M-HSE-002-03 HSE Plan-Parq Villa Project-Ubud

UBUD – PARQ PROJECT
RENCANA KESELAMATAN, KESEHATAN KERJA & LINGKUNGAN

HEALTH, SAFETY & ENVIRONMENT PLAN
No Document : M-HSE-002-03 Release Date : March 15, 2023
Revisi : 0 Page : 1 From : 41
PT. ECOCOMPLECT GROUP INDONESIA

PARQ VILLA PROJECT
RENCANA KESELAMATAN KESEHATAN KERJA DAN LINGKUNGAN

(RK3L)
HEALTH SAFETY & ENVIRONMENT PLAN

(HSE PLAN)
Doc. No. : M-HSE-0002-03 Prepared by, Reviewed by, Approved by,

Doc. Level : Level I
Edition No. 01
Revision 00 Nada Kiansyah Fauzi Pohan Mikhail Andrianov

Issued Date : March 15, 2023 HSE Manager Project Manager Operational Director
Catatan Revisi/ Revision Record

Tanggal/ Date No. Bagian/ Uraian
Rev. Section Description
ISU INTERNAL DAN EKSTERNAL

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i.DAFTAR ISI TABLE OF CONTENT
i. DAFTAR ISI TABEL OF CONTENT...................................................................................................4

1. PENDAHULUAN INTRODUCTION..................................................................................................6
1.1. LINGKUP SCOPE.................................................................................................................................6
1.2. TUJUAN PURPOSE..............................................................................................................................7
2. KEBIJAKAN K3L PERUSAHAAN COMPANY HSE POLICY......................................................7
2.1. KEBIJAKAN UTAMA K3L PERUSAHAAN......................................................................................8
3. PERENCANAAN PLANNING............................................................................................................8
3.1. HIRADC-ASDAM.................................................................................................................................8
(IDENTIFIKASI SUMBER BAHAYA KAJIAN RISIKO DAN PENETAPAN KONTROL – ASPEK
DAMPAK LINGKUNGAN HAZARD IDENTIFICATION RISK ASSESSMENT DETERMINED
CONTROL – ENVIRONMENT ASPECT AND IMPACT......................................................................9
3.2. PERATURAN PERUNDANGAN K3L DAN KETENTUAN LAIN HSE LEGAL AND OTHER
REQUIREMENTS...................................................................................................................................9
3.2.1. KETENTUAN UMUN PROYEK GENERAL PROJECT PROVISIONS...................................10
3.3. SASARAN DAN TARGET K3L HSE OBJECTIVE TARGET...................................................11
4. PELAKSANAAN IMPLEMENTATION...............................................................................................12
4.1. BAGAN ORGANISASI K3L PROYEK PROJECT HSE ORCHART........................................12
4.2. PERAN DAN TANGGUNG JAWAB ROLE AND RESPONSIBLE...........................................12
4.3. KOMPETENSI, PELATIHAN & PROMOSI.....................................................................................16
4.3.1. MATRIX KOMPETENSI COMPETENCY MATRIX.....................................................................16
4.3.2. RENCANA PELATIHAN K3L PROYEK PROJECT HSE TRAINING PLAN........................17
4.3.3. PELATIHAN INDUKSI K3L HSE INDUCTION TRAINING...................................................18
4.3.4. PROMOSI & SAFETY CAMPAIGN.........................................................................................18
4.3.4.1. RAMBU – RAMBU K3, POSTER DAN BANNER SIGNS, POSTER & BANNER.................18
4.4. PENGENDALIAN SUBKONTRAKTOR SUBCONTRACTOR CONTROLING..................................19
4.5. KOMUNIKASI COMMUNICATION..................................................................................................20
4.6. PENGENDALIAN OPERATIONAL OPERATIONAL CONTROL.......................................................20
4.6.1. PROGAM INSPEKSI INSPECTION PROGRAM.......................................................................21
4.6.2. MATRIX KETENTUAN APD PPE PROVISION MATRIX.......................................................22
4.6.3. STANDAR PENGGUNAAN GENSET STANDARD OF GENERATOR POWER HOUSE......23
4.6.4. STANDAR PENYIMPANAN TANKI MINYAK STANDARD OF FUEL TANK STORAGE..25
4.6.5. STANDAR PROTEKSI LUBANG HOLE PROTECTION STANDARD...................................26
4.6.6. STANDAR ATAP AKSES OVERHEAD SHELTER STANDARD.............................................26
4.6.7. STANDAR PAGAR PENGAMAN RAILING PROTECTION STANDARD..............................26
4.6.8. STANDAR TEMPAT KECING PORTABEL URINOIR PORTABLE STANDARD..................27
4.6.9. BERSIH-BERSIH HOUSEKEEPING.........................................................................................27
4.6.10. SURAT IJIN KERJA AMAN SAFE WORK PERMIT................................................................28
4.6.11. KETENTUAN BEKERJA PADA SAAT CUACA BURUK WORK IN BED WEATHER........29
4.7. REKAMAN DOKUMENTASI DAN PELAPORAN DOCUMENTATION AND REPORTING......30
4.8. RENCANA TANGGAP DARURAT, INVESTIGASI DAN LAPORANNYA EMERGENCY

RESPONSE PLAN, INVESTIGATION &
REPORTING.........................................................................................................................................31
5. PEMERIKSAAN CHECKING..........................................................................................................37
5.1. PENGUKURAN BERDASARKAN FREKUENSI & SEVERITY KECELAKAAN KERJA/
MEASUREMENT BASE ON ACCIDENT FREQUENCY & SEVERITY.............................................37
5.2. PENGUKURAN LINGKUNGAN ENVIRONMENTAL MEASUREMENT.......................................37
5.3. INTERNAL AUDIT AUDIT INTERNAL............................................................................................38
5.3.1 ASESMENT PROGRAM 10K3 PERUSAHAAN ASSESSMENT PROGRAM-10HSE....................38
5.4. PENGATURAN DENDA K3L HSE PINALTY SYSTEM...................................................................39

5.5. LAMPIRAN APPENDIX.....................................................................................................................40
1. PENDAHULUAN INTRODUCTION
PT. ECOCOMPLECT GROUP INDONESIA PT. ECOCOMPLECT GROUP INDONESIA

percaya bahwa sekecil apapun insiden dan believes that all incidents and injuries can be
injury pada dasarnya dapat dicegah. Moto prevented, no matter how minor they are.
organisasi kami terkait K3L adalah “Safety starts with me. One Team One Goal
“Keselamatan Dimulai Dari Diri Sendiri” dan Together we Can do.” is the motto of our
“Satu Tim Satu Tujan Bersama Kita Bisa”. organization.
Top Management dan jajaran management Top Managemen and line management of PT.
PT. ECOCOMPLECT GROUP ECOCOMPLECT GROUP INDONESIA, As
INDONESIA well as Project Manager and line Project
termasuk Project Manager dan jajaran Management of PARQ VILLA, has a high
manajemen proyek PARQ VILLA, memiliki commitment to Occupational Safety and
komitmen tinggi terhadap Keselamatan dan Health and seeks to prevent accidents and
Kesehatan Kerja serta berusaha untuk also protect the environment during the
mencegah kecelakaan dan juga melakukan construction period.
perlindungan terhadap lingkungan selama
periode konstruksi.
1.1. RUANG LINGKUP SCOPE
Rencana Keselamatan Kesehatan Kerja dan This occupational health, safety and
Lingkungan (RK3L) ini menjabarkan tentang environment plan (HSE Plan) is described the
sistem manajemen K3L selama masa HSE management system during the execution
pelaksanaan proyek. period of project.
Lingkup RK3L ini pada dasarnya mencakup These HSE Plan scopes basically include the
batasan sebagai berikut : following restrictions:
 Kegiatan yang berada pada batas pagar  Activities within the project site boundaries.
proyek
 Kegiatan terkait akses keluar dan masuk  Activities related to the access of in and out
proyek baik pekerja, peralatan dan of workers, equipments and vihicles
kendaraan.
 Kegiatan peralatan proyek yang keluar  Activities of project equipments that come
atau menjangkau keluar pagar proyek. out or reach out of site boundaries..
 Dampak lingkungan yang menyebar keluar  Environmental impacts that spreads outside
batas pagar proyek serta
the site boundaries.
 Kegiatan tertentu yang diatur khusus  Specifict activities which are specifically
diluar pagar proyek. arranged outside the site boundaries.
Sub-kontraktor, Sub-Kontraktor yang terpilih Sub-contractors, Nominated Sub-Contractors
dan Kontraktor yang ditunjuk langsung serta
and Direct Contractors and all parties
seluruh pihak yang terkait dalam pelaksanaan involved in the project execution are
proyek wajib untuk taat dan menenuhi seluruh
mandatory to comply and fulfill all the
ketentuan dari rencana RK3L ini. provisions of this HSE plan.
1.2. TUJUAN PURPOSE
Untuk secara jelas dan eksplisit menetapkan To clearly and explicitly lay down and specify
persyaratan K3L yang diharapkan dari semua the health and safety requirements expected
pihak yang melaksanakan proyek PARQ from all parties undertaking PARQ VILLA
VILLA. project.
Sebagai dokumen yang menjabarkan tentang As a document describes the fulfillment of client
pemenuhan persyaratan K3L klien, regulasi HSE requirements, relevant law and regulations
dan hukum yang relevan terhadap K3L pada of the country to the HSE in the execution of the
pelaksanaan proyek PARQ VILLA. PARQ VILLA project.
Bertindak sebagai referensi terhadap kesalah To act as a reference for any misunderstanding
pahaman atau miskomunikasi ekspektasi K3L or miscomunication of health and safety
antara semua pihak ketika diperlukan. expectation between all related parties at any
time when needed.
2. KEBIJAKAN K3L PERUSAHAAN COMPANY HSE POLICY

2.1. KEBIJAKAN UTAMA K3L PERUSAHAAN COMPANY HSE POLICY
Kebijakan Mutu dan K3L diatas adalah The above Quality and HSE Policy is an official
merupakan pernyataan resmi perusahaan yang statement of the company signed by Top
di tanda tangani oleh pimpinan tertinggi Management leadership of the company as a
perusahaan sebagai wujud komitmen terhadap commitment to the implementation of the
pelaksanaan K3L perusahaan dalam company's HSE in creating a safe and
menciptakan lingkungan kerja yang aman dan conducive working environment..
kondusif.
Jajaran manajemen bertanggung jawab untuk The management is responsible for playing an
berperan aktif atas terlaksananya kebijakan active role in the implementation of the HSE
K3L tersebut serta memastikan keterlibatan policy and ensuring the active involvement of
aktif dari semua pihak terkait dan all related and interests parties to provide a
berkepentingan sehingga terciptanya safe and conducive working environment.
lingkungan kerja yang aman dan kondusif.
Kebijakan K3L perusahaan tersebut diatas The above HSE policy shall be well understood
wajib dipahami oleh seluruh karyawan dan by all emloyees and related parties.
seluruh pihak terkait. Sosialisasi tentang isi Socialization of the contents of the HSE policy
kebijakan K3L tersebut harus dilakukan must be carried out at last once a month in
sedikitnya sekali dalam sebulan pada kegiatan general safety morning talk activities or other
general safety morning talk atau bentuk activities as an effort to promote it.
kegiatan lainnya sebagai usaha untuk
mempromosikannya.
3. PERENCANAAN PLANNING
3.1. HIRADC-ASDAM
(IDENTIFIKASI SUMBER BAHAYA KAJIAN RISIKO DAN PENETAPAN KONTROL –
ASPEK DAMPAK LINGKUNGAN HAZARD IDENTIFICATION RISK ASSESSMENT
DETERMINED CONTROL – ENVIRONMENT ASPECT AND IMPACT
HIRADC-ASDAM dibentuk sesuai dengan HIRADC-EAI is developed accordance with

SOP-HSE-002 Standard Pedoman HIRADC- SOP-HSE-002 Standard Pedoman HIRADC-
Aspek dan Dampak Lingkungan. Aspek dan Dampak Lingkungan.
HIRADC pada proyek ini akan dilakukan pada HIRADC-EAI of this project will be conducted
pekerjaan pekerjaan pada daftar dibawah to the listed activities below but not limited to:
namun tidak terbatas sebagai berikut:
 Akses proyek karyawan dan equipment.
 Access of emplyees and equipments.
 Pekerjaan mobilisasi dan pembuatan fasilitas
 Mobilization and site facilities works.
proyek.
 Structures works such as rebbaring,
 Pekerjaan struktur yaitu pembesian,
formwok, concrete pouring, steel structure
formwork dan pengecoran, struktur baja.
erection.
 Pekerjaan atap dan façade.
 Roof and facade works.
 Penggunaan alat berat seperti crane, earth
 Use of heavy equipments such as crean and
mover & compactor.
erath remover and compactors.
 Instalasi listrik sementara

 Temporary electrical installation
 Penggunaan scaffolding
 Use of scaffolding
 Pekerjaan pengelasan
 Welding works
 Pekerjaan pada ruang terbatas
 Confined space entry
 Penanganan dan penggunaan B3
 Handling and use of hazardous materials/
subtances.
Ketentuan:
Provision:
 HIRADC harus dibuat secara team yang
 HIRADC shall be made in a team that
melibatkan supervisor, site manager,
involves the supervisor, site manager,
engineer, engineer manager dan HSE team.
engineer, engineer manager and HSE team.
 Sub-contractors, Sub-Kontraktor yang
 Sub-contractors, nominated sub-contracotrs
terpilih dan Kontraktor yang ditunjuk
and directed contractor can develop their
langsung dapat membuat HIRADC masing –
own HIRADC, however it shall be using
masing sesuai standard EGI dan wajib
EGI standard and required to be presented
dipresentasikan kepada EGI sebelum
before approved by EGI.
disetujui.
 Pengendalian risiko lebih detail pada
 Detailed risk control on specific work is
pekerjaan khusus dikembangkan melalui
developed furtherly through work methods
metode kerja dan JSA.
and JSA.
Lampiran untuk bagian ini Appendix for this section
Lampiran/ Appendix 01 SOP-HSE-002 Standard Pedoman HIRADC-Aspek dan

Dampak Lingkungan SOP HIRA Hazard Identification & Risk
Assessment, Opportunity and Risk Controll.
Lampiran/ Appendix 01 F-QHSE-007 HIRADC-ASDAM FORM
Lampiran/ Appendix 01 F-QHSE-008 JSA FORM
3.2. PERATURAN PERUNDANGAN K3L DAN KETENTUAN LAIN

HSE LEGAL AND OTHER REQUIREMENTS.
Ketentuan legal dan peraturan lain yang terkait Legal and other requirements which related
dan wajib dipatuhi selama masa konstruksi and mandatory to comply for the construction
proyek PARQ VILLA mengacu pada period of PARQ VILLA project are refer to
lampiran 02. Appendix 02
Lampiran untuk bagian ini Appendix for this section.
Lampiran Appendix SOP-HSE-016 Standar Ketentuan legal dan peraturan lain

02
SOP-HSE-016 Legal and other requirement Standard
F-QHSE-009 Identifikasi & Evaluasi PPPL
Lampiran Appendix
Identification & Evaluation of Compliance Legislation & Other
02
F-QHSE-010 Daftar Peraturan Bidang K3L
List of HSE Legislation, Regulation & Standard
Lampiran Appendix
02
3.2.1.KETENTUAN UMUM PROYEK GENERAL PROJECT PROVISIONS

 Memenuhi ketentuan K3L yang ditetapkan  Comply with OHSE client requirements
oleh client.  Before start to work everyone shall be
 Setiap orang yang akan bekerja wajib sehat physically and mentally healthy and have a
secara fisik dan mental serta memiliki usia minimum age of 18 years and / or have a
minimum 18 tahun dan atau memiliki Kartu valid National Identity Card (KTP).
Tanda Penduduk (KTP) yang masih valid.
 Dilarang keras memiliki, mendistribusikan  Own, distribute or under the influence of
atau sedang dalam pengaruh alkohol atau alcohol or drugs is strictly prohibited in the
obat obatan terlarang. Perusahaan akan construction site. The company will take
melakukan tindakan tegas sesuai hukum yang firm action in accordance with the
berlaku. applicable law.
 Membawa senjata apapun sangat dilarang  Carrying any weapon is strictly prohibited
keras pada lokasi proyek. at the project location.
 Dilarang keras untuk melakukan tindak  It is strictly forbidden to carry out acts of
pidana seperti berjudi, mencuri, berkelahi, crime such as gambling, stealing, fighting,
mengancam dan sengaja mecelakakan sesama threatening and deliberately harming fellow
pekerja. Termasuk melakukan pelecehan workers.Including sexual harassment.
sexual.
 Dilarang merokok pada lokasi kerja proyek  Smoking is prohibited on the work site
kecuali pada lokasi yang telah ditentukan. unless at the specified location.
 Menjaga kebersihan dan ketertiban  Maintain environmental cleanliness and
lingkungan serta taat pada norma-norma orderliness and adhere to social norms that
sosial yang berlaku disekitar proyek atau apply around the project or worker
barak pekerja. barracks.
 Setiap alat wajib ditempelkan SOP.  Each equipment must be posted with its SOP
 Menjaga dan merawat seluruh sarana dan  Maintain HSE facilities
prasarana kerja dan K3L
 Menggunakan APD wajib yaitu tanda  Wearing mandatory PPE, such as helm,
pengenal, helm, rompi kerja dan sepatu kerja. work vest and shoes protection.
3.3. SASARAN DAN TARGET K3L HSE OBJECTIVE TARGET

Proyek manager dan jajaran manajemenya akan Project Manager and the project line management
selalu berusaha menciptakan suasana kerja will always strive to provide a safe and
yang aman dan ramah lingkungan dengan environmental friendly work condition with the
target: following target:
Fatality Accident Zero
Kecelakaan Zero
Fatal Lost Time Injury Zero
Hilang Waktu Zero
Kerja Index Frequency < 0.5 per 1 mio hours
Incident < 0.5 per 1 mio hours Rate
Frequency Rate Index < 2 per 1 mio hours
Incident < 2 per 1 mio hours Severity Rate
Severity Rate OHSE ≥ 80% Monthly Project score
Kinerja K3L ≥ 80% Monthly Project score Performance
≥ 80% P-10K3 per semester.
≥ 80% P-10K3 per semester.
Note:
Catatan : Formula Index Frequency Rate (IFR)
Formula Index Frequency Rate (IFR)
IFR = Nr. Of Accident LTI x 1,000,000
IFR = Jumlah Kecelakaan LTI x Total Worked Hours
1,000,000 Total Jam Kerja
Formula Index Severity Rate (ISR)
Formula Index Severity Rate (ISR)
ISR = Day Loss x 1,000,000
ISR = Day Lost x 1,000,000 Total Worked Hours
Total Jam Kerja
LTI = Lost Time Incident (Injured Person can
LTI = Lost Time Incident (korban tidak dapat nor back to work after 1 x 24hours from accident
bekerja kembali setelah 1 x 24 jam dari waktu time)
kecelakaan.)
The targets of IFR & ISR will be confirmed to the
Target dari IFR & ISR akan dikonfirmasikan client for approval. The HSE targets are to form
kepada klient untuk persetujuan. Target HSE part of individual key performance indicators of
adalah untuk menjadi bagian dari indikator each management staff of PARQ VILLA project.
kinerja utama individu dari masing-masing staf
manajemen proyek PARQ VILLA. The performance against these objectives and
targets has to be periodically and regularly
Kinerja atas sasaran dan target ini harus secara monitored in monthly basis, and HSE
periodik dan regular setiap bulan dan tindakan management action will be required to be
HSE manajemen akan dibutuhkan untuk improve if the target does not achieved.
memperbaiki jika target tidak tercapai.
SOP-HSE-017 HSE Objective, Target & Program
Lampiran Appendix F-QHSE-014 Objective, Target & Program
03
Lampiran Appendix
03
4. PELAKSANAAN IMPLEMENTATION
4.1. BAGAN ORGANISASI P2K3 PROYEK PROJECT HSE COMMITTEE ORCHART
Organisasi K3L terintegrasi dengan struktur HSE organogram is integrated with the
organisasi proyek dimana petugas K3L berada project organogram where the position of
langsung dibawah Project Manager dan HSE team is directly under project manager,
mempunyai functional structural line kepada however they have direct line functional to the
Corporate HSE Manager. HSE Manager.
Selain terintegrasi pada bagan organisasi In addition to being integrated in the project
proyek, juga terdapat komite K3L proyek organization chart, there are also have a HSE
dengan struktur organisasi sebagai berikut: project committees with the following
organizational structures:
4.2. PERAN DAN TANGGUNG JAWAB ROLE AND RESPONSIBLE
Project Manager
Penanggung jawab keseluruhan untuk HSE site Overall responsibility for site HSE lies with
terletak pada proyek. Secara khusus ia harus Project Manager. Specifically he/she shall
memastikan: ensure:
a. Rencana HSE telah dikeluarkan dan a. The HSE Plan has been issued and it is
memadai untuk kebutuhan Proyek. adequate for the Project’s needs.
b. Sumber Daya yang memadai disediakan b. Adequate Resources are provided for the
untuk keseluruhan Program HSE. overall HSE Programme.
c. Lengkapi kursus manajemen keselamatan c. Complete an Approved safety management
yang Disetujui. course.
d. Partisipasi pribadi dalam skema audit dan d. Personal participation in the HSE audit and
inspeksi HSE sedang diterapkan. inspection schemes being applied.

e. Menghadiri dan memimpin pertemuan HSE e. Attend and chair a monthly HSE meeting
bulanan yang melibatkan semua involving all Subcontractors‟ Senior
Perwakilan Senior Subkontraktor. Representatives.
f. Kembangkan, setujui dan terapkan f. Develop, approve and implement the HSE
Rencana HSE dan prosedur keselamatan Plan and construction safety procedures.
konstruksi. g. Ensure that adequately resourced and
g. Pastikan bahwa Subkontraktor yang competent Subcontractors are employed.
memiliki sumber daya yang memadai dan This requires that the resources provided
kompeten dipekerjakan. Ini mensyaratkan meet the needs of the project.
bahwa sumber daya yang disediakan
memenuhi kebutuhan proyek. h. Develop overall co-ordination and co-
h. Mengembangkan keseluruhan koordinasi operation of Subcontractors in order to
dan kerjasama Subkontraktor untuk minimize interface problems.
meminimalkan masalah antarmuka. i. Ensure that all risks are identified on site
i. Pastikan bahwa semua risiko diidentifikasi for construction and commissioning works.
di lokasi untuk pekerjaan konstruksi dan
commissioning. j. Ensure that these risks together with those
j. Pastikan bahwa risiko ini bersama dengan which have been identified during design,
risiko yang telah diidentifikasi selama are comm unicated to the appropriate
desain, dikomunikasikan kepada Subcontractors. Transmittal records shall
Subkontraktor yang sesuai. Rekaman be kept.
pengiriman harus disimpan. k. Obtain from Subcontractors their risk
k. Dapatkan dari Subkontraktor penilaian assessm ents, work method statements and
risiko mereka, pernyataan metode kerja dan HSE plans. Ensure that they are reviewed
rencana HSE. Pastikan bahwa mereka and approved prior to commencem ent of
ditinjau dan disetujui sebelum memulai work.
pekerjaan. l. Ensure that Subcontractors have been made
l. Pastikan bahwa Subkontraktor telah aware of their roles and responsibilities
mengetahui peran dan tanggung jawab with regard to safe working procedures and
mereka terkait dengan prosedur kerja yang that both Subcontractors and their workers
aman dan bahwa Subkontraktor dan com ply with any site rules, which have been
pekerjanya mematuhi peraturan lokasi apa set out in the HSE Plan.
pun, yang telah ditetapkan dalam Rencana
HSE. m. Ensure that all workers are properly
m. Pastikan bahwa semua pekerja inform ed and consulted.
diinformasikan dengan benar dan diajak
berkonsultasi. n. Ensure that field staff is suitably com petent,
n. Pastikan bahwa staf lapangan benar-benar and understand their HSE Responsibilities.
kompeten, dan pahami Tanggung Jawab
HSE mereka. o. Monitor HSE performance.
o. Pantau kinerja HSE. p. Participate in the HSE audit and inspection
p. Berpartisipasi dalam skema audit dan schemes being applied..
inspeksi HSE yang sedang diterapkan.
HSE Leader/ Coordinator
a. Membuat dan memperbaharui prosedur a. Develop and revice the HSE procedur.
K3L. b. Ensure all HSE procedures are
b. Memastikan prosedur K3L telah implemented by all parties.
dilaksanakan oleh seluruh pihak terkait. c. Develop the training program and ensure
c. Membuat program pelatihan K3L dan
the implementation.
memastikan pelaksanaannya. d. Conduct HSE induction to all employee and

d. Melakukan induction K3L kepada visitor.
karyawan dan tamu. e. Monitoring and control the implementation
e. Melaksanakan monitoring dan kontrol of HSE plan.
terhadap pelaksanaan RK3L. f. Ensure all necessary HSE facilities are
f. Memastikan tersedianya sarana &prasarana available including the emergency facilities
K3L termasuk sarana tanggap darurat. as well.
g. Melakukan koordinasi dan komunikasi g. Conduct communication and coordination
K3L kepada seluruh pihak terkait. to all related parties.
h. Melakukan penanganan & investigasi
h. Handling the accident or emergency
kecelakaan kerja dan kondisi darurat.
situation and conduct the investigation.
i. Melakukan simulasi penanganan keadaan
i. Conduct emergency drill
darurat.
j. Mendukung persyaratan administrasi
j. Porvide admistration needs in support to
terkait asuransi kecelakaan kerja.
insurance claims.
k. Melakukan inspeksi K3L secara berkala.
k. Conduct regular HSE inspection.
l. Berkoordinasi dengan client & client rep.
l. To coordinate with client or their
terkait K3L.
representative pertaining to HSE issues.
m. Membuat Laporan K3 bulanan kepada HSE
m. Prepared Monthly HSE report
Manager.
n. Mengkoordinasikan terlaksananya rapat
n. Ensure the implementation of HSE
komite K3L secara berkala.
commitee meeting.
o. Melakukan pengukuran kinerja K3L dan
o. Measure the HSE performance and its
program tindak lanjutnya.
follow up action implementation.
Lead Mechanic
a. Memastikan seluruh ketentuan K3L a. Ensure all HSE provision are well
dipahami dan dipenuhi dalam kelompok understood and complied within the
kerjanya. working group.
b. Melakukan pembinaan dan edukasi K3L b. Conduct HSE couching and education
terhadap kelompok kerjanya dan kelompok within the working group and other related
terkait lainnya tentang K3L mekanikal dan employees/ groups about HSE of
elektrikal. mechanical and electrical.
c. Melakukan inspeksi alat dan memastikan c. Conduct equipment inspection and other
keamanan alat/ sarana prasarana mekanik ME facilities including conduct pre-use
& elektrik. Termasuk melakukan pre-use equipment prior to mobilization.
inspeksi sebelum dimobilisasi. d. Ensure the legal document of equipments
d. Memastikan seluruh dokumen legal terkait and operator are available.
alat dan operator tersedia dan valid. e. Conduct equipment maintenance and well
e. Melakukan program perawatan alat documented.
dilakukan dan terdokumentasi. f. Ensure all equipments SOP are available
f. Memastikan seluruh tersedianya SOP dari and implemented.
perlatan dan dilaksanakan. g. Involving in establishment of work method
g. Terlibat dalam membuat metode kerja and JSA.
aman dan JSA.
Supervisor
a. Memimpin toolbox meeting. a. Lead the toolbox meeting

b. Melakukan site inspeksi K3L untuk b. Conduct HSE site inspection to ensure the
memastikan kinerja K3L pada lokasi HSE performance within his/ her
pengawasannya supervision working area.
c. Terlibat dalam pembuatan metode kerja c. Involve in establishing the method of work
dan JSA serta memastikan pelaksanaannya.
and JSA and also ensure the
d. Membuat surat ijin kerja yang dilengkapi implementation of it.
oleh seluruh dokumen terkait.
d. Prepare the work permit with all suppoting
e. Melakukan koordinasi terhadap pihak document required.
terkait dalam proyek dalam pelaksanaan
e. Coordinate with related parties within the
K3L.
project organization for HSE
f. Aktif mempromosikan isu K3L. implementation.
g. Melakukan pembinaan dan edukasi serta f. Actively promoting the HSE issues.
pelatihan kerja aman. g. Conduct HSE coaching , education and
h. Memastikan tersedianya lokasi kerja yang training of safe working proactices.
aman dan memenuhi seluruh ketentuan h. Provide safe working environmental and
K3L yang disyaratkan. fulfill all HSE requirements.
i. Menyedikan sarana dan prasarana K3L i. Provide the HSE facilities in working area.
pada lokasi kerjanya. j. Attend and play an active role at all HSE
j. Hadir dan berperan aktif dalam rapat-rapat meetings.
K3L. k. Co-ordination of all Subcontractors under
k. Koordinasi semua Subkontraktor di bawah his control.
kendalinya. l. Attend kick-off meetings to underline the
l. Hadiri pertemuan kick-pentingnya importance of safety.
keselamatan. m. Ensure that Subcontractors carry out all
m. Pastikan bahwa Subkontraktor works in agreement with approved work
melaksanakan semua pekerjaan sesuai methods
dengan metode kerja yang disetujui n. Ensure that staff under his control is
n. Pastikan bahwa staf di bawah kendalinya competent for tasks set, and understand
kompeten untuk tugas-tugas yang their HSE responsibilities
ditetapkan, dan pahami tanggung jawab
K3L
Site Manager/ Engineering Manager
a. Berkoordinasi dengan team HSE terkait a. Coordinate with HSE team for HSE matters.
K3L.
b. Memastikan seluruh pekerjaan proyek b. Ensure all the tasks are executed in safe
dalam kondisi aman dan terkedali. manner and well controlled.
c. Memastikan supervisor dan pihak terkait c. Ensure the HSE are carried out by
melaksanakan K3L supervisors and related parties.
d. Melakukan pembinaan dan edukasi K3L d. Conduct HSE couching and eduction on his
pada jajarannya. subordinates.
e. Memimpin rapat-rapat K3L dalam e. Leads the HSE meeting
jajarannya.
f. Memastikan tersediannya sarana dan f. Ensure the availability of HSE facilities
prasarana K3L needs.
g. Terlibat dalam pembentukan HIRADC, g. Actively involve in establishing of
metode kerja dan JSA serta memastikan HIRADC- EIA, methode of work, JSA and
pelaksanaannya. ensure the implementation of it.
h. Memastikan seluruh petunjuk teknis h. Ensure the availibility all technical
pelaksanaan proyek dan memastikan guidance needs and all changes are well
seluruh perubahan yang terjadi communicated including the new apear risk
dikomunikasikan dan serta mengkontrol to be controlled
seluruh risiko yang ditimbulkan.
i. Melakukan aproval ijin kerja.
i. Review the work permit to be issued
j. Melakukan investigasi kecelakaan serta
j. Conduct the accident investigation and
melakukan tindak perbaikan yang
follow up the corective action.
diperlukan.
k. Aktif mempromosikan K3L.
k. Actively promoting the HSE matters.
l. Penanggung jawab penyelesaian NCR
l. Responsible for NCR settlement.
Pekerja/ Worker
a. Patuhi semua sistem HSE perusahaan, a. Properly comply with all company HSE
aturan dan prosedur standar. systems, standards rules and procedures.
b. Jaga diri mereka sendiri dan mereka yang b. Take appropriate care of themselves and
terkena dampak kegiatan kerja mereka. those affected by their work activities.
c. Jangan menyalahgunakan peralatan. c. Do not misuse equipment.
d. Laporkan semua kecelakaan, insiden, dan d. Report all accidents, incidents and
kejadian berbahaya kepada penyelia dangerous occurrences to their supervisors.
mereka.
e. Berkontribusi pada manajemen
e. Contribute to the safety and health
keselamatan dan kesehatan melalui management through consultation and
konsultasi dan partisipasi.
participation.
Security
a. Memantau keamanan proyek dan a. Monitoring the project security and involve
mengendalikan situasi darurat. on controling the emergency situation.
b. Mengikuti kegiatan inspeksi bersama K3L. b. Involve in HSE inspection
c. Membuat laporan terjadinya situasi darurat c. Make a report of an emergency situation to
ke Project Manajer. Project Manager.
4.3. KOMPETENSI, PELATIHAN & KESADARAN COMPETENCE, TRAINING & AWARENESS

4.3.1. MATRIX KOMPETENSI COMPETENCY MATRIX
Fungsi Min. Competence
Operator Crane, Passenger Hoist, Gondola, Valid Operator License
Forklift, Excavator,Etc Min. 2 year
experiences
Sopir/ Drivers Light or Heavy Vehicles Driving License
Electrician Temporary installation Electrical Technician License
Scaffolder All Scaffolder License
Welder All Welder License
HSE Supervisor Supervise Min. Requirement Have a HSE
Expert License
(Rasio HSE Officer 1 per 100
employees)
Pekerja/ Workers All Must be Follow Induction
4.3.2. RENCANA PELATIHAN K3L PROYEK PROJECT HSE TRAINING PLAN

 Kebutuhan pelatihan K3L selama masa  K3L training needs during the construction
konstruksi telah diidentifikasi pada period are identified in the Project Training
Project Training Matrix dibawah. Matrix below.
 Pelaksanaan Project Training Matrix  The project training matrix shall be provided
harus dikuti dengan jadual yang baik dan with a proper implementation schedule and
seluruh peserta terkait diwajibkan untuk all appointed participants have to be
hadir. attended.
 Pelatihan ini dimaksudkan untuk
pembentukan kompetensi HSE untuk  The training is intended for the HSE
setiap pekerja dalam melakukan praktik competencies establishment for each worker
kerja aman mereka dan juga dalam in performing their safe working practices
menyediakan lingkungan kerja yang and as well as in providing a safe working
aman dari proyek. environment of the project.
 Setiap item pelatihan berlaku 6 bulan
dan pekerja wajib mengajukan untuk  Each training item is valid for 6 months and
mengikuti retraining pada item pelatihan workers must submit to follow retraining on
terkait setelahnya. Jika tidak ijin kerja the related training items afterwards.
akan ditangguhkan. Otherwise working permit will be suspended
PROJECT TRAINING MATRIX
Peserta Training
Mekanik & Electrical
No Item Training Media

Tukang Finishing
General Labor
Tukang Kayu
Store Keeper
Tukang Besi
Tukang Cor
Scaffolder
Operator
Security
Rigger
Staff
1 Safety Indcution ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas
2 WAH & Scaffolding ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas
3 Lifting operation ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas
4 Confined Space Entry ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas
5 Excavation and Disturbance

6 Manual handling ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk
7 APAR/ Light Fire Extinguisher use ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk
8 P3K/ First Aid ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk &Class
9 Tanggap Darurat - Emergency Exit ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Drill
10 Work Method & JSA Bagian Terkait

11 Hazardous Material Handling ⌂ ⌂ ⌂ ⌂ Kelas
12 5R ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk & Kelas
13 Alat Penindung Diri/ PPE ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk

4.3.3. PELATIHAN INDUKSI K3L HSE INDUCTION TRAINING
 Induksi HSE dilakukan untuk

 A HSE induction is conducted to welcome new
menyambut karyawan baru di proyek
employees to the project and prepare them for
dan mempersiapkan mereka untuk
their new role. It ensures workers are fully
peran baru mereka. Hal ini
informed about the organization and are
memastikan pekerja mendapat
aware of their work and responsibilities. It
informasi lengkap tentang organisasi
serves as a starting point for an organization
dan sadar akan pekerjaan dan
to introduce a culture of safety in the
tanggung jawab mereka. HSE
workplace.
induction juga berfungsi sebagai titik
awal bagi organisasi untuk
memperkenalkan budaya keselamatan
di tempat kerja.
 Induction training diwajibkan kepada
semua pekerja sebelum memulai
 HSE Induction is required to anyone prior join
bekerja pada proyek PARQ VILLA.
to work at PARQ VILLA project.
 Peserta harus berusia 18 tahun atau
telah memiliki KTP yang masih
 Participants must be 18 years old or must have
berlaku serta sehat secara fisik dan
a valid KTP and also be mentally and mentally
mental.
healthy.
 Program induction K3L mencakup :
 The HSE induction training is covering the
o Kebijakan HSE Perusahaan following items:
o Lingkup Pekerjaan. o Company HSE Policy
o Gambaran umum program dan o Scope of Work.
bahaya yang Diatasi.
o Overview of the program and hazards
o Organisasi Konstruksi. Addressed.
o Masalah dan Penggunaan kartu ID. o The Construction Organization.
o Mengemudi di Site. o Issue and Use of ID cards.
o Pakaian pelindung, persyaratan o Driving on Site.
situs minimum dan pertimbangan o Protective clothing, minimum site
hukum. requirements and legal considerations.
o Prosedur evakuasi dan
pengumpulan poin. o Evacuation procedures and muster points.
o Merokok.
o Pelaporan cedera dan insiden / o Smoking.
nyaris celaka.
o Reporting of injuries and incidents / near
o Fasilitas Pertolongan Pertama. misses.
Pencegahan Kebakaran. o First Aid Facilities. Fire Prevention.
Housekeeping. Housekeeping.
o Kebisingan di Tempat Kerja.
o Izin Sistem Kerja. o Noise at Work.
o Audit (audit keselamatan tempat o Permit to Work Systems.
kerja dan lokasi).
o Auditing (workplace and site safety audits).
o Pembicaraan Toolbox.
o Perancah dan penandaan. o Toolbox Talks.
o Penanganan manual. o Scaffolding and tagging.
o Pekerjaan panas termasuk o Manual handling.
penyimpanan dan penggunaan
o Hot work including gas cylinders storage
and use, spark containment.
tabung gas, penahanan percikan

api.
o Perlindungan Pernafasan. o Respiratory Protection.
o Peralatan listrik. o Electrical Equipm ent.
o Bekerja di ketinggian, Safety o Working at heights, Safety harnesses,
harness, jalur kehidupan. lifelines.
o Bahan dan bahan berbahaya / o Hazardous substances and materials /
tanah yang terkontaminasi. contaminated land.
o Kerjasama dengan pengusaha. o Co-operation with employers.
o Komunikasi. o Communications.
o Kebijakan Narkoba, Alkohol, dan
o Drug, Alcohol and Gun Policy.
Senjata.
o Mengangkat dan Mengangkat o Lifting and Heavy Lifts.
Berat.
o Ruang terbatas.
o Confined Spaces.
o Keamanan Site.
o Site Security.
o Barang terlarang.
o Prohibited items.
o Isu yang berkaitan dengan
o Environmental issues.
lingkungan.
Lampiran untuk bagian

Appendix for this section.
ini
Lampiran Appendix 04 SOP-HSE-018 Competence, Training & Promotion

Lampiran Appendix 04 F-QHSE-015 Induction Form
Lampiran Appendix 04 F-QHSE-017 Comptence Register
Lampiran Appendix 04 F-QHSE-018 Training Matrix
4.4. KOMUNIKASI, KONSULTASI & PARTISIPASI K3L

COMMUNICATION, CONSULTATION & PARTICIPATION.
Komunikasi yang efektif sangat penting untuk Effective communications are vital to the
keberhasilan implementasi rencana kesehatan successful implementation of the health safety
keselamatan dan lingkungan. Banyak bentuk and environment plan. Communications take
komunikasi tetapi tujuan umumnya adalah many forms but their common objective is to
untuk meningkatkan pemahaman tentang improve understanding of health and safety
masalah kesehatan keselamatan dan dan matters to obtain the support, co-operation
lingkungan guna mendapatkan dukungan, kerja and commitment of all interested parties
sama, dan komitmen semua pihak yang
berkepentingan.
Communication Matrix
No Program Time Participants Remarks
1 Safety Kick Meeting Begining of the project. All EGI & its HSE sistem
subcontractors. management
Prior to start of new explaination.
assigned sub-cont, NSC
or DC EGI Rep. And subcont
project management.
2 Weekly HSE Talk / Every Tuesday & Friday All employees General Meeting
HSE Morning
3 Toolbox Talks Daily All emplayees Conduct in group and
lead by direct
supervisor.
4 Weekly HSE Every Friday SM, EM, Spv & mandor HSE Issues
Meeting
5 Monthly Meeting 1st day of the month PM, SM, SPV & HSE Performance
(When required) Leader & Client/ rep. evaluation.
Lead By PM
6 Notice board Every Saturday HSE team General infromation
7 Pre-task When required Eng, SM, Related SPV, MOW & JSA
Mandor, HSE team explaination.
Lampiran untuk bagian ini/ Appendix for this section.
Lampiran/ Appendix 05 SOP-HSE-019 Communication, Consultation & Participation

Lampiran/ Appendix 05 F-QHSE-006 Communication, Consultation & Participation Form
RAMBU – RAMBU K3, POSTER DAN BANNER SIGNS, POSTER & BANNER
Jenis, jumlah, dan rencana penempatan rambu, Types, number and placement plan of HSE
poster dan banner K3L terdapat pada Lampiran signs, poster and banner is described in
5 – Rambu, Poster dan Banner. Appendix – 5.
Lampiran/ Appendix 05 F-QHSE-006-01 Project Signs, poster and banner
4.5. PENGENDALIAN SUB KONTRAKTOR SUBCONTRACTOR CONTROLING
Sub-contractor controling terhadap HSE Sub-contractor controling on HSE is

terintegrasi pada standard prosedur integrated on procurement standard. SOP-
procurement SOP-HSE-021 Standard HSE-021 Standard Persyaratan Kerja Bagi
Persyaratan Kerja Bagi Subcontractor Yang Subcontractor Yang ditunjuk and specifict of
ditunjuk dan item khusus tentang HSE berada HSE item is discribed in chapter no, 8. See
pada item 8. Lihat Lampiran 6 – HSE Appendix 6 - HSE Subcontractor handling.
Subcontractor handling.
Lampiran untuk bagian ini/ Appendix for this section.

Lampiran/ Appendix 06
SOP-HSE-021 HSE Subcontractor Handling
Lampiran/ Appendix 06
F-QHSE-064 Subcontractor Evaluation
4.6. PENGENDALIAN OPERASIONAL OPERATIONAL CONTROL
Kententuan oprational control yang secara The details oprational control are reffer to the
detail mengacu pada Lampiran 07 – Manual Appendix 07- Manual Plan OHSE
Rencana K3L STANDAR KESELAMATAN OCCUPATIONAL HEALTH AND SAFETY
& KESEHATAN KERJA LINGKUNGAN ENVIRONEMENT PLAN STANDARD.
Lampiran Appendix M-QHSE-001 Manual QHSE Company

07
M-HSE-001 Manual HSE Project Execution Plan
Lampiran Appendix
M-HSE-002 Manual HSE Plan
07
Lampiran Appendix
07
4.6.1. PROGAM INSPEKSI INSPECTION PROGRAM
No Inspection Program Frequency Action by

1. Site Walktrough 1 x per week PM, SM, Supervisor, Mandor
2. Scaffolding 1 x per week HSE Inspector & Scaffolder
3. Housekeeping 1 x per week PM, SM, Supervisor, Mandor
4. Excavator, Loader, Forklift 1 x per month HSE & ME
5. Power Generator 1 x per month HSE & ME
6. Bar bender/ cutter 1 x per month HSE & ME
7. Electrical & Handtools 1 x per month HSE & ME
8. Crane 1 x per month HSE & ME
9 Management Review
 Head Office Commitee Commitee Commitee team
 Operation Director Visit Bi-Monthly Operation Director
 Corporate HSE Manager Bi-Monthly HSE Manager
Inspeksi alat bulanan akan dilengkapi dengan Monthly equipment inspection will be equipped
equipment tagging card sesuai pengaturan by equipment tagging card accordance with its
kode warnanya berikut: color coding as follows:
(Pengaturan lebih lanjut mengacu pada (Further arrangement reffer to Appendix 8 -
lampiran 8 - IK Color Coding) Color Coding WI)
Merah Red Jan/Feb/Mar

Kuning Yellow Apr/May/Jun
Hijau Green Jul/Aug/Sep
Biru Blue Oct/Nov/Dec
Merah Gelap Dark Red Rusak/ Broke
Abu – Abu/ Gray On Service
Lampiran Appendix Lampiran Appendix 08

08 Lampiran Appendix 08
Lampiran Appendix
08
Lampiran Appendix
08
Lampiran Appendix
08
Lampiran Appendix
08
Lampiran Appendix
08
SOP-HSE-014 Inspeksi ehicle Inspection F-QHSE-047
K3L HSE Inspection PPE Inspection
WI F-QHSE-048 First Aid Box Inspection
Wor F-QHSE-049 Fire Extinguisher
k Inspection F-QHSE-050 Light Vehicle
Instr Inspection
uctio F-QHSE-052 Heavy Equipment
n Inspection F-QHSE-053 Equipment
Colo Inspection
r F-QHSE-054 Tools Inspection
Codi F-QHSE-058 Hygiene Inspection
ng & F-QHSE-059 Inspection & Measurement Plan
Tagg
ging
F-
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Colo
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Codi
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F
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4
6
V
4.6.2. MATRIX KETENTUAN APD PPE PROVISION MATRIX
No Deskripsi/ Description APD/ PPE Keterangan/ Remark

1 APD Wajib/ Mandarory PPE Helm Safety, Seragam Wajib digunakan selama bekerja
(Baju & Celana dilapangan
Panjang), Kacamata, Mandatory to use when working on site.
sepatu safety & HV
Vest
2 APD Pelindung tubuh Seragam,Celana Untuk pekerja agar memakai baju lengan
Panjang panjang dan celana panjang
Mandatory to use when working on site.
3 Pelindung mata Kacamata/ Goggles Chipping , grinding, concrete pouring,use
Eyes protection wood planer machine, drilling, cutting.
Face shield Grinding, cutting, spraying
4 Pelindung pendengaran Ear plug Seluruh kegiatan dengan level kebisingan
Ear protection Ear muff > 85dB/ all activities with noise level >
85dB.
5 Pelindung pernafasan Masker Pekerja cat, cleaning, pekerjaan berbau
Respiratory protection dan berdebu, bekerja dengan B3.
Painting work, cleaning, smelly & dusty
work, work with hazardouse material/
subtances.
6 Pelindung tangan Hand glove Pekerjaan dengan benda tajam dan atau
Hand protection keras.
Handling with hard or sharp stuff.
7 Pelindung jatuh Body Harness Bekerja diketinggian ≥ 1.8m keatas/
Fall protection working at ≥ 1.8m height.
8 APD pengelasan Welding Mask Selama proses pengelasan/ During welding
Welding PPE Welding Glove process.
Welding Jacket/ apron
9 Pelindung kaki Min. Rubber boot General

Foot wear protection Safety Shoes
Rubber boot
Kode Warna Helm & Rompi Working Vest & Helmet Color Coding
Warna rompi disesuaikan dengan posisi The color of the vest is adjusted according to
the position,
Sedangkan untuk warna helm diatur While the colors of helm is arranged as follows:
sebagai berikut:
Lampiran Appendix SOP-HSE-001 Management & Application

09
PPE F-QHSE-031 PPE Specification
Lampiran Appendix F-QHSE-032 PPE Handover list
09
F-QHSE-032-01 PPE Request &
Lampiran Appendix
Replacement F-QHSE-033 PPE Matrix
09
F-QHSE-034 PPE Stock Report
Lampiran Appendix
F-QHSE-034-01 PPE Stock
09
Record F-QHSE-047 PPE
Lampiran Appendix
Inspection
09
Lampiran Appendix
09
Lampiran Appendix
09
Lampiran Appendix
09
4.6.3. STANDAR PENGGUNAAN POWER GENSET STANDARD OF GENERATOR POWER HOUSE
- Bak Kontrol dilengkapi dengan petutup/ Control pit is equiped with cover
- Rambu – rambu K3L yang diperlukan/ Safety signs required:
Rambu menggunakan Rambu menggunakan
pelindung telinga pelindung mata
Rambu bahaya listrik Rambu larang merokok
Rambu bahaya mudah Rambu dilarang masuk

terbakar selain petugas
Bahaya licin Rambu tanda APAR
 Jenis kabel, untuk di dalam gedung  Type of cable, for inside the building using
menggunakan kabel NYM dan NYY untuk NYM and NYY cables while for the outside
diluar gedung sedangkan ukurannya of the building the size and typesshall be
disesuaikan dengan besar/ kekuatan arus yang matched with the size / strength of the
dilalui. current being passed.
 Hindari sambungan kabel ke kabel dan  Avoid cable to cable connections and secure
amankan sambungan dengan T Dos dari PVC the connection with PVC T Dos
 Shocket and plug harus menggunakan  Shocket and plug shall use industrial types.
standard industrial.
 Dilakukan inspeksi berkala setiap bulan  Montly inspection shall be conduted.
4.6.4. STANDAR PENYIMPANAN TANKI MINYAK STANDARD OF FUEL TANK STORAGE
 Tanki minyak wajib diberi grounding

 Grounding cables must be installed in
sesuai dengan standar peraturan
accordance with Government Regulation
perundangan.
.
 Salinan catatan penggunaan minyak wajib
 Use of fuel must be recorded and reported
dilaporkan bulanan.
in monthly basis.
 Tanki minyak ditempatkan pada lokasi
 Fuel tank shall be located in safe place and
yang aman dan tidak mengganggu akses.
not distrubs the access.
 Bak control wajib diberi penutup.
 Pit control shall be properly protected
against weather exposures.
Rambu bahaya Rambu

mudah terbakar menggunakan
pelindung mata
Bahaya licin Rambu larang

merokok
Rambu tanda APAR Rambu dilarang

masuk selain
petugas
Rambu rambu yang diperlukan Safety Signs required

4.6.5. STANDAR PROTEKSI LUBANG HOLE PROTECTION STANDARD
4.6.6. STANDAR ATAP AKSES SHELTER OVERHEAD SHELTER ACCESS STANDARD
4.6.7. STANDAR PAGAR PENGAMAN RAILING PROTECTION STANDARD

4.6.8. STANDAR TEMPAT KENCING PORTABEL STANDARD OF URINOIR PORTABLE
4.6.9. BERSIH-BERSIH HOUSEKEEPING
Ketentuan umum General Rule:
 Setiap mandor/ subcontractor/ Kontraktor  Mandors/ subcontractors/ Direct Contractor

yang ditunjuk langsung bertanggung jawab are responsible housekeeping at each
terhadap kebersihan lokasi kerja masing – working area and mandatory to clean up
masing dan wajib melakukan kebersihan every after works.
setelah selesai bekerja.
 Sampah puing harus dikumpulkan pada  Rubbish and debris shall be collected in
penumpukan sementara utama main temporary dumping area only.
 Setiap supervisor menjadi penanggung  Supervisor is appointed as PIC of the
jawab langsung terhadap kebersihan pada housekeeping in each work locations.
lokasi kerjanya masing masing.
 Kebersihan pada fasilitas umum seperti  The housekeeping on general facilities such
pada kantin, toilet, akses utama dll. Harus as canteen, toilet and main access shall be
diatur dengan baik oleh site manager. well managed by site manager.
4.6.10. HIGIENE DAN KESEHATAN KERJA HYGIENE AND OCCUPATIONAL HEALTH
Higiene dan kesehatan kerja dalam Hygiene and occupational health in the work
lingkungan kerja ada suatu usaha perusahaan environment there is a company's effort to
untuk menjamin kesehatan pekerjanya ensure the health of its workers against
terhadap faktor fisika, kimia, biologi, physical, chemical, biological, ergonomic and
ergonomi dan psikologi yang timbul dari psychological factors arising from work
kegiatan kerja pada proyek PARQ VILLA activities in the PARQ VILLA project. The
dilakukan namun tidak terbatas pada: following efforts will be made but not limited
to:
 Tersediannya fasilitas umum
o Sarana MCK, mengacu  Availability of public facilities
Permankertrans no.5 tahun 2018 o Facilities for MCK (Sanitation, bath and
tentang K3 dan Lingkungan Kerja dan
wash) referring to Government
peraturan perusahaan IK Instruksi
Regulation Permenakertrans no.5 of
Kerja.
2018 concerning K3 and Work
Environment and company regulations
o Sarana kantor proyek dan barak WI Work Insteuction.
pekerja, mengacu pada peraturan o Site office and workers camp, reffering
perusahaan IK Instruksi Kerja. to company rule IK-ODR-STR-001 R0.
o Sarana penyimpanan material
termasuk B3, Mengacu pada SOP- o Material storage including hazardous
HSE-031. material, reffering to company rule
o Menyediakan sarana kantin dan SOP- HSE-031 HSE Standard.
tempat istirahat pekerja. o Provide canteen and rest area fasilities.
 Melakukan Progam kebersihan proyek,

mengacu pada peraturan perusahaan IK-  Conduct housekeeping program,
HSE-011 Housekeeping. reffering to company rule WI-HSE-011
 Melakukan program penggunaan dan House Keeping.
perawatan alat secara berkala sehingga  Carry out a program for the use and
tidak berdampak terhadap kesehatan maintenance of equipment on a regular
pekerja. Program ini terkait pada bagian basis so that it does not have an impact
4.6.1 Program Inspeksi. on the health of workers. This program
is linked to in section 4.6.1 Inspection
 Melakuan promosi dan edukasi, terkait Program.
higiene, ergonomi, B3, kebisingan, debu,  Conducting promotion and education
emisi udara dan pencemaran. Melakukan programs, to hygiene, ergonomics, B3,
promosi dalam bentuk banner dan poster noise, dust, air emissions and pollution.
yang ditempatkan pada posisi yang tepat. Promoting in the form of banners and
posters that are placed in the
 Melakukan program pengukuran faktor appropriate position.
fisiki dan kimia dilokasi proyek setiap 6  Conduct a physics and chemical factor
bulan oleh pihak ketiga yang terakriditas measurement program at the project site
oleh dinas pemerintahan yang terkait. every 6 months by third parties who are
accredited to the relevant government
agencies.
Lampiran Appendix
SOP-HSE-030 Occupational Health &
10
Hygiene SOP-HSE-031 Hazardous B3 Waste
Lampiran Appendix
Handling WI-HSE-011 Housekeeping
10
Lampiran Appendix
10
4.6.11. KETENTUAN OPERASI PENGANGKATAN BERAT THE PROVISION OF HEAVY

LIFTING OPERATION
 Operasi pengangkatan berat yang  The heavy lifting operation means
dimaksud apabila beban yang akan when the lifting load ≥ 75% or
diangkat ≥ 75% atau unkown load dari unknown load from radius load
radius load capacity dari alat angkat capacity of lifting equipment to be
yang akan digunakan. used.
 Prinsip utama dari system operasi  The main principles of the safe system
pengangkatan berat aman adalah: of heavy lifting operation shall be:
o Terencana dengan tepat o Properly planned.
o Terorganisir dengan baik o Well organized
o Terawasi dengan benar o Appropriately supervised
o Dilakukan dengan aman o Carried out in safe maner
o Ditinjau dengan ketat o Closed reviewed
 Metode atau lifting plan setidaknya  Method or lifting plan should be at

berisikan hal hal berikut: least address the following subject:
o Tujuan dari lifting operation o Objective of the lifting operation.
o Karakteristik beban o Characteristic of the load
o Lifting equipment o Lifiting equipment
o Klasifikasi dari operasi pengangkatan o Clasification of liting operation.
o Identifikasi bahaya dan kajian risiko. o Identification of hazard and risk
o Sumberdaya assessment.
o Persiapan operasi pengangkatan o Resources
o Mengaplikasikan Ijin kerja o Prepartaion of lifiting plan
o Mengaplikasikan Lifting Plan o Application of Permit-to-work
o Application of Lifting Plan
Lampiran Appendix 11 SOP-HSE-006 Lifting And

Lampiran Appendix 11 Transportation F-QHSE-054 Lifting Gear
Lampiran Appendix 11 Inspection
F-QHSE-096 Lifting Plan
4.6.12. SURAT IJIN KERJA AMAN (SIKA) SAFE WORK PERMIT (SWP)
 Ijin kerja diperuntukan pada pekerjaan

 Permit to work is intended high risk
yang berisiko tinggi seperti daftar
activitied as listed bellow
dibawah.
 Setiap pengajuan ijin kerja wajib
 Every work permit submission must
melampirkan Work Method Statement
attach with the approve work method
(WMS) & Job Safety Analysis yang telah
Statement (WMS & Job Safety Analysis).
di setujui.
 Surat Ijin Bekerja menggunakan standar
 Workpermit shall use standard form F-
formulir F-QHSE-011.
QHSE-011.
 Surat ijin bekerja harus berisikan
 The contains of workpermit shall be
o Durasi waktu mecakup tanggal dan jam
covered :
mulai dan selesai
o Date, time and duration
o Gambar kerja
o Working drawing
o Peralatan yang digunakan (jenis dan
o Equipment to be used
jumlah)
o Release Note (Disetujui atau disetujui

o Realease note (approved or approved by
dengan catatan)
note)
o Tanda tangan persetujuan dari yang
o Approval signatures from authorized
berwenang.
person.
Jenis Ijin Kerja dan Durasi Validasi Type of Working Permit and its Validation Duration:
No Jenis/ Types Validation Duration
1 Hotwork : welding & gas cutting 7 days
2 Confined space 7 days
3 Scaffolding 7 days
4 Excavation> 2m depth 7 days
5 Lifting > 5ton or 85% from crane SWL 7 days
6 Working at height 7 days
Lampiran Appendix SOP-HSE-003 Safe Work

12
Permit F-QHSE-011 SIKA
Lampiran Appendix
Permit
12
F-QHSE-011-01 SIKA Permit Register
Lampiran Appendix
F-QHSE-012 Complementary SIKA Permit
12
Lampiran Appendix
12
4.6.13. KETENTUAN BEKERJA PADA SAAT CUACA BURUK

THE PROVISION WORKING IN BAD WEATHER
Threshold Limit Activities Remark
9.8 m/s (22 m.p.h.) Mobile Cranes + Gondala + Hoist See also the
14 m/s (31 m.p.h.) paused manufacturer's
20 m/s (45 m.p.h.) Crawler Cranes paused recommendation.
Tower Cranes + PH
paused
Thunderbolt and rains Outdor activities paused
Penangkal petir harus dirancang dan dipasang sebelum pekerjaan dimulai Lightning rod shall be well
designed and installed prior start to work.
4.7. REKAMAN, DOKUMENTASI DAN PELAPORAN

RECORD, DOCUMENTATION AND REPORTING
Rekaman dokumen dan laporan yang selalu Document record and reporting shall be well
terdata selama masa proyek adalah sebagai maintain during the project periode :
berikut
 Dokumen rencana K3L termasuk seluruh  HSE Plan and all revises
pembaharuannya
 Dokumen sertifikasi kompetensi dan alat
 Equipment & Compontencies sertificate
 Dokemen pengukuran faktor fisika kimia
 Environment measurement
tempat kerja
 Rekaman Induction K3L
 HSE Induction
 Rekaman inspeksi dan tindak lanjutnya
 Inspection and follow up record
 Rekaman temuan dan NCR serta tindak
 NCR record
lanjutnya
 Rekaman assessment Program-10K3 skore

 Assessment Program-10K3 scoring
recorded
 Rekaman keluhan pelanggan
 Costumer Complient
 Hasil meeting
 Meeting record
 Ijin kerja
 Work permit
Laporan bulanan harus dipersiapkan dan
Monthly report shall be prepared and submit
diserahkan ke Head Office dan Client pada
to Head Office and Client by the 1st day of
hari pertama disetiap bulannya.
each month.
Isi laporan kepada klien minimum terdiri dari
The report contents to client shall be minimum
hal-hal berikut:
consisted of the following items:
 Tabulasi semua kecelakaan dan insiden
 A tabulation of all accidents and incidents
serta penyebabnya yang jelas.
and their apparent causes.
 Tabulasi semua bahaya yang diamati atau
 A tabulation of all hazards observed or any
pelanggaran peraturan keselamatan di lokasi
breach of safety rules at the work site, a
kerja, deskripsi tindakan korektif yang
description of corrective action tak en to
dilakukan untuk memperbaiki kekurangan.
rectify the shortfall.
 Ringkasan kegiatan HSE Kontraktor,
 A summary of the Contractor’s HSE
bidang masalah, tindakan korektif,
activities, problem areas, corrective
kunjungan Pemerintah dan audit HSE.
actions, Government visits and HSE audits.
 Jumlah personel di tempat kerja dan total
 The numbers of personnel on work site and
jam kerja bekerja secara bulanan dan
the total man-hours worked on a monthly
kumulatif.
and cumulative basis.
Lampiran Appendix SOP-HSE-020 Controll of Record and Report

13 F-QHSE-023 Master List of Internal
Lampiran Appendix Document
13
F-QHSE-024 Master List of External Document
Lampiran Appendix F-QHSE-025 Doc. Creation, Amendment & Replacement Requests
13 F-QHSE-026 Master List of Record and
Lampiran Appendix Notification F-QHSE-027 Document Distribution
13
Lampiran Appendix
13
Lampiran Appendix
13
4.8. RENCANA TANGGAP DARURAT, INVESTIGASI DAN LAPORANNYA EMERGENCY

RESPONSE PLAN, INVESTIGATION & REPORTING
 Senter
Perencanaan tanggap darurat, investigasi dan  APAR
laporannya ini dipersiapkan selama kegiatan
berlangsung.
Fasilitas emergency yang akan disiapkan

adalah:
 Tempat tidur P3K
 Tandu
 Obat – obatan P3K (sesuai peraturan
pemerintah)
ERP, Investigation and reporting is maintaining
during construction activities.
Emergency facilities to be prepared:
 First aid bed

 Stretcher
 First Aid Kit (as regulation)
 Flashlight
 Fire Extinguisher
 8 First Aider
 Fasilitas cuci tangan

 Hand washing facilities
 Tempat sampah medis
 Medical disposal bin
 Bidai
 Splints
 Thermometer klinik
 Clinical thermometer
 Lemari P3K
 Cupboards medical tools
 Sabun dan pencuci kuku
 Soap & nail brush
Isi kotak P3K
First-Aid Box Containts
 Pembalut perekat steril yang dibungkus
 Individually wrapped sterile
sendiri.
adhesive dressings.
 Perban krep (5 cm)
 Crepe bandage (5 cm)
 Perban krep (10 cm)
 Crepe bandage (10 cm)
 Kasa penyerap.
 Absorbent gauze.
 Pita hypoallergenic.
 Hypoallergenic tape.
 Kapas (25 gr)
 Cotton (25 gr)
 Perban segitiga.
 Triangular bandages.
 Gunting.
 Scissors.
 Peniti.
 Safety pins.
 Sarung tangan sekali pakai
 Disposable gloves (pairs).
(berpasangan).
 Resuscitation mask (one-way).
 Masker resusitasi (satu arah).
 Tweezers.
 Pinset.
 Torch light.
 Cahaya obor.
 Eye pad.
 Bantalan mata.
 Plastic bag
 Kantong plastik
 Sterile water or saline in 100
 Air steril atau garam dalam 100 ml
ml disposable containers.
wadah sekali pakai.
 Antiseptic / povidone iodine (60 m l).
 Antiseptik / povidone iodine (60 ml).
 Alcohol 70 %.
 Alkohol 70%.
 First aid hand book.
 Buku pegangan P3K.
 First aid log book
 Buku catatan P3K
 First aid box contents list
 Daftar isi kotak P3K

14
Lampiran Appendix
14
Lampiran Appendix
14
Lampiran Appendix
14
Lampiran Appendix
14
Lampiran Appendix
14
Lampiran Appendix
14
Lampiran Appendix
14
Lampiran Appendix
14
SO 043 Evaluation of Emergency Drill F-QHSE-
P- 044 Attendance List Emergency
HS
E-
015
Em
erge
ncy
Res
pon
se
Pro
ced
ure
F-
QH
SE-
036
ER
T
Orc
har
t
F-QHSE-037 ERT Contact
Number
F-QHSE-038 ERT
Responsibilities &
Authority
F-QHSE-
039
Emergency
Identificatio
n and
Simulation
F-QHSE-
040
Evacuation
Route Map
F-QHSE-041 List of
Emergency Facilities
F-
Q
HS
E-
04
2
E
me
rg
en
cy
In
ves
tig
ati
on
Re
po
rt
F-
Q
H
SE
-
Penanganan Keadaan Darurat, Kecelakaan Kerja, Investigasi dan Pelaporannya

Handling of Emergency Situation, Accident and Reporting
Kejadian berbahaya adalah insiden tempat A dangerous occurrenceis a serious work place
kerja yang serius di mana tidak ada korban. incident in which no one is killed or injured.
Kejadian berbahaya yang berikut harus The following dangerou soccurrences must be
dilaporkan adalah sebagai berikut: reported:
 Runtuhnya atau kegagalan alat angkat  Collapse or failure of lifting equipment
 Ledakan atau kebakaran di suatu ruangan  Fire or Explosion in a room/place
/ tempat
 Hubungan arus pendek listrik atau  Electrical short circuit or failure of
kegagalan mesin, pabrik atau peralatan electrical machinery, plant or apparatus,
listrik, yang mengakibatkan usia ledakan, resulting in explosion, fire or structural dam
kebakaran atau kerusakan struktural dan age and causing its stoppage for at least five
menyebabkan penghentiannya setidaknya hours
selama lima jam.
 Ledakan atau kebakaran di sebuah
ruangan di mana orang-orang sedang  Explosion or fire in a room in which
bekerja, yang mengakibatkan persons are at work, resulting in the
penangguhan total pekerjaan normal di complete suspension of norm al work in the
ruangan setidaknya selama 24 jam. room for at least 24 hours.
Pekerjaan akan dapat dihentikan sementara
apabila terdapat kecelakaan LTI hingga The work might be suspended if there is an LTI
proses investigasi selesai dilakukan dan accident until the investigation process is
tindakan perbaikan telah terlaksanan. Namun, completed and the corrective action is carried
untuk kasus kecelakaan KEMATIAN maka out. However, in the case of a FATALITY
seluruh pekerjaan harus ditangguhkan hingga accident all work must be suspended until the
seluruh proses investigasi dan perbaikan telah entire investigation and corrective process has
dilakukan. been carried out.
Rencana Tanggap Darurat Emergency Response Plan

Keadaan darurat adalah situasi yang An emergency is a situation that poses an
menimbulkan risiko langsung terhadap immediate risk to health, safety, life, property,
kesehatan, keselamatan, kehidupan, properti, or environment. Most emergencies require
atau lingkungan. Sebagian besar keadaan urgent intervention to prevent a worsening of
darurat memerlukan intervensi segera untuk the situation.
mencegah memburuknya situasi.
Keadaan darurat dapat terjadi dari: An emergency can occur by:

 Kebakaran  Fire
 Kecelakaan Major  Major Accident
 Crane rubuh/ gagal  collapsed / failed
 Kebocoran gas  Toxic gas leaks
 Ruang terbatas  Confined space
 Tumpahan kimia  Chemical spillage
 Huru hara/ perkelahian  Riot / strikes
 Ancaman teroris.  Terrorist threat.
Proses penanganan keadaan darurat dan The process of emergencies handling and
kecelakaan kerja juga mengacu pada occupational accidents are also refers to the
prosedur perusahaan yang tertuang pada company procedures of Work Instruction Flow
Instruksi Kerja Penanganan Kecelakaan Chart for Accident and Emergency
dan Keadaan Darurat, Standard Management, Occupational Safety Health &
Keselamatan dan Kesehatan Kerja Environment Standards section-Emergency
Lingkungan bagian – Tanggap Darurat. Response.
Rencana tanggap darurat ini mencakup: These emergency response plans are covering:
1. Penanganan kecelakaan kerja. 1. Occupational Accident Responses
2. Penanganan gempa bumi dan kebakaran. 2. Earthquakes and Fire Responses
3. Penangaanan huru - hara 3. Riot Responses
4. Penanganan tumpahan. 4. Spills Responses
Penanganan Kecelakaan Kerja Occupational Accident Response

Penanganan Keadaan Darurat Emergency Situation Handing

Penanganan Tumpahan Spills Handling

5. PEMERIKSAAN CHECKING
5.1. PENGUKURAN BERDASARKAN FREKUENSI & SEVERITY KECELAKAAN KERJA

MEASUREMENT BASE ON ACCIDENT FREQUENCY & SEVERITY
Pengukuran ini berdasarkan variabel sebagai This measurement is based on the following
berikut: variables:
 Jumlah jam kerja  Number of working hours
 Jumlah kecelakaan kerja LTI  Number of Lost Time Incident
 Jumlah kehilangan hari kerja  Number of days loss
Dengan rumusan sebagai berikut: With the formula as
Formula Incident Frequency Rate follows:
(IFR) Formula Incident Frequency Rate (IFR)
IFR = Jumlah Kecelakaan LTI x IFR = Nr. Of Accident LTI x 1,000,000

1,000,000 Total Jam Kerja Total Manhours
Formula Incident Severity Rate (ISR) Formula Incident Severity Rate (ISR)
ISR = Day Lost x 1,000,000 ISR = Day Loss x 1,000,000

Total Jam Kerja Total Worked Hours
LTI = Lost Time Incident (korban tidak LTI = Lost Time Incident (Injured Person can
dapat bekerja kembali setelah 1 x 24jam dari nor back to work after 1 x 24hours from
waktu kecelakaan.) accident time)
5.2. PENGUKURAN LINGKUNGAN ENVIRONMENTAL MEASUREMENT
Pengukuran lingkungan kerja mencakup hal The enviromental measurement to conducted for:
hal berikut .
 Pengukuran kebisingan  Noice level measurement
 Pengukuran air limbah dan air bersih  Waste water and clean water measurement
 Pengukuran udara ambient  Air embient measurement

15
Lampiran Appendix
15
Lampiran Appendix
15
Lampiran Appendix
15
Lampiran Appendix
15
Lampiran Appendix
15
Lampiran Appendix
15
SO QHSE-057-02 Hygiene Measurement-Ilumination F-
P- QHSE-028 Waste Manifest
HS F-QHSE-029 Evidence of Handover B3 Waste
E-
030
Occ
upa
tion
al
He
alth
&
Hy
gie
ne
SO
P-
HS
E-
031
Ha
zar
dou
s
B3
Wa
ste
Ha
ndli
ng
SO
P-
HS
E-
032
Da
nge
rou
s
Ch
emi
cal
Ha
ndli
ng
F-
QH
SE-
057
-01
Hy
gie
ne
Me
asu
re
me
nt-
Noi
se
F-QHSE-057-02 Hygiene
Measurement-Vibration
F-
5.3. INTERNAL AUDIT AUDIT INTERNAL
No Jenis Audit Program By

1. External audit (Survaillance or Per 1 year Certification body, based on ISO
Renewal) 45001 for OHS and 14001 for
Environmental.
2. Company internal audit Per 6 months Company Audit committe, this
program is integrated audit program of
ISO 45001, 14001, 9001
3. Internal HSE Audit Per 3 months Coorporate HSE Department, this
audit based on project HSE plan.
5.3.1. PENILAIAN PROGRAM 10K3 PERUSAHAAN ASSESSMENT PROGRAM-10HSE
Penilaian program 10 dimaksud sebagai Assessment Program 10-HSE is intended as the

sarana promosi & kampanye K3L company HSE campaign and promotion tool to
perusahaan guna memacu peningkatan rise better HSE performance in regular basis,
performa K3 secara berkala, terukur dan quantified and consistent. This program will
konsisten. Program ini akan dilakukan conduted 1time a month started form project
Satu kali dalam sebulan terhitung sejak commencement date with the target is 85%
proyek dimulai. Minimum pemenuhannya achieved from total score as follows:
adalah 85% dari total skor yang mencakup
performa dari:
No Program 10K3 SUB-ELEMENT NILAI MAX Bobot

1 Kebijakan & Administrasi Kepemimpinan & Partisipasi 90
Policy & Administration Perencanaan 50
Penunjuang 115 5%
Pengukuran kinerja 95
Perbaikan berkelanjutan 35
2 Kontrol Operasi Pagar Pengaman 15
Operational Controll Proteksi Lubang 90
Safety Deck 25
SafefyVertikal Screen 40
Scaffolding 70
Platform Kerja 65
Crane 45
Lifting Gear 75
Lifting Operation 65
Passenger Hoist 90
Terminal PH 110
Terminal Material 85
Elektrikal 125
Gondola 75
Alat Berat 55
Alat Pelindung Diri 70
Genset 45 60 %
Alat KerjaLainnya 50
3 Lingkungan & Kesehatan Gudang Material 50
Health & Environment Penanganan B3 105 10 %
Kantin 95
Kesehatan & P3K 45
Gate Control 50
Promosi K3L 60
Lingkungan 35
4 Kebersihan Kebersihan Lokasi Proyek 115
Hygiene MCK Proyek 50 25 %
Mess 55
MCK Mess 45
Lampiran Appendix SOP-HSE-024 Audit Internal

16
F-QHSE-073 Annual Audit Plan Schedule
Lampiran Appendix
F-QHSE-074 Internal External Audit Schedule
16
F-QHSE-075 Check List Internal Eksternal
Lampiran Appendix
Audit F-QHSE-076 Audit Register
16
F-QHSE-077 List of NCR, CPAR Internal External
Lampiran Appendix
Audit F-QHSE-078 Result of Internal External Audit
16
Report
Lampiran Appendix
16
Lampiran Appendix
16
Lampiran Appendix
16
5.4. Pengaturan Denda K3L HSE Pinalty System
Denda K3L sebagai biaya administrasi untuk HSE fines as an administrative charges for
kinerja keselamatan yang buruk akan poor safety performance to be applied during
diterapkan selama periode the construction period. PT. ECOCOMPLECT
konstruksi. PT. GROUP INDONESIA entitled to fines any
ECOCOMPLECT GROUP INDONESIA HSE violation or non-compliance to the itsown
berhak untuk mendenda pelanggaran HSE atau emplyees, sub-contractor and or "Mandors"
ketidakpatuhan terhadap karyawan, sub- due to individual and or organization action.
kontraktor dan atau "Mandor" yang dimilikinya
karena tindakan individu dan atau organisasi.
PELANGGARAN K3 DAN DENDA
NO. JENIS PELANGGARAN DENDA NO. JENIS PELANGGARAN DENDA

Tidak menggunakan Full Body Harness/Sabuk
1 Rp 500.000,- 9 Tidak memproteksi pekerjaan pengelasan Rp 500.000,-
Pengaman
2 Merokok tidak pada tempatnya Rp 500.000,- 10 Pengelasan tanpa Apar Rp 300.000,-
Tidak menggunakan alat pelindung diri standard

3 Buang air kecil/Kencing sembarangan Rp 500.000,- & Dikeluarkan 11 Rp 100.000,- #
di dalam proyek
4 Buang air besar sembarangan Rp 500.000,- & Dikeluarkan 12 Merusak fasilitas K3 (Railing, safety net, DLL) Rp 500.000,-
Bertindak ceroboh yang dapat membahayakan Penempatan dan penyimpanan tabung

5 Rp 300.000,- 13 Rp 300.000,-
pekerja lain bertekanan yang tidak aman
6 Kabel listrik tanpa stecker dan kabel dilantai Rp 300.000,- 14 Area kerja kotor dan tidak rapih Rp 300.000,-
Menggunakan platform kerja (Lantai kerja) yang

7 Rp 300.000,- 15 Kehadiran safety morning tidak mencapai 80% Rp 250.000,-
tidak aman
2400
5.5. LAMPIRAN APPENDIX
LAMPIRAN / APPENDIX 01 SOP-HSE-002 SOP HIRADC

Hazard Identification Risk Assessment Determine Controll
F-QHSE-007 HIRADC Form
F-QHSE-008 JSA Job Safety Analysis Form
LAMPIRAN / APPENDIX 02 SOP-HSE-016 Standar Ketentuan legal dan peraturan lain
SOP-HSE-016 Legal and other requirement Standard
F-QHSE-009 Identifikasi & Evaluasi PPPL
Identification & Evaluation of Compliance Legislation & Other
F-QHSE-010 Daftar Peraturan Bidang K3L
List of HSE Legislation, Regulation & Standard
LAMPIRAN / APPENDIX 03 SOP-HSE-017 HSE Objective, Target & Program
F-QHSE-014 Objective, Target & Program
LAMPIRAN / APPENDIX 04 SOP-HSE-018 Competence, Training & Awareness
F-QHSE-015 Induction Form
F-QHSE-017 Comptence Register
F-QHSE-018 Training Matrix
LAMPIRAN / APPENDIX 05 SOP-HSE-019 Communication, Consultation & Participation
F-QHSE-006 Communication, Consultation & Participation Form
F-QHSE-006-01 Project Signs, poster and banner
LAMPIRAN / APPENDIX 06 SOP-HSE-021 HSE Subcontractor Handling
F-QHSE-064 Subcontractor Evaluation
LAMPIRAN / APPENDIX 07 M-QHSE-001 Manual QHSE Company
M-HSE-001 Manual HSE Project Execution Plan
M-HSE-002 Manual HSE Plan
LAMPIRAN / APPENDIX 08 SOP-HSE-014 Inspeksi K3L HSE Inspection
WI Work Instruction Color Coding & Taggging
F-QHSE-013 Colour Coding
F-QHSE-045 Office Inspection
F-QHSE-046 Vehicle Inspection
F-QHSE-047 PPE Inspection
F-QHSE-048 First Aid Box Inspection
F-QHSE-049 Fire Extinguisher Inspection
F-QHSE-050 Light Vehicle Inspection
F-QHSE-052 Heavy Equipment Inspection
F-QHSE-053 Equipment Inspection
F-QHSE-054 Tools Inspection
F-QHSE-058 Hygiene Inspection
F-QHSE-059 Inspection & Measurement Plan
LAMPIRAN / APPENDIX 09 SOP-HSE-001 Management & Application PPE
F-QHSE-031 PPE Specification
F-QHSE-032 PPE Handover list
F-QHSE-032-01 PPE Request & Replacement
F-QHSE-033 PPE Matrix
F-QHSE-047 PPE Inspection
F-QHSE-034 PPE Stock Report
F--QHSE-034-01 PPE Stock Record
F- QHSE-047 PPE Inspection
LAMPIRAN / APPENDIX 10 SOP-HSE-030 Occupational Health & Hygiene

SOP-HSE-031 Hazardous B3 Waste Handling

WI-HSE-011 Housekeeping
LAMPIRAN / APPENDIX 11 SOP-HSE-006 Lifting And Transportation
F-QHSE-054 Lifting Gear Inspection
F-QHSE-096 Lifting Plan
LAMPIRAN / APPENDIX 12 SOP-HSE-003 Safe Work Permit
F-QHSE-011 SIKA Permit
F-QHSE-011-01 SIKA Permit Register
F-QHSE-012 Complementary SIKA Permit
LAMPIRAN / APPENDIX 13 SOP-HSE-020 Controll of Record and Report
F-QHSE-023 Master List of Internal Document
F-QHSE-024 Master List of External Document
F-QHSE-025 Doc. Creation, Amendment & Replacement Requests
F-QHSE-026 Master List of Record and Notification
F-QHSE-027 Document Distribution
LAMPIRAN / APPENDIX 14 SOP-HSE-015 Emergency Response Procedure
F-QHSE-036 ERT Orchart
F-QHSE-037 ERT Contact Number
F-QHSE-038 ERT Responsibilities & Authority
F-QHSE-039 Emergency Identification and Simulation
F-QHSE-040 Evacuation Route Map
F-QHSE-041 List of Emergency Facilities
F-QHSE-042 Emergency Investigation Report
F-QHSE-043 Evaluation of Emergency Drill
F-QHSE-044 Attendance List Emergency
LAMPIRAN / APPENDIX 15 SOP-HSE-030 Occupational Health & Hygiene
SOP-HSE-031 Hazardous B3 Waste Handling
SOP-HSE-032 Dangerous Chemical Handling
F-QHSE-057-01 Hygiene Measurement-Noise
F-QHSE-057-02 Hygiene Measurement-Vibration
F-QHSE-057-02 Hygiene Measurement-Ilumination
F-QHSE-028 Waste Manifest
F-QHSE-029 Evidence of Handover B3 Waste
LAMPIRAN / APPENDIX 16 SOP-HSE-024 Audit Internal
F-QHSE-073 Annual Audit Plan Schedule
F-QHSE-074 Internal External Audit Schedule
F-QHSE-075 Check List Internal Eksternal Audit
F-QHSE-076 Audit Register
F-QHSE-077 List of NCR, CPAR Internal External Audit
F-QHSE-078 Result of Internal External Audit Report

M-HSE-002-03 HSE Plan-Parq Villa Project-Ubud

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UBUD – PARQ PROJECT

RENCANA KESELAMATAN, KESEHATAN KERJA & LINGKUNGAN

PT. ECOCOMPLECT GROUP INDONESIA

RENCANA KESELAMATAN KESEHATAN KERJA DAN LINGKUNGAN

HEALTH SAFETY & ENVIRONMENT PLAN

Doc. No. : M-HSE-0002-03 Prepared by, Reviewed by, Approved by,

Revision 00 Nada Kiansyah Fauzi Pohan Mikhail Andrianov

Catatan Revisi/ Revision Record

ISU INTERNAL DAN EKSTERNAL

i.DAFTAR ISI TABLE OF CONTENT

i. DAFTAR ISI TABEL OF CONTENT...................................................................................................4

4.8. RENCANA TANGGAP DARURAT, INVESTIGASI DAN LAPORANNYA EMERGENCY

5.4. PENGATURAN DENDA K3L HSE PINALTY SYSTEM...................................................................39

PT. ECOCOMPLECT GROUP INDONESIA PT. ECOCOMPLECT GROUP INDONESIA

1.1. RUANG LINGKUP SCOPE

1.2. TUJUAN PURPOSE

2. KEBIJAKAN K3L PERUSAHAAN COMPANY HSE POLICY

2.1. KEBIJAKAN UTAMA K3L PERUSAHAAN COMPANY HSE POLICY

HIRADC-ASDAM dibentuk sesuai dengan HIRADC-EAI is developed accordance with

 Instalasi listrik sementara

Lampiran untuk bagian ini Appendix for this section

Lampiran/ Appendix 01 SOP-HSE-002 Standard Pedoman HIRADC-Aspek dan

3.2. PERATURAN PERUNDANGAN K3L DAN KETENTUAN LAIN

Lampiran untuk bagian ini Appendix for this section.

Lampiran Appendix SOP-HSE-016 Standar Ketentuan legal dan peraturan lain

3.2.1.KETENTUAN UMUM PROYEK GENERAL PROJECT PROVISIONS

3.3. SASARAN DAN TARGET K3L HSE OBJECTIVE TARGET

4.1. BAGAN ORGANISASI P2K3 PROYEK PROJECT HSE COMMITTEE ORCHART

4.2. PERAN DAN TANGGUNG JAWAB ROLE AND RESPONSIBLE

inspeksi HSE sedang diterapkan. inspection schemes being applied.

HSE Leader/ Coordinator

memastikan pelaksanaannya. d. Conduct HSE induction to all employee and

a. Memimpin toolbox meeting. a. Lead the toolbox meeting

Site Manager/ Engineering Manager

4.3. KOMPETENSI, PELATIHAN & KESADARAN COMPETENCE, TRAINING & AWARENESS

4.3.2. RENCANA PELATIHAN K3L PROYEK PROJECT HSE TRAINING PLAN

PROJECT TRAINING MATRIX

No Item Training Media

1 Safety Indcution ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas

2 WAH & Scaffolding ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas

3 Lifting operation ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas

4 Confined Space Entry ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Kelas

5 Excavation and Disturbance

7 APAR/ Light Fire Extinguisher use ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk

8 P3K/ First Aid ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk &Class

9 Tanggap Darurat - Emergency Exit ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Drill

10 Work Method & JSA Bagian Terkait

12 5R ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk & Kelas

13 Alat Penindung Diri/ PPE ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ ⌂ Safety Talk

4.3.3. PELATIHAN INDUKSI K3L HSE INDUCTION TRAINING

 Induksi HSE dilakukan untuk

tabung gas, penahanan percikan

Lampiran untuk bagian

Lampiran Appendix 04 SOP-HSE-018 Competence, Training & Promotion

4.4. KOMUNIKASI, KONSULTASI & PARTISIPASI K3L

Lampiran untuk bagian ini/ Appendix for this section.

Lampiran/ Appendix 05 SOP-HSE-019 Communication, Consultation & Participation

Lampiran untuk bagian ini Appendix for this section.

Lampiran/ Appendix 05 F-QHSE-006-01 Project Signs, poster and banner

4.5. PENGENDALIAN SUB KONTRAKTOR SUBCONTRACTOR CONTROLING