Gresik, 24 Februari 2023

HSE PLAN
Penyediaan Jasa Pencucian Tangki Tanjung Field

Client:
PT. Pertamina EP Region 3 Zona 9
BALIKPAPAN – KALIMANTAN TIMUR – INDONESIA

Preparation by:

PT. Suci Energi Solusi Indonesia ( Seiso )

Pondok Permata Suci
Jl. Raya Berlian Biru No. 20 Manyar – Gresik – Jawa Timur 61551 Indonesia
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ACKNOWLEDGEMENT

HSE PLAN

Penyediaan Jasa Pencucian Tangki Tanjung Field

Prepared for:

PT. PERTAMINA EP REGION 3 ZONA 9

BALIKPAPAN – KALIMANTAN TIMUR – INDONESIA

APPROVAL SHEET

Prepared By Reviewed By Approved By

HSSE SEISO: PM SEISO: HSSE ROV: PM ROV:

Date: 24/02/2023 Date: 24/02/2023 Date: Date:

REVISION STATUS

Rev Date Revision

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DAFTAR ISI
APPROVAL SHEET ..................................................................................................................................... i
DAFTAR ISI............................................................................................................................................... ii
1. GENERAL ......................................................................................................................................... 1
1.1 OBJECTIVE ............................................................................................................................... 1
2. LEADERSHIP AND COMMITMENT ................................................................................................... 1
2.1 HSE POLICY STATEMENT ......................................................................................................... 2
2.2 DRUG AND ALCOHOL POLICY STATEMENT ............................................................................. 3
2.3 HSE KEY PERFORMANCE INDICATOR (KPI) HSE....................................................................... 4
3. HSE ORGANIZATION, RESPONSIBILITY, COMPETENCY AND STANDARD ........................................ 5
3.1 ORGANIZATION ....................................................................................................................... 5
3.2 RESPONSIBILITY ....................................................................................................................... 5
3.1.1 Project Manajement ....................................................................................................... 5
3.1.2 Project Manager.............................................................................................................. 6
3.1.3 Safety Officer .................................................................................................................. 6
3.1.4 Project Supervisor ........................................................................................................... 7
3.1.5 All Employee ................................................................................................................... 7
3.3 AWARENESS, TRAINING AND COMPETENCY .......................................................................... 7
3.4 HSE MEETING PROGRAM ........................................................................................................ 8
3.5 WORK STANDARD ................................................................................................................... 8
3.5.1 PT. SUCI ENERGI SOLUSI INDONESIA WORK STANDARD AVAILABILITY.......................... 8
4. WORK PLANNING AND PROCEDURE ............................................................................................... 9
4.1 WORK PROCEDURE ................................................................................................................. 9
4.1.1 CONFINED SPACE WORK ................................................................................................. 9
4.1.2 WORKING AT HEIGHTS .................................................................................................. 10
4.1.3 FALL PROTECTION EQUIPMENT .................................................................................... 10
4.1.4 SAFETY HARNESSES WITH SUSPENTION TRAUMA STRAPS........................................... 10
4.1.5 SCAFFOLDING ................................................................................................................ 11
4.1.6 DIESEL ENGINE DRIVEN PUMPS, COMPRESSORS, WELDING SET, POWER PACK,
HYDRAULIC POWER UNIT, ETC...................................................................................................... 11
4.1.7 ELECTRICAL SAFETY ....................................................................................................... 12
4.1.8 GUARDS, BARRICADES AND WARNING SIGNS .............................................................. 12
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4.1.9 PERSONAL PROTECTIVE EQUIPMENT ........................................................................... 13

4.1.10 DRIVING SAFETY ............................................................................................................ 13
4.1.11 PERMIT TO WORK ......................................................................................................... 14
4.2 WORK PLANNING AND HSE PROGRAM ................................................................................ 14
4.2.1 SAFETY ASPECT.............................................................................................................. 14
4.2.2 HEALTH ASPECT............................................................................................................. 15
4.2.3 ENVIRONMENT ASPECT ................................................................................................ 15
4.3 PROCEDURE FOR HANDLING, TRANSPORTING AND STORAGE OF WASTE OF HAZARDOUS
AND TOXIC MATERIALS (B3) ............................................................................................................. 16
4.3.1 CHEMICALS DISPOSAL ................................................................................................... 16
4.4 COMPLETION OF THE HSE PROCEDURES .............................................................................. 17
4.5 HSE EQUIPMENT DATA USED ............................................................................................ 19
5. RISK MANAGEMENT...................................................................................................................... 20
5.1 METHODS USED AND AVAILABILITY ..................................................................................... 20
5.1.1 RISK ASSESSMENT DAN MANAGEMENT ....................................................................... 20
5.1.2 OBJECT AND RISK ASSESSMENT .................................................................................... 20
5.1.3 RISK ASSESSMENT METHODS ....................................................................................... 21
5.1.4 RISK LEVEL/GRADE ........................................................................................................ 22
5.2 JOB HEALTH SAFETY ENVIRONMENT ANALYSIS (JHSEA)....................................................... 23
6. EMERGENCY SITUATION ............................................................................................................... 23
6.1 EMERGENCY RESPONSE PLAN............................................................................................... 23
6.2 EMERGENCY REPORTING INFORMATION ............................................................................. 23
7. INCIDENT, ACCIDENT AND INVESTIGATION REPORTING .............................................................. 26
7.1 INCIDENT INVESTIGATION PROCEDURE ............................................................................... 26
7.2 INCIDENT REPORT FORM ...................................................................................................... 28
8. INSPECTION AND AUDIT ............................................................................................................... 29
8.1 INSPECTION AND AUDIT PROCEDURE .................................................................................. 29
8.1.1 INSPECTION ................................................................................................................... 29
8.1.2 MANAGEMENT AUDIT .................................................................................................. 30
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1. GENERAL

This HSE Plan has been developed to enhance the HSE aspect of the project and in still
greater HSE awareness to all employees as well as PT. Suci Energi Solusi Indonesia. There
by minimizing the possibility of an accidental occurrence through out the Project/Work
execution.
PT. Suci Energi Solusi Indonesia Project Manager and Senior Engineer to monitor all
projects HSE activities in all work location area shall use this overall HSE Plan.

1.1 OBJECTIVE

PT. Suci Energi Solusi Indonesia sets the following basic objectives for the project:
a. Execute the project without hurting anyone, damaging any equipment or assets,
losing any materials or damaging the environment.
b. Ensure that only qualified and competent personnel carry out work.
c. Instill high safety awareness among all PT. Suci Energi Solusi Indonesia personnel.
d. Ensure adherence to Project HSE Plan
e. Identify all known hazards
f. Eliminate and minimize those hazards
g. Report all near misses
h. Promote positive reinforcement for safe behavior

2. LEADERSHIP AND COMMITMENT

The PT. Suci Energi Solusi Indonesia manager, engineer and technician shall be fully
committed to HSE. They are to be seen as providing a leading role towards constant HSE
improvement through their leadership and action planning. It can be manage in:
a. Regular attendance at HSE meetings through out the project.
b. Displaying an active interest in incident report and follow up action by project and
progress report.
c. Assist client pro-active HSE targets underpinned by activity plans and visible
commitment to client’s HSE policy.
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2.1 HSE POLICY STATEMENT

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2.2 DRUG AND ALCOHOL POLICY STATEMENT

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2.3 HSE KEY PERFORMANCE INDICATOR (KPI) HSE

Company Name : PT. Suci Energi Solusi Indonesia
Job Title : Tank Cleaning Tanjung Field PT Pertamina EP Region 3 Zona 9
Location : Balikpapan, Kalimantan Timur
Work Duration :

NO URAIAN TARGET UNIT INDICATOR NOTES

1 Jumlah Tenaga Kerja 15 orang Absensi
2 Jumlah Kerja Aman 240 hari Data jam kerja
LAGGING INDICATOR
1 Kejadian (Incident)
- Fatality 0 Kasus Angka Total Kasus Actual < Target
- Kejadian Berdampak Kecil 0 Kasus Angka Total Kasus Actual < Target
- First Aid 0 Kasus Angka Total Kasus Actual < Target
- Near Miss 3 kasus Angka Total Kasus Actual < Target
2 Pelanggaran
- Pelanggaran thd APD 0 Kasus Dok. pelanggaran Actual < Target
- Pelanggaran terhadap
0 Kasus Dok. Pelanggaran Actual < Target
Pengelolan sampah
- Pelanggaran thd hygiene
0 Kasus Dok. pelanggaran Actual < Target
industry
- Pelanggaran thd rokok 0 Kasus Dok. pelanggaran Actual < Target
LEADING INDICATOR
1 HSE Meeting 3 kali Notulen Actual ≥ Target
2 HSE Talk / Briefing / Toolbox 150 kali Daftar Hadir Actual ≥ Target
3 HSE Reporting 6 kali Laporan Bulanan Actual ≥ Target
4 Management Visit 3 kali Dokumen Visit Actual ≥ Target
5 Closure Action 100 persen Dok. Tindak Lanjut Actual ≥ Target
6 Inspection / Audit 3 kali Dok. Inspection Actual ≥ Target

Tabel 2.1. Key Performance Indicator HSE PT. Suci Energi Solusi Indonesia
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3. HSE ORGANIZATION, RESPONSIBILITY, COMPETENCY AND STANDARD

3.1 ORGANIZATION

Proyek : Tank Cleaning Tanjung Field PT Pertamina EP Region 3 Zona 9

Lokasi : Balikpapan, Kalimantan Timur

3.2 RESPONSIBILITY
3.1.1 Project Manajement
The Project Management and line supervisor are fully responsible for HSE Management as
an integral part of their activities and all activities executed under their control.
PT. Suci Energi Solusi Indonesia Project Management responsible for:
a. Establishing the HSE objective for the project
b. Ensuring that the systems are established for the implementation of HSE objectives.
c. Making available the necessary resources to put HSE policy into effect and the project
objective are met
d. Ensuring continuous improvement in HSE Performance through out the project duration
e. Promoting the HSE policy to all project personnel of PT. Suci Energi Solusi Indonesia
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PT. Suci Energi Solusi Indonesia Management team responsibility collectively and in their
individual function for the occupational health and safety of their project staff and for the
environmental aspects of their activities, includes:
a. Coordinating and monitoring the implementation in HSEMS matters
b. Actively pursuing the project objectives and targets and cascading these to all project
staff
c. Monitoring the HSE performance through out the Project duration
d. Overseeing the compliance with this HSE plan
e. Providing the necessary resources to support the Project HSE requirements

3.1.2 Project Manager

a. To ensure or allocate sufficient resources for the management of the HSE plan.
b. To contribute as necessary to the plan.
c. To agree and approve the HSE plan.
d. The development of this plan and associated documentation ensuring that these are
updated or modified to suit changes in conditions.
e. Ensure that measures are in place to control security on site.
f. Ensure that effective communications are in place that advises all parties of risks,
concerns, activities etc. as they are identified.
g. Ensure that arrangements for the coordination of all parties to prevent interface risks are
in place.
h. Joint in the safety walkabout weekly

3.1.3 Safety Officer

a. To be familiar with all local, national, and international laws those are applicable to
operations.
b. To prioritize and produce a strategy for implementing the various elements of the plan
and to ensure that it is being communicated effectively throughout the Project
Organization and Subcontracting Companies, updating it as required.
c. To establish and maintain a professional relationship with Client and subcontractor
representatives.
d. To provide direction as necessary to attain HSE management standards and goals required
by the project HSE plan.
e. To establish a system of audits that measures the effectiveness of the HSE plan and
ensures that the requirements being effectively communicated throughout the workforce.
f. To ensure sufficient training and induction of all personnel is being provided and
maintained.
g. Review Job Safety Analysis
h. To develop the HSE awareness of all personnel employed on the project and ensures their
participation in all aspects of the health and HSE plan.
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i. Joint in the safety walkabout weekly

3.1.4 Project Supervisor

a. To support the Safety Officer in the practical implementation of the HSE Safety Plan and
supporting documents
b. Provide support to field supervision, provide technical guidance ensuring industry best
practices are adhered to on site as a minimum requirements
c. Perform periodic inspections, audits in accordance to the project HSE schedule
d. Actively participate the project Training and People Based Safety program
e. Attend HSE meetings, with client, supervisors and workers as necessary
f. Ensure risk assessments, method statements, JSA are performed periodically throughout
the project
g. Enhance and participate in HSE communication campaigns
h. Assist in the development of trends, review of incident investigation s and project specific
HSE reviews such as HAZIDS and SIMOPS.
i. Joint in the safety walkabout weekly

3.1.5 All Employee

All of PT. Suci Energi Solusi Indonesia personnel related to this project is responsible for:
a. Conducting their work in safe and environmentally sound manner
b. Stopping work/operation is the defined HSE standards or procedures are not fully
complied with
c. Taking initiatives in reporting unsafe acts, unsafe conditions, near misses and
incidents.
d. Recognizing the importance role in health and safety and acting accordingly.

3.3 AWARENESS, TRAINING AND COMPETENCY

The clients and PT. Suci Energi Solusi Indonesia supervisor to identify any potential hazards
relating to equipment, materials and work practices shall conduct worksite inspection
periodically. And also awareness of safety sign and safety alert.

3.3.1 Training and Competence

A key element in ensuring competency will be the assessment of experienced personnel
supplemented by extensive and ongoing training. The project policy is that all personnel
associated with the project, at all locations, undergo a mandatory induction, to ensure they are
aware of the aims and requirements of the project and the plan for HSE Execution. Emphasis
shall be placed on the Incident and Injury Free Philosophy from the outset of the project.
Records shall be kept of the names of people receiving HSE training and these records shall
be stored on a computerised log.
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The training program will be tailored to meet the requirements established from a training
needs and competency assessment.

A preliminary training matrix for the project shall be prepared for the project’s specific
needs. This indicates the type and extent of training courses being planned for each category
of worker. It includes senior personnel thorough to site operatives and visitors. Specific
groups of personnel who perform safety critical activities, e.g. Crane operators, truck and bus
drivers, fire team members, electricians, scaffolders and first aiders will receive detailed and
targeted training to ensure a high level of competence and safety awareness.

3.4 HSE MEETING PROGRAM

Communication of HSE related information is vital to and from project management and will
be administrated. PT. Suci Energi Solusi Indonesia personnel are stipulated to through the
following medium:
a. Safety Induction is given to new workers, project visitors (guests), and management
before entering the project location by Shell Gresik Terminal.
b. Daily toolbox safety briefing before mobilizing crew which includes the scope of
work, policies, procedures and hazards awareness
c. Monthly safety committee meeting for reviewing performance of HSE program
d. Weekly meeting discuss about work progress and issues about HSE

3.5 WORK STANDARD

3.5.1 PT. SUCI ENERGI SOLUSI INDONESIA WORK STANDARD AVAILABILITY
 API 2015 : 2001 Edition, SafeEntry and Cleaning Storage Tank
 API 2016 : 2001 Edition, Guidelines and Procedures for Entering and Cleaning
Petroleum Storage Tank
 ASME DIV 1 1995 Edition Pipeline
 ANSI B 31.3
 ANSI B 31.4
 ASME A-328
 ASME B16.5
 UU No. 1 ahun 1970
 ANSI Z 535
 SNI 12-7079-2005
 SNI 16-6070-1999
 EN 455
 19-10-252
 Z 1949
 SNI 06-1903-2000
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 ANSI Z 89
 Sistem manajemen keselamatan & kesehatan kerja OHAS 18001 penulis soehatman
Ramli Edtor : Husjain Djajaningrat
 Manajemen keselamatan, dan kesehatan kerja penulis Dr. Gempur Santoso, Drs.,
M.Kes
 Kesehatan dan keselamatan kerja penulis John Ridley
 Pedoman praktis keselamatan, kesehatan kerja, dan lingkungan (K3LL) penulis Ir.
B. Boedi Rijanto, MM
 Pedoman praktis manajemen resiko dalam perspektif K3 OHS Risk Management
penulis Soehatman Ramli Edtor : Husjain Djajaningrat
 Basic life support emergency medical technician (EMT)
 Pengawasan Kesehatan Kerja (Dep Tenaga kerja dan Trasnmigrasi RI)
 Pengawasan K3 Mekanik (Dep Tenaga Kerja dan Transmigrasi RI)
 Pengawasan K3 Konstruksi (Dep Tenaga Kerja dan Transmigrasi RI)
 Pengawasan K3 Penanggulangan kebakaran (Dep Tenaga kerja dan Transmigrasi
RI)
 SMK3 dan Audit SMK3 (Dep Tenaga kerja dan Transmigrasi RI)
 Pengawasan K3 Lingkungan Kerja (Dep Tenaga kerja dan Transmigrasi RI)

4. WORK PLANNING AND PROCEDURE

4.1 WORK PROCEDURE
4.1.1 CONFINED SPACE WORK
Definition of a Confined Space is a space that has limited openings for entry and exit, limited
ventilation and lighting, contains potentially dangerous air contaminants, not suitable for
continuous occupancy and permits the accumulation of flammable or toxic vapours or oxygen
deficiency atmosphere.
Supervisor will ensure that the following facilities are to be provided:
- All other options have been ruled out
- Permit is issued with authorization by a responsible person(s)
- Permit is communicated to all affected personnel and posted, as required.
- Gas monitoring devices for the continuous gas monitoring of the confined space
- All persons involved are competent to do the work and trained in the use of air-lines and
breathing apparatus
- A safety standby is to be stationed outside the confined space at all times, whenever there
is work in progress
- Unauthorized entry is prevented
- Display board for Permit to Work, Passes and Logsheet.
- Rescue equipment and water igloo available.
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4.1.2 WORKING AT HEIGHTS

- The primary means of achieving safe working conditions when working at heights is to
provide adequate and sufficient access and egress arrangements and suitable working
platforms at the place of work.
- A toolbox Talk will be given to each person carrying out work at height. Following an
assessment of the risks, supervisors will instruct personnel on the instructions and
precautions to be followed when working at height.
- Approved full body safety harnesses with suspention trauma straps should only be used as
a last resort where conditions make it impracticable to provide a safe working platform

4.1.3 FALL PROTECTION EQUIPMENT

- All personnel working above ground level will be provided with, and will use,
appropriate fall protection equipment and PPE. Appropriate regulatory standards must be
observed when using fall arrest equipment.
- A competent person must regularly inspect fall protection equipment. It should also be
maintained so that it remains satisfactory for use during the construction period. Effective
actions must be taken to rectify any defects observed as a result of these inspections.
- Fall protection equipment that has been deployed in a fall must be examined by a
competent person and repaired or destroyed, as necessary.
- Fall protection devices and systems will not be used for any other purpose than those for
which they are designed.

4.1.4 SAFETY HARNESSES WITH SUSPENTION TRAUMA STRAPS

- Fall protection in the form of full body harnesses with suspention trauma straps and
lifelines must be used in situations where it is impracticable to provide primary systems.
- Whenever full body harnesses with suspention trauma straps are used they must be
secured to a secure anchorage point, running line or arrestor device.
- Safety harnesses and lifelines will be used for working at elevations in excess of 1.8
metres or where a fall of this distance is possible.
• A proper anchor, mounted preferably overhead
• Full body harness with suspention trauma straps using double latch self locking
snap hooks at each connection.
• Synthetic fibre lanyards
- Shock absorbers must be provided with the harness system in order to reduce the shock
loading in the event of a fall.
- A visual inspection of the fall arrest equipment and system is completed and any
equipment that is damaged or has been activated is taken out of service.
- Person(s) are competent to perform the work.
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- A fixed platform is used with guard or hand rails, verified by a competent person, or the
safety harness which restricts to fall must be used. The properties of safety harness are
written above.

4.1.5 SCAFFOLDING
- Following approved design drawing.
- All high level scaffolding, both external shall be erected, altered, moved and dismantled
only by the trained scaffold erectors.
- Temporary work platforms, tower and mobile scaffolds, or support structures are to be
approved by the supervisor responsible for the work to be carried out from the platforms.
All such scaffolds or work platform structures shall be constructed to a similar standard to
that provided by the trained scaffold erectors.
- Whilst working at height above 1.8 metres scaffold erectors shall use safety harness
complete with shock absorber and double lanyard during erecting and dismantling
scaffolds.
- Scaffold erectors will employ standard safety signs for warning of incomplete or
prohibited access to incomplete or otherwise unsafe scaffolds. The Safety Officer shall
employ these signs whenever he is unsatisfied with any part of a scaffold. Use of these
signs will be regarded as a temporary measure to be used only until the fault in the
scaffold can be rectified and the whole structure brought up to the correct standard of
safety.
- Welders and fabrication supervisors will ensure that all loose tools, wedges, scrap metal
pieces, disc and welding rods etc are safely stored in an appropriate container provided
and secured in a convenient and safe place. Welders and fabrication supervisors will
ensure all workers keep their work platform area clean and to place loose items in
containers.
- Scaffold shall be inspected and tagged by scaffold supervisors and record the result of
inspections in a check list. This shall be done on a weekly basis. Unsafe scaffold shall
display a scaffold tag ‘NOT SAFE FOR USE’ to ensure not used by workers. A project
scaffold tag system will be implemented. All scaffolds shall be registered.

4.1.6 DIESEL ENGINE DRIVEN PUMPS, COMPRESSORS, WELDING SET,

POWER PACK, HYDRAULIC POWER UNIT, ETC.
- Diesel engine driven pumps, compressors, welding sets, hydraulic power unit (HPU)
and any other diesel engine driven equipment must be located in a safe area. Any such
equipment must be well maintained and in good operational order and prior to use
may be inspected by Company’s representative. Any equipment must be maintained,
install grounding, and all exhaust shall be fitted with spark arrestor and in good
operational, and when operating in SGT order and prior to use may be inspected
company.
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4.1.7 ELECTRICAL SAFETY

- Only authorised personnel (trained personnel) are permitted to perform work of an
electrical nature.
- All electrical circuits rated at 600 volts or more, except when being tested, must be
deenergised and grounded before any work is done on them. Circuits of lower voltages
need not be grounded but should be de-energised.
- Working with live circuits has its hazards, and should be performed by authorized
personnel only. Unless properly and safely handled, all voltages used in the refinery can
cause injury to the human body.
- It is especially important that employees realise this fact even while handling relatively
low voltages such as 230 volts and 110 volts.
- All electrical circuits consisting of switching contacts housed in explosion-proof
enclosures and located in hazardous areas must be de-energised before the explosion-
proof enclosures are opened.
- When required to work inside vessels / equipment containing electrodes or electrically
driven agitators, paddles, or on powered conveyors, the electrical switches must be locked
out and tagged out.
- All supply sources must be equipped with earth-leakage circuit breakers (ELCB) when
using the following portable electrical equipment:
• Grinders
• Drills
• Floodlights / Stringer Lights
• Welding Sets
• Step-Down Transformers
• Blower
- All electrical tools should be in good, safe operable condition and with ‘Dead Man’
switch. It is the onus of the owner and user to ensure that their equipment and tools are
safe for use.

4.1.8 GUARDS, BARRICADES AND WARNING SIGNS

- No one should disobey Barricade Signs by crossing barricades unless prior approval has
been obtained.
- Safety guards of tools, machinery and equipment must be operable and in position before
such equipment is used.
- Suitable barriers and warning signs must be erected whenever work is being performed
and need more attention.
- Warning signs and barricades must be installed and the area roped off when there is a
potential or existing hazard. When the hazards ceases to exist, the signs and barricades
must be promptly removed.
- List below are the colour codes for the rope barricade system:
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• RED : General, hot work, temporary storage, housekeeping, manual rigging

• ORANGE : Scaffolding erection and dismantling. Erection of more than 6 min
height requires hard barricade
• YELLOW-BLACK : Lifting using lorry cranes or mobile cranes
• HARD BARRICADR : Storage more than 3 days

4.1.9 PERSONAL PROTECTIVE EQUIPMENT

- All required PPE would be provided to company employees. Sub-contractors are required
to provide PPE items to their own staff.
- As a risk control measure, the following PPE will be provided for use, as required on the
project:
• Safety helmet with chin straps
• Safety goggles
• Leather gloves
• Safety boots, Safety shoes ankle height
• Ear plugs
• Body harness with Suspension Trauma Straps
• Face shields for grinders
• Full protection equipment for welders
• Any specialist items required by Risk Assessment
• Coverall 100% cotton with reflector
- For this project, the wearing of coverall 100% cotton, safety shoes ankle height, eye
protection and safety helmet with chin straps at all times is mandatory. All personnel shall
comply with the PPE requirements.
- The workforce will be trained and briefed on the correct usage and maintenance of their
personal equipment.
- All personnel are required to request any individual not wearing the correct PPE to leave
the work area

4.1.10 DRIVING SAFETY

All categories of vehicle, including self-propelled mobile plants, must not be operated unless:
- Vehicle is fit for purpose, inspected and confirmed to be in safe working order
- Number of passengers does not exceed manufacturer’s design specification for the
vehicle
- Loads are secure and do not exceed manufacturer’s design specifications or legal limits
for the vehicle
- Seat belts are installed and worn by all passengers
- Banksman in place to escort driver when vehicle inside terminal.
- Safety helmets are worn by riders and passengers of motorcycles, bicycles,quads, snow
mobiles and similar type of vehicle
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Drivers must not be authorized to operate the vehile unless:

- They are trained, certified and medically fit to operate the clss of vehicle
- They are not uner the influence of alcohol or drugs, and are not suffering from fatigue
- They do not use hand-hels cell phones and radios while driving.

4.1.11 PERMIT TO WORK

Permit to Work (PTW) hold by trainer permit holder. The purpose of the Permit to Work
system is to ensure that the controls necessary are available to provide safe performance for
work against specific range of potentially hazardous task. PTW is the generic term that refers
to documents for controlling work. These documents are design to cover different work
activities.

4.1.16 LIFTING AND HOISTING

An authorized subject matter is appointed and their responsibilities are clearly understood.
The competence riggers and crane operators, lifting supervisor and signal men has been
checked before they use stationary or mobile hoisting equipment. A geotechnical engineer or
competent person has assessed ground conditions before work begins. All rigging equipment
and gears are inspected prior to each use and colour coding or tagging from inspection is
current.

Data loggers are fitted to all cranes. In the event this is not possible due to the machine’s
configuration. All crane operations must stay within the safe limits as detailed for the
particular model and they must be approved by the SME and recorded on approved the lift
plan or the other lift document that formally record. Tag lines are used and are long enough to
enable operators to be safe distance from the load. No hand in the line of fire or in harm’s
way must be followed. Outrigger must be fully extended and landed on adequate size pads.
The swing radius of the counter weight and outrigger section of crane is clearly shall be of a
ration 1:3 of the size pad and of certain thickness and marked by warning sign and safety line
yellow-black. Lifting and hoisting activities must be suspended during high winds, lightning
or abnormal weather conditions.

4.2 WORK PLANNING AND HSE PROGRAM

4.2.1 SAFETY ASPECT
1. The introduction of an evacuation route is carried out every time it starts work,
usually during the first week of work on the project site.
2. The introduction of PPE is done every time you start work, usually during the first
week of work in the office
3. Introduction to the way to use APAR is done every time you start a job, usually
during the first week of work at the PT. SUCI ENERGY SOLUTION INDONESIA.
4. Emergency situation training is carried out every time the work starts, usually during
the first week of work by bringing in an approved and experienced party.
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5. Installation of K3 banners will be carried out every time they start work until the
workers are on site at the project site.
6. The implementation of safety induction is carried out once every 1 (one) month when
the work is carried out until the project is completed
7. The morning / tool box implementation is carried out every day the work will begin
until the project is finished
8. Work Socialization of work equipment is carried out as soon as the day starts work
until the work is completed in the project location, management inspection is carried
out every 1 (one) month when the work is carried out until the project is completed
9. Management audit is carried out 2 (two) times every time the work is carried out until
the project is completed

4.2.2 HEALTH ASPECT

1. A periodic medical examination program is carried out every time you start work at
the Public Health Center or nearest hospital
2. A healthy food program is carried out every time you start work on the project site
3. The management of PT. Suci Energi Solusi Indonesia pays the worker insurance
program (BPJS) every month at the BPJS office in the Gresik region.

4.2.2.1 FATIGUE MANAGEMENT

Fatic management is setting work time to prevent fatigue in workers resulting in loss of
concentration, decrease in health conditions that trigger harm while working.

Within one day, the maximum worker is allowed to work for 12 hours within 1 week
(Monday – Friday) 14 hours maximum overtime in 1 week there must be 1 day off based
on the above rules. PT. Suci Energi Solusi Indonesia regulates working time per person.
If the work requires 1 week working without a day off, then PT. Suci Energi Solusi
Indonesia must provide additional numbers of workers fatigue management report will be
documented and submitted to Customer.

4.2.3 ENVIRONMENT ASPECT

1. Examination of the location of work every time you will start work on the project site
2. Cleaning the location of work is carried out every time the work is done by providing
a trash can
3. The assessment of residual waste is carried out every time the project is carried out
until it is completed by providing a waste disposal site in three places, and providing
shelter for liquid waste.
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4.3 PROCEDURE FOR HANDLING, TRANSPORTING AND STORAGE OF

WASTE OF HAZARDOUS AND TOXIC MATERIALS (B3)
Each activity in handling hazardous chemicals, it certainly contained a risk of potential
hazards which can cause serious losses at any time, materially, morally, and socially if not
handled seriously in accordance with the OHS procedure. For this reason, it is deemed
necessary to implement OHS which must be carried out carefully and integratedly by work
units directly involved in handling hazardous chemicals in the workplace. The intended OHS
implementation includes: Planning, implementation, improvement / guidance and emergency
response, the purpose and objectives are:

1. Prevent / suppress as little as possible the occurrence of undesirable things such as

fire, poisoning, blasting, occupational diseases and other things that can harm the
company, employees of the community and the environment
2. Increasing the quality of human resources or workers in the field of Occupational
Safety and Health especially for workers who are directly involved in direct handling
of these dangerous chemicals.

For this reason, it is necessary to make K3 standardization to be understood and implemented

seriously by all workers involved in each stage of the handling of hazardous chemicals as
follows:

4.3.1 CHEMICALS DISPOSAL

In order to support efforts to create a pollution-free environment, the waste disposal
instructions below must be known and implemented, as they should by all workers:
K3 implementation instructions:

1. Every waste, due to either damage, purging, expiration, or the remainder of the
process that is not used anymore, must be disposed of on a special channel that has
been prepared.
2. If the chemical waste is a dangerous acid-base, it must be neutralized before being
discharged, while the hazardous metal substances must be deposited first until the
discharge is completely safe not exceeding the NAB.
3. Waste in the form of large amounts of combustible gas remaining must be burned in a
controlled manner carried out in the burning pit
4. All used containers / packaging of hazardous chemicals must be burned / planted
according to the instructions of the authorized official
5. Dispose of hazardous waste manually by using the appropriate PPE. Be careful of the
dangers of splashing, falling, slipping, splashing, etc.
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By paying attention to the procedures for handling hazardous chemicals above, it is expected
that all activities involving workers in handling hazardous chemicals can avoid accidents,
blasting and work-related diseases.
1. Make sure the PPE matches the size of your body, and fits the position of the PPE to
feel comfortable when you work
2. Make sure the PPE is in accordance with the type of work to be done
3. Make sure the PPE works properly and correctly, if not immediately report it to the
safety officer.
4. If using 2 or more PPE at the same time, make sure the PPE is compatible and does
not reduce the effectiveness of each PPE
5. Report symptoms of pain or discomfort when using PPE immediately
6. Inform the safety officer if special training is needed on the use of PPE

4.4 COMPLETION OF THE HSE PROCEDURES

4.4.1 EMERGENCY PROCEDURE
When looking at fires, things that need to be done by workers at the project location are:
a. Do not panic
b. If the fire is still out, use a small Fire Extinguisher
c. Report to the safety engineer, the safety engineer will report the incident to the SGT
safety officer on site
d. Securing funding equipment to the evacuation point
e. Towards the evacuation point
f. Wait until the situation returns to normal
4.4.2 FIRE EXTINGUISHER USE PROCEDURE
a. Take the Fire Extinguisher from its place
b. Free the hose from the clip
c. Unplug the safety pin
d. Hold the nozzle with your left hand and aim it up
e. Take an ideal distance of ± 4 meters behind the wind direction
f. Point the nozzle to the fire source
g. Sweep starts from the smallest fire

HOW TO USE FIRE EXTINGUISHER

1. Make sure the Fire Extinguisher is filled and can be used (see indicator)
2. Pull the Fire Extinguisher pin or lock
3. Before entering the fire location, test first by pressing the pump slightly
4. Stand in the direction of the wind to avoid the heat of the fire
5. Hold the Fire Extinguisher hose, not the nozzle, press the lever, brush to the left and
right fire repeatedly
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4.4.3 PROCEDURE OF PURCHASE, STORAGE, TRANSPORTATION, AND

MATERIAL DISASSEMBLY
a. Officers who have been appointed by the company who understand the problem of
certain material specifications must make material purchases.
b. Material purchased must be in accordance with the technical specifications requested
by the user.
c. Material storage must be specified according to the shape, type, and usability of the
material.
d. Material placement must be such that it is safe from possible damage.
e. The space where the material is placed must be shaded, not exposed to direct sunlight
or close to other heat sources and has good ventilation.
f. Material collection must be carried out carefully according to the type of material.
g. If there is material that is damaged and declared to be unsuitable for use, it must be
reported to the head of the company or the officer appointed by the company.
h. Material transportation systems must be based on the principles of work safety as
specified.

4.4.4 SAFETY WHEN CARRYING GOODS

a. When you are going to lift things, find the right position so as not to harm yourself,
others and surrounding items.
b. Pay attention to the space around the item whether it is wide enough to move or too
many items or other obstacles and do the job carefully.
c. Estimate the weight of the item whether or not someone needs help.
d. Maximum weight 25 kg / person.
e. If more than one person is required to lift the item, one must act to give the command
to appoint the item with a 1-2-3 signal so that the appointment of goods can be carried
out safely, simultaneously and simultaneously.
f. Use the leg muscles to lift things, don't use your back muscles
g. When walking carrying items, it is very important that the carrier be able to look
forward so as not to retreat. Do not carry items too high so that the item covers the
front view. This is very dangerous.
h. Lower the item in its place in an orderly and regular manner so that the item is not
damaged by impact.
i. Place the item in a stable position, do not close / block the road and smooth work and
do not close / obstruct the retrieval of fire extinguishers placed in the area if at any
time there is a fire.
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4.4.5 SOLID WASTE HANDLING PROCEDURE

a. OFFICE WASTE
- Separate wet & dry waste according to the available space, packed with plastic bags
(office waste bins)
- Waste disposal is carried out in the afternoon so that in the morning the office is
clean.
- Trash is brought to a large shelter
- Furthermore, the garbage will be taken by the City Sanitation Service officers to be
taken to the final shelter.
b. FIELD WASTE
- Separate wet & dry waste according to the place available with a plastic bag
- Waste must be carried in the garbage bin (user owner)
- Waste disposal is carried out in the afternoon so that in the morning the field is clean.
c. WASTE DON'T BE PASSED BECAUSE IT CAN CAUSE HEALTH RISK

4.5 HSE EQUIPMENT DATA USED

Equipment Merk/Spec
No Amount Year Check Procedure
Name Equipment
1 HSE Equipment
Personal Helmet 15 Unit 2022 Good Safe
Protective Shoes 15 Unit 2022 Good Safe
Equipment (PPE) Boot 15 Unit 2022 Good Safe
Masks 15 Unit 2022 Good Safe
Gloves 160 Unit 2022 - -

2
Other Equipment DCP-9 Kg 2 buah 2022 Good Safe
APAR Safety Sign 1 lot 2022 Good Safe
Signs Rechargeable 2 buah 2022 Good Safe
Lamp - 1 box 2022 Good Safe
Lighting
First Aid

Tabel 5.2. HSE Equipment

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5. RISK MANAGEMENT
5.1 METHODS USED AND AVAILABILITY
5.1.1 RISK ASSESSMENT DAN MANAGEMENT
1. Definition
Risk assessment is the whole process of identifying, estimating, and measuring (assessing)
potential risks that may arise due to project production activities, as well as planning and
deciding anticipatory steps and actions on the results of the risk assessment.
2. Objectives
The objectives of the risk assessment procedure are:
- To identify and control all possible risks
- To ensure an effective security / safety system by measuring and controlling risks that
may occur
- To determine preventive measures against identified risks both related to security / safety
risks and health risks and environmental risks
3. Application
Risk assessment applied to:
- Activities that have been planned and which have not been planned
- Changes in working conditions and operational conditions
- Changes in human resources
4. Term
- Incident is events related to the possibility of injury, illness or death
- Accident (kecelakaan) is an incident that has resulted in injury, illness or death
- Hazard is any source of situation or action that has the potential to cause injury, illness
and fatal health
- Risk is a combination of possible events with a fatality rate from a dangerous event that
results in injury or illness / disease
- Hazard identification is the process of recognizing hazard and determining its
characteristics
- Risks assessment is the process of evaluating risks arising from hazards, controlling risks
that occur, and deciding whether the risk is acceptable or not (tolerable or not)
- Acceptable risk is that the risk has been reduced to a level that can be tolerated

5.1.2 OBJECT AND RISK ASSESSMENT

Risk Assessment Object
- Management of all work, activities and situations related to the object of risk assessment
- All personnel involved in project activities
- A detailed list of risk assessment objects listed / identified in the risk assessment list
- Object of risk assessment can increase / develop at any time, according to conditions and
conditions
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Risk Determination
- In terms of identifying potential risks or risks found during the activity, the results of the
risk assessment must be reported with information including:
• Information on operational accidents and their critical level
• System changes
• Potential risks to equipment changes and / or system changes
• Changes in environmental conditions
• Emergency Status
- Project Managers and Safety Officer must carry out risk assessments of project activities
and provide risk reduction measures to prevent recurrence of events
Preparation for Risk Assessment
- Prepare procedures, form documents and documentation systems
- Making procedures for implementing activities
- Prepare equipment and materials to be used
- Preparing classification of risk factors and measuring the level of risk
- Grouping damage objects into:
• Object of human damage
• Objects of non-human physical damage
- Arrange risk rating, risk grouping in standard risk acceptance, in a matrix. Arrange risk
grade, ranking risk tolerance level, and anticipate action in a matrix

5.1.3 RISK ASSESSMENT METHODS

1. Create a matrix risk rating for each activity with coordinates:
- To the right: the severity rating (fatality) of a hazard, identified as mild, moderate, severe.
- Down: rating the probability of occurrence of hazards, identified as low, medium, and
high frequency.
- Determine the risk rating of an activity obtained by associating the rating to the right with
the rating down or between the rating Severity with a rating of Possible Frequency of
Events.
- The risk rating matrix is as follows:

Mild Moderate Severe

Low Trivial Tolerable 1 Moderate 1
Average Tolerable 2 Moderate 2 Substantial 1
High Moderate 3 Substantial 2 Intolerable
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2. Risk Rating are grouped as Follows:

- Trivial Risk, is the risk of fatality impact is mild with the frequency of low occurence
- Tolerable Risk 1, is the risk of fatality impact is moderate with the frequency of low
occurence
- Tolerable Risk 2, is the risk of fatality impact is mild with the frequency of average
occurrence
- Moderate Risk 1, is the risk of fatality impact is severe with the frequency of low
occurrence
- Moderate Risk 2, is the risk of fatality impact is moderate with the frequency of average
occurrence
- Moderate Risk 3, is the risk of fatality impact is low with the frequency of high
occurrence
- Substantial Risk 1, is the risk of fatality impact is severe with the frequency of moderate
occurrence
- Substantial Risk 2, is the risk of fatality impact is moderate with the frequency of high
occurrence
- Intolerable Risk, is the risk of fatality impact is severe with the frequency of high
occurrence

5.1.4 RISK LEVEL/GRADE

Is identification of actions that must be taken (anticipated) against each risk rating, as
generated by the rating risk process above as follow:

Grade
Rating Risk Steps and Action (Anticipation)
Risk
This risk is considered acceptable. There are no further
Minor Risk
E actions, other than those needed to ensure that controls
(Trivial)
are maintained
No additional control is needed unless they can be
implemented at a low cost (in terms of time, money and
Tolerable D1 dan
effort). Actions to further reduce this risk are not a top
Risk D2
priority. Arrangements must be made to ensure that
controls are maintained
Consideration should be given to whether the risk level
can be lowered, at a level that can be tolerated, or if
Controllable possible at an acceptable level, although it must have an
C1, C2,
Severe Risk impact on the cost of landfill. Risk reduction must be
dan C3
(Moderate) carried out within the stipulated period. The arrangement
of actions related to the level of risk associated with
hazards must be controlled
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Serious efforts must be made to reduce risk. Reduction

actions must be carried out immediately within the
specified time. If there is a need to suspend or limit
activities, or apply strict internal risk control to
Major Risk
B1 dan B2 completion. Sufficient resources may be allocated for
(Substantial)
additional control measures. Arrangements must be made
to ensure that control measures are maintained,
especially if the level of risk is related to hazards and is
very dangerous.
This risk is not acceptable. Substantial actions in
reducing the level of risk must be carried out, so that the
Unacceptable reduced risk level becomes a tolerable or acceptable
Major Risk A category. Work activities must be stopped until the risk
(Intolerable) control can reduce the level of risk, so it is no longer
high. If it is not possible to reduce risk, then work is still
prohibited

5.2 JOB HEALTH SAFETY ENVIRONMENT ANALYSIS (JHSEA)

JSA will perform on site for all non-routine jobs. Safety Officer, Supervisor and Project
Manager are required to take time with their workers and safety officer to prepare a JSA prior
starting the job, identifying what could go wrong and organizing control measures for
everybody to work safely. The job divided into steps. For each step, HSE risks and control
measures are identified and discussed by the team. A facilitator or the supervisor records the
analysis. JSA then displayed in working area and approved by HSSE Project.

6. EMERGENCY SITUATION
6.1 EMERGENCY RESPONSE PLAN
PT. Suci Energi Solusi Indonesia personnel will follow Shell Gresik Terminal emergency
response procedures, including medical emergency operation, first aid action, fire
protection/ prevention and Incident investigation.

Although so, PT. Suci Energi Solusi Indonesia has described procedure for manual
emergency response operation in its own work area and handling victims from jetty to the
nearest hospital. For First aid case action in work area, PT. Suci Energi Solusi Indonesia
technicians will use First Aid Equipment and Kits of SGT in work area to do first aid action.

6.2 EMERGENCY REPORTING INFORMATION

If an emergency occurs in the work area, the safetyman has the duty to provide information
and reports related to the occurrence of emergency events. The information reported contains
some data, including:
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- Time and location of the incident

- Officers or personnel involved
- Event description
- Description of countermeasures
To make it easier for officers to report, an emergency report form is used as shown in Figure
6.5.
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HARI / TANGGAL : KONDISI CUACA

JAM : CUACA :

LOKASI : ARAH ANGIN :

OBYEK :

PETUGAS
NO. NAMA KETERANGAN
1

URAIAN KEJADIAN

KRONOLOGI PENANGGULANGAN

JAM URAIAN

PERALATAN YANG DIPAKAI

KOMENTAR / KOREKSI DARI MANAJEMEN

MENGETAHUI
PENGAWAS K3LL MANAJER PROYEK DIREKTUR

Gambar 6.5. Emergency Report Form

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7. INCIDENT, ACCIDENT AND INVESTIGATION REPORTING

7.1 INCIDENT INVESTIGATION PROCEDURE
To prevent work accidents that result in loss of work time, PT. Suci Energi Solusi Indonesia
applies an investigative procedure to investigate all incidents that occur at work. The incident
is defined as an unwanted event, which can cause losses to workers, property damage or loss
of process. All workers must be aware of the investigation process so that they will be able to
contribute to all events in the workplace.
Procedure for Investigating Incidents includes:
A. Take Immediate Action
- Take immediate action to prevent injury or damage
- Inform workers about identified costs and ways to control these costs
- Securing the scene until the investigation at the crime scene is complete
B. Collect Evidence
Collecting evidence helps to get a clear picture of events (incidents) that occur so actions can
be taken to prevent similar incidents (incidents) in the future:
- Identify all activities from beginning to event (incident)
- Propose complete data and descriptions of the location, events, and production
processes that occurred during the incident.
- Investigate workers in a cooperative manner, not to seem to blame workers so that
information can be properly conveyed.
- Ensure that the evidence collected is complete and in accordance with the conditions
in the field.
There are 2 ways to collect evidence:
1. Look for clues from the scene, for example:
- Take pictures and make sketches
- Take measurements
- Take samples of substances / liquids
- Note environmental conditions (eg household, lighting, noise, signs, and or work
space)
- Collect foreign objects or pieces of equipment
- Review work processes or procedures
2. Gather information from people (eg injured workers, witnesses, and or supervisors)
- Asking effective questions so that the information obtained is in accordance with the
field conditions.
- Objective, not asking questions that only support predetermined conclusions.
- Ask whether workers, witnesses and / or supervisors have ideas for further settlement.
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C. Analysis Of Evidence (Incident)

- Sort all the evidence that has been collected. This will help to develop a picture of the
incident that occurred.
- Ensure that the evidence that is possessed is sufficient (avoiding information gaps) and
the available evidence can be dinalar and each event relates to other activities.
- Analyze incidents; how incidents can occur so prevention can be determined.
D. Recommend Corrective Actions
Recommendations for actions based on the analysis of events serve to reduce and prevent
similar incidents. Recommendations can be:
- Revision of policies or procedures
- Training
- Maintenance, repair and replacement of equipment
- Supervision
Recommendation Terms:
- Effective, fixing existing problems without creating new safety problems
- Practical, can be implemented quickly and precisely
- Affordable, within the available resources
- Credible, can be trusted for workers
- Develop priorities, if all recommendations cannot be implemented at once, then the
priority recommendations are arranged which is more important
- Based on consultation with experts
E. Following The Corrective Action
Follow up on corrective actions to determine whether they carry out the recommended
corrective actions. It also aims to find out whether the action is effective to do.
F. Writing Investigation Reports
Write a report to explain the incident that occurred, the cause of the incident, and
recommendations that can be done to prevent similar incidents. The requirements for an
investigative report are:
- Objective, according to events in the field
- Describe the sequence of events clearly, including who experienced the incident, what
caused it, so that readers who have no knowledge of the incident will be able to
understand what happened
- Identify hazards
- Suggest corrective actions
- Schedule of follow-up corrective actions
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7.2 INCIDENT REPORT FORM

Gambar 7.1. Incidents Report Form

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8. INSPECTION AND AUDIT

8.1 INSPECTION AND AUDIT PROCEDURE
8.1.1 INSPECTION
Inspection is one of the management control tools that applied in an effort to find problems
faced in the field, including estimating the risk of inspection activities as one of the efforts
that is 'proactive'.
Inspection Objectives:
1. Identify unsafe conditions
2. Identify unsafe actions
3. Determine the basic causes
4. Obtain feedback that is very valuable for management in planning corrective actions.
5. Not looking for mistakes.
Types of inspection and responsible parties for inspection carried out at PT. Suci Energi
Solusi Indonesia is a Planned Inspection covering:
1. General Safety & Health Inspection is a general safety and health examination by
carrying out a planned round trip throughout the work area. Field supervisors (foremen)
and Safety Man pay attention to everything to determine unsafe conditions at the work
site. The party conducting the inspection is Pengiwas Lapangan (Mandor), Safety Man,
Project Manager, USE Manager, and Director of PT. Suci Energi Solusi Indonesia.
Performed at the beginning of the first week during the work.
2. Housekeeping Inspection is the most important part and planned general inspection,
Inspection of this type is related to cleanliness and tidiness that includes machinery, and
equipment, materials, tools, floor of the building, and others. The party conducting the
Mechanical Engineering Inspection, Field Supervisor (Overseer), and Safety Man and
witnessed by the Director of PT. Suci Energi Solusi Indonesia. Performed every week
(Monday) to identify work progress as progress and find out the feasibility of the machine
used.
Inspection Steps
1. Inspection Preparation
2. Inspection
 Observation Cycle
 Inspection object
 Observation of Total Hazard Clarification
3. Inspection Report
 Clearly written
 Sequential finding numbers
 Clarification of findings / hazards
 Include the last (past) findings and then mark
 Follow-up report
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8.1.2 MANAGEMENT AUDIT

A series of activities to recognize, identify, and test in detail the information and facts that
exist to reveal the actual events in the framework of evidence to support the legal process for
alleged irregularities that could be detrimental.
1. Ensure that the OSH Management System implemented has fulfilled the procedure.
2. Know whether the OSH Management System is run at all levels according to its scope.
3. Ensure that the K3 Management System is effective.
Things must be considered in conducting an audit
1. K3 management system documentation
2. K3 Policy
3. K3 objectives and facilities
4. K3 work procedures and instructions
5. Results of hazard identification, assessment and risk control
6. Regulations related to permits, certificates of work results
7. Related regulations permit certificates, examination results.
8. Audit procedures.
9. Procedure for incompatibility and results of previous audits.
10. Results of management review and follow-up.
Audit Team
- Consists of various disciplines or functions in the organizational structure
1. Director of PT. Suci Energi Solusi Indonesia
2. Safety Officer
3. Supervisor
- Duties and responsibilities
1. Determine the target, scope, frequency, and method of audit, arrange work plans and
implementation lists
2. Develop a checklist and assessment standards
3. Inspection of workplaces, implementation of procedures and interviews for verification
of audit reports and suggestions for improvement