Contractor Safety, Health and Environmental Management System (CSMS) Guidelines
Pre-Qualification Forms
Pre-Qualification New Contracts Qualification Phase: Select A Qualified Contractor
Pre-Qualification Selection
Risk Assessment
CSMS
Contract Award
Data Bank Contract Implementation Phase: Ensure Field Safe Work
Pre-Job Activity
Work In Progress
Final Evaluation
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02 Form CSMS/PQ/01
PRE-QUALIFICATION
Date
: 29 April 2013
Project Period
: ------
Job Title
: INTEGRITY MANAGEMENT & CORROSION SERVICES
Contract No
: ------
Work Location
: Company & Contractor Jakarta Office and Company Offshore
Contractor Name : PT. KARYA SEJAHTERA PRATAMA
Address
: Graha Mobisel Lt.3 Jl. Warung Buncit Raya No.139 Jakarta Selatan 12740
Page 44 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02 Form CSMS/PQ/02: Contractor HSE MS Questionnaires
Company Name :
PT. KARYA SEJAHTERA PRATAMA
Work Subject
Personnel Services Contract for Operational and Project Activities Support Services
:
SECTION 1 : LEADERSHIP AND TOP MANAGEMENT COMMITMENT 1. Commitment to HSE through leadership
a) How are senior managers is top management personally involved in HSE management? Keterlibatan Manager Senior (Top Management) PT.KSP dilakukan melalui penandatanganan Kebijakan HSE dan Larangan penggunaan Obat-obatan terlarang. Kemudian kunjungan kelapangan (Management Walktrough) setiap 3 bulan serta rapat HSE yang dilaksanakan setiap bulannya yang semua itu masuk menjadi KPI (Key Performance Indicator) PT.KSP
b) Provide evidence of commitment at all levels of the organization by:· (i) Stating this year's company targets for HSE performance· Pernyataan tentang target kinerja HSE perusahaan dituliskankan melalui HSE MOM dan participants list
(ii) Describing how you ensure that your organization understands and is committed to deliver your company HSE targets Komitmen HSE untuk setiap jenjang organisasi yang ditandatangani setiap level jabatan yang ada dikantor dan juga level manajemen melalui HSE meeting setiap bulan.
c) How do you promote a positive culture towards HSE matters? Promosi budaya positif masalah HSE dilakukan melalui penerbitan bulletin HSE bulanan, dan Safety Alert.
Page 45 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02
d) Provide your current Organization chart Terlampir bagan organisasi PT.KSP
SECTION 2 : POLICY AND STRATEGIC OBJECTIVES 2.1. HSE Policy & Documents
a) Does your company have an HSE policy document that is applied? (Yes/No) If yes, please attach.
Yes, PT.KSP memiliki kebijakan HSE, mutu dan larangan pemakaian narkoba, minuman keras dan merokok yang sudah ditandatangani oleh Direktur Utama
b) Who has overall and final responsibility for HSE in your organization?
Pengaturan untuk memberitahukan karyawan mengenai perubahan kebijakan dengan cara membuat dokumen distribusi untuk masing-masing fungsi dan membuat berita acara penyerahan dokumen kebijakan revisi terbaru
c) How do you ensure HSE Policy compliance and communication at site?
Cara memastikan kepatuhan akan kebijakan dan komunikasi HSE yaitu dengan menjelaskan HSE function dan responsibilites
2.2. Availability of Policy Statements to Employees
How do you communicate your company's policy to your employees including any changes? Page 46 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02
Cara mengkomunikasikan kepada karyawan mengenai perubahan kebijakan perusahaan dengan cara membuat dokumen distribusi untuk masing-masing fungsi dan membuat berita acara penyerahan dokumen kebijakan revisi terbaru.
SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION 3.1. Organizations - Commitment and Communication
a) How is management involved in HSE activities, objective setting and monitoring? Keterlibatan Top Manajemen (BOD) dalam penetapan sasaran dan pemantauan HSE melalui sasaran ukuran kinerja terpilih pada KPI (Key Performance Indicator) yang dibuat setiap awal tahun.
b) What provision does your company make for HSE communication and meetings? Ketentuan yang perusahaan buat untuk mengkomunikasikan masalah HSE yaitu dengan cara membuat jadwal meeting setiap bulannya dan mendokumentasikan hasil dari penyelenggaraan komunikasi tersebut.
3.2. Competence and Training of Manager/Supervisors/Senior Site Staff/HSE Advisor
Have the managers and supervisors at all levels that will plan, monitor, oversee and carry out the work received formal HSE training in their responsibilities with respect to conducting work to HSE requirements? (Yes/No) Yes,
If yes, please attach the training matrix. PT.KSP sudah melakukan inhouse training dengan materi Building Emergency Respon Plan & Evacuation Course dengan lama waktu 1 hari
3.3. Competence and General HSE Training
a) What arrangements does your company have to ensure employees have knowledge of basic industrial HSE, and to keep this knowledge up to date? Untuk memastikan bahwa karyawan mempunyai pengetahuan tentang HSE dasar dalam industri maka PT.KSP melakukan inhouse training untuk Crew untuk menjaga agar pengetahuan mengenai HSE mereka tetap update.
b) What arrangements does your company have to ensure ALL employees, including sub contractors, also have knowledge of your HSE policies and practices? Page 47 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02
Seluruh karyawan diberikan Safety Induction sebelum memulai bekerja dan informasi mengenai bahaya khusus yang timbul dari sifat pekerjaan dilakukan pada saat Pre Job Meeting dengan membahas JSA untuk pekerjaan yang akan dilakukan.
3.4. Specialized Training
Have you identified areas of your company's operations where specialized training is required to deal with potential hazards? (Yes/No) PT.KSP telah mengidentifikasikan lokasi operasi yang membutuhkan pelatihan khusus melalui Prosedur Identifikasi Bahaya, Penilaian Resiko, dan Penentuan Kontrol. Sebagai penjabaran maka dilakukan : Fire Drill, Evacuation Drill, dll
If Yes, please provide the list (e.g. radioactive, asbestos, explosive, diving, etc). Identifikasi terhadap bahaya baik terhadap manusia maupun peralatan dinilai dan diatasi melalui pembuatan JSA untuk masing-masing proses kegiatan yang ada di Rig. Kegiatan ini diatur dalam Prosedur Identifikasi Bahaya, Penilaian Resiko, dan Penentuan Kontrol.
3.5. HSE Qualified Staff - Additional Training
Does your company have HSE specialist (related to your company's services) who can provide training for other employees? (Yes/No) Yes, PT.KSP memiliki kualifikasi HSE yang mampu memberikan pelatihan dasar
If Yes, please attach the curriculum vitae Terlampir CV dari pekarya PT.KSP
3.6. Assessment of Suitability of Subcontractors
a) Do you employ sub-contractor(s) for the intended service? (Yes/No) No, PT.KSP tidak memiliki subkontraktor
If No, please go to the question 3.7. Do you have sub-contractor(s) selection procedure in term of HSE?
b) How do you assess your sub-contractor(s) to ensure they comply with your company's HSE policy and standards? PT.KSP tidak memiliki subkontraktor Page 48 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02
3.7. Standards
a) What kind of HSE regulatory or industrial standards that your company refer to for the intended service? PT.KSP mengenali standar-standar industri baru yang mungkin berlaku dengan menggunakan Daftar Peraturan Perundangan yang terkait dengan HSE yang berasal dari Ditjen Migas, API, & SNI
b) How do you ensure these are met and verified? Standar-standar ini dipenuhi dan diperiksa melalui berbagai macam kegiatan inspeksi. Seperti : Inspeksi kendaraan, checklist sebelum tanjak, pemeliharaan HSE umum dan laporan inspeksi yang dilakukan oleh PJIT.
SECTION 4: HAZARDS AND EFFECT MANAGEMENT 4.1. Hazards and Effect Management
Does your company have procedure for the identification, assessment, control and mitigation of hazards and effects? (Yes/No) Yes,
If Yes, please attach the index/table of content including the sub-index. Dalam mengidentifikasi, menilai, mengurangi bahaya dampak yang ada di PT.KSP menggunakan general risk assesment yang menggunakan teknik atau metode FMEA untuk mengukur Probaility dan Consequnce.
4.2. Exposures of the Workforce
What systems are in place to monitor the hazard's exposure of your workforce e.g. chemical or physical agents? Untuk memantau paparan pekerja terhadap bahan kimia atau unsur fisika yang diakibatkan oleh bahanbahan material atau kimia yang digunakan PT.KSP yaitu dengan cara menempelkan MSDS disekitaran gedung inventory kerja dan tempat yang dekat dengan lokasi penggunaan bahan kimia tersebut. Disamping itu penjelasan MSDS juga dijelaskan ke Crew melalui Tail Gate Meeting.
4.3. Handling of Potential Hazards
How is your workforce advised on potential hazards, e.g. chemicals, noise, radiation, etc., encountered in the course of their work? PT.KSP memberitahukan bahaya yang mungkin timbul seperti bahan kimia, kebisingan melalui prosedur Pengelolaan Bahan-bahan Berbahaya dan Komunikasi Informasi HSE. Kemudian pekerja tersebut mengkomunikasikan pada saat Tail Gate Meeting Page 49 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02
4.4. Personnel Protective Equipment
a) What arrangements does your company have for provision and unkeep of protective equipment and clothing, both standards issue, and that required for specialized activities? PT.KSP membuat prosedur P-012 Alat Pelindung Diri untuk pengadaan dan pemberian alat pelindung diri dan dipakai kerja baik untuk yang standar maupun yang diperlukan untuk kegiatan-kegiatan khusus.
b) Do you provide appropriate personal protective equipment (PPE) for your employees? (Yes/No) Yes,
Please provide a listing of the PPE for the scope of this work. PT.KSP menyediakan PPE yang sesuai untuk karyawan, daftar PPE untuk pekerjaan yang ada dilokasi kerja juga sudah dibuat. Disamping itu distribusi PPE ke masing-masing Area kerja j uga sudah dibuat
c) Do you provide training on how to use PPE? (Yes/No) Yes,
Explain the content of the training and any follow-up PT.KSP sudah memberikan pelatihan tentang cara penggunaan PPE kepada karyawan yang baru masuk dan tamu yang berkunjung kelokasi pengeboran melalui Safety Induction.
d) Do you have a program to ensure that PPE is impacted and maintained? PT.KSP membuat program dan data base PPE yang ada disetiap Area Kerja untuk memastikan penggunaan dan jumlah PPE yang dibutuhkan dimasing-masing Area Kerja. Inspeksi dilakukan oleh HSE Officer dengan menggunakan General HSE Inspeksi.
4.5. Waste Management
a) What systems are place for identification, classification, minimization and management of waste? PT.KSP membuat prosedur P-010 (Pengelolaan Limbah dan Pemantauan Lingkungan) untuk mengidentifikasi, klasifikasi, pengurangan dan penanganan limbah.
b) Please provide the number of accidents resulting in environmental damage in the amount greater than $50,000 for the last 24 months. Attach copies of any governmental reports submitted. Dalam 24 bulan terakhir PT.KSP tidak pernah mengalami kecelakaan yang menyebabkan kerusakan lingkungan dalam jumlah melebihi $50.000,Page 50 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02 c) Do you have procedures for waste disposal? (Yes/No) Yes, PT.KSP membuat prosedur P-010 (Pengelolaan Limbah dan Pemantauan Lingkungan) untuk pembuangan limbah
d) Do you have procedures for spill reporting? (Yes/No) Yes, PT.KSP membuat prosedur P-010 (Pengelolaan Limbah dan Pemantauan Lingkungan) untuk pelaporan tumpahan minyak (oil spill) yang diakibatkan oleh peralatan PT.KSP
e) Do you have procedures for spill clean up?(Yes/No) Yes, PT.KSP membuat prosedur P-010 (Pengelolaan Limbah dan Pemantauan Lingkungan)
f) Please provide details at any of your equipment related to environmental matters. PT.KSP memiliki peralatan yang berkaitan dengan masalah lingkungan yang telah diuji coba (commisioning) yang dapat dilihat pada lampiran.
4.6. Industrial Hygiene
Do you have an industrial hygiene program? (Yes/No) Yes,
Please describe this process. If Yes, please provide the list. PT.KSP memiliki program kesehatan yang dijelaskan pada P-007 (Kesehatan Kerja) seluruh crew setiap awal kontrak wajib melakukan MCU sedangkan asuransi untuk crew menggunakan Jamsostek.
4.7. Drugs and Alcohol
Do you have a drugs and alcohol policy in your organization? (Yes/No) If yes, please attach Yes, PT.KSP memiliki Kebijakan Larangan Pemakaian Narkoba, Minuman Keras, dan Merokok
SECTION 5: PLANNING AND PROCEDURES 5.1. HSE or Operations Manuals
a) Do you have HSE procedures? (Yes/No) If Yes, please attach the list of content Yes, PT.KSP memiliki buku prosedur HSE yang dijelaskan secara rinci, dapat dilihat pada daftar prosedur HSE
b) How do you ensure that the working practices and procedures used by your employees on-site are consistently in accordance with your HSE policy objectives and arrangements?
Page 51 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02 Untuk memastikan cara kerja dan prosedur yang digunakan oleh karyawan dilapangan konsisten dengan tujuan dan kebijakan HSE maka dilakukan penetapan prosedur Ijin Kerja untuk pekerjaan berbahaya.
5.2. Equipment Control and Maintenance
How do you ensure that plant and equipment used within your work environment, onsite, or at other locations by your employees are correctly registered, certified with regulatory requirement, inspected, controlled and maintained in a safe working condition? PT.KSP membuat maintenance schedule dan maintenance record untuk masing-masing peralatan. Disamping itu untuk mempermudah pekerjaan maka dibuat Tata Kerja Individu (Work Instruction) untuk masing-masing pekerjaan pemeliharaan.
5.3. Transport Safety Management and Maintenance
What arrangement does your company have for vehicle incidents prevention? PT.KSP menetapkan prosedur P-025 untuk Keselamatan Berkendaraan di Darat.
5.4. Lifting Operation Procedure (if applicable)
Do you have any procedures to control the work involved in lifting operation?
5.5. Maintenance Schedule of Lifting Operation Equipments (if applicable)
Do you have any inspection, testing, maintenance and certification programs and schedule for lifting equipments e.g. crane, forklift and rigging equipment?
5.6. Competency of Lifting Operation Personnel (if applicable)
Do you have any system to ensure that the lifting teams e.g. lifting equipment operators, signalmen and rigging personnel are competent?
SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING 6.1. HSE Management and Performance Monitoring of Work Activities
a) What arrangement(s) does your company have for supervision and monitoring of HSE performance? Pengawasan dan pemantauan kinerja HSE dilakukan setiap bulannya oleh Top Manajemen melalui HSE meeting.
b) What arrangements does your company have for passing on any results and findings of this supervision and monitoring to your:
Page 52 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02 (i) Top/Base management Melalui laporan management walktrough yang dilakukan BOD dan HSE Manager
(ii) Site employees Melaksanakan hasil temuan & melakukan tindakan pencegahan melalui komunikasi dan informasi yang dilakukan oleh seluruh karyawan dilapangan.
c) Has your company received any award for HSE performance achievement? (Yes/No) PT.KSP belum memiliki penghargaan atas prestasi kerja.
6.2. Statutory Notifiable Incidents/Dangerous Occurrences, Improvement Requirement and Prohibition Notices
Has your company suffered any improvement requirement or prohibition notices on statutory notifiable incidents/dangerous occurrences by the relevant national body, regulatory body for HSE or other enforcing authority or been prosecuted under any HSE legislation in the last five years? (Yes/No) PT.KSP tidak pernah mengalami insiden berbahaya
If yes, please give the number of occurrences and its short description. 6.3. HSE Performance Records
a) Please provide statistical details of your HSE performance over the past 3 years (if not recorded/applicable please mark N/R or N/A) Total Number Frequency (incl. All contract & sub contract personnel) (based on OSHA) Fatalities Days Away From Work Cases (DAFWC) or Loss Time Incidents (LTI) Total Recordable Cases (e.g. Medical Treatment, Restricted Work, Transfer to Another Job, Unconsciousness)
b) How is health performance recorded? Dokumentasi kinerja kesehatan didokumentasikan sesuai P-007 (Kesehatan Kerja) dan kemudian dibuat rekap Medical Check Up untuk seluruh karyawan yang sudah melaksanakan Medical Check Up dan dilakukan analisa terhadap medical tersebut.
c) How is environmental performance recorded? Kinerja lingkungan didokumentasikan kedalam berita acara, dan kemudian dirangkum dalam laporan bulanan HSE.
Page 53 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02
6.4. Incident Investigation and Reporting
a) Do you have a procedure for the investigation, reporting and follow-up of accidents, dangerous occurrences or occupational illnesses? (Yes/No) If yes, please attach Yes, PT.KSP memiliki prosedur P-011 (Penyelidikan dan Pelaporan Kecelakaan dan Pencemaran Lingkungan) untuk melakukan investigasi, pelaporan dan ti ndak lanjut insiden.
b) How are the findings following an investigation, or a relevant incident occurring elsewhere, communicated to your employees? Melalui safety alert dan bulletin HSE PT.KSP
Please attach an example of investigation reports during the last 12 months. Yes, kami laporkan investigasi untuk 12 bulan terakhir.
SECTION 7: AUDIT AND REVIEW a) Do you have a written procedure on HSE auditing? (Yes/No) Yes, PT.KSP memiliki prosedur Internal Audit
b) How does this procedure specify the standards for auditing, including schedule, coverage and the qualifications for auditors? Prosedur Internal Audit menjelaskan standar pelaksanaan Internal Audit, ketidaksesuaian dan kualifikasi Auditor serta hasil yang sudah dilaksanakan.
c) How is the effectiveness of audit verified and how does management report and follow up audits? Efektifitas audit diperiksa, direkapitulasi dan dianalisa yang kemudian disajikan kedalam rapat management review yang dilakukan setiap 6 bulan.
SECTION 8: EMERGENCY RESPONSE PROCEDURE Do you have an emergency response plan? (Yes/No) If yes, please attach Yes, PT.KSP menjaga kesiapan Tanggap Darurat melalui prosedur P-013 (Tanggap Darurat) yang didalamnya dijelaskan struktur komando dan tanggung jawab masing-masing tim/fungsi dalam menghadapi keadaan darurat.
Page 54 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02 SECTION 9: HSE MANAGEMENT - ADDITIONAL FEATURES Does your company hold association(s) membership? (Yes/No) Yes,
If yes, please provide the list PT.KSP memiliki sertifikat keanggotaan dari GAPENSI, KADIN, APMI, PT.KSP juga memiliki sertifikat CSMS dari Chevron, EMP Malacca Strait S.A, Tately N.V, CNOOC
Page 55 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT