JTB-RJJ000-S0-PRC-900-00043 HSE Minimum Requirement PDF

REVISION HISTORICAL SHEET
Rev. Date Section Description
0 6 Apr 18 All Issued for information
Document No. : JTB-RJJ000-S0-PRC-900-00043

Revision :0 Page 2 of 24
Contractor Doc. No. : S-000-1654-G0043
CONTENTS
Description Page
1. OBJECTIVE ................................................................................................................................5
2. SCOPE ........................................................................................................................................5
3. HSE MINIMUM REQUIREMENTS ............................................................................................5
3.1. SUBCONTRACTOR HSE Plan ....................................................................................................6
3.2. HSE Man Power ..........................................................................................................................6
3.3. Minimum Requirement Prior to Work (Request for ID Badge) ....................................................8
3.4. Personal Protective Equipment (PPE) ........................................................................................16
3.5. Permit to Work (PTW) and Job Safety Analysis (JSA) ...............................................................17
3.6. Tools and Equipment .................................................................................................................17
3.7. Excavation .................................................................................................................................18
3.8. Working at Height and Scaffolding Requirements ....................................................................19
3.9. Handling and Storage Compressed Gas ...................................................................................19
3.10. Electrical Safety .........................................................................................................................20
3.11. Radiography...............................................................................................................................20
3.12. Lock Out Tag Out (LOTO) .........................................................................................................21
3.13. Environmental Requirement ......................................................................................................21
3.14. Inspection ..................................................................................................................................22
3.15. Reporting ...................................................................................................................................22
3.16. Consequence Management ......................................................................................................22
3.17. Emergency Response ...............................................................................................................22
3.18. Campaign ..................................................................................................................................23
3.19. Welfare and Security .................................................................................................................23
3.20. Food Supplier ............................................................................................................................23
3.21. Audit...........................................................................................................................................24
3.21.1. . HSE Performance Audit ................................................................................................24
3.21.2. . Critical Work / Focus Audit ............................................................................................24
3.22. Reward & Punishment ...............................................................................................................24

Section
Description of Change Consortium Response Rev.
Affected
All Issued for information - 0

1. OBJECTIVE
The purpose of the requirements is to provide the SUBCONTRACTOR with the minimum
requirements to which SUBCONTRACTOR shall comply when conducting work on or in
connection with the project.
SUBCONTRACTOR working on the project shall comply with these requirements and all other
applicable laws including but not limited to labour, environmental, health, and safety standards. If
conflict arises between the requirements and applicable regulatory requirements, the most
stringent shall apply.
SUBCONTRACTOR shall comply with all written or verbal instruction regarding safety and health
issued pursuant to these requirements by CONTRACTOR.
2. SCOPE
Where these requirements do not adequately address SUBCONTRACTOR activities, the

SUBCONTRACTOR required to comply with all aspects of CONTRACTOR Policy, Procedure, and
Work Instruction (PPWI) and all applicable HSE laws, standards, and guidelines from
internationally recognized HSE agencies, organizations, and associations.
As these requirements cannot address every possible condition, work activity or situation which
may arise on site, the SUBCONTRACTOR required and expected to exhibit competence, exercise
best management and safe work practices with regard to health and safety of their workers and
work activities. Omission or failure to mention a specific issue in these requirements in relation to
any activity being conducted on theProject does not relieve the SUBCONTRACTOR from its
obligations under its CONTRACT.
In addition, all requirements stated in this document equally applied to other parties under control
of SUBCONTRACTOR.
3. HSE MINIMUM REQUIREMENTS
The following are the minimum requirements that the SUBCONTRACTOR shall comply with for all
HSE issues relating to work activities associated with their CONTRACT.
All SUBCONTRACTOR are subject to pre-qualification with CONTRACTOR Safety Management

System process. SUBCONTRACTOR are required to pass the CSMS process prior to being
awarded. CONTRACTOR HSE Corporate Division shall conduct the CSMS Process. The CSMS
process include the following:
- SUBCONTRACTOR must pass the CONTRACTOR Safety Management System process. It

will be conducted by procurement;
- SUBCONTRACTOR are required to follow approved CONTRACTOR's HSE Plan;
- List of tools & equipment and man power loading will be submitted to CONTRACTOR;
- Especially for national SUBCONTRACTORs, minimum score of CSMS evaluation is 90;
- Following copies of competence certificates will be submitted to CONTRACTOR, but not limited
to:
Table 1. Certificate of Competencies

No Certificate of Competencies
1 AK3 from Depnaker (AK3 Umum) or Oil & Gas (AK3 Migas)
2 Crane Operator
3 Rigger & Signal man
4 Scaffolder
5 Scaffolding Assessor / Inspector

No Certificate of Competencies
6 Welder
7 Fire Fighting Class D
8 First Aid (Basic & Advance)
9 Confined Space Entry
10 Authorized Gas Tester
11 Defensive Driving Course
12 Working at Height
13 SSOW Technical Expert (AT)
14 Painter & Abrasive Blaster
Where any situation arises which may require possible deviation from these requirements, it shall
be discussed with and approved, in writing, by the CONTRACTOR representative prior to
commencement of work.
3.1. SUBCONTRACTOR HSE Plan
SUBCONTRACTOR shall submit HSE Plan to CONTRACTOR. CONTRACTOR will review and
approve the HSE Plan. The HSE Plan shall be described herein below, but not limited to:
a) Objective
b) Scope of Work
c) Compliance to Regulations
d) Personnel Responsibilities for HSE Implementation
e) HSE Manpower Plan
f) Training Plan (including Short Service Employee (SSE) Program)
g) Personal Protective Equipment and Fire Protection Plan
h) Emergency Preparedness and Response Plan
i) Work Method
j) HSE Program (including HSE awareness)
k) Communication Program (including Management of Change)
l) HSE Reporting System
m) Reward and Punishment Program
n) Hazards and Risks Register
Approved SUBCONTRACTOR HSE Plan shall be presented by Project Manager of

SUBCONTRACTOR in HSE Workshop after Kick off Meeting. Project Manager of
SUBCONTRACTOR shall display the HSEcommitment for completion of work as stated in HSE
Commitment Sheet signed by Project Manager of SUBCONTRACTOR and CONTRACTOR.
3.2. HSE Man Power
CONTRACTOR will carry a written test and an interview to determine acceptance or rejection of
safety personnel SUBCONTRACTOR. If the SUBCONTRACTOR does not able to meet the
manpower requirement of CONTRACTOR, then CONTRACTOR will supply the manpower, and its
budget will be charged to SUBCONTRACTOR in accordance with CONTRACTOR’s standard.
Certain violations will lead to rejection to HSE SUBCONTRACTOR and the SUBCONTRACTOR
shall provide a replacement in accordance with the rules above to be able to get permission to
work.

Table 2. Requirements of HSE Man Power
No Position Attachment Requirement
SUBCONTRACTOR is required to provide 1 HSE
Coordinator with work experience minimum 8 years
Curriculum Vitae in HSE construction, K3 certification from Depnaker
for submission (AK3 Umum) or Oil & Gas (AK3 Migas), minimum
1 HSE Coordinator
HSE training and education bachelor degree prefers majoring K3.
induction
The candidate shall pass assessment from
CONTRACTOR HSSE Manager.
SUBCONTRACTOR is required to provide 1 HSE
Engineer / Trainer with work experience minimum 5
Curriculum Vitae years in HSE construction, minimum education
HSE Engineer / for submission bachelor degree majoring engineering.
2
Trainer HSE training and
induction
CONTRACTOR HSE Coordinator.
SUBCONTRACTOR is required to provide HSE
Supervisor with work experienced minimum 5 years
in HSE; minimum education bachelor degree prefers
majoring K3.
Manpower estimation:
HSE SV: Employee = 1: 25
If there is a critical and high risk potential of work,

SUBCONTRACTOR is required to provide an
Curriculum Vitae additional Safety Supervisor and Safety Man. Critical
for submission and high risk potential of work such as:
3 HSE Supervisor
HSE training and 1. Tie-in
induction 2. Working at height above 4 m
3. Confined space
4. Lifting
5. Excavation
6. Welding in existing area
7. Material supply (jetty  existing area)
8. Simultaneous works

SUBCONTRACTOR is required to provide HSE
Inspector (specific related to scope of work) with
work experience minimum 5 years in HSE
construction, minimum education diploma degree.
Curriculum Vitae
for submission HSE Inspector shall be prepared for several aspects /
4 HSE Inspector
HSE training and activities such as but not limited to:
induction 1. Electrical
2. Heavy Equipment (Lifting and Hauling)
3. Scaffolding

No Position Attachment Requirement
Curriculum Vitae SUBCONTRACTOR is required to provide HSE
for submission Administrator with work experienced minimum 3
5 HSE Administrator
HSE training and year in administration, minimum education diploma
induction degree.
Responsibility of HSE SUBCONTRACTOR:

- Conduct training for their workers, in the specified training room.
- Develop a safety records as requested by CONTRACTOR’s HSE.
- Deliver daily report to CONTRACTOR’s HSE every day at 17:00 pm.
- Ensure all labors are comply with HSE rules.
- Comply with all CONTRACTOR’s HSE rules and regulations, includes in establishment of
teams and committees.
- Attend HSE coordination meeting as scheduled by CONTRACTOR.
- Actively participate in safety campaign either on own HSE programs or CONTRACTOR’s HSE
programs.
- Maintaining active participation of all parties in the implementation of a system for recognising,
correcting, and reporting unsafe acts / conditions such PEKA card
3.3. Minimum Requirement Prior to Work (Request for ID Badge)
SUBCONTRACTOR and Sub-SUBCONTRACTOR personnel must attend HSE Induction and

Training organized by CONTRACTOR prior to work. Training matrix refer to Table 3. HSE Training
Matrix.In addition, all workers are also required to obtain a fit for work letter from the Doctor of
CONTRACTOR (based on a review of health examination / MCU results).
Cost for external competency training (training provided by third party) and health examination /
MCU for workers shall be to SUBCONTRACTOR and / or Sub-SUBCONTRACTOR account.

5
4
3
2
1
No
(Project
Finance
Revision
First Aider
Floor Warden
Document No.
- HSE Manager
JTB Project
Discipline Engineer
Position
Contractor Doc. No.

Manager,
Engineering Manager)
Non-Rotator - Jakarta Based
Lead Discipline Engineer

- Quality Control Manager
:0
Procurement Manager and
Project
Manager,
Control Manager, Adm. &
Project Management Team
M
M
M
M
M
M
M
HSE Project Induction
Safe Behaviour Training Competency
M
M
M
M
M
M
M
for All
(SBTC)
: S-000-1654-G0043
Mandatory
M
M
M
M
M
M
M
PEKA (Pengamatan Keselamatan Kerja)
Lifting Assessment and Authorization

Scaffolding Assessment and
Authorization
: JTB-RJJ000-S0-PRC-900-00043
Personnel
for Certain
Mandatory
Provided by COMPANY (9)
M
M
AT Assessment and Authorization
Site Induction (Project Specific
1
1
1
1
1
M
M
M
M
M
Orientation)
M
M
Permit to Work (PTW) System
M
PPE Awareness
M
M
M
M
JSA & Risk Assessment
M
Food Hygiene
M
Environmental Management System
M
Incident Investigation
M
M
Hot Work
Page 9 of 24
M
M
H2S
Table 3. HSE Training Matrix
Lock Out Tag Out (LOTO)

Internal
M
M
Electrical Safety (Basic)

HSE Training Matrix
M
M
Basic First Aid & CPR

M
M
Basic Fire Fighting

M
Advanced First Aid & CPR

M
M
SSOW Technical Expert / AT

Provided by CONTRACTOR
Authorized Gas Tester (AGT)

Confined Space Entry
(pre entry, attendant & rescue)
Working at Height
Defensive Driving (8)
Scaffolder
Scaffolding Inspection
Certification by MIGAS
Certification by DEPNAKER
Basic Rigging & Lifting

Party Training Provider
Government and / or Third
Painter & Abrasive Blaster

9
8
7
6
5
4
3
2
1
No
Revision
Engineer
instrument)
instrument)
HSE Officer
Site Manager
Document No.
Rotator - Site Based
Lead Engineer
HSE Coordinator
JTB Project
Position
Contractor Doc. No.

piping, civil, electrical,
piping, civil, electrical,
Construction Manager
Safety Superintendent
Construction Supervisor /
Work Leader (mechanical,
:0
Superintendent (mechanical,
General / Lead / Construction
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
for All
(SBTC)
: S-000-1654-G0043
Mandatory
M
M
M
M
M
M
M
M
M
M
M
M
Authorization
: JTB-RJJ000-S0-PRC-900-00043
Personnel
for Certain
Mandatory
M
M
M
M
M
M
M
M
M
M
M
M
Orientation)
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
PPE Awareness
M
M
M
M
M
M
M
M
M
Food Hygiene
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
Hot Work
Page 10 of 24
M
M
M
M
M
M
M
M
M
M H2S
M
M
M
M
M
M
M

Internal
M
M
M
M
M
M
M
M
M

HSE Training Matrix
M
M
M
M
M
M
M

M
M
M
M
M
M
M
Basic Fire Fighting

M
M
M

M
M
M

2
2
2
2
M
M
M
M
M

M
M
M
M
Working at Height
M
Scaffolder


19
18
17
16
15
14
13
12
11
10
No
Revision
Security
vehicles)
IT Officer
electrical)
Scaffolder
Development
Document No.
Chief Security
Chief Community
JTB Project
Position
Contractor Doc. No.

Operator Equipment
Equipment Inspector
Scaffolding Inspector
Supervisor Scaffolding
(lifting, heavy equipment,
Administrator and Drafter
:0
(heavy equipment, electrical,
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
for All
(SBTC)
: S-000-1654-G0043
Mandatory
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
Authorization
: JTB-RJJ000-S0-PRC-900-00043
Personnel
for Certain
Mandatory
M
M
M
M
M
M
M
M
M
M
Orientation)
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
PPE Awareness
M
M
M
M
M
M
Food Hygiene
M
M
M
M
M
M
M
M
M
Hot Work
Page 11 of 24
M
M
M
M
M
H2S
M
M
M

Internal
M
M
M
M
M

HSE Training Matrix
M
M
M
M

M
M
M
M
M
Basic Fire Fighting


2
2
2
2
M
M
M
M

M
M
M
Working at Height

M
M
M
Scaffolder
M
M
3
4
M
M
M
M
5
M


32
31
30
29
28
27
26
25
24
23
22
21
20
No
Man
Aider
Rigger
Welder
Revision
Mechanic
Pipe Fitter
Electrician
Signal man
Helper, Labor
Document No.
PTW Coordinator
JTB Project
Position
Contractor Doc. No.

Field Fire Team Member
Field Rescue Team & First
Environmental Coordinator
Painters & Abrasive Blaster
:0
Carpenters / Masonry / Rebar
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
for All
(SBTC)
: S-000-1654-G0043
Mandatory
M
M
M
M
M
M
M
M
M
M
M
M

Authorization
: JTB-RJJ000-S0-PRC-900-00043
Personnel
for Certain
Mandatory
M
M
M
M
M
M
M
M
M
M Orientation)
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
PPE Awareness
M
M
M
M
M
M
M
M
M
M
Food Hygiene
M
M
M
M
M
M
M
M
M
M
M
M
M
M
Hot Work
Page 12 of 24
M
M
M
M
M
M
M
M
H2S
M
M

Internal
M
M
M
M
M
M

HSE Training Matrix
6
M
M
M
M

6
M
M
M
M
Basic Fire Fighting

M


2
M

7
7
M
M
Working at Height
Scaffolder
M
M
M
M

M

47
47
46
45
44
43
42
41
40
39
36
35
34
33
No
Cook
Revision
BATAN)
Surveyor
and Crew
Paramedic
HSE Trainer
Chief Quality
Drivers for LV
Document No.
Catering Crew
JTB Project
Position
Contractor Doc. No.

NDT Crew (certified by
Scheduler Engineer Site

Construction Control Site
Chief Construction Control
Cost Control Engineer Site
:0
Quality Control Inspector (site)
Chief Administration & Finance
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
for All
(SBTC)
: S-000-1654-G0043
Mandatory
M
M
M
M
M
M
M
M
M
M
M
M
M
M

Authorization
: JTB-RJJ000-S0-PRC-900-00043
Personnel
for Certain
Mandatory
M
M
M
M
M
M
M
M
M
M
M
M
M
M
Orientation)
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
PPE Awareness
M
M
M
M
M
M
M
M
Food Hygiene
M

M
M
M
M
M
M
Hot Work
Page 13 of 24
M
M
M
M
H2S
M
M

Internal
M
M
M
M
M
M
M
M
M
M
M
M
M

HSE Training Matrix
M
M
M
M
M

M
M
M
M
M
M
Basic Fire Fighting

M


2
M

Working at Height
M
Scaffolder

M

HSE Training Matrix
Provided by COMPANY (9) Provided by CONTRACTOR

JTB Project
Mandatory
Mandatory Government and / or Third
for Certain Internal
for All Party Training Provider
Personnel








Basic Fire Fighting
Working at Height
PPE Awareness
Food Hygiene
Authorization
Orientation)
Scaffolder
Hot Work
(SBTC)
H2S
No Position
47 Drivers for HV M M M M M M M M M
49 Drivers for Ambulance M M M M M M M M M
51 Chief Logistic M M M M M M
52 Warehouse Superintendent M M M M M M M M M M M
Material Control
53 M M M M M M M M M M M
Superintendent
54 Warehouse Man M M M M M M M M
Notes:
1. Required only if the person travel to site;
2. Mandatory only for personnel involved in confined space;
3. Mandatory only for lifting inspector;
4. Mandatory for lifting operator;
5. Mandatory for heavy equipment (excavator, dozer, compactor);
6. Mandatory for helper / labor who assigned as dedicated fire watcher;
7. Mandatory if applicable based on task;
8. Driver stated as a visitor are not required to follow this training;
9. COMPANY only train all of CONTRACTOR personnel (for SUBCONTRACTOR personnel, COMPANY will conduct a Training of Trainer (ToT) to CONTRACTOR HSE Trainer.

SUBCONTRACTOR obliged to submit:
1. Proposal for HSE Induction and Training. CONTRACTOR HSE will check the completeness
and conformity of the data.
2. Other requirements for each personnel such as:
a. Complete filled of man power register form
b. Copy of ID card
c. Copy of employment card / BPJS
d. Formal photograph (3x4) with blue color as a background
e. Valid personnel (skill) certificate (scaffolder, scaffolding inspector, rigger, welder, etc.)
SUBCONTRACTOR HSSE CONTRACTOR
Submit an Application
Letter Regarding ID
Badge Request No
Data
Complete
Attachment of Letter:
• List of Workers (Hardfile)

Yes
• Copy of Competence Certificate
Such as Welder / Operator
Unfit
(Hardfile) MCU Review by (Worker Shall re-MCU
• Form of Man Power Register Health Coordinator Based on Recommendation)
(Softfile in .xls Format) for Each
Worker Fit for Work
• Formal Photo (3x4) with Blue Color
as a Background (Softfile in .jpg
HSSE Induction &
Format Max. 75 KB)
Matrix Training
• MCU Result (Softfile in .pdf Format
Max. 2 MB)
• Identity Card (Softfile in .jpg Format
Max. 75 KB)
• Employment Card / BPJS (Softfile SIML & ID Badge
in .jpg Format Max. 75 KB) Approval
By HSE Coordinator
Approved SIML
& ID Badge
Table 4. Requirements of Competence Certificate

No Position Certification
1 Scaffolder MIGAS Certificate
2 Scaffolding Assessor/ Inspector MIGAS Certificate
3 Rigger MIGAS Certificate
4 Operator of Crane & TMC MIGAS Certificate
5 Operator of Other Heavy Equipment DEPNAKER Certificate
6 Operator of Concrete Pump DEPNAKER Certificate
7 Welder Refer to requirement from QC
f. Personnel Medical Check Up (MCU) result

Medical examination shall require for all personnel of SUBCONTRACTOR and shall
examined by COMPANY approved health institution. The maximum validity of the MCU
proposed is 1 year from the date the MCU was taken. The list of MCU to be checked must
be obtained from the COMPANY’s requirement as follows:

Table 5. Type of MCU Examination
Duration Package of MCU
< 3 months employment or contract MCU Package A
3-12 months employment or contract MCU Package B
>12 months employment or contract MCU Package C
Table 6. Frequency of MCU Examination

Age / Position Frequency
Until 45 years old 2 yearly with refresh annually, if any indication
Over 45 years old Once a year, if there are any personnel aging above 55 years
old, a specific dispensation work permit shall be approved by
COMPANY medical doctor and project manager.
Crane operator Annualy / yearly basis
Table 7. MCU Package

MCU Package
No
A B C
1 Medical history Medical history Medical history
2 Complete physical examination Complete physical examination Complete physical examination
3 Chest x-ray Chest x-ray Chest x-ray
4 Electrocardiography Electrocardiography Electrocardiography
5 Blood routine test Blood routine test Blood routine test
6 Urine routine test Urine routine test Urine routine test
7 Treadmil test (> age 40 yo or Liver function test (SGOT, SGPT, Liver function test (SGOT, SGPT,
based on indication) alkali phospatase) alkali phospatase)
8 Stool culture (for food handler Test for HbsAg Test for HbsAg
or catering crew)
9 Alcohol and drug test Chemical blood test (blood lipid, Chemical blood test (blood lipid,
blood sugar, uric acid) blood sugar, uric acid)
10 Treadmil test (> age 40 yo or Treadmil test (> age 40 yo or
based on indication) based on indication)
11 Stool culture (for food handler or Spirometric test (based on
catering crew) indication / job risk)
12 Alcohol and drug test Audiometric test (based on
indication / job risk)
13 Ureum and creatinin test
14 Stool culture (for food handler or
catering crew)
15 Alcohol and drug test
3.4. Personal Protective Equipment (PPE)
All personnel, SUBCONTRACTOR, and visitors shall provided PPE that complies with the
minimum requirement and type of PPE to be used at project site area. SUBCONTRACTOR shall
provide sufficient PPE for their personnel with minimum stock for consumable PPE at least for
covering 2 weeks during execution. The standards are following:

Table 8. PPE Standards
Type of PPE Standards
Head protection All head protection with chinstrap shall meet requirements set out in
ANSI Z89.1 – 2003
Eye and face protection All eye and face protection shall meet the requirements set out in
ANSI Z87.1 – 2003 or current EN standard
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;
Air line mask BS EN 139, 1995; Self Contained Breathing Aparatus
(SCBA) BS EN 137, 1993
Hearing protection All hearing protection shall meet the requirements set out in ANSI
S12.6 – 1997, all type of hearing protective shall be used
appropriately depend on noice 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 Cotton / denim clothing coverall, provided with COMPANY logo /
name and individual name
Foot protection All foot protection shall meet the requirements set out in BS EN 345,
1993
Fall protection All fall protection shall meet the requirements refer to ANSI A10.14
Notes:
- SUBCONTRACTOR shall provide eye glasses with clear lense for night shift and working inside
building or vessel;
- Full body harness mandatory at > 1.8 m elevation and must equipped with double lanyard
including shock absorber.
3.5. Permit to Work (PTW) and Job Safety Analysis (JSA)
- Approved Permit to Work is required for every work and violation on this requirement will be
impact to termination of Person in Charge (work leader / supervisor / foreman / etc.).
- CONTRACTOR and / or SUBCONTRACTOR's construction and commissioning
Superintendent / Supervisor shall prepare Job Safety Analysis (JSA) and propose Work Permit
before starting the work.
- Approved JSA as CONTRACTOR’s format shall be submitted and presented as requirement of
Permit to Work issuance.
- Approved method statement is required for high risk activities or others that will be defined by
CONTRACTOR.
- Others related documents shall be attached as PTW requirements (such as rigging / lifting plan,
drawing / layout plan, ground disturbance certificate, confined space certificate, etc.).
- Permit to Work and all attachments shall be display at the workplace and in a good
understanding of all workers involved.
3.6. Tools and Equipment
- Only competent personnel and assigned person able to operate machinery &equipment proven
by valid Migas certificates no except for rigger.
- Pre-mobilization inspection shall be proposed to CONTRACTOR subsequently gain approval
from COMPANY.
- SUBCONTRACTOR shall propose equipment (include heavy equipment) & vehicles produced
in the last 5 years (starting from 2013).
- SUBCONTRACTOR shall conduct internal inspection afterward routinely inspection by
CONTRACTOR as per scheduled that proven tools, machinery, and equipment are in safe
services and good condition of performing the function.

- SUBCONTRACTOR shall ensure that all rotating or moving parts of all tools and equipment are
adequately guarded to prevent direct contact to personnel. Every power-driven machine should
be provided with adequate means, immediately accessible and readily identifiable to the
operator, of stopping it quickly, and preventing it being started again.
- All tools and equipment are allowed to use after get approval from CONTRACTOR and
COMPANY (pre-mobilization and gate inspection).
- Modification and handmade for tools are prohibited.
- All equipment used shall be equipped with a closed covered cabin (including Dozer).
- SUBCONTRACTOR shall provide Multi Gas Detector with the valid calibration certificate from
third party while working in existing plant, confined space, and excavation > 2 m depth.
- SUBCONTRACTOR shall conduct annual certification renewal of heavy equipment used.
Table 9. Administration & Certification Requirements of Tools and Equipment

No. Equipment Administration / Certification
1 Crane MIGAS Certificate
2 TMC MIGAS Certificate
3 Sky Lift MIGAS Certificate
4 Forklift MIGAS Certificate
5 Gondola MIGAS Certificate
6 Excavator DEPNAKER Certificate
7 Dozer DEPNAKER Certificate
8 Grader DEPNAKER Certificate
9 Genset (> 200 kVA) DEPNAKER Certificate
10 Transport Vehicles (Trailer, Dump Truck, Truck, etc.) STNK & KIR
11 Concrete Pump DEPNAKER Certificate
Lifting Gear such as Webbing Sling, Chain Block,
12 MIGAS Certificate
Shackle, etc.
3.7. Excavation
- Design for excavation > 1.5 m (5 feet) (including protection system) shall be develop 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
other place to avoid landslide.
- For permanent retaining walls, check the overload capacity first.
- Support systems should only be erected, altered or dismantled by competent workmen under
supervision.
- Safe access must be provided into all excavations by means of ladders, ramps or stairs.
- Access ladders or other means of access should be placed at regular distances (max. 7.5 m)
so that workers only have to travel a short distance to escape if there any emergency situations.
- Access ladders should 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 1.7m depth).
- Trucks should not transport soil beyond capacity and shall be covered with blue sheet to
prevent scattered soil during transportation activities.
- Related to site preparation works, SUBCONTRACTOR shall provide a dedicated washing bay
at the Quarry area. In addition, this washing bay shall be equipped with drainage channel and
sedimentation pond to accomodate waste water (resulted from truck washing activities) prior to
discharged outside the Quarry area.
3.8. Working at Height and Scaffolding Requirements
- Working at height requirement: access, platform, and fall protection.

- Accessing, egressing, ascending, descending, or working in any position where a person can
fall from, into, or anything that exceeds 2 meters from one level to another.
- Scaffolding and related PPE such as safety full body harness double lanyards shall be used
when working ≥1.8 meters.
- Safety full body harness double lanyards complete with shock absorber shall be used when
working ≥ 6 meters.
- Scaffolding type: Tubular Steel Pipe with outside diameter 48,3 mm / 1.9” and pipe thickness
4,0 mm. Couplers, Fitting and accessories shall comply as appropriate for scaffold which be
erected.
- The utilization of gondola shall be completed with clear SOP and several requirement such as
Engineering calculation, QC test, Installation & Inspection procedure, etc.and approved by
Construction Manager of CONTRACTOR.
- Frame scaffolding shall not be used for working at height activity as working platform.
- Scaffolding shall not be used until they have been inspected and certified by competent person
as safe and fit for use.
- Any scaffold work shall be undertaken only by scaffolders holding certificate of competency:
scaffolding erection shall be supervised by competent person (have advance scaffold Training),
and erected by scaffolder (Scaffolding Operator).
- Inspections shall be carried out by Scaffold Inspectors/ Assessor who will either accept the
scaffold or reject it and detail deficiencies to be corrected. In either case, the tagging system will
be used to visually indicate the result of inspection.
- Inspections of scaffolds in regular service shall take time every 7 days, i.e. a scaffold approved
for use on a Monday must be re-inspected and recertified each subsequent Monday, or
immediately after severe or adverse weather. Tagging shall be signed and dated after each
inspection either reject or safe for use.
3.9. Handling and Storage Compressed Gas
- Cylinder gas shall be in an upright position and secure properly with chain.
- Oxygen cilinders in storage shall be separated from fuel-gas cylinders or combustible materials
(especially oil or grease), a minimum distance of 20 feet (6,1 m) or by a non-combustible barrier
at least 5 feet (1,5 m) high having a fire-resistance rating of at least one half hour.
- Flashback Arrestor shall be install in all oxygen, acetylene and LPG Gas Cylinder. Flash back
arresters shall be used at both ends of the hose, ie, immediately after the regulator and
immediately before the torch.
- All gas cylinder shall be provided with cap and sticker which indicate the gas cylinder.
- LPG cylinder including hose shall be met industrial type and safe for use.
- Provide MSDS and fire extinguisher in each work location that involved the use of compressed
gas.
- Cylinders shall be identified by a color code in accordance with respective national standards.
- SUBCONTRACTOR shall provide label for all gas cylinders to indicate the contents of the
cylinder. Label has to be weather proof, readable in English and/or Bahasa in the format of
stencil, sticker, etc.

3.10. Electrical Safety
- Trained and competent person for operate portable electrically powered tools and equipment.
- Electrically powered portable tools and equipment shall be 110 volts center-tapped
- Electrically powered portables tools and equipment with 240 volts is allowed with follows double
insulated and the power source shall be equipped with ELCB 10 milli-amps
- Electrical tools for confined space work usage shall be supplied by DC current, if it’s not
available, AC current shall be equipped with Ground Fault Circuit Interrupter (GFCI).
- Use only tools that are grounded, double – insulated, and approved by Electrical Engineer.
- Do not use tools that spark, smoke or become excessively hot when in use.
- Electrically powered tools shall meet the hazardous zone requirement where applicable.
- All electrical cables and connector must be water proof material and industrial grade (IP 4.4).
Cables shall have NYYHY standard. Socket shall be 3 phase chord.
- All extension cords used must have explosion-proof ends (connectors).
- All “cheater cords” must be less than 2 feet in length with one male explosion-proof end and
one female standard U-ground plug, and must be used only at the immediate location of the
tool or test equipment.
- Sub-CONTRACTOR shall repair or replace defective tools and equipment at Sub-
CONTRACTOR cost.
- Welding machine and Generator Set must be equipped with distribution panel and emergency
stop.
- Distribution panel shall be equipped by MCB and ELCB / RCD.
- Temporary Construction Generator shall be located at appropriate area that not violating
operability of existing plant, in non hazardous area, consider the prevailing wind, and consider
safe distance from nearest hydrocarbon leakage. The running genset shall be monitored by
technician and fire watcher.
- Appropriate protective equipment must be worn at all time when using any tools or equipment.
Wherever required, wear protective equipment; insulated gloves, shock - resistant footwear,
safety goggles, etc.
3.11. Radiography
SUBCONTRACTOR shall ensure that radiography work shall be done in accordance with the
provisions of BAPETEN (BadanPengawasTenagaNuklir) regulations, as follows but not limited
to:
- All radiography equipment including X-rays shall have a valid license issued by BAPETEN.
- Radiography workers shall has received training and legal certification (permit) from BAPETEN.
- Radiography workers shall use the film / radiographic badge or personal dosimeter to control
the radiation exposure.
- Radioactive source must be stored (if not used) in a safe place (in accordance with regulations)
and locked properly. Only authorized personnel who havethe authority to take / check.
- Transportation of radioactive source from the storage to the work location shall meet the
requirements / procedures issued by BAPETEN especially vehicles used shall be equipped with
a radioactive symbol sign. During the transportation, survey meter shall be enabled to ensure
that workers who carry the source are not exposed to radiation levels (should not exceed 20 Sv
/ H).
- Radiography work area shall be provided with radiography / radioactive sign that refer to
international code (clearly visible, in Bahasa is a must, addition others language is optional,
weather proof (paper laminating is not accept)) and SUBCONTRACTOR shall maintain and
replace if damage. This sign also include warning regarding “Radiography Hazards – Prohibited
Area”.
- Radiography work shall also be provided with barricade around the area and standby man to
ensure unauthorized persons enter the area.
- Emergency equipment shall be provided near the work area.
- Radioactive waste shall be restored in a dedicated container and labeled “Radioactive Waste”.

- The allowed maximum dose is 25 Sv / H (in the work area) and the acceptable dose to
environment not exceed 1 m Sv per year.
3.12. Lock Out Tag Out (LOTO)
LOTO procedures shall be implemented in the work area to prevent workplace accidents due to
the unintentional operating of the equipment, unintentional opening / closing the valve, working
on a live system, testing of systems / equipment, repairingmachine / equipment, and etc.
Implementation of LOTO procedures are integrated withworking permit system applied in JTB
Project. Related to this procedure, SUBCONTRACTOR associated with LOTO works shall
provide a sufficient amount of equipment such as lock (dedicated lock for LOTO) and tag.
Color of lock separated as per discipline basis:

Red  Electrical
Yellow  Mechanical
Blue  Piping
Green  Operation
Tag shall be weather proof (paper laminating is not accept) and SUBCONTRACTOR shall
maintain and replace if damage.
3.13. Environmental Requirement
- Segregation hazardous solid waste (chemicals contaminated objects), non hazardous solid
waste (domestic waste), metal waste, and hazardous liquid waste (waste of chemical material
used).
- Provide vehicle for waste transportation.
- Provide trash can with criteria as follows:
• Hazardous Solid Waste (Red)
• Non Hazardous Organic Solid Waste (Green)
• Non Hazardous Anorganic Solid Waste (Yellow)
• Metal Waste (Blue)
- SUBCONTRACTOR responsible to manage by proper plan on hazardous waste, periodically
report / manifest shall submit to CONTRACTOR with refer to CONTRACTOR Waste
Management Plan and / or local regulation.
- The storage area shall display the MSDS, equipped with bund wall to prevent the widening of
the spill area, segregated for each type of waste and fire extinguishers (APAR).
- SUBCONTRACTOR shall provide vehicle to transport hazardous waste from workplace to
CONTRACTOR dedicated temporary hazardous waste storage (max store time is 90 days).
- SUBCONTRACTOR shall coordinate with licensed 3rd party to manage all hazardous waste
generated.
- Incompatible waste should be stored separately or in a manner that prevents the event of
mixed up and spill. This requirement can be met i.e. by providing adequate space between in
compatibles or physical separation such as walls or containment curbs.
- Label and symbol shall be unique and patched on each package of waste to describe
information of waste.
- Hazardous materials container / can shall be equipped with the MSDS (Material Safety Data
Sheet) can be obtained from suppliers. MSDS should contain the following information as a
minimum:
• Chemical identification and data
• Fire and explosion (Flash point temperature, flammable limit range, auto ignition
temperature)
• Health aspects (nature of hazards TLV-STEL, TLV-TWA)
• Emergency procedures
• Environmental (emission to atmosphere, spillage, neutralizer procedure, waste disposal)
• Transportation procedure
• Personal protective equipment to be worn
• Storage and spill kit requirements
- SUBCONTRACTOR responsible to manage construction waste as properly with refer to
CONTRACTOR Waste Management Plan and / or local regulation.
- SUBCONTRACTOR shall create a waste monitoring (volume, waste generated) and minimize
program.
3.14. Inspection
- Pre - Mobilization Inspection. Requirements that must be fulfilled for Pre - Mobilization
Inspection:
• Submission Letter for Pre – Mobilization Inspection
• Copy of SILO
• Copy of SIO
• Equipment (include heavy equipment) & vehicles produced in the last 5 years (starting from
2013)
- Monthly management walkthrough lead by CONTRACTOR Project Manager and attend by
Project Manager, HSE Manager, A&F Manager, QAQC Manager and Construction Manager of
CONTRACTOR and SUBCONTRACTOR
- Weekly safety patrol lead by CONTRACTOR Construction Manager and attend by Construction
Manager, GSI, Chief HSE/ HSE Coordinator of CONTRACTOR and SUBCONTRACTOR
- Daily inspections of work areas, fire extinguishers, heavy equipment (before and after
mobilization to the field), sling and wire rope, machine, scaffolding, etc.
- Unsafe Action & Unsafe Condition report (minimum target per person 5 PEKA / week)
- HSE COMPANY has authority to conduct safety inspection on the project
- Light vehicle shall be equipped with speed sensor, anti-lock brake system, air bag for driver &
passenger, and safety belt for all passengers.
- Workers transport vehicle shall be equipped with seat belt for passenger
- Quarterly inspection mark with color coding system:
• Jan-Mar (Red)
• Apr-Jun (Yellow)
• Jul-Sep (Green)
• Okt-Dec (Blue)
3.15. Reporting
SUBCONTRACTOR shall report HSE report to CONTRACTOR’s HSE:

- Daily Report (Man Hour, Tool Box Meeting, and unsafe act & unsafe condition reporting /
PEKA)
- Inspection Report
- Incident Investigation Report
3.16. Consequence Management
In order to stringent of HSE enforcement CONTRACTOR initiate one committee called

Consequence Management Committee. The Consequence Management Committee will be a
forum to adjudicate of violations to HSE rules and or regulation. The members of committee are
CONTRACTOR management representative and SUBCONTRACTOR management
representative. The members name will be assigned on HSE committee meeting or P2K3
meeting. Violations effect to consequence is in the form of warning letter to termination from
project depend on type of violations. Type of violations and the consequences will be detail in
CONTRACTOR’s Safety Management Plan.
3.17. Emergency Response
SUBCONTRACTORshall prepare emergency response methods and conduct emergency

response drill prior to work. SUBCONTRACTORshall conduct emergency response drill at least
two (2) times within one (1) year and initial drill shall conduct 2 weeks after Kick of Meeting at
project site. Emergency drill involving SUBCONTRACTOR and CONTRACTOR rescue teams.

When CONTRACTOR conducts emergency response drill, all SUBCONTRACTORpersonnel
shall actively involve the drill.
In addition, SUBCONTRACTOR shall prepare all emergency response equipment such as but
not limited to fire extinguishers, first aid kit, etc. The amount of emergency response equipment
shall comply with applicable government regulations
3.18. Campaign
HSE campaign shall be one of the parameter of HSE performance and will be evaluated in audit
of SUBCONTRACTOR’s HSE Performance. The program of HSE campaign shall be put in
SUBCONTRACTOR HSE Plan at least but not limited to:
a. Displaying of SUBCONTRACTOR’s HSE statistic on HSE statistic board. It shall be shows

numbers of manpower, safe man-hours reached, HSE indicator (near-miss, RWDC, LTI and
fatality), period of updating, etc.
b. Providing of HSE sign. SUBCONTRACTOR shall provide HSE sign as their obligation.
Providing of HSE sign at least must refer to the condition of hazard related
SUBCONTRACTOR scopes. HSE sign can be a sticker, poster, banner, billboard, etc. HSE
sign shall refer to international code of HSE sign as clearly visible, in Bahasa is a must,
addition others language is optional, weather proof (paper laminating is not accept) and
SUBCONTRACTOR shall maintain and replace if damage.
3.19. Welfare and Security
SUBCONTRACTOR shall provide welfare and security requirements for their workers, at least
but not limited to:
a. Labor toilet in work area, 1 toilet for maximum 25 workers.

b. Housekeeper with ratio 1 housekeeper for 50 workers.
c. Potable water, SUBCONTRACTOR shall supply in accordance with the requirements of
CONTRACT.
d. Smoking shelter, SUBCONTRACTORshall provide smoking shelter which approved area by
CONTRACTOR. Smoking shelter shall be equipped with one dry chemical Fire Extinguisher
at least 6 kg cylinder. Housekeeping of smoking shelter shall be periodically maintained by
SUBCONTRACTOR.
e. SUBCONTRACTOR shall provide centralize feeding station for their workers.
f. Security officer, SUBCONTRACTOR shall provide an adequate number of security officers to
secure their assets (including but not limited to temporary office, workshop, materials, etc.) in
accordance with the requirements of CONTRACT. The source of security officers employed
by SUBCONTRACTOR shall be from BUJP (Badan Usaha Jasa Pengamanan) / security
provider that has cooperated with CONTRACTOR.
3.20. Food Supplier
Supplying of food has established for preventive measure to be implemented in order to assure
the safety and suitability of food in controlling the food hazards accordance to HACCP (Hazard
Analysis and Critical Control Point).
Food supplier shall follow and provide:
a. Valid Laik Hygiene & Sanitasi Jasa Boga Certificate from Dinas Kesehatan Bojonegoro.
b. Food handler hold valid certificate by Dinas Kesehatan Bojonegoro.
c. Food handler stated fit by MCU.
d. Water quality test certificate.
e. Food Storage with temperature control.
f. Adequate PPE for food handler.
g. Disinfectant for food handler, tools and pantry as periodically.

h. No parasites, microorganisms, toxic, decomposed and other undesirable substances in raw
material for food.
i. Food packaging design and material shall adequate protect to minimize contamination.
j. Replacement of food handler who indicates/ suspect of infectious disease carriers shall be as
soon as possible.
k. Food supplier fully responsible and accountable in order to fulfill audit recommendation by
CONTRACTOR Industrial Hygiene Specialist and or by local authority.
3.21. Audit
3.21.1. HSE Performance Audit
The implementation of the work is in accordance with the Project Safety Management Plan at the
work place, in the field or in work location will be monitored and audited by CONTRACTOR in
monthly basis. The score of this audit shall meet minimum 80 of 100.
SUBCONTRACTOR shall attach KPI audit result in monthly progress report to submit invoice.The
consequences to fail the minimum score, will impact to suspension of monthly progress report
approval. The report will be proceed if SUBCONTRACTOR fullfil all of the audit recommendation
and proved by evidences.
3.21.2. Critical Work / Focus Audit
SUBCONTRACTOR has obliged to program the audit in weekly basis focusing on working at
height, confined space entry, electrical safety, scaffolding, lifting work and nevertheless others
activities/ works which high possibility lead to incident.
The audit checklist and follow up action on the deviation will be fill in attachment of HSE
Performance Audit.
3.22. Reward & Punishment
In order to comply with COMPANY’s ITB, CONTRACTOR will be implement rewards system in
term of appreciation on best HSE contribution & performance to workers and staff level as weekly
and monthly. The detail of program will be explained in Safety Management Plan.
In other side, SUBCONTRACTOR shall organize SUBCONTRACTOR own rewards system to

recognize and appreciation of best HSE contribution to their workers and required to state in HSE
Plan of SUBCONTRACTOR.
CONTRACTOR and COMPANY has the authority to stop the work if the HSE violation is found
such as unsafe acts and unsafe conditions and has the authority to terminate workers from the
project if already done 2 times violations.


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REVISION HISTORICAL SHEET

Rev. Date Section Description

0 6 Apr 18 All Issued for information

Document No. : JTB-RJJ000-S0-PRC-900-00043

Document No. : JTB-RJJ000-S0-PRC-900-00043

Document No. : JTB-RJJ000-S0-PRC-900-00043

Where these requirements do not adequately address SUBCONTRACTOR activities, the

3. HSE MINIMUM REQUIREMENTS

All SUBCONTRACTOR are subject to pre-qualification with CONTRACTOR Safety Management

- SUBCONTRACTOR must pass the CONTRACTOR Safety Management System process. It

Table 1. Certificate of Competencies

Document No. : JTB-RJJ000-S0-PRC-900-00043

3.1. SUBCONTRACTOR HSE Plan

Approved SUBCONTRACTOR HSE Plan shall be presented by Project Manager of

3.2. HSE Man Power

Document No. : JTB-RJJ000-S0-PRC-900-00043

If there is a critical and high risk potential of work,

The candidate shall pass assessment from

The candidate shall pass assessment from

Document No. : JTB-RJJ000-S0-PRC-900-00043

Responsibility of HSE SUBCONTRACTOR:

3.3. Minimum Requirement Prior to Work (Request for ID Badge)

SUBCONTRACTOR and Sub-SUBCONTRACTOR personnel must attend HSE Induction and

Document No. : JTB-RJJ000-S0-PRC-900-00043

Contractor Doc. No.

Lead Discipline Engineer

Lifting Assessment and Authorization

Site Induction (Project Specific

Lock Out Tag Out (LOTO)

Electrical Safety (Basic)

Basic First Aid & CPR

Basic Fire Fighting

Advanced First Aid & CPR

SSOW Technical Expert / AT

Authorized Gas Tester (AGT)

Defensive Driving (8)

Basic Rigging & Lifting

Painter & Abrasive Blaster

Contractor Doc. No.

Site Induction (Project Specific

JSA & Risk Assessment

Environmental Management System

Lock Out Tag Out (LOTO)

Electrical Safety (Basic)

Basic First Aid & CPR

Basic Fire Fighting

Advanced First Aid & CPR

SSOW Technical Expert / AT

Authorized Gas Tester (AGT)

(pre entry, attendant & rescue)

Defensive Driving (8)

Basic Rigging & Lifting

Painter & Abrasive Blaster

Contractor Doc. No.

Administrator and Drafter

AT Assessment and Authorization

Site Induction (Project Specific

JSA & Risk Assessment

Environmental Management System