PT CIPTA MULIA SEMESTA

HSE PLAN

PT CIPTA MULIA SEMESTA

PT CIPTA MULIA SEMESTA HSE PLAN

1 PURPOSE
This HSE PLAN is established to provide all PT CIpta Mulia Semesta Management and Employees, Sub-
Contractors, Visitors and Other Persons involved in the Project Site a clearly defined plan to ensure
that CMS takes every possible action to protect the Health and Safety of all persons, prevent damage
to and loss of property and to protect the environment.

All CMS Management & Employees and Sub-Contractor personnel for construction site shall be familiar
with their responsibilities to Health, Safety and the Environment as outlined in this document. For this
purpose, this HSE PLAN and other documents required such as client HSE guidance, if any, will be
located at site offices and work sites and be readily available to all personnel.

2 SCOPE
The HSE Plan covers the health, safety, and environmental protection procedures, work instructions,
and standards that will be applied for construction works of the Project and the works shall be
performed in accordance with the related HSE requirements.

Should there be any conflicts between this Plan and the Client’s Health, Safety and Environmental
requirements, the Client’s documents shall be governed.

This is a “Living Document” and, as such, will be subject to regular Review and Updating in accordance
with changes in duties and responsibilities, processes and practices, systems of work and other aspects
of CMS’S activities. The original & revised HSE Plan shall be approved by the approver before
implemented.

During the course of the work, CMS Management & Employees, Subcontractor Personnel and Other
Persons involved in the Project site shall follow not only the Plan, but also any other Health, Safety and
Environmental rules and regulations specified in Indonesia law and the provisions of applicable other
requirements.

3 TERMS AND DEFINITIONS

Owner : the organization that give order to and receives products from CMS

CMS : PT. Cipta Mulia Semesta, the Main Contractor that receives order from the Owner and
subcontracts the work package to Subcontractors

Subcontractor : The organizations that provides the products and service to CMS

HSE Committee : The HSE Committee at project site that lead by Construction Manager or his/her
designated personnel from CMS site organization members. Members of the committee are consist of
CMS Construction Representatives.

2
PT CIPTA MULIA SEMESTA HSE PLAN

4 REFERENCES
• Owner HSE Requirements (ITB / Contract / Etc.)

• Project HSE Plan

• RI – Law No. 1 / 1970 : Occupational Safety (Consists of Health and Safety)

• RI – Law No. 23 / 1997: Environmental Management.

5 HSE ORGANIZATION AND RESPONSIBILITY

5.1. Organization

HSE site organization shall be established by CMS and entire subcontractor that involved in the Project.
CMS shall assign one personnel as CMS HSE supervisor/Admin with role and responsibility as stated in
the point 5.2 hereto. CMS site HSE supervisor shall work together with CMS supervisors to ensure
entire HSE requirement are followed by entire project site organization. CMS HSE supervisor shall
supervise entire subcontractor safety officers and drive them to prepare report, JSA and investigation if
any incident or accident occurred. Subcontractor HSE officers are responsible for day to day operation
and management of the project HSE program for their respective company on the job site. They report
to the subcontractor project manager and CMS HSE supervisor.

5.2. Responsibility

5.2.1. All Management Levels from Project Manager to Discipline Managers

All level of management from the Project Manager to the Discipline Managers must be involved in the
HSE organization, and must recognize that attaining the HSE objectives and performance is their own
duty and responsibility.

5.2.2. Project Manager

The Project Manager has overall responsibility for HSE management and performance of the project as
well as for the engineering, procurement and construction throughout the project execution period.

His/her major roles and responsibilities for HSE management are to:

a. Establish the project HSE Policies and targets.

b. Establish the project organization and assign competent personnel to the organization.
c. Define and assign individual’s roles and responsibilities.
d. Participate in setting up the project HSE strategy just after project award
e. Arrange necessary resources of people, thing and funds
f. Incorporate the requirements of HSE into the subcontracting scheme.
g. Be responsible for the selection of subcontractors according to their attitude toward HSE, past
record of HSE performance, etc., as well as their experience and ability to do the work,
proposed price and conditions.
h. Propose to be assigned: Engineering Manager, Procurement Manager, Construction Manager,
HSE Manager and other managerial personnel who are competent and highly experienced in
their designated roles and responsibilities.

3
PT CIPTA MULIA SEMESTA HSE PLAN

i. Encourage the Engineering Manager, Procurement Manager, Construction Manager and QHSE
Manager to establish HSE management strategy, programs and procedures for the project.
j. Visit the site, as frequently as possible, to confirm and evaluate the HSE management status
and performance as well as the construction status.

5.2.3. Construction Manager

The Construction Manager is responsible for the implementation of theConstruction HSE Plan. The
plan shall be according to the Project HSE Plan, applicable Legal & Other Requirements and OWNER
Requirements with the assistance of the QHSE Manager/Safety Supervisor and all supervisory
personnel, accident prevention procedures will be implemented in all activities by the application of
sound HSE planning.

Specifically, the Construction Manager shall be the driving force behind the Project HSE Program and
shall take the following responsibilities:

a. Assume full responsibility for HSE activities on the project and maintain liaison with the Project
Manager as well as with the Construction Management Department Manager and Project
Operation Division Manager in Head Office.
b. Establish and, with the assistance of the QHSE Manager/HSE Supervisor, direct the Site HSE
Program.
c. Promote full support of the HSE Program by enthusiastically advocating the Program.
d. Delegate responsibilities for the various safety functions and authority for departmental and
craft HSE promotion.
e. Require full HSE compliance by all departments of CMS and all of its Subcontractors.
f. Establish the job HSE rules with special attention to unusual operations and HSE requirements
of OWNER.
g. Establish the disciplinary action necessary to develop an efficient, functioning HSE Program.
h. Plan for prompt accident investigations, ensuring that adequate, informative reports are
completed and their distribution is accomplished.
i. Be directly concerned with the planning for those operations which have a potential loss or
hazard above that of normal construction activities.
j. Pursue improvements in HSE performance.
k. Prevent damage to the environment by construction activities.

5.2.4. HSE Supervisor

The HSE Supervisor is responsible for the implementation and monitoring of the Construction HSE
Plan. As HSE Administrator, the HSE Supervisor shall function as advisor and consultant to site
management, supervisory personnel and Subcontractor's HSE organizations, in establishing,
implementing, maintaining and continually improving compliance with the Project HSE Plan, Client and
CMS HSE Requirements.

The specific responsibilities of the HSE Supervisor include, but are not limited to:

a. Coordinating site HSE efforts between Client, CMS and subcontractor HSE personnel.
b. Keeping site management aware of the progress of the HSE Program and making
recommendations for site-related HSE improvements.
c. Administering site HSE policies and procedures within the framework of the HSE Plan with
particular emphasis on potentially hazardous operations.

4
PT CIPTA MULIA SEMESTA HSE PLAN

d. Proposing Programs to implement the accomplishment of short and long term site HSE
objectives and to initiate the motivation for employee participation needed to obtain these
objectives.
e. Preparing and distributing all relevant HSE reports, which will include accident, incident and
near miss details.
f. Maintaining a continuing inspection Program and reporting the findings and recommendations
to the appropriate supervisor or Subcontractor for prompt remedial action.
g. Conducting and participating in HSE meetings.
h. Supervising HSE training in accordance with the HSE PLAN.
i. Coordinating the site first aid and rescue services.
j. Investigating all accidents, injuries, fires, property damage, and other HSE-related incidents
and completing relevant reports.
k. Being responsible for the classification of occupational injuries/illness and following up on the
control and management of all cases. Assisting Subcontractors with their HSE Programs to
meet government, Client and CMS site HSE requirements.
l. Evaluating the need for, and requisitioning of, HSE, first aid, and fire protection equipment
needed at each job location, and ensuring that HSE equipment meets appropriate standards
and is maintained in good condition.
m. Effectively displaying and maintaining publicity material on site bulletin boards, posters, HSE
signs and banners and distributing HSE literature.
n. Monitoring the site hazardous waste Program.
o. Monitoring the site radiation HSE Program.
p. Maintaining knowledge of current state-of-the-art concepts of accident prevention and
continually contributing to upgrading the site HSE effort.
q. Ensuring, by adequate practical means and "follow-up" methods, that all directions and advice
is understood and acted upon.
r. Pursuing improvements in HSE performance.
s. Monitoring the effect of the construction activities on the environment.

5.2.5. Construction Supervisor

Construction Supervisors are directly responsible for the control and activities of craft employees on
construction projects. They play a key role in the execution and maintenance of an effective job site
HSE Program.

The standards for the HSE Program are established by the Construction Manager. The actual
performance of the HSE Program is a prime responsibility of the Construction Supervisor who has
direct contact with the crafts. The Construction Supervisor's ability to instill an HSE attitude in the
crafts is a direct reflection of his talents.

The specific HSE responsibilities of Construction Supervisors shall include, but will not be limited to the
following:

a. Reviewing all work and all new personnel for HSE requirements. Complete familiarization with
HSE requirements is an integral part of the total job responsibility.
b. Continual monitoring of the HSE attitudes of employees, their responsibilities toward the HSE
of their crafts, and their participation in the job HSE effort.
c. Insist on compliance with all established HSE legal & other requirements during performance
of the work.

5
PT CIPTA MULIA SEMESTA HSE PLAN

d. Conduct HSE inspections and make recommendations on a daily basis.

e. Hold HSE meetings and other activities to perpetuate HSE consciousness
f. Ensure that proper craft HSE training is provided.
g. Initiate plans prior to the start of work to supply the personnel; tools materials, and equipment
necessary to complete the job safely.
h. Assist accident investigations to ensure proper reporting and documentation and ensure
prompt corrections are made following an accident or incident to eliminate recurrences.
i. Coordinate planning and work activities with other supervisory personnel performing work
within, or adjacent to, their assigned work areas

5.2.6. Site HSE Committee

a. Promote cooperation amongst all levels of management.

b. Give recommendation and consideration to the management
c. Hold HSE meeting at least 1 x per month.
d. Take inventory of HSE Problems
e. Identify and take inventory of hazard sources
f. Implement HSE
g. Conduct inspection periodically
h. Conduct accident investigation and analysis in case of accident
i. Ensure competence, training and awareness
j. Ensure procedures including evacuation procedure
k. Maintain HSE records and data

5.2.7. Subcontractor/Supplier/Vendor’s Construction Manager/Superintendent

Subcontractor's Construction Manager/Superintendent will provide his workers with a safe and
healthy working environment.

He/She shall be responsible for promoting HSE and health consciousness among all his workers at all
times and shall :

a. Familiarize himself and comply with all INDONESIAN GOVERNMENT, OWNER and CMS
regulations/requirements, including the contents of the CMS HSE Plans.
b. Provide adequate safe construction equipment, tools and apparatus for the work, including
personal protective equipment for his workers.
c. Ensure the construction work is being executed in the safest manner based on planned work
procedures.
d. Inspect and maintain the entire work area in a safe, healthy and environmentally friendly
condition, instructing his supervisors to take immediate corrective action if he detects
discrepancies.
e. Lead subcontractor's HSE meetings.
f. Act as a Site HSE Committee Member.
g. Provide HSE training for his work-force.
h. Maintain records of employees’ qualifications.
i. Prevent damage to the environment.

5.2.8. Subcontractor/Supplier/Vendor’s Construction Supervisor/Foreman

6
PT CIPTA MULIA SEMESTA HSE PLAN

a. It is the responsibility of the subcontractor's supervisors/foremen to ensure that their workers

strictly adhere to HSE procedures in their specific work areas. They shall stop the work and
correct any unsafe acts and/or conditions promptly when these are recognized during the
work.
b. Ensure that all work adheres to the CMS and subcontractors HSE plans.
c. Prevent work activities causing damage to the environment.
d. Be familiar with those parts of the Schedule applicable to the work on which subordinate
workers are engaged.
e. Incorporate HSE procedures in routine tasks and ensure they are obeyed (Pre-task HSE
Instructions).
f. Implement a Job Safety Analysis (JSA) for all hazardous tasks.
g. Conduct weekly HSE meetings with subordinates.
h. Conduct daily work site inspections to identify and correct any existing unsafe conditions.
Document and coordinate the HSE inspection activities and findings.
i. Prevent unsafe acts, such as horseplay or the taking of unnecessary risks.
j. Ensure that new employees are properly instructed in precautions to be taken before they are
allowed to start work.
k. Commend men who, by action or initiative, eliminate hazards.
l. Report accidents, unsafe conditions and defects in equipment to their immediate supervisors.
m. Participate in Accident/Incident investigations.
n. Set a personal example.

5.2.9. All Personnel

a. Stop work when an unsafe condition is identified; warn fellow-workers and supervisors
immediately.
b. Use the correct tools and equipment for each job. Use personal protective equipment as
required and provided.
c. Do not endanger self or fellow workers.
d. Keep tools and equipment in good condition. Inspect tools/equipment for defects before use
and report defects immediately to a supervisor.
e. Refrain from horseplay and abuse of HSE devices, equipment and welfare facilities.
f. Report any accidents, near misses or hazardous conditions to a supervisors
g. Read OWNER and CMS HSE rules and take note of special HSE precautions in restricted areas.
h. Obey all posted warning signs.
i. Follow instructions from supervisors. If in doubt, ask questions. Never commence work
without a work permit if a Permit-to-Work system is operating.
j. Cooperate with HSE Personnel. They are on the site for everyone's safety.
k. Know emergency procedures (siren codes, assembly points, wind socks, etc.). These
procedures could safe a life.
l. Prevent damage to the environment.

6 HEALTH, SAFETY AND ENVIRONMENTAL

6.1. General Requirement

7
PT CIPTA MULIA SEMESTA HSE PLAN

Sub contractor shall establish, implement, maintain and continually improve its (Sub contractor’s) HSE
Plan and all other associated documents in accordance with the requirements of the Project HSE Plan
and legal & other requirements, and determine how it will fulfil these requirements.

The sub contractor shall define and document the scope of this HSE Plan.

6.2. HSE Policy

It is the policy of CMS to provide a safe, healthy and environmentally friendly work place. This is for the
benefit of all employees, sub-contractors and other persons that may be affected by their operations
while engaged in the engineering, procurement and construction work.

CMS will comply with all applicable Legal & Other requirements.

A safe, healthy and environmentally friendly work place will be maintained by using work methods
with the objectives acting as guidance.

Where hazards exist that cannot be entirely removed, personnel will be advised and trained regarding
the risks involved.

CMS Management will continually monitor and report conditions controlling and reducing risks
wherever possible and stop un-safe work conditions.

This HSE Policy is refer to the CMS Corporate HSE Policy that is integrated in the Corporate QHSE Policy

6.3. HSE Risk Assessment

There are two types of hazard analysis that will be used to minimize risks at the work area. They are
described below.

6.3.1 Hazard Identification and Risk Assessment (HIRA)

The sub contractor shall establish and / or implement and maintain a documented HIRA procedure to:

a. Identify the HSE hazards/aspects of its activities, products, services and facilities included in
the project
b. Identify risks/impacts of the hazards/aspects
c. Assess the potential of the hazards/aspects
d. Determine the significant hazards/aspects
e. Determine the control for the significant hazards/aspects
f. Implement the control
g. Monitor, measure, and evaluate the determined control to reduce the significant
hazards/aspects to a level that is as low as reasonably practicable (ALARP) or until
corrective/preventive actions are completed

The HIRA shall be implemented before commencing the project, periodically at least once per year,
and in case of any change

6.3.2 Job Safety Analysis (JSA)

Refer to the JSA described below

6.4. HSE Legal & Other Requirements Identification, Review and Evaluation

8
PT CIPTA MULIA SEMESTA HSE PLAN

The sub contractor shall establish and / or implement and maintain a documented Legal & Other
Requirements, Review and Evaluation procedure to:

a. Identify the applicable legal & other requirements to the project’s activities, products, services
and facilities
b. Review the applicable requirements specifically
c. Implement the applicable specific requirements
d. Monitor, Measure and evaluate the implementation until the corrective/preventive actions are
completed

The Legal & Other Requirements, Review and Evaluation shall be implemented before commencing
the project, periodically at least once per year, and in case of any change

6.5. HSE Objectives and Targets

The main HSE Objectives of this project are to ensure that project activities, facilities, products and
services are effectively and efficiently planned, organized, lead, executed and controlled in order to
achieve the objectives and targets as below:

 Zero Injury
 Zero Illness
 Zero Property Damage
 Zero Environmental Damage

To achieve the objectives and targets, our strategies are:

 State HSE requirements

 Establish HSE organization and responsibilities
 Establish targets criteria and program
 Specify HSE documents required (manuals, procedures, work instructions, legal and standards
& codes, forms) to be applied throughout the project.
 Ensure that hazards and risks are identified, assessed, and controlled and records of them are
maintained.
 Ensure adequate training is achieved.
 Identify and Plan HSE Inspections and Audits.
 Actively promote HSE awareness
 Establish feedback and performance indicators.

6.6. HSE Programs

6.6.1 Resources, Roles, Responsibility and Authority

In accordance with its scope of works, Sub contractor shall ensure the availability of resources
essential to establish, implement, maintain and improve its HSE Plan. Resources include human
resources and special skills, organizational infrastructure, technology and financial resources

Role, responsibility and authority are as described in the point 5. above.

9
PT CIPTA MULIA SEMESTA HSE PLAN

6.6.2 HSE Competence, Training and Awareness

The sub contractor shall establish and / or implement and maintain a documented HSE Competence,
Training and Awareness procedure.

The HSE qualification / training / certification needs of the project shall be analyzed prior to job-start
and periodically thereafter, to determine training requirements of Indonesian regulations, OWNER,
CMS & other parties’ requirements. These will be then implemented as required.

The trainings include:

a. Basic Safety Training

It shall be given to all employees (project team). This training shall inform HSE policy, safe working
procedure & practices and any other safety topics.

b. Specific Training

It shall be given to employees who work for specific jobs such as work at height, confined space, etc.

c. Certified Skill Training

It is required for a specific job and shall be certified by government or a third party. The specific jobs
will include Welding, Rigging, Operating Crane, Installing Scaffold, First Aide and Driving.

6.6.3 HSE Communication

Internal Communication

HSE communication shall be conducted through Safety Committee Organization or daily safety
activities using the following methods:

a. Safety Induction

Safety Induction is to be conducted by CMS site management/Subcontractor site management and

HSE team to all new employees or visitors who come to the project site at the first time.

b. Tool Box Meeting

Tool box meeting is to be conducted every day by Supervisors or Foreman’s with their members before
starting their work. Job sequences, accident prevention plant and safe work methods will be discussed
in this meeting.

c. Pre-Job Safety Meeting

Pre-job safety meeting is a special meeting for high risk construction activities such as: heavy lift
rigging, high elevation work, confined space work and any other works that need work permit. This
meeting will be conducted by contractor representative (Project Manager, Construction Manager, and
Superintendent) to discuss safety aspects of the high risk construction activities.

d. Weekly Construction Coordination Meeting

Weekly construction coordination meeting is to be conducted by CMS Construction Manager and

Subcontractor management member. The agenda on the meeting shall be review of construction
progress, HSE program and its improvement, and safe work practice.

e. Safety Morning Talk

10
PT CIPTA MULIA SEMESTA HSE PLAN

Safety Morning Talk is to be conducted by safety committee on Site to all employees and will be held
once a month.

f. Monthly Safety Committee Meeting

Monthly Safety Committee Meeting is conducted by safety committee members and others who are in
charge in the project. The agenda of this meeting is to discuss health, safety and environmental issues,
accidents, unsafe condition and unsafe act, personal protective equipment, the physical conditions of
worksite area.

CMS will convene a Site Safety Committee to analyze the safety record of the site and to encourage all
parties to promote and improve safety controls across the site.

 Safety Committee meeting will be conducted every two weeks or at least every month by CMS.
 The meeting will be chaired by the CMS Construction Manager, accompanied by the CMS HSE
Supervisor who will write the minutes.
 All main Subcontractors’ Construction Managers and HSE Managers will attend the meeting.

Topics for discussion will include:

 Performance Review
 Accident / Incident investigation
 Areas of concern
 Recommendation / actions
 Results of site inspection

g. Others

Other communication will be implemented as required.

External Communication

a. Safety Committee Report

As required by the government, Safety Committee shall report its activities and performance at least
once per 3 months to local government

b. Incident Reporting

As required by the government, Safety Committee shall report incident occurred within 2 x 24 hours to
local government

c. Others

Other communication will be implemented as required.

6.6.4 Documentation

Applicable HSE documents shall be prepared or referred by subcontractors in accordance with the
Project HSE Plan, their scope of work and field activities, and other applicable legal & other
requirements.

6.6.5 Control of Documents

Control of documents shall be implemented refer to the Project HSE Plan.

11
PT CIPTA MULIA SEMESTA HSE PLAN

6.6.6 Operational Control

a. General

The below procedures of operational control shall be prepared by subcontractor in accordance with
their scope of work and field activities:

 Subcontractor HSE Plan

 HSE Procedure for Personnel Protective Equipment
 Subcontractor Environmental Control
 HSE Procedure for Hazardous Material Control
 Safety Procedure for Equipment Inspection
 Safety Procedure for Log Out and Tag Out (LOTO)
 Safety Procedure for Welding and Cutting
 Safety Procedure for Electrical Work
 Safety Procedure for Scaffolding
 Safety Procedure for Working at Height/Fall Protection
 Safety Procedure for Confined Space
 Safety Procedure for sand Blasting and Painting
 Safety Procedure for Excavation and Trenches
 Safety Procedure for Radiography
 Safety Procedure for Lifting and Erection.

The other applicable documents, if any, shall be prepared or referred by the sub contractor.

b. Providing Personal Protective Equipment

Personal protective equipment that follows international standard for all kind activities shall be
provided by each organization and distributed to its employees sufficiently and properly:

 Hard Hat (helmet) ANSI Z89.1 / SNI / AS NZS or equivalent.

 Safety Shoes (type: Rigger Boot) ANSI Z41 or equivalent
 Safety Rubber Boot (for Concrete work, wet work and land preparation)
 Safety Glasses with side shields. ANSI Z87.1 or equivalent
 Gloves (leather gloves shall be worn, Welding, leather and cut resistant Kevlar)
 Hearing Protection
 Full body harness for work above > 2 meter.
 Welding Goggles
 Respirators and Masks
 Multiple Gas Detector (O2 and LEL Monitor include)
 Fire Retardant Clothes – FRC (NFPA 1975) in the flame or flash fire hazard area
 And others as required.

c. HSE Patrol and Inspection

HSE Patrol

Every day, the CMS HSE Supervisor and each subcontractor HSE Officer shall conduct a site HSE patrol.
Owner representative may participate in this patrol. The objectives of this patrol are all construction
site personnel & visitors and all construction areas

12
PT CIPTA MULIA SEMESTA HSE PLAN

HSE Inspection

Every week, the CMS HSE Supervisor and each subcontractor HSE Officers shall conduct a site safety
inspection. Owner representative may participate in this inspection. The inspection result i.e. site
monitoring records, pictures and / or others will be a documented inspection evidences that will be
discussed during the weekly meeting and followed-up with corrective/preventive action

As inspection will move from one area to another area the appropriate disciplines
superintendent/supervisor will joint with the inspection team. During the inspection employees may
be questioned as to their understanding of work being performed, communication of safety concern,
how safety meeting and job safety analysis are conducted.

The items to be inspected during the inspection are:

 House keeping and industrial hygiene around project and work area
 Equipment check
 Hazardous spill, chemical or other materials
 Electrical tools or equipment
 Potential Fire Hazard Identification
 Other Potential hazard identification

d. Job Safety Analysis (JSA) and Risk Assessment

The sub contractor shall establish and / or implement and maintain a documented JSA procedure.

The JSA shall be conducted for any new activity, job or changes to a job. Essentially, a JSA is simply
taking the time before performing the job to plan for safety and identify and remove hazards rather
than starting work assuming that all those involved in the work know what to do and how to do it in a
safe manner.

The stages to be followed to conduct a JSA are as follows:

 Select the job and JSA participants

 Break job into steps
 Identify hazards/aspects
 Develop solutions
 Record and distribute JSA
 Review JSA at completion
 Revisit JSA at bi-monthly intervals

Experienced supervisors, workers and inspectors, including HSE supervisors/officers, assigned to the
specific work activity will perform JSA’s for each project activity. The JSA system develops worker
involvement in planning and doing the work in a safe and efficient manner. The system develops and
promotes teamwork and good communications, and focuses workers on their specific responsibilities.
The JSA also facilitates the training of relatively unskilled work force.

e. Working Permit

The work permit system will incorporate checks and authorizations that are consistent with risk or
hazards involved.

The following points are contained in the permit system:

13
PT CIPTA MULIA SEMESTA HSE PLAN

 The Permit to Work system contains pre-start checks to ensure that the work site is safe, that
necessary isolations are performed and verified, necessary bypasses are performed, and the
work does not present a hazard to other work in progress or planned. Those affected by the
work must be informed of the work and the possible affects upon their work, and appropriate
communication and coordination meetings are held and key decisions recorded.
 Work Permits are approved for a specific duration.
 Senior operations / construction management is responsible for ensuring an effective work
permit system and verifying that it is used correctly.
 The type of work and work conditions that are managed with work permits are defined for
each site based on the risks involved.
 Each work permit has a description of the work to be performed and details specific
precautions to protect personnel, environment and equipment from potential hazards.
 Permit procedures require closeout checks to be performed at completion of the work to
ensure that: (a) the work was performed satisfactorily, (b) isolations and bypasses are
restored, (c) workplace and processes are returned to a safe condition, and (d) completion of
work is communicated to affected personnel.
 The authority to approve and closeout work permits is clearly designated and documented at
each site.
 All personnel issuing or using work permits are trained in the application of the work permit
procedure.
 Work permit system and training effectiveness is audited periodically and results documented.
Work permits and records are retained to facilitate assessment.
 In the case of work at night, the special work permit shall be applied and lighting for work is
mandatory.

Working permit must be prepared before starting the work and must be available during the work.
All the safety instructions that are mentioned on the work permit must be obeyed by all personal
in charge before starting the work.

The work permits that are required:

 Excavation Work Permit

 Hot work permit
 Cold Permit
 Entry permits to confined space
 Electric work permit
 Radiography work permit
 Others as required

f. Lock out and Tag out / Dangerous label

All equipment operated by each company at any CMS project must be inspected and shall have a
green tag for “safe to operate” / red tag for “unsafe to operate” or lock out “for do not use”. This
procedure is to avoid any accident, injury or property damage caused by improper operation of
any equipment.

Worker supervisor, subcontractor safety officer, CMS disciplines supervisor in charge and CMS HSE
supervisor shall utilise and control their personnel key log and worker to ensure that entire worker
or work area have safe during LOTO working execution and termination period.

14
PT CIPTA MULIA SEMESTA HSE PLAN

g. Safe Driving

 To ensure that all vehicles are in safe condition for operation, regular maintenance shall be
scheduled.
 Heavy equipment and vessel must be certified by a third party or government when
operated inside project site.
 Drivers must have driving licenses issued by Police and follow entire CMS’s save driving
requirements.

Any operator for a crane or other heavy equipment must have a valid Police driving

h. Environmental Management

Pollution Control

Project team shall have an environmental monitoring program. The purpose of this program to
control and manage all waste from the construction activities such as: organic waste, non-organic
waste, air pollution, noise pollution, and water pollution. This program shall be discussed with the
client and is to be in line with the client’s environmental management program.

House Keeping

A planned, clean, orderly project site is mandatory. Worksites, shop areas and lay down areas shall
be kept clear of scrap and unnecessary materials. Materials necessary for work shall be properly
stacked and kept out of roadways to allow proper access for fire fighting equipment. Lay down
areas shall be planned and laid out in sections with access roadways adequate for fire fighting and
materials handling equipment.

The basic requirements of house keeping are:

 Scrap lumber, scrap materials, formwork, etc. shall be picked up, de-nailed, and stored or
put in waste bins as the work progresses
 Full waste bins shall be removed from site on a daily basis.
 Waste bins shall not be overfilled.
 Areas where personnel are expected to pass or work shall be kept free of tripping hazards
such as small pipe scrap materials, rolled steel, etc.
 Trash barrels are located throughout the project site and shall be used.
 Surplus materials shall be returned to the stockpile at the completion of each job.
 Tools and materials shall be kept in gang boxes or returned to the tool room, and not be
left where they create a hazard for others.
 Oily rags shall be placed in approved metal containers.
 Spilled liquids shall be wiped up immediately.
 Soiled clothes, food scraps and soft drink bottles/cans shall not be left to accumulate.
 If drinking cups are used, they shall be deposited in the containers provided.
 Periodic checks shall be made on the cleanliness of drinking water and eye wash.
 Sandwich wrappers, paper bags, and food waste shall be deposited in covered containers.
 Toilets, wash-up facilities, and drinking water cans are provided for employee convenience
and comfort, and shall be kept clean and sanitary.
 Flagging placed to designate hazardous areas shall be tagged by the supervisor placing it,
maintained, and off the ground or removed when unnecessary.

15
PT CIPTA MULIA SEMESTA HSE PLAN

i. First Aids Facilities

In each project site; supporting facilities such as site office, site worker hut/shelter, workshop,
warehouse, security shelter and other designated location by site safety committee shall have Fist
Aid Kit Box that used for first aid in case of any accident and injury. The CMS HSE supervisor and
subcontractor admin personnel shall ensure the first aid kit box have contain completely and easy
to access by personnel in charge.

There must be at least a party that assigned by CMS and each subcontractor to provide clinic,
ambulance, and first aid facilities during Project site activities that locate near and outside project
area to take further action if any major accident or incident upon a worker.

j. Accident / Incident Reporting

If an accident or incident occurs, it must be immediately reported to CMS.

 When injury or damage is sustained, the area must be roped-off until the investigation has
been completed. Equipment / material or goods must not be moved unless causing a
serious obstruction or blocking an emergency access-route.
 Other minor injuries, incidents and near-miss must also be reported.
 In all cases, report together with witness statement and sketches must be submitted to
CMS within 24 hours.
 An “Accident” is a happening which may involve physical injury and damage to property /
equipment whereas a “near-miss” is a happening where no physical injury is involved at
time of occurrence

k. HSE Performance

Performance Indicators will be used to measure the achievement of overall HSE objectives and to
communicate current HSE performance throughout the Project. Criteria used to measure the
performance will be:

 Total Recordable Incident Rate (TRIR)

TRIR = Recordable incident x 200,000 / hours worked

 Lost Workday Incident Rate (LWDR)

LWDR = (Fatalities + days away from work cases + restricted activity cases) x 200,000 /
hours worked

 Lost Time Incident Rate (LTIR)

LTIR = Fatalities + days away from work cases) x 200,000 / hours worked

 Day Away From Work Rate (DAFWR)

DAFWR = Days away from work cases x 200,000 / hours worked

This rate shall be calculated monthly, quarterly and yearly. It will be maintained on a year
to date and job to date basis.

The minimum information that apply in HSE statistic board:

 Total Man-Hours

16
PT CIPTA MULIA SEMESTA HSE PLAN

 Total Fatality
 Total Major Incident/Accident case
 Total First Aid Case
 Total Man-Power
 Revision Date

l. Rules of Entering the Site, Drugs, Alcohols, Weapon & Smoking

All sub-contractors and visitors that will enter, leave and work at site must follow HSE regulation of
CMS.

Using drugs, alcohols, carrying weapon, and smoking inside site office and site area are strictly
prohibited.

m. Termination and Suspension

CMS HSE Department has a right to stop the work if there is any non-conformance, unsafe act and
unsafe condition has been found, until the corrective action has taken by sub-contractor and
acknowledge by CMS HSE Department.

n. Unsafe Act and Unsafe Condition

To achieve zero accident and no damage to environment, all supervisors and above level in project
site shall report any unsafe act & unsafe condition.

o. Safety Sign Board

To ensure all area in safe condition and task recognise by other employee, safety sign board shall
be installed on proper location.

p. Fire Prevention and Regulation

Prevention of fire is a goal. Identification of potential fire hazards and prevention and protection
will be an important factor in the job safety analysis performs for each specific activity.

Fire prevention and fighting training will emphasize planning work in such a way that potential fire
hazards are removed or reduced to the greatest extent possible. Particular emphasis will be on hot
work permits, control of flammable gas, liquids and other material, proper electrical wiring, and
proper removal and storage of waste materials.

Each subcontractor’s safety officer shall become a Fire Marshal on site. He will be responsible for
maintaining a living fire protection training program. It will be his responsibility to conduct training
classes on the proper selection and safe use of fire extinguishers, types of fires, training of
personnel to respond to any fire emergency on the jobsites.

Emergency alarms, evacuation procedures, fire protection training will all are part of the training
supplied by the CMS and Subcontractor. CMS HSE and Owner will provide assistance and guidance
in developing these training programs. All programs are subject to continuous updates to maintain
compliance.

Entire the Fire regulations that applied by CMS on site are mandatory to follow by all construction
workers during the period of construction.

6.7. Emergency Preparedness and Response

17
PT CIPTA MULIA SEMESTA HSE PLAN

Project team shall prepare site emergency response procedure with the following breakdown
items:

a. Rescue procedure on the emergency condition.

b. Organization of emergency response.
c. Communication and coordination procedure in the emergency condition.
d. Evacuation procedure (process and system).
e. Decided temporary or permanent of muster point.

Coordination with the client / owner on the emergency response program is required.

6.8. Monitoring and Measurement

The organization shall establish and / or implement, maintain and continually improve a
procedure(s) to monitor and measure, on a regular basis, the key characteristics of its operations
that can have a significant HSE risk/impact. The procedure(s) shall include the documenting of
information to monitor performance, applicable operational controls and conformity with the
organization’s HSE objectives and targets

The organization shall ensure that calibrated or verified monitoring and measurement equipment
is used and maintained and shall retain associated records.

6.9. Evaluation of Compliance

Evaluation of Compliance shall be implemented refer to (combined with) the point 6.4 above

6.10. Nonconformity, Corrective Action and Preventive Action

Nonconformity, Corrective Action and Preventive Action control shall be implemented refer to the
Project HSE Plan

6.11. Control of Records

Control of records shall be implemented refer to the Project HSE Plan.

6.12. Internal Audit

Internal audit shall be implemented refer to the Project HSE Plan.

6.13.Management Review

Management review shall be implemented refer to the Project HSE Plan.

6.14. Reporting System

Document that shall be reported by CMS are:

No Document Name Person In Schedule Report To

Charge
1 HSE Monthly Report Construction Monthly Client and PM
Manager
2 Disability Accident, Fatality Construction 1x24 Hours Client, and PM
Accident and Environmental Manager and
that need government HSE
concerned Supervisor
3 Medical Treatment CMS HSE 1x24 Hours Client and PM
Supervisor

18
PT CIPTA MULIA SEMESTA HSE PLAN

19