASSESSMENT QUESTIONER 30
IX. FORWARDER HSE BID EVALUATION 34
X. HSE BUDGET FOR SUBCONTRACTOR 36

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I. PURPOSE
This procedure is a system for selecting a sub-contractor in terms of HSE system.
The main objective of this procedure is to select and choose a sub-contactor which has a proper HSE system,
so that the probabilities of all kinds of accidents that will affect properties, environment, and personnel during
execution of work can be reduced.
II. SCOPE
This procedure will be implemented for selecting a sub-contractor for executing a specific work package in an
EPC project such as: Piping, Mechanical, Steel Structure, Electrical, Instrument, Insulation, Piling, Chemical
Cleaning, NDT, X-Ray, Heavy Awkward Oversize (HAO), Dangerous Cargo Transport, Roofing and Siding,
Fencing, Civil, Painting, Pavement, Deep Well Work and General Cargo Transport.
III. DEFINITION
All Clear.
IV. REFERENCE
- Corporate Policy Penerapan Sistem Manajemen Keselamatan, Kesehatan Kerja dan Lindungan
Lingkungan . Doc. No 4200-PL-13
- Procedure of Bidder List Selection. Doc. No 4220-GP-44-04
- UU No.1 1970 Undang Undang tentang Keselamatan Kerja
- OHSAS 18001:1999
- Manpower Minister (Menteri Tenaga Kerja) Regulation No. Per.02/MEN/1980.
V. RESPONSIBILITY
The Procurement General Manager and QC-HSE General Manager shall be responsible for implementation of
this procedure in corporate.
The Project Manager, Vendor Management Manager, and HSE Manager shall be responsible in assisting the
Procurement General Manager and QC-HSE General Manager for implementation of this procedure in every
project.
VI. DETAILED PROCEDURE
All sub-contractor and fabricator must pass the pre-qualification / assessment process before entering the
technical and commercial assessment processes. The pre-qualification process starts from filling the HSE Pre-
Qualification / Assessment Questioner form (See in Attachment 1, 2 and 5).
6.1 Sub-contractor Scoring System
The minimum score that must be achieved by each sub-contractor to pass the HSE Pre-Qualification /
assessment is:

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> 60: High Risk Category (Piping Work, Mechanical Work, Steel Structure Work, Electrical and
Instrument, Insulation, Piling, Chemical Cleaning, NDT, X-Ray, Roofing & Siding, High Risk Building
(more than 2 Floor), Excavation, Commissioning & Pre-commissioning, Blasting & Painting).
35 59 : Low Risk Category (Fencing, Deep Well Pump, Road Pavement, Temporary Site Office).
a sub-contractor, which does not pass this assessment process can be re-apply minimum 3 month.
6.2 Fabricator Scoring System
The minimum score that must be achieved by fabricator to pass the HSE Pre-qualification / assessment is
minimal 50.
The validity of this assessment is two years.
6.3 Forwarder Scoring System
The minimum score that must be achieved by forwarder to pass the HSE Pre-qualification / assessment is >
50: Heavy Lift, Dangerous Cargo Transport, International Forwarder; 35-50: Local Transporter, and General
Cargo Transporter.
The validity of this assessment is two years.
6.4 Record System
All CSMS record will be recorded by HSE Corporate and the validity of the assessment is 2 (two) years.

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ATTACHMENT 1: FLOW CHART FOR PRE-QUALIFICATION / ASSESSMENT PROCESS

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Start
Prepare Questioner & Sent to Vendor

Management
(Attachment 2 / 5)
By HSE
Distribute to Subcontractor / Fabricator
Vendor Management
Complete Questioner & Sent Back

to Vendor Management
Subcontractor / Fabricator
Receive Questioner & Sent Back to HSE

Vendor Management
Prepare Bid Evaluation (Attachment

3 / 6)
HSE
Copy to Vendor Management

Keep Original
HSE
HSE
Pass
Distribute to Subcontractor / requirement
score
Fabricator
Do Not Pass Vendor Management
Recommended
Review in 3 month period Bidder List

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ATTACHMENT 2
SUBCONTRACTOR'S SAFETY, HEALTH AND ENVIRONMENT (HSE)
PRE-QUALIFICATION / ASESSMENT QUESTIONNAIRE
Project :
Subcontractor's Name :
Section I HSE Policy and Leadership
1. Does your company have an HSE policy document?

Apakah perusahaan anda mempunyai Kebijakan Keselamatan Kerja, Kesehatan dan Lingkungan?
Yes No
If yes, please attach / Jika Ya, silahkan untuk dilampirkan.
2. Who has overall and final responsibility for HSE in your organisation?
Siapa yang bertanggung jawab terhadap Keselamatan Kerja, Kesehatan dan Lingkungan
diperusahaan anda?
3. Who is the most senior person in the organisation responsible for this policy being carried out at the
premises and on site where his employees are working?
Siapa senior staff di perusahaan anda yang bertanggung jawab dalam implementasi kebijakan ini di
project tempat anda bekerja?
Section II General Organisation - Management Structure / Organisation
4. Who has ultimate responsibility for HSE management in your organisation?

Siapa yang bertanggung jawab terhadap management K3 di perusahaan anda?
Name: Job Title:
5. Please attach a current organisation chart showing reporting relationships from your Chief Executive
Officer to lowest line manager / Silahkan lampirkan struktur organisasi perusahaan anda mulai dari
Direktur Utama sampai ke Manager
Organization chart attached?
Yes No
6. Does a full time HSE Department exist in your organisation?

Apakah Departement K3 tersedia di perusahaan anda?
Yes No
7. If answer to 6 above is yes, do you have job descriptions for the person(s) employed in your HSE
Department?
Jika jawaban no 6 Ya, Apakah perusahaan anda mempunyai job description terhadap karyawan di
Departement K3.
Yes No
If yes, Please give detail the position and responsibilities
Jika Ya, silahkan lampirkan detail dari posisi masing-masing karyawan dan responsibilitinya.
8. If the answer to item 7 above is no, who is responsible for providing safety advice and monitoring the
implementation of HSE Management System at your work sites and what is their qualification?
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Jika jawaban no.7 Tidak ada, siapa yang bertanggung jawab dalam memberikan arahan K3 dan
melakukan monitoring terhadap implementasi K3 management system ditempat perusahaan anda
bekerja dan apa kualifikasi orang tersebut?
Person Responsible :
___________________________________________________________________
Qualification :
Section III Organising for HSE - HSE Planning
9. Do you produce an HSE Plan for each Project?

Apakah anda menyiapkan rencana pelaksanaa K3 dan Lindungan Lingkungan di project ini?
Yes No
10. If answer to Question 9 above was no, briefly describe how you ensure that the required HSE Systems
are communicated and implemented on time.
Jika jawaban anda Tidak, Jelaskan bagaimana anda memastikan K3 dan Lindungan Lingkungan
yang disyaratkan dapat terkomunikasi dan dilaksanakan dengan baik.
Section IV Organising for HSE - HSE Training
11. Do you have a HSE Training Matrix for your employees?

Apakah perusahaan anda mempunyai rencana training K3 dan Lindungan Lingkungan untuk
karyawan anda?
Yes No
12. If the answer to Question 11 above was no, briefly describe how you identify and implement HSE
Training for your staff.
Jika jawaban no 11 Tidak ada, Jelaskan bagaimana anda mengidentifikasi dan mengimplementasi
kebutuhan trainining K3 dan Lindungan Lingkungan untuk karyawan anda.
13. Do you have a formal training program(s) for Supervisors their responsibilities in HSE Management
as Supervisors?
Apakah perusahaan anda mempunyai program training untuk safety suprvisor ?
Yes No
14. If the answer to item 13 above is yes, briefly describe this program and who conducts this training.
Jika jawaban no 13 Ya, Jelaskan bagaimana program ini berjalan dan siapa yang melakukan training
tersebut.
15. Do you have a formal HSE Orientation Programme for new employees?
Apakah perusahaan anda mempunyai Program Safety Orientation untuk karyawan baru?
Yes No
Section V Organising for HSE - HSE Procedure
16. Does your Company have written HSE procedures?

Apakah perusahaan anda mempunyai procedure K3 dan Lindungan Lingkungan?
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Yes No
17. If answer to Question 16 was yes, please attach HSE Procedure that you have.
Jika jawaban no.16 Ya, Silahkan lampirkan procedure K3 dan Lindungan Lingkungan yang
perusahaan anda punyai.
Section VI Managing HSE - Accident Performance Measurement
18. Do you measure environmental performance?

Apakah perusahaan anda mengukur performance lingkungan?
Yes No
If yes, state what and how

Jika Ya, Jelaskan apa yang di ukur dan Bagaimana
What?
How?
19. Do you keep Accident/Incident Statistics for your Employees?

Apakah perusahaan anda menyimpan statistic kecelakaan terhadap karyawan anda?
Yes No
20. If the answer to item 19 above is yes, briefly describe the Accident/Incident Statistics you keep and
the analysis you perform on these.
Jika jawaban no 19 Ya, jelaskan jenis kecelakaan yang anda muat di statistic tersebut.
21. Do you keep Accident/Incident Statistics on your Subcontractors?

Apakah perusahaan anda mempunyai statistic kecelakaan terhadap subcontractor anda?
Yes No
Section VII Managing HSE - Monitoring and Improvement
22. Do your Senior Management use an HSE Audit and Inspection process at the work site?
Apakah senior management anda melakukan audit K3 dan Lingkungan dan melakukan inspeksi
terhadap tempat anda melaksanakan pekerjaan?
Yes No
Section VIII Current HSE Statistical Information
23 Please provide the following information:
(A) Please provide your statistical HSE Performance for 3 last years:
Lampirkan statistic kecelakaan K3 dan Lingkungan untuk 3 tahun terakhir
Section IX Personnel Protective Equipment
24. Do you provide appropriate personal protective equipment (PPE) for your employees? Please provide
a listing of the PPE for the scope of this work?
Apakah perusahaan anda menyiapkan alat pelindung diri untuk karyawan perusahaan anda?
Silahkan list alat pelindung diri yang akan anda siapkan untuk pekerjaan ini?
25. Do you have a program to ensure that PPE is impacted and maintained?
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Apakah perusahaan anda mempunyai program pemeliharaan alat pelindung diri?
Section X Hazards and Effect Environmental Management
26. Please provide the number of accident resulting in environmental damage in the amount greater than
$ 50,000 for the last 24 months. Attach copies of any governmental reports submitted
Lampirkan kecelakaan lingkungan yang perusahaan anda terima dengan jumlah kerugian lebih dari
Rp. 500.000.000 untuk dua tahun terkahir.
27. Who is the person in charge for coordinating environment matter and what is he/she experience?
Siapa yang bertanggung jawab dalam menghandle untuk melakukan perlindungan lingkungan
diperusahaan anda dan apa pengalaman orang tersebut?
Section XI Drugs and Alcohol
28. Do you have a drugs and alcohol policy in your organisation? If yes please attach.
If No, how do you ensure that your employees do not use drugs and alcohol during project.
Apakah perusahaan anda mempunyai kebijakan pelarangan menggunakan obat dan minuman
terlarang? Jika Ya silahkan lampirkan.
Jika Tidak, bagaimana perusahaan anda memastikan karyawan anda tidak menggunakan obat dan
minuman terlarang selama project berjalan.
Section XII Safety Achievement or Awards
29. Please provide any significant achievements or awards?

Lampirkan penghargaan safety yang pernah didapat.jika ada.
I understand, follow all the requirement and all the answer above is correctly and honest,
Saya mengerti, mengikuti semua persyaratan dan menjawab semua pertanyaan diatas dengan jujur dan benar.
Signs,
( )
Tittle: Director / Direktur
Date:
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ATTACHMENT 3
SUBCONTRACTOR HSE BID EVALUTION
Evaluation Result
No Evaluation Item Max Remarks
Achievement
Score
1 HSE Policy & Leadership * (P) = < 5
1.1 HSE Policy (G) = 5 - 10
1.2 Final Responsibility (E) = > 10
1.3 Senior Person in Organization
Total 15
2 Management Structure / Organization

2.1 Responsible for HSE Management
2.2 Organization Chart * (P) = < 5
2.3 HSE Department (G) = 5 - 8
2.4 Job Description in HSE Department (E) = > 8
2.5 Responsible for safety advice & monitoring
Total 10
3 HSE Planning * (P) = < 5
3.1 Produce HSE Plan (G) = 5 - 8
3.2 Implement plan for HSE (E) = > 8
Total 10
4 HSE Training
4.1 HSE Matrix Training * (P) = < 5
4.2 Identify and implement HSE Training (G) = 5 - 8
4.3 Training Program for Supervisor (E) = > 8
4.4 Program & Conduct HSE Training
4.5 HSE Orientation
Total 10
5 HSE Procedure * (P) = < 5
5.1 Written Procedure (G) = 5 - 8
5.2 Attachment HSE Procedure (E) = > 8
Total 10
6 Accident Performance Measurement
6.1 Measure Env. Performance * (P) = < 2
6.2 Keep of Accident Statistic of Employee (G) = 2 - 3
6.3 Describe of the Accident Statistic (E) = > 3
6.4 Keep of Accident Statistic of Sub-cont
Total 5
Monitoring and Improvement * (P) = < 5

7 7.1 Senior Management use of HSE Audit (G) = 5 - 8
Inspection (E) = > 8
Total 10
* (P) = < 2
8 HSE Statistic Information (G) = 2 - 3
8.1 HSE Statistic Performance for 3 last year (E) = > 3
Total 5
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9 Personal Protective Equipment * (P) = < 5

9.1 List of PPE (G) = 5 - 8
9.2 Maintenance PPE Program (E) = > 8
Total 10
10 Environmental Management * (P) = < 2
10.1 Accident of Environmental (G) = 2 - 3
10.2 Person in coordinating environmental (E) = > 3
Total 5
* (P) = < 2
11 Drugs and Alcohol Program (G) = 2 - 3
11.1 Drug and Alcohol Policy (E) = > 3
Total 5
* (P) = < 2
12 Safety Achievement or Awards (G) = 2 - 3
12.1 Award Achievement (E) = > 3
Total 5
Total Score 100 Risk category
SUMMARY PASS / FAILED HIGHT / LOW
Recommendation:
Note : Score achievement: > 60: High Risk, 35 59: Low Risk
*Criteria Score:
Poor (P) Can not answer the question and can not give attachment
Good (G) Can be answer the question but can not give attachment
Excellence (E) Can be complete the question
Prepared By :
Name :
Tittle of Job :
Sign :
Date :
NOTE: > 60 : High Risk Category (Piping Work, Mechanical Work, Steel Structure Work, Electrical
and
Instrument, Insulation, Piling, Chemical Cleaning, NDT, X-Ray, Roofing & Siding, High
Risk Building (more than 2 Floor), Excavation, Blasting & Painting).
35 59 : Low Risk Category (Fencing, Deep Well Pump, Road Pavement, Temporary Site Office).
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ATTACHMENT 4
HSE REQUIREMENT FOR SUBCONTRACTOR
I. COMMITMENT AND POLICY
Sub-contractor strongly request to write HSE Policy which is sign by Sub-contractor Directors. This HSE
Policy must be socializing to all employees who will assign in this project.
This Policy should be in English or Indonesia.
II. LEGAL REQUIREMENTS AND REGULATIONS
Subcontractor shall comply with all applicable safety laws (international, national, regional, or local),
regulations (including work permit system), and additional safe operating standards. Subcontractor shall take
all necessary precautions to protect the work from un-safe work and un-safe condition, and protect all
personnel, the environment, and property of Owner, Rekayasa, Subcontractor, and all third parties from
accident.
III. SUBCONTRACTOR HSE PLAN
Sub-contractor shall issue its HSE Plan as a part of the bid proposal.
HSE Plan document shall be established by Sub-Contractor, defining all the HSE requirements applicable,
how they are implemented and monitored for compliance.
After approval by HSE Manager PT. Rekayasa Industri, the agreed version of its HSE Plan must be propose
before the kick-off meeting. Before HSE Plan approved by HSE Manager PT. Rekayasa Industri, sub-
contractor does not allow to start work.
The agreed HSE Plan must be communicated to any involved personnel before the works start effectively on
site.
The content of HSE Plan as minimum is:

- Purpose
- Scope of Work
- Responsibility each personal in team project related to HSE
- Planning of HSE personal / coordinator resources
- Health Plan
- Personal Protective Equipment and Fire Extinguisher Plan
- Emergency Response Plan
- Security Plan
- Construction / Commissioning Activities Plan.
Sample of Construction Activities Plan:
No Construction Activities Applicable Whats To Be How Do We Frequency Person

Procedure Done Check Responsibility
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1 Excavation Procedure Prepare Work Work Before start Project

Number / Permit, JSA Permit, JSA the work Supervisor
None and Safe and Safe
Operating Operating
Procedure Procedure
must be
completed
2 Install Pipe Procedure Prepare Work Work Before start Project
Operating Operating
Procedure Procedure
must be
completed
3 Built Temporary Site Procedure Prepare Work Work Before start Project
Office Number / Permit, JSA Permit, JSA the work Supervisor
Operating Operating
Procedure Procedure
must be
completed
4 Erection Vessel Procedure Prepare Work Work Before start Project
Operating Operating
Procedure Procedure
must be
completed
IV. SUB-CONTRACTOR HSE REPRESENTATIVE
Sub-Contractor shall assign one HSE Coordinator, with 1 year for Low Risk and 3 years experience for High
Risk in HSE related to this activity.
One HSE Coordinator must be supported by one or more Safety Mans, with ratio 1 safety man will be
supervising 50 employees. (1 safety man: 50 employees).
PT. Rekayasa will conduct interview for sub-contractor HSE Coordinator that will assigned to the project site
on technical clarification or kick off meeting before sub-contractor mobilize the staff.
Sub-contractor HSE Coordinator will be becomes correspondent for managing the day to day HSE matters
relating to Sub-Contractor activities. He will keep close contact with the PT. Rekayasa Industri site Health,
Safety and Environment personnel.
One HSE man ratio to supervise employee work at site is 1:50.
V. TERMINATION AND SUSPENSION
Any unsafe condition and unsafe work, which done by subcontractor and identified by Rekayasa through
either jointly or separately by Owner and/or Rekayasa. Rekayasa has the right to stop all or any part of the
work, until corrective action taken by sub-contractor.
VI. PUBLIC RELATION

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Subcontractor shall promptly take such steps as necessary to maintain good relations with the public and local
authorities with whom they will come into contact with during the course of the work. Subcontractor shall also
require all employees to conduct themselves in a safe and courteous manner. Whenever necessary, Rekayasa
may assist Subcontractor in the maintenance of good public relations.
VII. SAFETY REGULATION
VII.1 Responsibility for HSE
Rekayasa will require subcontractor to affirm that all managers, HSE representatives, and employees are
responsible for ensuring that the work is performed in accordance with all applicable safety rules, regulations,
and good working practices.
VII.2 Accident / Incident Reporting
Subcontractor shall follow an accident reporting system of PT. Rekayasa Industri standards. Any hazardous
accident, near miss involving Owner, Rekayasa, Sub-contractor employees, any third partys personnel, plant,
and equipment shall be immediately reported to PT. Rekayasa Industri within 24 hours.
VII.3 HSE Meetings
Subcontractor is responsible for maintaining and enhancing the HSE awareness of its personnel. In principle,
management subcontractors members should attend a HSE meeting that arrange by PT. Rekayasa Industri.
Subcontractor shall ensure that no employee of its subcontractor shall carry out work, until they have received
basic HSE information (Safety Induction or Safety Orientation), which conduct by HSE PT. Rekayasa Industri.
VII.4 Scaffolding
Scaffolding that we give permit is pipe tube scaffolding for working in mechanical work, piping work, steel
structure and pre-cast erection work, electrical and instrument work and insulation work.
Frame scaffolding only allowed using in office building work and any activity inside office building just for
civil work, electrical and instrument.
The standards of pipe tube scaffolding are galvanized tube and steel tube, which must be following: AS
1576.3.1995 with:
Requirement of Galvanized Tube:

Outside Diameter/Diameter Luar: 48.3 mm (0.5 tolerance); Minimum Wall Thickness/Minimum Tebal (t): 3.2
mm (0.48 tolerance); Weight per meter/Berat per meter: 3.56 kg/m.
Requirement of Steel Tube:

Outside Diameter/Diameter Luar: 48.3 mm (0.5 tolerance); Minimum Wall Thickness/Minimum Tebal (t): 4.0
mm (0.5 tolerance); Weight per meter/Berat per meter: 4.37 kg/m.
Material Steel Tube must be painted to eliminate the corrosion of the steel tube.
The standard of frame scaffolding that must be following: OSHA standard with:
Material of the frame scaffolding must be galvanized.
The frame scaffolding specification:

Legs: 40.87 mm (0.5 tolerance) OD (Outsite Diameter/ Diameter Luar) Tube Diameter / Diameter Pipa 2.4
mm (0.5 tolerance) Wall Thickness / Ketebalan Pipa.
Cross Braces: 25.73 mm OD (Outside Diameter / Diameter Luar) Tube Diameter / Diameter Pipa.
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Subcontractor must be providing scaffold supervisor that having a licensed from Depnaker to build the
scaffolding at site, with minimal experience 1 year.
VII.5 Work Permit System
Sub-contractor must follow the Work Permit Procedure PT. Rekayasa Industri.
Supervisor must be responsible to make and process the work permit.
VII.6 Equipment / Material
Sub-contractor shall ensure that all its equipment and materials on PT. Rekayasa Industri site, must meet the
HSE standard required by PT. Rekayasa Industri and Owner and listed in the Sub-contractor HSE Plan.
Sub-contractor shall ensure that any equipment and materials under these standards called sub-standard are
removed from the project site.
VII.7 Inspection
PT. Rekayasa Industri will conduct inspection regular at site and before mobilize to site for all machinery
equipment, tools, cranes, trucks and cars before mobilize to site.
VII.8 Reporting System
Sub-contractor shall report daily to HSE PT. Rekayasa Industri the data resulting from its health, safety and
environmental monitoring according to PT. Rekayasa Industri form.
VIII. ENVIRONMENT
VIII.1 General
Subcontractor shall pay due regard to the environment by acting to preserve air, water, animal and plant life
from adverse effects of Subcontractor activities, and minimize any nuisance, which may arise from such
operations.
Subcontractor shall adhere to existing national statutory regulations concerning environmental damage
resulting from the performance of the Work and in particular any specific environmental requirements, which
may apply to the project site and its surroundings.
Sub-contractor requires proper planning and safe work to ensure their no environmental damage during
construction and commissioning.
VIII.2 Housekeeping and Site Restoration
Subcontractor shall be responsible for maintaining good housekeeping continuously throughout the duration
of the work with due regard being paid to tidiness, ensuring that access ways and emergency exits are kept
clear at all times and without exception.
Sub-contractor shall remove any equipment, material, and waste from the work-site before leave the project
site.
Sub-contractor does not allow destroying the scrap and rubbish material at project site and surrounding by
burning.
VIII.3 Safe Handling of Hazardous Material

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Subcontractor shall be responsible for the control and safe handling of all substances potentially hazardous to
health, stored on its facilities. Subcontractor shall maintain an up to date file or database of all such
substances and their Material Safety Data Sheets (MSDS). Subcontractor shall also supply to Rekayasa with
copies of these MSDS as soon as they are dispatched to location. MSDS will contain the following
information as a minimum:
a. Chemical identification and data
b. Fire and explosion (Flash point temperature, flammable limit range, auto ignition temperature)
c. Health aspects (nature of hazards TLV-STEL, TLV-TWA)
d. Emergency Procedure (Fire Fighting, agent, spillage, personnel exposure, first-aid)
e. Environmental (emissions to atmosphere, spillage, neutralizer procedure, waste disposal)
f. Transportation procedure
g. Personnel protective equipment to be worn
h. Storage requirements
Subcontractor shall have in place a suitable means of communicating the safety requirements for handling all
substances that have the potential to be health hazard and will ensure that appropriate handling equipment,
and Personal Protective Equipment, as advised by the MSDS, is available and used each time such substances
are handled.
Subcontractor shall ensure that all substance is stored in compliance with its MSDS.
VIII.4 Local Customs, Cultural and Religious Considerations
Subcontractor shall ensure that all local customs, cultural and religious requirements are respected and those
suitable facilities are available for the observance of these by Local employees.
IX. PERSONAL PROTECTIVE EQUIPMENT
The minimum Personal Protective Equipment that must be provided for all employees at site are:
- Safety Shoes: Follow European Harmonize Standard BSEN 345:1993 or equivalent and for civil
work must be wearing safety rubber boot.
- Safety Helmet: Follow ANSI Standard No. Z89.1 1997or equivalent: MSA Indonesia.
- Full body harness double lanyards must be worn by any employee, who shall work on an elevated
area higher than to 2 m above ground level / floor: ANSI standard.
- Safety glasses : Follow ANZI.Z87.1 or equivalent
- All employees must be wearing cotton gloves and long sleeves.
Any other PPE that require during project is sub-contractor cost responsibilities.
X. JOB SAFETY ANALYSIS & RISK ASSESSMENT
Sub-contractor shall produce a Job Safety Analysis and Risk Assessment for all activity.
For its evaluation of the JSA and Risk Assessment associated with performing the works, Subcontractor shall
review with the PT. Rekayasa Industri before start the job.
Supervisor must be responsible to make the Job Safety Analysis and Risk Assessment.
XI. ALCOHOLIC, DRUG, CARRY WEAPON, AND NO SMOKING POLICY
Sub-contractor shall ensure that the prohibition of the alcoholic consumption and / or the use of drugs, carry
weapon and smoking within the PT. Rekayasa Industri premises are strictly followed:
- on the work sites, during the working and non-working hours
- when traveling from / to home work site
- when driving at land, at sea or in the air.
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- Inside at office site.
XII. AUDITS & INSPECTION BY PT. REKAYASA INDUSTRI
PT. Rekayasa Industri will be carrying out HSE inspection and audits at any time to ensure that the HSE
requirements are being complied with 13 elements HSE Management System PT. Rekayasa Industri.
XIII. CORRECTIVE ACTION
Sub-contractor shall be following up any recommendation during inspection and audit into a corrective action.
XIV. KEY PERFORMANCE INDICATOR
PT. Rekayasa Industri will conduct monthly evaluation to the sub-contractor performance and it will affect to
the sub-contractor monthly progress report.
Please see flow chart bellow for the process.
Tool: HSE-FF-Z.1 (ATTACHMENT 7)
Star
t
Subcontractor HSE Receive Document Submit monthly progress

Performance Progress Report report
Indicator
Chief Construction Control Subcontractor
Chief HSE
Do Not
Proceed
Evaluate HSE Performance Submit to CCC to be
Indicator Form follow-up by
subcontractor
HSE Department Site
Proceed
Send back to CCC to

progress report
XV. HEALTH REQUIREMENT
Based on UU No.1 1970, OHSAS 18001:1999 requirement and Manpower Minister (Menteri Tenaga Kerja)
Republik Indonesia Regulation No.Per.02/MEN/1980, sub-contractor shall conduct basic medical check-up for
their key personal (start from supervisor) who will assign to project and it shall be repeated once a year.
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The lists of laboratory checks for basic medical check-up are:

Hematology: LED, Hb, Ht, Leukosit (White Body Cell), Trombosit, Diff, VER, HER, KHER; Function of
Liver: SGOT, SGPR;
Function of Kidney: Ureum, Kreatinim; Karbohidrat: Gula Darah Sewaktu (Blood Glucose without fasting);
Urine Complete: Bj(Species Gravity), pH, Albumin, Glukosa, Bilirubin, Urobilinagen, Keton, Nitrit, Darah
Samar(Blood Transparent), Sedimen and drug and alcohol test.
For level Workers below Supervisor must be attach letter from doctor or hospital to indicate that the workers
fit for work. The lists of laboratory checks for Workers below Supervisor are: SGOT, SGPT and EKG.
The result of the medical check-up must be consulted to doctor occupational medicine to know whether they
fit to the job assignment or not.
XVI. LIFTING OPERATION
Lifts utilizing cranes, hoists, or other mechanical lifting devices will not commence unless:
- An assessment of the lift has been completed and the lift method and equipment has been determined
by competent persons.
- Operators of powered, lifting devices are trained and certified for that equipment.
- Rigging of the load is carried out by a competent person(s).
- Lifting devices and equipment has been certified for use within the last 12 months (at a minimum).
- Load does not exceed dynamic and/or static capacities of the lifting equipment.
- Any safety devices installed on lifting equipment are operational.
- All lifting devices and equipment have been visually examined before each lift by a competent
person(s) or manufacture certificate. (wire rope sling, man-made fibred sling, chain sling, spreader
beam, lifting clam, hooks and fitting, swivels, shackles, eyebolts, rigging screw(turnbuckles), wedge
sockets, plate clamps, personnel basket, fall arrest devices and similar equipment).
- Crane, TMC, Forklift, Excavator, Dozer shall have certificate from Migas/Depnaker/Minerbapum
which depend on the area of the project.
XVII. MECHANICAL EQUIPMENT OPERATION
Sub-contractor shall ensure that only trained competent (certificated) person operates all mechanical
equipment (Migas/Depnaker/Minerbapabum) depend on the area of the project.
The equipment will include but may not be limited to the following:
- Crane
- Fork lift
- Self Loading Truck
- Trailer and Prime Movers
- Compressor
- Temporary Electrical Distribution Boards
- Scaffolding Equipment
- Rigging Equipment
- Aerial Work Platform
XVIII. TOOLS AND EQUIPMENT
Sub-contractor shall ensure that a Sub-contractors machinery, tools and equipment, facilities, and other items
associated with the works whether purchased or rented are maintained in a safe condition and to be operated
by competent operators. Tools shall only be used for the job they were designated to perform with considering
the presence of hydrocarbons at worksite.
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All guards must be fitted and shall be in good condition at all times.
Welding machine and Generator Set must be equipped with distribution panel and emergency stop.
All grinding discs must be checked for correct size and speed prior to fitting (rpm speed of grinding disc is
equal or more than rpm speed of grinding machine)
Electrically powered tools shall meet the hazardous zone requirement where applicable. All electrical cables
and connector must be water proof material and industrial types. Use of domestic electrical cable is prohibited.
Sub-contractor shall repair or replace defective tools and equipment at Sub-contractor cost. Appropriate
personal protective equipment must be worn at all times when using any tool or equipment.
XIX. COMPRESSED GAS CYLINDER
Sub-contractor shall ensure that:

- Compressed gas cylinders are stored, transported or used shall be in an upright position and secured
to some substantial object or structure by a chain or other suitable means capable of supporting the
weight of cylinder. This applies to all cylinders, whether empty or full.
- Cylinder valves shall be closed and hoses depressurized when cylinder are not in use.
- Cylinders shall have protective valve caps in place while they are being transported / stored.
- Cylinders shall be returned promptly to a suitable storage area after use. They shall not be left at any
site. Cylinder storage areas should be kept away from general traffic paths and must not be adjacent
to vehicle paths.
- Flammable gases and oxygen cylinders must not be stored in close proximity unless separated by a
non-combustible wall.
- Cylinder may only be hoisted when enclosed in an approved box or cradle within which they are
securely fastened.
- Cylinders must be identified by a color code in accordance with respective national standards.
- Gas welding cylinders shall have hose check valve (non-return valves), which allow gases to the
blowpipe, but not back from it. Flashback arrestors shall be installed to quench flashback flames and
cut off the gas flow automatically, in both oxygen and fuel gas outlet lines.
XX. ELECTRICAL SAFETY / POWER LINES
All electrical receptacles shall be of industrial grade and comply with area classification requirement.
No part of any lifting devices or any equipment operated around power lines is closer than below:
Power Line Min. Lifting Clearance

150 750kV 2.0 m
750 - 50kV 3.0 m
50k 250kV 4.5 m
Over 250kV 6.0 m
REKAYASA
MANAGEMENT SYSTEM
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PROJECT SERVICES 01
The above clearance applies in all directions. All overhead lines shall be identified with a highly visible sign
placed 7 m from both sides of the lines, 1.8m above ground. A restriction guard pole connected with ropes
shall be installing to restrict clearance close to power lines.
XXI. HSE BRIEFING / TOOLBOX MEETING
Sub-contractor shall perform daily HSE briefing/tool box meeting prior to start of each working day.
Representative from Management shall address the workers on the rotational basis.
Sub-contractor shall ensure that his appointed Work Supervisors hold tool box meeting for about 5 10
minutes daily or prior to commencement of work. Specific topics shall include hazards identified in the
Job Safety Analysis relevant to the current work, Permit to Work requirements, and review of accidents,
near misses and any new equipment or machinery. Sub-contractor shall maintain record of attendances
and submit to CONTRACTOR as daily basis.
XXII. USE OF PUBLIC ROAD
Sub-contractor shall keep public road free from its debris due to vehicle movement to and from site. Sub-
contractor shall provide tyre-washing facilities at site. In the event of spillage onto the road, sub-
contractor shall undertake the cleaning activities at sub-contractor cost.
XXIII. HSE AWARENESS
Sub-contractor shall at its own expense provide continuous HSE awareness to their employee through but
not limited to the following:
- HSE Bulletin Board, which located at strategic location of site and updated regularly.
- HSE Banners, which strung at entrance and strategic location at site and changed periodically.
- HSE Sign Board, which located at strategic location at site and updated regularly.
XXIV.RADIOGRAPHY
Sub-contractor shall ensure that all radiographic, sub-contractor be appointed is in possession of valid
operating license issued by Nuclear Energy Regulatory Agency (BAPETEN).
Sub-contractor shall obtain a permit to work for radiography work. Extra precaution shall be taken to keep
away all non relevant personnel from the area. The area shall be isolated by visible barricades, signs, warning
lights etc. The source shall be stored according to approved procedure. Sub-contractor shall employ only
qualified radiography operators for the job. Properly calibrated radiation survey must be available.
Each radiography technician shall be supplied with a personal beeper.
XXV. AIR HOSE
Air hose connection shall be equipped with anti whipping device to prevent accidental disconnection. Air
hose should not be used to clean any part of the body or clothing or use to blow off dirt on the floor.
Compressor supplying air shall posses a valid certificate of fitness and equipped with automatic relief valve.
The relief valve must carry a current calibration tag.
XXVI.WORKING AT HEIGHT
All work at elevated areas in the excess of two (2) meters shall require the use of full body harness double
lanyards.
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MANAGEMENT SYSTEM
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When working at height more than 7.5 meters, sub-contractor shall provide suitable safety nets, which extends
2.5 meters beyond the edge of work level. The nets shall be sufficiently anchored using steel hooks or shackle.
The net shall be inspected daily.
XXVII. PETROL STATION
Diesel and petrol are hazardous goods and therefore shall be stored and supplied to users with precaution.
Facilities shall be kept clean and in good conditions.
Adequate warning signs shall be displayed and firefighting equipment shall be available in immediate
vicinity.
Storage and filling facilities shall be equipped to collect any leak which could affect the environment.
XXVIII. PERSONNEL BASKET

Design of personnel baskets shall be supported by a comprehensive calculation note. Their fabrication shall be
only undertaken by qualified welders. Personnel baskets shall be certified by an independent certification
COMPANY. They shall be checked and inspected by a competent person prior any use.
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
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ATTACHMENT 5
FABRICATOR'S SAFETY, HEALTH AND ENVIRONMENT (HSE)

Project :
2. Does your company have an HSE policy document ?

Yes No
diperusahaan anda?
tempat anda bekerja?

Name: Job Title:
Yes No
6. Does a full time HSE Department exist in your organisation?

Apakah Departement K3 tersedia di perusahaan anda?
Yes No
7. If answer to 6 above is yes, do you have job descriptions for the person(s) employed in your HSE
Department?
Jika jawaban no 6 Ya, Apakah perusahaan anda mempunyai job description terhadap karyawan di
Departement K3.
Yes No
If yes, Please give detail the position and responsibilities
Jika Ya, silahkan lampirkan detail dari posisi masing-masing karyawan dan responsibilitinya.
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
PROJECT SERVICES 01
8. If the answer to item 7 above is no, who is responsible for providing safety advice and monitoring the
implementation of HSE Management System at your work sites and what is their qualification?
Jika jawaban no.7 Tidak ada, siapa yang bertanggung jawab dalam memberikan arahan K3 dan
melakukan monitoring terhadap implementasi K3 management system ditempat perusahaan anda
bekerja dan apa kualifikasi orang tersebut?
Person Responsible :
___________________________________________________________________
Qualification :
Section III Organising for HSE - HSE Planning
9. Do you produce an HSE Plan in your workplace?

Apakah anda menyiapkan rencana pelaksanaa K3 dan Lindungan Lingkungan di tempat anda
bekerja?
Yes No
10. If answer to Question 9 above was no, briefly describe how you ensure that the required HSE Systems
are communicated and implemented on time.
Jika jawaban anda Tidak, Jelaskan bagaimana anda memastikan K3 dan Lindungan Lingkungan
yang disyaratkan dapat terkomunikasi dan dilaksanakan dengan baik.
11. Do you have a HSE Training Matrix for your employees?

karyawan anda? Please attach the HSE training matrix / Silahkan lampirkan HSE training matrux
Yes No
12. If the answer to Question 11 above was no, briefly describe how you identify and implement HSE
Training for your staff.
Jika jawaban no 11 Tidak ada, Jelaskan bagaimana anda mengidentifikasi dan mengimplementasi
kebutuhan trainining K3 dan Lindungan Lingkungan untuk karyawan anda.
13. Do you have a formal training program(s) for Supervisors their responsibilities in HSE Management
as Supervisors?
Apakah perusahaan anda mempunyai program training untuk safety suprvisor ?
Yes No
14. If the answer to item 13 above is yes, briefly describe this program and who conducts this training.
Jika jawaban no 13 Ya, Jelaskan bagaimana program ini berjalan dan siapa yang melakukan training
tersebut.
15. Do you have a formal HSE Orientation Programme for new employees?
Apakah perusahaan anda mempunyai Program Safety Orientation untuk karyawan baru? If Yes,
Please attach / Jika ya, silahkan lampirkan
Yes No

REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
PROJECT SERVICES 01
16. Does your Company have written HSE procedures?

Apakah perusahaan anda mempunyai procedure K3 dan Lindungan Lingkungan?
Yes No
17. If answer to Question 16 was yes, please attach HSE Procedure that you have.
18. Do you measure environmental performance?

Yes No

What?
How?

Yes No
22. Do your Senior Management conduct regular HSE Audit and Inspection?
Secara regular? If yes, please attach sample / Jika ya silahkan lampirkan bukit dari pelaksanaan
Yes No
23 Please provide the following information:
(A) Please provide your statistical HSE Performance for 3 last years:
a listing of the PPE for the scope of this work ?
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
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Signs,
( )
Date:
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
PROJECT SERVICES 01
ATTACHMENT 6
FABRICATORS HSE BID EVALUTION
Evaluation Result
Achievement
Score
1.1 HSE Policy (G) = 5 - 10
Total 15

Total 10
Total 10
4 HSE Training
4.5 HSE Orientation
Total 10
Total 10
Total 5

Total 10
* (P) = < 2
Total 5
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
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9.1 List of PPE (G) = 5 - 8
Total 10
Total 5
* (P) = < 2
Total 5
* (P) = < 2
Total 5
HIGHT /
SUMMARY PASS / FAILED
LOW
Recommendation:
Note : Score achievement: 60: Pass the HSE requirement

*Criteria Score:
Prepared By :
Name :
Tittle of Job :
Sign :
Date :
ATTACHMENT 8
FORWARDER'S SAFETY, HEALTH AND ENVIRONMENT (HSE)

Project :
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
PROJECT SERVICES 01
1. Does your company have an HSE policy document ?

Yes No
diperusahaan anda?
tempat anda bekerja?

Name: Job Title:
Yes No
6. Please provide HSE Leader for this works / operation? (Just for Heavy Lift Transporter)
Sebutkan siapa yg akan menjadi HSE Leader untuk kegiatan ini?
Section III Risk Identification
7. Please provide your Risk Identification for route through survey for this job or project?
Apakah anda menyiapkan rencana pelaksanaa K3 dan Lindungan Lingkungan di tempat anda
bekerja?
8. Do you have a HSE Training Matrix for your employees? (Just for head quarter International
Transporter)
karyawan anda? Please attach the HSE training matrix / Silahkan lampirkan HSE training matrux
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
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Yes No
9. If the answer to question no.8 was no, briefly describe how you identify and implement HSE
training for your staff?
Jika jawaban no.11 tidak ada, jelaskan bagaimana anda mengindentifikasi dan mengimplementasi
kebutuhan training K3 dan lindungan lingkungan untuk karyawan anda.
10. Do you have a formal HSE Orientation Programme for new employees? (Just for head quarter
International Transporter)
Apakah perusahaan anda mempunyai Program Safety Orientation untuk karyawan
baru? If Yes, Please attach / Jika ya, silahkan lampirkan
Yes No
11. Does your Company have written Safety procedures (Just for International Transporter and Local
Transporter) and Environmental Procedure (Just for Intrainsular Transporter) ?
Apakah perusahaan anda mempunyai procedure K3 (Untuk International Transporter dan Local
Transporter) dan Lindungan Lingkungan (Untuk Intrainsular Transporter)?
Yes No
12. If answer to Question 16 was yes, please attach Safety and Environmental Procedure that you have.
13. Do you measure environmental performance? (Just for Heavy Lift Transporter)
Yes No

What?
How?

Yes No
REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
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16. Do your Management conduct HSE Audit and Inspection at the work site? (Just for Heavy Lift
Transporter)
Secara regular? If yes, please attach sample / Jika ya silahkan lampirkan bukit dari pelaksanaan
Yes No
17. Please provide the following information:
(A) Please provide your statistical HSE Performance for 3 last years: (Just for Heavy Lift
Transporter)
a listing of the PPE for the scope of this work ?
(Just For International Transporter)

REKAYASA
MANAGEMENT SYSTEM
Doc. No : 4210-GP-13- Rev : J
PROJECT SERVICES 01
Signs,
( )
Date:
REKAYASA
MANAGEMENT SYSTEM
PROJECT SERVICES Doc. No : 4210-GP-13-01 Rev : J
ATTACHMENT 9
FORWARDER HSE BID EVALUTION
Evaluation Result
Achievement
Score
1.1 HSE Policy (G) = 5 - 10
Total 15

Total 10
Total 10
4 HSE Training
4.5 HSE Orientation
Total 10
Total 10
Total 5

Total 10
* (P) = < 2
Total 5
REKAYASA
MANAGEMENT SYSTEM

9.1 List of PPE (G) = 5 - 8
Total 10
Total 5
* (P) = < 2
Total 5
* (P) = < 2
Total 5
HIGHT /
SUMMARY PASS / FAILED
LOW
Recommendation:
Note: Score achievement: > 60: Heavy Lift, Dangerous Cargo Transport, International
Forwarder; 35 59: Local Transporter and General Cargo Transport.
*Criteria Score:
Prepared By :
Name :
Tittle of Job :
Sign :
Date :
ATTACHMENT 10
HSE BUDGET FOR SUBCONTRACTOR

LOCATION Of PROJECT :
ESTIMATED MANPOWER REK :
ESTIMATED PROJECT DURATION :
NO HSE EQUIPMENT SPECIFICATION QTY UNIT PRICE TOTAL REMARKS

REKAYASA
MANAGEMENT SYSTEM
PRICE
A PERSONAL
PROTECTIVE EQT
1 Safety Helmet + Chin MSA + CHAIN ea Apabila pecah sub-cont wajib mengganti
Strip STRIP
2 Safety Glasses ea Untuk pekerjaan chipping dan dekat
dengan grinda dan welding
3 Face Shield ea Setiap pekerjaan grinda
4 Ear Plug ea Untuk bekerja dikebisingan melebihi 80 db
selama 8 jam
5 Ear Muff ea For Commissioning
6 Full Face Mask + ea For Commissioning
Canister Respirator
7 Dust Mask / Kanvas ea
8 Cotton Gloves (Palm prs Semua pekerja wajib menggunakan hand
glove
Dotted)
9 Leather Gloves prs Untuk welding, grinda
10 Rubber Gloves prs For Commissioning
11 Safety Shoes prs Setiap satu tahun sekali wajib diganti
12 Wear Pack prs For Commissioning
13 Safety Rubber Boots prs Untuk pekerjaan civil (excavation,
pekerajaan mixing cement)
14 Rain Coats ea bila hujan
15 SCBA / ELSA ea bila diperlukan untuk pekerjaan confined
space
16 Work Vest ea wajib untuk bekerja diatas air
B MASS PROTECTIVE
EQT
1 Full Body Harness c/w Double Land Yard untuk pekerjaan diatas 1 m
lanyard
2 Safety Nets untuk mengcover pekerjaan diketinggian
3 Safety Ropes
4 Safety Tapes /
Barricades
5 Safety Cones
6 Yoyo (Full Block Untuk pekerjaan diatas 5 m dalam kondisi
vertikal dan ladder yg vertikal diatas 3 m
Arrestor)
7 Safety Life Line Sling/Tali Tambang Proteksi bekerja diketinggian
C SAFETY SIGNS,
POSTERS, etc
1 Safety Signs c/w stand 60 cm x 80 cm, 30
Aluminium
2 Safety Poster c/w frame Paint on canvas 40
3 Safety Banner 40
(Spanduk)
4 Wind Sock 5
5 Bendera K3 5
6 Bendera Perusahaan 5
7 Bendera Merah Putih 5
8 Bendera Muster Point 5
9 Stickers
D FIRE PROTECTION
EQUIPMENT
1 Fire Extinguishers Cap. 20 Lbs, ABC Untuk setiap welding machine, trafo,
genset, didalam kantor, workshop dan
Powder machinery yang lain yang ada dilapangan
2 Fire Extinguishers, Cap. 10 Lbs, ABC untuk setiap excavator, kendaraan, dozer,
crane, tmc
Powder
3 Fire Blanket, Fibre setiap botol bertekanan yang ada
dilapangan
4 Fire Extinguishers, CO2 Cap. 6 Lbs untuk pekerjaan di exisiting area dekat
dengan electrical equipment
type
5 Fire Hoses, 25 mtr Untuk di existing area
6 Jet-Spray Nozzles Untuk di existing area
7 Y-Piece / Dividing Untuk di existing area
breeching
REKAYASA
MANAGEMENT SYSTEM
E MEASUREMENT
EQUIPMENT
1 Multiple Gas Detector Analog/Digital Untuk pekerjaan diexisting
2 O2 Gas Detector Analog/Digital Untuk pekerjaan diexisting dan confined
space
3 Kalibrasi dan Repair
F HEALTH EQUIPMENT
1 First aids Kit set + ER SNI Standard untuk Untuk diworkshop dan kantor sub-
contractor
Set diatas 50 orang
2 Medical Check Up Surat keterangan sehat untuk setiap
pekerja sedangkan untuk karyawan
organic follow CSMS procedure Rekayasa
Industri.
G ENVIROMENT
EQUIPMENT
1 Portable Toilet 1:50 pekerja
2 Solar dan Oil Storage Concrete Floor Untuk penampungan solar dan oil
H COMMUNICATION
EQUIPMENT
1 Handy Talky Gas Proof Type for untuk setiap HSE Coordinator sub-
contractor yg compatible dengan
existing Rekayasa
I SCAFFOLDING
1 Type pipe tube+ thickness min 2.5 untuk pekerjaan diatas 1 m
toeboard+ladder mm, jika client
mensyaratkan lebih
makan sub-cont
harus mematuhi.
Material galvanized
J SERTIFIKASI
1 Crane Oil and Gas (Migas Sertifikat), Selain itu
Depnaker sertifkat
2 TMC Oil and Gas (Migas Sertifikat), Selain itu
Depnaker sertifkat
3 Scafolder Scafolder SV setiap Depnaker Sertifikat
crew
4 Rigger Depnaker Sertifikat
5 Genset > 200 Kva Depnaker Sertifikat
6 Operator Crane Oil and Gas (Migas Sertifikat), Selain itu
Depnaker sertifkat
7 Operator TMC Oil and Gas (Migas Sertifikat), Selain itu
Depnaker sertifkat
8 Excavator, Dozer Depnaker Sertifikat
K SLING, TACKLE, Harus mempunyai

CHAIN BLOCK sertifcate
manufacture
L PRESSURE BOTTLE
1 Flash Back Arrestor O2, Acyteline dan
Argon
2 Regulator
3 Clam Selang
4 Rack Botol Bertekanan penggunaan dilapangan dan warehouse
M HSE MANPOWER
1 HSE Coordinator Setiap sub-contractor wajib menyediakan
1 orang HSE Coordinator dengan
pengalaman kerja minimal 4 tahun di oil
dan gas, mempunyai pengetahuan K3 dan
minimal berpindikan D3 lebih baik D3
OHS
2 HSE SV Total HSE SV adalah 1 : 50 pekerja
Date :
REKAYASA
MANAGEMENT SYSTEM
Subcontractor name :
Direktur :
Tanda Tangan dan Cop Company :
Note: HSE requirement di atas bisa berubah sesuai persyaratan Klien, apabila mengakibatkan cost impact karena persyaratan dari Klien dan pekerjaan di lapangan,
sudah merupakan tanggung jawab sub-contractor dan tidak ada penambahan biaya.

(4210-GP-13-01) Prosedur CSMS - Rev J

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(4210-GP-13-01) Prosedur CSMS - Rev J

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PT.

REKAYASA INDUSTRI CORPORATE PROCEDURE

Controlled Copy, Do Not Duplicate For Internal Used

Document Change History

Rev. Date Change Description

A 3/06/05 REV. A Initial Release

Controlled Copy, Do Not Duplicate For Internal Used

VI. DETAILED PROCEDURE 4

I. FLOW CHART PROCESS PRE-QUALIFICATION / ASSESSMENT 6

II. SUBCONTRATOR HSE PRE-QUALIFICATION / ASSESSMENT QUESITIONER 7

III. SUBCONTRACTOR HSE BID EVALUATION 11

IV. HSE REQUIREMENT FOR SUBCONTRACTOR 13

V. FABRICATOR HSE PRE-QUALIFICATION / ASSESSMENT QUESTIONER 24

VI. FABRICATOR HSE BID EVALUATION 28

VII. SUBCONTRACTOR HSE KEY PERFORMANCE INDICATOR (please refer to

HSE form Doc No. HSE-FF-Z.1)

VIII. FORWARDER HSE PRE-QUALIFICATION / ASSESSMENT QUESTIONER 30

IX. FORWARDER HSE BID EVALUATION 34

X. HSE BUDGET FOR SUBCONTRACTOR 36

Controlled Copy, Do Not Duplicate For Internal Used

- Procedure of Bidder List Selection. Doc. No 4220-GP-44-04

- UU No.1 1970 Undang Undang tentang Keselamatan Kerja

- Manpower Minister (Menteri Tenaga Kerja) Regulation No. Per.02/MEN/1980.

VI. DETAILED PROCEDURE

6.1 Sub-contractor Scoring System

Controlled Copy, Do Not Duplicate For Internal Used

6.2 Fabricator Scoring System

6.3 Forwarder Scoring System

6.4 Record System

Controlled Copy, Do Not Duplicate For Internal Used

ATTACHMENT 1: FLOW CHART FOR PRE-QUALIFICATION / ASSESSMENT PROCESS

Controlled Copy, Do Not Duplicate For Internal Used

Prepare Questioner & Sent to Vendor

Distribute to Subcontractor / Fabricator

Complete Questioner & Sent Back

Receive Questioner & Sent Back to HSE

Prepare Bid Evaluation (Attachment

Copy to Vendor Management

Controlled Copy, Do Not Duplicate For Internal Used

Section I HSE Policy and Leadership

1. Does your company have an HSE policy document?

If yes, please attach / Jika Ya, silahkan untuk dilampirkan.

Section II General Organisation - Management Structure / Organisation

4. Who has ultimate responsibility for HSE management in your organisation?

Name: Job Title:

6. Does a full time HSE Department exist in your organisation?

Section III Organising for HSE - HSE Planning

9. Do you produce an HSE Plan for each Project?

Section IV Organising for HSE - HSE Training

11. Do you have a HSE Training Matrix for your employees?

16. Does your Company have written HSE procedures?

Section VI Managing HSE - Accident Performance Measurement

18. Do you measure environmental performance?

If yes, state what and how

19. Do you keep Accident/Incident Statistics for your Employees?

21. Do you keep Accident/Incident Statistics on your Subcontractors?

Section VIII Current HSE Statistical Information

23 Please provide the following information:

Section IX Personnel Protective Equipment

Apakah perusahaan anda mempunyai program pemeliharaan alat pelindung diri?

Section X Hazards and Effect Environmental Management

Section XI Drugs and Alcohol

Section XII Safety Achievement or Awards