Professional Documents
Culture Documents
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
1 HSE Policy 20
1.1 s the Subcontractors Corporate HSE Policy be signed by Top
10 10
Management?
1.2 Is the Subcontractor's Corporate HSE Policy posted in prominent
10 10
locations?
3 HSE Committee 39
3.1 Is a HSE Committee established with adequate representation from
5 5
Subcontractor?
3.2 Are the objectives of the Committee clearly defined? 5 5
3.3 Are the operating rules of the Committee defined? 5 5
3.4 Are the activities of the Committee carried out in accordance with the
5 5
operating rules?
3.5 Are the HSE Committee Meeting conducted regularly and in timely
7 7
manner?
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
4 HSE Administration 48
4.1 Written HSE program plus project rules 5 5
4.2 HSE program enforced by mgmt/Supervisor 10 10
4.3 HSE Coordination Mgr - Authority, Qualified 5 5
4.4 Personnel injury log - accurate, complete 2 2
4.5 Accident investigation/reports 3 3
4.6 Weekly HSE report 3 3
4.7 Loss Prevention inspections performed 5 5
4.8 Hazards anticipated 5 5
4.9 Accident Statistics 10 10
5 Jobsite Information 16
5.1 Posting jobsite warning poster 3 3
5.2 Do you have HSE internal meetings? 5 5
5.3 Are there medical service and first-aid equipment, stretchers and
4 4
emergency vehicles available?
5.4 Is Fire Fighting, Clinic/Hospital/Ambulance phone number being posted? 4 4
7 Fire Prevention/Protection 0
7.1 Adequate fire extinguishers for hazard 0 0
7.2 Proper type and location 0 0
7.3 Fire watches trained 0 0
7.4 No smoking signs posted 0 0
7.5 Inspections & maintenance of extinguishers-monthly 0 0
7.6 Fires/Extinguisher use - reported 0 0
7.7 Storage of flammable material - labeled 0 0
7.8 Containers grounded 0 0
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
13 Heavy Equipment 16
13.1 Operator qualified, licensed 3 3
13.2 Regular inspection and maintenance 3 3
13.3 Wheels chocked when parked on grade 1 1
13.4 Speeding controlled as posted 1 1
13.5 Dump beds chocked up during repairs 1 1
13.6 Backup alarms provided on all equipment 3 2
13.7 Signalmen as needed 1 1
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
13.8 Fire extinguishers-minimum cover radius at the same floor with type ABC 1 1
13.9 Engine off when re-fuelling 2 2
15 Safety Inspection/Audit 19
15.1 Are the Safety Inspection procedure and check list Prepared and
5 5
available?
15.2 Are Safety Inspection at the site carried out regularly according to the
2 2
inspection procedures by * Site Manager / Construction Manager
* Site HSE Manager 2 2
* HSE Officer 1 1
15.3 Are the above listed individual authorized to halt operation and use
3 3
facilities in emergency or imminent danger situation?
15.4 Are the results of the safety inspection recorded and corrective actions
3 3
confirmed?
15.6 Is a safety audit by a third party or a safety consultant from
3 3
Subcontractors Home Office periodically carried out?
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
18 Explosives 0
18.1 Qualified operators and supervision 0 0
18.2 Proper transport vehicles 0 0
18.3 Local laws and regulations observed 0 0
18.4 Storage magazines constructed per regulation or as recommended 0 0
18.5 Experience personnel handling explosive at all times 0 0
18.6 No Smoking sign posted at right places 0 0
18.7 All personnel familiar with signals properly used at all times 0 0
18.8 Inspection after each shot 0 0
18.9 Proper protection and accounting for all explosive at all time 0 0
18.10 Proper Disposition of wrapping, waste and scrap 0 0
18.11 Advise residents nearby of blasting cap danger 0 0
18.12 Check radio frequency hazards 0 0
19 Motor Vehicles 11
19.1 Regular inspection and maintenance (Pre-Trip Inspection for Light
3 3
Vehicle on Daily Basis)
19.2 Lubrication Qualified Operators 1 1
19.3 Local and state vehicle laws and regulations observed 1 1
19.4 Brakes, lights, warning devices in good condition 1 1
19.5 Weight limit and load controlled 1 1
19.6 Personnel carried in a safe manner 1 1
19.7 Is all glass in good condition? 1 1
19.8 Are back-up signals provided? 1 1
19.9 Are fire extinguishers installed where required? 1 1
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
22 Ionizing Radiation 0
22.1 Are procedures for work involving ionizing radiation provided, in
0 0
accordance with statutory and / or company Regulations?
22.2 Is any work involving ionizing radiation devices mainly Executed during
0 0
off-peak hours or night, and obtained the work permit system?
22.3 Is a qualified (licensed) supervisor and experienced workers assigned to
0 0
the work?
22.4 Are all persons involved in radiation activities obliged to carry personal
0 0
radiation mattering devices at all times?
22.5 Are radiation meter evaluation and calibration intervals specified and
0 0
recorded on the site?
22.6 Is the work area protected against unauthorized entry by barricade and
0 0
warning signs?
22.7 Is a safe distance specified? 0 0
22.8 Is the handling and storage of radioactive source and emergency
procedures specified in accordance National (BATAN )or International 0 0
standards?
22.9 Are storage areas for ionizing radiation hazards equipped with relevant
0 0
warning sign and locked to avoid unauthorized entre?
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
23 Barricades 8
23.1 Floor opening planked over or barricaded 1 1
23.2 Roadways and sidewalk effectively protected 2 2
23.3 Adequate lighting provided 2 2
23.4 Traffic controlled 3 1
24 Transportation 21
24.1 Employee transport adequate seating 5 2
24.2 Seat belt use enforced 5 2
24.3 Tires, lights, etc. maintained 2 1
24.4 No riding back of open trucks without proper seats 2 1
24.5 Traffic regulation enforced 3 1
24.6 Driver qualified/licensed 2 1
25.7 Operational car passed permit 2 1
25 Concrete Construction 20
25.1 Form properly installed and braced? 3 3
25.2 Adequate shoring, plumbed, and cross-braced? 3 3
25.3 Shoring remains in place until strength as attained? 1 2
25.4 Proper curing period and procedure? 2 2
25.5 Check heating devices? 2 2
25.6 Mixing and transport equipment supported and traffic planned and noted? 3 2
25.7 Adequate runways? 2 2
25.8 Protection from cement dust? 2 2
25.9 Is the work place be kept neat and orderly 2 1
26 Steel Erection 0
26.1 Safety nets or planked floors 0 0
26.2 Taglines for tools 0 0
26.3 Fire hazards at rivet forge and welding operations 0 0
26.4 Floor opening covered and barricaded 0 0
26.5 Ladders, stairs, or other access provided 0 0
26.6 Hoisting apparatus checked 0 0
27 Scaffolding 0
27.1 Dismantling/erection supervised 0 0
27.2 Designed properly for height/loading 0 0
27.3 Connections secured 0 0
27.4 Platform and walkway min. width 40 cm 0 0
27.5 Scaffold tied to structure every 20 feet 0 0
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
28 Excavation/Trenching/Shoring 21
28.1 Supervised/inspected daily- competent person 5 5
28.2 Access/egress 1 0
28.3 Shoring/sloping-Adequate for soil type 4 2
28.4 Barrier and warnings 1 1
28.5 Spoil clearance over 2 from edge 2 2
28.6 Adjacent structures shored 2 2
28.7 U/G lines identified and located hand dig 2 2
28.8 Equipment kept clear of excavation edge 2 2
28.9 Checked for flammable/toxic gas 2 2
30 Electrical System 28
30.1 Service panel: a) Fused 5 5
b) 3-Wire distribution 5 2
c) Grounding 5 5
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
32 Welding/Cutting 0
32.1 Secured cylinders upright 0 0
32.2 Gauges removed when moved 0 0
32.3 Hoses-condition 0 0
32.4 Fire extinguisher ABC 0 0
32.5 Operators protective equipment used 0 0
32.6 Shields and spark catchers installed 0 0
32.7 Grounding close to work station 0 0
32.8 Cable condition/roll up 0 0
32.9 Permit obtained as required 0 0
32.10 Equipment off when not in use 0 0
33 Abrasive Blasting/Painting 0
33.1 Operator hood/Air supplied 0 0
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
36 Housekeeping/Material Handling 14
36.1 Good site layout 3 1
36.2 Site Access/Dust controlled 2 1
36.3 Trash containers/covers used 1 1
36.4 Material stacked and stable 1 1
36.5 Flammable & Combustible storage/access clear 3 1
36.6 Timber de-nailed/picked up 1 1
36.7 Passageways clear at all times 1 1
36.8 Proper manual material handling 2 1
37 Steel/Pipe Erection 0
37.1 Perimeter guarding 0 0
37.2 Platforms/floors w/in 30 0 0
37.3 Tagline used 0 0
37.4 Floor opening cover/labeled 0 0
37.5 Ladders or stair provided/used 0 0
37.6 2 connecting bolts before releasing beam 0 0
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
38 Power Tools 7
38.1 Correct voltage 1 1
38.2 Properly grounded 1 1
38.3 Properly guarded at all times 1 1
38.4 Cable/hose, plug, connectors in good condition 1 1
38.5 Inspection/Maintenance-daily/monthly 2 1
38.6 Correct disk for grinding 1 1
39 Hand Tools 5
39.1 Correct tool for the job 1 1
39.2 Correct use 1 1
39.3 Inspection 2 1
39.4 No makeshift devices 1 1
41 Air Compressors/Generators 5
41.1 Pressure valve/Mufflers 1 1
41.2 Air pressure gauges in working order 1 1
41.3 Hoses and connection/Cords/Grounding 1 1
41.4 General condition 1 1
41.5 Correct coupling/secured 1 1
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
GENERAL :
Kesiapan Bekerja di ketinggian harus selalu diperhatikan (akses, lifeline, pengunaan full body
harness)
II. Value
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
PT PETROKIMIA GRESIK
Rev. No. : 1
GRESIK - JAWA TIMUR
Total Value =
535 X 100%
586
PERCENTAGE RANKING
+85% Outstanding Superior Loss Control-All
75 - 85% Good Good Loss Control/Key request
70 - 75% Marginal Needs Some Improvement
AUDITORS:
AUDITY: