Hse Plan Pt. Gta Construction

HSE
MANAGEMENT PLAN
PT. GUNA TEGUH ABADI
PROJECT : PUSRI – IIB PROJECT
CLIENT : PT. PUPUK SRIWIDJAJA PALEMBANG
LOCATION : PALEMBANG, SOUTH SUMATRA
DOCUMENT NO. : GTA-HSE-001
CONTRACT NO : 12-1812/ BA 1066
PT. GUNA TEGUH ABADI

Jalan raya Bojonegara RT 01 RW 01
Desa Kedaleman Kecamatan Cibeber
Kota Cilegon Propinsi Banten
Telp ( 0254 ) 5751341 – 5751342 Fax. ( 0254 ) 5751344
HEALTH, SAFETY AND ENVIRONMENT CO No :
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TABLE OF CONTENTS/ DAFTAR ISI
No Contents/ ISI Page

1 General/Umum _____________________________________________________ 3
1.1. Introduction/Pendahuluan________________________________________ 3
1.2. Scope of Work/ Cakupan_________________________________________ 4
1.3. HSE Objective, Goal and Target/Tujuan dan Target K3LL______________ 4

2 Reference/ Referensi________________________________________________ 4
3 Pusri II-B Project Organization Structure/Struktur Organisasi Proyek Pusri II-B 7
4 Workplace Organization/Organisasi Tempat Kerja_______________________ 5

Responsibility/Tanggung Jawab______________________________________ 5
5 PPE Requirement/ Persyaratan Alat Pelindung Diri_______________________ 12
6 Documentation and Data Control/ Dokumentasi dan Manajemen Data_______ 13
Project Health, Safety and Environment Management Program/ Program Pengelolaan

7 15
K3LL Proyek____________________________________________
HSE Activity Plan Pusri II-B Project/ Rencana Aktivitas K3LL Proyek Pusri II-B
8 22
__________________________________________________________________
Appendix/ Lampiran
Project Ocupational Health and Safety Policy/ Kebijakan Keselamatam dan Kesehatan
1
Proyek
2 Project Environment Policy/ Kebijakan Lindungan Lingkungan Proyek
Alcohol, Drugs and Carry Weapon Policy/ Kebijakan Perusahaan tentang Membawa
3
Senjata dan Obat-obatan Terlarang dan Minuman Beralkohol
PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 2 of 29

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I. GENERAL UMUM
1.1 INTRODUCTION PENDAHULUAN
Health Safety Environment (HSE) considered to be a paramount importance and shall be GTA’s primary
consideration in all projects, ultimate goal of causing no harm to people.
Manajemen Keselamatan dan Kesehatan Kerja bagi PT. GTA adalah bagian terpenting dan menjadi tujuan
utama disetiap pekerjaan
There are compelling economic reasons for reducing work-related accidents and work-related disease, as well
as ethical and regulatory reasons for doing so. A proactive Health Safety Environment (HSE) management
promotes business efficiency and ultimately, profits.
Ada beberapa alasan ekonomis untuk mengurangi kecelakaan yang berhubungan dengan pekerjaan dan
penyakit hubungan kerja, seperti juga alasan etika dan aturan-aturan. Manajemen Keselamatan Kesehatan
Kerja dan Lindungan Lingkungan (K3LL) yang proaktif mempromosikan efisiensi bisnisnya, yaitu
keuntungan
Indonesia has a comprehensive legal framework for HSE, requiring organizations to manage their operations
safely without damaging the environment and exposing the workers to risks of injury and to prevent hazards
that may result in occupational diseases and health-related problems. HSE education and training programmes
ensure effective implementation and seek to improve the overall HSE performance in organizations.
Indonesia memiliki kerangka kerja yang menyeluruh untuk bidang K3LL, yang memerlukan organisasi untuk
mengatur operasionalnya dengan cara yang aman tanpa merusak lingkungan dan mengekspose pekerja
terhadap risiko kecelakaan untuk mencegah bahaya-bahaya yang dapat menimbulkan penyakit akibat kerja
dan masalah-masalah yang berhubungan dengan kesehatan
We believe that all successful organizations actively manage HSE as an integral aspect of their business. We
also believe that organizations which integrate HSE into the heart of their businesses are also creating a distinct
advantage as employers of choice are equally successful in public relations and impact marketing to consumer
/ the public.
Kami percaya bahwa organisasi yang sukses aktif mengelola K3LL sebagai aspek integral dari bisnis. Kami
juga percaya bahwa organisasi yang mengintegrasikan K3LL kedalam naluri bisnis juga menciptakan sebuah
keuntungan yang berbeda bagi perusahaan yang merupakan keberhasilan public relation dan berpengaruh
terhadap pemasaran kepada konsumen / masyarakat.
As a responsible corporate citizen, we will follow Government of Republic Indonesia Regulation or Project /
Owner Regulation or any HSE requirement in order to implement an effective HSE Management System in
our Company and this project.

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Sebagai warga Negara yang bertanggung jawab, kami akan mengikuti Peraturan Perundang-undangan yang
berlaku di Indonesia, Peraturan Proyek dan Pemilik Proyek, serta ketentuan K3LL lainnya dengan tujuan
untuk menerapkan Sistem Manajemen K3LL yang efektif di Perusahaan dan proyek ini.
1.2 SCOPE OF WORK RUANG LINGKUP PEKERJAAN

The HSE Management Plan will be implemented to all sites ( both onsite and off site fabrication areas) and
all work under the Management of PT. Guna Teguh Abadi. It apply to all worker , including lower tier
worker organization who provide services to the Project.
Rencana Pengelolaan K3LL Proyek ini akan di implementasikan untuk semua area kerja ( di lokasi dan di
arae fabrikasi) dan semua pekerjaan yang dilaksanakan dibawah Manajemen PT. Guna Teguh Abadi.
Dilaksanakan untuk semua pekerja, termasuk dari bagian paling bawah dari organisasi pekerja yang
menyediakan jasa untuk Proyek.
1.3 HSE OBJECTIVE, GOALS AND TARGET TUJUAN & SASARAN K3LL
To implement the HSE Management System in this project, therefore to get the best quality for Health and
Safety and to prevent property, environmental, and personal accident.
Untuk menerapkan Sistem Manajemen Keselamatan Kesehatan Kerja dan Lindungan Lingkungan di proyek
dan menghasilkan kualitas terbaik aspek Keselamatan dan Kesehatan Kerja dan melindungi lingkungan,
kerusakan barang-barang berharga, dan kecelakaan pada pekerja.
The Project goal is to achieve of “Zero Harm to Health, Safety and Environment”. The specific project target
are :
Target Project ini adalah untuk mencapai “Zero Harm to Health, Safety and Environment”. Target spesifik
dari project ini adalah
1. Zero Restricted Work Cases Tidak ada kasus kecelakaan
2. Zero Medical Treatment Injury Cases Tidak ada kasus medical treatment
3. Zero Environmental Incidents Damage Tidak ada kasus pencemaran lingkungan
4. Zero Damage to Property or assets Tidak ada kasus kerusakan peralatan atau aset
2 REFERENCE REFERENSI
 Law of the Republic of Indonesia Number 1 of 1970 Concerning Safety in the Work Place (UU No.1
Tahun 1970 Tentang Keselamatan Kerja).
Hukum Negara Republik Indonesia No. 1 Tahun 1970 Mengenai Keselamatan di Tempat Kerja (UU
No.1 Tahun 1970 Tentang Keselamatan Kerja).

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 International Standards, Guidelines and Industrial Practices as Set Forth in The Specifications.
Standar Internasional, Pedoman dan Praktek-Praktek Industri Seperti Yang Dinyatakan Dalam
Spesifikasinya.
 Special Project Standards (AMDAL, ANDAL, RKL, and RPL)
Standar-Standar Khusus Proyek (AMDAL, ANDAL,RKL, dan RPL)
Indonesian legislation applicable to the Project is as follows:

Perundangan-undangan Indonesia yang dapat diterapkan dalam proyek adalah sebagai berikut :
 Republic of Indonesia Act No. 23 of 1997 regarding the Management of Environment.
Undang-undang Republik Indonesia No. 23 Tahun 1997 tentang Pengelolaan Lingkungan Hidup.
 Government Regulation No.41 of 1999 regarding Air Pollution Control.
Peraturan Pemerintah No. 41 Tahun 1999 tentang Pengendalian Pencemaran Udara.
 Government Regulation No. 74 of 2001 regarding Hazardous Material Management.
Peraturan Pemerintah No. 74 Tahun 2001 tentang Pengelolaan Bahan Berbahaya.
 Minister of Mines and Energy Regulation No. 103.K/088/M.PE/1994 regarding Supervision of
Implementation of Environmental Management Plan & Environmental Monitoring Plan (RKL-RPL).
Keputusan Menteri Pertambangan dan Energi Republik Indonesia No.103.K/088/M.PE/1994 tentang
Pengawasan Pengelolaan Lingkungan dan Pemantauan Lingkungan (RKL-RPL)
 Minister of State for Living Environmental Decree No.35/MENLH/10/1993 regarding the Standard of
Gas Emission of Vehicle Exhaust.
Keputusan Menteri Negara Lingkungan Hidup Republik Indonesia No. 35/MENLH/10/1993 tentang
Baku Mutu Emisi Gas Buangan Kendaraan.
 Minister of State for Living Environmental Decree No. 48/MENLH/11/1996 regarding the Standard of
Noise Level.
Keputusan Menteri Negara Lingkungan Hidup Republik Indonesia No. 48/MENLH/11/1996 tentang
Baku Mutu Tingkat Kebisingan.
 Minister of State for Living Environmental Decree No. 111 of 2003 regarding Guidelines on
Requirements and Permits of disposing effluents to water bodies.
Keputusan Menteri Negara Lingkungan Hidup Republik Indonesia No. 111 Tahun 2003 tentang
Pedoman Mengenai Syarat dan Tatacara Perizinan serta Pedoman Kajian Pembuangan Air Limbah ke
Air atau Sumber Air.
 Environment Impact Agency Decree No KEP-68/BAPEDAL/05/1994 regarding Guideline on
Requirement and Permits for Storing, Collecting, Operating facilities, Treatment and Disposing
Hazardous Waste.
Peraturan BAPEDAL No KEP-68/BAPEDAL/05/1994 tentang Aturan untuk penyimpanan,
pengoperasiaan, pengolahan dan pembuangan limbah berbahaya.
 Environmental Impact Agency Decree No KEP-04/BAPEDAL/09/1995 regarding Guideline on
Requirement for Disposal of Treated Hazardous Waste and Locations.
Peraturan BAPEDAL No. KEP-04/BAPEDAL/09/1995 tentang Ketentuan untuk Pembuangan dan
Pengolahan Limbah B3.
 Local Governor’s Regulation regarding the Water Quality Standards and its Usage in Province.

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Peraturan pemerintah setempat tentang Baku Mutu Kualitas Air dan Penggunaannya di Provinsi
tersebut.
 Ministry of Manpower and Transmigration Regulations No. 04/MEN/1980 regarding Requirements for
the Installation and Maintenance of Portable Fire Extinguishers
Peraturan Menteri Tenaga Kerja dan Transmigrasi No. 01/MEN/1980 tentang Syarat-syarat
Pemasangan dan Pemeliharaan Alat Pemadam Api Ringan.
 Ministry of Manpower and Transmigration Regulations No. 01/MEN/1979 regarding Mandatory
Hygiene Training, Occupational Health and Safety for Company Paramedics
Peraturan Menteri Tenaga Kerja dan Transmigrasi No. 01/MEN/1980 tentang Kewajiban Latihan
Hygiene Perusahaan, Kesehatan dan Keselamatan Kerja bagi Paramedis Perusahaan.
 Ministry of Manpower and Transmigration Regulations No. 02/MEN/1980 regarding Medical Check Up
of Workers in Practicing Occupational Safety
Peraturan Menteri Tenaga Kerja dan Transmigrasi No. 02/MEN/1980 tentang Pemeriksaan
Kesehatan Tenaga Kerja dalam Penyelenggaraan Keselamatan Kerja.
 Ministry of Manpower and Transmigration Regulations No. 01/MEN/1981 regarding Requirement to
Report Work Related Illnesses
Peraturan Menteri Tenaga Kerja dan Transmigrasi No. 01/MEN/1981 tentang Kewajiban Melapor
Penyakit Akibat Kerja.
 Ministry of Manpower and Transmigration Regulations No. 03/MEN/1982 regarding Workers Health
Assistance
Peraturan Menteri Tenaga Kerja dan Transmigrasi No. 03/MEN/1982 tentang Pelayanan Kesehatan
Tenaga Kerja.
 Ministry of Manpower Regulations No. 05/MEN/1985 regarding Lifting and Transporting Equipments
Peraturan Menteri Tenaga Kerja No. 03/MEN/1982 tentang Pesawat Angkat dan Angkut.
 Ministry of Manpower Regulations No. 05/MEN/1996 regarding Occupational Safety and Health
Management System
Peraturan Menteri Tenaga Kerja No. 03/MEN/1982 tentang Sistem Manajemen Keselamatan dan
Kesehatan Kerja.
 Ministry of Manpower Regulations No. 03/MEN/1998 regarding Reporting and Investigating Accidents
Peraturan Menteri Tenaga Kerja No. 03/MEN/1982 tentang Tata Cara Pelaporan dan Pemeriksaan
Kecelakaan.
 Ministry of Manpower Decree No. Kep-186/MEN/1999 regarding Fire Prevention in Work Places.
Keputusan Menteri Tenaga Kerja No. Kep-186/MEN/1999 tentang Penanggulangan Kebakaran di
Tempat Kerja.
 Ministry of Manpower Decree No. Kep-333/MEN/1989 regarding Diagnosing and Reporting Work
Related Illnesses
Keputusan Menteri Tenaga Kerja No. Kep-333/MEN/1989 tentang Diagnosis dan Pelaporan Penyakit
Akibat Kerja
 Ministry of Labour Regulations No. Men No. 7 -1964 regarding Health, Hygiene and Lighting
Requirements in Work Places
Peraturan Menteri Perburuhan No. 7 tahun 1964 tentang Syarat Kesehatan, Kebersihan Serta
Penerangan dalam Tempat Kerja.

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III. PUSRI II-B PROJECT ORGANIZATION STRUCTURE STRUKTUR ORGANISASI PROYEK

PUSRI II-B
3.1 WORKPLACE ORGANIZATION ORGANISASI TEMPAT KERJA

The workplace organization chart such as company HSE organization, HSE construction organization and HSE
committee organization please see below :
Struktur organisasi tempat kerja seperti organisasi K3LL konstruksi, organisasi K3LL
perusahaan tercantum berikut ini
3.2 RESPONSIBILITY TANGGUNG JAWAB

1. Project Manager / Manajer Proyek
a. Enforcement and implementation of Work Procedures (WP) / Work Instructions (WI) HSE to
ensure HSE control and compliance related to office / site activities./ Memonitor pelaksanaan
dan penerapan Prosedur dan Instruksi Kerja K3LL untuk memastikan pengawasan aspek K3LL
dan penerapannya dalam aktivitas lapangan maupun diarea kantor.
b. Ensure compliance to legal and other requirements. / Memastikan dipatuhinya hukum dan
peraturan-peraturan lainnya.
c. Identification of significant aspects and impacts / hazards and risks and implementation of
control measures. / Mengidentifikasi aspek dan dampak penting/ bahaya dan risiko dan
implementasi tindakan pengendaliannya.
d. Monitoring of HSE performance. / Memantau kinerja K3LL.
2. Construction Manager / Manajer Konstruksi
a. To assist the Project Manager in all levels / areas of implementing the HSE Management
System. / Membantu Manajer Proyek di semua tingkatan dan area dalam menerapkan Sistem
Manajemen K3LL.
b. Construction Manager as top leadership in the safety committee. He /she will be as a chairman
of safety committee. / Manajer Konstruksi adalah pucuk pimpinan di dalam komite K3LL, dan
akan menjadi ketua komite K3LL.
c. He has the responsibility concerning safety to all personnel in the project work place. /
Bertangggung jawab terhadap aspek keselamatan semua personil di dalam proyek.
d. He has authority to stop any operation or activity that constitutes an imment hazard to personnel
or could result in loss of equipment or facility and environment. / Berwenang untuk
menghentikan kegiatan operasional atau aktifitas yang dapat menimbulkan bahaya terhadap
personil atau yang akan menyebabkan kerugian pada peralatan, fasilitas dan lingkungan.
e. To investigate and report all accidents / incidents if necessary to Owner./ Melakukan
penyelidikan dan melaporkan semua kecelakaan atau kejadian penting kepada Pemilik Proyek.

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f. Carry out the HSE program for the construction and commissioning./ Melaksanakan program –
program K3LL pada kegiatan konstruksi dan commissioning.
g. Authorized to take necessary action against HSE violation by CONTRACTOR or
Subcontractor’s personnel./ Berwenang untuk mengambil tindakan yang dianggap perlu untuk
kasus pelanggaran K3LL yang dilakukan oleh Kontraktor maupun personil sub-kontraktor.
3. Supervisor / Superintendent work executor/ Pengawas atau Pengawas Utama Pelaksana Pekerjaan
a. To prepare JSA and consult with HSE Department in task/job responsibilty./ Menyiapkan JSA
dan berkonsultasi dengan department K3LL sesuai dengan jenis pekerjaannya.
b. To comply with related Procedures (WP) / Work Instructions (WI) HSE which are related to
their activities./ Mematuhi semua Prosedur Kerja atau Instruksi Kerja K3LL yang berhubungan
dengan pekerjaannya
c. To report all unsafe acts and unsafe conditions to their superior immediately./ Melaporkan
semua tindakan dan kondisi tidak aman kepada atasannya dengan segera
d. To report all accidents / incidents in their area and related areas to their immediate superior./
Melaporkan semua kecelakaan atau kejadian yang terjadi di area dan yang berhubungan
dengan area mereka sesegera mungkin kepada atasannya,
e. To utilities all personal protective equipments (PPE) when necessary./ Menggunakan Alat
Pelindung Diri (APD) yang diperlukan
f. To maintain good housekeeping and physical arrangements./ Memelihara kebersihan dan
kerapihan lingkungan kerja.
g. To attend all HSE training and meeting when requested./ Menghadiri seluruh pelatihan dan
rapat K3LL jika diminta.
4. HSE Committee Chairman/ Construction Manager/ Ketua Komite P2K3
a. To chair Site HSE Committee Meeting or his designate./ Memimpin Rapat K3LL di lapangan
atau yang telah ditunjuknya.
b. To plan overall schedule for HSE Management Programme(s) for Objectives and Targets./
Merencanakan seluruh jadwal Program Manajemen K3LL untuk pencapaian target dan tujuan
yang ditetapkan.
c. To plan the budget and seek for approval if necessary for implementation and improvement
activities./ Merencanakan anggaran dan meminta persetujuan anggaran untuk aktifitas
penerapan dan pengembangan K3LL.
d. To coordinate team members participation and identify improvement through brainstorming./
Mengkoordinasikan partisipasi setiap anggota tim dan mengidentifikasi pengembangan melalui
gagasan-gagasan yang di sampaikan.
e. To implement and monitor progress of HSE Objectives and Targets. / Menerapkan dan
mengawasi perkembangan Tujuan dan Target K3LL.

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f. To take necessary corrective and preventive action to achieve HSE Objectives and Targets./
Melakukan tindakan koreksi dan pencegahan untuk mencapai Tujuan dan Target K3LL.
g. To prepare related Work Instructions (WI), conduct training and education for related
personnel./ Menyiapkan segala yang berhubungan dengan Instruksi-instruksi Kerja,
melaksanakan pendidikan dan pelatihan bagi personil terkait.
h. To ensure compliance to legal and other requirements./ Memastikan telah dipenuhinya semua
hukum dan ketentuan-ketentuan lainnya
i. To present HSE Objectives and Targets during Site HSE Committee Meeting, and Management
Review Meeting./ Menyajikan Target dan Tujuan K3LL selama Rapat Komite K3LL, dan Rapat
Tinjau Ulang Manajemen.
j. Selection of Site HSE Committee members./ Menyeleksi anggota komite K3LL di lapangan
k. To attend Site HSE Committee Meeting./ Menghadiri Rapat Komite K3LL di lapangan
5 Chief HSE/ Pemimpin K3LL
a. To ensure all HSE activities in site concerned./ Memastikan semua aktivitas K3LL di lapangan
diperhatikan.
b. To establish related Procedures (WP) and other related documents on HSE./ Membuat
Prosedur-prosedur dan dokumen lainnya yang berhubungan dengan K3LL.
c. To become secretary of Site HSE Committee./ Menjadi Sekretaris dalam Komite K3LL di
lapangan.
d. To establish statistic on any accidents / incidents in the workplace./ Membuat statistik
kecelakaan dan kejadian di tempat kerja
e. To coordinate and investigate any serious accidents / incidents which has happened in the place
of work./ Mengkoordinasikan dan melakukan penyelidikan terhadap kecelakaan / kejadian
serius yang terjadi di area kerjanya.
f. To establish training and education programme for Site HSE Committee members./
Menyelenggarakan program pendidikan dan pelatihan K3LL untuk anggota Komite K3LL di
lapangan.
g. To identify legal and other requirements./ Mengidentifikasi hukum dan ketentuan-ketentuan
K3LL lainnya.
h. To implement Site HSE Committee meeting./ Melaksanakan Rapat Komite K3LL di lapangan.
i. To attend Site HSE Committee Meeting./ Menghadiri Rapat Komite K3LL di lapangan
j. To attend continuous training on HSE./ Menghadiri pelatihan K3LL yang berkelanjutan
k. To inspect place of work every month./ Menginspeksi tempat kerja setiap bulan
8 HSE Superintendent / Pengawas Utama K3LL
a. Assist Chief HSE to ensure all HSE activities in site concerned. / Membantu Pimpinan K3LL
memastikan semua aktivitas K3LL di lapangan diperhatikan.

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b. Assist Chief HSE to establish related Procedures (WP) and other related documents on HSE./
Membantu Pimpinan K3LL membuat Prosedur-prosedur dan dokumen lainnya yang
berhubungan dengan K3LL.
c. Assist Chief HSE to become secretary of Site HSE Committee./ Membantu Pimpinan K3LL
menjadi Sekretaris dalam Komite K3LL di lapangan.
d. Assist Chief HSE to establish statistic on any accidents / incidents in the workplace./ Membantu
Pimpinan K3LL membuat statistik kecelakaan dan kejadian di tempat kerja
e. Assist Chief HSE to coordinate and investigate any serious accidents / incidents which has
happened in the place of work./ Membantu Pimpinan K3LL mengkoordinasikan dan melakukan
penyelidikan terhadap kecelakaan / kejadian serius yang terjadi di area kerjanya.
f. Assist Chief HSE to establish training and education programme for Site HSE Committee
members./ Membantu Pimpinan K3LL menyelenggarakan program pendidikan dan pelatihan
K3LL untuk anggota Komite K3LL di lapangan.
g. Assist Chief HSE to identify legal and other requirements./ Membantu Pimpinan K3LL
mengidentifikasi hukum dan ketentuan-ketentuan K3LL lainnya.
h. Assist Chief HSE to implement Site HSE Committee meeting./ Membantu Pimpinan K3LL
melaksanakan Rapat Komite K3LL di lapangan.
i. Assist Chief HSE to attend Site HSE Committee Meeting./ Membantu Pimpinan K3LL
menghadiri Rapat Komite K3LL di lapangan
j. Assist Chief HSE to attend continuous training on HSE./ Membantu Pimpinan K3LL menghadiri
pelatihan K3LL yang berkelanjutan
k. Assist Chief HSE to inspect place of work every month./ Membantu Pimpinan K3LL
menginspeksi tempat kerja setiap bulan
6 HSE Supervisor / Pengawas K3LL
a. To assist Chief HSE./ Membantu Pimpinan K3LL

b. To coordinate all HSE activities in site concerned./ Mengkoordinasikan semua aktifitas K3LL di
lapangan
c. To prepare and maintain related Procedures (WP) and other related documents on HSE to
become secretary of Site HSE./ Menyiapkan dan menjaga Prosedur-prosedur dan dokumen
K3LL lainnya dan menjadi sekretaris K3LL di lapangan.
d. To collect, analyze and maintain statistic on any accidents / incidents in the workplace./
Mengumpulkan, menganalisa dan menjaga data statistic kecelakaan / kejadian di tempat kerja
e. To coordinate and investigate any serious accidents / incidents which has happened in the place
of work./ Mengkoordinasikan dan melakukan penyelidikan terhadap kecelakaan / kejadian
serius yang terjadi di tempat kerjanya.
f. To coordinate training and education programme for Site HSE Committee members./
Mengkoordinasikan program pendidikan dan pelatihan K3LL untuk anggota Komite K3LL di
lapangan.
g. To identify legal and other requirements./ Mengidentifikasi hukum dan ketentuan-ketentuan
lainnya.

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h. To coordinate Site HSE Committee meeting./ Mengkoordinasi Rapat Komite K3LL di lapangan
i. Document control for HSE Management System./ Mengawasi dokumen untuk Sistem
Manajemen K3LL
j. To attend Site HSE Committee Meeting./ Menghadiri Rapat Komite K3LL di lapangan.
k. To attend continuous training on HSE./ Menghadiri pelatihan K3LL yang berkelanjutan.
l. To inspect workplace./ Menginspeksi tempat kerja
7. Site HSE Committee Member/ Anggota Komite K3LL di Lapangan
a. To promote cooperation among all levels of management./ Melakukan kerja sama pada semua
tingkatan manajemen
b. To conduct workplace inspection./ Melakukan inspeksi tempat kerja
c. To prepare, review and update HSE Management Programme(s) and other related documents./
Menyiapkan, meninjau ulang dan memperbarui Program Manajemen K3LL dan dokumen-
dokumen yang terkait.
d. To keep under review the measures taken to ensure implementation of HSE in the company./
Meninjau ulang tindakan yang dilaksanakan untuk memastikan penerapan ketentuan K3LL di
perusahaan.
e. To study the trends of accidents / incidents data./ Mempelajari kecendrungan data kecelakaan /
kejadian.
f. To review the effectiveness of HSE management system and programme(s)./ Meninjau ulang
efektifitas program dan sistem manajemen K3LL.
g. To investigate any accidents / incidents which has happened in the worksite./ Melakukan
penyelidikan terhadap kecelakaan / kejadian yang terjadi di tempat kerja
h. To attend any meeting and training related to HSE issues./ Mengikuti rapat dan pelatihan yang
berhubungan dengan masalah K3LL
i. To prepare schedule action plan of HSE program ./ Menyiapkan jadwal rencana tindakan
program K3LL.
j. To conduct internal HSE audits when requested./ Melakukan internal audit K3LL jika diminta.
8. HSE Auditor/ Auditor K3LL
a. Lead auditor to arrange schedule and conduct audits to verify the effectiveness of HSE
Management System Performance./ Memimpin auditor untuk menyusun jadwal dan melakukan
audit untuk memeriksa efektifitas Kinerja Sistem Manajemen K3LL
b. To set Objective / Scope of audit with HSEMR and establish CONTRACTOR audit system with
methodology./ Membuat Tujuan / Lingkup audit dengan HSEMR dan membuat sistem audit
Kontractor dengan sistematis.
c. To communicate audit findings to all concerned personnel./ Menyampaikan temuan audit
kepada personil yang berkepentingan

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d. To submit audit report for Management Review./ Mengumpulkan laporan hasil audit untuk
Tinjauan Ulang Manajemen.
9. HSE Administrator / Administrator K3LL

a. To assist Chief HSE./ Membantu Pimpinan K3LL
b. To prepare and maintain all of HSE Data (total Fatality record, total Man Hour, total Man
Power, total Medical Treatments, total First Aid Case, Work Permit record, etc) at the project
site. / Menyiapkan dan mendokumentasikan seluruh data K3LL (angka laporan kematian akibat
kecelakaan, jumlah Jam Kerja Karyawan, jumlah karyawan, kasus pengobatan yang tercatat,
kasus Pertolongan Pertama Pada Kecelakaan, Data Izin Kerja, dll) di area proyek.
IV. PPE REQUIREMENT/ PERSYARATAN ALAT PELINDUNG DIRI
Personal Protective Equipment that is require to be worn while working in the Workplace, except inside
offices or outside workplace are:
Alat Pelindung Diri yang dipersyaratkan untuk digunakan ketika bekerja di tempat kerja, terkecuali
didalam kantor atau diluar area kerja adalah:
1. Hard Hat as ANSI Z89.1 / SNI / AS NZS or equivalent / Helm berdasarkan ANSI Z89.1 / SNI / AS NZS
atau sejenisnya.
2. Safety Shoes (type: Rigger Boot) as ANSI Z41 or equivalent (For Concrate work, wet work, and land
preparation work use Safety Rubber Boot) / Sepatu Keselamatan (tipe: Rigger Boot) berdasarkan ANSI
Z41 atau sejenisnya (Untuk pekerjaan konkrate, pekerjaan basah dan pekerjaan tanah menggunakan
safety rubber boot).
3. Safety Glasses with side shields as ANSI Z87.1 or equivalent/ Kacamata Keselamatan dengan pelindung
samping berdasarkan ANSI Z87.1 atau sejenisnya.
4. Gloves (leather gloves shall be worn, Welding, leather and cut resistant Kevlar) / Sarung tangan (sarung
tangan kulit harus dipakai pada pekerjaan pengelasan, dan terbuat dari bahan tahan api).
5. Hearing Protection/ Pelindung Telinga
6. Full body harness for work above > 2 m either Sub-contractor or CONTRACTOR./ Full body harness
untuk pekerjaan di ketinggian > 2 m untuk Sub-kontraktor ataupun Kontraktor
7. Welding Goggles/ Kacamata Pelindung untuk aktifitas Pengelasan
8. Face Shields / Pelindung Muka
9. Rain Coat/ Jas Hujan
10. Respirators and Masks/ Alat Pernapasan dan Masker
11. SCBA/ SCBA
12. Sound Level Meter ( SLM)
V. DOCUMENTATION AND DATA CONTROL/ DOKUMENTASI DAN MANAJEMEN DATA

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CONTRACTOR shall establish and maintain all information related to HSE Management System in paper or
electronic form. In order to describe the core elements of the HSE Management System and their interaction
and also to provide information related to those document.
Kontraktor harus membuat dan menjaga semua informasi yang berhubungan dengan Sistem Manajemen
K3LL dalam bentuk kertas atau bentuk file elektronik. Hal tersebut untuk menjelaskan elemen utama dari
Sistem Manajemen K3LL serta interaksinya dan juga menyediakan informasi yang berhubungan dengan
dokumen tersebut
All HSE issues will be documented and the records maintained at the job site. All documentation and records
should be: / Semua masalah K3LL akan didokumentasikan dan catatannya akan disimpan di tempat kerja.
Semua dokumentasi dan catatan-catatan harus:
 Legible/ Dapat dibaca, jelas

 Identifiable / retrievable. / Dapat dikenali / dapat dengan mudah dicari.
 Stored and maintained to avoid loss or damage/ Disimpan dan dijaga untuk mencegah dari bahaya
kerusakan maupun kehilangan
 Retention time / Masa simpan
Documentation and records will include: / Catatan – catatan dan data dokumentasi akan termasuk:
 Environmental and Injury incident and investigation report./ Data tentang serta penyelidikan terhadap
kejadian celaka atau kerusakan lingkungan.
 Loss prevention records. / Data mengenai pencegahan kerugian.
 Equipment inspection records. / Data Inspeksi Peralatan.
 Non-conformance and corrective actions. / Temuan ketidaksesuaian dan tindakan koreksi.
 Training records./ Data Pelatihan.
 Induction records./ Data pelatihan pengenalan K3LL proyek.
The following statistical records will be maintained and recorded on a daily basis and will be documented in
the written minutes from the weekly review meetings:
Catatan statistic dibawah ini akan disimpan dan dicatat dalam catatan kerja harian dan akan
didokumentasikan dalam berita tertulis pada rapat tinjauan ulang mingguan:
- Total Man Hour./ Jam Kerja

- Total Fatality/ Kematian Akibat Kecelakaan
- Total Man Power /Tenaga Kerja
- Total medical treatments./ Kasus pengobatan yang tercatat
- First Aid cases./ Kasus Pertolongan Pertama Pada Kecelakaan
- Revision Date /Tanggal Revisi

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The Project Chief HSE will maintain statistical data in the statistic board HSE summary. A copy of this
statistical data will be submitted to Owner and Contractor home office on a monthly basis.
Pemimpin K3LL akan menjaga data statistic dalam bentuk Ringkasan statistic K3LL. Salinan dari data
statistik ini akan diserahkan pada Pemilik Proyek dan Kantor Pusat Kontraktor dalam laporan bulanan

VI. PROJECT HEALTH SAFETY ENVIRONMENT MANAGEMENT PROGRAM
Procedure /
HSE Activity Plan /
No Appendix Tools What’s to be done? How do we check? Frequency Primary Responsibility
Expectation
Reference
VI.1 Communicate CONTRACTOR HSE Policy and procedures to all employees, sub-contractors, client and other stakeholders as appropriate to ensure they aware of their obligations with respect to
CONTRACTOR’S operation.
1 Conduct orientation / APPENDIX-E Project Induction All project PT. Guna Teguh Abadi, Personal induction record is New hire employees, Construction Manager.
induction for Guideline Subcontractor Staff and visitor maintained. Transferred employees
employees, and visitor
subcontractors and Project Staff Project Chief HSE or HSE
visitors to the site Induction Record Superintendent/ HSE Manager
General Superintendent
2 Conduct regular None Daily Tool Box A HSE discussion for each group on worker Record of Daily Tool Box Every starting of shift Project Supervisor
meetings with Meeting readiness, work plan for that day and Meeting for attendance and work
CONTRACTOR possible JSA. topics.
staff, subcontractors
Site top management have to
and client to discuss
attend this daily tool box
HSE issues
Weekly Construction Construction progress coordination and Minutes of meeting record with Weekly Construction Manager
Meeting discussion meeting, include HSE issues HSE as the first agenda
Safety Committee Discuss HSE issues and Project progress Minutes of Meeting of record Monthly Construction Manager
Meeting and attendance record
3 Conduct periodic None Basic Safety All project personal Basic Safety attendance record Minimum 1 times a Project Manager, Construction
basic safety training Training year. Manager. Project HSE
to communicate Supervisor, Project Chief HSE,
safety to all HSE Superintendent or HSE
employees Manager.
CONTRACTOR and
subcontractor to
communicate our
safety expectation
4 Establish HSE None Safety Notice Board Display all policies, Safety minute of Safety notice boards are placed Monthly Project HSE Officer or HSE
promotional material meeting, review result of inspection, in each work areas and Supervisor
to improve the incidents, audits and others displaying
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Procedure /
HSE Activity Plan /
Expectation
Reference
employee awareness Safety Performance Display project performance review against Safety performance board Update Weekly Project HSE Officer or HSE
boards its objective and target placed in infront of GTA’s Supervisor
office and displaying project
performance review result
Safety Alerts A Safety Alert shall be produced for high Safety Alerts produced and Each occurance Project Manager, Construction
actual or potential incidents displayed Manager, Project Chief HSE or
Follow up all relevant corrective action of Follow up action incorporated As Job condition HSE S Manager,
Project i t d Constructon
t HSE
incoming safety alerts from other projects into the Project HSE Plan require Manager, Project Chief HSE or
HSE Superintendent or HSE
Cautionary and Develop and display relevant cautionary and Cautionary and warning signs Once when it's General Superintendent
Warning Sign warning sign (list of warning sign like tape developed and displayed on the determined
barricade, etc) hazardous work places
VI.2 Comply with all applicable HSE laws, regulations, and statutory obligations.
Ensure that we are GTA-HSE- Legal Gap Analysis Review all relevant legal aspects project such Legal Gap Analysis is At start of project and Project Manager, Construction
fully informed of all DOC-02 Form as: relevant statutory requirements, developed and reviewed. Project as a result of any Manager, Project Chief HSE or
applicable health and contractual requirements and Company HSE procedures or working amendments to HSE Manager
safety laws, requirements instruction may be developed to legislations and client
regulations, statutory fill the gap requirements
obligations and
Company Safety
requirement and
comply with those
laws and regulation
2 Keep abreast of any None Government decrees, Review all changes of those government The changes are identified with Whenever required Construction Manager
changes in laws, articles and reference a specific mark in the Legal Gap
regulation amendments Analysis
VI.3 Ensure that health and safety management and practices are incorporated into all aspects of CONTRACTOR operations
1 We will analyze all 2010-GT-01-04 JSA & Risk Identify all common hazards and risks, which Conceptual Risk Assessment is At start of project / Project Supervisor
areas of our activity Assessment are associated with each project activity developed every starting of job
and identify the risk
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Procedure /
HSE Activity Plan /
Expectation
Reference
rank
2 Where those 2010-GT01-04 Job Safety Analysis JSA must be completed for new jobs and Completed JSA Prior to start of the Project Supervisor
procedures are not high-risk jobs. jobs
applicable or suitable
develop, implement
and maintain specific JSA Review Ensure all JSA's are suited to jobs carried out JSA Review report During the job in HSE Supervisor
workplace procedures progress
to ensure operations Workplace Hazard Carry out workplace hazard inspection for Checklist of workplace hazard As per schedule Project Supervisor and Chief HSE
are conducted in such Inspection each project work area inspection is completed, or HSE Superintendent
a manner that followed up and closed out
eliminates the risk of
injury, illness or
damage.
VI.4 Seek to achieve the personal commitment of all employees, sub-contractors and suppliers to HSE workplace practices.
1 Instigate a workforce HSE-GT-00-03 Project Safety Safety Incentive criteria is established and Safety Performance is Monthly Construction Manager
safety performance Incentive Scheme communicated monitored and reviewed by
incentive scheme None To given reward for the best reporting UAC i
UAC Monthly Report Monthly Construction Manager
d
Involve the workforce HSE-GT-00-03 Project Safety Regular meetings, which attended all member Minutes of meetings is Monthly Project Manager and Construction
2 in the implementation Committee of project safety committee. produced and communicated. Manager
of the safety program
through the formation Regular inspection or Management Walk A checklist for this inspection is Monthly Chief HSE or HSE Superintendent
of a workplace safety Through Inspection, which are to carried out developed and completed
committee by all member of project safety committee.
3 Provide Leadership HSE-GT-00-03 Workplace Hazard All signatories carried out a workplace A checklist of this inspection is Monthly Construction Manager, Project
on all issues of safety Inspection hazard inspection for their own area of completed, followed up and General Superintendent, Project
management Project Safety All signatories take a part in Project Safety Signatories attended on meeting Monthly Construction Manager
Committee Committee, if appointed as a member of it and recorded. Take a part on
inspection
Tool Box Meeting All signatories involved in this meeting on Signatories attended on meeting Daily All Signatories. Project
their own area of responsibility and recorded. Supervisor and HSE Supervisor /
I t

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Procedure /
HSE Activity Plan /
Expectation
Reference
Safety Talks All signatories involved in this meeting. Signatories attended meeting Monthly All Signatories. Project S/V and
Weekly Construction All signatories involved in this meeting , with Signatories attended on meeting Weekly Construction Manager
Meeting "safety" as the first agenda of meeting. and recorded.
Internal Safety Audit All signatories carry out Internal Safety Internal Safety Audit record Monthly Construction Manager, Project
Audit (including sub-contractors) General Superintendent, and
Chief/Superintendent or HSE
Manager.
VI.5 Provide HSE risk management systems and procedures that are relevant to the nature and scale of work undertaken
1 Ensuring that APPENDIX-E Standard Instruction Developing specific standard instruction or Standard Instruction is All works shall Project General Superintendent,
operations are carried Work Permit A restriction and limitation to personnel in Excavation Permit, Working at As required Project General Superintendent,
out according to carrying out the works known as a high risk Height Permit, Radiography Project Supervisor, and HSE
standard Job Safety Analysis JSA must be completed for new jobs, risk Completed JSA (Job Safety Prior to Project Supervisor
CONTRACTOR (JSA) jobs, or jobs that are not covered by SOP or Analysis) commencement of the
procedures Standard Instruction prior to commencement jobs
JSA Review Ensure all the jobs are carry out in JSA Review report, Updated During the job in HSE Supervisor
accordance to JSA JSA revision number progress
Pre-start inspection Inspection of all equipment and tools must be Checklist completed Before mobilize to site HSE and Project Supervisor
carried out before mobilize to site
2 Risks to health, safety None Pre-start inspection Inspection of all equipment must be carried Checklist completed Before mobilize to site Operators, Project supervisor
and environment will out
Preventive All plant and equipment are scheduled for Checklist completed As per Schedule Project GSI and Mechanical
be dealt with by
Maintenance maintenance Supervisor
elimination, or
Inspection
removal, substitution,
design, redesign, or Workplace Hazard Carry out workplace hazard inspection A checklist of this inspection is weekly Project Supervisor and HSE
separation, Inspection regularly completed and closed out Supervisor
administrative and
personal protection
3 Provide risk 2010-GT-01-04 Job Safety Analysis JSA must be completed for new jobs, risk Completed JSA Prior to Project Supervisor
identification and jobs, or jobs that are not covered by SOP or commencement of the
management in their JSA Review d all
Ensure d the jobs i are carry out suited to JSA JSA Review report, Updated j b
During the job in HSE Supervisor
work areas JSA revision number progress

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Procedure /
HSE Activity Plan /
Expectation
Reference
Hazard Reporting Supervisory staff to enforce the reporting of Hazard report is produced. Every Day Project Supervisor, HSE Inspector
hazards that may arise before, during and Hazard register is maintained.
after the works Corrective Action is recorded
4 Ensuring that 2010-GT-01-05 Standard Instruction Developing environment standard instruction Standard Instruction is All works shall Project General Superintendent,
operations are carried or review existing or template environment developed, communicated and covered by standard Project Supervisor, and HSE
out according to standard instruction to be suited to the works maintained instruction Supervisor.
environmental
standard
VI.6 Set measurable targets and seek to continually improve our HSE performance
1 Set the Safety None Project Safety To do better than the corporate target: LTIFR Safety Statistic Performance Monthly Construction Manager
Performance targets Performance Target = 0 and LTISR = 0, with Fatality=0, Medical
for the project Treatment < 0, Property Damages < 0,
Environmental Damage <0, First Aid < 24
Audit internal project minimum 1 sub- Target is reviewed and Monthly Construction Manager
contractor per month communicated
VI.7 Periodically review and revise our HSE Policy and procedure to maintain CONTRACTOR relevance
1 Conduct assessment None Assessment HSE Formal review of the implementation HSE Action plan from the review Every 2 months or as Corporate HSE Manager and GM
and review of key Management System Management System and performance required QC-HSE
personal HSE in Checklist Project Manager or Chief HSE
implementing HSE
Management System
Internal Safety Every workplace shall be evaluated against Internal site HSE audit Monthly General Superintendent and
Evaluation the HSE plan by internal audit Project Chief HSE or HSE
Manager
VI.8 Prepared for emergencies and response quickly, effectively and with care to incidents resulting form CONTRACTOR operation
1 Undertake and 2010-GT-01-01 Emergency Develop emergency response plan and Plan’s are regularly reviewed. Every Six-Month/As Construction Manager, Project
establish Emergency Response Plan maintain its preparedness and equipment The preparedness emergency per need Chief HSE or HSE Superintendent
Preparedness First Aid Training Minimum of 10% of workforce and or ERP Review Training Record As per schedule Construction Manager, Chief HSE
Team or HSE Superintendent
Rehabilitation Plan Ensure that rehab plan is developed and Completed Rehab Plan Every Rehabilitation Construction Manager, Project
agreed to by employee Case Chief HSE or HSE Superintendent
VI.9 Prepared for Exercise Program
1 Conduct Exercise None Gym or Exercise All signatories involved in this Gym or Signatories attended this Gym Weekly Construction Manager, Project
Program Exercise or Exercise Chief HSE or HSE Superintendent

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Procedure /
HSE Activity Plan /
Expectation
Reference
VI.10 Rules and Regulation At Site
1 Prohibited smoking at None Safety Notice Board All project PT. Guna eguh Abadi Staff, Result of Monitoring Monthly Construction Manager, Project
office site and and Project Subcontractor Staff and visitor Chief HSE or HSE Superintendent
working area, use Induction
drug and alcohol and
carry weapon
VI.11 Accident Investigation and Reporting
1 Conduct Accident 2010-GT-01-02 Accident All Major Accident and Minor Accident Completed Accident As per Event Chief HSE or HSE
Investigation Investigation Form (First Aid) Investigation Form Superintendent, Construction
Manager
2 Regular report None Accident Reporting All Major Accident and Car Accident Completed Accident Reporting 1 x 24 Hours Chief HSE or HSE Superintendent
Accident Form Form
VI.12 Safety Awareness Program

1 In encourage Safety None Unsafe Act and All unsafe act and unsafe condition shall be Completed Unsafe Act and Daily All Internal PT. Guna Teguh
Behavior Awareness, Unsafe Condition reported Unsafe condition Form Abadi Project Team
will request to our Form Construction Manager
employee to report all
unsafe act and unsafe
condition
2 To supervise of None HSE Report Form Implementation HSE Management System, Completed HSE Report Form Monthly Chief HSE or HSE Superintendent
implementation HSE Man-Hours, Man-power, Total Accident for
Management System all employee of PT. Guna Teguh Abadi and
at project site by All Subcontractor
provide HSE Report
VI.13 Health Program
1 Conduct General Project Spec General Medical All employee of PT. Guna Teguh Abadi who Result of General Medical As required Project Manager and Construction
Medical Check-up for Check-up Form assign to the Project Check-up Manager
all new employee of
PT. Guna Teguh
Abadi
2 Conduct Pest Project Spec Record of PT. Guna Teguh Abadi and Sub contractor Check the record Every 6 month or more Construction Manager
Control/ Industrial implementation the Camp facilities and Work Area often depend on
Hygiene Recognition insect and pest Government Authority

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Procedure /
HSE Activity Plan /
Expectation
Reference
and Control nuisance requirement.
3 Conduct Canteen Project Spec Canteen Inspection Canteen Facilities The food hygiene and nutrition Every 3 month or more Paramedic Supervisor
Inspection Form often depend on
Government Authority
requirement.
VI.15 PROJECT ENVIRONMENTAL OPERATION PROGRAM
Environmental Activity Procedure / Appendix

No What’s to be done? How do we check? Frequency Primary Responsibility
Plan Reference
1 Communicate Contractor 2010-GT-01-03, All project PT. Guna Teguh Abadi Induction record, Record daily tool As required Construction Manager, Project
Environmental Policy & APPENDIX E staff, subcontractor staff and visitor box meeting, minute of meeting and Chief HSE or HSE Superintendent
Procedure attendance all HSE Meetings
2 Establish Environmental None Display in HSE notice board, in HSE Display all promotional material in Refer to HSE Management Project HSE Supervisor
promotional material to performance board, produced best area Plan
improve the employee environmental alerts and produced
awareness warning sign
3 Analyze all areas of our APPENDIX-01-D Identify all common hazards and Conceptual Risk Assessment is At start of project / every Project Supervisor
activity and identify the risk risks, which are associated with each developed starting of job
rank project activity use JSEA and Risk
Assessment
4 Undertake and establish 2010-GT-01-01 Develop emergency response plan Plans are regularly reviewed. The Once a year for Fire Drill and Construction Manager, Project
emergency preparedness and maintain its preparedness and preparedness emergency equipment Twice a year for Emergency Chief HSE or HSE Superintendent
equipment is checked regularly Response Drill
6 Conduct accident 2010-GT-01-02 All major and minor accident Complete accident and investigation As per event for investigation Project Chief HSE or HSE
investigation and reporting form and 1 x 24 hours for accident Superintendent, and Construction

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Environmental Activity Procedure / Appendix

No What’s to be done? How do we check? Frequency Primary Responsibility
Plan Reference
reporting Manager
7 Rules & Regulation at site: APPENDIX-3 All project PT. Guna Teguh Abadi Result of monitoring Monthly Project Chief HSE or HSE
No smoking, use drug and staff, Subcontractor staff and visitor Superintendent, and Construction
alcohol and carry weapon Manager
8 Encourage behaviour None All unsafe act and unsafe condition Complete unsafe act and unsafe Daily All internal PT. Rekayasa Industri
awareness condition form Project Team
VII. HSE ACTIVITY PLAN PROJECT
SCHEDULE
DAY WEEK MONTH

PROGRAM
No ELEMENT PIC REMARKS
/ACTIVITY
Thurs
Mon
Wed
2nd
Tue
3th
4th
Sat
1st
Fri
1 2 3 4 5 6 7 8 9 10 11 12
a) Provide HSE Construc-tion

1 LEADERSHIP When starting project
Committee Manager
b) Monthly HSE Construc-tion Every months
Committee Manager (Saturday 2nd

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SCHEDULE
DAY WEEK MONTH

PROGRAM
/ACTIVITY
Thurs
Mon
Wed
2nd
Tue
3th
4th
Sat
1st
Fri
1 2 3 4 5 6 7 8 9 10 11 12
meeting week)
c) Weekly HSE
Chief HSE /
internal meeting on Monday,
HSE
with all HSE Spv every week
Superintendent
and Inspector
a) Basic Safety Mgr / Chief
2 TRAINING Internal
Training HSE
b) Eksternal training
Paramedic Eksternal
(Basic First Aid )
c) Regular Safety
Training at
Project Site:
Behavior Base Mgr / Chief
Eksternal
Safety (BBS) HSE
Mgr / Chief
Defensive Driving Eksternal
HSE
Mgr / Chief
Scaffolding Eksternal
HSE
Mgr / Chief
Rigging and Lifting Eksternal
HSE
Mgr / Chief
Job Safety Analysis Internal
HSE
Mgr / Chief
Electrical Safety Eksternal
HSE
Fire Emergency Mgr / Chief
Eksternal
Evacuation HSE

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SCHEDULE
DAY WEEK MONTH

PROGRAM
/ACTIVITY
Thurs
Mon
Wed
2nd
Tue
3th
4th
Sat
1st
Fri
1 2 3 4 5 6 7 8 9 10 11 12
d) Basic First Aid Before Assignt to

Mgr HSE
(HO) Project
a) Standard
MANAGEMENT
3 SUB-CONT
Instruction Chief HSE
socialisation
b) Key Performance
Indicator Chief HSE on 7, every month
Assessment
c) Conduct daily
HSE Spv
regular inspection
Chief HSE /
d) Plan area on wed, every
HSE
inspection week
Superintendent
a) Establish work
permit for
Chief HSE Based on project site activities
HSE operation
control
b) Daily Hazard
HSE S/V Daily
Assessment
c)Environmental
Mgr / Chief
Monitoring & Based on EIA (AMDAL) requirement
HSE
Control
d) Fume and Dust Mgr / Chief
Two Times a year
Monitoring HSE
a) Daily work area
5 INSPECTION HSE Spv Daily reporting
inspection

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SCHEDULE
DAY WEEK MONTH

PROGRAM
/ACTIVITY
Thurs
Mon
Wed
2nd
Tue
3th
4th
Sat
1st
Fri
1 2 3 4 5 6 7 8 9 10 11 12
b) Weekly plan on wed, every

Chief HSE
inspection week
c) Fire extinguisher on 1-4th, every
HSE Spv
inspection month
General safety talk

d) PPE inspection HSE Spv
3rd week
e) Equipment
Mgr / Chief /
inspection before
Superintendent Based on project site needs
delivery to
HSE
project site
f) Heavy equipment
Every Three
inspection at HSE Spv
Month
project site
g) Cable and Sling Every Three

HSE Spv
inspection Month
h) Machinery
HSE Spv Every Two Month
Inspection
i) Hose for Pressure

HSE Spv Every Week
Bottle Inspection
j) Hand Tool
HSE Spv Every Two Month
Inspection

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SCHEDULE
DAY WEEK MONTH

PROGRAM
/ACTIVITY
Thurs
Mon
Wed
2nd
Tue
3th
4th
Sat
1st
Fri
1 2 3 4 5 6 7 8 9 10 11 12
a) Safety induction
and training
(Basic Safety Mgr / Chief
6 COMMUNICATION Based on project site needs
Training) for new HSE
employee and
visitor
b) Daily Tool Box Before starting the
Spv or Foreman
Meeting jobs
Chief HSE /
c) Weekly general Before starting the
HSE
safety talk jobs
Superintendent
d) HSE Committee 2nd week every

Project Manager
meeting month
d) Safety promotion
Chief HSE /
by banner, safety 1st week, every
HSE
sign board & month
Superintendent
bulletin
e) Safety statistic 1st week,
HSE Adm
board everyweek
f) Green card
GTA’s All 5 Reports of UAC
(pelaporan UA &
Department permonth
UC) program
a) Provide fire and
EMERGENCY Mgr / Chief
7 RESPONSE
emergency rescue Provide by Main Contractor When Starting Project
HSE
team

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SCHEDULE
DAY WEEK MONTH

PROGRAM
/ACTIVITY
Thurs
Mon
Wed
2nd
Tue
3th
4th
Sat
1st
Fri
1 2 3 4 5 6 7 8 9 10 11 12
a) Conduct Accident
investigation Mgr / Chief If Accident
8
INVESTIGATION for minor and HSE Happen
AND ACC. major injury
REPORT
b) Reporting minor Chief HSE /
If Accident
and major injury HSE
Happen
(1x24 jam) Superintendent
a) Provide weekly HSE Spv &
The end of the
9 DOCUMENTATION HSE activities HSE
week
report Superintendent
b) Provide monthly
Mgr HSE
safety report
c) Review HSE
the end of the
Documenta-tion Mgr HSE
month
System
a) Award to all
employees for
REWARD AND 1.000.000 Construction
10 PUNISHMENT man-hour without Base on Man-Hours Project
Manager
Lost Time Injury
b) Award that show

good performance Construction last week of the
in Monthly Manager month
Evaluation

CO No :
REV
DOCUMENT NO. 0
DATE BY CHKD APVD
23 Jul 13 ARN WR KH
SCHEDULE
DAY WEEK MONTH

PROGRAM
/ACTIVITY
Thurs
Mon
Wed
2nd
Tue
3th
4th
Sat
1st
Fri
1 2 3 4 5 6 7 8 9 10 11 12
c) Monthly award to
employee that
Construction last week of the
show safety
Manager month
behaviour /
reporting UA/UC
d) Punishment to all
employee that
show bad Chief HSE
condition in HSE
performance

STANDARD INSTRUCTION FOR PERSONAL
PROTECTIVE EQUIPMENT
PUSRI – II B PROJECT Doc. No. Date:

APPENDIX B 23 July 2013
TABLE OF CONTENT
Daftar isi
Page
1.0 INTRODUCTION Pendahuluan 2
2.0 PURPOSE Tujuan 2
3.0 RESPONSIBILITY Tanggung Jawab 2
4.0 STANDARD INSTRUCTION Instruksi standar
4.1 Mandatory PPE Alat Pelindung Diri yg wajib dipakai

4.2 Controlling Hazards Pemeriksaan Sumber Bahaya 2
4.3 Factor Affecting Use Factor dari dampak penggunaan
4.4 Issuing, Using, Wearing and Looking After PPE
Pengeluaran, Penggunaan, Pemakaian dan setelah APD 3
4.5 Head Protection Pelindung Kepala 3
4.6 Eye Protection Pelindung mata
4.7 Hearing Protection Pelindung pendengaran 4
4.8 Foot Protection Sepatu Keselamatan
4.9 Whole Body Protection Pelindung seluruh tubuh 4
4.10 Hand Protection Pelindung tangan
4.11 Respiratory Protection Pelindung pernafasan 5
4.12 Fall Protection Pelindung dari jatuh 6
PT. Guna Teguh Abadi Page 1 of 10 Doc.APPENDIX B


1.0 INTRODUCTION Pendahuluan
1.1 This standard instruction covers the types of Personal Protective Equipment (PPE) that
may need to be worn on worksites.
Instruksi standar ini meliputi semua jenis Alat Pelindung Diri yang mungkin diperlukan
dilokasi
1.2 This standard instruction is applicable to all employees of PT. Guna Teguh Abadi.
Employees who exposed to the hazardous condition are compulsory to wear the
suitable of PPE. It is our prime concern to provide full protection facilities towards our
employees and related parties.
Instruksi standard ini digunakan untuk seluruh karyawan PT. Guna Teguh Abadi. Karyawan yg
dimaksud adalah karyawan yang kontak langsung dengan kondisi-kondisi berbahaya dan
mengharuskan menggunakan alat pelindung diri yang sesuai. Ini adalah dasar dasar Utama
kami untuk menyediakan alat pelindung diri untuk karyawan dan relasi lain yang terkait
2.0 PURPOSE Tujuan
2.1 To acknowledge our employees regarding the area required wearing PPE.
Dasar pengetahuan bagi para karyawan dalam menentukan Alat Pelindung yang harus
digunakan
2.2 To know the types of PPE available at PT. Guna Teguh Abadi for the head, face,
eyes, hands, arms, fingers, and body and foot protection.
Untuk mengetahui jenis alat pelindung yang tersedia di PT. Guan Teguh Abadi untuk
melindungi kepala, muka, mata, tangan, lengan, jari, dan tubuh juga kaki.
2.3 To overcome employees objections to use PPE and educate them about the importance
of such gear.
Untuk mengatasi keengganan karyawan dalam menggunakan Alat Pelindung Diri dan
membina mereka tentang pentingnya alat pelindung tersebut.
2.4 To provide a guidance pertaining PPE requisition, distribution and inventory.

Sebagai alat petunjuk sistim permintaan, pendistribusian dan penyimpanan (pendataan untuk
Alat pelindung Diri)
3.0 RESPONSIBILITY
TANGGUNG JAWAB
3.1 The Project Manager shall be responsible for the contents of this standard instruction.
Pimpinan Proyek bertanggung jawab mengenai isi Standar Instruksi tersebut
The Chief HSE concerned is responsible to ensure that this procedure is followed
within PT. Guna Teguh Abadi worksite .
HSE bertanggung jawab untuk memastikan bahwa prosedur ini dijalankan di setiap lingkungan
kerja disetiap proyek PT. Guna Teguh Abadi.


3.2 Chief HSE shall advise on compliance to legal and other requirements.
Pimpinan Safety akan memberikan saran mengenai ketentuan hukum yang berlaku dan
ketentuan lainnya.
3.4 All employees concerned are responsible to comply with this standard instruction.
Setiap karyawan bertanggung jawab dalam melaksanakan intruksi standar ini
4.0 STANDARD INSTRUCTION
4.1 Mandatory Personal Protective Equipment

Alat Pelindung Diri yang wajib digunakan
All personal who work in PT. Guna Teguh Abadi project must be worn mandatory
PPE. The standard PPE that must be worn are:
Setiap karyawan yang bekerja di Proyek PT.Guna Teguh Abadi harus menggunakan alat
pelindung diri yang diwajibkan, antara lain:
1. Head Protection: ANSI Standard No. Z89.1 1997 or equivalent.

Pelindung Kepala.
2. Foot Protection : European Harmonised Standard BSEN 345: 1993 or equivalent.

Pelindung Kaki (sepatu keselamatan)
3. Eye Protection : ANSI Standard No. Z87.1 or equivalent.

Pelindung Mata
4. Ear Protection : Australian/New Zealand Standard AS/NZS 1270:1990 or

equivalent
Pelindung Pendengaran
5. Fall Protection : ANSI Standard

Pelindung dari Jatuh / Pelindung bekerja diketinggian
4.2 Controlling Hazards

Mengendalikan sumber bahaya
4.2.1 Employees who must work in hazardous area should use PPE, which can
protect themselves from head to toe.
Setiap karyawan / kontraktor yang bekerja area yang berbahaya harus
menggunakan/memakai alat pelindung diri yang sesuai standard, dari Kepala s/d
kaki.
4.2.2 To develop an effective PPE programme, our employees should:

Dalam mengembangkan Program penggunaan PPE yang evektif Karyawan harus:
a) Be familiar with related legal and other requirements.
Membiasakan diri dengan peraturan dan ketentuan lainnya.
b) Be able to identify hazards.

Mampu mengidentikasi sumber bahaya
c) Be familiar with the safety equipment given to protect against the specific
hazards.

Membiaskan diri dengan Peralatan Keselamatan Kerja yang dapat melindungi

dari bahaya-bahaya tertentu.
d) Develop effective safety awareness to convincing ourselves to dress safely

and to wear proper protective equipment.
Mengembangkan kepedulian akan Keselamatan Kerja dan menyakinkan diri kita
untuk selalu menggunakan Peralatan Keselamatan Kerja yang sesuai.
e) Review all MSDS that require PPE for protection against hazardous
chemicals and materials.
Memeriksa ulang setiap MSDS untuk menentukan alat pelindung diri mana yang
sesuai apabila bersentuhan dengan bahan kimia atau material yang berbahaya.
f) Consider establishing an industrial hygiene evaluation procedure to

determine whether PPE is needed to meet MSDS requirements.
Mertimbangankan prosedur evaluasi kesehatan industri untuk menentukan PPE
apakah yang dibutuhkan dan memenuhi standard MSDS..
4.3 Factor Affecting Use

Faktor efektiditas penggunaaan.
4.3.1 A good fit is required to ensure full protection.

Kondisi APD yang baik untuk memenuhi standar keselamatan.
4.3.2 Factor affecting use include period of use, comfort, maintenance, training,
interference, and storage.
Faktor efektifitas penggunaan termasuk periode penggunaan, kenyaman, pelatihan,
perawatannya dan penyimpanannya
4.4 Issuing, Using, Wearing and Looking After PPE

Permintaan, Pengunaa, Pemakaian dan Pemeliharaan APD
4.4.1 PPE is given out on a personal basis to all workers who are exposed to safety
hazards at the sites where they work by HSE Unit.
APD diberikan secara individual kepada seluruh karyawan yang bersentuhan dengan
lokasi kerja yang berbahaya dimana mereka bekerja bersama unit HSE
4.4.2 Workers must sign for the receipt of the PPE issued to them, using Personal
Protective Equipment (PPE) Requisition.
Para pekerja harus menandatangani tanda terima penyerahan APD.
4.4.3 When PPE is issued to a worker they will be given instructions on how to fit,
use and look after their PPE.
Penyerahan APD pada para pekerja diikuti oleh pemberian instruksi bagaimana cara
penggunaannya dan pemeliharaannya.
4.4.4 When PPE is given to workers because of hazards at the sites they must wear
the PPE at all times.
APD diberikan kepada para pekerja karena lokasi kerja yang berbahaya dan harus
selalu digunakan.


4.4.5 Where a special safety or health hazard exists and a special item of PPE is
needed, this will be issued for that task. Workers will be given special
instruction in the use of this PPE if they have not used it before.
Apabila APD khusus harus digunakan di lokasi kerja, maka pekerja akan diberikan
petunjuk khusus dalam penggunaannya apabila mereka belum pernah
menggunakannya sebelumnya.
4.4.6 Workers are required to look after their PPE. When the PPE becomes damaged
or worn, it should be replaced.
Pekerja diharuskan untuk menjaga APD mereka. Apabila telah rusak harus diberikan
penggantinya.
4.4.7 Site HSE Committee need to record in Personal Protective Protective

Equipment (PPE) Distribution for individual record.
Komite HSE lapangan perlu mendokumentasikan pendistribusian APD per individu.
4.4.8 Site HSE Committee shall update Personal Protective Equipment (PPE)
Inventory if necessary.
Komite HSE Lapangan harus memperbaharui inventaris APD jika diperlukan.
4.4.9 PT. Guna Teguh Abadi shall be responsible to provide adequate PPE for their
own workers and kept as record.
PT. Guna Teguh Abadi bertanggung jawab dalam penyediaan APD bagi perkerjanya
dan menyimpan catatan pendistrubusiannya.
4.4.10 All visitors will be loan adequate PPE during visit to the site by Security /
HSEO / HSE Committee.
Security/Komite HSE akan meminjamkan APD pada Tamu yang berkunjung dan
selama kunjungannya ke lapangan.
4.5 Head Protection

Pelindung Kepala
4.5.1 All workers must wear safety helmet at all times in working area on the site.
Semua pekerja harus selalu menggunakan Helm Keselamatan selama mereka berada
di area kerja.
4.5.2 Cracked, badly scratched or damaged safety helmet must be handed in for
replacement.
Retak, Goresan yang parah atau kerusakan helm keselamatan harus di serahkan dan
diganti yang baru.
4.5.3 All safety helmets must have internal straps so that they can be properly
adjusted to make a good fit to the head.
Semua helm keselamatan harus memiliki alat pengatur agar penggunaannya nyaman
dan pas di kepala.
4.5.4 When working at height all workers must wear chinstraps to stop the hard hat
from falling off.
Ketika bekerja diketinggian seluruh pekerja harus menggunakan pengikat pada helm
keselamatannya agar tidak terjatuh dari ketinggian pada saat digunakan.

4.6 Hearing Protection

Pelindung Pendengaran.
4.6.1 When exposed to high noise levels permanent hearing loss can occur. Serious
site noise hazards must be identified and steps taken to control or reduce the
hazard.
Kerusakan pendengaran permanen dapat terjadi jika telinga terpapar dengan
intensitas suara yang tinggi. Sumber bahaya kebisingan harus diidentifikasi dan
dibuatkan langkah penanganan untuk mengurangi akibat dari bahaya tersebut
4.6.2 If possible, relocate noisy equipment away from places where people are
working.
Jika memungkin, segera pindahkan sumber kebisingan dari tempat kerja
4.6.3 Noisy machinery should have effective silencers fitted or be upgraded and
screened to reduce noise levels as much as possible.
Sedapat mungkin upgrade peredam suara untuk mengurangi kebisingan yang
ditimbulkan
4.6.4 When there are no suitable steps that can be taken to reduce the noise a
warning sign will be put up making sure that every worker wears hearing
protection in that area.
Jika langkah untuk mengurangi kebisingan tidak memungkinkan lagi dilakukan,
segera pasang tanda peringatan agar karyawan menggunakan alat pelindung diri
4.7 Foot Protection

Pelindung kaki
4.7.1 As there are many hazards on sites that can cause injuries to feet, all people
working on or visiting a site, must wear safety footwear.
Terdapatnya sumber bahaya di lokasi site mengakibatkan semua orang yang bekerja
di site wajib menggunakan sepatu keselamatan
a) Use safety boots where support and protection for the ankle is required.
Penggunaan sepatu keselamatan diperlukan untuk melindungi kaki dan bagian
kaki lainnya
b) All safety footwear must have ‘built-in’ steel toecaps and sole plates.
Semua sepatu keselamatan harus dilengkapi dengan besi dan plat pelindung
c) Waterproof boots must be worn when working in water or wet concrete.

Sepatu tahan air harus dipergunakan ketika bekerja dilokasi berair atau
pengecoran
4.7.2 The main hazards to feet come from heavy objects falling or being dropped on
the feet. In addition there are sharp objects that protrude from the ground or
from timber (nails) that can penetrate the soles of ordinary footwear.
Bahaya utama untuk kaki bersumber dari tertimpa benda berat atau kaki menabrak
benda. Bahaya lain adalah kaki tertusuk benda tajam dari tanah atau paku yang
menembus alas sepatu

4.7.3 Walking over uneven ground on construction sites can also be unsafe. Safety
footwear can help to support the ankle and prevent serious injuries.
Melakukan aktivitas berjalan di lokasi kontruksi dapat merupakan pekerjaan yang
berbahaya. Sepatu keselamatan dapat melindungi pergelangan kaki dan mencegah
cidera yang serius
4.8 Whole Body Protection

Perlindungan untuk tubuh keseluruhan
4.8.1 Where hazardous substances, or dirty materials are used, e.g. paint, grease etc.,
suitable overalls must be worn. Overalls protect the skin from substances that
may soak through ordinary clothing. Some substances used on sites are
harmful when absorbed through the skin e.g. diesel fuel.
Ketika bahan berbahaya atau material yang kotor digunakan seperti cat, grease (
gemuk) pakaian kerja terusan harus digunakan. Pakaian kerja terusan melindungi
kulit dari bahaya yang tidak dapat dilindungi pakaian biasa. Beberapa bahan yang
digunakan di site merupakan bahan berbahaya seperti minyak diesel.
4.8.2 Overalls should be reasonably close fitting. Loose or torn clothing may be
caught in machinery or tools being used.
Pakaian kerja terusan harus pas dibadan. Pakaian kebesaran atau terlalu ketat dapat
menyebabkan pakaian tersangkut mesin
4.8.3 Do not allow towels or rags to hang from pockets.

Jangan menggantung handuk atau lap didalam kantong
4.8.4 Oil or other flammable liquids spilled on overalls are a fire hazard – change
overalls immediately.
Minyak atau cairan mudah terbakar yang tumpah dipakaian kerja merupakan sumber
bahaya kebakaran – segera ganti pakaian kerja
4.8.5 When working in the rain or in wet conditions waterproof coats will be
provided and worn.
Jas hujan harus dipakai ketika bekerja di kondisi hujan atau lembab
4.9 Hand Protection

Pelindung tangan
4.9.1 Injuries to hands can be avoided with the use of appropriate gloves.
Cidera pada tangan dapat dicegah dengan menggunakan sarung tangan yang sesuai
4.9.2 Suitable gloves need to be used whenever there is a risk of injury from
handling or using sharp tools, abrasive materials or hazardous materials
(chemicals).
Sarung tangan yang sesuai perlu dipakai ketika terdapat sumber bahaya dari
penggunaan peralatan yang tajam, kasar atau bahan berbahaya ( kimia).
4.9.3 Gloves must be replaced when they become holed, worn or saturated with
solvents or other materials or substances.


Sarung tangan harus diganti ketika sobek, bekas digunakan untuk bahan kimia atau
bahan lain yang berbahaya
4.9.4 Sometimes wearing gloves may be hazardous, e.g. when working close to in-
running rollers or using rotating hand tools.
Terkadang menggunakan sarung tangan dapat berbahaya contoh ketika bekerja
didekat benda yang berputar atau menggunakan peralatan jenis berputar
4.10 Respiratory Protection

Pelindung pernafasan
4.10.1 There are a number of materials and substances used on construction sites that
can cause health hazards when they are inhaled. Gases can be toxic, or cause
asphyxiation (by excluding oxygen).
Terdapat beberapa bahan berbahaya yang digunakan di lokasi konstruksi yang dapat
mengakibatkan gangguan kesehatan ketika menghirupnya. Bahan jenis gas dapat
bersifat racun, atau dapat menyebabkan gangguan pernafasan ( selain oksigen).
4.10.2 Where operations at the site give rise to hazardous or toxic gases or fumes, the
first steps will be to ensure that suitable extraction / ventilation equipment is
used to control the level of fumes in the immediate area where the workers are
working.
Ketika suatu pekerjaan di lokasi site menggunakan bahan jenis gas berbahaya,
langkah pertama yang dilakukan adalah memasang peralatan ventilasi untuk
mengurangi bahaya yang terdapat dilokasi kerja
4.10.3 Where there is a need for further protection, appropriate respirators and
breathing apparatus must be used.
Jika diperlukan perlindungan lebih lanjut, penggunaan respirator atau alat Bantu
pernafasan harus digunakan
4.10.4 If work has to be done in confined spaces, only competent respirators and
breathing apparatus must be used.
Jika pekerjaan harus dilaksanakan di ruang tertutup, hanya respirator dan alat bantu
pernafasan yang standard yang boleh digunakan
4.10.5 If work has to be done in confined spaces, only competent workers will be
employed and permit to work systems will be used as per Entry Into
Confined Space Management.
Jika pekerjaan harus dilaksanakan di ruang tertutup, hanya pekerja yang
berkompeten yang boleh bekerja dan sebelumnya harus memilki ijin kerja di ruang
tertutup
4.10.6 Where noxious gases are present, suitable emergency rescue equipment must
be kept on site.
Peralatan emergency harus disiapkan dilokasi site jika terdapat gas berbahaya
4.10.7 Only trained and competent workers are allowed to use self-contained
breathing apparatus (SCBA).
Penggunaan SCBA hanya boleh digunakan oleh karyawan yang berkompeten dan
telah mendapat training


4.10.8 Where abrasive-blasting or similar work is carried out, positive pressure

powered respirators must be used.
Jika pekerjaan pengelasan atau penggosakan, karyawan wajib menggunakan tekanan
positif respirator
4.11 Fall Protection

Pelindung dari jatuh
4.11.1 When working at a place where there is a risk of falling more than 3 metres,
safety belts must be used. If the fall risk is high, a safety belt / harness must be
worn.
Ketika bekerja diketinggian lebih dari 3 meter, safety belt harus digunakan. Jika risiko
jatuh tinggi, safety belt atau safety harness harus di pakai
4.11.2 A competent person must regularly inspect safety belts / harness for defects.
Safety belt atau safety harness harus diinspeksi secara berkala oleh orang yang
berkompeten
4.11.3 Before using a safety belt / harness, it should be carefully checked for defects,
paying attention to snap hook latches.
Inspeksi terhadap safety harness atau safety belt harus dilaksanakan sebelum
digunakan, terutama pada bagian hook latches
4.11.4 Before placing any weight on safety belt / harness check that:
Sebelum membebani safety harness maka perlukan dilakukan pemeriksaan pada:
a) The lifeline snaps hook is properly engaged.
Tali keselamatan dan hook terpasang dengan baik
b) The lifeline is attached to a secure part of the structure so that it cannot slip
off.
Tali keselamatan dipasang pada bagian kuat dan stabil sehingga tidak mudah
terlepas
c) The safety line will not become caught or snagged when moving around.
Tali keselamatan bukan merupakan pegangan ketika sedang berjalan diatas
ketinggian
4.11.5 Workers working from a sky lift or an elevating scissor – lift vehicle:
Pekerja yang bekerja dengan menggunakan lift atau elevator – alat angkat
a) Must attach their belts by the safety line to a secure part of the man hoist or
platform.
Harus memasang sabuk keselamatan untuk memastikan keselamatan dalam
platform.
b) Must not attach them selves to an adjacent structure or other piece of
equipment.
Tidak boleh bergantungan pada bagian kontruksi yang tidak stabil atau bagian
lain yang mudah terlepas
c) Must not attach them selves to an adjacent bucket, if working on another
structure or piece of equipment.
Tidak boleh bergantung ember atau bagian lain yang tidak stabil
4.11.6 Workers working on fixed platforms do not need to wear safety belts if they
remain inside a substantial waist-high guard rail at all times.


Karyawan yang bekerja di platform dan teradpat sisi pelindung tidak diwajibkan
mengenakan safety belt setiap saat
4.11.7 When using an anchorage point it must be as high and as near to vertical as
possible to limit any possible drop and swing, should the worker fall.
Ketika menggunakan tempat berpindah maka tempat berpindah harus sama tinggi dan
dapat memperkecil kemungkinan karyawan terjatuh

STANDARD INSTRUCTION FOR HOT WORK
PUSRI - II B PROJECT Doc. No. Date :

APPENDIX C 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
1.0 INTRODUCTION/PENDAHULUAN 2
2.0 PURPOSE/TUJUAN 2
3.0 RESPONSIBILITY/TANGGUNG JAWAB 2
4.0 STANDARD INSTRUCTION/INSTRUKSI STANDAR 2
4.1 Hot Work Permit Instruction/Instruksi ijin kerja panas 2

4.2 Gas Welding/Pengelasan Gas (oxygen &Acetylene) 7
4.3 Electrical Welding/Pengelasan Listrik 7
PT. Guna Teguh Abadi Page 1 of 11 APPENDIX C


1.0 INTRODUCTION
Pendahuluan
1.1 This procedure covers the requirements for hot work performed by employees and
contractors.
Prosedur ini meliputi / memenuhi ketentuan-2 dalam pekerjaan pengelasan dan pekerjaan lainnya
yang menggunakan api terbuka.
2.0 PURPOSE
Tujuan
2.1 To establish procedure for employees and contractors during cutting, welding, brazing or
other hot work operations.
Menempatkan /memenuhi prosedur dalam pekerjaan penegelasan, pemotongan dan lainnya yang
menggunakan api.
3.0 RESPONSIBILITY
Tanggung Jawab
3.1 The Project Manager shall be responsible for the contents this permit-to-work.
Pimpinan proyek bertanggung jawab atas isi dan maksud daripada isi ijin keja
3.2 The Project Managers / Construction Manager concerned shall be responsible to ensure the
implementation of this Permit-to-Work.
Pimpinan proyek bertanggung jawab untuk meyakinkan pelaksanaan prosedur ijin kerja.
3.3 The Chief HSE concerned shall coordinate the implementation and management of this
Permit-to-Work.
Chief Safety akan mengkoordinir dan mengatur dalam pelaksanaan prosedur ijin kerja.
3.4 HSEO shall advice on compliance to legal and other requirements.

HSE Officer akan memberikan saran pada legal dan aturan lainnyal
3.5 All employees and other relevant interested parties concerned are responsible to comply
with this procedure.
Setiap karyawan dan lainnya bertanggung jawab untuk mengikuti prosedur ini.

Instruksi Standar
4.1 Hot Work Permit Instruction

Instruksi dalam hal Ijin kerja panas
4.1.1 Welding, cutting, brazing or other open flame work will not be carried out without
Hot Work Permit.
Pengelasan, pemotongan, brazing dan pekerjaan lainnya yg menggunakan api tidak boleh
dilaksanakan tanpa ijin kerja.


4.1.2 The authorization and issuance of the permit will be done by HSE Manager/ Site
Safety Supervisor.
Yang berwenang untuk mengeluarkan ijin kerja adalah Petugas Safety.
4.1.3 This permit is valid until work is completed. Permit to be returned to HSEO / Site
Safety Supervisor.
Ijin kerja berlaku sampai pekerjaan selesai, ijin kerja harus dikembalikan kepada petugas
Safety.
4.1.4 Verification of the completed job will be done by Chief HSE / Site Safety
Supervisor.
Verifikasi pada penyelesaian pekerjaanakan dilakukan oleh Chief HSE / HSE Supervisor..
4.2 Gas Welding

Pengelasan (Oxygen and Acetylene)
4.2.1 Protection from Gas Welding Hazards

Perlindungan dari bahaya gas welding
a) Eyes and Burns

Mata dan terbakar
i- Wear eye protection with a filter shade suitable for gas welding.
Gunakan pelindung mata lengkap dengan filter untuk gas welding
ii- Wear welding gloves and overalls.

Gunakan sarung tangan las dan pakian overall
iii- Chalk a warning onto hot metal so others will not touch it or stand on
it.
Di setiap besi yang panas harus di pasang tanda peringatan untuk mencegah
jangan sampai karyawan lain terluka.
b) Fires in the General Work Area

Kebakaran dilokasi pekerjaan
i- Before starting work ensure there are no flammable liquids (solvents,

petrol, kerosene etc.) or combustible materials (rags, waste) near to
your work area.
Sebelum memulai pekerjaan yakinkan bahwa tidak terdapat cairan mudah
terbakar (solvent, minyak tanah dsb.) atau bahan mudah terbakar dilokasi
pengelasan atau pemotongan.
ii- Do not leave a lighted welding torch unattended, or hung over the gas
bottles or regulators.
Jangan meninggalkan welding torch dalam keadaan menyala dengan
menggantungnya pada botol gas atau pada regulator.
iii- Fires in the confined space

Never use pure oxygen, acetylene or propane to freshen the air in a
confined space. If oxygen levels in the air exceed 21%, fires can start

very easily, and a welder’s clothes can easily ignite. Where this
cannot be done, the oxygen and acetylene connections shall be
disconnected at the cylinders situated outside of the confined space.
Closing the valve is not a disconnection.
Kebakaran dalam ruangan tertutup

Dilarang menggunakan oxygen murni, gas acetylene dan propan untuk membuat
Udara dalam ruang tertutup menjadi fresh, bila level oxygen mencapai 21%
kebakaran akan sangat mudah terjadi dan pakaian welder akan mudah terbakar,
bila terjadi kondisi separti ini segera putuskan atau lepaskan setiap sambungan
selang dari botol gas, menutup valve bukan berarti memutuskan aliran.
c) Heat Stress
i- Provided shade if welding or burning in the open.

Siapkan dan pasang tirai pelindung bila pengelasan harus dilakukan di
daerah terbuka.
d) Fumes and Welding Gases

Uap/udara dari welding gas
i- In poorly-ventilated areas, welding fumes can be hazardous. Nitrogen

dioxide and carbon monoxide gases can build up in a confined or
poorly-ventilated space.
Bila ventilasi atau sirkulasi udara tidak memenuhi syarat, uap/asap dari
welding gas sangat berbahaya, nitrogen dioxide dan carbon monoxide akan
berakumulasi dalam ruangan tertutup atau diruangan yang sistim
ventilasinya tidak baik
.
ii- You must follow the confined space permit-to-work when working in
a chamber, tank, manhole or similar space and use mechanical fume
extraction in poorly ventilated areas.
Prosedur ijin kerja dalam ruangan tertutup diperlukan untuk pekerjaan
dalam tabung, tank, bak dan tempat-2 yg menyerupai dan memakai
mekanikal fume extraction di ruangan yg ventilasinya tidak baik.
iii- If welding lead, galvanised metal or coated metal, fumes may be

dangerous. Wear a respirator (suitable for welding fumes) or use a
portable welding fume extraction unit.
Uap/asap dari pengelasan lead, galvaized dan coated metal membahayakan
buat pernafasan, pakailah alat pelindung pernafasan.
4.2.2 Explosions Due to Flashback

Peledakan akibat flashback
a) Uncontrolled burning of gas back through the blowpipe mixer causes

flashbacks.
Pembakaran tidak terkontrol dari gas balik melalui blowpipe dikarenakan flashback.


b) A flashback can damage your welding equipment and in the worst situation if
the flame travels back into the fuel-gas cylinder, it can cause the cylinder to
explode.
Flashback dapat merusak peralatan las dan pada situasi yang buruk bila jalur api
kembali ke dalam botol gas, ini akan menyebabkan terjadinya peledakan.
c) To protect against flashbacks always use the following instruction:

Instruksi dibawah ini dapat mencegah terjadinya flashback:
i- Ensure all connections are tight.

Yakinkan setiap sambungan terpasang dengan baik dan kuat
.
ii- Ensure all cylinder valves are open and all blowpipe valves are closed.
Yakinkan kerangan botol gas terbuka dan kerangan blowpipe tertutup.
iii- Set regulators to the required pressure.

Seting regulator pada tekanan yang diperlukan
iv- Purge each hose separately by opening the blowpipe valve and
allowing gas to flow out until only pure gas remains in the hoses.
Bersihkan selang secara terpisah dengan cara buka kerangan blowpipe dan
alirkan gas sampai betul-2 bersih dan hany gas murni yang berada didalam
selang.
v- When complete close the valve for each gas.

Bila selesai semua kerangan harus ditutup
vi- Only carry out this exercise in the open-air or a well-ventilated area.
Kegiatan ini hanya boleh dilakukan di lokasi terbuka atau ruangan dengan
ventilasi yang memenuhi syarat.
vii- Ensure there is a flashback arrester or non-return valve on the fuel gas
line and the oxygen line as well.
Yakinkan bahwa flashback arrester atau check valve terpasang baik pada
line gas dan oxygen.
viii- Oxygen and acetylene hoses shall be turned off at the cylinder valve
anytime the equipment is not being actively used. A check valve shall
be installed in both the oxygen and acetylene lines. A flashback
arrester shall be installed adjacent to the acetylene regulator valve.
Selang acetylene dan oxygen harus dilepas dari botol gas bila sudah tidak
digunakan, check valve harus dipasang pada line oxygen dan acetylene dan
flashback arrester harus dipasang pada regulator acetylene.
d) Should a flashback occur:

Bila terjadi flashback
i- First turn off the blowpipe oxygen and then the acetylene.
Pertama tutup blowpipe oxygen kemudian acetylene.
ii- Check for cylinder heating. If it is hot, cool with water and evacuate
others from the immediate area.

Check kondisi botol gas, bila panas segera dinginkan dengan ai, dan segera
keluarkan botol-2 gas lainnya dari lokasi tersebut
iii- When flashback into hose occurs, the hose should be replaced and all
equipment checked before reusing.
Bila terjadi flashback pada selang, selang harus diganti baru dan semua
peralatan harus diperiksa sebelum digunakan lagi.
4.2.3 Explosions Due to the Incorrect Use or Storage of Gas Cylinders

Peledakan akibat dari penggunaan dan penyimpanan botol gas yang tidak benar.
a) Grease ignites rapidly if it comes in contact with pure oxygen.

Gemuk akan terbakar bila kontak langsung dengan oxygen murni.
b) Acetylene can react with copper and silver to form explosive compounds.
Gas karbit akan menimbulkan reaksi bila kontak dengan tembaga dan perak dan bisa
terjadi ledakan.
c) Acetylene itself can become unstable and is stored in special cylinders with
liquid acetone. If the cylinder is left on its side, the acetone can leak out which
may make the acetylene unstable.
Gas karbit bisa menjadi tidak stabil dan disimpan dalam tabung khusus dengan
aceton. Bila disimpan dengan ditidurkan aceton akan keluar dan dapat berakibat
acetylene tidak stabil.
d) Heating of fuel gas cylinders can also cause explosions.

Suhu panas pada botol gas juga dapat menimbulkan ledakan
e) Oxygen and acetylene shall be stored separately in an upright position,

protective caps on and secured in place. Preferably, the oxygen and acetylene
shall be stored in separate well ventilated areas. A minimum of 20 feet or a
non-combustible wall should separate the two types of cylinders.
Oxygen dan gas karbit harus disimpan secara terpisah, harus di berdirikan, cap
pengaman harus terpasang, terikat di suatu tempat. Oxygen dan gas karbit dapat
disimpan secara terpisah dalam ruangan yang berventilasi. Minimal 20 kaki atau
dipisahkan oleh tembok anti api.
4.2.4 Release of Gases Under Pressure

Gas keluar dengan tekanan tinggi.
a) Both fuel gases and oxygen are stored under very high pressures.
Pada umumnya oxygen dan acetylene disimpan dengan kondisi tekanan tinggi
b) If a cylinder is dropped and the valve breaks, the cylinder can become a
dangerous missile. They have been known to smash through brick walls.
Bila botol gas jatuh dan kerangannya patah, botol gas akan meluncur seperti peluru
kendali dan merusak yang diterjangnya.
4.2.5 Cylinder Safety Rules

Prosedur Keselamatan pada Botol Gas


a) Do not oil or grease the valves or seal the thread with tape.
Kerangan dan seal botol gas harus bebas dari segala jenis minyak.
b) Check the gas content in the workshop before carry to site.

Periksa tekanan botol gas di workshop sebelum dibawa ke lapangan
c) Ensure there are any sign in the bottle gas mentioned the content of the gas.
Yakinkan pada botol gas terdapat label yang menginformasikan isi dari botl gas
tersebut
.
d) Do not drop or throw gas cylinders.
Dilarang menjatuhkan atau melempar botol gas
.
e) Secure cylinders against falling and store upright.
Hindari botol gas dari jatuh dan selalu disimpan dengan posisi berdiri
.
f) Keep cylinders away from flames and heat.
Jauhkan botol gas dari sumber panas dan api terbuka.
g) Use proper trolleys for moving cylinders.

Gunakan kereta khusus untuk memindahkan botol gas.
h) Do not use chains to lift cylinders. Lift in proper frames or carriages only.
Jangan menggunakan rantai untu mengangkat botol gas, gunakan keranjang atau
basket untuk mengangkat botol gas.
i) The cylinders shall be in a vertical position in any place.

Posisi botol gas harus selalu berdiri disetiap saat.
4.2.6 Explosions Due to Working on Drums and Tanks

Ledakan pada pekerjaan drum dan tangki
a) Gas cutting of empty drums, pipes or containers that contain residual

flammable materials (solvents and petrol) can cause explosions.
Memotong dengan menggunakan gas pada drum kosong, pipa atau container yang
sudah atau bekas menyimpan / mengalirkan bahan mudah terbakar, dapat
mengakibatkan ledakan.
b) The flame heats up vapours inside the drum, which may then explode. This can
happen even when the drum or tank looks empty. Find out what the vessel
contained. Never start cutting the vessel until you have found out.
Panas akan membuat terjadi uap gas dalam drum, kemungkinan bisa terjadi ledakan,
Hal ini bisa terjadi walupun drum atau tangki kelihatannya kosong.
Periksa bekas menyimpan apa drum atau tangki tersebut, jangan memulai
pemotongan sampai diketahui drum atau tangki bekas menyimpan apa.
c) If you need to weld or cut a container that has contained flammable materials
you must:
Bila anda harus mengelas atau memotong drum atau container bekas bahan mudah
terbakar, anda harus perhatikan hal-2 berikut:
i- Arrange to have the container steam cleaned;


Siapkan steam untuk container (untuk menetralisir gas)
ii- Fill the container with water (leaving a vent to allow vapours to
escape); or
Isi dengan air dan usahakan ada vent untuk keluarnya uap dari container
tsb.
iii- Fill with an inert gas such as carbon dioxide or nitrogen prior to
cutting.
Isi dengan inert gas (nitrogen) pada saat akan mulai.
4.2.7 Explosions Caused by Leakage of Fuel Gases

Ledakan akibat dari kebocoran gas
a) If gas leaks into pits or confined spaces, it can build up and explode if ignited.
For example a mixture of only 3% of acetylene in air can be explosive. LPG is
heavier than air and can collect in low or confined spaces such as trenches, pits
or basements.
Bila gas bocor dan masuk ke parit,atau ruangan tertutup akan menjadikan akumulasi
gas dan dapat meledak setiap saat bila ada percikan panas. Sebagai contoh mixture
acetylene hanya 3% dalam udara dapt terjadi ledakan. LPG lebih berat dari udara
dan dapat terkumpul di bagian bawah atau diruangan tertutup seperti parit dan
basement.
b) A blowpipe should never be left burning.

Blowpipe jangan ditinggalkan dalam keadaan menyala.
c) Check hoses and gas fitting regularly for leaks. Use soapy water to check hoses
for leaks.
Periksa selang dan setiap fitting secara regular untuk mengetahui adanya kebocoran,
gunakan air sabun.
4.3 Electrical Welding

Las Listrik
4.3.1 Protection from Electric Welding Hazards

Proteksi dari bahaya-2 las listrik
a) Injuries From Burns During and After Welding

Luka terbakar sedang atau setelah pengelasan
i- A full welding mask must be worn when electric welding to prevent

radiation damage to the eyes.
Masker muka untuk pengelasan harus dipakai pada pengelasan listrik utnuk
mencegah radiasi yg dapat merusak mata.
ii- Overalls, gloves and neck protection should also be worn. Exposed
skin will be burnt by the radiation from the arc.
Coverall, sarung tangan dan pelindung leher harus dipakai, bila kontak
dengan kulit dapt berakibat terbakar karena radiasi cahaya.

iii- Chalk a warning onto hot metal so other workers will not touch it or
stand on it.
Setiap permukaan logan/besi yang panas, harus diberitanda peringatan
untuk mencegah terlukanya pekerja lain.
iv- If other workers are working nearby you should erect a welding screen
to protect them from welding ‘flash’.
Kalau disekitar pekerjaan terdapat pekerjaan lain, tirai pelindung harus
dipasang untuk memprotek mereka dari sinar dan percikan-2 las.
b) Electric Shock
Bahaya listrik (tersengat)
i- Never arc-weld in wet conditions.

Dilarang mengelas di lokasi yang basah.
ii- Never connect work-return cables to structures other than that to

which you are welding. This may cause damage or electrical shock.
Dilarang menyambng kabel pada structure, tersengat listrik dan rusaknya
peralatan bisa terjadi.
iii- Check the insulation of all cables and the condition of the work-return
clamp regularly.
Periksa secara regular kondisi isolasi dan clamp kabel.
iv- No work should be done on the wiring, switches or other components

of the welder unless it is disconnected from the power source.
Dilarang melakukan pekerjaan pada sistim wiring, switches atau component
lain yang aktip, kecuali setiap sambungan arus diputuskan.
c) Fumes and Electric Welding

Uap/asap las listrik
i- Fumes are produced from the electrode and the parent metal being
welded. The fumes can cause health hazards ranging from a short-term
illness to more serious lung diseases.
Uap/asap yang diproduksi dari electrode dan metal dalam proses
pengelasan, uap /asap tsb dapat membahayakan kesehatan dari waktu sakit
yg pendek menjadisakit yang lebih serius
ii- Always weld in a well-ventilated area.

Selalu mealkukan pengelasan di tempat yang sistim ventilasinya baik.
iii- Check what you are welding. If welding lead, galvanised metal or
coated metals the fumes may be dangerous. Wear a respirator (suitable
for welding fumes) or use a portable welding fume extraction unit.
Periksa apa yang akan anda las, bila lead, galvanized atau coated metal,
uap/asapnya akan berbahaya, gunakan alat pelindung pernafasan atau
gunakan portable welding fume extraction unit.


d) Fumes from Engine-Driven Welding Machines

Uap/asap dari mesin las
i- When electric welding generators driven by internal combustion

engines are used inside a building or confined space, the engine
exhaust must be ventilated to the outside air.
Bila menggunakan mesin las / generator di dalam bangunan, gas buang
harus harus di buang keluar.
ii- Carbon monoxide in exhaust fumes can be deadly.

Gas carbon monoxide yang dikeluarkan dapat membunuh.
e) Suffocation and Electric Shock in Confined Spaces

Mati lemas dan tersengat listrik dalam ruang tertutup.
i- As with gas welding you must follow the confined space procedure
when working in a chamber, tank, manhole or similar space.
Seperti halnya pada welding gas, prosedur bekerja pada ruang tertutup
harus diikuti.
ii- Note that the risk of electric shock in a confined space is higher
because of the cramped conditions and possible sweating of the
welder. The welder should stand on a dry wooden platform or other
insulating material if the confined space is a metal structure.
Risiko tersengat arus listrik dalam ruang terbatas sangat besar karena
kondisi tukang las yang berkeringat. Tukang las harus berdiri diatas balok
kayu/platform kayu atau material lain yg tidak menghantar arus bila
ruangan terbuat dari metal.
f) Heat Stress
Tekanan panas
i- Provide shade if welding work must be carried out in the sun. Ensure
that there is plenty of drinking water for the welders.
Harus menyiapkan/memasang tirai/tenda bila pekerjaan dilakukan diarea
panas terik, siapkan air minum secukupnya.
4.3.2 Welding or Cutting in or on Containers

Pengelasan atau pemotongan dalam atau diatas container
a) As with gas welding, don’t weld or cut containers, which have held
combustible or flammable materials without taking the required precautions.
Seperti halnya pengelasan oxygen & Acetylene dilarang mengelas atau memotong
container yang sudah terkontaminasi atau mengandung bahan mudah terbakar tanpa
ada nya prosedur tertentu.
b) For electric welding this should involve filling the tank completely with water.
Untuk las listrik, tanki harus diis air sampai penuh.
c) Never use a container to serve as a support for welding if you do not know
what it has held.

Dilarang menggunakan container sebagai penyangga/penunjang pada pengelasan

bila anda tidak mengetahui container tsb pernah dipakai untuk apa.
d) Reminders about the hazards of welding or cutting on containers can be given

at toolbox meetings or induction sessions.
Untuk mengingatkan akan bahayanya pengelasan atau pemotongan pada containers
dapat dilaksanakan pada saat tool box meeting atau safety orientasi program.
e) Empty oxygen tanks must be removed from the site.

Tanki oxygen yang kosong harus dikeluarkan dari lapangan.
4.3.3 Fires Cause by Sparks

Kebakaran akibat percikan api las.
a) Before working ensure there are no flammable liquids (solvents, petrol and
kerosene) or combustible materials (rags and waste) near you or in the area
where sparks might travel.
Sebelum mulai bekerja yakinkan tidak terdapat bahan-2 mudah terbakar atau cairan
mudah terbakar seperti solvent, minyak tanah,petrol dll. Dilokasi pengelasan diman
percikan api las dapt berhamburan.
b) Where there is a risk of fire you should ensure there is a fire extinguisher or
fire hose near by.
Bila risiko kebakaran kemungkinan bisa terjadi, alat pemadam api ringan dan selang
pemadam dengan air siap pakai harus disediakan.

STANDARD INSTRUCTION FIRST AID
MANAGEMENT
PUSRI - II B PROJECT Doc. No. Date:

APPENDIX D 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
1.0 INTRODUCTION / PENDAHULUAN 2
2.0 PURPOSE / TUJUAN 2
3.0 REFERENCE / REFERENSI 2
4.0 RESPONSIBILITY / TANGGUNGJAWAB 2
5.0 STANDARD INSTRUCTION / INSTRUKSI STANDAR 2
5.1 First Aiders / Petugas P3K 2

5.2 First Aid Boxes / Kotak P3K 4
5.3 First Aid Room / Ruang P3K 5
PT. Guan Teguh Abadi Page 1 of 5 Doc. APPENDIX D

MANAGEMENT

1.0 INTRODUCTION / PENDAHULUAN
This standard instruction shall apply throughout the organization and shall cover all types of first aid facilities,
service and personnel in PT. GUNA TEGUH ABADI.
Instruksi standar ini akan di aplikasikan keseluruh organisasi dan akan mencakup semua jenis fasilitas
pertolongan pertama, pelayanan dan petugasnya di PT. GUNA TEGUH ABADI
2.0 PURPOSE / TUJUAN
The purpose of this standard instruction is to ensure the proper provision of first aid facilities in PT. Guna
Teguh AbAdi.
Tujuan dari instruksi standar ini untuk menjamin ketentuan yang benar mengenai fasilitas P3K di PT.Guna
Teguh Abadi
3.0 REFERENCE
- SNI-19-3993-1995
- OHSAS 18001:1999
- Doc HSE Policy: 4200-PL-13-00
4.0 RESPONSIBILITY / TANGGUNGJAWAB
The HSE Committee shall be responsible for the contents of this standard instruction.
Komite HSE harus bertanggungjawab terhadap muatan dari standar ini.
All First Aider shall be responsible to maintain the first aid facilities. They should ensure that only first-aid
equipment is kept inside the box. They should check them.
Semua Petugas P3K bertanggungjawab untuk menjaga fasilitas P3K. Mereka harus menjamin bahwa hanya
peralatan P3K yang tersimpan didalam kotak. Mereka harus melakukan pengecekan.
The HSE Committee at the workplace shall periodically review the first-aid facilities to ensure that the
facilities are adequate at all times.
Komite HSE di tempat kerja harus secara berkala mengkaji fasilitas P3K untuk menjamin bahwa fasilitas
cukup setiap saat.
The HSE Manager concerned shall be responsible to ensure first aid facilities in a good condition.
Manajer HSE / Chief HSE yang berperan bertanggungjawab untuk menjamin fasilitas P3K dalam keadaan
baik.
All employees and contractors, subcontractors shall be responsible to follow this procedure.
Semua pekerja dan kontraktor, subkontraktor bertanggungjawab untuk mengikuti prosedur ini.
5.0 STANDARD INSTRUCTION / INSTRUKSI STANDAR
5.1 First Aiders / Petugas P3K
Number of first aiders needed – One (1) for every 50 workers or part thereof.

MANAGEMENT

Jumlah Petugas P3K yang dibutuhkan – Satu (1) orang untuk setiap 50 pekerja atau bagian
daripada itu.
There should be a sufficient number of first aiders for each shift.

Harus cukup tersedia Petugas P3K setiap jam jaga.
The names and locations of first aiders and should also be provided with a form of identification for
easy recognition and supporting.
Nama dan lokasi Petugas P3K dan harus dilengkapi dengan formulir identifikasi untuk
mempermudah pengenalan dan pemberian dukungan
The first aiders should:

Petugas P3K, harus
a) Mature and responsible.

Matang dan bertanggungjawab
b) Remain calm in emergency./

Tetap tenang saat keadaan darurat
c) Free to leave their work immediately to respond to an emergency.

Segera meninggalkan pekerjaannya untuk menangani keadaan darurat
d) Physically fit.
Sehat jasmani
A person is considered as being trained if he / she successfully completed a first aid course conducted
by recognized external training providers.
Seseorang dapat dipertimbangkan sebagai orang yang terlatih, jika mereka telah menyelesaikan
keseluruhan kursus P3K yang diadakan oleh lembaga yang berwenang
The need for further training may be necessary whenever change within the workplace is likely to
alter the hazards and thus the type of potential injuries or occupational illness.
Kebutuhan untuk pelatihan selanjutnya akan diperlukan jika ada perubahan didalam area kerja
seperti mungkin adanya sumber bahaya lain dan jadi potensi luka atau penyakit akibat kerja.
First-aid certificates are usually valid for one (1) year for construction and the validity of certificates
may be subject to specific requirement:
Sertifikat P3K biasanya berlaku untuk satu (1) tahun bagi konstruksi dan validitas sertifikat ini
tergantung dari ketentuan khusus yang berlaku.
a) Refresher training.
Pelatihan penyegaran
b) Evidence of proficiency in cardiopulmonary resuscitation.

Bukti kecakapan di bidang bantuan pernafasan buatan dengan peminjatan jantung.
Training records shall be kept by site concerned.

Catatan pelatihan harus di simpan di lapangan yang bersangkutan.
The first-aider has an important role to play. In the management of an injured worker or in case of
sudden collapse, he should:
Petugas P3K mempunyai peran yang penting. Pada penanganan pekerja yang terluka atau di kasus
pingsan mendadak, dia harus:

MANAGEMENT

a) Assess the situation without endangering his own life;

Mengamati situasi tanpa harus membahayakan dirinya sendiri.
b) Identify the injuries or recognize the sudden collapse;

Lakukan identifikasi luka atau kenali sifat pingsan mendadak.
c) Give the immediate first-aid treatment, keeping in mind that casualty may have more
than one injury;
Berikan pertolongan pertama dengan segera, pikirkan bahwa korban kemungkinan
mendapat luka lebih dari satu.
d) For more than one casualty, recognize the priority of administration of first-aid
treatment to the more seriously injured; and
Untuk kasus lebih dari satu, kenali prioritas pertolongan yang harus diberikan kepada
luka yang lebih parah.
e) Arrange without delay for the injured worker(s) to be sent to a doctor, hospital or
home, according to the seriousness of his condition.
Atur segera pengiriman korban ke dokter, rumah sakit atau rumah, sesuai dengan
keparahan / kondisinya.
4.1.1 The first-aider’s responsibility ends when the casualties are handed over to the care of a
doctor, nurse or other appropriate persons.
Tanggungjawab Petugas P3K berakhir ketika korban ditangani oleh dokter, perawat atau
petugas lain yang berwenang.
4.1.2 Treatment records shall be kept according to the Management procedure.

Catatan pengobatan harus disimpan sesuai dengan prosedur pengelolaan
5.2 First Aid Box / Kotak P3K
First-aid boxes should be made of sturdy material and be portable so that it can be taken to the site of
an incident. The boxes should also be clearly marked with a green crescent on a white background.
Kotak P3K harus dibuat dari bahan yang kokoh dan mudah dibawa, sehingga dapat diletakan di
tempat kejadian. Kotak juga harus diberi tanda gambar palang hijau dengan latar putih.
Each first-aid box should be place in a clearly identifiable, well illuminated and accessible location.
Where a workplace covers a large area, an adequate number of first-aid boxes should be provided.
The box must be kept locked and the key must be kept by a responsible person available during all
working hours.
Setiap kotak P3K harus diletakan pada tempat yang mudah dikenali, diberi penerangan yang cukup
dan mudah dijangkau. Apabila tempat kerja sangat luas, sejumlah kotak P3K harus disediakan.
Kotak harus terkunci dan kunci dipegang oleh seseorang yang berwenang yang harus selalu ada
didalam jam kerja.
The employees should be informed of the location of all first-aid boxes.

Para pekerja harus diberi tahu lokasi dari kotak P3K
First-aid boxes should contain a sufficient quantity of suitable first-aid materials. They should not
contain materials other than those required for first-aid treatment.
Kotak P3K harus berisi sejumlah obat-obatan yang cukup . Kotak P3K tidak boleh berisi selain
daripada obat-obatan untuk pertolongan pertama.

MANAGEMENT

It is essential that first-aid boxes should be checked frequently so as to make sure they are fully
equipped and all items are usable. Material used should be replaced as soon as possible.
Sangatlah penting untuk memeriksa kotak P3K secara berkala sehingga dapat meyakinkan bahwa
kotak tersebut terisi oelh obat-obatan yang diperlukan. Obat-obatan yang telah digunakan segera
diganti.
The content of first-aid box is:

Isi dari kotak P3K adalah:
- 50 gram kapas putih - 20 buah plester lebar 2.5 cm

- 100 gram kapas gemuk - 1 bidal
- 3 rol pembalut gulung lebar 2.5 cm - 1 gunting pembalut / scissors
- 2 rol pembalut gulung lebar 5 cm - 1 buah sabun / cleansing agent / soap
- 2 rol pembalut gulung lebar 10 cm - 1 dos kertas pembersih (cleansing
- 2 pembalut segitiga (mitella) tissue)
- 2 pembalut cepat steril / snelverband - 1 pinset
- 10 buah kassa steril ukuran 5 x 5 cm - 1 lampu senter
- 10 buah kassa steril ukuran 7.5x7.5 - 1 buku catatan / note book
cm - 1 buku pedoman P3K / first aid book
- 1 rol plester lebar 1cm - 1 daftar isi kotak P3K
- 20 buah plester cepat (mis. - Obat gosok
Tensoplast) / pieces of band aid. - Salep anti histamimka
- Obat pelawan rasa sakit (mis: - Salep sulfa atau S.A powder
antalgin, acetosai, dll) - Boor Zalif
- Obat sakit perut (mis: Paverin, - Sofratulle
enterovioform, dll) - Larutan rivanol 1/10 500 cc
- Norit - Amoniak cair 25% 100 cc
- Obat Anti Alergi
- Soda kue, garam dapur
- Merculochrom
- Obat tetes mata
Source / Sumber: SNI-19-3994-1995
5.3 First Aid Room / Ruang P3K
First Aid room located at Site Office.

Ruang P3K diletakan di kantor konstruksi
The employee should be informed of location of the first aid room.

Pekerja harus diberitahu lokasi Ruang P3K
First aid room should contain a sufficient quantity of suitable of first aid facilities.
Ruang P3K harus berisi fasilitas P3Kdalam jumlah yang cukup dan sesuai kebutuhan.
First aiders and paramedics shall be stand-by during construction activity.

Petugas P3K dan paramedik harus siaga selama kegiatan konstruksi

STANDARD INSTRUCTION
SAFETY ORIENTATION

APPENDIX-E 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
PT. Guna Teguh Abadi Page 1 of 5 Doc. APPENDIX E

SAFETY ORIENTATION

This standard instruction shall apply throughout the organization and site project in PT. Guna Teguh Abadi
Instruksi standar ini akan di aplikasikan keseluruh organisasi dan lingkungan proyek-proyek PT. Guna Teguh
Abadi
The purpose of this standard instruction is to give information about the HSE Policy PT. Guna Teguh Abadi,
HSE Management System PT. Guna Teguh Abadi ; PPE should be use and hazard that can be face to the new
employee who will work and visitor who will visit job site.
Tujuan dari instruksi standar ini untuk memberikan informasi mengenai Kebijakan HSE PT. Guna Teguh
Abadi dan Sistem Pengelolaan HSE PT. Guna Teguh Abadi, Alat Pelindung Diri yang harus dipakai dan
bahaya-bahaya yang dihadapi pekerja saat bekerja dan tamu yang akan dating ke lapangan.
3.1 The HSE Commitee shall be responsible for the implementation this standard instruction.
Komite HSE akan bertanggungjawab untuk mengimplementasikan standar ini.
3.2 Chief HSE concerned shall be responsible to ensure the implementation this standard instruction.
Chief HSE yang berperan akan bertanggungjawab untuk menjamin implementasi dari satandar ini.
3.3 All employees and contractors, subcontractors shall be responsible to follow this standard instruction.
Semua pekerja dan kontraktor, subkontraktor akan bertanggungjawab terhadap dipatuhinya standar
ini.
Occupational Health and Safety (OHS) orientation involves acquainting employees and others to the
workplace’s health and safety program and the hazards a worker, visitor, or customer may be exposed to.
Orientasi Keselamatan dan Kesehatan Kerja melibatkan pengenalan kepada pekerja dan yang lain atas
program keselamatan dan kesehatan di tempat kerja dan bahaya-bahaya yang dapat tertapar kepada
pekerja, tamu atau pelanggan.
Orientation ensures that individuals are familiar with the company’s expectations for health and safety, the
role that individuals have in the health and safety program and the hazards of the particular worksite.
Orientasi menjamin bahwa setiap individu akan memahami harapan perusahaan atas aspek keselamatan
dan kesehatan, peran individu-individu daalam program keselamatan dan kesehatan kerja dan bahaya-
bahaya pada tempat-tempat tertentu.

SAFETY ORIENTATION

HSE orientation / Induction gives to new hires, temporary, seasonal or full time returning employees,
outside contractors, visitors and others. Orientation may also be needed for employees who are newly
assigned or unfamiliar with the work and/or equipment.
Orientasi / Induksi HSE diberikan kepada karyawan baru, sementara, musiman atau tetap yang masuk
lagi, kontraktor luar, tamu-tamu dan lain-lainnya. Orientasi juga diperlukan untuk pekerja yang baru
dipekerjakan atau yang belum mengenal tempat kerja dan/atau peralatan.
Health and Safety coordinator might deliver the overall orientation of the organization’s policies and
program. Supervisor might outline specific safe work procedures for a particular job or change in job/task.
Koordinator Keselamatan dan Kesehatan harus memberikan orientasi mengenai kebijakan-kebijakan dan
program-program organisasi secara menyeluruh. Pengawas harus memberikan garis besar prosedur kerja
aman yang spesifik untuk pekerjaan tertentu atau pada perubahan tugas/pekerjaan.
The time to conduct HSE orientation is 2 -4 hours.

Waktu untuk melakukan orientasi HSE adalah 2 – 4 jam.
Person who will give Safety Orientation /Induction should inform the following matters such as:
Petugas yang akan memberikan Orientasi/Induksi harus menginformasikan mengenai hal-hal sbb:
HSE Management Policy / Kebijakan Manajemen HSE
HSE management Policy is a commitment of Top Management PT. Guna Teguh Abadi to give high priority
on accident prevention and environment protection program.
Kebijakan Manajemen HSe adalah tekad Pimpinan Puncak PT. Guna Teguh Abadi dalam memberikan
prioritas utama terhadap program pencegahan kecelakaan dan lindungan lingkungan.
Personal Protective Equipment / Alat Pelindung Diri
All employees PT. Guna Taguh Abadi must wear Personal Protective Equipment, such as:
Semua karyawan harus memakai Aalat Pelindung Diri, seperti misalnya:
1. Safety Shoes
Sepatu keselamatan kerja
2. Safety Helmet
Helmet keselamatan kerja
3. Safety Belts or Safety Harness when they work at more than 2 meters hight.
Sabuk keselamatan atau Penahan Tubuh jika bekerja diketinggian lebih dari 2 meter.
4. Ear Plug or Ear Muff when they work on noisy areas.

Pelindung Telingan atau Pendengaran jika bekerja di area yang bising.
5. Other Personal Protective Equipment according to the type and location of their jobs.

SAFETY ORIENTATION

Alat Pelindung DIri lainnya sesuai dengan jenis dan lokasi tempat kerjanya.
Traffic Safety / Keselamatan Lalulintas
All people who drive vehicles on site area must be obey the maximum speed 40 km/hours in Construction
Area and/or 10 km/hours in Construction Site Plan or other traffic rules which determined by client.
Semua orang yang mengendarai kendaraan di area lapangan harus mematuhi kecepatan maksimum 40
km/jam dia area konstruksi dan/atau 10 km/jam di area kerja konstruksi atau peraturan lalulintas lainnya
yang ditentukan oleh klien.
Safe Work Permits / Surat Ijin Kerja
Every body want to execute their jobs on Construction Site Plan Area should be prepared JSA and Safe Work
Permits issued by PT Rekayasa Industri or other safe work permits determined (issued) by Client.
The types of Safe Work Permits, such as: Hot Work, Cold Work, Excavation, Working At Height, Isolate etc
Setiap orang yang ingin melakukan pekerjaan di area kerja konstruksi harus mempersiapkan JSA dan Surat
Ijin Kerja Aman yang diterbitkan oleh PT Rekayasa Industri atau klien. Jenis-jenis Surat Ijin Kerja Aman,
seperti misalnya Ijin Kerja Panas, Izin Kerja Dingin, Kerja Di Ketinggian, dll.
Overtime Permits / Ijin Kerja Lembur
Everybody want to do their job on holiday (Sunday and / or other national holiday), they should be applied
“Overtime Permits” one (1) day before they execute the job.
Setiap orang yang akan melakukan pekerjaan pada hari libur (Minggu dan/atau hari libur nasional lainnya),
mereka harus mengajukan permohonan “Ijin Lembur”, satu (1) hari sebelumhari pelaksanaan kerja.
Construction Equipment and Vehicles. / Peralatan dan Kendaraan Konstruksi
All equipment and vehicles which will use on Construction job site should inspected by HSE Department
before. ALL documents of this equipment and vehicles must submit at least 2 (two) days before the day of
inspection.
Semua peralatan dan kendaraan yang akan dipakai di area kerja harus diinspeksi oleh Departemen HSE
sebelumnya. Semua dokumen peralatan atau kendaraan tersebut harus sudah diserahkan 2 (dua) hari
sebelum tanggal pelaksanaan inspeksi.
Bring In and Bring Out Permits / Ijin Keluar dan Masuk Barang
All construction equipment and vehicles which will be entered into or moved out from job site should be
provided with Bring-In or Bring-Out Permits. These permits should be signed by Chief of appropriated
Department, Chief Logistic, Chief Project Control, Chief Security and Construction Manager PT. Guna Teguh
Abadi.
Semua peralatan dan kendaraan konstruksi yang akan memasuki atau keluar dari area kerja harus dilengkapi
dengan Ijin Masuk atau Keluar Barang. Ijin harus ditandatangani oleh Kepala Departemen yang
bersangkutan, Kepala Logistik, Kepala Pengendali Proyek, Kepala Sekuriti dan Manajer Konstruksi PT.
Guna Teguh Abadi.
Emergency Situation. / Situasi Darurat

SAFETY ORIENTATION

In case of emergency situation (fire, power failure, etc) and the general alarm sounded all personnel should be
directly go to the safe area (Muster Point) . On they go to the safe area (Muster Point) the must follow the
direction of their Supervisor or other competent persons (HSE, Security, etc).
Dalam keadaan darurat (kebakaran, kegagalan tenaga, dll) dan tanda bahaya umum dibunyikan, semua
orang harus segera menuju ke tempat aman (Lokasi Tempat Berkumpul) . Saat menuju tempat aman tersebut,
harus mengikuti petunjuk / pengarahan dari Pengawas atau petugas lain yang berwenang (HSE, Sekuriti,
dll).
Prohibited / Larangan
During stay on PT. Guna Teguh Abadi, they prohibited to:

Selama berada di area PT. Guna Teguh Abadi, dilarang untuk:
1. Smoking on certain area

Merokok pada tempat-tempat tertentu
2. Drink alcohol beverages.

Minum minuman beralkohol
3. Fight with other persons / employees

Berkelahi dengan orang lain / karyawan
4. Bring weapons (fire arms, knifes, etc)

Membawa senjata api atau tajam
5. Bring and use narcotic

Membawa dan memakai narkotika.

STANDARD INSTRUCTION FOR ENTRY
INTO CONFINED SPACE

APPENDIX F 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
3.0 RESPONSIBILITY / TANGGUNG JAWAB 2
4.0 STANDARD INSTRUCTION PERMIT-TO-WORK / STANDAR INSTRUKSION

IJIN KERJA 2
4.1 Working Safely in Confined Space or in Other Places With

Poor Ventilation 2
Kerja aman dalam ruangan tertutup atau diruangan dgn ventilasi tidak baik
4.2 Safe Entry Instruction 3
Prosedur kerja aman
4.3 Safety Precaution-Always 4
Peringatan Keselamatan - Selalu
4.4 Safety Precaution-Never 5
Peringatan Keselamatan – Tidak pernah
4.5 Verification 5
Ferifikasi
4.6 Training 6
Pelatihan
PT. Guna Teguh Abadi Page 1 of 6 Doc. APPENDIX F

INTO CONFINED SPACE

1.0 INTRODUCTION
Pendahuluan
This standard instruction applies to all persons who enter a confined space.
Prosedur ini disiapkan untuksetiap karyawan yang akan masuk ruangan tertutup/terbatas
.
2.0 PURPOSE
Tujuan
To provide standard instruction and Permit-to-Work System to protect employees in a place of work
from the hazards of entry into confined space.
Untuk menyiapkan instruksi standard dan ijin kerja untuk melindungi setiap karyawan dari bahaya-2
yang timbul di tempat kerja (dalam memasuki ruang terbatas).
3.0 RESPONSIBILITY
Tanggung jawab
Construction Manager concerned are responsible to ensure that this instruction is followed in their
worksite.
ManagerKonstruksi bertanggung jawab atas diikutinya stsndar instruksi ini oleh setiap lapangan.
Chief HSE concerned shall ensure the proper implementation and management of this instruction.
Chief HSE harus meyakinkan penerapan dan managemen instruksi standard ini.
3.1 Chief HSE / HSEO shall advice on compliance to legal and other requirements.
Chief HSE/HSEO memberikan saran untuk hal legal dan ketentuan-2 lain
3.2 All employees and contractors / subcontractors concerned are responsible to comply to this
instruction.
Setiap karyawan dan kontrktor bertanggung jawab untuk mengikuti prosedur ini.

Instruksi Standar
4.1 Working Safely in Confined Space or in Other Places with Poor Ventilation
Bekerja dengan aman dalm ruangan tertutup atau diruangan dgn ventilasi tidak baik.
4.1.1 You must not enter any confined space with a restricted entry or exit point (sewer,
drain, manhole, pipe, tank, duct, borehole, well etc.) without following the Safe Entry
Instruction (refer Clause 4.2).
Dilarang masuk ruangan terbatas/tertutrup (sewer, drain, manhole, pipa, tangki,etc)
tanpa mengikuti atuarn-2 keselamatan kerja.
4.1.2 You must not enter any enclosed space (trench, pit, excavations or other semi-enclosed
space) that has been designated as hazardous without following the Safe Entry
Instruction (refer Clause 4.2).
Dilarang masuk ke lokasi tertutup (trench, pit, galian etc.) bila lokasi tsb dinyatakan
berbahaya tanpa mengikuti aturan keselamatan kerja.
4.1.3 You must not use petrol, solvents, paints or any other chemical that gives off
dangerous solvent vapours inside a confined space or semi-enclosed area with poor
ventilation.

INTO CONFINED SPACE

Dilarang menggunakan petrol, solvents, cat atau jenis kimia yang dapat menimbulkan
bahaya di dalam ruang tertutup atau dalam ruangan dengan ventilasi yg tidak baik.
4.1.4 You must only use welding equipment inside a confined space or semi-enclosed area
under carefully controlled conditions. When welding, the fumes must be extracted and
air forced into the space to provide adequate ventilation.
Bila diharuskan menggunakan alat pengelasan dalam ruangan tertutup atau ruangan
yang dalam kondisi pengontrolan. Bila ada pengelasan uap/asap harus dilakukan
pengaturan udara sehingga tersedia ventilasi yg baik.
4.1.5 You must avoid having welding gas cylinders (e.g. acetylene bottles) inside a confined
space or poorly-ventilated enclosed area. Where possible these should be sited outside
the area.
Dilarang membawa gas oxygen/acetylene ke dalam ruangan, bila diperlukan simpan
diluar botol gas tsb.
4.1.6 You must not smoke or carry matches or lighters in a confined space.
Dilarang merokok dan membawa korek api ke dalam ruangan.
4.1.7 Where potentially dangerous gases such as liquid nitrogen must be used in a trench or
confined space, then air must be forced into the space to provide ventilation. Testing
devices to monitor oxygen levels should be maintained in the work area to measure
that there is enough oxygen for breathing.
Bila potensi bahaya gas seperti cairan nitrogen harus di gunakan dalam trench atau
ruangan tertutup, kemudian udara harus ditekan untuk ventilasi. Test peralatan untuk
monitor oxygen level harus di pelihara dalam area pekerjaan untuk mengukur bahwa
oxygen cukup untuk bernafas.
4.2 Safe Entry Instruction

Instruksi Keselamatan
4.2.1 Before entering the confined space (sewer, drain, manhole, vessel, tank, vat or other
enclosed area with restricted entry and exit) you must have an Entry into Confined
Space Permit and approved by Chief HSE / Construction Manager / Owner
Representative.
Sebelum memasuki ruang tertutup/terbatas (sewer, drain, manhole, vessel, tank dan
lokasi yg dinyatakan berbahaya) harus memiliki ijin tertulis untuk memasuki ruang
tertutup/terbatas dan disetujui oleh Chief HSE/ Construction Manager dan perwakilan
dari owner.
a) You do not need a permit to enter for excavations unless the pit or trench has been
designated as hazardous to enter.
Anda tidak memerlukan ijin tertulis untuk memasuki galian, kecuali galian tsb.
Sudah dinyatakan sebagai daerah berbahaya.
4.2.2 A permit Entry Into Confined Space Permit must be issued by the Chief HSE / Site
Safety Supervisor, but only once the following conditions have been met:
Ijin masuk daerah tertutup/terbatas harus dikeluarkan oleh Chief HSE/ Safety
Supervisor, tetapi harus mengikuti ketentuan dibawah ini:
a) The air inside the space has been tested for flammable and toxic gases, and
oxygen levels.
Udara didalam ruangan sudah di periksa dari unsur-2 gas racun, gas mudah
terbakar dan oxygen level.
b) The space has been checked for hazards (e.g. sludge deposits) that may harbour
gases.
INTO CONFINED SPACE

Lokasi sudah diperiksa dari kondisi-2 berbahaya, yang mungkin terdapat

kumpulan gas.
c) No other hazards, such as electrical hazards, possible flooding, or possible gas

leakages have been identified that could be dangerous to anyone entering the area.
Tidak terdapat bahaya lain seperti bahaya listrik, kemungkinan gas bocor masuk
ke ruangan, dan sudah di chek tidak terdapat bahaya lain bagi si pekerja didalam
ruangan
.
d) The space has been cleaned, purged with fresh air and ventilated if found
necessary.
Lokasi sudah dibersihkan, di bilas dengan menggunakan air bersih dan terdapat
sistim ventilasi.
e) The appropriate equipment for entry (harness, lifeline, rescue equipment and
respiratory equipment) is on hand.
Peralatan keselamatan seperti Safety harness, lifeline, alat penyelamatan dan alat
pernafasan sudah tersedia.
f) Adequate lighting has been provided.

Penerangan yg sesuai sudah tersedia.
g) The persons entering the space are trained in safe entry procedures and persons
outside the space are trained in emergency rescue procedures.
Pekerja yg akan masuk sudah terlatih dan memahami prosedur kerja aman dalam
ruangan terbatas dan pekerja yg standby diluar sudah menguasai teknik-2
penyelamatan dalam kondisi darurat.
h) Any electrical equipment inside a confined space must be isolated and locked off.
Peralatan listrik didalam ruangan harus aman (di isolasi atau di kunci)
i) Any valves in or leading into the confined space must be shut down and locked
off.
Setiap kerangan yang menuju /memasuki ruangan harus di blok dan di matikan.
4.2.3 In an emergency the Safe Entry Procedure must still be followed. Failure to do so
could lead to possible additional loss of life.
Dalam kondisi darurat ijin kerja dalam ruangan terbatas masih harus di ikuti,
kesalahan yang terjadi dapat berakibat kematian
.
4.3 Safety Precautions – Always:
Peringatan Keselamatan – Selalu:
4.3.1 Use safe grounded explosion proof equipment of low voltage (110v).
Gunakan peralatan yang explosion proof atau yang voltage nya rendah (110 V)
4.3.2 Provide adequate lighting which is able to illuminate the entire confined space.
Sediakan penerangan yang dapat menerangi dengan baik dalam ruangan.
4.3.3 Provide adequate forced ventilation.

Sediakan sistim ventilasi yang memenuhi syarat.

INTO CONFINED SPACE

4.3.4 Identify the last substance that was placed in the confined space. Know its hazard, its
relevant specific safety precautions, and actions during an emergency, chemical
properties and hazards and conduct monitoring accordingly. It is useful to refer to the
MSDS of the particular substances.
Periksa kondisi terakhir dari ruang tertutup tsb (digunakan untuk apa), ketahui
bahaya-2, spesifikasi terkait, peringatan Keselamatan activitas saat kondisi darurat,
bahan kimia yang tersedia dan bahayanya dan lakukan pengawasan dengan baik. Hal
ini akan lebih baik mengacu pada MSDS.
4.3.5 Wear approved personal protective equipment prescribed for the specific hazards.
Gunakan alat pelindung diri yang sesuai dan spesifik akan bahaya yg ada.
4.3.6 Cut off all incoming suppliers e.g. steam, gas etc., which may e accidentally
discharged into the confined space in which persons are still present. Use lockouts and
tags.
Tutup semua system yang masuk ke ruangan (steam, gas etc) gunakan lock and tag out
System, hal ini untuk mencegah terjadinya kecelakaan atas pekerja dalam ruangan.
4.3.7 Ensure that you have a valid permit for entry into confined spaces.
Periksa lagi dan yakinkan bahwa anda memiliki ijin kerja dialam ruangan tertutup.
4.3.8 Ensure that safe accesses are provided into and out of the confined space. If ladders are
used, ensure that they are securely lashed.
Yakinkan bahwa jalan untuk masuk dan keluar dari ruangan tersedia, kalau harus
memakai tangga periksa lagi apakah sudah terikat denganbaik dan kuat.
4.3.9 Be alert! At any sign of trouble e.g. dizziness, breathing difficulty, nausea etc. Leave
confined space immediately and inform the Supervisors concerned.
Untuk Menjadi Perhatian!, bila terjadi masalah seperti, sulit bernafas dan
sebagainya,
tinggalkan /stop pekerjaandan segera meninggalkan lokasi tersebut dan lapor pada
pengawas.
4.3.10 Ensure that the emergency exit route is clearly indicated preferable using
photoluminescence paint.
Yakinkan bahwa jalur untuk keadaan darurat tersedia dan dilengkapi oleh petunjuk
yg terbuat dari spot light.
4.3.11 Wear a lifeline where practicable.

Gunakan lifeline
4.3.12 Have a stand-by man waiting outside at the access hole leading into the confined
space.
Sediakan satu karyawan untuk standby di luar ruangan dekat dengan pintu masuknya.
4.3.13 emove all possible cause of explosion or fire.

Keluarkan semua benda yang dapat menimbulkan bahaya api atau ledakan.
4.4 Safety Precautions – Never:

Peringatan Keselamatan – Tidak pernah

INTO CONFINED SPACE

4.4.1 Use aluminium ladders or any equipment coated with aluminium or aluminium paint in
confined spaces where there exists a fire explosion risk.
Menggunakan tangga aluminium atau equipment coated dengan aluminium atau
menggunkan cat aluminium dalam ruangan sehingga dapat menyebabkan bahaya
kebakaran.
4.3.2 Smoke in a confined space.

Merokok dalam ruangan terbatas.
4.5 Verification
Ferifikasi
4.5.1 Verification of the completed job will be done Chief HSE / Site Safety Supervisor /
Construction Manager
Ferifikasi dalam penyelesaian pekerjaan dilakukan oleh Chief HSE, Pengawas Safety,
Construction Manager,Construction supervisor.
4.6 Training
Pelatihan
If you carry out work in a confined space, HSE Department must give training such as:
Bila anda akan melaksanakan pekerjaan dalam ruang tertutup, HSE Dept. Harus memberikan
Safety induction sbb.:
- The hazards of confined spaces

Bahaya-2 dalam ruangan tertutup/terbatas.
- Risk assessment procedures
Prosedur dalam mendata risiko-2 yg bisa terjadi.
- Risk control measures
Sistem mengontrol risiko bahaya.
- Emergency procedures
Prosedur dalam kondisi darurat.
- Selection, use, fit and maintenance of personal protective equipment.
Periksa, seleksi, gunakan dan pelihara setiap alat pelindung diri.

STANDARD INSTRUCTION FOR HSE
MONTHLY MANAGEMENT REPORT

APPENDIX G 23 July 2013
TABLE OF CONTENT
Daftar isi
Page
1.0 INTRODUCTION / Pendahuluan 2
2.0 PURPOSE / Tujuan 2
3.0 RESPONSIBILITY / Tanggung Jawab 2
4.0 STANDARD INSTRUCTION / Instruksi standard 2
5.0 FLOW CHART / Diagram Alur 3
Pt. Guna Teguh Abadi Page 1 of 3 Doc. APPENDIX G


1.0 INTRODUCTION
Pendahuluan
1.1 The standard instruction describes the monthly management reporting requirements of the Health,
Safety and Environment Management Systems.
Instruksi Kerja ini menguraikan syarat pembuatan laporan bulanan manajemen dalam Sistem
Pengelolaan Kesehatan, Keselamatan Kerja dan Lingkungan
2.0 PURPOSE
Tujuan
2.1 To provide consistent method for collecting data on work related implementation of HSE, this
will provide a measure of the effectiveness of HSE management.
Memberikan metoda baku untuk mengumpulkan data yang berkaitan dengan implementasi
HSE, guna memberikan ukuran efektivitas pengelolaan HSE.
.
3.0 RESPONSIBILITY
Tanggung Jawab
3.1 Chief HSE must be responsible this procedure apply at site.

Chief HSE harus bertanggungjawab terhadap aplikasi prosedur ini dilapangan.
3.2 All employees and contractors, subcontractors concerned are responsible to comply with this
standard instruction.
Setiap karyawan dan kontraktor, subcontractor bertanggung jawab untuk menjalankan
instruksi standar ini

Instruksi Standart
.
4.1 Chief HSE shall prepare to the Client HSE Department / representative , Project Manager and
Corporate HSE Manager the “Health, Safety and Environment Monthly Report” in
accordance with the timetable set out for Project Reports
Chief HSE akan menyiapkan “Health, Safety and Environment Monthly Report“ kepada
Departemen HSE / perwakilan HSE Client dan Corporate HSE Manager sesuai dengan
jadwal yang ditentukan untuk Laporan Proyek.
4.2 The report shall provide a summary of the following information:

Laporan mencakup informasi sebagai berikut:
 Compilation of Data Man Hours / Total jumlah data jam kerja
 Safety Performance Statistic / Data Statistik Kinerja HSE
 Monthly Accident Summary Report / Rangkuman Laporan Bulanan Kecelakaan
 Weathers Report / Laporan Keadaan Cuaca
 Implementation HSE Management System Report / Laporan Implementasi
Program HSE Magemen Sistem

4.3 The Corporate HSE Manager shall forward a monthly report for General Manager QC-HSE
Corporate HSE Manager akan meneruskan laporan bulanan untuk General Manager QC-
HSE
4.4 General Manager QC - HSE shall consolidate the "Workplace Health, Safety & Environment
monthly reports" and project report the Health, Safety and Environment Management
activities and performance in Corporate Executive Monthly Meeting.
General Manager QC-HSE akan merangkum “laporan-laporan bulanan Kesehatan,
Keselamatan Kerja dan Lingkungan ” dan melaporkan kegiatan dan kinerja Pengelolaan
Kesehatan, Keselamatan Kerja dan Lingkungan seluruh proyek pada Corporate Executive
Monthly Meeting.
5.0 FLOW CHART

Diagram Alir
HSE Monthly Report Prepared By

Chief HSE
Report to Project Manager Report to Main Contractor

STANDARD INSTRUCTION FOR WORK
PERMIT SYSTEM

APPENDIX H 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
1.1 INTRODUCTION 2
1.2 PURPOSE 2
1.3 RESPONSIBILITY 2
1.4 STANDARD INSTRUCTION 5
PT. Guna Teguh Abadi Page 1 of 6 Doc. APPENDIX H

PERMIT SYSTEM

1.1 INTRODUCTION
Pendahuluan
This standard instruction covers working permit system for all activities.
Standar ini mencakup instruksi system izin kerja untuk semua aktifitas.
This standard instruction shall apply to all employees and contractors in throughout
this projects.
Standart instruksi ini untuk diterapkan kepada seluruh pekerja dan kontraktor yang
terlibat diproyek.
1.2 PURPOSE
Tujuan
To ensure safe working practices and to protect employees and contractors in a

place of work from the hazards activities.
Untuk menjamin pelaksanaan pekerjaan aman dan melindungi pekerja dan
kontraktor di tempat kerja dari bahaya aktivitas pekerjaan.
1.3 RESPONBILITY
Tanggung Jawab
The Project Manager shall be responsible for the contents of this standard
instruction.
Project Manager bertanggung jawab untuk pelaksanaan isi dari instruksi kerja ini.
The Construction Manager concerned are responsible to ensure that this standard
instruction is followed in their area.
Menejer Konstruksi bertanggung jawab untuk menjamin standar instruksi ini
terlaksana di area kerjanya.
Chief HSE shall advice on compliance to legal and other requirements.

Chief HSE mengarahkan terhadap pemenuhan persyaratan hukum dan persyaratan
– persyaratan lain.
All employees and contractors concerned are responsible to comply with this
standard instruction.
Semua pekerja dan kontraktor bertanggung jawab untuk menyesuaikan /
melaksanakan standar instruksi ini.

PERMIT SYSTEM

Standar Instruksi
1.4.1 Responsibility of field supervisor before work start

Tugas supervisor sebelum melakukan pekerjaan
FIELD SUPERVISOR
1
MENGISI FORM PERMIT
FILL UP WORK PERMIT FORM
2
MENYIAPKAN JSA & SOP
PROVIDE JSA & SOP
3 MENYERAHKAN KE REK-HSE
UNTUK DI PERIKSA
SUBMIT TO REK-HSE FOR
REVIEW (Satu Hari Sebelum
Bekerja / Jam 4 sore)
GTA - HSE

PERMIT SYSTEM

1.4.2 Responsibility of HSE PT. Guna Teguh Abadi before submit to construction
Tanggung jawab HSE PT. Guna Teguh Abadi sebelum diserahkan ke manager
konstruksi
GTA - HSE
1
Memeriksa lokasi pekerjaan
Check location of actvity and
Preparation on safety matters
2
Memeriksa JSA yg diterima
Review JSA
Meyakinkan kembali persiapandi lokasi
3
Sebelummenandatanganidan
menyerahkan ke HSE Rekayasa
Ensure at site before sign and submit t
Ke Rekayasa HSE .

PERMIT SYSTEM

1.4.3 Responsibility of field supervisor after get approval from HSE

Rekayasa Industri.
Tanggung jawab supervisor pekerjaan setelah mendapat persetujuan
dari HSE Rekayasa Industri

PERMIT SYSTEM


STANDARD INSTRUCTION FOR
HOUSEKEEPING AND CLEANLINES

APPENDIX I 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
4.1 Planning the Worksite for Good Housekeeping and Cleanliness 3

Rencana Housekeeping dan Kebersihan lokasi
4.2 Maintaining Site Cleanliness and Tidiness 3
Pemeliharaan Kebersihan dan Kerapihan lokasi
4.3 Use of Chutes for Disposing of Waste Materials and Debris 4
Penggunaan lorong/corong untuk pembuangan limbah (sampah)
4.4 Use of Waste Containers 4
Penggunaan container (drum) limbah
4.5 Run-off from the Site 5
Keluar – masuk dari lokasi proyek
4.6 Sanitation 5
Sanitasi
4.7 Illumination 6
Penerangan
PT. Guna Teguh Abadi Page 1 of 6 Doc. APPENDIX I


1.0 INTRODUCTION
Pendahuluan
Good site housekeeping and cleanliness helps to prevent many accidents. Untidy worksites can cause:
House keeping dan kebersihan akan banyak membantu dalam mencegah terjadinya kecelakaan,
tetapi bila house keeping dan kebersihan tidak terpelihara, dapat menyebabkan:
a) Wastage of building materials;

Menumpuknya sampah dilokasi
b) Hazards to workers and the public;

Membahayakan karyawan dan masyarakat sekitar
c) Increases in cost of the building work;

Meningkatnya biaya dalam pekerjaan
d) Negative effects on the environment;

Berdampak tidak baik (negatip) terhadap lingkungan hidup.
e) The creation of breeding grounds for mosquitoes;

Berkembang biaknya nyamuk.
f) Infestation of pests and vermin;

Tempat berkumpul nya tikus, dan lain-lain
g) A decrease in work production; and

Menurunkan produksi kerja
h) Others. / lain-lain
This standard instruction shall apply throughout the organization and shall cover all types of activities
within PT. Guna Teguh Abadi.
Instruksi Standar ini akan di terapkan melalui organisasi dan akan meliputi setiap jenis kegiatan di PT.
Guna Teguh Abadi.
2.0 PURPOSE
Tujuan
To provide guidance to Site Supervisors and other relevant interested parties on the importance of clean
and orderly worksites and how to set up the worksite in a way that will make sure that the site is kept in
an orderly condition at all times.
Sebagai petunjuk setiap pengawas dan karyawan lainnya bahwa kerapihan dan kebersihan itu sangat
penting dan bagaimana membuat lokasi proyek agar selalu dalam kondisi bersih rapih setiap saat.
3.0 RESPONSIBILITY
Tanggung Jawab.
Panitia K-3 bertanggung jawab atas isi dari prosedur ini.


Chief HSE concerned are responsible to ensure that this working instruction is followed within the site
by the workers and other relevant interested parties.
Chief HSE bertanggung jawab untuk meyakinkan bahwa instruksi standard ini dijalankan disetiap
lokasi oleh seluruh karyawan.
Chief HSE shall advice on the legal and other requirements.

Chief HSE akan memberi saran dalam hal hukum dan ketentuan lainnya.
The HSE Officer shall be responsible to ensure good housekeeping and cleanliness.
HSE Officer bertanggung jawab untuk meyakinkan bahwa program house keeping dan Kebersihan di
laksankan.
All workers and other relevant interested parties concerned are responsible to comply to this working
instruction.
Setiap karyawan bertanggung jawab atas program ini.

Instruksi Standar
4.1 Planning the Worksite for Good Housekeeping and Cleanliness

Rencana lokasi dalam program housekeeping dan kebersihan
Before work begins at the site, places must be set aside for the storage of different kinds of
materials and equipment:
Sebelum pekerjaan di lapangan dimulai tempat untuk menumpuk/menyimpan material
dan peralatan yang berbeda.
a) Access isles and exits;

Jalan masuk dan keluar
b) Pre-cast concrete items, steel and timber;
Concrete, besi dan kayu
c) Formwork and scaffolding;
Formwork dan perancah
d) Proper access for delivery and carnages;
Jalan untuk mengirim / mengangkut yang memadai
e) Waste materials; and
Limbah material, dan
f) Materials that can be recycled or reused on the same worksite.
Sampah atau material yang dapat diduar ulang atau dpat digunakan lagi apad
proyek yg sama.
There is sometimes a need to set up smaller depots where supplies of building materials can be
stored nearer to where the work is being carried out. These depots will need to be properly laid
out and kept clean and tidy so that the materials can be safely and properly stored.
Kadang perlu dibuatkan depot kecil untuk menampung material sehingga lebih dekat ke tempat
pekerjaan, depot ini harus dibuat sedemikian rupa dan selalu dalam keadaan bersih dan rapih.
Sehingga material dapat disimpan dengan aman.
4.2 Maintaining Site Cleanliness and Tidiness

Pemeliharaan kebersihan dan kerapihan lokasi.
Site Managers and Supervisors must ensure that regular site clean-up activities are carried out
(preferable after each day’s work).

Site manager dan pengawas harus meyakinkan bahwa kegiatan pembersihan lokasi
dilaksankan secara regular (bila memungkinkan setiap hari setelah selesai bekerja).
Contractors, Subcontractors and their workers shall make sure that they keep their areas of the
workplace in a tidy condition. All waste materials should be disposed of and equipment should
be returned to its correct place at the end of each work shift. If required, floors should be swept
and all rubbish placed in waste bins for disposal.
Kontraktor dan subkontraktor dan karyawannya harus selalu menjaga lokasi tempat kerjanya
agar selalu bersih dan rapih, setiap sampah harus dibuang dansetiap peralatan harus
berada/disimpan ditempat yg benar setiap setelah selesai bekerja, bila perlu lantai tempat
kerja dip el dan semua kotoran sampah dibuang.
Supervisors shall ensure that good housekeeping standards are enforced where housekeeping is
poor. Work areas that give rise to large amounts of waste will need to be cleaned up when
required so that they do not become untidy and unsafe.
Pengawas akan meyakinkan bahwa housekeeping standard harus dilakukan bila kondisi house
keeping sangat buruk, Tempat kerja dengan sampah yang banyak akan memerlukan
pembersihan, akan menjadikan tempat kerja yg tidak bersih dan berbahaya.
HSE Officer will check site housekeeping on their regular inspections. Areas that fall below the
required standard will be raised with the Contractor or Subcontractor responsible for that area. If
necessary the HSE Officer will arrange for that area to be cleaned up and will charge the
Contractor for the costs.
HSE Officer akan memeriksa kebersihan lapangan secara rutin, lokasi yang tidak memenuhi
persyaratan dalam kebersihqan maka daerah itu akan menjadi tanggung jawab kontraktor dan
subkontraktor. Bila perlu HSE Officer akan menyiapkan team kebersihan dan membersihkan
lokasi tsb. Semua biaya yg timbul menjadi tanggung jawab kontraktor tsb.
Site Managers may consider stopping work at the site from time to time to carry out a special
site clean up. There will need to be enough trucks available to take the waste materials away to
the nearest landfill. This time can also be used to sort out reusable or recyclable materials.
Site Manager dapat mempertimbangkan untuk menghentikan pekerjaan setiap saat untuk
keperluan pelaksanaan kebersihan lokasi. Diperlukan truk untuk mengangkut sampah dengan
jumlah yg cukup dan tersedia, pada waktu yg sama dapat juga mensortir material yang akan
digunakan dan di daur ulang.
4.3 Use of Chutes for Disposing of Waste Materials and Debris

Penggunaan lorong/corong untuk membuang sampah dan kotoran.
Chute is required whenever waste materials need to be dropped; an enclosed chute made of
wood or other suitable material must be used.
Corong khusus diperlukan bila akan mendropsampah dari ketinggian, corong dibuat dari kayu
atau material lain.
Chutes, which are at an angle of more than 45 degrees with the horizontal, must be completely
enclosed on all sides, except for the top and bottom openings.
Corong dengan kemiringan lebih dari 45 derajat dan horizontal, seluruh sisinya harus tertutup.
Kecuali pada ujungnya harus terbuka.
Chutes must be securely supported.

Corong harus ditunjang dengan kuat
Chutes at an angle of less than 45 degrees may be open on the upper side.
Corong dengan kemiringan kurang dari 45 derajat, bagian atasnya bisa terbuka.

All openings in chutes, except the top opening, shall be closed when they are not being used.
Setiap bagian yg terbuka pada corong tsb, harus ditutup bila tidak digunakan kecuali bagian
atasnya.
Barricades around the chute point and warning signs in all the languages used at the site must be
put at the bottom end of all chutes in a place where everyone can see, to warn workers and the
public of the danger.
Pagar pengaman dan poster peringatan disekitar corong dalam bahasa yg digunakan di proyek
harus ditempatkan di bagian bawah ujung daripada corong yang dapat dilihat setiap
karyawan, dan menjelaskan bahwa sedang ada kegiatan berbahaya.
4.4 Use of Waste Containers

Penggunaan sampah kaleng bekas kemasan
It may be useful to consider using different skips for different types of waste that will be created
at the site, e.g.:
Ini mungkin dapat menjadi sebagai bahan pertimbangan, sampah serta containernya berbeda
dan hal ini dapt terjadi di proyek:
a) Bricks, rubble concrete or plaster.

Bekas tembok, adukan dan tembokan
b) Empty paint or adhesive tins, containers or drums.

Kaleng bekas cat, container atau drum
c) Wood, cardboard or paper.

Kayu, triplek dan atau kertas.
d) Waste chemicals, oils or grease.

Limbah kimia, minyak dan gemuk
e) Scrap metal such as pipes or wire.

Potongan besi seperti bekas pipa atau kawat/kabel
Remember to place the container in places where the collector has access to pick them up.
Harus diingat, tempatkan container ditempat yang biasa digunakan.
Remember to cover the waste if the wind can scatter it over the site – place nets or lids over it.
Ingat harus dipasang penutup sampah untuk mencegah agar sampahnya tidak berhamburan.
Haul off rubbish as soon as possible.

Bersihkan sampah sesegera mungkin
Do not burn rubbish at the site. All the authorities ban the burning of rubbish at worksites.
Jangan membakar sampah di lokasi proyek.
4.5 Run-off from the Site

Keluar masuk dari proyek
Special safety precautions must be taken to prevent the seepage of chemicals and other
materials, such as cement-bled residues, into nearby waterways and streams.
Instruksi keselamatan yg khusus harus diambil untuk mencegah bocoran bahan kimia dan yg
lainnya, seperti minyak residu, semen yg mungkin masuk ke dalam system.

If there is an accidental leak of substances that could pollute waterways or streams it should be
scrapped up by an excavator and placed into a skip for proper disposal.
Bila terjadi kecelakaan/ kebocoran yang bisa membuat polusi pada system, harus segera
diangkat dengan menggunakan excavator dan dibuang ketempat pembuangan.
Setting ponds should be constructed before any site drains discharge into public drains or
natural channels.
Bak penampungan harus disediakan sebelum di buang ke pembuangan umum.
4.6 Sanitation
Sanitasi
Thought must be given to the placement of toilets and washing facilities so that:
Saluran khusus harus tersedia untuk toilet dan tempat cuci, sehingga:
a) Wastewater does not seep into nearby watercourses.

Air kotor tidak meresap kedalam system
b) Toilets and washing facilities should be cleaned every day.

Toilet dan tempat cuci/mandi harus selalu bersih setiap hari
c) All workers have good access to them.

Setiap karyawan harus ikut memelihara.
d) They are placed in areas where they will not be contaminated by mud and rubbish.
On some portables or semi-permanent septic tanks may be good alternatives.
Lokasi toilet harus di tempat yg tidak terkontaminasi oleh Lumpur dan sampah,
septic tank sementara atau permanent mungkin bisa dijadikan alternatip.
4.7 Illumination
Penerangan
Areas accessible to employees shall be lighted to not less than the minimum illumination
intensities listed in the following table:
Penerangan di lokasi harus tersedia, berikut adalah standard untuk penerangan:
Foot-candles Area or operations

5 General site areas
3 Excavation and waste areas, access ways, active storage areas, loading platforms,
refuelling, and field maintenance areas.
5 Indoors: Warehouse, corridors, hallways, and exit ways.
5 Tunnels, shafts, and general underground work areas. (Exception: Minimum of 10
foot-candles is required at tunnel and shaft heading during drilling mucking, and
scaling. Mine Safety and Health Administration approved cap lights shall be
acceptable for use in the tunnel heading)
10 General shops (e.g., mechanical and electrical equipment rooms, active storerooms,
barracks or living quarters, locker or dressing rooms, dining areas, and indoor toilets
and workrooms)
30 First aid stations, infirmaries, and offices.

STANDARD INSTRUCTION FOR LIFTING
HANDLING AND STORAGE

APPENDIX J 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
4.0 STANDARD INSTRUCTION / STANDAR INSTRUKSI 2
4.1 Manual Handling 2

Penanganan secara manual
4.2 Mechanical Handling 5
Penanganan secara mekanis
4.3 Storage 11
Penyimpanan
PT. Guan Teguh Abadi Page 1 of 15 Doc. APPENDIX J


1.0 INTRODUCTION
Pendahuluan
1.1 This standard instruction shall apply throughout the organization and shall cover all types of
operation involved material handling (manual and mechanical) and storage.
Instruksi Standar ini akan diterapkan melalui Organisasi dan akan meliputi/mencakup semua
jenis operasi/kegiatanyang menyangkut penanganan material (secara biasa atau secara
mekanik) juga penyimpanan.
2.0 PURPOSE
Tujuan
2.1 To ensure safe manual and mechanical handling methods for lifting and carrying loads and to
prevent injuries cause by unsafe practices – improper lifting, carrying too heavy load, incorrect
gripping, failing to observe proper foot and hand clearances, and failing to use personal
protective equipment (PPE).
Untuk memastikan metode pengangkatan serta pemindahan material dilakukan dengan cara
yang aman untuk mencegah terjadinya cedera yang dikarenakan cara yang tidak aman atau
kesalahan dalam pengangkatan, beban terlalu berat, salah posisi pada kaki dan tangan, dan
kesalahan dalam pemakaian alat pelindung diri.
3.0 RESPONSIBILITY
Tanggung Jawab
3.1 The HSE committee shall be responsible for the contents of this standard instruction.
Panitia K-3 bertanggung jawab atas pelaksanaan instruksi ini.
3.2 The HSE committee concerned are responsible to ensure that this procedure is followed within
the Worksite.
Panitia K-3 / HSE manager bertanggung jawab untuk memastikan bahwa prosedur ini
dijalankan di setiap lokasi proyek.
3.3 HSE Officer shall advice on the legal and other requirements.
HSE Officer akan memberi saran dalam hal hukum dan ketentuan lainnya.
3.4 All employees and subcontractors concerned are responsible to comply with this standard
instruction.
Setiap karyawan dan subkontraktor bertanggung jawab untuk menyesuaikan dengan prosedur
ini.

Instruksi Standar
4.1 Manual Handling

Penanganan secara biasa
4.1.1 The Load

Beban

Try to reduce the need for manual handling.

Usahakan mengurangi penanganan dengan cara biasa.
i- If a load has to be moved, think about whether it can be moved by a
machine or piece of equipment, e.g. a forklift truck. If it can, then
organise with the HSE Officer and Site Supervisor to have the equipment
brought to the place where the load is placed.
Bila barang harus dipindahkan, pertimbangkan untuk menggunakan alat
seoerti forklift, bila memungkinkan diskusikan dengan HSE Officer dan
Supervisor untuk memindahkan dengan alat.
ii- Make sure that the place where the load is to be taken has been set up to
take it, as this will minimise further handling later.
Pastikan bahwa alat dan tempat yang akan dipindahkan sudah siap,
untuk mencegah terlambatnya waktu.
Assess any risks before moving the load.

Data dan catat setiap risiko sebelum mulai
i- If there could be some difficulties moving the load, and if it is not

possible to have equipment move the load then we need to look at any
risks that might be present when lifting or carrying the load.
Bila ada kesulitan dalam pemindahan barang dan tidak mungkin
memindahkan barang dengan memakai alat pertimbangkan
kemungkinan ada risiko bahaya pada saat mengangkat atau
memindahkan barang.
Will the load be hard to carry?

Kesulitan pada saat membawa barang ?
i- If it will be hard to get into the place where it is going to be taken, make
sure that you think about a safe way to get it in. Can the load be taken
apart into smaller pieces?
Bila mendapat kesulitan dalam memasukan barang, pastikan untuk
memikirkan jalan lain yang aman, mungkin dengan cara memperkecil
barang ( re-assembly)
ii- If it will be hard to keep a grip on it, use lifting strops or other devices.
Bila mendapat kesulitan lain, coba dengan cara diangkat atau car lain.
iii- Make sure there are enough people to carry it.

Pastikan bahwa tenaga yang tersedia cukup jumlahnya.
d) Is the load in a cramped place?
i- Clear enough room around it so that people can position themselves

properly around the load. Make sure they have a safe posture before
taking up the weight.
Pastikan ruangan cukup luas sehingga pekerja dapat memposisikan
badannya dalam melaksanakan pekerjaan, dan pastikan bahwa posisi
badan anda aman


ii- Make sure the path to where the load is going is clear and that people
will not trip over objects lying in the way.
Pastikan jalur yg dilalui aman, kemungkinan tersandung tidak ada.
iii- Make sure that the place where the load is being taken has enough room
to put the load down safely. Clear a space big enough for the load and
the people carrying it.
Pastikan bahwa ruangan yang akan dipakai menyimpan barang cukup
dan aman untuk membawa dan mentimpan barang.
iv- If the load has to be moved to a place where it could fall on people
below, make sure that the load can be prevented from falling, and that
they are warned of the hazard and moved out of the way.
Bila barang sudah pindah dan kemungkinan bisa jatuh, pastikan dan
cegah barang tersebut untuk tidak jatuh, peringatan adanya bahaya
harus di tempatkan.
Can the people lifting and carrying the load do it safely?

Dapatkah pekerja memindahkan barang dengan aman?
i- When the load will be hard to carry because of some of the reasons
above, make sure that the people chosen to lift and carry the load are
strong and fit enough to do it.
Bila ada kesulitan dalam memindahkan disebabkan kondisi diatas,
pastikan untuk memilih pekerja yang kuat dan fit.
ii- Make sure no one in the team already has a back injury and that they are
all fit and healthy.
Pastikan dalam group tsb tidak ada yg pernah mengalami cedera
punggung dan semua pekerja kondisinya sehat dan kuat.
iii- Make sure that they have any PPE or other gear that will help them to lift
the load safely. Also make sure any PPE will not get in the way and
cause a hazard.
Pastikan bahwa para pekerja mempunyai alat pelindung diri atau alat
pengaman lainnya dan yakinkan agar alat pelindung tsb tidak
merupakan sumber bahaya.
iv- Make sure you know what is in the load so that you can take any special
precautions, e.g. If it is fragile.
Pastikan bahwa kita tahu barang yang akan diangkat itu sehingga kita
dapat melaksankannya dengan secara hati-2 dan baik.
4.1.2 Safe Lifting Techniques

Tehnik mengangkat dengan aman.
a) Make sure that you have thought about the risks discussed earlier and that you
have planned to deal with any possible hazards.
Pastikan bahwa anda sudah mendiskusikan risiko bahaya sebelumnya, sehingga
anda dapat merencanakan untuk menghadapi / mengantisipasi kemungkinan
bahaya.
b) How to lift loads safely.


Bagaimana mengangkat dengan aman.
i- Get into a relaxed position in front of the load and facing the way you
want to take the load.
Ambil posisi rileks didepan barang yang akan diangkat.
ii- Place your feet apart. If you are carrying a load on your own, place your
leading leg slightly in front of the load.
Tempatkan kaki anda dengan baik, bila anda membawa barang
sendiriposisikan kaki anda bertumpu dengan kuat didepan barang.
iii- Bend your knees, crouch down, test the weight of the load to make sure
that it is not too heavy to lift on your own.
Tekukan lutut anda, jongkok tes berat barang, pastikan bahwa beban
tidak terlalu berat.
v- To pick up the load, bend forward slightly, straightening up when you

have a firm grip under the load.
Untuk mengangkat beban, tekukan pelahan langsung berdiri bila anda
merasa sudah mampu mengangkatnya.
vi- Keep the back straight and upright, and your hips in line with the
shoulders.
Perhatikan bagian belakang dan harus tegak lurus dan pinggul anda
sejajar dengan pundak.
vii- To stand up with the load, push up from the ground with the leg and
thigh muscles.
Untuk berdiri dengan beban, gunakan kekuatan kaki anda.
viii- Make sure you carry the load as close to the centre of your body as
possible.
Pastikan anda membawa beban dengan cara mendekatkan barang
dengan tubuh anda.
ix- Do not rush while lifting or carrying – use smooth movements.

Jangan terburu-buru pada saat anda mengangkat atau membawa beban,
ambilah cara yang perlahan dan santai.
x- When turning, move the feet in the direction you want to go. Don’t turn
from the hips.
Bila berputar, pindahkan lah kaki anda ke arah anda mau berputar,
jangan memutarkan pinggul anda.
xi- When putting the load down, do the opposite of picking it up, i.e. bend
the knees and keep the back straight and upright to put it down. Do not
bend from the waist.
Bila menyimpan beban, tekukan lutut anda dan jaga punggung anda
tetap tegak.
4.2 Mechanical Handling

Dengan cara mekanik
Crane

Alat angkat
a) Lifting Operations – Lift Coordinator

Kegiatan pengangkatan – koordinator
i- The lift co-ordinator is the person on site who has experience of lifting
and hoisting techniques and is called in to give advice when needed.
Koordinator dalam kegiatan pengangkatan adalh petugas lapangan yg
berpengalaman dalam kegiatan pengangkatan dan tehnik2 mengangkat.
ii- The lift co-ordinator has experience of how to deal with special lifts and
will actually control and direct the lifts. They are usually in a supervisory
position.
Koordinator kegiatan harus mempunyai pengalaman bagaimana dalam
menentukan pengangkatan khusus dan kondisi kontrolyang actual,
biasanya dijabat oleh posisi Supervisor.
b) Lifting Operations – Crane Operator

Operasi pengangkatan – operator
i- All crane operators must carry the necessary licences and on engagement
produce a letter from their previous employer stating the number of years
experience and competence in operations cranes.
Setiap operator crane harus mempunyai lisensi dan syrat pengalaman
yg menyatakan berapa tahun sebagai operator dan keahlian sebagai
operator crane.
ii- All crane operator must be trained, competent and authorised to operate
the crane. In addition, a Depnaker / Migas certificate is required.
Setiap operator crane harus terlatih, ahli dan mempunyai hak/ijin untuk
mengoperasikan crane, sertifikat dari Depnaker / Migas diperlukan.
iii- They must know how to use the crane and all of its safety devices.
Mereka harus mengetahui bagaimana menggunakan crane dan semua
alat keselamatannya.
iv- They must understand the signals used by the slinger / banksman.
Mereka harus mengerti aba-aba yang digunakan rigger/signalman.
v- The crane operator is responsible for the correct and safe operation of the
crane.
Operator crane bertanggung jawab atas kebenaran dan keamanan
operai crane.
vi- They must be authorised to use the crane.

Mereka harus mempunyai ijin untuk mengoperasikan crane.
c) Lifting Operations – Slinger / Banksman.

Operasi pengangkatan – signalman dan rigger
i- Attaching and detaching the load to and from the crane.

Tambahkan dan kurangi beban dari dan untuk alat.


ii- Making sure that the correct lifting gear and equipment is used for the lift
and the load.
Memastikan bahwa alat untuk mengangkat dan alat angkat yang akan
digunakan benar dan aman.
iii- Signalling (using hand-signals or radio) to the crane driver to make sure
he can carry out a safe lift.
Pemberi aba-aba (dengan tangan atau radio) kepada operato crane
untuk memastikan dia dapat melaksanakan pekerjaan dengan aman
.
iv- Must wear a special coloured hard hat and high visibility vest and have a
whistle.
Harus memakai warna khusus untuk helmet juga memiliki peluit dan
memiliki visi yg tinggi.
d) Preparing for Lifting – The Crane

Persiapan untuk pekerjaan pengangkatan – Crane
i- The crane must be regularly inspected and have a valid Depnaker /

Migas Certificate.
Crane harus diperiksa setiap saat secara reguler dan memiliki sertifikat
dari Depnaker/Migas yang masih berlaku.
ii- There must be a load chart displayed in the cab of the crane.
Daftar beban / load chart harus terpasang di kabin crane.
iii- The crane must be properly maintained, with all of its safety devices in
good working order, e.g. limit switches and load indicator.
Crane harus dirawat dengan baik, semua peralatan safety pada crane
harus berfungsi dengan baik,antara lain switch pembatas dan indikasi
beban.
iv- The ground under the crane must be stable and level.
Tanah / landasan crane harus stabil dan rata.
v- For wheeled mobile cranes, the outriggers must be fully extended with
the crane body horizontal.
Untuk mobil crane (Pake Ban) outriggernya harus dikeluarkan semua
pada saat dioperasikan.
vi- Steel plates or solid timbers must be placed under the outriggers to make
sure that they do not sink into the ground.
Pelat besi atau kayu yg kuat harus ditempatkan dibawah outriggers
untuk memastikan tidak masuk/terbenam ke dalam tanah.
e) Preparing for Lifting - Slings, Ropes and Strops

Persiapan untuk operasi pengangkatan – sling, tali dll.
i- The Safe Working Load (SWL) must be marked on all slings, ropes and
strops and they must be regularly checked by the user and the HSE
Officer.
Safe working Load harus tertera pada setiap sling, tali dan strops dan
harus diperiksa setiap saat / reguler oleh sipengguna dan HSE.


ii- They must not be used if they have any defects - Kinks – these are often
caused by sling wire ropes around sharp bends.
Bila ada sling yg rusak akibat salah pemakaian jangan digunakan.
iii- They must not be used if they have any defects - Wear and tear such as
flattening of the rope.
Jangan menggunakan tali yang sudah rusak.
iv- They must not be used if they have any defects - Broken wires.
Jangan menggunakan wire yg rusak.
v- Do not use home-made slings.

Jangan menggunakan sling buatan sendiri
vi- When defects are found, the items must not be used until they have been
checked by authorised person who will reject the rope or sling if the
defect is serious.
Bila didapati ada yg rusak, jangan digunakan sampai diperiksa oleh yg
berwenang yang akan memutuskan dibuang atau tidak.
vii- Color code system shall be use, color code will be affixed or painted
on to the lifting equipment/slings. The periods for color code
compliance will last for three (3) month. The following four colors,
red, green, blue and yellow will be used in rotation. The rotation of
the color will be communicated before the end of three (3)-month
period. The color coding used for slings testing is :
Sistem kode warna harus diimplementasikan, kode warna harus
dipasang atau di cat pada peralatan angkat/sling. Masa berlaku
untuk kode warna dalah 3 bulan. Adapun kode warna setiap tiga
bulan tersebut adalah merah, hijau, biru dan kuning. Pergantian
kode warna harus dikomunikasikan sebelum masa 3 bulan tersebut
berakhir.
Kode warna yang dipakai pada uji sling adalah
- January to March Red
Junuari sampai Maret Merah
- April to June Green
April sampai Juni Hijau
- July to September Blue
Juli sampai September Biru
- October to December Yellow
Oktober sampai Desember Kuning
f) Preparing for Lifting - Loads

Persiapan operasi pengangkatan – Beban
i- The load to be lifted must be within the crane’s capacity as shown on the
load chart.
Beban yang akan diangkat beratnya harus sesuai dengan kapasitas
crane, lihat daftar beban/kapasitas.
ii- Maximum load 10 ton for lifting work at night.

Beban maximum 10 ton untuk pekerjaan pengangkatan dimalam hari.


iii- Provide good lighting/illumination condition before started lifting work

at night.
Siapkan penerangan/pencahayaan dengan kondisi baik sebelum
melakukan pekerjaan pengangkatan di malam hari.
iv- Loads should not be lifted over people’s heads.

Beban tidak boleh diangkat diatas kumpulan orang / karyawan.
v- The area must be cleared by the banks man before the load is lifted.
Lokasi operasi pengangkatan harus aman, yakinkan sebelum mulai.
vi- The load should be balanced and horizontal.

Beban harus seimbang dan sejajar.
vii- Loads should be steadied with tag lines.

Beban harus di kendalikan oleh tali pengaman
viii- No one should stand in the back of any lorry when loads are being
lowered into it, e.g. re-bar cages.
Tidak seorangpun diijinkan berada dibelakang truck bila beban sedang
diturunkan (besi rebar dsb).
ix- Loads should be kept as near as possible to the ground.

Beban yang diangkat diusahakan harus sedekat mungkin dengan tanah.
x- The crane driver must make the final decision on the lifting of the load.
Operator crane harus membuat satu keputusan dalam kegiatan
pengangkatan.
g) Placing the Crane at the Site: The following safety matters are considered.
Memparkir crane di lokasi proyek: pertimbangkan kondisi-2 yg aman berikut ini;
i- How close will the crane need to be placed to other hazards such as
buildings or power lines?
Bagaimana agar crane yg diparkir tidak menimbulkan bahaya bagi
fasilitas lain seperti bangunan dan jalur kabel listrik.
ii- No part of the load or the crane is to be closer than the allowable safe
working distance from live power lines. If the crane must work near to or
move closer to power lines than the allowable safety limits, the
Supervisor will arrange with the electrical authority to de-energise the
lines.
Tidak dibenarkan crane dioperasikan berdekatan dengan jalur listrik
tanpa adanya persiapan khusus, bila diharuskan crane beroperasi dekat
jalur listrik, supervisor harus menyiapkan untuk memblok arus listrik
bersama supervisor listrik.
iii- The condition of the ground that the crane will stand or move on.
Kondisi tanah untuk crane stand by dan berpindah.
iv- How wind will affect the crane when it is working or standing.
Sebesar apa pengaruh angin bila crane sedang beroperasi.


v- The access to the site and the room needed for setting up and dismantling
the crane.
Diperlukan jalan untuk setting dan dismantling crane.
vi- Before setting-up and starting lifting operations on a new site or when
moving to a new area of the site, crane drivers must thoroughly inspect
the working area for power lines, ground conditions, proximity to drains,
slopes (banks can collapse), hoardings, fences and walls (no closer than
600 mm) and any other potential hazards.
Sebelum diset up dan sebelum mulai operasi pengangkatan di lokasi
proyek yang baru, operator crane harus segera memeriksa lokasi kerja
untuk jalur listrik, kondisi tanah, saluran /parit, kemiringan
(kemungkinan bias terbalik), pagar dan tembok (tidak terlalu dekat
jaraknya harus sekitar 600 mm minimal.dan bahaya2 lainnya.
h) General Safety
Peraturan Keselamatan Umum
i- The crane driver must stay alert, keeping his eyes on the load at all times.
Operator crane konsentrasi, selalu perhatikan beban setiap saat.
ii- He must not make the load start and stop suddenly when lifting.
Tidak dibenarkan menghentikan atau mengangkat operasi dengan tiba2
iii- All slings, ties and hooks must be properly placed and secured before the
load is raised or lowered.
Setiap sling, hook dan lainnya harus terpasang dengan baik dan aman
sebelum dimulai (mengangkat atau menurunkan beban)
iv- All workers not involved in the lift should be cleared from the area.
Setiap karyawan yangtidak terlibat dengan pekerjaan ini harus keluar
dari lokasi pekerjaan.
v- All workers in and around the lift area must wear the required personal
protective equipment (PPE).
Setiap karyawan yang terlibat dan berada dilokasi pekerjaan, harus
menggunakan alat pelindung diri.
vi- Workers must not squeeze past narrow gaps between the crane and walls
or fences.
Setiap karyawan tidak boleh memotong/menggunakan jalan diantara
crane dan dinding tembok atau pagar.
vii- If any lifting becomes hazardous it must be stopped immediately.

Bila pada saat operasi pengangkatan sedang berjalan ada hal-hal yang
membahayakan harus segera dihentikan.
viii- Ignition keys must not be left in unattended cranes.

Kunci kontak crane tidak boleh ditinggalkandi cabin crane.
4.2.1 Forklift
Forklift
a) Only trained operators are allowed to operate forklifts.


Hanya karyawan yg terlatih yang boleh mengoperasikan alat ini.
b) Safe distances must be maintained approximately three trucks lengths from the
truck in front.
Jarak aman harus selalu dijaga dengan jarak sekitar 3 kali panjang alat dari alat
didepannya.
c) Drivers are required to slow down and sound horns at cross aisles and other
locations where vision is obstructed. If the forward view is obstructed because of
the load being carried, drivers are required to travel with the load trailing behind
them.
Operator dalam menjalankan alat harus perlahan-lahan dan selalu membunyikan
klakson bila berada diposisi tikungan atau peresimpangan dan dilokasi lain
dimana penglihatan terhalang. Bila beban yg dibawa menghalangi pandangan
operator, alat harus dijalankan dengan cara mundur.
d) Trucks must be always operated at a speed that will permit them to stop safely.
Drivers are required to slow down on wet and slippery floors.
Alat harus selalu dioperasikan dengan kecepatan yang diijinkan, dan operator
diharuskan menjalankan alat dengan perlahan di lokasi lantai yang licin.
e) Stunt driving and horseplay are not tolerated.

Menjalankan alat dengan ugal-2an dan bermain-main adlah dilarang.
4.3 Storage
Penyimpanan
General
Umum
a) The general principles of safe material storage that stacks should be kept as low as
possible, be kept level and be stable.
Dalam prinsip umum untuk menyimpan barang diharapkan tidak menumpuk
terlalu tinggi dan selalu menjaga level yang aman serta stabil.
b) When the site is designed, places for storing materials are set out on the plans. As
work progresses there is usually a need to make other smaller depots for materials
that are closer to the work than a main store. These smaller storage areas are
sometimes more difficult to keep clean and tidy. They may even need to be
moved. Good planning of where to locate a material storage are can often
minimise much work later on.
Bila lokasi untuk menyimpan barang sudah di seting/disiapkan, sesuai dengan
progress pekerjaan biasanya diperlukan tempat penyimpanan yang kecil yang
dekat dengan lokasi kegiatan, tempat inikadang sulit untuk dibersihkan/dirapikan,
harus dengan cara dipindahkan tempatnya (box nya, Perencanaan yang baik
dalam menyimpan barang dapat mencegah kelambatan pekerjaan.
c) Material stores should be located :
Penyimpanan barang harus dilokasi:
i- Where the ground is reasonably level, dry and stable enough to carry the
weight of the materials.
Kondisi lantai yang cukup rata, kering dan stabil untuk menahan beban
barang tersebut.


ii- Where they are at least one metre from any floor opening or open floor
ledge.
Harus dengan jarak minimum 1 meter dari lantai yang terbuka (lobang)
atau dari lantai yang selalu dibuka.
iii- So that the materials do not lie on top of underground services, or

damage underground drainage.
Barang tidak boleh disimpan di lokasi diatas yng terdapat fasilitas
bawah tanah atau diatas saluran bawah tanah yang rusak.
iv- Where they will not create hazards with overhead power lines when
materials are loaded or unloaded.
Tidak menimbulkan bahaya pada jalur listrik pada saat bongkar muat.
v- So there is enough space for the quantity of materials needed, and they
can be placed neatly in rows or stacks.
Lokasi yang ckup untuk menampung barang sehingga barang dapat
disusun / ditumpuk dengan baik
vi- So equipment and people can come to the area and safely pick up and
take away the materials that are needed.
Setaip alat dan karyawan dapat mengambil barang dengan mudah dan
aman.
vii- So that items stacked at the top are those to be used first.
Setiap pengambilan barang yg ditumpuk, harus diambil yang paling atas
terlebih dahulu.
viii- So they will not be in the path of plant or equipment, other accessways or
where there will be other building work carried on later.
Tidak mengganggu peralatan jalan yang lain atau pekerjaan bangunan
yang akan dating.
Taking proper care of the materials

Penanganan barang dengan baik.
a) Timber (sheet and framing)

Kayu / balok
i- Timber should be protected from excessive sun, rain and moisture. If

long term storage is required the timber should be covered with plastic
sheet or tarpaulins or placed under cover.
Kayu harus terlindung dari sinar matahari, hujan dan kelembaban, bila
akan disimpan dalam waktu lama harus Ditutup lembaran plastik atau
terpal.
ii- Timber should be placed on battens to keep it off the ground.

Dilarang disimpan secara langsung ke tanah, gunakan bantalan.
iii- It should be stored so that it is not bent or bowed. Neat stacks make it
easier to handle.
Dismpan dengan cara penyususnan yang baik, tidak bengkok dan
mudah untuk di handle.


iv- Make sure that you stack items on top that are to be used first.
Pastikan bahwa setiap pengambilan harus diambil yg diatas dulu.
b) Structural steel and reinforcing bar

Besi struktur dan besi beton
i- Structural steel members must be safely stacked so that they do not

topple. Placing strong battens between steel members will prevent them
from sliding off and injuring someone. It will also make it easier to place
slings around when lifting them. If pipes or cylinders are being stacked
make sure solid timber wedges are used to stop them from rolling.
Besi rangka harus disimpan dengan disusun secara baik penggunaan
bantalan yang kuat antara rangka besi akan mencegah terjadinya
tergulirnya barang (mencegah kecelakaan) Hal tersebut juga akan
memudah kan memasang sling bila akan diangkat, dalam penyimpanan
pipa atau cylinder pengaman harus dipasang agar barang tsb tidak
merosot dan menggelinding.
ii- Keep stacks of material low; do not exceed the manufacturer’s

recommendations.
Usahakan penumpukan barang tidak terlalu tinggi, ikuti rekomendasi
dari pabrik pembuat.
iii- Re-bar needs to be kept clean. When stacking, place battens on the
ground and between bundles. Make sure that bundles are kept as straight
as possible. If the re-bar will be at the place for a long time, store on
crusher run.
Besi beton harus dijaga kebersihannya, bila ditumpuk gunakan bantalan
dan simpan diantara ikatan besi beton tsb. Pastikan ikatan besi beton
dalam kondisi yg lurus.
c) Loose materials (sand, crusher run etc.)

Barang yg mudah tercecer (pasir dll)
i- These materials can be very dangerous in large quantities because they

can slip or collapse.
Barang seperti ini dapat menjadi berbahaya dal jumlah yang banyak
karena dapat terjadi longsoran.
ii- Do not store sand or similar materials against structural walls as the
weight has been known to push walls over.
Jangan menimbun pasir atau sejenisnya dekat tembok (dinding) karena
dapat m,endorong dinding tsb dan rubuh.
iii- If a large supply is required a special area should be set up where trucks
can operate safely.
Bila diperlukan dengan jumlah yg banyak, harus disediakan tempat
khusus sehingga alat dapat beroperasi dengan aman.
iv- Do not place large items equipment or other heavy materials on top of
piles of sand as they may not be stable enough to hold the weight.
Jangan menempatkan peralatan atau barang berat lainnya diatas
tumpukan pasi.


d) Perishable materials (cement, plaster etc.)

Barang mudah menyerap (semen, plester, dll)
i- These materials can be easily damaged when they become wet. Cover
them with a polythene sheet or store them under cover.
Barang jenis ini cepat / mudah rusak dalam kondisi basah, tutuplah
dengan plastik sheet untuk mencegah terkena air.
ii- These materials should not be placed in contact with the ground. Stack
them on pallets or on timbers.
Jangan menyimpan barang ini langsung diatas tanah, gunakan bantalan
penyekat.
e) Hazardous materials
Barang berbahaya
i- There are number of hazardous substances and materials used on site;

e.g: dusts – such as cement, and silica. Chemicals – such as resins,
solvents, paints and fuels, preservatives, acids and lubricants.
Banyak barang berbahaya digunakan di lokasi proyek antara lain, Yang
Berdebu (Pasir, semen dan silica), Kimia (resin, solvent, cat dan bahan
bakar etc)
ii- These types of materials should be separated from other materials as they
require special attention and controlled by regulations.
Barang ini harus disimpan secara terpisah dari yang lainnya, juga
diperlukan perhatian khusus dan dikontrol oleh aturan-2.
iii- Different groups of hazardous materials need to be kept separate.

Disimpan dengan cara dipisah untuk masing-2 jenisnya.
iv- They also often need to be handled with special safety equipment and/or
PPE.
Diperlukan alat keselamatan / pelindung diri bila menangani barang ini.
v- Follow instructions on the Materials Safety Data Sheet (MSDS) /

Chemical Safety Data Sheet (CSDS).
Ikuti ketentuan-ketentua yg tercantun dalam MSDS dan CSDS
vi- Refer to Standard Instruction Chemical and Hazardous Material.

Mengacu ke Standard Instruction Chemical and Hazardous Material
f) Fragile materials
Barang mudah pecah
i- Some materials must be handled and stored with care so that they are not
damaged. This includes copper and plastic ducting, plumbing
components, electrical cable, glass and special roofing materials.
Ada beberapa barang yg memerlukan penanganan secara baik untuk
mencegah kerusakan, hal ini termasuk untuk tembaga, plastik ducting,
plumbing componen, kabel listrik, gelas / kaca dan material untuk atap.


Some fragile materials may need to be supported and separated by soft,

compressible materials to prevent damage.
Sebagian dari barang ini memerlukan penunjang yg terpisah dengan
jenis bantalan yg halus/lunak untuk mencegah kerusakan.
ii- When storing, unpacking and handling these materials, make sure that
the area is kept tidy.
Bila menyimpan dan menanangani barang ini pastikan bahwa lokasi
dalam keadaan bersih dan rapi.
g) Equipment (scaffolding, ladders etc.)

Peralatan (Perancah, tangga dll.)
i- Scaffolding, planks, ladders etc. must be stored so that they are not
damaged.
Perancah, papan, tangga dll. Harus disimpan dengan baik untuk
mencegah rusaknya barang.
ii- They should be stored where they can easily found and re-used.
Harus disimpan sedemikian rupa sehingga mudah ditemukan dan
digunakan.
iii- They should be stored so that they are not damaged by weather or
moving plant and vehicles.
Dijaga jangan sampai rusak dalam penyimpanan atau perpindahan.

TRANSPORTATION AND TRAFFIC

APPENDIX K 23 July 2013
TABLE OF CONTENT
Daftar Isi
Page
4.1 Public Vehicular Traffic Lalu lintas umum 2

4.2 Vehicle and Traffic Safety within a Site Keselamatan lalu lintas di lokasi 3
4.3Public Safety Keselamatan Umum 8
4.4 Worker Safety Keselamatan Karyawan 12
PT. Guna Teguh Abadi Page 1 of 15 Doc. APPENDIX K


1.0 INTRODUCTION
Pendahuluan
1.1 This standard instruction covers the safe management of transportation and traffic within a
construction site and management of transportation and traffic where construction work is
carried out on or across public roads.
Instruksi standar ini meliputi managemen keselamatan dalam bidang lalu lintas dan angkutan
untuk keperluan proyek dengan menggunakan jalan umum
2.0 PURPOSE
Tujuan
2.1 To ensure safe management of transportation and traffic within a construction site and public
roads.
Untuk meyakinkan manajemen keselamatan dalam lalu lintas dang angkutan konstruksi di
jalam umum.
3.0 RESPONSIBILITY
Tanggung Jawab
3.1 The HSE Committee shall be responsible for the contents of this standard instruction.
Panitia K-3 bertanggung jawab atas maksud serta isi daripada Instruksi Standar ini.
3.2 Chief HSE concerned is responsible to ensure that this standard instruction is followed within
the site.
Chief HSE bertanggung jawab dalam memastikan bahwa ketentuan/instruksi ini diikuti oleh
setiap lokasi.
3.3 HSE Officer shall advice on compliance to the legal and other requirements.
Petugas HSE akan memberi saran dalam hal hukum/ketentuan serta peraturan lainnya.
3.4 All employees and contractors / subcontractors concerned are responsible to comply with this
procedure.
Setiap karyawan kontraktor dan subkontraktor bertanggung jawab untuk mentaati ketentuan
ini.

Standar Instruksi
4.1 Public Vehicular Traffic

Dalam aturan lalu lintas umum
4.1.1 Whenever any work is being performed over, on or in close proximity to a highway or
any other place where public vehicular traffic may cause danger to men at work, the
working area shall be so barricaded and suitable warning signs and warning lights shall
be set up to direct traffic away from it, and when necessary, the traffic shall be
specially controlled by designated persons.
Pada kegiatan konstruksi di jalan umum dapat menimbulkan bahaya yang cukup
serius bagi si pekerja, untuk keselamatan semua pihak diperlukan pemasangan


rambu-2 keselamatan seperti barikade,poster peringatan atau mungkin diperlukan

petugas khusus untuk memnagtur lalulintas.
4.1.2 All vehicles used at construction worksites must be roadworthy and registered with the
appropriate authority.
Setiap kendaraan yang digunakan di proyek harus laik pakai dan tercatat
4.1.3 No person shall drive a vehicle of any class or description in a construction worksite
unless he is the holder of a driving license authorizing him to drive a vehicle of that
class or description.
Setiap karywan dilarang untuk mengemudikan kendaraan di lokasi proyek kecuali
mempunyai ijin untuk mengemudi.
4.2 Vehicle and Traffic Safety Within a Site

Keselamatan kendaraan dan lalu lintas di proyek
4.2.1 General
Umum
a) All drivers or operators must have valid licenses for the class and type of vehicle
that they drive or operate.
Setiap pengemudi atau operator harus memiliki ijin mengemudi yang masih
berlaku dan sesuai dengan jenis atau klasifikasi kendaraannya.
b) Each vehicle is to have a valid Vehicle Inspection (KIR) unless used only on the
worksite.
Setaip kendaraan harus memiliki ijin operasi atau sertifikat hasil inspecksi
kecuali yang digunakan di dalam proyek saja (Plant use_
c) All vehicles must be in a safe operating condition at all times. They are to be
checked at the beginning of each shift.
Setiap kendaraan harus dalam kondisi aman untuk dioperaikan setiapsaat, harus
diperiksa setiap pergantian shift.
d) Standard highway traffic signs as used on public roads are to be used to warn and
control site traffic.
Standar rambu lalulintas yang digunakan di jalan umum akan didgunakan
dilokasi proyek untuk mengontrol lalulintas proyek.
e) Drivers are prohibited from operating vehicles if they are under the influence of
alcohol or other intoxicants.
Dilarang mengemudi (terutama pengemudi) bila sedang berada dalam pengaruh
alcohol atau mabuk.
f) Drivers are required to comply with all posted speed limits, traffic control signs
and flagmen.
Setiap pengemudi harus mengikuti rambu lalulintas yang berlaku.
g) Vehicles and equipment will not be parked closer than five metres from fire
hydrants, fire fighting equipment or road intersections.
Kendaraan dan peralatan lain dilarang parkir menutup fasilitas pemadam
kebakaran (APAR dan Hydrant) minimal harus 5 mtr dari fasilitas pemadam
kebakaran juga dilarang parkir di perempatan atau yg dapat menghalangi
kendaraan lain.

h) Ignition keys are to be removed from all parked vehicles and equipment.
Kunci kontak jangan ditinggalkan pada kendaraan yang diparkir.
i) Haul roads have to be pre-planned and well maintained. Approval may be

required from the Local Authority.
Haul road harus disiapkan dengan baik dan selalu dirawat, mungkin diperlukan
persetujuan dari pemerintah setempat.
j) Watering of unsealed haul roads is to be carried out during dry periods to control
dust.
Penyiraman diperlukan dalam musim panas untuk menghilangkan/mengurangi
debu.
k) Loaded vehicles have the right of away on haul roads unless signs indicate
otherwise.
Kendaraan dengan beban/muatan dilarang menggunakan haul road kecuali ada
tanda-2 khusus.
l) Operators and drivers are to report to their Supervisor any accident, incident, near-
miss, dangerous occurrence or defect on any vehicle or plant item using Accident
/ Non-Conformance Report.
Setiap pengemudi harus melaporkan setiap kejadian kecelakaan, hampir celaka
dan bahaya-2 yang terjadi atau kerusakan kendaraan dengan menggunakan
format yang tersedia.
m) Immediately report all damaged barricades, warning signs or other dangerous

conditions to the Supervisor.
Lapor segera kepada supervisor bila terjadi kerusakan atas barikade, tanda
peringatan atau kondisi-2 berbahaya.
n) Barricades and other demarcation markers are not to be moved or tampered with.
Dilarang memindahkan barikade dan rambu-rambu lalulintas dan keselamatan.
o) While moving, operators are to turn on the machine lights whenever visibility is
poor.
Dalam kondisi operasi, operator akan menggunakan mesin/alat ringan dimana
kondisi kurang baik.
p) Safety belts are to be worn in all light vehicles.

Sabuk pengaman harus selalu digunakan.
4.2.2 Loads
Beban
a) All loads transported on vehicles are to be properly secured with wire rope, chain
and buckle or cargo webbing. Tarpaulins and nets are to be used also.
Semua beban pada kendaraan harus terikat dengan baik dan aman dengan
menggunakan tali kawat, rantai, atau alat pengikat khusus kargo, terpal penutup
dan net/jaring harus dipasang.
b) Vehicles are not to be overloaded.

Kendaraan dilarang kelebihan beban.


c) Workers are not to ride on loads being moved.

Karyawan dilarang naik pada kendaraan yang sarat muatan.
d) Clearance signs are to be placed under overhead utility cables, bridges or other
overhead obstructions. Drivers are to stop and make sure that their vehicles and
loads have adequate clearance.
Tanda untuk jarak aman pada ketinggian harus dipasang untuk mencegah
kerusakan pada fasilitas yg terdapat dibagian atas (kabel listrik dan laninya)
setiap pengemudi harus memastikan jarak aman tersebut.
e) When over-length materials are transported, a red flag or light must be placed at
the end of the material at the rear of the vehicle. (Note: overhanging materials are
not permitted on public roads).
Bila panjang beban melebihi panjang kendaraan, tanda khusus pada ujung beban
tsb harus dipasang (bendera merah dsb), kondisi begini tidak dibenarkan pada
jalan raya umum.
f) Where workers are required to work alongside roads or act as spotters or flagmen,
then reflective safety vests or jackets are to be worn at all times.
Bila diperlukan bekerja disepanjang jalan umum, signalman harus dilengkapi
dengan rompi/jaket dengan reflection light setiap saat.
4.2.3 Access and Exit Points to the Site

Jalan keluar dari lokasi proyek
a) Entrances and exits from a site onto the public road system need to be carefully
positioned to ensure good visibility and safe merging and slowing down of
vehicles entering and leaving the site.
Jalan keluar masuk dari dan ke lokasi proyek harus diatur sedemikian rupa
untuk memastikan agar setiap kendaraan serta pengemudinya dapat melihat
kondisi jalanan dan menjalankan kendaraan dengan perlahan pada saat
memasuki atau keluar dari lokasi.
b) If work is carried out at night, the entrances and exits must be well lit and have
flashing lights.
Bila pekerjaan dilakukan pada malam hari, lampu lalulintas harus dipasang.
c) Trucks entering or leaving the site must be guided by a flagman who will stop
public traffic as necessary.
Setiap kendaraan yang keluar masuk lokasi proyek harus dipandu/dikontrol oleh
signalman.
d) Special care must be given to pedestrians that have to cross the access and entry
points. A flagman should be used to assist pedestrians.
Perhatian khusus harus diberikan kepada pejalan kaki, signalman harus
membantu/memandu para pejalan kaki.
e) Vehicle wash-down points are to be provided at exits where there is a possibility

of delivery vehicles or spoil trucks trailing site mud out onto public roads.
Tempat cuci kendaraan harus disediakan untuk mencegah terbawanya
kotoran/Lumpur dari lokasi ke jalan raya.
f) All of the truck is to be washed with the high-pressure hose. Pay particular
attention to the tyres, tailboard and sides.

Setiap kendaraan yg kotor harus dibersihkan dengan menggunakan air

bertekanan terutama pada bagian roda, belakang dan samping kendaraan.
g) Vehicle wash-down points must have silt traps and be cleaned and properly
maintained to avoid creating mosquito-breeding areas.
Tempat pencucian harus dijaga kebersihannya dan saluran air harus dipelihara
untuk mencegah genangan air yg dapat menimbulkan nyamuk.
h) It is preferable that only construction vehicles are allowed on to the site. All
privately – owned vehicles should be parked in specially – designated car parks
away from the construction activity.
Hanya kendaraan proyek yg boleh memasuki area proyek, kendaraan pribadi
harus diparkir diluar dan terhindar dari kegiatan konstruksi.
i) Vehicles must never park inside partially – completed buildings.

Kendaraan tidak boleh diparkir di dalam bangunan.
j) Where a job site has severe space restrictions, delivery trucks must be scheduled
so that they do not interfere with trucks hauling materials off site.
Bila kondisi lapangan terbatas untuk pergerakan kendaraan, maka lalulintas truk
harus dijadwal sehingga tidak akan terjadi kemacetan dan mengganggu kegiatan
truk material.
4.2.4 Machinery and Earthworks Plant

Peralatan untuk pekerjaan tanah
a) Earthworks plant and machinery are to travel only on designated haul roads
separated where possible from light vehicle traffic.
Alat dan mesin untuk pekerjaan tanah harus beroperasi atau bergerak dujalur
terpisah dari kendaraan kecil.
b) Plant and vehicle operators are to ensure before reversing that :

Setiap pengemudi atau operator harus memastikan kondisi atau lingkungan
sebelum bergerak:
i- They have clear visibility.

Pandangan yang bebas tidak terhalang
ii- They are under separate guidance from a signalman.

Dalam pengawasan atau kontrol sugnalman.
iii- They have independently satisfied themselves that the way is clear.
Mempunyai keleluasaan dalam beroperasi.
iv- Whenever possible operators should slew their machine through 180
degrees and move forward.
Bila memungkinkan operator harus memposisikan mesinnya secara 180
derajat dan berjalan kedepan
c) Signalmen are to be used at all times where site conditions are congested or the
operations require men and vehicles to work in close proximity.
Signalmen harus disediakan setiap saat bila kondisi atau operasi dilaksanakan
dekat dengan kegiatan lain.


d) All moving equipment must be fitted with audible and visible reversing alarms.
Setiap alat yg bergerak harus dilengkapi dengan alarm atau klakson.
e) Signalmen are to be used whenever large cranes or equipment are moved around
the site.
Signalman diperlukan bagi setiap pergerakan alat berat (crane)
f) All equipment must be parked neatly in a designated parking area at the end of
each shift.
Setelah selesai pekerjaan, peralatan harus diparkir ditempat yg aman dan
disetujui.
g) Cranes should be parked with booms in a direction where collapse would cause
the least damage.
Crane harus diparkir dengan posisi boom mengarah ke lokasi yg aman (kosong).
h) Excavators and other plant are to be parked with their buckets or blades on the
ground.
Excavator dsb bila diparkir bucketnya harus disimpan diatas tanah tidak boleh
digantung.
i) Passengers are not to ride on any construction vehicle except for a good reason,
and then only in the seat provided for that purpose. Riding on a drawbar or in the
bowl or bucket of a machine is strictly forbidden.
Dilarang menumpan pada alat berat kecuali untuk alas an tertentu, disetujui dan
menempati posisi/kursi yg disediakan, menumpang pada bucket atau hook crane
adalah dilarang.
4.2.5 Pedestrians
Pejalan kaki
a) Site planning is required to provide safe pedestrian access around, and when
necessary, through construction sites.
Jaluraman untuk pejalan kaki harus tersedia dan direncanakan, bila diperlukan
melalui kegiatan konstruksi.
b) The public must be prevented from entering the worksite, unless they are
reporting directly to the site office.
Umum yang masuk lokasi harus dilindungi dari bahaya konstruksi.
c) Pedestrians must always use the designated walkways.

Pejalan kaki harus menggunakan jalur yg sudah ditentukan dan diberitanda.
d) Walkways or access lanes are to be kept clear at all times and not used for the
storage of materials or be cluttered with rubbish.
Jalur pejalan kaki harus selalu dalam kondisi bersih , tidak boleh untuk
menyimpan barang dan banyak sampah.
e) Short cuts by climbing over pipes, steel structures or by walking through unsafe
areas is forbidden.
Mengambil jalan pintas seperti memanjat jalur pipa,rangka bangunan dan
melewati daerah berbahaya adalh dilarang.
f) Do not enter barricaded or roped restricted areas or other contractor’s areas

without permission.

Dilarang memasuki daerah yang dinyatakan daerah berbahaya atau lokasi lain
tanpa ijin.
4.2.6 Flaggers
Pemandu
a) Flaggers or signalmen must be properly trained and have attended a training

course on the use of flags, light batons and paddles.
Pemandu atau signalman harus terlatih dan pernah mengikuti pelatihan/kursus
dalam pelaksanaa sebagai signalman.
b) The training is to cover where to stand, how to slow or stop traffic, and how to co-
ordinate public and construction traffic movements.
Kursus tersebut harus meliputi dimana mengambil posisi, bagaimana
menghentikan atau menyuruh kendaraan jalan pelahan, dan bagaimana
mengkoordinirpergerakan kendaraan umum dan konstruksi.
4.2.7 Signs, Markers and Barriers

Rambu atau tanda serta pembatas
a) All signs and markers are to comply with the appropriate statutory requirements
e.g. OSHA and Police.
Setiap tanda/rambu harus mengacu kepada ketentuan OSHA dan Polisi
b) Unnecessary traffic control signs must be removed as they tend to confuse

motorists and make them careless.
Tanda/rambu yang tidak perlu harus dihilangkan untuk mencegah terjadinya
kebingungan para pengguna jalan.
4.2.8 Traffic Control Plan must prepare.

Rencana pengaturan lalulintas harus disiapkan
4.2.9 When Accidents occurs using (Accidents and Non-Conformances Report).

Bila terjadi kecelakaan gunakan format yg tersedia.
4.3 Public Safety

Keselamatan publik/umum
4.3.1 Warning Signs

Rambu perhatian
a) Warning signs, barriers and marker cones are essential. Only approved authorised
signs should be used for traffic control. All signs must be maintained in good
condition.
Tanda peringatan, pembatas dan cones, hanya yang disetujui yang boleh
dipasang untuk mengatur lalulintas, setiap rambu harus dirawat kondisinya.
b) All signs, markers, barricades and layouts must comply with the requirements of
the OSHA and Police.
Setiap rambu dan penempatannya harus sesuai dengan ketentuan OSHA dan
Polisi.
c) Where permanent road signs conflict with temporary signage, cover the
permanent signs up for the duration of the job.

Bila terjadi konflik antara rambu permanent dengan rambu sementara, tutup
untuk sementara rambu permanent selama periode konstruksi.
d) Signs must be clearly visible to the traffic i.e. not obscured by poles, trees, other
signs or construction equipment.
Rambu-2 harus terlihat oleh setiap orang jangan terhalamg oleh tiang atau
pohan atau oleh poster-2 lain atau oleh alat-2 konstruksi
e) Signs must be secure and stable and not fall down in the wind or by the draft
created by passing heavy vehicles.
Rambu harus terpasang dengan kuat dan stabil jangan sampai jatuh karena
angin atau oleh angin akibat dari lalu lalangnya kendaraan.
f) Signs should not block the view of vehicles entering the area.
Rambu harus tidak memblok pandangan setiap pengemudi yg akan masuk lokasi
proyek.
g) Install blinkers and illumination for night time.

Tempatkan penerangan pada malam hari.
h) Signs must be kept clean so that they are clearly visible to approaching motorists.
Rambu harus bersih sehingga mudah dilihat oleh setiap pengguna jalan
i) Place signs and cones / barriers at the distances stated in the traffic management
plan. Set them out in the right sequence.
Tempatkan rambu-rambu dan cones atau pembatas jalan pada jarak tertentu
sesuai dgn aturan lalulintas.
j) Both day and night drive-through checks of the signage should be made to check
their adequacy.
Mengendarai baik siang maupun malam,pemeriksaan-2 atas kondisi kendaraan
harus dilakukan, periksa semua kondisi agar selalu dalam keadaan baik dan
aman.
4.3.2 Traffic
Lalu lintas
a) A Traffic Management Plan must be produced for all road works carried out. This
will tell you what traffic cones, signs and barriers are required and state if traffic
controllers are needed. You must ask your Supervisor what the plan requires.
Rencana manajemen lalu lintas harus dibuat untuk setiap pekerjaan yang
dilaksanakan di jalan. Kondisi ini akan memberitahukan perihal cones, rambu,
dan pembatas jalan yang diperlukan dan dipasang sebagai alat kontrol. Harus
ditanyakan kepada pengawas anda rencana yang dibutuhkan.
b) At night, flashing lamps must be erected to warn road users of hazards on the
roadway at both attended and unattended worksites.
Pada malam hari,lampu flashing (beacon ray) harus dipasang sebagai tanda
peringatan atau tanda bahaya kepada pengguna jalan.
c) Temporary speed limits will be imposed when required in the traffic management
plan.
Batas kecepatan sementara akan termasuk dalam rencana manajemen lalulintas
bila diperlukan.

d) On Two – Lane and Multi – Lane Roads divided by median barriers, traffic can be
controlled by the use of cones / barriers and there is usually no need for traffic
controllers.
Dua jalur –garis serba guna – garis pembatas jalan dipisahkan oleh pembatas
jalan, lalulintas dapat dikontrol oleh cones/pembatas dan biasanya disana
diperlukan pengawas lalulintas.
e) On Two – Lane Two – Way Roads where there is no median barrier separating
opposing traffic, and where work intrudes into a traffic lane, traffic controllers are
required at all times because traffic is being directed into a lane used by vehicles
coming from the other direction.
Dua jalur – garis dua – jalur jalan dimana tidak terdapat pembatas yang
memisahkan jalur lalulintas, dan bila pekerjaan masuk ke lokasi garis, pengontrol
lalulintas diperlukan setiap saat karena lalulintas akan langsung memasuki lokasi
tsb yang datangnya dari arah lain.
f) Traffic Controllers (Flagmen) must wear high visibility clothing and will need to
use two-way radio communication where the traffic controllers cannot see each
other. For night work, fluorescent vests and illuminated flashing batons must be
used.
Pengontrol lalulintas harus menggunakan pakaian yg mudah dilihat dan dikenali
dan memerlukan alat komunikasi (HT) bila petugas tidak dapat melihat kondisi
yang lainnya, Pada malam hari spot light dan lampu flashing harus digunakan.
g) Monitor the layout of the site and warning signage constantly. Accidents or near-
misses, bad traffic congestion or damaged signs, cones and barriers are all
indicators of problems. Traffic controls may need to be reviewed.
Awasi lay out lokasi proyek dan rambu atau tanda peringatan secara terus
menerus, kecelakaan atau hampir terjadi kecelakaan, lalulintas yang buruk atau
rambu-2 rusak, cones, pembatas dan semua tanda peringatan dalam masalah,
pengawasan lalulintas memerlukan pemeriksaan ulang.
h) Provide safe pedestrian routes if necessary.

Siapkan jalur untuk pejalan kaki bila diperlukan.
i) Traffic Control Situations for Two-Lane Two-Way Roads and Multi-Lane Two-
Way Roads.
Pengaturan situasi lalulintas untuk dua jalur ,dua arah dan kedua-duanya.
Situation and Precaution:

Situasi dan pengaturan pengamanan
i- Works on the roadside where workers and plant do not need to move
onto the shoulder or the road proper.
Pekerjaan di jalan raya dimana pekerja tidak boleh bergerak ke bahu
jalan atau jalan raya itu sendiri.
 Erect warning signs that road works are ahead.

Pasang rambu peringatan bahwa pekerjaan sedang berlangsung.
 Space signs at distances shown in the Traffic Management Plan.


Jarak rambu-rambu lalu lintas terdapat pada pedoman pengaturan

laulintas
ii- Work which involves personnel or plant intruding onto the shoulder but
not out into the traffic lane.
Pekerjaan yg melibatkan pekerja di lokasi bahu tapi tidak keluar dan
memasuki jalur lalulintas.
 This case again requires warning signs to be posted as above.

Kondisiseperti ini diperlukan pemasangan rambu-rambu.
 In addition, the area of shoulder should be barricaded off and an

appropriate speed restriction should be applied as shown in the
Traffic Management Plan.
Sebagai tambahan, lokasi bahu jalan harus dibarkade dan batas
kecepatan harus ditearpkan dan terdapat dalam pengaturan
lalulintas plan.
iii- Work, which requires personnel or plant to move out into a traffic lane
effectively restricting traffic normally occupying that lane.
Pekerjaan yang memerlukan pekerja untuk memasuki lokasi jalur
lalulintas.
 Where the road is a two-lane two-way system, this restricts traffic to

one way at a time and requires cones / barriers and signs as above.
Bila jalan dua jalur dan sistim dua arah, diperlukan cones,
pembatas dan rambu-rambu.
 In addition traffic controllers will be needed to stop traffic and allow

movement through the area from only one direction at a time.
Sebagai tambahan dalam pengawasan lalulintas diperlukan
penghentian lalulintas dan memberikan jalan melalui lokasi hanya
satu arah.
 This situation requires additional signage, warning motorists to stop

on request.
Bila kondisi memerlukan tambahan rambu/tanda 2 perhatian pada
pengemudi untuk berhenti.
 On longer duration work, temporary traffic lights may be required.

Pada pekerjaan yang cukup lama/panjang, lampu lalulintas
sementara mungkin diperlukan.
iv- Where the worksite is close to an intersection.

Bila pekerjaan di lokasi persimpangan.
 Signage must be placed at the specified distances on each additional

road to ensure all traffic approaching the worksite receives adequate
warning of the work.
Rambu-2 peringatan harus dipasang di lokasi yang spesifik dan
pastikan setiap pengemudi dapat melihat dan mentaatinya
.
j) General Public Safety Rules

Peraturan keselamatan secara umum
Do
Yang harus dikerjakan.
i- Keep the work site tidy at all times. Clean up debris.

Jaga dan pelihara kebersihan dan kerapian lokasi setiap saat, bersihkan
semua sampah-2.
ii- Keep vehicles, plant, equipment and materials within the barricaded
areas.
Jaga dan pelihara kendaraan, peralatan dan barang agar selalu diberi
tanda pengaman (barikade)
iii- Clean-up spillages immediately. Stop traffic until the site is made safe.
Setiap bocoran atau tetesan minyak harus langsung dibersihkan,
hentikan lalulintas sampai dengan kondisi aman.
iv- Avoid working on traffic lanes during peak traffic flow periods.
Hindari pekerjaan pada jalur lalulintas disaat volume kendaraan penuh.
v- Provide lighting if a pedestrian detour around a worksite must be left

overnight.
Siapkan penerangan bila pejalan kakisedang berjalan dilokasi proyek
harus segera m,eninggalkan lokasi
.
vi- Regularly clean and realign signs and barriers.
Pembersihan lokasi dan perbaikan atas rambu lalulintas harus
dilakukan secara rutin.
Do Not
Yang tida boleh dikerjakan
i- Allow vehicles or plant to work outside barricaded areas unless all traffic
is stopped.
Mengijinkan kendaraan bekerja diluar lokasi yang dibarikade kecuali
semua lalulintas dihentikan.
ii- Delay vehicles for long periods of time. Allow traffic to pass in convoy
every few minutes.
Mengulur waktu pekerjaan yg cukup lama, lalulintas agar di atur untuk
dapat diberi jalan setiap beberapa menit.
iii- Leave excavations un barricaded and until at night.

Meninggalkan galian tanpa diberi pengaman (barikade)
iv- Leave excavated fill on the road overnight. Remove to a safe place
before nightfall.
Meninggalkan tumpakan tanah galian tanpa pengaman dan sampai
malam hari, pindahkan ketempat yg aman sebelum malamhari.
v- Restrict vehicle access to private property longer than is necessary. If

trenches are cut across a driveway, provide an access bridge with a metal
plate.

Bila galian memotong jalan, agar disediakan jembatan sementara dari

jenis metal (plat besi)
4.4 Worker Safety

Keselamatan Pekerja
4.4.1 General Safety

Umum
a) Inexperienced personnel must receive induction training and be initially

accompanied by experienced, trained operatives.
Pekerja yg tidak berpengalaman harus menerima orientasi / pengarahan dari
perusahaan dibidang HSE.
b) All personnel working on or near roads must wear high visibility vests.
Setiap pekerja yg melakukan kegiatan di atau dekat jalan raya harus memakai
rompi yg dilengkapi spot light.
c) Personnel should not cross a trafficked carriageway unless it is essential and safe
to do so.
Setiap pekerja tidak dibenarkan memotong jalur lalulintas kecuali kondisi nya
dinyatakan aman.
d) All visitors to roadwork sites must wear suitable safety clothing and be fully
aware of the safety precautions.
Tamu atau pengunjung harus memakai bajudan alat keselamatan dan harus
memperhatikan peringatan pengamanan keselamatan.
e) The risks to safety brought about by prolonged working hours and often the
monotony of the work needs to be considered when planning the work.
Risiko bahaya atas keselamatan dapat diakibtakan oleh jam kerja dan seringnya /
monoton atas pekerjaannya, hal ini perlu dipertimbangan pada saat
perencanaan.
f) Control of dust over the whole roadwork site must receive careful attention to
minimise the risks to the health of workers and the public, as well as maintaining
good visibility.
Perhatian yang penuh atas kondisi proyek yang diakibatkan oleh debu harus
dilaksanakan untuk mengurangi risiko bahaya atas kesehatan para pekerja dan
umum.
g) Stability of cut and fill slopes must be monitored by regular checking for any
indications of instability that could endanger workers, the public, or plant.
Kestabilan dari pemotongan dan penimbunan pada kemiringan harus dikontrol
secara reguler untuk indikasi dan ketidak stabilan dapat menimbulkan kondisi
bahaya bagi pekerja, umum dan peralatan.
h) Attention must be given to storm water runoff during the course of the work so
that public property is not damaged by flooding, scour or erosion and unnecessary
flooding does not occur on the roadway.
Perhatian harus diambil,pada saat hujan besar atau badai, sehimgga tidak akan
terjadi bahaya pada pekerja dan kerusakana alat karena terjadi banjir pd jalan.
4.4.2 Plant Safety


Keselamatan Peralatan
a) Beware of overhead power lines and other overhead hazards.

Hati-2 dengan jalur listrik dan bahaya lainnya di atas.
b) Make sure the vehicle you are driving has a working reverse alarm and warning
lights.
Pastikan kendaraan anda dilengkapi dengan alarm / klakson dan lampu
peringatan
c) Only reverse if using a signalman or you are satisfied the way is clear.
Sebagai cadangan bila menggunakan pemandu atau anda merasa puas dengan
kondisi jalan.
d) Obey the worksite speed signs.

Taati batas kecepatan yang diberlakukan.
e) Always move plant with the traffic flow and ensure headlights and flashing lights
are on when working.
Selalu menggerakkan peralatan sesuai dengan arus arah lalulintas, patikan
lampu dan lampu peringatan bekerja dengan baik.
f) Don’t allow workers to ride on the side of trucks or other vehicles.

Jangan mengijinkan karyawan untuk naik dan duduk di bagian sisi truk.
g) Always check mobile plant for defects before use.

Selalu diperiksa setiap peralatan sebelum digunakan.
h) Slewing vehicles, cranes and excavators must be carefully sited to ensure that no
part of the machine may interfere or collide with passing traffic.
Memutarkan kendaraan, peralatan berat (crane dan excavator) harus hati-2,
yakinkan bahwa tidak mengganggu jalur lalulintas.
i) Crane jibs should be directed away from roads wherever possible. No lifting shall
be carried out over traffic.
Jib / boom dari crane harus diarahkan keluar dari jalan sejauh mungkin,
pengangkatan dalam kondisi lalulintas padat adalah dilarang.
4.4.3 Personal Protective Equipment

Alat Pelindung diri.
a) Wear bright orange or day-glow overalls or jackets so you are more visible to
vehicles.
Gunakan jaket ata rompi denagn warna yg hidup.
b) Wear safety boots or shoes.

Gunakan Sepatu Keselamatan
c) Wear gloves if using jackhammers or similar equipment.

Gunakan sarung tangan bila mengoperasikan jackhammer atau alat yg serupa.
d) Wear earmuffs when using or working near noisy equipment (jackhammers,

compressors etc.)
Gunakan pelindung telinga bila mengoperasikan atau dekat alat yg bising
(jackhammer atau kompresor)

e) Wear hard hats.

Pakailah helmet
f) You may also need safety goggles or safety glasses if the work creates flying
objects (concrete chips etc.) or if there could be liquid splashes (e.g. discharging
bitumen tankers).
Anda mungkin memerlukan pelindung mata bila kemungkinan terkena percikan
atau benda yg melayang karena pekerjaan, atau percikan cairan kimia.
g) If handling bitumen for sealing, cover the skin with overalls, and wear suitable
gloves. Wear trousers outside boots and socks, and do not tuck them in.
Bila mengerjakan bitumen untuk sealing, lindungi kulit anda, gunakan sarung
tangan dan alat pelindung lainnya yg sesuai.
h) If handling bagged lime or cement, wear goggles, overalls and gauntlet-type

gloves. Lime and cement can cause bad burns and affect the skin.
Bila mengerjakan semen, gunakan pelindung mata, coverall, semen dapat
membahayakan kulit anda
4.4.4 Underground Services

Fasilitas bawah tanah
a) Check the location and depth of underground services before work starts.
Periksa fasilitas di bawah tanah (pipa, kabel listrik dsb) sebelum anda memulai
pekerjaan
b) Follow the Permit to Dig.

Taati ketentuan-ketentuan untuk penggalian.
4.4.5 Pipe Laying

Pemasangan pipa
a) Ensure pipes are stacked securely and that they will not move if struck or as a
result of vehicle vibration.
Pastikan pipa yg disimpan cukup aman sehingga tidak akan jatuh menggelinding
bila terbentur atau karena getaran kendaraan yg lewat.

HANDTOOLS AND PORTABLE POWER
TOOLS
APPENDIX L 23 July 2013
TABLE OF CONTENT
Daftar Isi
Page
1.0 INTRODUCTION / Pendahuluan

2
4.0 WORKING INSTRUCTION/ Instruksi Bekerja 2
4.1 Basic Safety Rules Aturan-2 dasar Keelamatan 2

4.2 General Aturan-2 Umum 4
4.3 Hand Tools Peralatan kerja Ringan 4
4.4 Portable Tools Peralatan kerja 5
4.5 PPE Requirement Ketentuan Alat Pelindung Diri 13
PT. Guna Teguh Abadi Page 1 of 14 Doc. APPENDIX L

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1.0 INTRODUCTION
Pendahuluan
This standard instruction shall apply to all employees and who use hand tools and portable power tools in
PT. Guna Teguh Abadi
Standar ini akan disampaikan kepada seluruh karyawan dalam penggunaan alat kerja ringan dan alat
kerja listrik di PT. Guna Teguh Abadi
2.0 PURPOSE
Tujuan
To guide how to select the rights tools, use correctly and safely, keep tools in good condition and store
tools in a safe place.
Untuk memandu bagaimana dalam memilih, menggunakan alat ygbenar dan aman, menjaga agar alat
selalu dalam kondisi baik serta bagaimana menyimpan alat di tempat yg aman.
3.0 RESPONSIBILITY
Tanggung Jawab
Panitia K-3 bertanggung jawab atas penyediaan standar ini
The HSE Committee concerned are responsible to ensure that this procedure instruction is followed
within the worksite.
Panitia K-3 bertanggung jawab untuk meyakinkan bahwa aturan ini dijalankan disetiap lokasi.
The HSE Officer shall be responsible to train their employee on proper use of all tools.
Petugas Safety bertanggung jawab dalam pelatihan karyawan dalam menggunakan alat kerja yg baik.
HSE Officer shall advice on compliance to legal and other requirements.

Petugas Safety akan memberi saran dalam hal ketentuan lainnya,
All employees concerned are responsible to comply with this procedure instruction.
Seluruh karyawan bertanggung jawab menyesuaikan dengan ketentuanini.
4.0 WORKING INSTRUCTION

Instruksi Kerja
4.1 Basic Safety Rules

Ketentuan dasar Keselamatan
4.1.1 Select the Right Tools

Memilih alat kerja yg benar
a) It is the policy of the PT. Guna Teguh Abadi to use the safest tools for the job; it
is depend on job set-up, workspace and working height.
Adalah merupakan kebijakan PT. Guna Teguh Abadi dalam pemakaian alat kerja
aman di lokasi proyek, hal kembali kepada set up dilapangan, tempat kerja dsb.

TOOLS
b) Proper selection means choosing the right tools that can be most safely used by
the employee.
Menyeleksi alat yg benar adalah memilih alat yg benar sesuai dan aman bila
digunakan oleh pekerja
4.1.2 Use Tools Correctly and Safely

Menggunakan alat yg benar dan aman
a) It is the policy of PT. Guna Teguh Abdi to use tools correctly and safely.
Adalah merupakan kebijkan PT. Guna Teguh Abadi untuk menggunakan alat yg
benar dan aman
b) The Site Supervisor should educate employees how to use tools safely and
correctly.
Pengawas lapangan akan melatih karyawannya bagaimana dalam menggunakan
alat yg benar dan aman.
c) The work area needs to be clean, dry, well lighted and ventilated.
Lokasi pekerjaan harus bersih dan rapi, kering, cukup penerangan dan baik
sirkulasi udaranya.
d) Site Supervisors should ensure that the workers understand the correct use of their
tools and are aware of other workers in the vicinity.
Pengawas lapangan akan memastikan bahwa para pekerja mengerti dalam cara
menggunakan alat kerja yg benar dan peduli akan pekerja yg lainnya.
e) Guard on tools must be checked to be sure they operate effectively.

Pelindung alat harus selalu diperiksa agar selalu dalam kondisi baik untuk
dioperasikan.
4.1.3 Keep Tools in Good Condition

Jaga agar alat kerja selalu dalam kondisi baik dan aman
a) It is the policy of PT. Guna Teguh Abadi to keep tools in good condition.
Merupakan kebijakan PT. Guna Teguh Abadi dalam memelihara alat kerja
b) Every tool should be examined before use. Employees in the tools store and
workers using tools on the job should be taught how to check equipment properly.
Setiap alat kerja akan diperiksa sebelum digunakan, karyawan di tempat
penyimpanan alat dan pekerja yg menggunakan alat kerja akan selalu memeriksa
peralatannya dengan baik dan aman.
c) Tools must be kept in good repair through a planned tool maintenance

programme.
Alat kerja harus dijaga agar selalu baikdan aman melalui program perawatan
alat.
d) Tools that have deteriorated should not be used until repaired to meet
manufacturer’s specifications.
Peralatan yang rusak atau meragukan tidak akan dipakai sampai dengan selesai
perbaikan dan sesuai dengan spek pabrik pembuat.
e) All tools need to be replaced from time to time.

Setiap alat harus diganti setiap saat bila diperlukan
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f) Good housekeeping should be encouraged.

Kebersihan dan kerapian agar digalakan dan dilaksanakan
4.1.4 Store Tools in a Safe Place

Penyimpanan alat ditempat yg aman
a) It is the policy of PT. Guna Teguh Abadi to store tools in a safe place.
Merupakan kebijakan PT. Guna Teguh Abadi dalam cara menyimpan alat
ditempat yg aman
b) Tools need to be stored properly either in the work area or in a common tools
store, If employees own their own tools, safe storage is of equal importance.
Peralatan perlu disimpan dengancara yg baik di lokasi pekerjaan maupun di
gudang, bila pekerja mempunyai alat sendiri, penyimpanan dengan cara yg aman
juga sangat penting.
c) Also make a complete check of operations to determine the need for special tools
to do the work more safely.
Persiapan untuk keperluan pekerjaan dalam kebutuhan peralatan khusus
diperlukan untuk pelaksanaan pekerjaan yg lebih aman.
4.2 General
Umum
Only tools in safe working order shall be used.

Hanya alat yang dinyatakan aman yg boleh dipakai
Comply with all of the manufacturer’s instructions on how to use the tool.
Menyesuaikan dengan instruksi pabrik dalam hal pemakaian alat.
Inspect tools daily to ensure that they are in proper working order.
Pemeriksaan harian atas peralatan untuk meyakinkan bahwa alat ada dalam kondisi yg baik
dan aman.
Do not use damaged or defective tools. If they are damaged or defective, have them repaired or
replaced.
Jangan menggunakan alat yg rusak atau tidak baik, bila alat rusak atau kurang sempurna ganti
dengan yg baru atau segera perbaiki.
Always use the correct tool for the job. Don’t improvise.
Selalu menggunakan alat yg sesuai dan benar untuk setiap pekerjaan.
Site Supervisors are to make sure that workers are properly instructed in how to use the tools
and to provide competent supervision to ensure that the work is correctly and safely carried out.
Pengawas lapangan harus memastikan bahwa para pekerja sudah mendapat instruksi
bagaimana cara menggunakan alat dan menyediakan seorang ahli untuk mengawasi untuk
meyakinkan bahwa pekerjaan dilaksanakan dengan benar dan aman.
4.3 Hand Tools

Alat kerja ringan
Keep your hand tools clean.

Jaga agar alat selalu bersih
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Regularly check handles for splits or cracks and that the wedges are tight.
Periksa secara regulerpada kondisi perlengkapannya.
Do not use hammers with loose heads. Use the right hammer for the job.
Jangan menggunakan palu yg longgar pada bagian atasnya, gunakan yg baik dan aman.
Screwdrivers are frequently misused and abused. They must not be used as chisels, drifts or
wedges.
Penggunaan obeng kadang salah, jangan digunakan sebagai pahat dsb.
Cutting edges should be kept sharp to permit accurate working and to avoid the need to force
the tool.
Alat potong agar selalu dalam kondisi tajam agar dapat memotong dengan akurat dan sesuai
harapan.
Handles should be fitted to all files to avoid damage to hands.

Pegangan harus selalu terpasang disetiap laci file untuk mencegah cedera tangan anda.
Chisel and bolster cutting edges should be kept sharp. When mushrooming develops, heads
should be reground. Wear goggles to protect your eyes.
Alat potong ( chisel & bolster) harus selalu tajam, bila digunakan bagian kepalanya agar
diarahkan ke tanah (bawah) Gunakan pelindung mata.
Shovel blades should not be allowed to become blunt, turned, split or jagged.
Pisau shovel tidak boleh blunt, turned, split atau jagged.
Jacks should be the right size for the lift, placed on firm solid support with the load on the centre
line of the jack. Once the load has been raised it must be shored or blocked. Security must not
rely solely on the jack.
Jack harus dengan ukuran yg benars dan cocok dalam mengangkat, tempatkan pada tanah yg
keras/kuat dan gunakan sebagai pusat beban.
Only spanners of the right size should be used and the jaws first checked for signs of opening
out or other damage.
Hanya kunci-2 yang benar ukurannya yg boleh digunakan, dan selalu periksa kondisinya.
Do not use a spanner as hammer.

Jangan menggunakan kunci sebagai alat pemukul
Each worksite concerned shall fill in / update the List of Hand Tool and Portable Power Tool
and submit to HSE Section for record.
Setiap kegiatan harus mengisi list of hand tool dan portable tool secara regular dan sampaikan
ke bagian HSE untuk di record.
4.4 Portable Tools

Peralatan yg menggunakan power listrik.
4.4.1 General Safety Rules for All Portable Tools

Ketentuan Keselamatan secara umum untuk portable tool
Do
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Yg harus dilakukan
a) Check the condition of the tool (including leads for electric power tools) before
use.
Periksa kondisi alat (termasuk sistim listriknya) sebelum digunakan.
b) Use the correct protective equipment (eye and hearing protection).

Gunakan alat pelindung diri (Pelindung mata dan pendengaran)
c) Make sure there is adequate lighting. Ensure all cutting tools are kept sharp.
Pastikan bahwa penerangan mencukupi, dan pastikan bahwa semua alat potong
cukup tajam.
d) Maintain the tool as required by the operating manual.

Perawatan alat sesuai dengan operation manual
Do Not
Yang tidak boleh dilakukan
a) Use a portable tool if you have not had training or instruction on its safe use.
Menggunakan alat tanpa menguasai (belum di training dan mendapat
pengarahan keselamatan) adalah dilarang.
b) Leave them lying about where other workers could fall or trip over them.
Meninggalkan alat tergeletak sehingga dapat mencelakakan pekerja lain.
c) Use defective or damaged tools.

` Menggunakan alat yang rusak adalah dilarang.
d) Ignore the instructions in the operating manual.

Merubah atau menghilangkan instruksi pemakaian dalam operation manual.
4.4.2 Safety Precautions for Cartridge-Operated Tools

Pengamanan Keselamatan untuk cartridge –pengoperasian alat
a) Only operators with the appropriate Police license or permit may operate or carry
a Cartridge-Operated tool.
Hanya operator yang memiliki ijin dari polisi atau ijin khusus yang boleh
membawa dan mengoperasikan cartridge-dan peralatan.
b) Erect a sign where cartridge tools are being used to warn others of the dangers.
Pasang poster pengaman bila sedang beroperasi untuk mencegah timbulnya
bahaya kepada pihak lain.
c) Never leave primed tools unattended.

Dilarang meninggalkan motor penggerak alat.
d) Always ensure other workers are clear of the area when the tool is being fired
including the area behind the material or structure.
Selalu memastikan pekerja lain untuk tidak memasuki area pekerjaan termasuk
lokasi sekitarnya.
e) Never use a cartridge-operated tool unless you have been trained in its use.
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Hanya pekerja yang sudah dilatih yang boleh menjalankan alat.
f) Eye protection must be worn at all times when handling tools or cartridges.
Selalu menggunakan alat pelindungmata setiap saat.
g) Ear muffs / hearing protection must be worn.

Gunakan alat pelindung pendengaran.
h) Check for defects prior to use each day.

Selalu memeriksakondisi alat setiap hari untuk mencegah dari kerusakan.
i) Clean the tool daily and carry out maintenance as per the supplier’s instructions.
Bersihkan alat sewtiap hari dan rawat alat tsb sesuai dengan petunjuk dari
penyalur.
j) Never use cartridge-operated tools in areas where flammable vapours or dusts

exist. This may ignite them causing an explosion.
Dilarang menggunakan alat ini di lokasi yang mengandung uap bahan mudah
terbakar atau lokasi berdebu, hal tsb dapat mengakibatkan terjadi api dan
mungkin peledakan.
k) Never fire a tool while working on a ladder or makeshift platform.

Dilarang membakar/memanaskan alat pada ssat bekerja menggunakan tangga
atau memindahkan platform.
l) Never point a loaded tool at another person or any part of the operator’s body.
Dilarang membebani pekerja lain atau operatornya sendiri dengan alat tsb.
4.4.3 Safety Precautions for Mechanically-Powered Staplers and Nail Guns (Nailers)
Pengamanan Keselamatan untuk Mechanical – Powered Stapler dan Nail Guns
a) Nailers and staplers require a daily inspection.

Alat-alat ini harus diperiksa setiap hari
i- Check compressor and airlines for damage, leaks or breaks. Check that
the compressor has a clean air supply.
Periksa kondisi kompresor dan saluran udaranya, kebocoran atau
rem. Periksa bahwa udaranya bersih
ii- Check electrical connections on electric power.

Periksa sambungan-2 listrik pada sistim
iii- Check that air and gas pressure is not exceeding manufacturer’s
recommendations.
Periksa bahwa gas serta tekanan udaranya tidak melebihi dari ketentuan
pabrik.
iv- Check moisture indicators or self-feed lubricator.

Periksa penunjuk kelembaban atau pelumas sistim
v- Check lubrication.
Periksa sistim pelumas

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vi- Check that hose couplings are properly secured to the compressor and to
the hose.
Periksa setiap sambungan-2 dan yakinkan terpasang dan terikat dengan
baik dan kuat.
b) Safety Rules for Using Staplers and Guns

Ketentuan Keselamatan dalam menggunakan Staplers dan Nail Guns
Always
Perhatikan selalu
i- Be familiar with the operator’s instruction manual including safety hints.

Membiasakan dengan petunjuk dalam pengoperasian termasuk factor
keselamatannya.
ii- Check airlines, power leads and/or air pressure before use.
Selalu memeriksa kondisi saluran udara, sistim listrik dan tekanan udara
sebelum dipakai.
iii- Wear safety glasses when using.

Memakai alat pelindung mata.
vii- Assume the tools are loaded.

Asumsi bahwa alat loaded
iv- Take extra care when nailing close to the edge of material.
Perhatian tambahan diperlukan bila sedang bekerja pada ujung
material yang sedang dikerjakan.
v- Locate compressor, airlines and electric leads where they will not be
damaged.
Tempatkan kompresor, saluran udara dan sistim listriknya dengan
baik untuk mencegah dari kerusakan.
vi- Have a competent experienced person carry out repairs or maintenance.

Untuk memperbaiki dan merawat alat harus oleh petugas yang
berpengalaman dan akhli.
vii- Disconnect the tool when it is left unattended and before carrying out
any cleaning or adjustment.
Putuskan sambungan bila alat tidak digunakan dan sebelumdibersihkan
atau di setting.
Never
Dilarang melakukan hal-2 berikut,
i- Horseplay or fool around with any stapler or nail.

Bermain-main dengan alat
ii- Depress the trigger unless the tool is directed onto a safe work surface
or test material.
Menekan trigger kecuali pada permukaan yg aman atau pada metrial
yang akan di test.

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iii- Point the stapler or nail at any other person or yourself.

Mata dari alat menuju kepada karyawan lain atau anda sendiri
iv- Use a volatile or flammable gas to power a pneumatic tool. Do not use
oxygen.
Gunakan volatile atau gas pembakar sebagai tenaga alat, jangan
menggunakan oxygen.
v- Use a defective or damaged tool.

Menggunakan alat yang rusak
vi- Use a tool that has loose bolts, screws or fittings.

Menggunakan alat dengan kondisi unsafe (Baut/mur serta sambungan
yang longgar)
vii- Trigger the tool when moving it from fixing to fixing.

Trigger alat tsb bila dipindahkan dari sati titik ke titik yang lain
viii- Exceed the air pressure recommended by the tool maker.

Tekanan udara harus sesuai dengan rekomendasi pembuat/pabrik
4.4.4 Safety Precautions for Angle Grinders and Cutters

Petunjuk keselamatan untuk gerinda dan alat potong
a) Before use, check for any damage to leads. Check condition of blade, disc or
stone. Replace if the diameter of wheel or blade is reduced by 50% or appears
excessively worn or cracked.
Periksa kondisi daripada pisau pemotong, disc atau batu gerinda sebelum
digunakan, ganti dgn yg baru bila garis tengah batu gerinda berkurang 50% atau
retak dsb.
b) Ensure the guard is in good condition.

Pastikan alat pelindung alat terpasang dengan baik dan berfungsi
c) Check to make sure the blade, disc or stone is fitted properly.

Periksa untuk memastikan bahwa pisau pemotong, disc atau batu gerinda
terpasang dengan baik, kuat dan aman.
d) Eye and hearing protection must be used with grinders. Safety glasses or goggles
must be impact resistant.
Alat pelindung mata dan pendengaran harus digunakan bila mengoperasikan
alat.
e) The material to be cut or ground must be securely fixed or clamped.

Material yang akan dipotong atau sisting pentanahan harus terpasang dan
diclamp dengan baik.
f) Ensure there are no combustible materials nearby e.g. paper or rags – as sparks
can cause fires.
Pastikan tidak terdapat bahan mudah terbakar di sekitar lokasi pekerjaan, untuk
mencehag terjadinya bahaya kebakaran.
g) Ensure other workers are kept at a safe distance from the work. They can be hit by
flying fragments.
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Pastikan tidak terdapat pekerja lain disekitar kegiatan untuk mencegah terjadinya
bahaya akibat dari percikan-2 yg timbul.
h) Be aware of the inertia effect of high-speed rotating tools.

Selalu memperhatikan dampak inertia dari perputaran yg tinggi
i) No fabric or woven gloves are to be used as they may entangle with rotating parts.
Dilarang menggunakan sarung tangan yg memungkinkan terbawa putaran alat.
4.4.5 Safety Precautions for Saws

Petunjuk Keselamatan untuk Gergaji
a) Portable Saws
Gergaji Listrik
i- Check that the blade is guarded and that the guard rotates properly.
Periksa pisau gergaji terlindung dan melindungi putaran dengan baik
ii- Check the saw blade is correctly fitted before use.

Periksa pisau gergaji terpasang dengan baik, aman sebelum digunakan.
iii- Wear ear and eye protection.

Gunakan alat pelindung mata dan pendengaran
iv- Adequately support timber and items to be cut.

Memasang penunjang pada barang yang akan dipotong.
v- Keep a reasonable distance away from other workers.

Jaga jarak aman dari pekerja lainnya.
vi- Do not wear fabric or woven gloves as they may entangle with rotating
parts.
Dilarang memakai sarung tangan yg memungkinkan terbawa putaran
alat.
vii- Be aware of the inertia effect.

Perhatikan dampak inertia
viii- Check for slipping or tripping hazards in the vicinity.

Periksa lokasi jangan sampai ada bahaya tersandung dan terpeleset.
b) Bench Saws
i- You should be properly trained to use a bench saw.

Untuk menggunakan alat ini harus orang yg terlatih
4.4.6 Safety Precautions for Jackhammers

Petunjuk Keselamatan untuk Jack hammer
a) The jackhammer should have a safety trigger so that it will only operate when this
trigger is depressed.
Jackhammer harus dilengkapi dengan trigger,hanya pada saat dioperasikan
trigger ini akan menekan.

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b) The operator must check the tool, the compressed airlines and couplings for
defects before use and ensure the hose does not create a tripping hazard.
Operator harus selalu memeriksa alat, saluran udara dari kompresor,
sambungan-2 sebelum digunakan dan pastikan bahwa selang udara tidak akan
menimbulkan bahaya tersandung.
c) The operator must wear ear and eye protection. Gloves are also recommended.
Operator harus menggunakan pelindung mata dan pendengaran, sarung tangan
juga di sarankan.
d) The operator must be trained in the safe use of the tool and the compressor.
Operator harus terlatih bila mengoperasikan alat ini.
e) Bystanders should be kept well clear of the work, and screens and warning signs
should be erected.
Lokasi pekerjaan clear dan tirai pelindung, poster peringatan harus dipasang
disekitar pekerjaan.
4.4.7 Safety Precautions for Other Pneumatic Tools

Petunjuk Keselamatan untuk pneumatic tool
a) An approved safety check valve must be installed at the manifold outlet of each
supply line for hand-held pneumatic tools.
Safety chek valve harus terpasang pada manifold pengeluaran setiap jalur supply
untuk alat,
b) Safety clips or retainers must be fitted on all pneumatic tools to prevent the
accidental expulsion of the tool from the barrel.
Pengikat keselamatan harus terpasang pada setiap pneumatic tool untuk
mencegah kecelakaan
c) Pneumatic tools such as riveting guns and impact wrenches, have similar hazards,
although this will depend on the tool itself.
Pneumatic tool seperti Riveting guns dan impact wrench, mempunyai sumber
bahaya yang sama, dan akan kembali kepada kondisi daripada alat itu sendiri.
d) Hearing protection will normally be required as such tools often create high noise
levels.
Pelindung pendengaran diperlukan dalam pekerjaan yg menimbulkan tingkat
kebisingan yg tinggi.
e) Eye protection should always be worn.

Selalu menggunakan alat pelindung mata
f) Ensure the trailing hose and air lines are not tripping hazards.
Pastikan bahwa selang serta saluran udara tidak menimbulkan bahaya
tersandung bagi pekerja lain.
g) For heavy tools ensure that the tool is securely supported or slung.
Untuk alat yg besar dan berat pastikan penunjang yg kuat sudah terpasang
4.4.8 Safety Precautions for Electrical Power Tools

Petunjuk Keselamatan untuk Alat yg digerakan oleh listrik

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a) Always inspect tools before use.

Selalu memeriksa alat sebelum digunakan
b) Make sure that the casings of double-insulated tools are not cracked or broken.
Pastikan bahwa casing daripada double insulated tool tidak retak atau patah.
c) Check leads before use. If the sheathing is damaged exposing the internal wiring,
the power tool must not be used. Attach a warning tag to the tool to show that it is
unsafe and send it in for repair.
Periksa kabel listrik sebelum digunakan, Jangan digunakan alat ini bila ada
kerusakan pada sistim wiring kabel, pasang tanda peringatan pada alat bahw
alat tersebut dalam kondisi tidak aman dan segera kembalikan untuk diperbaiki.
d) Do not hold on to water pipes or other grounded conductors when using electric
tools. A defect in a tool or flexible cord may make you part of the circuit, resulting
in an electric shock.
Dilarang menyimpan alat diatas pipa air atau memasang grounding pada pipa
bila menggunakan alat listrik, hal ini dapat berakibat korsleting.
e) Before drilling, hammering or cutting with hand or power tools, check for
electrical wires or equipment behind walls, above ceilings or under floors in the
area where you are working.
Sebelum melakukan pemboran, pemukulan atau pemotongan dengan alat listrik,
periksa kabel listrik atau peralatan di sekitarnya, diatas atap atau dibawah lantai
dimana kegiatan akan dilaksanakan.
f) Never use electrical equipment or tools while standing in water or when your
hands are wet.
Dilarang menggunakan alat listrik atau alat lainnya di lokasi yang berair/basah.
g) Never allow leads to trail through water.

Dilarang menggelar kabel listrik dilokasi yang berair/basah.
h) When drilling into reinforced concrete be aware that the bit may catch on the
reinforcement causing the tool jerk violently.
Bila melakukan pengeboran atas lantai beton perhatikan kemungkinan mengenai
bagian yang dapat merusak alat.
i) Always use electrical power tools with an isolating transformer or residual current
device (earth leakage protection).
Selalu menggunakan alat listrik dengan isolasi yg baik atau grounding sistim
4.4.9 Petrol or Diesel-Powered Tools

Alat yang menggunakan bahan bakar diesel atau petrol
a) Never refuel and engine while it is running.

Dilarang mengisi bahan bakar saat mesin sedang hidup
b) Avoid using these tools in enclosed spaces. If there is no other alternative, use
only diesel-powered tools and ensure that there is adequate ventilation.
Hindari penggunaan alat diruang tertutup, bila kondisi terpaksa gunaka alat yg
menggunaka bahan bakar diesel dan sediakan sirkulasi udara yg baik.
c) Ensure that ear-protection is used at all times that the engine is operating.
TOOLS
Gunakan alat pelindung pendengaran setiap saat
d) Never pour petrol into the intake of a diesel engine if it is reluctant to start.
Dilarang membuang bahan bakar petrol ke dalam alat yg menggunakan bahan
bakar diesel.
e) The chainsaw is one of the most dangerous tools used. Serious injuries can result
from ‘kick-back’ and from the materials being cut coming free when under
tension.
Chinsaw salah satu alat yg berbahaya bila digunakan, cedera yg serius dapat
terjadi akibat tekanan balik juga dari material yg sedang dipotong.
i- The operator must always stand completely to one side of the chainsaw.
Operator harus selalu mengambil posisi disatu sisi yg aman.
ii- Never reach above chest height to cut something.

Dilarang memotong material yg berada di bagian atas anda.
iii- PPE must include hardhat, earmuffs, gloves, goggles for the eyes, and if
necessary special leggings should also be worn.
Alat Pelindung diri termasuk helmet, pelindung pendengaran, sarung
tangan, pelindung mata dan bila diperlukan pelindung khusus untuk kaki
harus dipakai.
iv- Special precautions must be taken when working at height with

chainsaws.
Petunjuk Keselamatan secara khusus harus diberikan bila bekerja
diketinggian dengan menggunakan chinsaw.
v- The operator must have special training in cutting under special

situations.
Operator harus sudah mendapat pelatihan khusus perihal memotong
dalam kondisi dan situasi yg khusus.
4.5 PPE Requirements

Ketentuan Alat Pelindung Diri
Tool Additional Protective Equipment
4.5.1 Jackhammers Tampers Eye protection /Pelindung mata

Chainsaws Hearing protection / Pelindung pendengaran
Gloves / Sarung tangan
Leather gloves (Chainsaws) / Sarung tangan kulit
4.5.2 Pneumatic chipping hammers Eye protection

Impact wrenches Reamers Hearing protection
Cartridge-operated tools Power saws Leather gloves only
4.5.3 Cutting torches Eye protection

Arc welders Hand protection
4.5.4 Drills Grinders and cutters Eye protection

TOOLS
Hand-held chipping hammers Leather gloves only for drills, grinders & cutters
Powered staplers and nail
Each worksite concerned shall update the List of Hand Tool and Portable Power Tool and
submit to HSE Department for record.
Setiap lokasi proyek akan selalu meng update daftar peralatan ringan dan peralatan yg
menggunakan power listrik serta menyerahkan ke bagian HSE untuk direkod.

MACHINERY AND EQUIPMENT

APPENDIX M 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
4.0 WORKING INSTRUCTION / INSTRUKSI KERJA 2
4.1 Assessment / Kajian 2

4.2 Safeguards / Pengamanan 2
4.3 Training / Pelatihan 3
4.4 Maintenance / Pemeliharaan 3
4.5 Personal Protective Equipment / Alat Pelindung Diri 4
PT. Guna Teguh Abadi Page 1 of 4 Doc. APPENDIX M


This standard instruction shall apply throughout the organization and shall cover all types of machines
and equipments.
Instruksi standard ini harus diaplikasikan pada seluruh jajaran organisasi dan meliputi semua jenis
mesin dan peralatan.
This standard instruction shall apply to all employees and contractors in PT. Guna Teguh Abadi.
Instruksi standard ini akan di aplikasikan kepada semua karyawan dan kontraktor di PT. GUNA
TEGUH ABADI
To ensure that all machines and equipments, are sufficiently safeguarded to ensure the safety of the
worker and persons who may be affected by the operation of these machines and equipments.
Menjamin bahwa semua mesin dan peralatan telah cukup diberi pengaman guna menjamon keselamatan
pekerja dan orang yang dapat mungkin terpapar oleh pengoperasian mesin dan peralatan ini
The HSE Committee is responsible for the contents of this standard instruction.
Komite HSE bertanggungkjawab terhadap muatan / isi dari instruksi standard ini.
The Chief HSE concerned is responsible to ensure that this working instruction is followed in their area.
Chief HSE yang terlibat bertanggungjawab untuk menjamin instruksi kerja ini ditaati di area kerja
mereka.
Chief HSE / HSE Officer shall advice on compliance to legal and other requirements.
Chief HSE / Officer HSE akan memberikan saran guna mematuhi hokum dan persyaratan lain.
All employees concerned are responsible to comply with this standard instruction.
Semua karyawan yang terlibat bertanggung jawab untuk mematuhi instruksi standard ini.
4.0 WORKING INSTRUCTION / INSTRUKSI KERJA
4.1 Assessment / Kajian
An assessment must be done for each machine and piece of equipment to determine the inherent
risk to worker(s), support of maintenance personnel resulting from the operation, maintenance
and repair of the machine and equipment.
Suatu kajian harus dilakukan untuk setiap mesin dan peralatan guna menentukan resiko terkait
pada para pekerja, dukungan petugas pemeliharaan sebagai hasil operasi, pemeliharaan dan
perbaikan terhadap mesin dan perlatan
In the planning and design of new parts, equipment, manufacturing or service operations, an
assessment must be conducted to identify reduce or eliminate potential hazards created in or by
the manufacturing and / or services of the new part or piece of equipment.
Dalam merencanakan dan merancang suku cadang, peralatan, pabrik atau layanan operasi
baru, kajian harus dilakukan untuk mengidentifikasi, mengurangi atau mengeliminasi sumber

bahaya yang potensial yang muncul di atau pada pembuatan dan / atau layanan terhadap
sukucadang baru atau bagian yang baru.
4.2 Safeguards / Pengamanan
Based on the assessment, safeguards will be installed so as to prevent any part of the employee’s
body from entering the point of the machine while the machine is in operation.
Sesuai kajian, pengamanan akan di pasang sedemikian rupa guna melindungi setiap anggota
tubuh karyawan tidak masuk ke titik tertentu suatu mesin smentara mesin sedang beroperasi.
Guards shall be designed, constructed and used that they will :

Pengaman harus dirancang, dibuat dan dipergunakan sehingga meraka akan:
Provide positive protection;

Mendapatkan perlindungan secara positif.
Prevent access to the danger zone during operation;

Mencegah menuju ke zona berbahaya sementra sedang beroperasi.
Cause the worker no discomfort or inconvenience;

Menyebabkan pekerja tidak merasa tidak nyaman atau tidak senang
Withstand long use with minimum maintenance;

Tahan dipakai lama dengan pemeliharaan minimum.
Resist normal wear and shock; and

Tahan pada pemakaian normal dan goncangan
Not constitute a hazard by themselves that is to say without splinters, sharp corners, rough
edges, and other sources of accidents.
Tidak merupakan bahaya bagi diri sendiri karena itu dapat dikatakan tanpa berbelit, ujung-
ujung tajam, sudut-sudut kasar, dan sumber kecelakaan lainnya.
Every guard shall be securely fastened to the machine or to the floor, wall or ceiling and shall be
kept in place whenever the machine is operating.
Setiap pengaman harus dipasangkan dengan kuat ke mesin atau ke lantai, dinding, atau atap
dan harus dijaga tetap terpasang saat mesin beroperasi.
4.3 Training / Pelatihan
Training and annual refresher course shall be provided to all personnel involved in the set up,
installation, use, service, maintenance, operation, etc. of the machines / equipments. The training
must include the function of each safeguard.
Pelatihan dan kursus penyegaran tahunan harus diadakan terhadap semua petugas yang
terlibat dalam penyetelan, pemasangan, penggunaan, perawatan, pemeliharaan,
pengoperasian, dll mesin atau peralatan. Pelatihan tersebut harus mencakup penjelsan
mengenai fungsi alat pengaman.
Written, operating and maintenance instructions must be developed by Supervisor and approved
by Project Manager / Construction Manager for each machine / equipment.
Instruksi tertulis cara pengoperasian dan pemeliharaan harus dikembangkan oleh Pengawas
dan di setujui oleh Manajer Proyek / Manajer Konstruksi untuk setiap mesin / peralatan.
4.4 Maintenance / Pemeliharaan


A scheduled and documented preventive maintenance program must be developed for all
machines, equipment and safeguards by the individual worksite.
Semua program pemeliharaan pencegahan terencana dan terdokumentasi dari tiap-tiap mesin /
peralatan termasuk pengamanannya, harus selalu di kembangkan oleh masing-masing area
kerja.
4.5 Personal Protective Equipment / Alat Pelindung Diri
Personal Protection Equipment (PPE) as per Standard Instruction for Personal Protective
Equipment.
Alat Pelindung Diri seperti yang digambarkan di dalam Standar Instruksi Alat Pelindung Diri.

WORKING AT HEIGHT

TABLE OF CONTENT
DAFTAR ISI
Page
4.0 PERMIT-TO-WORK / IJIN KERJA 3
4.1 Instruction / Perintah 3

4.2 Safety Measure / Pengukuran Keselamatan 3
4.3 Handrails and Toe boards / Pagar Pengaman dan Tepi Penahan Jatuh 4
4.4 Safety Net / Jaring Keselamatan 4
4.5 Safety Lines, Belts and Harnesses / Tali , Sabuk dan Penahan Tubuh Pengaman 4
4.6 Working at Night / Kerja Di Malam Hari 5
4.7 Safety Mesh / Jaring Kawat Pengaman 5
4.8 Catch Platform / Lantai Kerja 6
4.9 Working on Roofs / Kerja Di Atap 6
PT. Guna Teguh Abadi Page 1 of 8 Doc. APPENDIX N

WORKING AT HEIGHT

This standard instruction covers the hazards and safety requirements when working at height and how to
prevent people falling from height or objects falling and injuring people below.
Instruksi standard ini meliputi bahaya-bahaya dan ketentuan keselamatan kerja saat bekerja di
ketinggian dan bagaimana mencegah seseorang jath dari ketinggian atau suatu barang jatuh dan
menciderai orang dibawahnya.
Legislation requires that where workers have to work more than 10 feet above the ground they must be
protected from falling.
Peraturan menyatakan bahwa apabila ada pekerja yang bekerja diatas ketinggian lebih dari 10 kaki
dari permukaan tanah maka harus diproteksi dari kemungkinan jatuh.
This standard instruction covers all operations, which the height is more than 2 meter.
Instruksi standard ini meliputi semua kegiatan yang dilakukan lebih dari 2 meter diatas permukaan
tanah.
To provide guidelines to those who are responsible for operations involving working at height.
Memberikan pedoman kepada seseorang yang bertanggungjawab terhadap pekerjaan-pekerjaan yang
dilakukan diatas ketinggian.
Komite HSE harus bertanggungjawab terhadap isi / muatan dari instruksi standard ini.
The HSE Committee concerned shall be responsible to ensure the implementation of this standard
instruction.
Komite HSE yang terkait harus bertanggungjawab untuk menjamin implementasi dari instruksi standard
ini.
The Chief HSE concerned shall coordinate the implementation and management of this standard
instruction.
Chief HSE yang terlibat akan mengkoordinasikan implementasi dan pengelolaan dari instruksi standard
ini.

Officer HSE akan memberikan saran-saran atas ketentuan hokum dan ketentuan-ketentuan lain.
All employees and other relevant interested parties concerned are responsible to comply with this
standard
instruction.
Semua pekerja dan pihak-pihak lain yang terlibat bertanggungjawab untuk mematuhi instruksi standard
ini.
4.0 WORKING INSTRUCTION / INSTRUKSI KERJA
4.1 Instruction / Instruksi

WORKING AT HEIGHT

4.1.1 Any work involving working at height will not be carried out without supervision from
PIC for any routine and non-routine works.
Setiap pekerjaan yang melibatkan bekerja di ketinggian tidak boleh dilakukan tanpa
pengawasan dari petugas yang berwenang, baik untuk kegiatan rutin mapun yang
tidak rutin.
4.1.2 Any work involving working at height will not be carried out without Working at
Height Permit.
Setiap pekerjaan yang melibatkan bekerja di ketinggian tidak boleh dilakukan tanpa
dilengkapi dengan Surat Ijin Kerja di Ketinggian.
4.1.3 The authorization and issuance of the permit will be done by Chief HSE / HSE Officer
/ Site Safety Supervisor.
Otorisasi dan penerbitan surat ijin akan dilakukan oleh Chief HSE / Officer HSe /
Supervisor HSE di lapangan.
4.1.4 Verification of the completed job will be done by Chief HSE / HSE Officer / Site
Safety Supervisor.
Verifikasi terhaap pekerjaan yang sudah selesai akan dilakukan oleh Chief HSE /
Officer HSE / Supervisor HSE di lapangan.
4.2 Safety Measures / Pengukuran Keselamatan
4.2.1 Strong handrails and toe boards (and, if necessary, mid-rails) around all openings and
the edges of all working platforms.
Pagar pengaman yang kuat dan penahan benda jatuh (dan, jika diperlukan penahan
bagian tengah) di sekeliling semua lobang dan sudut-sudut lantai kerja.
4.2.2 Cover floor openings.

Tutup lobang-lobang di lantai
4.2.3 Safety nets under the place where workers are working above ground.
Jaring keselamatan dibawah tempat kerja pekerja yang berada diatas tanah.
4.2.4 Safety lines, belts and harnesses, attached to strong anchorage points or running lines –
safety harnesses must be worn when the fall risk is high.
Tali, sabuk pengaman dan penahan tubuh dicantolkan ke titik penahan atau tali
penyelamat – penahan tubuh harus dipakai jika resika jatuh sangat tinggi.
4.2.5 Adequate lighting when working at night.

Penerangan yang cukup saat bekerja malam hari.
4.2.6 Safety mesh on the outside of building and scaffolding.

Jaring kawat keamanan dibagian luar gedung dan perancah.
4.2.7 Catch platforms.

Lantai kerja
4.2.8 Equipment for working on roofs such as roof ladders and crawling boards.
Peralatan untuk bekerja di atap seperti tangga atap dan papan geser
4.3 Handrails and Toe boards / Pagar Pengaman dan Sisi Penahan Jatuh
4.3.1 All openings in the outside walls, floors and the outer edges of all working platforms
and access ways must have strong handrails fitted to them. If any opening does not
WORKING AT HEIGHT

have a strong handrail, or it is broken or missing, it must be repaired or reported to a

Supervisor immediately.
Semua lobang-lobang di dinding luar, lantai dan sisi luar dari lantai kerja dan jalan
keluar harus mempunyai pagar pengaman yang kuat yang terpasang pada alat tsb.
Apabila terdapat opening yang tidak mempunyai pagar pengaman yang kuat, atau
rusak atau hsebagian hilang, maka hal tersebut harus segera diperbaiki atau
dilaporkan ke Pengawas sesegera mungkin.
4.3.2 Toe boards are used to protect the edge or openings in floors, walls and platforms so
that materials will not fall on people working below.
Sisi Penahan Benda Jatuh dipakai untuk mencegah sisi-sisi atau lobang-lobang di
lantai, dinding dan lantai kerja sehinga bahan-bahan tidak akan menjatuhi orang
yang bekerja dibawah.
4.4 Safety Nets / Jaring Pengaman
4.4.1 Safety nets are used where it is not practical to put up working platform or gangways.
They are often used in the building of bridges and for overhanging roofs.
Jaring Pengaman digunakan pada suatu tempat tidak dimungkinkan memasang lantai
kerja atau jalan setapak. Alat ini sering digunakan pada bangunan berbentuk
jembatan atau atap yang menggantung.
4.4.2 When working above places where other people work or pass through, make sure that
the mesh is fine and strong enough to prevent tools and materials from falling through.
Apabila bekerja diatas, dimana orang lain bekerja atau lewat dibawahnya, yakinkan
bahwa jarring mempunyai anyaman yang cukup kecil dan kuat untuk menahan
peralatan atau bahan jatuh kebawah.
4.4.3 Safety nets must be supported by wire ropes and fixed to strong anchorage points,
which have been properly designed by a Professional Engineer.
Jaring pengawan harus diperkuat dengan tali dan diikatkan secara kuat ke titik
penahan, peralatan ini harus dirancang dengan benar oleh seorang Ahli Teknik.
4.5 Safety Lines, Belts and Harnesses / Tali, Sabuk Pengaman dan Penahan Tubuh.
4.5.1 Many workmen think that wearing a safety belt is nuisance, but they have saved many
lives.
Banyak Pekerja berpikir bahwa memakai sabuk pengaman akan menggangu, tetapi
mereka tidak sadar bahwa sabuk pengaman telah menyelamatkan banyak nyawa.
4.5.2 Safety belts are to be used in work places where it is not possible to put up a safe
working platform or other barrier to prevent falling off.
Sabuk Pengaman harus dipakai di tempat kerja dimana tidak memungkinkan untuk
memasang lantai kerja yang aman atau alat pelindung pencegah jatuh.
4.5.3 A person who has been trained and is competent must regularly inspect safety belts,
lines and harnesses.
Seseorang yang sudah dilatih dan berwenang harus secara berkala melakukan
inspeksi sabuk pengaman, tali pengaman dan penahan tubuh.
4.5.4 Workers who have to wear safety belts when working must check them for defects
before starting work each day. If they find any defects they must not use the belt and
they must report the defect to their Supervisor.
Pekerja yang memakai sabuk pengaman saat bekerja harus memeriksa kerusakan-
kerusakan yang mungkin ada sebelum mulai kerja. Jika mereka menemukan
WORKING AT HEIGHT

kerusakan, meraka tidak boleh memakai alat tersebut dan mereka harus melaporkan
kerusakannya ke Supervisor.
4.5.5 Safety belts must be looked after and properly stored to prevent them from being
damaged.
Sabuk pengaman harus memelihara dan menyimpan dengan benar untuk mencegah
kerusakan.
4.5.6 It is very important when a belt must be worn that the safety line is fixed to a part of
the building that is strong enough to carry the worker’s weight, should they fall. The
safety line on belts and harnesses should be fixed to the building structure or to a
specially provided anchor point.
Sangatlah penting ketika sabuk pengaman dipakai, maka tali pengaman harus
diikatkan pada bagian gedung yang cukup kuat menahan berat pekerja, jika mereaka
jatuh. Tali pengaman pada sabuk pengaman attau penahan tubuh harus diikatkan ke
struktur bangunan atau ke titik khusus yang disiapkan untuk itu.
4.5.7 The place where the safety line is attached should be as high as comfortable above the
position they have to work in. The distance of fall must be kept as short as possible.
Tempat kerja dimana tali pengaman diikatkan harus cukup tinggi an nyaman terhadap
posisi pekerja. Jarak jatuh harus dibuat sependek mungkin .
4.6 Working at Night / Kerja pada Malam Hari
4.6.1 When work has to be done at height during the night, good lighting is very important.
Jika pekerjaan harus dilaksanakan pada malam hari, penerangan yang baik sangat
penting.
4.6.2 If workers cannot see properly they may not be able to see a hazard that could cause
them to fall.
Jika pekerja tidak dapat melihat dengan benar / baik , mungkin mereka tidak bias
melihat bahaya yang dapat menyebabkan mereka jatuh.
4.7 Safety Mesh / Jaring Pengaman
4.7.1 Safety mesh is a very useful way to protect tools and materials from falling from
scaffolding and from other openings on the outside of buildings.
Jaring anyaman kawat sangat berguna untuk mencegah peralatan dan bahan-bahan
jatuh dari perancah dan dari lobang-lobang diluar bangunan.
4.7.2 Safety mesh is not used to prevent workers from falling because it is not strong
enough. Strong handrails and toe boards must still be used even when safety mesh is
used.
Jaring Pengaman tidak digunakan untuk mencegah orang jatuh, sebab tidak
dirancang cukup kuat. Pagar pengaman yang kuat dan Sisi Penahan Benda Jatuh
harus tetap dipasang, meskipun telah dipasang Jaring Pengaman.
4.8 Catch Platforms / Lantai Kerja
4.8.1 Catch platforms should be fitted not more than 6 metres below the floor where workers
are working.

WORKING AT HEIGHT

Lantai kerja harus dipasangkan tidak lebih dari 6 meter dibawah lantaidimana
pekerja bekerja.
4.8.2 The outer edge of the catch platform slopes up so that objects falling on it do not
bounce off the edge.
Sisi luar dari lantai kerja harus miring naik
4.8.3 Catch platforms must not be used for storage of building materials.
Lantai kerja tidak boleh dipakai untuk menyimpan bahan-bahan bangunan
4.8.4 Catch platform construction must be strong timber boards or plywood supported on
scaffold tubes or other steel members.
Konstruksi lantai kerja harus terbuat dari papan yang kuat atau plywood yang
ditunjang oleh pipa-pipa perancah atau dari bahan besi lainnya.
4.9 Working on Roofs / Kerja di Atap
4.9.1 Access / Jalan Masuk/Keluar
a) Ladder / Tangga
i- If a ladder is used, it must be placed at the correct angle (1 metre out at

the bottom for every 4 metres up).
Jika tangga digunakan, maka harus diletakan pada tepi yang tepat
(bagian bawah berjarak 1 meter dari dinding, untuk setiap 4 meter
ketinggian)
ii- Must be tied at the top where it rests, and preferably it must be tied or
fixed at the bottom as well.
Bagian atas harus diikat dan lebih baik jika bagian bawah juga diikat.
iii- Must protrude 1 metre above the platform being accessed.

Harus menonjol 1 meter diatas lantai kerja.
iv- Both stringers to rest evenly on the floor or ground and be prevented
from kicking out.
Kedua tali penahan harus rata / lurus dilanatai atau ditanah dan
dicegah dari tekukan.
Construction/Konstruksi:
- Aluminium/Aluminium - Not to be used on electrical

equipment or supply.
Tidak digunakan pada
peralatan atau jaringan listrik
- Timber/Kayu - Styles and rungs must be

secured by ties.
Anak tangga dan sisi tangga harus
diperkuat dg ikatan.
- Home Made/ Buatan sendiri - Not to be used.

Tidak boleh dipakai.

WORKING AT HEIGHT

v- Inspection of ladders must be regular. Damaged ladders must be taken

out of service.
Inspeksi tangga harus dilakukan secara berkala. Tangga yang rusak
harus disingkirkan.
b) Scaffolding / Perancah
i- Scaffolds are the main way that workers can get up to or work on the
roof of buildings or other structures.
Perancah adalah sarana utama bagi pekerja untuk naik atau bekerja di
atap bangunan atau struktur lain.
ii- Refer to Scaffolding Working Instruction.

Lihat Instruksi Berkeja pad Perancah.
c) Mechanised Scissor Lifts or Sky Lifts / Lift Mekanis Pemotong atau Lift Tinggi.
i- This type of equipment is very useful where it is not practical to put up

fixed scaffolding and for areas where access to a high place needs to be
made for a short time.
Jenis peralatan ini sangat berguna, pada kondisi sangat tidak praktir
untuk memasang perancah tetap dan untuk area dimana jalan menuju
ke tempat tinggi harus secepat mungkin.
ii- Some models are only suitable for level or even floors and others have
outriggers and can be set up on uneven ground.
Beberapa model hanya sesuai untuk lantai yang rata dan lainnya
mempunyai kaki penunjang dan dapat dipasang pada tanah yang tidak
rata.
4.9.2 Steepness of roofs (Gradient) / Jalan setap di Atap
a) When on the roof the gradient will have to be considered. Roofs that have a
gradient of less than 10% are considered to be flat roofs.
Jika kemiringan atap menjadi pertimbangan. Atap yang mempunyai kemiringan
kurang dari 10% dipertimbangkan menjadi atap datar.
b) Roofs that slope more steeply may need to have places where safety belts or
harnesses can be fitted or have proper crawling boards placed on them.
Atap dengan kemiringan lebih steeply mungkin memerlukan tempat dimana sabuk
pengaman atau penahan tubuh dapat diikatkan atau mempunyai papan geser
yang benar.
c) All roofs where it is possible for the worker to fall more than 10 feet must be fitted
with proper handrails and toe boards as described earlier.
Semua atap dimana ada kemungkinan pekerja bias jatuh setinggi 10 kaki, harus
dilengkapi dengan pagar pengaman dan sisi penahan benda jatuh
d) In some places they may also need to have rails or cross-braces put between the
top of the handrail and the toe-boards. This is to stop a worker from sliding under
the handrail if they are crouching or bending down.
Pada beberapa tempat, mungkin memerlukan juga pengaman atau penguat
melintang yang dipasang dari atap pagar ke sisipenahan benda. Ini untuk

WORKING AT HEIGHT

menghentikan pekerja jika tergelincir dibawah pagar pengaman, saat mereka

membungkukan badan atau tunduk.
4.9.3 Strength of the roofing material / Kekuatan Bahan Atap.
a) Roofs that are made of material, which is very strong to walk and work on, are
obviously much safer than those made of fragile material, e.g. glass, sheet or
corrugated plastic.
Atap yang dibuat dari bahan bangunan, sangat kuat untuk diinjak dan orang
bekerja diatasnya, jelas lebih aman daripada yang dibuat dari bahan yang mudah
remuk, seperti misalnya: gelas, lempengan atau plastic berlobang.
b) Remember that some roofing material looks stronger than it is, especially if is has
been installed for a number of years.
Ingat bahwa beberapa abahan atap kelihatannya lebih kuat daripada itu,
khususnya jika telah dipasang beberapa tahun.
4.9.4 Fixing roofing sheets in windy conditions / Memasang lembaran atap pada kondisi
berangin
a) When fixing roofing materials, especially large sheets, much care must be taken to
ensure that wind will not catch it and blow or knock a worker off the roof.
Apabila memasang bahan atap, khususnya yang berbentuk lembaran lebar,
tindakan kehati2an perlu diambil agar angina tidak menerbangkannya atau
memukul si pekerja.
b) When it is too windy to handle the sheets safely, work on that job should stop
until the wind drops.
Jika angin terlalu kencang untuk tetap bisa tetap memegang dengan aman
lembaran atap tersebut, maka pekerjaan harus dihentikan sampai kekuatan
angina melemah.

ELECTRICAL SAFETY

APPENDIX O 23 July 2013
TABLE OF CONTENT
Daftar Isi
Page
1.0 INTRODUCTION / Pendahuluan 2
4.0 WORKING INSTRUCTION / Instruksi Kerja 3
4.1 Distribution Board / Panel Distribusi 2

4.2 Power Lines / Jalur Listrik 3
4.3 Use of “Goal Posts” / Menggunakan Goal Posts 4
4.4 Temporary Lighting / Penerangan Sementara 4
4.5 Flexible Cords and Plugs / Kabel dan plug serba guna 5
4.6 Electric Tools / Peralatan listrik 6
4.7 Electric Shock / Korsleting 7
4.8 Training / Pelatihan 7
4.9 Colour Coding/Kode warna 7
4.10 Precaution and Permit-to-Work / Petunjuk Keselamatan dan Ijin Kerja 8
PT. Guna Teguh Abadi Page 1 of 9 Doc. APPENDIX O

ELECTRICAL SAFETY

1.0 INTRODUCTION
Pendahuluan
This standard instruction covers the safe use of electricity, electrical equipment and electrical tools on
construction sites.
Standar ini meliputi petunjuk Keselamatan dalam menggunakan power listrik, peralatan listrik dan alat
yg menggunakan listrik di lapangan.
This standard instruction shall apply to all employees and contractors especially electricians in PT. Guna
Teguh Abadi.
Standar ini disampaikan kepada seluruh karyawan dan kontraktor khususnya pekerja bagian listrik di
PT. Guna Teguh Abadi.
2.0 PURPOSE
Tujuan
To clarify GTA’s electrical safety management to execute a safe working environment at worksite.
Menjelaskan/menguraikan Pengaturan Keselamatan pada pekerjaan listrik untuk menciptakan
lingkungan kerja yang aman.
3.0 RESPONSIBILITY
Tanggung Jawab
Panitia K-3 bertanggung jawab atas isi serta materi daripada ketentuan standar.
Chief HSE concerned shall be responsible to prevent electrical failures and to ensure safe installation,
maintenance and safe operation of all electrical appliances.
Chief HSE bertanggung jawab untuk melindungi/mencegah terjadinya power shut down karena
pekerjaan dan memastikan serta meyakinkan keamanan instalasi, perawatan serta keselamatan dalam
operasi daripada bagian listrik.
Chief HSE concerned are responsible to ensure that this working instruction is followed within the
worksite.
Petugas Safety bertanggung jawab untuk memastikan/meyakinkan bahwa instruksi standar ini
dijalankan di lokasi proyek.

Petugas Safety akan memberi saran dal penyesuaian ketentuan-2 keselamatan.
All employees and contractors / subcontractors concerned are responsible to comply with this procedure
instruction.
Setiap karyawan dan kontraktor / subkontraktor bertanggung jawab untuk menyesuaikan dengan
ketentuan ini.
4.0 WORKING INSTRUCTION

Instruksi kerja
4.1 Distribution Boards

ELECTRICAL SAFETY

Panel Distribusi
Only authorised persons can work on substations, distribution boards and in areas where high
voltage electrical equipment is installed.
Hanya petugas yg diijinkan yang boleh bekerja di dalam substation, panel listrik dan lokasi
dimana terpasang tegangan tinggi.
Temporary distribution boards must be safely mounted, protected from weather and water,
accessible to workers and kept clear of obstructions.
Panel distribusi sementara harus terlindung dari cuaca dan air, tidak menghalangi jalan.
They must use only fuses or breakers of the recommended current rating.
Fuse/sikring dan breaker yang digunakan harus sesuai dengan rekomendasi yg dikeluarkan.
Follow approved guidelines for tagging and locking out.

Ikuti petunjuk untuk pemasangan tag dan locking out yang sudah disetujui.
Never leave any materials that will burn or any explosives near distribution boards.
Dilarang meninggalkan material yang dapat terbakar atau meledak dekat panel listrik.
All distribution boards must be clearly labelled for each section or area of use.
Setiap panel distribusi harus dipasang label yang menunjukan lokasi atau seksi yang
menggunakan.
4.2 Power Lines

Jalur Listrik
Before starting work find out where all underground and overhead services are located.
Determine the voltages of the electrical services.
Sebelum mulai bekerja perhatikan lokasi setiap fasilitas bawah tanah dan di bagian atas,
Perhatikan tegangan yang terpasang.
Mark where underground cables are located on all plans and drawings and post warning signs
along their route.
Setiap kabel bawah tanah harus diberi tanda pada gambar dan dipasang tanda-2 peringatan
disepanjang jalur kabel tsb.
Where high voltage cables pass through places where people are working, put up danger notices
drawing attention to the high voltage cables.
Bila kabel tegangan tinggi melintasi lokasi dimana banyak pekerja, pasang tanda bahaya
tegangan tinggi.
Have power lines moved, insulated or de-energised if necessary so that work can be performed
safely.
Untuk lebih amannya setiap pekerjaan, pindahkan jalur kabel tsb, isolasi dan bila perlu
diputuskan aliran powernya.
Before moving ladders, rolling scaffolds or elevated work platforms, always check for overhead
lines.
Sebelum memindahkan tangga, perancah beroda atau merubah ketinggian platform selalu
periksa dulu kondisi di bagian atas (jalur kabel).
Avoid storing material or equipment under power lines. If it must be stored there, hang warning
flags and signs to prevent other workers from using hoisting equipment to move or lift it.
ELECTRICAL SAFETY

Hindari penyimpanan material atau peralatan dibawah jalur kabel listrik, bila harus disimpan
dibawah jalur kabel pasang bendera /papan peringatan untuk mencegah karyawan
menggunakan alat angkat dalam memindahkan material.
When using back hoes, cranes and similar equipment near power lines, use a banksman to warn
the operator when any part of the equipment or load gets too near to the minimum approach
distances to live power lines. Where possible set up goal posts to mark the safe distance.
Bila menggunakan back hoe (alat penggali), crane atau sejenisnya di dekat jalur listrik,
banksman harus disiapkan untuk memberi petunjuk kepada operator bila ada bagian dari alat
tsb atau beban yg diangkat sangat dekat dengan jalur listrik, bila memungkinkan set up Goal
Posts untuk menentukan jarak aman.
a) AC Voltage Rating of Minimum Approach

Power Lines Distance
i- Not exceeding – 750 volts 3.5 m
ii- 751 – 150 000 volts 4.0 m
iii- 150 000 – 250 000 volts 4.5 m
iv- Over – 250 000 volts 6.0 m
In cases where equipment may need to be operated closer than the distances stated, special
permission must be obtained from an authorised person before beginning work. The above
rating is a guideline only. At each site the Electrical Supply Authority should be contacted for
the safe working clearance distances.
Bila equipment harus beroperasi diluar ketentuan tsb diatas (lebih dekat) ijin khusus harus
dikeluarkan oleh pejabat berwenang sebelum pekerjaan dimulai, petunjuk diatas hanya
merupakan pedoman, di lapangan / proyek penyaluran listrik harus dalam jarak yang aman.
4.3 Use of ‘Goal Posts’
When mobile plant must move underneath power lines, the place where they pass should be as
small as possible (ideally not more than 10 metres wide).
Bila peralatan harus melintas dibawah jalur listrik, jalur yg akan dilewati harus seminim
mungkin (idealnya tidak lebih lebar dari 10 mtr).
The passageway should be marked off by barriers or plastic netting and goal posts must be put
up across it.
Jalan tsb harus dibatasi dengan tanda-2 atau dipasang pembatas atau jarring plastik, dan goal
posts harus dipasang.
Goal posts must be made of a material that will not conduct electricity e.g. fibreglass or PVC,
and they should be robust and painted to make them easily seen. For large spans it may be
necessary to use well-earthed, plastic-coated, tensioned steel cables.
Goal post harus terbuat dari bahan yg tidak menghantar listrik seperti plastik , fibber dan
harus dicat sedemikian rupa sehingga mudah dilihat, untuk ukuran besar mungkin harus
dilengkapi grounding, plastik coat dsb.
Warning signs giving the clearance distance to the overhead service must be placed where
drivers can see them to warn them to lower their jib.
Tanda peringatan untuk jarak aman dengan jalur diatas harus dipasang sehingga setiap
driver/operator dapat melihat dan mengamankan alatnya dari jaluir listrik tsb.
ELECTRICAL SAFETY

4.4 Temporary Lighting

Penerangan Sementara
Avoid contact with overhead temporary lighting lines.

Hindari kontak dengan penerangan sementara yg dipasang dibagian atas.
Be aware that frequent movement of circuits can loosen connections, break insulation and create
other hazards.
Perhatikan frekuensi perubahan dari sirkuit dapat melonggarkan setiap sambungan, isolasi
and dapat menimbulkan bahaya.
Do not use temporary lighting circuits as extension cords. If a fuse blows, it may be dangerous
to find the way to the distribution board in the dark.
Dilarang menggunakan sirkuit penerangan sementara sebagai perpanjangan kabel. Bila
sikring terbakar, memeriksa panel distribusi dalam kondisi yg gelap dapat menimbulkan
bahaya.
In the final stages of work, temporary lines often pass through doors that may be accidentally
closed on them. This could damage the cable insulation and allow exposed wires to come into
contact with steel doorframes.
Dalam ahir pekerjaan, jalur listrik sementara selalu akan dipasang melewati pintu sehingga
dapat menimbulkan kecelakaan bila pintu ditutup, Rusaknya isolasi kabel sehingga kabel listrik
bagian dalam keluar dapat menimbulkan bahaya listrik bila kontak dengan frame pintu yg
terbuat dari metal.
Replace missing or burnt – out light bulbs to keep the required lighting levels in stairwells,
basements, halls and other areas where good lighting is required.
Ganti setiap kabel yg rusak terbakar atau hilang untuk selalu menerangi di lokasi tangga,
lantai dasar, bangunan dan lokasi lain yang memerlukan penerangan.
Protect light bulbs from damage with cages.

Lindungi bola lampu dengan keranjang lampu.
Do not use conductive materials such as steel or copper, for handles of temporary electric lights.
Dilarang menggunakan material penghantar listrik seperti besi atau tembaga untuk
menghandel lampu penerangan sementara.
Temporary lighting in confined space use fire or gas proofing material and maximum power
12 Volt and DC.
Lampu penerangan sementara didalam ruang terbatas harus terbuat dari bahan tahan gas dan
api dan maksimal daya 12 Volt dan DC.
4.5 Flexible Cords and Plugs

Kabel yang flexible dan plug listrik
Never cut off, bend back, or ‘cheat’ the earth (ground) pin on three pin plugs.
Dilarang memotong , membengkokan/melipat grounding sistim.
Make sure that all plugs, cords and connections are in good condition before plugging in and
switching on.
Pastikan semua plug/penutup, kabel and sambungan-2 dalam kondisi baik dan aman sebelum
ditutup dan di hidupkan.

ELECTRICAL SAFETY

The use of electric cords or extension cords for hoisting or lowering power tools is not
permitted.
Menggunakan kabel listrik untuk mengangkat atau menurunkan barang/alat adalah dilarang.
Do not use flexible cords that are defective or have not been properly repaired.
Dilarang menggunakan kabel flexible yang rusak dan tidak diperbaiki dengan baik.
Make sure that flexible cords are joined by an approved plug and socket connector.
Pastikan bahwa kabel flexible disambung dengan menggunakan plug dan socket sambungan.
Make sure that flexible cords are of the right gauge for the job to prevent overheating, voltage
drops and tool burnout.
Pastikan dan yakinkan bahwa kabel flexible yang digunakan sesuai dengan ukurannya untuk
mencegah terjadi panas pada kabel , turunnya tegangan dan terbakarnya alat.
Support flexible cords off floor or ground where they cross passages or access ways. Never run
a cord through water.
Gunakan penyangga kabel bila harus melewati jalan, dilarang menggelar kabel melalui air
atau area yg basah.
Do not attach flexible cords to metal scaffolds or frames.

Dilarang menyimpan kabel listrik pada perancah besi.
Any flexible cord that feels more than comfortably warm should be reported to the Site
Supervisor.
Bila terdapat kabel yang dirasakan kurang aman, segera lapor pada pengawas anda.
Protect flexible cords from mechanical damage or damage by liquids.

Lindungi kabel dari kerusakan akibat mekanikal dan cairan.
4.6 Electric Tools

Peralatan Listrik
All electric tools should be used in conjunction with either approved isolating transformers or
Residual Current Devices (RCD’s with 30 mill-ampere maximum tripping current).
Setiap alat-2 listrik harus digunakan dengan persetujuan atas kondisi isolasi transformer atau
residual current devices.
Use only tools that are grounded or double – insulated.

Gunakan alat dengan grounding terpasang atau double isolasi.
Do not use double – insulated tools with cracked or broken casings.

Dilarang menggunakan alat yang double isolasi retak / rusak.
Do not use tools that spark, smoke or become excessively hot when in use.
Dilarang menggunakan alat yang mengeluarkan asap atau percikan api saat dipakai.
Use hand tools with insulated handles and grips.

Gunakan alat yang pegangannya terisolasi.
Wherever required, wear protective equipment; insulated gloves, shock – resistant footwear,
safety goggles, etc.
Gunakan/pakailah alat pelindung diri (sarung tangan listrik, anti listrik, sepatu anti listrik,
pelindungmata)dll.
ELECTRICAL SAFETY

Never bypass broken switches on tools or equipment by plugging and unplugging the cord.
Shutting off power will take too long in an emergency.
Dilarang mengambil jalan pintas bila switch dari alat rusak dengan cara memasang dan
melepas kabel, matinya listrik akan memakan waktu yg lama dalam kondisi emergensi.
Do not hold water pipes or other grounded conductors when using electric tools. A defective
electrical tool or flexible cord may give you a serious electric shock.
Dilarang menggunakan pipa air sebagai grounding conducter, alat yang rusak dapat
menyebabkan anda tersengat listrik.
Before drilling, hammering or cutting with hand or power tools, check for electrical wires or
equipment behind walls, above ceilings or under floors in the area where you are working.
Sebelum membor, pmemukul atau memotong dengan tangan atau alat, periksa kabel listrik atau
alat disebelah anda, diatas atau dibawah lantai dimana anda akan bekerja.
Keep flexible cords out of the path of electric tools and equipment.
Jauhkan dan jaga setiap kabel flexible dari alat listrik dan equipment.
Regular checks of all electrical tools and equipment, and recording the checks on tags fixed to
the item or cord should be carried out.
Pemeriksaan rutin atas alat listrik dan equipment dan pencatatan harus dilaksanakan.
Before making adjustments or changing attachments, disconnect electric tools from the power
source. Switching off the tool may not be enough to prevent accidental start-up.
Sebelum mengatur atau merubah posisi, putuskan arus listrik, mematikan arus pada alat tidak
akan menjamin keselamatan anda.
Do not clean electric tools with flammable or toxic solvents or use them in areas containing
combustible materials.
Dilarang membersihkan alat dengan cairan mudah terbakar atau cairan beracun atau
menggnakan alat di lokasi yang terkontaminasi bahan mudah terbakar.
Never use electrical equipment or tools while standing in water or when your hands are wet.
Dilarang menggunakan alat atau equipment dengan posisi berdiri di lokasi yang basah.
4.7 Electric Shock

Tersengat Listrik
The passage of electricity through the body is called electric shock. Effects can range from a
tingling sensation to death. While some electric shocks may not be enough to kill or even injure,
they can startle a worker and cause a fall from a ladder or other place.
Aliran listrik yg melalui badan/tubuh disebut tersengat listrik, dapat berakibat kematian, dapt
juga tidak berakibat kematian walaupun cedera (luka bakar), akibat dari sengatan listrik ketika
sedang bekerja diketinggian dapat berakibat fatal.
Burns are the most common electric shock-related injury. Electricity can cause severe burns at
points of entry and exit. The damage is often more serious than it looks. Although entry and exit
wounds may be small, bone and muscle can be extensively burned in-between.
Luka bakar biasanya yg selalu terjadi akibat senagatan listrik, keruskan pada organ tubuh
bagian dalam bisa serius.
Leave electrical work to the electrician and do not try to do it yourself.

Serahkan kepada akhli listrik setiap pekerjaan listrik jangan mencoba-coba.
ELECTRICAL SAFETY

4.8 Training
Latihan
All Contractors and Subcontractors must attend an Electrical Safety Course before commencing
work on site if they not already done so.
Setiap kontraktors dan sub.kontraktor harus menghadiri kursus bidang listrik yang diadakan
sebelum memulai pekerjaan di proyek.
4.9 Color Coding

Kode Warna
Color code system shall be used, color code will be affixed or painted on to the electrical
equipment. The periods for color code compliance will last for three (3) month. The
following four colors, red, green, blue and yellow will be used in rotation. The rotation of
the color will be communicated before the end of three (3)-month period. The color coding
used for cable testing is :
Sistem kode warna harus diimplementasikan, kode warna harus dipasang atau di cat pada
peralatan listrik. Masa berlaku untuk kode warna dalah 3 bulan. Adapun kode warna setiap
tiga bulan tersebut adalah merah, hijau, biru dan kuning. Pergantian kode warna harus
dikomunikasikan sebelum masa 3 bulan tersebut berakhir.
Kode warna yang dipakai pada kabel adalah
- January to March Red

Junuari sampai Maret Merah
- April to June Green
April sampai Juni Hijau
- July to September Blue
Juli sampai September Biru
- October to December Yellow
Oktober sampai Desember Kuning
4.10 Precaution and Permit-to-Work

Petunjuk Keselamatan dan ijin kerja
Electric equipment, in areas where work is being performed, should be protected with insulated
materials, railings or completely fenced off to prevent accidental contact.
Peralatan listrik, dimana pekerjaan dilaksanakan, harus dipasang pengaman dengan material
non penghantar listrik, pemagaran atau pemasangan pagar permanen untuk mencegah
terjadinya kecelakaan.
When working with electricity or electrical tools use only wooden or fibreglass non-conductive
ladders.
Bila bekerja dengan menggunakan power listrik atau alat yg memakai arus listrik gunakan
kayu atau fiberglas.
Ensure that hands are dry when connecting, disconnecting and operating electrical equipment.
Pastikan/yakinkan bahwa tangan anda kering bila akan menyambung atau memutus
sambungan dan mengoperasikan alat listrik.
Be familiar with the electrical hazards associated with your workplace.

Mengetahui bahaya-2 listrik dalam pekerjaan yang akan dilakukan.

ELECTRICAL SAFETY

Assume that all electrical equipment is alive unless the appropriate safety measures have been
taken.
Selalu berasumsi bahwa peralatan listrik yg ada dalam keadaan on kecuali terdapat peringatan
atau keterangan keselamatan.
Report all electrical problems and hazards including tripped breakers, blown fuses, broken
switches, flickering lights including dangerous installation method etc. to the Site Supervisor.
Laporkan segala masalah dan bahaya-2 termasuk matinya breaker, sikring terbakar, switch yg
rusak demikian juga dengan metode pemasangan instalasi yang tidak aman kepada pengawas
anda.
A Permit-to-Work with appropriate lockouts, tagging and release procedures are required for all
work carried out on installed equipment.
Ijin kerja dengan pemasangan lock out, tagging dan prosedur diperlukan setiap pekerjaan yg
dilaksanakan pada peralatan yg terisolasi.
Electrical repairs and alterations may only be carried out by an appropriately-trained electrician.
Do not try to fix electrical faults yourself.
Perbaikan listrik dan alteration dapat dilaksanakan oleh tukang listrik yang terlatih.

STANDARD INSTRUCTION LOCKOUT /
TAGOUT

APPENDIX P 23 July 2013
TABLE OF CONTENT
DAFTAR ISI
Page
1,0 INTRODUCTION / PENDAHULUAN 2
4.0 PROCEDURE / PROSEDUR 2
4.1 Instruction / Instruksi 2

4.2 Verification / Verifikasi 3
PT. Guna Teguh Abadi Page 1 of 3 Doc. APPENDIX P

TAGOUT

This standard instruction shall apply throughout the organization and shall cover all types of facilities for
locking out and tagging out equipment and electricity during maintenance and repair.
Instruksi standard ini akan diaplikasikan keseluruh organisasi dan akan meliputi semua jenis fasilitas
untuk penguncian dan penandaan peralatan dan perlistrikan selama pekerjaan pemeliharaan dan
perbaikan.
The isolation of all hazardous energy sources while service or maintenance is performed.
Mengisolasi semua sumber energi berbahaya sementara lpemeliharaan dilakukan.
To protect employees from the possible release of stored energy.

Mencegah pekerja dari kemungkinan terkena energi yang tersimpan.
3.0 RESPONSIBILITY/ TANGGUNGJAWAB
The HSE Committee shall be responsible to the contents of this standard instruction.
Komite HSE bertanggungjawab atas muatan / isi dari standar ini.
The HSE Committee concerned are responsible to ensure that this standard instruction is followed within
the worksite.
Komite HSE yang berperan bertanggungjawab untuk meyakinkan bahwa standar ini dipatuhi di area
kerja.
HSE Officer shall advice on the administrative of lockout and tag-out programme and compliance to
legal and other requirements.
Officer HSE akan memberikan saran secara administatif pada program penguncian dan penandaan dan
pemenuhan terhadap perundang-undangan atau ketentuan lain.
All employees and contractors / subcontractors concerned are responsible to comply with this standard
instruction.
Semua pekerja dan kontraktor / subkontraktor yang berperan bertanggungjawab untuk memenuhi
instruksi standar ini.
4.1 Instruction / Instruksi
4.1.1 Workers engaged in any of these activities are covered by lockout / tag out when any
of the following conditions occur:
Pekerja yang betugas pada setiap kegiatan ini dicakup dengan penguncian /
penandaaan ketika keadaan tersebut dibawah ini terjadi:
a) The employee must remove or bypass guards or safety devices;

Pekerja harus membongkar atau mengalihkan pelindung atau peralatan
pengaman.
TAGOUT

b) The employee is required to place a part of their body in contact with the point of
operation of a machine or piece of equipment; or
Menharuskan pekerja untuk menempatkan bagian anggota tubuh bersinggungan
dengan mesin atau bagian-bagiannya yang beroperasi.
c) The employee is required to place a part of their body into a danger zone
associated with a machine operating cycle.
Menharuskan pekerja untuk menempatkan bagian dari tubuh mereka didalam
area berbahaya yang berkaitan dengan mesin yang sedang beroperasi.
4.1.2 Before working on any machinery or equipment authorized employees must notify the
Project Manager in the event of any connection or disconnection of machine or
appliances.
Sebelum bekerja di mesin atau peralatan, pekerja yang berwenang harus memberitahu
Proyek Manajer mengenai adanya penyambungan atau pemutusan dengan mesin atau
perlatan.
4.1.3 Connect or disconnect energy source(s) for any machine or appliances.

Sambung dan lepaskan sumber energi dari semua mesin atau peralatan.
4.1.4 The Electrician shall confirm with the Project Manager prior to any connection /
disconnection.
Ahli listrik akan mengkonfirmasikan ke Proyek Manajer berkaitan dengan
penyambungan / pemutusan.
4.1.5 The Electrician shall fill-up Lockout / Tag out Permit before confirmation.
Ahli listrik akan mempersiapkan ijin Penguncian / Penandaaan sebelum pelaksanaan..
4.1.6 Then Electrician shall connect / disconnect the relevant sources or control and display
the paper caution notice and lock the system with padlock.
Kemudian ahli listrik akan menyambung/melepas sumber energi atau pengendali dan
menggantungkan tanda peringatan dan mengunci system dengan gembok.
4.1.7 Periodic inspections should be performed to evaluate the effectiveness of the lockout /
tag out programme.
Inspeksi berkala harus dilakukan untuk menilai efektivitas program penguncian /
penandaaan.
4.2 Verification / Verifikasi (Penegasan)
4.2.1 Verification of the completed job will be done by Project Manager / Construction
Manager / HSE Committee.
Verifikasi (penegasan) bahwa pekerjaan telah selesai akan dilakukan oleh Manajer
Proyek / Manajer Konstruksi /Komite HSE.

CO No :
REV
12-1812/ BA 1066
0
DOCUMENT NO.
APPENDIX-01-A
HEALTH, SAFETY AND ENVIRONMENT
Date BY Chkd Appvd
MANAGEMENT PLAN
23 Jul 13 ARN WR KH
PROJECT OCCUPATIONAL HEALTH AND SAFETY POLICY

KEBIJAKAN KESEHATAN DAN KESELAMATAN KERJA PROYEK
PT. Guna Teguh Abadi is committed to conduct its operation in a manner that protects the safety of its employees, customers,
PT. Guna Teguh Abadi’s and the public.
PT. Guna Teguh Abadi berkomitmen bahwa didalam kegiatan operasinya dan melakukan perlindungan terhadap keselamatan
untuk pekerja, pelanggan, PT. Guna Teguh Abadi, dan masyarakat sekitar
PT. GUNA TEGUH ABADI will strive to prevent accident, injuries, and occupational illness through the active participation of
every employee.
PT. Guna Tegh Abdi berusaha untuk mencegah kecelakaan, luka dan penyakit akibat kerja melalui
partisipasi aktif dari tiap pekerja.
PT. GUNA TEGUH ABADI is committed to continuous efforts to identify and eliminate or manage safety risks associated with its
activities.
PT. GUNA TEGUH ABADI berkomitmen melakukan suatu usaha terus menerus untuk mengidentifikasi, mengurangi dan
mengelola risiko keselamatan kerja yang berhubungan dengan pekerjaan.
Therefore it is PT. GUNA TEGUH ABADI policy to:
Oleh karena itu kebijakan PT. GUNA TEGUH ABADI adalah :
- Comply with the relevant HSE legislation, regulation and any other associated requirement.
Memenuhi Undang-undang, aturan dan beberapa persyaratan lain yang berhubungan dengan HSE
- Stress to all employees, PT. GUNA TEGUH ABADI and other working on company’s behalf, their responsibility and
accountability for safe performance on the job.
Melakukan penekanan untuk semua karyawan, PT. GUNA TEGUH ABADI dan pekerjaan lain yang mengatasnamakan
perusahaan, bertanggung jawab dan tanggung gugat atas kinerja keselamatan pada tiap pekerjaan.
- Provide adequate instruction, training, and supervision of work.
Menyediakan instruksi, training dan pengawasan yang sesuai pada setiap pekerjaan.
- Set HSE objective and targets to achieve superior performance through the utilization of a continuous improvement
process.
Membuat tujuan dan sasaran K3LL untuk mendapatkan kinerja terbaik dengan menggunakan proses perbaikan
berkesinambungan/berkelanjutan.
- Ensure that systems are developed and implemented to identify, assess, monitor, periodically review and control impacts
related to our business activities.
Memastikan system dikembangkan dan diimplementasikan untuk mengidentifikasi, menganalisa, memantau,
peninjauan berkala dan pengendalian dampak yang berhubungan dengan aktifitas bisnis.
- Implement mechanisms to communicate with and obtain input from employees, customers and PT. GUNA TEGUH ABADI
within the HSE Management System.
Melaksanakan mekanisme komunikasi dengan dan memperoleh masukan dari pekerja, pelanggan dan PT. GUNA
TEGUH ABADI sesuai dengan Sistem Managemen K3LL
- Provide or arrange for medical services necessary for the treatment of employee occupational illness or injuries and for
handling of medical emergencies.
Menyediakan pelayanan kesehatan untuk penyakit akibat kerja atau kecelakaan dan untuk penanganan kondisi darurat.
PT. GUNA TEGUH ABADI recognizes that the achievement of an effective Occupational Health and Safety Program demands
the active and positive on going involvement of personnel at all levels within the company.
PT. GUNA TEGUH ABADI mengukur efektifitas pencapaian program K3LL berdasarkan keterlibatan aktif dan positif dari
semua level pekerja didalam perusahaan.
Cilegon, 23th July 2013
Project Manager
PT. Guna Teguh Abadi Page 1 of 1 Doc. APPENDIX-01-A

CO No :
REV
12-1812/ BA 1066
01
DOCUMENT NO.
APPENDIX-01-B
Date By Chkd Appvd
MANAGEMENT PLAN
23 Jul 13 ARN WR KH
PROJECT ENVIRONMENTAL POLICY

KEBIJAKAN LINDUNGAN LINGKUNGAN PROYEK
PT. GUNA TEGUH ABADI Environmental Policy conforms to the Government Environmental Impact Assessment. The
policy strives to meet the requirements applicable to the Government Environmental Impact Assessment regarding air,
water, and noise.
Kebijakan Lindungan Lingkungan bagi PT. Guna Teguh Abadi harus sesuai dengan peraturan pemerintah mengenai
Analisis Dampak Lingkungan (AMDAL). Kebijakan Lindungan Lingkungan sebisa mungkin disesuaikan dengan AMDAL,
mengenai : udara, air, dan kebisingan.
To realize this goal, PT. GUNA TEGUH ABADI will:

Untuk mencapai tujuan ini, PT. Guna Teguh Abadi akan melakukan :
- Assess the environmental sensitivity of potential operating sites and the impact of our operations on the local and
regional environments.
Mengukur kepekaan lingkungan akibat aktifitas proyek serta dampak penting pada lingkungan sekitar.
- Limit waste generation, discharge and emission by handling the risk of spills, leaks and accidental discharges.
Membatasi jumlah limbah, pembuangan dan emisi limbah dengan cara mengantisipasi risiko tumpahan, kebocoran
dan pembuangan limbah yang tidak disengaja.
- Maintain emergency preparedness plans and response capabilities.
Membuat rencana tanggap darurat dan kemampuan dalam meresponse kondisi darurat.
- Demonstrate our commitment through environment excellence.
Menunjukkan komitmen kami dengan cara mengelola lingkungan dengan baik.
- Be responsive to public attitudes and concerns.
Merespon dan memperhatikan perilaku masyarakat
- Commit appropriate means and resources to meet stated goals and standards to comply with applicable laws and
regulations.
Berkomitmen untuk memenuhi semua aturan hukum dan regulasi yang berlaku
- Ensure that inspections, audits, reviews and follow-up actions are planned and carried out.
Memastikan semua inspeksi, audit, tinjauan dan tindak lanjut telah direncanakan dan dilaksanakan
- Encourage concern and respect for the environment and emphasize every employee’s responsibility for
environmental performance to ensure appropriate operating practices.
Memberikan perhatian dan penghargaan kepada setiap pekerja yang bertanggung jawab terhadap kinerja lingkungan
sesuai dengan prosedur yang berlaku.

Project Manager
PT. Guna Teguh Abadi Page 1 of 1 Doc. APPENDIX-01-B

CO No :
REV
12-1812/ BA 1066
01
DOCUMENT NO.
APPENDIX-01-C
MANAGEMENT PLAN Date By Chkd Appvd
23 Jul 13 ARN WR KH
ALCOHOL, DRUG AND CARRY WEAPON POLICY

KEBIJAKAN ANTI ALKOHOL, OBAT TERLARANG DAN MEMBAWA SENJATA API
PT. GUNA TEGUH ABADI is committed to a safe, healthy, and productive workplace.
PT. GUNA TEGUH ABADI berkomitmen menciptakan tempat kerja yang aman, sehat, dan produktif.
Worksite under control of PT. GUNA TEGUH ABADI shall be free of alcohol, drugs, and weapon and banned substances.
The misuse of legitimate drugs, alcohol and carry weapon or the use or possession of banned or controlled drugs on
company premises, is strictly prohibited.
Tempat kerja dibawah pengawasan PT. GUNA TEGUH ABADI harus bebas dari alcohol, obat terlarang dan senjata api dan
bahan terlarang. Jika terdapat penyalahgunaan obat terlarang, alcohol, dan membawa senjata api atau menggunakan atau
memiliki bahan terlarang atau obat terlarang maka perusahaan menganggap ini merupakan pelanggaran berat.
Any employee taking prescribed drugs shall notify the company physician or medic to verify if he can work whilst under the
influence of such medication.
Pekerja yang mengambil resep obat harus melalui klinik perusahaan untuk memastikan apakah dia bisa bekerja selama
berada di bawah pengaruh obat
PT. GUNA TEGUH ABADI reserves the right to conduct searches or perform tests to determine the presence of alcohol or
drugs or carry weapon. Employees who refuse to submit to alcohol and/or drug testing may be subject to disciplinary action
which may lead to termination of employment.
PT. GUNA TEGUH ABADI menyediakan tes dan pemeriksaan yang berhubungan dengan alcohol, obat terlarang dan senjata
api. Pekerja yang tidak melampirkan hasil tes alkohol, dan atau obat terlarang akan mendapatkan tindakan disiplin dengan
sanksi hukum pemecatan.

Project Manager
PT. Guna Teguh Abadi Page 1 of 1 Doc. APPENDIX-01-C

P T. G U N A T E G U H A B A D I
PUSRI II-B CO NO : REV
12-1812/ BA 1066
PROJECT
DOC. NO: GTA-HSE-P-001 0
DATE BY CHKD APVD

HSE PROCEDURE 23 Jul 13 ARN WR KH
PROCEDURE
HSE FOR CONSTRUCTION
APPROVED :
DIRECTOR
K. HIROTA
REVIEWED :
PROJECT MANAGER
WARMAN
PREPARED :
HSE DIVISION
ARINA
REVISION HISTORY
REV DATE RESPONSIBLE PERSON DESCRIPTION
0 20 Jan 12
Distribution List:
Project Manager
Project Control Division
Engineering Manager
Procurement Division
QC Division
HSE Division
Document Control
PT. Guna Teguh Abadi Page 1 of 10 Doc. GTA-HSE-P-001

12-1812/ BA 1066
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DATE BY CHKD APVD

TABLE OF CONTENT
Page
1. PURPOSE 3
2. SCOPE 3
3. DEFINITION 3
4. REFERENCE 3
5. RESPONSIBILITY 3
6. HEALTH, SAFETY AND ENVIRONMENTAL PROGRAM 3
6.1 HSE Orientation 3
6.2 HSE Documentation & Reporting System 3
6.3 Health, Safety and Environment Communication 4
6.4 Health, Safety and Environmental Inspection 5
6.5 JSA and Risk Assessment 6
6.6 Potential Hazard Identification 6
6.7 Working Permit 6
6.8 Lock Out and Tag Out / Dangerous Label 6
6.9 Providing Personal Protective Equipment 7
6.10 Emergency Response 7
6.11 First Aid Facilities 7
6.12 Health, Safety and Environmental Campaign 7
6.13 Traffic regulation 7
6.14 Safe Driving 7
6.15 Supervising 8
6.16 Training, Education and Competency 8
6.17 Environmental Management 8
6.18 Health, Safety and Environmental Performance 8
6.19 Electrical Safety 9
6.20 Compressed Gas 9
6.21 Rule and Regulation 9
6.22 Industrial Hygiene 9
6.23 Termination and Suspension 10
6.24 Unsafe Act and Unsafe Condition 10
6.25 Safety Sign Board 10

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1. PURPOSE
This procedure is a guideline for HSE activities on project site to achieve a high quality level of HSE
aspects.
The main objective of this procedure is to prevent all kinds of accidents that will affect properties,
environment, and personnel.
2. SCOPE
Health, Safety and Environment Policy and HSE Management System Policy will be implemented at
each Project Site of PT. Guna Teguh abadi to create and maintain safe working environment and good
industrial hygiene.
3. DEFINITION
Safety Committee is safety organisation at project site, who lead by Construction Manager and the
members of this organisation are chief every discipline, subcontractor representative and owner
representative. The secretary of this organisation is Project Chief / Manager HSE.
4. REFERENCE
- Undang Undang Keselamatan dan Kesehatan Kerja NO.1 1970
5. RESPONSIBILITY
The Project Manager shall be responsible for implementation of this procedure in project.
The Construction Manager shall be responsible in assisting the Project Manager for implementation of
this procedure in the work site area.
HSE Manager’s responsibility is to ensure that this procedure is followed and implemented in the
worksite.
All employees and subcontractors are responsible to comply with this procedure.
6. HEALT, SAFETY AND ENVIRONMENTAL PROGRAM
6.1 Health, Safety and Environmental Orientation
 Health, Safety and Environmental Orientation Program is to be conducted through

Induction or Safety tour to all new comers. Implementation of this program shall be
documented.
 Corporate and Project Safety Policy is the main topic in the Orientation program.
 All participants are to be informed about the risks and hazards on the job site,
prevention and protection methods of unsafe conditions and the Company’s
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DATE BY CHKD APVD

HSE Policy and HSE program in project.

Tools : Doc No. GTA-HSE-MP-001-10
6.2 HSE Documentation and Reporting System
Documents that shall be reported are:
No Document Person In Charge Schedule Report To

Name
1 HSE Monthly Project HSE Manager / Chief Monthly Client and HSE
Report Division
2 Major Construction Manager and Project 1x24 Hours Client, HSE Division,
Accident: HSE Manager / Chief Director
-Medical Construction Manager and Project 1x24 Hours Client and HSE
Treatment HSE Manager / Chief Division
-Disability Construction Manager and Project 1x24 Hours Client, Director
Accident, HSE / Chief
Fatality
Accident and
Environmenta
l that need
government
concerned
HSE Activities that should be documented at Project site are:
No Document Name
1 HSE Daily and Monthly Report
2 HSE Induction or Orientation
3 Tool Box Meeting
5 Safety Committee Meeting
6 Safety Morning Talk
7 Equipment and Tools Inspection Result
9 Job Safety Analysis
10 Work Permit
11 Internal Project Audit Report
12 Corporate Audit Report
13 Material Safety Data Sheet
14 PPE Distribution Record
15 Emergency Response Flow Chart
16 Accident Report
17 Investigation Report
Tools: Doc No. GTA-HSE-MP-001-12
6.3 Health, Safety and Environmental Communication
HSE communication can be conducted through Safety Committee Organization using the
following methods:
Safety Induction

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DATE BY CHKD APVD

Safety Induction is to be conducted by Owner / Client HSE Representative or Project HSE

Manager / Project Chief HSE to all new employees or visitors who come to the project site at
the first time.
Safety Morning Talk
Safety Morning Talk is to be conducted by Site Management to all employees and will be
held once a month.
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.
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 GSI) to discuss safety aspects of the high risk construction
activities.
Weekly Construction Safety Meeting
Weekly construction safety meeting is to be conducted by Project Management and / or

Safety committee members. The agenda on the meeting shall be review of construction
progress, HSE program and its improvement, and safe work practice.
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, and monitoring the implementation of
11 elements HSE Management System PT. Guna Teguh Abadi.
6.4 Health, Safety and Environmental Inspection
Inspection by Management (every six month) and Site Management (every one month)
 Execution / working Procedure

 Management system
 Policy
 Skills and quality of the workers.
General HSE Construction Equipment and Personal Protective Equipment Inspection
 Lifting Equipment inspection

 Heavy Equipment inspection
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DATE BY CHKD APVD

 Light Vehicle inspection

 Welding machine, Transformer, Rectifier inspection
 Hand Power Tool Inspection
 Air Compressor inspection
 Scaffolding Inspection
 Portable Fire Extinguisher inspection
 Personal Protective Equipment Inspection
Housekeeping and Industrial Hygiene Inspection:
 Warehouse
 Flammable material storage
 Site Office
 Work Shop
 Fuel storage
 Work Place
 Wearing of PPE
Inspection Schedule
 Daily.
 Management Joint Safety Patrol (weekly and monthly).
 General Inspection / Internal Audit (Monthly).
 Tools, equipment and Safety equipment included PPE (Monthly, weekly, daily).
Colour Code Inspection

For Sling Inspection and Cable Inspection require to conduct colour code system.
(Tools: GTA-HSE-MP-001-014)
6.5 Job Safety Analysis (JSA) and Risk Assessment
Job Safety Analysis (JSA) and risk assessment shall be done for all activities (high risk,
middle risk and regular) to provide safe work and environment at project site.
Tools: Doc No. GTA-HSE-P-003
6.6 Potential Hazard Identification
6.6.1 Material
All potential hazards on material shall be identified, through hazardous material system in the
work area using MSDS (Material Safety Data Sheet) and Labelling requirement.
6.6.2 Process of Construction work.
Potential hazards on construction work shall be identified with JSA (Job Safety Analysis)
Program. All the identified risk shall be reduced and under control as per standard, procedure
and work instruction issued by Government (Depnaker & Migas) and International rule.
6.7 Working Permit

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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:
- Hot work permit
- Work permit for working at height
- Entry permits to confined space
- Electric work permit
- Excavation work Permit
GTA-HSE-MP-001-8
GTA-HSE-MP-001-11
GTA-HSE-MP-001-17
GTA-HSE-P-006
6.8 Lock Out and Tag Out / Dangerous Label
All equipment operated by each company at any GTA’s 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.
6.9 Providing Personal Protective Equipment
Personal protective equipment that follows international standard for all kind activities shall
be provided by each company and distributed to its employees sufficiently and properly.
6.10 Emergency Response
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.
6.11 First-Aid Facilities
There must be at least a party to provide site clinic, ambulance, and first aid facilities during
Project site activities.
Tools: GTA-HSE-MP-001-9
6.12 Health, Safety and Environmental Campaign
HSE Campaign can be held with the following system:

a. Safety Information or Warning.
b. Information board for HSE Improvement included HSE Performance Record.
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DATE BY CHKD APVD

c. Safety Poster.
d. Safety award program for the best worker on the HSE Program
6.13 Traffic Regulation
Traffic regulation inside project site area must be obeyed by all drivers.
All drivers and holders must attend on the safe driving course conducted by their companies.
To prevent traffic accident, traffic regulation and driving procedure issued by client and
PT. Guna Teguh Abadi must be implemented at job location; seat belt must be worn when
driving.
Tools: Doc. No GTA-HSE-MP-001-16
6.14 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 Client or PT. Guna Teguh Abadi.
Any operator for a crane or other heavy equipment must have a valid Police driving license
and Permit for operating the heavy equipment (SIO) issued by Government (Depnaker
,MIGAS and MBP).
Tools: Doc. No GTA-HSE-MP-001-14 & GTA-HSE-MP-001-16
6.15 Supervising
Any Supervisor must know that any instruction, guide or working procedure issued to
workers under his control is clear / stainable.
Each supervisor should inspect and ensure that any tool or equipment to use is safe to operate
and in good condition.
Site Supervisor is responsible to implement and improve Health, Safety and Environmental
program and ensure that all activities, including subcontractor’s activities, have followed the
HSE Procedure.
Ratio between safety personnel and employees at project site shall be minimum 1: 50.
6.16 Training, Education and Competency
To achieve zero accident and no damaged to environment, Basic Safety Training shall be
conducted for all employees (Project team). In this training shall inform HSE policy, safe
working procedure and practices and any other specific safety topic.
Special skills required for a specific job shall be certified by government or a third
party.

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DATE BY CHKD APVD

Specific Jobs will include: Welding, Rigging, Operating Crane, Installing Scaffold, First
Aider and Driving.
Guna Teguh Abadi will conduct assessment for HSE key personnel such as: Project HSE
Chief and Project HSE Manager.
Tool: Doc No. GTA-HSE-P-002 & GTA-HSE-MP-001-2
6.17 Environmental Management
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.
Tools: Doc No. GTA-HSE-P-002 & GTA-HSE-MP-001-2
6.18 Health, Safety and Environmental Performance
Health, Safety and Environment Performance or HSE statistics shall be recorded periodically
based on this HSE statistics, the management will know and how far PT. Guna Teguh Abadi
has implemented and improved the Health, Safety and Environment Program.
The minimum information that apply in HSE statistic board:

a. Total Man-Hours
b. Total Fatality
c. Total Medical Treatment
d. Total First Aid
e. Total Man-Power
f. Revision Date
The following formula is to be used to calculate the Frequency and Severity Rate:
a. Frequency Rate
Formulation to measure frequents of accident every 1.000.000 man working hour.

Formulation: FR =  Recordable Case X 1.000.000
 Total man working hours
Recordable Case = Restricted Work Day Case + Medical Treatment + Lost Time Injury.
Lost Time Injury = Fatality + Lost Work Day Case
b. Severity Rate
Formulation to measure severity of accident and total lost work day every 1.000.000
man working hour.
Formulation: SR =  Total Lost Work Day X 1.000.000

 Total man working hours
6.19 Electrical Safety

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All Portable tools, hand tools and other portable electrical apparatus, must meet standard
safety requirement. For example: They must follow current regulation, and their plugs and
sockets should comply with the standard regulations.
Temporary electrical installation including distribution boards, cabling and switchgear shall
comply with the current wiring regulations.
Tools: Doc No. GTA-HSE-P-001 & GTA-HSE-MP- 001-16
6.20 Compressed Gas
The use of compressed gas should follow standard and regulation in terms of: how to storage,
how to handle, how to transport and use it and so on.
Tools: Doc. No GTA-HSE-P-001
6.21 Rule and Regulation
All employee and visitors that will enter, leave and work at site must follow safety regulation
of PT. Guna Teguh Abadi or Client Regulation.
Using drugs, alcohols, carrying weapon, and smoking inside site office and site area are
strictly prohibited.
Tools: Doc. No. GTA-HSE-P-001 & GTA-HSE-P-001-3
6.22 Industrial Hygiene
To control the industrial hygiene, Project team shall manage the housekeeping at field and
site office area.
Tool: Doc No. GTA-HSE-P-001 & GTA-HSE-001-13
6.23 Termination and Suspension
Guna Teguh Abadi HSE Department has a right to stop the work if there are any non-
conformance and unsafe act and condition finding, until the corrective action taken by
sub-contractor.
6.24 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 and unsafe condition.
6.25 Safety Sign Board

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

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

CORPORATE PROCEDURE
ACCIDENT AND NON-CONFORMANCE REPORT
APPROVED :
DIRECTOR
K. HIROTA
REVIEWED :
PROJECT MANAGER
WARMAN
PREPARED :
HSE DIVISION
ARINA
Distribution List:
Project Manager
Engineering Manager
QC Manager
HSE Division
Document Control
PT. Guna Teguh Abadi Page 1 of 15 DOC. NO: GTA-HSE-P-002

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

TABLE OF CONTENT
Page
1.0 PURPOSE 4
2.0 SCOPE 4
3.0 REFERENCE 4
5.0 PROCEDURE 5
5.1 Definition 5
5.2 Formula 8
5.3 HSE Target 9
5.4 Accident/Incident and Non-conformance Report 10
5.5 Monthly HSE Performance Report 14

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

1.0 PURPOSE TUJUAN
This procedure describes the guideline to provide consistent reporting method for accidents,
near miss, hazard condition and non conformance that will be occurred in the workplace.
The datas can be used for measuring effectiveness of safety management system.
Prosedur ini memberikan deskripsi tentang metoda baku pelaporan atas kecelakaan, insiden / nyaris
celaka, kondisi berbahaya dan ketidaksesuaian yang terjadi di tempat kerja. Data yang ada dapat
dipakai untuk mengukur efektivitas pelaksanaan manajemen K3
2.0 SCOPE RUANG LINGKUP
This procedure should be applied in all activities at Home Office and Project PT. Guna Teguh
Abadi
Prosedur ini diterapkan disemua kegiatan Gedung Kantor dan Project PT. Guna Teguh Abadi
3.0 REFERENCE REFERENSI
- Undang-Undang No.1 Tahun 1970 tentang Keselamatan dan Kesehatan Kerja
4.0 RESPONSIBILITY TANGGUNG JAWAB
This document is supplement guidance for preparing accident and non-conformance reports and
must be followed.
Dokumen ini dipergunakan sebagai petunjuk tambahan dalam pembuatan laporan kecelakaan dan
ketidaksesuaian dan harus dipatuhi.
Each HSE Project site should be responsible for the recording.

Setiap HSE di site bertanggungjawab terhadap pencatatan dokumen.
The accuracy of recording is critical for statistics and improvement actions.

Catatan yang akurat merupakan hal yang kritis untuk statistic dan tindakan perbaikan.
Every effort must be made to maintain the accuracy of recording and reporting.
Setiap usaha diperlukan untuk menjaga akurasi dari penyimpanan dan pelaporan
All employees and contractors / subcontractors shall have responsibilities to comply this
procedure.
Semua pekerja dan kontraktor / subkontraktor yang terlibat harus bertanggungjawab untuk mematuhi
prosedur ini
HSE Committee has responsibility to ensure that the content of this procedure is suited with
purpose.
Komite HSE akan bertanggungjawab terhadap muatan / isi prosedur ini sesuai dengan kebutuhan.
Chief HSE / HSE Manager has responsibility to ensure that this procedure will be applied at site
properly.
Chief HSE / Manajer HSE harus bertanggungjawab bahwa prosedur ini dilakukan dengan baik
dilapangan
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

5.0 PROCEDURE / PROSEDUR
5.1 Definition
a. Accident / Kecelakaan
Undesired event giving rise to death, ill health, injury, damage or other loss.
Kejadian yang tidak diinginkan yang dapat mengakibatkan kematian, sakit, luka, rusak atau
kerugian yang lain.
b. Incident / Nearmiss – Insiden / Nyaris Celaka

Event that gave rise to an accident or had the potential to lead to an accident.
Kejadian yang timbul dapat mengakibatkan kecelakaan atau mempunyai potensi menjadi
kecelakaan
c. Hazard Condition / Kondisi Bahaya

Any event, which has or could have caused injury or illness. Such an event may also
involve damage, product loss or interruption of work.
Setiap kejadian, yang menyebabkan atau dapat menyebabkan luka atau sakit. Beberapa
kejadian dapat melibatkan kerusakan, hilangnya produksi atau terganggunya pekerjaan
d. Non-conformances / ketidak-sesuaian
Any deviation from work standards, practices, procedures, regulation, management
item performance, etc. that could either directly lead to injury or illness, property
damage, damage to the workplace environment, or combination of these.
Suatu penyimpangan dari standard kerja, praktek, prosedur, peraturan perundangan, hal-
hal yang menjadi ketentuan kinerja manajemen dll. yang dapat secara langsung maupun
tidak langsung mengarah terjadinya kecelakaan atau sakit, kerusakan properti, kerusakan
lingkungan tempat kerja atau kombinasi dari semuanya
Note / Catatan:
1. Exposure to hazard of industrial injuries should be measured by the total number of
employment hours of:
- All employees of reporting companies
- All employees of reportable contractors whilst engaged on work for the
reporting companies.
Paparan terhadap bahaya luka akibat kerja harus diukur dengan jumlah jam kerja pekerja
dari:
- Semua pekerja dari perusahaan yang telah terdaftar.
- Semua pekerja dari kontaktor yang terdaftar, yang bekerja di tempat kerja untuk
perusahaan yang tercatat.
2. Exposure hours should be calculated from time sheets or other records. When this
is not possible they may be estimated by multiplying the total number of worked
days for certain period by the number of worked hours per day.
Jam paparan harus dihitung dari data jam kerja atau catatn lainnya. Jika hal tersebut
tidak memungkinkan, maka dapat diperkirakan dengan mengalikan jumlah hari kerja pada
periode tertentu dengan jumlah jam kerja atau jam kerja nyata per hari

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

e. Unsafe Act / Tindakan tidak aman

Unsafe act is a behavior or activity that conducts in purpose or not purpose give rise
to an accident or lead to a potential accident.
Unsafe act adalah suatu tindakan yang baik dilakukan secara sengaja ataupun tidak
disengaja yang dapat mengakibatkan kecelakaan atau memiliki potensi bahaya.
f. Unsafe Condition / Kondisi tidak aman

Unsafe condition is a condition of working area event inside or outside building that
has a potential to lead an accident.
Unsafe condition adalah suatu kondisi tempat kerja baik di dalam maupun di luar ruangan
yang dapat berpotensi mengakibatkan terjadinya kecelakaan
g. Fatality / Fatal
A fatality is a death caused by a Work Injury, regardless of the time intervening
between injuries or death.
Fatal adalah kematian sebagai akibat dari luka saat kerja, tanpa dipengaruhi oleh waktu
antara luka dan kematian
h. First Aid Case (FAC)

Each one-time treatment and subsequent observation of minor scratches, cuts, burns,
splinters, and so forth, which do not require special medical care. Such treatment
and observation are considered first aid even though provided by physician or
registered professional personnel.
Setiap satu kali perawatan dan observasi berikutnya untuk luka gores kecil, tersayat,
terbakar, terkilir dan sejenisnya, yang tidak membutuhkan perawatan khusus. Seperti halnya
perawatan dan observasi yang termasuk pertolongan pertama termasuk yang diberikan oleh
dokter atau tenaga profesional yang terdaftar.
i. Lost Time Injuries (LTI)

Lost Time Injuries are the sum of Fatalities, Permanent Total Disabilities,
Permanent Partial Disabilities and Lost Work day Cases.
Lost Time Injuries can be started counting if the victim unable to work more than 2
times 24 hours since he/she get injured. Moreover, if the victim still under
observation from doctor since he/she get injured and he able to work after that
without absent from work, it can not be considered as a Lost Time Injury.
Cidera dengan hari hilang adalah penjumlahan kasus fatal, Ketidak-mampuan Tetap
seluruh anggota tubuh, Ketidak-mampuan tetap untuk sebagaian anggota tubuh dan, kasus
Hilang Hari Kerja.
Cidera dengan Hari Hilang mulai dapat dihitung jika korban tidak dapat bekerja lebih dari
2 x 24 jam, sejak mereka mendapatkan luka. Selain itu, jika korban masih berada dalam
observasi dokter, dan kemudian masih dapat bekerja kembali, maka kondisi ini tidak
tercatat sebagai Cidera dengan Hari Hilang.
j. Lost Workday Case (LWDC)

A Lost Workday Case is Work Injury other than Permanent Partial Disability, which
renders the injured person temporarily unable to perform Regular Job or Restricted
Work after the accident was ocurred.
Note: A single accident can cause increasing of Lost Workday Cases, which
depend on the number of people injured.
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Kasus Hari Kerja Hilang adalah setiap cidera karena kerja selain ketidak-mampuan tetap
sebagian anggota tubuh, dimana pekerja tersebut tidak dapat mengerjakan tugas seperti
biasanya ataupun mengerjakan pekerjaan terbatas, pada hari setelah yang bersangkutan
mengalami kecelakaan.
Catatan: Satu kecelakaan dapat mengakibatkan beberapa Kasus Hari Hilang, tergantung
jumlah orang yang terluka sebagai akibat kecelakaan tsb
k. Medical Treatment Case

A medical Treatment Case is any Work Injury that involves neither Lost Workdays
nor Restricted Workdays but which requires treatment by or under the specific order
of, a physician or could be considered as being in the province of a physician.
Note: Medical treatment does not include first aid treatment (one-time
treatment and subsequent observation of minor scratches, cuts, burns,
splinters, and so forth, which do not ordinarily require medical care) even
though provided by a physician or registered professional personnel.
Kasus Perawatan Kesehatan adalah setiap cidera karena kerja yang melibatkan apakah
Hari Kerja Hilang atau Hari Kerja Terbatas, tetapi memerlukan pengobatan atau dibawah
permintaan khusus dokter atau dapat dipertimbangkan dalam penanganan dokter.
Catatan: Perawatan Kesehatan tidak termasuk perawatan luka ringan (satu kali
perawatan dan observasi selanjutnya pada luka gores kecil, tersayat, terbakar, terkilir dan
sejenisnya, yang mana tidak memerlukan penangan kesehatan khusus) bahkan
ditangani lebih dahulu oleh dokter atau petugas professional yang terdaftar.
l. Motor Vehicle Accident (MVA)

All accident which involve a vehicle when it is in used, under driver control, have a
physical contact that resulting in harm to people and/or property damage.
Semua kecelakaan yang melibatkan kendaraan yang sedang berjalan, dibawah kendali
seorang pengemudi, dan terjadi kontak fisik yang mengakibatkan luka / sakit pada
seseorang dan / atau kerusakan harta benda
m. Restricted Work Activity

It is work – related to injury or illness, which impact to a person (employee or
contractor):
1. Was assigned to another job on a temporary basis or
2. Worked at his or her permanent job but less than full time or
3. Could not perform all duties associated with his or her permanent job.
Adalah setiap pekerjaan – yang berkaitan dengan cidera atau sakit, yang berakibat pada
seseorang (pekerja atau kontraktor).
1. Yang telah ditugaskan pada pekerjaan lain yang bersifat sementara.
2. Bekerja pada pekerjaan tetap ybs tetapi tidak dapat dalam jangka waktu kerja yang
normal.
3. Tidak dapat melakukan semua tugas-tugas yang berkaitan dengan pekerjaan tetapnya.
n. Restricted Work Day Case

An injury or illness that involve restricted work or job transfer but does not involve
death or days away from work.
Cidera atau Sakit yang berakibat tidak dapat bekerja normal sesuai dengan pekerjaan tapi
tidak berakibat kematian ataupun kehilangan hari kerja
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

o. Reportable Incident (RI)

Incidents which cause damage to equipment or materials, or incidents, which were
“near miss” where a small change in circumstance could have resulted in injury or
damage.
Kejadian yang melibatkan kerusakan peralatan atau bahan, atau kejadian yang
mendekati “hampir celaka”, dimana jika ada perubahan keadaan sekitar sedikit saja
dapat mengakibatkan cidera atau kerusakan.
p. Total Recordable Cases (TRC)

Total Recordable Cases are the sum of Fatalities, Permanent Total Disabilities,
Permanent Partial Disabilities, Lost Workday Cases, Restricted Work Cases and
Medical Treatment Cases.
Jumlah Kasus Tercatat adalah jumlah dari Kasus Fatal, Ketidak-mampuan Tetap seluruh
tubuh, Ketidak-mampuan Tetap Sebagian anggota tubuh, Kasus Hari Kerja Hilang,
Kasus Kerja Terbatas dan Kasus Perawatan Kesehatan
5.2 Formula / Rumus:
a. Lost Time Injury Severity Rate (LTISR) Tingkat Keparahan Cidera dengan
Hari Hilang
LTISR = (Lost Work Days / Exposure Hours) x 1.000.000

LTISR = (Jumlah Hari Hilang x Jumlah Jam Kerja) x 1.000.000
Where dimana :
The number of Lost Workdays is the total number of calendar days,

which the injured person was temporarily unable to work as a result of a Lost
Workday Case or a Permanent Partial Disability.
Note: In cases of Fatality or Permanent Total Disability no Lost
Workdays are recorded.
Jumlah Hari Kerja Hilang adalah jumlah hari kalender, dimana seseorang yang
cidera tidak dapat bekerja sementara karena kasus Hari Kerja Hilang atau Ketidak-
mampuan Tetap sebagian anggota tubuh
b. Lost Time Injury Frequency Rate (LTIFR) / Tingkat Keseringan Cidera

dengan Hari Hilang
LTIFR = (Recordable Case/ Exposure Hours) x 1.000.000

LTIFR = (Jumlah Kecelakaan yang Tercatat / Jumlah Jam Kerja) x 1.000.000
Recordable Case = Restrict Work Day Case + Medical Treatment + Lost Time
Injury.
Kasus Kecelakaan yang Tercatat = Kasus Kecelakaan dengan Hari Kerja Terbatas +
Pengobatan + Cidera dengan Hari Hilang.
Where dimana :

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

The Lost Time Injury Frequency Rate is the number of Lost

Time Injuries per 1.000.000 exposure hours worked during
the period.
Tingkat Keseringan Cidera dengan Hari Hilang adalah jumlah
Hari Hilang karena Kecelakaan per 1.000.000 jam kerja pada
suatu periode tertentu
c. Total Recordable Case Frequency (TRCF) Total Keseringan Kasus Tercatat
TRCF = (TRC/Exposure Hours)  1.000.000

TRCF = (Total Kasus Tercatat / Jam Kerja) x 1.000.000
Where dimana :
The Total Recordable Case Frequency is the number of

Total Recordable Cases per million Exposure Hours worked
during the period.
Total Keseringan Kasus Tercatat adalah jumlah Kasus Tercatat
pada setiap satu juta Jam Kerja selama periode tertentu
5.3 HSE Target Sasaran HSE
This target is applicable to all projects of PT. Guna Teguh Abadi, which defined:
Sasasan ini berlaku untuk semua proyek PT. Guna Teguh Abadi, dengan ketentuan:
1. Zero Accident (Fatality, Permanent Disability, Restricted Day Case, Medical

Treatment)
Nihil Kecelakaan (Fatal, Ketidak-mampuan Tetap, Kasus Hari Kerja Terbatas, Perawatan
Kesehatan).
2. Total Recordable Frequency Rate : <1

Total Tingkat Keseringan Tercatat : <1
Range Target for Objective Score for achievement
0 – 0.2 5
0.2 – 0.4 4
0.4 – 0.6 3
0.6 – 0.8 2
0.8 – 1 1
3. Total Recordable Severity Rate : <1

Tingkat Keparahan Total Kasus Tercatat : < 1
Range Target for Objective Score for achievement
0 – 0.2 5
0.2 – 0.4 4
0.4 – 0.6 3
0.6 – 0.8 2
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

0.8 – 1 1
4. Each workplace (Project) must achieve HSE Performance with minimum score 70.
Setiap tempat kerja (proyek) harus mencapai Kinerja HSE dengan nilai minimal 70.
5.4 Accident / Incident and Non Conformance Report Laporan Kecelakaan / Kejadian
dan Ketidak-sesuaian
5.4.1 Non-Conformance Report / Laporan Ketidak-sesuaian
a) NCR shall be issued from :

NCR harus diterbitkan dari
Monitoring activities and the non-compliance to legal requirement

Aktifitas pemantauan dan ketidaksesuaian terhadap persyaratan hokum
b) The person responsible for conducting the audit or monitoring shall have
authority to issue NCR.
Petugas yang bertanggungjawab melakukan audit atau pemantauan harus
mempunyai otorisasi untuk mengeluarkan NCR
c) NCR shall be issued using HSE Non-Conformance Report

NCR harus diterbitkan menggunakan Laporan Ketidak-Sesuaian HSE
d) The auditee is responsible for investigating and resolving of the problem

and to fill-up HSE Non-Conformance Report for corrective action.
Petugas yang diaudit bertanggungjawab untuk menyelidiki atau memecahkan
masalah dan mengisi lembar Ketidak-sesuaian HSE sebagai tindakan koreksi
5.4.1.2 Verification of Corrective Action Penegasan Tindakan Koreksi
a) All completed NCR should be submitted to Project Manager /

Construction Manager maximum within 2 weeks, unless it is specified by
Project Manager / Construction Manager or audit team.
Semua lembar NCR yang sudah lengkap harus dikirimkan ke Manajer Proyek /
Manajer Konstruksi paling lambat 2 minggu, kecuali jika ditentukan khusus oleh /
Manajer Proyek / Manajer Konstruksi atau team audit
b) Project Manager / Construction Manager will assign the auditors to follow-

up and verify the effectiveness of the corrective action.
Manajer Proyek / Manajer Konstruksi akan menugaskan auditor untuk menindak-
lanjuti dan memverifikasi keefektifan tindakan perbaikan
c) The auditor shall verify the action and shall make the judgement as follow:
Auditor harus memverifikasi tindakan perbaikan yang telah dilakukan dan
memutuskan, sebagai berikut:

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

i- Close the NCR if the action which is taken by the audited is

satisfactory based on approved evidence; or
Tutup NCR jika tindakan koreksi telah dilakukan secara memuaskan sesuai
dengan bukti-bukti, atau
ii- Re-issue another NCR if the corrective action which is taken by

auditee is unsatisfactory.
Terbitkan kembali NCR yang lain, jika tindakan koreksi yang telah
dilakukan tidak memuaskan.
c) Unsatisfactory corrective action shall be brought to the attention of the

Project Director / Project Manager / Construction Manager.
Tindakan koreksi yang tidak memuaskan harus menjadi perhatian Direktur
Proyek / Manajer Proyek / Manajer Konstruksi
d) All closed NCR shall be kept as record by HSE Section at Site and
Cilegon.
Semua NCR yang sudah selesai (ditutup) akan disimpan sebagai catatan HSE
Departemen di Lapangan dan Cilegon
5.4.1.3 Unclosed NCR (After re-issued) NCR belum selesai (Setelah diterbitkan ulang)
a. Unclosed NCR after re-issued shall be reported to Project Manager /
Construction Manager.
NCR yang belum selesai dan telah diterbitkan kembali harus dilaporkan ke
Manajer Proyek / Manajer Konstruksi
b. Project Manager / Construction Manager shall bring up the unclosed NCR

to the attention of GTA’s Management for further action.
Manajer Proyek / Manajer Konstruksi harus membawa NCR yang belum selesai
tersebut untuk menjadi perhatian Pimpinan PT. Guna Teguh Abadi agar dapat di
tindak lanjuti
5.4.2 Accidents and Incidents Reporting Pelaporan Kecelakaan dan Kejadian
5.4.2.1 Fatality / Serious Injury – Fatal / Cidera Serius
a) The Site Supervisor / Safety Supervisor shall immediately notify the

Project Manager, Construction Manager via telephone.
Pengawas Lapangan / Officer HSE harus segera memberitahu ke Manajer
Proyek, Manajer Konstruksi melalui telepon.
b) The Project Manager and / or the Construction Manager / Chief HSE shall
immediately notify the Director and any other relevant personnel via
telephone or fax.
Manajer Proyek dan/atau Manajer Konstruksi / Chief HSE harus segera
memberitahu Direktur dan semua pihak terkait melalui telepon atau faksimili.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

c) The Project Manager, Construction Manager and / or the HSE shall notify
the police (for fatalities), and / or any other related agencies via telephone /
fax as soon as possible.
Manajer Proyek, Manager Konstruksi dan/ Chief HSE harus memberitahu pihak
Kepolisian (jika ada yang meninggal), dan/atau institusi terkait lainnya melalui
telepon / faksimili sesegera mungkin.
d) Chief HSE / Site Supervisor shall complete the Accident / Incident

Report and submit to Project Manager / Construction Manager / HSE
Department Home Office within 24 hours.
Chief HSE / Pengawas Lapangan harus melengkapi Laporan Kecelakaan /
Kejadian dan mengirimkannya ke Manajer Proyek / Manajer Konstruksi /
Departemen HSE dalam waktu 24 jam.
e) Project Manager / Construction Manager shall submit a written report to

client within 24 hours or as soon as possible.
Manajer Proyek / Manajer Konstruksi wajib mengirimkan laporan tertulis ke
klien dalam waktu 24 jam atau sesegera mungkin.
f) Project Manager, Chief HSE and other relevant personnel shall conduct
site visit within 48 hours and conduct accident / incident investigation
immediately using Accident / Incident Investigation Report including
interview witness (if any) using Witness Statement Form (2010-GT-01-
02 – ATTACHMENT 2) and interview victim (if possible) using Victim
Statement Form (2010-GT-01-02 – ATTACHMENT 3).
Construction Manajer, Chief HSE dan pihak terkait lainnya harus melakukan
peninjauan lapangan dalam waktu 48 jam setelah kejadian dan melakukan
penyelidikan kecelakaan / kejadian dengan menggunakan Laporan Kecelakaan /
Kejadian (2010-GT-01-02 – ATTACHMENT 1), termasuk melakukan interview
saksi-saksi (jika ada) menggunakan Lembar Pernyataan Saksi (2010-GT-01-02
– ATTACHMENT 2) dan mewawancarai korban (jika memungkinkan)
menggunakan Lembar Pernyataan Korban (2010-GT-01-02 – ATTACHMENT
3).
g) HSE Committee will conduct periodic monitoring and report corrective

action progress to the Management Meeting.
Komite HSE akan melakukan pemantauan secara berkala dan membuat laporan
perkembangan tindakan koreksi ke Rapat Manajemen.
5.4.2.2 Lost Time (more than 2 workdays) / Hospitalization /Serious -

Kehilangan Hari Kerja (lebih dari 2 hari kerja) / Perawatan Rumah Sakit / Serius
Damage to machine and Property (including fire) / Dangerous Occurrence /

Major Fire.
Kerusakan pada mesin dan harta benda (termasuk kebakaran) / Kejadian Yang
Membahayakan / Kebakaran Besar.
a) The Chief HSE / Site Supervisor shall immediately notify the Project
Manager via telephone.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Chief HSE / Pengawasan Lapangan wajib memberitahu segera Manajer Proyek

melalui telepon.
b) The Project Manager and Construction Manager / or the Chief HSE shall
immediately notify the Director or other relevant personnel via telephone
or fax.
Manajer Proyek dan Manajer Konstruksi / atau Chief HSE wajib memberitahu
segera Direktur dan pihak lain yang terkait menggunakan telepon atau faksimili.
c) The Chief HSE / Site Supervisor shall complete the Accident / Incident
Report and submit to Project Manager / Construction Manager within 24
hours.
Chief HSE / Pengawas Lapangan harus melengkapi Laporan Kecelakaan /
Kejadian dan menyerahkannya ke Manajer Proyek / Manajer Konstruksi dalam
24 jam.
d) The Project Manager / Construction Manager / Site HSE and other

relevant personnel shall conduct accident / incident investigation within 48
hours and complete Accident / Incident Investigation Report within 7
days.
Manajer Proyek / Manajer Konstruksi / HSE lapangan dan petugas lain yang
terkait akan melakukan penyelidikan kecelakaan / kejadian dalam jangka waktu
48 jam setelah kejadian dan melengkapi laporan penyelidikan Kecelakaan /
Kejadian dalam 7 hari.
e) Site HSE Committee will provide the full investigation report which will
be reviewed at the committee meeting. Site HSE will monitor the
corrective action progress until the issue is closed.
Site HSE akan mengkaji laporan penyelidikan dalam rapat komisi dan akan
memantau perkembangan tindakan koreksi sampai kejadian dinyatakan selesai.
5.4.2.3 Occupational Disease / Penyakit Akibat Kerja
a) The Chief HSE / Site Supervisor shall notify the Project Manager and
Construction Manager once received a confirmation / report from
Occupational Health Doctor / Hospital.
Chief HSE / Pengawas Lapangan harus memberitahu Manajer Proyek dan
Manajer Konstruksi saat menerima laporan dari Petugas Medik / Dokter /
Rumah Sakit.
b) The Project Manager / Construction Manager shall submit a written report

to Depnaker / Migas when necessary.
Manajer Proyek / Manajer Konstruksi akan menyerahkan laporan tertulis ke
Depnaker / Migas jika diperlukan.
5.4.2.4 Restricted Duty / Medical Treatment / Near Miss / Minor Fires and
Other Incidents.
Tugas Terbatas / Pengobatan / Hampir Celaka / Kebakaran Kecil dan Kejadian
lainnya

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

a) As per Clause 5.4.2.3. / Sebagaimana di Pasal 5.4.2.3
5.4.2.5 Road Accident (Commuting Accident). /

Kecelakaan Lalulintas (Kecelakaan Umum)
a) The victim / witness / Chief HSE / site supervisor shall notify the Project
Manager / Construction Manager within 24 hours.
Korban / saksi / Chief HSE / Pengawas Lapangan harus memberitahu Manajer
Proyek / Manajer Konstruksi dalam waktu 24 jam.
b) Attach Police Report when necessary.

Lampirkan laporan kepolisian jika diperlukan
c) If involved fatality / serious injury, follow Clause 5.4.2.1

Jika ada korban meninggal / cidera serius, ikuti Pasal 5.4.2.1.
5.5 Monthly HSE Performance Report / Laporan Bulanan Kenerja HSE
HSE Division require all Project site shall report their HSE Performance Report in
monthly basis to the HSE Division Cilegon and Owner.
Divisi HSE meminta agar semua proyek harus melaporkan Kinerja HSE setiap bulan ke
Departemen HSE di Cilegon dan Pemilik Proyek.
The content of the HSE Performance Report are:

Isi Laporan Kinerja HSE, adalah:
1. Total Manpower / Jumlah Seluruh Tenaga Kerja
2. HSE Activity at site / Kegiatan HSE di lapangan
3. Weather Condition / Kondisi cuaca
4. Accident Statistic such as: Statistik Kecelakaan, seperti:
a. First Aid / Pertolongan Pertama
b. Near Miss / Hampir Celaka
c. Unsafe Act and Unsafe Condition / Tindakan dan Kondisi yang tidak aman
d. Lost Work Days / Hari Kerja Hilang
e. Lost Work Case / Kasus Hari Hilang
f. Fatality / Kematian
g. Medical Case / Kasus Kesehatan
h. Restricted Duty Case / Kasus Tugas Terbatas
i. Restricted Days / Hari Tidak Dapat Bekerja
j. Frequency Rate / Tingkat Keseringan
j Severity Rate / Tingkat Keparahan
k Environmental Accident / Kecelakaan Lingkungan
l. Total Kilometer Driven / Total Jarak Perjalanan

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

FLOWCHART
NON CONFORMANCE REPORT
START
Receive
NCR
Chief HSE
The Other Monitoring Activity Audit Finding
Fill-up HSE Non -

Conformance Report for
corrective action
Chief HSE
Verification Of Corrective
Action
Auditor
No
Issued the new NCR Close?
Auditor
Yes
All closed NCR shall be

kept as record by HSE
Section at Site and Jakarta
FINISH

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

ACCIDENT REPORT
START
Accident
Occurred
Minor Serious Road Accident Occupational Disease Lost Time
Immediately notify the

Project Manager,
Construction Manager
Yes
First Aid
Treatment Immediately notify the
Fatality?
Police / Client
No
Conduct the accident

investigation (jump to
2010-GT-01-02)
Conduct corrective action
Yes
Report to MIGAS or Need
Depnaker reporting ?
No
Monitoring corrective
action and verification
FINISH

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

PROCEDURE
JSA AND RISK ASSESSMENT
APPROVED :
DIRECTOR
K. HIROTA
REVIEWED :
PROJECT MANAGER
WARMAN
PREPARED :
HSE DIVISION
ARINA
Distribution List:
Project Manager
Engineering Manager
QC Manager
HSE Division
Document Control

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

TABLE OF CONTENT
Page
1.0 PURPOSE 3
2.0 SCOPE 3
3.0 REFERENCE 3
5.0 DEFINITION 3
6.0 STANDARD INSTRUCTION 4
6.1 Job Safety Analysis 4
6.2 Risk Assessment 7

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

1.0 PURPOSE
This procedure prescribe the activities to establish and maintain ongoing hazard identification,
risk
assessment and control measure for ensuring the job have been conducted with acceptable level
of risk.
Prosedure ini adalah acuan untuk mengindentifikasi bahaya secara terus menerus., memeriksa atau
mendata risiko berbahaya, menerapkan control yang perlu dan menempatkan metoda kerja yang benar
dan pencegahan untuk mengeliminasi atau menurunkan tingkat bahaya dalam setiap tingkatan termasuk
pekerjaan rutin, tidak rutin dan pekerjaan baru.
2.0 SCOPE
This procedure shall be applied to all activities (routine and non-routine) in home office and project PT.
Guna Teguh Abadi.
Prosedure ini diterapkan di semua kegiatan Gedung Kantor dan Project PT. Guna Teguh Abadi
3.0 REFERENCE
- Undang – Undang Keselamatan dan Kesehatan Kerja No.1 Tahun 1970..
4.0 RESPONSIBILITY
HSE Committee / P2K3 is responsible to:

HSE Komite / P2K3 bertanggung jawab untuk:
- Identifying hazards on Site activities

Melakukan identifikasi bahaya terhadap kegiatan di lapangan
- Ensure all HSE procedure has been implemented properly

Memastikan semua prosedur HSE diimplementasikan dengan baik
- Implementing JSA and Risk Assessment

Melaksanakan JSA dan Penilaian Resiko
The highest construction organization level at site should lead JSA and Risk Assessment team,
JSA and risk assessment team consist of HSE Officer and other related member.
Manager tertinggi di lapangan harus menjadi contoh dan memimpin dalam kelompok pelaksanaan
program JSA dan risk assessment, dan akan termasuk Petugas Safety, anggota team yang terkait..
Supervisor and HSE Officer are responsible in preparing the JSA Form.
Pengawas lapangan dan petugas Safety bertanggung jawab dalam hal penyediaan formulir JSA.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

5.0 DEFINITIONS
Hazard means activity or condition that can cause harm (e.g., working at elevated area, working
on a ladder, etc).
Bahaya adalah sesuatu yang dapat membuat cidera (sepert: bekerja diketinggian, bekerja diatas tangga
dsb.)
Risk is a chance, of any particular hazard that will cause harm, major or minor.
Resiko adalah peluang bahaya yang dapat mengakibatkan cidera baik ringan maupun berat.
HSE Committee P2K3 consist of Construction Manager, Chief HSE, Chief QC,
Superintenedent, Engineering Manager, , Representative Staff from all Unit for Home Office
PT. Guna Teguh Abadi
HSE Komite / P2K3 terdiri dari Manager Konstruksi, Chief HSE, Superintendent, General
Superintendent, Chief OQ, Engineer Manager, Perwakilan karyawan dari semua unit untuk Kantor
Pusat PT. Guna Teguh Abadi

INSTRUKSI STANDAR
6.1 Job Safety Analysis (JSA)
Job Safety Analysis is also referred to as job hazard analysis or job risk analysis in
some places.
Job Safety Analysis is a technique that focuses on job tasks as a way to identify all
hazards in performing a job. It focuses on the relationship between the employee, the
job, the tool and the work environment. After the hazards are identified, JSA should
then establish proper job methods, risk analysis and preventive measures to eliminate or
reduce hazards to an acceptable level.
JSA disebut juga analisa bahaya dalam pekerjaan atau analisa risiko di suatu tempat (Bekerja).
JSA adalah teknik yang terarah dalam suatu pekerjaan dan sebagai jalan untuk
mengindentifikasi setiap bahaya dalam pelaksanaan pekerjaan. Ini mengarah pada relasi
antara pekerja, pekerjaan, peralatan dan lingkungan pekerjaan. Setelah bahaya-bahaya
terindentifikasi, JSA akan menentukan cara kerja yang benar dan aman, analisa risiko dan
mencegah serta mengeliminasi dan menurunkan bahaya yang berlaku disetiap tingkatan.
JSA can be regarded as an expected job instruction, including hazards, and control
methods. The outcome of JSA can be as training material to educate employee for
understanding job method and hazard protection.
JSA dapat sebagai sesuatu yang diharapakan oleh instruksi kerja, termasuk bahayanya dan
cara mengontrol. Hasil daripada JSA dapat digunakan untuk training dan melatih karyawan
untuk melaksanakan cara kerja yang benar dan cara menghindari dan mengurangi bahaya.
6.1.1 Scope
Ruang lingkup
JSA should be conducted in all PT. Guna Teguh Abadi project. Priority should be
given for following jobs:
JSA harus dilaksanakan oleh setiap karyawan Guna Teguh Abadi di lapangan, Prioritas akan
diberikan kepada jenis pekerjaan sbb.:

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

- Jobs with high injury or illness rates

Pekerjaan dengan risiko kecelakaan atau penyakit yang tinggi
- Jobs with potential severe or disabling injuries or illness, even if there is not
history from previous accident.
Pekerjaan dengan potensi yang tinggi untuk terjadinya cidera yang parah, walaupun
belum pernah terjadi sebelumnya.
- Jobs which could lead to a severe accident or injury by one simple human
error.
Pekerjaan yang dapat menimbulkan kecelakaan atau cidera berat yang diakibatkan
kesalahan orang yang sangat simple (kecil).
- Jobs that are new to the current operation or have changed in processes and
procedures
Pekerjaan yang ada kaitannya dengan operation atau mempunyai perubahan dalam
proses dan prosedur.
- Job that require written job instructions.

Pekerjaan yang memerlukan instruksi tertulis
6.1.2 Instruction for conducting JSA

Instruksi dalam pelaksanaan JSA
To ensure JSA would be implemented effectively, management must commit to rectify

any uncontrolled hazards which has been identified.
Untuk efektifnya pelaksanaan JSA, manajemen harus mempraktekkan kesepakatan untuk
memperbaiki setiap bahaya yang terindikasi dan tidak terkontrol.
If hazards which can cause an immediate danger to an employee’s life or health, exist
immediate actions should be taken to protect the employee.
Segera ambil tindakan untuk melindungi pekerja bila terdapat bahaya yang dapat
membahayakan kehidupan dan kesehatan pekerja secara langsung
To protect employees, problems which can be corrected easily should be corrected as

soon as possible without waiting for completed JSA. This will demonstrate
management’s commitment to health and safety. It is also enable the management to
focus on the job hazards that need more study because of its complexity.
Setiap masalah yang dapat diselesaikan dengan mudah segera selesaikan jangan menunggu
selesainya JSA sebelum melakukan perlindungan kepada karyawan. Hal ini membuktikan
managemen komitmen terhadap HSE dan membuat manajemen lebih fokus pada bahaya
dipekerjaan yang perlu pembelajaran lebih karena tingkat kerumitannya yang cukup tinggi.
A. Involve Employees
Keterlibatan Karyawan
JSA should be conducted by people who have knowledge about the tasks which is
associated with the job. They may include supervisor, engineering staff, HSE staff,
training staff and the employees who are doing the job.
JSA harus dilaksanakan oleh seseorang yang mempunyai kemampuan tentang kaitannya
dengan pekerjaan

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

It is very important to involve the employees who are doing the job. They have a
unique understanding of the job and this knowledge is valuable for identifying hazards.
Involving employees will help minimize oversights, ensure a quality analysis, and help
employees to comply with the agreed job methods.
Sangat penting dalam pelaksanaan JSA dengan melibatkan pekerja yang akan melakukan
kegiatan tsb mereka mempunyai pengetahuan atau penguasaan teknik yang unik sehingga
dengan pengetahuan tersebut, dapat mengidentifikasikan suatu bahaya yang bisa terjadi.
Dengan melibatkan pekerja akan membantu mengurangi persiapan yang berlebihan, menjamin
kualitas analisa dan, membantu karyawan agar bekerja sesuai dengan metode kerja yang telah
disetujui..
B. Outline the job steps or tasks

Langkah-2 pelaksanaan pekerjaan
Break the job down into steps. Avoid making the breakdown of steps so detailed that it
becomes unnecessarily long or so broad that it does not include basic steps. Each of the
job steps should accomplish some major task.
Uraikan jenis pekerjaan dalam langkah-langkah yang akan dilaksanakan, hindari dalam
penguraian yang terlalu detail dan memasukan hal-hal yang tidak perlu, uraikan secara simple
atau yang bersifat garis besar saja.
Review the job steps with the employees who are doing the job to make sure that all
basic steps are listed.
Periksa kembali bersam-sama pekerja yang akan melaksanakan kegiatan hal ini untuk
meyakinkan setiap dasar atau komponen pekerjaan sudah tertulis.
C. Identify hazards
Mengidentifikasikan suatu Bahaya
Hazards include any potential danger, potential cause of an accident or unsafe

condition.
Sumber bahaya termasuk didalamnya potensi terjadinya bahaya, potensi terjadinya
kecelakaan atau kondisi yang tidak aman.
Hazards associated with each step should be identified to show which part(s) of body
could be injured.
Sumber bahaya yang di dalam setiap uraian pekerjaan harus memperlihatkan bagian anggota
badan mana yang akan terluka.
Review the relationship between the employee, the job, the tool and the work
environment to identify all hazards.
Periksa kembali keterkaitannya antara si karyawan, pekerjaan, peralatan dan lingkungan
tempat bekerja untuk mengindentifikasikan sumber bahaya
.
Describe a hazard in consistent way to answer the following questions in order to
ensure that the control methods target the most important contributor to the hazard:
Untuk menjawab pertanyaan dibawah ini uraikan sumber-sumber bahaya secara konsisten
yang juga sekaligus untuk meyakinkan bahwa cara atau sistem pengontrolan yang merupakan
kontributor atas sumber bahaya:

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

- What can go wrong?

Apa yang bisa menjadi kesalahan?
- What is the outcome should it happen? (consequence)

Apa yang bisa terjadi (Konsekuensi)?
- Where can it happening? (environment)

Dimana bisa terjadi (Lingkungan)?
- How or what is it happening to? (exposure)

Bagaimana dan apa yang terjadi ?
- How could it happen? (trigger)

Bagaimana bisa terjadi?
- What are other contributing factors?

Apakah ada keterlibatan factor lain.?
Review the list of hazards with the employees who are doing the job.
Periksa daftar sumber bahaya bersama-sama karyawan yang akan melaksanakan pekerjaan.
D. Prevent injuries
Mencegah terjadinya cidera / kecelakaan
After reviewing the list of job steps and hazards with the employees, next step is to
consider and agree on the control methods to eliminate or reduce hazards.
Setelah daftar pekerjaan dan sumber bahaya diperiksa kembali bersama karyawan, selanjutnya
membuat pertimbangan dan menyetujui atas cara atau sistem pemeriksaan untuk
mengeliminasi atau menurunkan tingkat bahaya yang ada.
The control methods should be specific. The most effective controls are engineering
control that physically change a machine or work environment to prevent employee
exposure to hazards. The more reliable a hazard control is by testing, the better.
Metode pengendalian harus spesifik, yang paling efektif adalah melalui pengendalian
engineering kontrol dimana dilakukan perubahan secara fisik pada peralatan dan lingkungan
kerja untuk melindungi pekerja dari bahaya. Yang lebih realistis dalam pengendalian bahaya
adalah dengan cara pengujian. Hal ini lebih baik.
If the engineering controls are not feasible, administrative control should be considered.
This may involve changing how employees do their jobs, establishing safe work
practices and procedures, training, reinforcement, etc.
Bila dengan cara engineering control tidak memungkinkan, kontrol secara administrasi dapat
dipertimbangka. Hal ini dapat dilakukan dengan cara melihat bagaimana karyawan melakukan
pekerjaan, menciptakan perilaku kerja yang aman dengan prosedur, pelatihan dan penegakan
aturan.
.
If engineering controls and administrative control cannot totally eliminate the hazards,
the PPE (Personal Protective Equipment) should be considered.
Bila dengan cara engineering control dan administrasi control juga tidak dapat mengeliminasi
bahaya-2 yang ada, penggunaan alat pelindung diri dapat dipertimbangkan.
.
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

PPE is an essential last resort to reduce the risk where hazards can not be controlled in
other ways.
Pemakaian alat pelindung diri merupakan alternatif akhir untuk mengurangi sumber bahaya
bila cara yang lain belum dapat membuat jalan keluar yang diharapkan.
6.1.3 JSA Review

Pemeriksaan ulang JSA
Periodically reviewing JSA ensures that it remains current and continues to help reduce
workplace accidents and injuries. Even if the job has not changed, new hazards which
are overlooked may be identified during review.
Peninjauan ulang JSA secara periodik menjamin kesinambungan dalam penurunan kejadian
kecelakaan dan cidera ditempat kerja, meskipun pekerjaan tidak berubah, sumber bahaya yang
baru mungkin ditemukan pada saat peninjauan ulang.
6.2 Risk Assessment

Pengukuran Risiko
6.2.1 Six Step to Risk Assessment

Enam langkah dalam mengukur Risiko
Six steps to risk assessment are:

Enam Langkah tersebut sbb.:
A. Identify hazards
Identifikasi bahaya
B. Identify those who can be harmed and how they might be harmed
Identifikasi siapa yang bisa terluka dan bagaimana mereka terluka
C. Assess the risks

Beri penilaian setiap risiko yang ada
D. Introduce control measures to reduce risks

Gunakan pengukuran pengendalian bahaya untuk mengurangi risiko
E. Record, review, and revise if necessary

Catat, periksa ulang dan perbaiki bila diperlukan.
F. Communication
Komunikasi
A. Identify hazards
Identifikasi sumber bahaya
The essential first step in risk assessment is to identify hazards. Relevant sources of
information include:

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Tahap awal dalam mendata risikio-2 adalah mengidentifikasikan sumber bahaya, sumber
informasi yang relevan termasuk:
- Local legislation and supporting documents (such as code of practice,

standards guidance, etc) which give practical guidance and minimum basic
works.
Ketentuan lokal dan dokumen penunjang (seperti petunjuk pelaksanaan, petunjuk
baku dsb.) akan memberikan petunjuk dalam pekerjaan dan dasar-dasar minimum
- Industry or trade association guidance

Pedoman atau petunjuk dari Perindustrian atau perdagangan
- Expert advice and relevant research

Saran dari tenaga akhli dan penelitian yang relevan.
- Process information, including machinery

Informasi proses termasuk peralatan (mesin)
- Product information, such as material safety data sheet, manufacturers

instructions, etc
Informasi produksi, seperti MSDS, instruksi atau manual dari pabrik dsb.
- Working environment, including temperature, noise, light, restricted

ventilation, vibration, confined spaces, housekeeping, etc
Lingkungan kerja, termasuk suhu, kebisingan, penerangan, sirkulasi udara terbatas,
getaran, ruang terbatas, kebersihan & Kerapihan dsb.
- Personal knowledge and experiences of managers and workers

Pengetahuan karyawan dan pengalaman dari manajer dan karyawan
- Accident, illness, and incident data from within the production site, from other
sites within company, from group HSE or from outside.
Data-data kecelakaan, sakit akibat kerja dan cedera dari lingkup site dan berbagai
site proyek lainnya dalam lingkup perusahaan, dari group HSE dan dari pihak luar.
.
Do not be overcomplicated, but use common sense. It is important that the employees
are always consulted because through daily works they may have noticed things that
are not immediately obvious.
Jangan terlalu rumit tapi gunakan cara yang umum dilakukan. Ini cukup penting bagi
karyawan untuk selalu berkonsultasi karena dalam aktifitas kerjanya sehari-hari, mereka
mungkin menemukan sesuatu yang belum dapat dipahami.
In the simplest cases, hazards can be identified by observation and by applying

common knowledge.
Dalam kasus yang sederhana, sumber bahaya dapat diidentifikasi melalui pengamatan dan
penggunaan pengetahuan yang umum.
In more complex cases, hazards can be identified only by measurements, for example
air sampling to identify the presence of harmful chemicals in the air.
Dalam kasus yang komplek, sumber bahaya dapat diidentifikasi hanya melalui pengukuran,
contoh, udara yang tercemar oleh bahan kimia.
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

For mechanical and electrical hazards involving machine operation, the technical
experts have to directly involve.
Untuk bahaya-bahaya mekanis dan listrik yang berkaitan dengan pengoperasian mesin, tenaga
ahli yang berkaitan harus terlibat secara langsung
.
B. Identify those who can be harmed and how they might be harmed
Identifikasikan siapa yang bisa terluka dan bagaimana mereka terluka
People exposed to the hazards may not limit to the workers, but also other employees
walking by, contracting and visitors in the area, users of the products and services, and
members of the public (for example, in case of air emission or effluent discharge).
Setiap orang dapat terpapar dengan sumber bahaya tidak hanya pekerja saja, tetapi karyawan
lain, kontraktor dan tamu perusahaan, pengguna produk dan pelayanan dan lingkungan umum
(sebagai contoh tercemarnya udara)
For all significant hazards identified, we must identify people who can be harmed and
how they might be harmed. This information is necessary for the next steps of process.
Untuk setiap sumber bahaya yang teridentifikasi, kita harus mengidentifikasi siapa yang bisa
terluka dan bagaimana mereka terluka. Informasi ini diperlukan untuk langkah berikutnya.
C. Assess the risks

Pendataan Risiko
The type of harm includes injury, illness, fire, other property damage, etc.
Jenis dari cidera termasuk luka, sakit akibat pekerjaan, kebakaran, dan kerusakan asset atau
harta benda milik Perusahaan.
When assessing the risks, consider two dimensions: likelihood / probability and
severity / consequence of harm.
Dalam mendata risiko, pertimbangkan dua dimensi:
- How likely is it that each hazard could cause harm?
Seberapa sering setiap bahaya dapat menyebabkan keparahan?
The likelihood / probability of harm may be rated:
Kemungkinan dari tingkat keparahan dapat di lakukan penilaian dengan cara berikut:
Likelihood /
Rating Description
Probability
Frequent 5 The event is expected to occur in most circumstance
Selalu terjadi
Probable 4 Will occur frequently
Sering terjadi
Occasional 3 Will occur several time
Kadang-kadang dapat terjadi
Unlikely 2 Unlikely, but can reasonable be expected to occur
Mungkin dapat terjadi
Improbable 1 Unlikely to occur, but possible
Sangat jarang terjadi
- If the hazard does cause harm, what is the severity / consequence?

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Jika suatu bahaya dapat menyebabkan keparahan, apa yang akan menjadi
konsekuensinya?
The severity / consequence of harm may be rated:
Konsekuensi dari tingkat keparahan dapat dilakukan penilaian dengan cara berikut:
Severity index Rating Description

Death, Permanent serious, environmental Damage, Major
property damage, toxic release off site, huge financial
Catastrophic 5 loss.
Meninggal dunia, cacat permanent / serius, kerusakan
lingkungan yang parah, kebocoran bahan B3, kerugian
finansial yang sangat besar
Lost time accident, permanent / partial disability, non-
permanent environmental damage, high financial loss
Major 4 Hilang hari kerja (akibat kecelakaan), cacat permanen /
sebagian, kerusakan lingkungan sedang, kerugian finansial
cukup besar
Medical treatment required work restriction, high
financial loss, on site release contained with outside
Moderate/Serious 3 assistance
Membutuhkan perawatan medis, terganggunya pekerjaan,
kerugian finansial besar, perlu bantuan pihak luar
First aid treatment, on site release immediately contained,
Minor 2 medium financial loss
Penanganan P3K, tidak terlalu memerlukan bantuan dari
luar, kerugian finansial sedang
No affecting work performance. No injury, low financial
Negligible 1 loss
Tidak mengganggu proses pekerjaan, tidak ada cidera / luka,
kerugian finansial kecil
- Risk rate
In the most simplified method, risk can be defined as the combination of
severity of harm with the likelihood of its occurrence.
Secara sederhana, risiko dapat diartikan sebagai kombinasi antara tingkat keparahan
akibat terjadinya suatu kecelakaan / nyaris celaka dengan kemungkinan peluang
terjadinya kecelakaan / nyaris celaka tersebut.
Risk rate = severity of harm x likelihood of occurrence.

Nilai Risiko = tingkat keparahan x kemungkinan terjadi
Risk Rank Description

19 - 25 Extreme High Risk – Risiko Sangat Tinggi
13 - 18 High Risk – Risiko Tinggi
6 – 12 Medium Risk – Risiko Sedang
1-5 Low Risk – Risiko Rendah
Extreme High : Need authorization from Construction Manager through consult

Risk with specialist personnel and conduct assessment with full team.
Diperlukan tindakan serius dari Manager Konstruksi melalui
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

konsultasi dengan personil khusus dan dilakukan penilaian dari

seluruh Tim
High Risk : Work can be done, with tight monitoring and control
Pekerjaan dapat dilanjutkan, namun dengan pengawasan dan
pengendalian secara ketat
Medium Risk : Level of risk can be tolerate, need further control and
monitoring.
Tingkat risiko masih dapat diterima, namun masih diperlukan
pengawasan dan pengendalian lebih lanjut.
Low Risk : Level of risk can be tolerate, control and monitoring if necessary.
Tingkat risiko masih dapat diterima, pengawasan dan
pengendalian dilakukan apabila diperlukan
D. Introduce Hierarchy of Control measures to reduce risks

Gunakan tingkatan pengendalian dalam mengurangi risiko.
Hierarchy of Control :
1. Elimination – Eliminasi (dihilangkan)
2. Substitution – Penggantian
3. Engineering Control –Rekayasa Teknik
4. Administrative Control – Pengendalian Administrasi
5. Personnel Protective Equipment – Alat Pelindung Diri (APD)
Elimination risks through eliminating part or all of process. This approach

should be the first priority, if feasible. For example:
Mengeliminasi risiko dengan cara menghilangkan sebagian atau seluruh proses.
Tindakan ini merupakan prioritas utama untuk dilaksanakan apabila memungkinkan,
contoh :
Dangerous Goods Storage are constitute of very high-risk activity, we can

eliminate this process by partial or the whole of process. That means,
storage activity for hazardous material is not needed because it will be
perform by vendor.
Karena risiko penyimpanan material B3 (Bahan Beracun Berbahaya) sangat
tinggi maka proses / kegiatan penyimpanan material B3 dihilangkan, artinya
kegiatan penyimpanan sudah tidak diperlukan lagi karena material B3 akan
diantar oleh vendor pada saat diperlukan.
Substitution risks through substituting them with the less dangerous

alternatives. For example:
Mengganti risiko dengan cara menggantinya dengan alternatif lain yang lebih rendah
risikonya, sebagai contoh:
In installing scaffolding system, replace bamboo / wood scaffold to iron

scaffold with knockdown system
Pada sistem pemasangan perancah , mengganti perancah dari bambu / kayu dengan
perancah dari besi dengan sistem knock down

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Engineering Control, minimization of the hazard, e.g. designing the facility,

machinery, or process to reduce the hazard.
Rekayasa Teknik, meminimkan sumber bahaya dengan cara mendesain fasilitas,
peralatan, proses, peralatan, material atau faktor lain untuk mengurangi bahaya
Misalnya :
- Enclosure of the hazard using enclosed cabs, enclosures for
noisy machinery, or other means.
Menutup sumber bahaya dengan menggunakan penutup cabs,
menutup tingkat kebisingan suatu peralatan (mesin) atau dengan cara
lain.
- Isolation of the hazards with interlocks, machine guards, blast
shield, welding curtain, etc.
Isolasi sumber bahaya dengan sistem interlocks, alat pengaman mesin,
pelindung atau tirai blast, tirai pengelasan
- Removal or redirection of the hazard, e.g. using local exhaust
ventilation
Mengambil atau merubah arah sumber bahaya, seperti memakai
exhaust van
Administrative Control, combat risks through administrative controls. For

example:
Menanggulangi Risiko bahaya melalui adminitrasi control, sebagai contoh:
- Written operating procedures, permit to work system, safe work
practices, etc.
Membuat prosedur operasi, ijin kerja, cara kerja yang aman dsb
- Exposure time limitations

Batasi waktu pemaparan
- Monitoring the use of highly hazardous substances

Memonitor dalam penggunaan bahan bahaya tingkat tinggi.
- Alarms, warning signs, information signs, etc.

Alarm, poster peringatan, poster pemberitahuan dsb.
- Training
Kursus dan Pelatihan.
Personal Protective Equipment, minimise risk through personal protective

equipment (PPE), e.g. respirators, hearing protection, safety shoes, safety
glasses, etc. Remember PPE is acceptable as a control method only in the
following circumstances:
Mengurangi Risiko bahaya melalui penggunaan alat pelindung diri, seperti pelindung
pernafasan, pelindung pendengaran, sepatu keselamatan, alat pelindung mata, dsb.
Kita harus ingat bahwa alat pelindung diri dapat dijadikan alternatif sebagai alat
control bila :
- When engineering controls are not feasible
Cara engineering control tidak berhasil

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

- When engineering controls do not totally eliminate the hazard,

e.g. noise level
Bila engineering control tidak dapat mengeliminasi secara total
sumber bahaya, seperti tingkat kebisingan,
- While engineering controls are being developed

Bila engineering control sedang dalam tahap persiapan
- When safe work practices do not provide sufficient additional

protection
Bila cara-cara kerja yang aman belum tersedia.
Recommended action base on Risk ranking and Hierarchy of Control can be

defined as following pattern:
Dalam menentukan rekomendasi tindakan pengendalian berdasar Tingkat Risiko dan
Tingkatan Pengendalian dapat mengikuti rumusan sebagai berikut :
Risk Ranking (RR) Recommended Action

Tingkat Risiko Tindakan Pengendalian
Tingkat Hierarchy of Control
Score Level Pengendalian
18-25 Extreme High E = 1 + 2 + 3 + 4 + 5 1 = Eliminasi
13-18 High H=3+4+5 2 = Substutusi
6-12 Medium M=4+5 3 = Rekayasa Teknik
1-5 Low L=5 4 = Pengendalian Adm.
5 = APD
E. Monitoring, Review, record and revise if necessary

Pengawasan, Periksa ulang, pencatatan dan perbaikan bila diperlukan
Hazard identification which has been conducted at HO and Project must be

supervise, it is to ensure whether control action which has been conducted can
decrease severity rate (SR) or probability rate (PR)or not? To decrease risk rate
(RR)
Identifikasi bahaya yang telah dilakukan harus dipastikan selalu diawasi
penerapannya di lapangan baik di HO maupun Project, hal ini untuk mengetahui
apakah tindakan pengendalian yang telah dilakukan dapat menurunkan SR (severity)
maupun PR (probability)? sehingga berdampak pula pada penurunan tingkat
risikonya (RR)
If there are significant changes, such as adding new types of machinery,

introducing new production process or using new chemicals, etc., new hazards
could occur. We must assess the new hazards and revise the protection plan if
necessary.
Bila terdapat perubahan yang signifikan seperti penambahan mesin tipe baru, proses
produksi baru atau produk kimia baru dsb. Bahaya-bahaya baru akan muncul kita
harus mendata sumber bahaya yang baru dan memperbaiki rencana proteksi bila
diperlukan.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Risk assessment and control is one of the key parts of the HSE Management
system. It is also one of the most important elements during HSE audit. Record
must be kept until project finish or at least 1 year.
Penilaian dan pengendalian resiko adalah salah satuhal yang penting dalam sistem
manajemen HSE, ini juga salah satu element yang akan diaudit. Catatan atau file
harus disimpan sampai proyek selesai atau paling lama 1 tahun.
F. Communication
Komunikasi
After risk assessment, if there is no legal implication we must communicate to

all employees about findings and involve them in improvement actions. If
necessary, training should be provided.
Setelah penilaian resiko dilakukan, kita harus memberitahukan kepada setiap
karyawan tentang temuan-temuan dan melibatkan mereka dalam melakukan
perbaikan, bila tidak terdapat implikasi hukum. Bila perlu, pelatihan atau kursus
harus disiapkan

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

PROCEDURE
WORK PERMIT SYSTEM
APPROVED :
DIRECTOR
K. HIROTA
REVIEWED :
PROJECT MANAGER
WARMAN
PREPARED :
HSE DIVISION
ARINA
Distribution List:
Project Manager
Project Control Div.
Engineering Manager
Procurement Div.
QC Div.
HSE Div
Document Control

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

TABLE OF CONTENT
Page
I. INTRODUCTION 3
II. PURPOSE 3
III. RESPONSIBILITY 3
IV. TYPE OF WORK PERMIT 3
V. WORK PERMIT REQUIREMENTS 3
VI. WORK PERMIT FLOW LINE 4
VII. DISTRIBUTION WORK PERMIT 4
VIII. WORK PERMIT NUMBERING 4
ATTACHMENT:
I. FLOW CHART WORK PERMIT SYSTEM

II. GENERAL WORK PERMIT FORM
III. HOT WORK CERTIFICATE FORM
IV. CONFINED SPACE ENTRY CERTIFICATE FORM
V. WORKING AT ELEVATED AREA CERTIFICATE FORM
VI. ELECTRICAL WORK CERTIFICATE FORM
VII. COLD WORK CERTIFICATE FORM
VIII. RISK.ASSEEMEN.FORM

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

I. INTRODUCTION / PENDAHULUAN
This working permit system cover for all activities.
Sistem izin kerja ini berlaku untuk semua aktivitas.
This working permit system shall apply to all employees and contractors in throughout this projects.
Sistem izin kerja ini harus diterapkan kepada seluruh pekerja dan kontraktor yang terlibat di proyek.
II. PURPOSE / TUJUAN

To ensure safe working practices and to protect employees and contractors in a place of work from the hazards
activities.
Untuk menjamin pelaksanaan pekerjaan aman dan melindungi pekerja dan kontraktor di tempat kerja dari
bahaya aktivitas pekerjaan.
III. RESPONSIBILITY / TANGGUNG JAWAB

The Project Manager of Contractor shall be responsible for the contents of this work permit system.
Manajer Proyek Kontraktor bertanggung jawab untuk pelaksanaan isi dari sistem izin kerja ini.
The Construction Manager of Contractor concerned are responsible to ensure that this working permit system
is followed in their area.
Manajer Konstruksi Kontraktor bertanggung jawab untuk menjamin sistem izin kerja ini terlaksana di area
kerjanya.
Chief HSE shall advice and review on compliance to work permit requirement and other legal requirements.
Chief HSE harus mengarahkan dan meninjau terhadap pemenuhan persyaratan hukum dan persyaratan –
persyaratan lain.
Supervisor of Contractor are responsible to prepare the requirement of this work permit and propose the work
permit for approval and supervise all the work activity at work area to ensure work permit has implemented.
Supervisor kontraktor bertanggung jawab untuk menyiapkan persyaratan dari izin kerja dan mengajukan izin
kerja tersebut untuk memperoleh persetujuan dan mengawasi pekerjaan di area kerja untuk memastikan
pekerjaan di lapangan dilakukan sesuai dengan izin kerja.
All employees of Contractor and sub-contractors are responsible to comply with this work permit system.
Semua pekerja kontrraktor dan subkontraktor bertanggung jawab untuk menyesuaikan / melaksanakan sistem
izin kerja ini.
HSE Administrator are responsible in work permit numbering and record the work permit which is released
and closed.
HSE Admin bertugas melakukan penomoran dan mencatat izin kerja yang dikeluarkan dan yang ditutup.
IV. TYPE OF WORK PERMIT / JENIS WORK PERMIT
There are any 5 type work permit certificate, which use in work permit system /
Ada 5 lima macam sertifikat izin kerja yang digunakan dalam sistem work permit:
- Hot Work Permit / Izin Kerja Panas (See Appendix D, HSE Procedure)
- Entry into Confined Space Permit / Izin Kerja Masuk Ruang Terbatas (See Appendix F, HSE Procedure)
- Working at Height Permit / Izin Kerja Bekerja di Ketinggian (See Appendix N, HSE Procedure)
- Electrical Work Permit / Izin Kerja Elektrikal (See Appendix S, HSE Procedure)

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

- Cold Work Permit, include Mechanical Erection, Steel Structure Erection, Rebar install, Concrete Casting
/ Izin Kerja Dingin, termasuk pekerjaan Pemancangan Mekanikal, Pemancangan Struktur Baja,
Pemasangan Rebar, Pengecoran Beton (See HSE Procedure)
-
V. WORK PERMIT REQUIREMENT / PERSYARATAN PELAKSANAAN WORK PERMIT
Izin kerja Umum berupa satu buah formulir berisi ceklist jenis pekerjaan dan lampiran sertifikat izin kerja serta
lampiran-lampiran lain sesuai persyaratan pelaksanaan izin kerja. For Work Permit Application, Subcontractor
shall attach the following documents:
General Work permit form contain job type checklist and work permit certificate attachment and another
required attachments. Untuk pengajuan Izin Kerja, Subkontraktor harus melampirkan dokumen-dokumen
berikut:
- Job Safety Analysis, (Analisa Keselamatan dari setiap tahapan Pekerjaan)
- Risk Assessment (Penaksiran Risiko berdasarkan angka kemungkinan terjadi kecelakaan dan tingkat
keparahan dari kecelakaan yang akan terjadi.)
- Construction Method (Metode pelaksanaan pekerjaan Konstruksi)
- Drawing Area Activity (Gambar area tempat berlangsungnya aktivitas pekerjaan.)
- As-Built Drawing Existing (Gambar Area Existing)
- Rigging Plan for Erection Activity (Perencanaan pekerjaan pengangkatan untuk aktivitas
pemancangan)
- Underground Composite Drawing (Gambar area bawah tanah)
VI. WORK PERMIT FLOW LINE / ALUR IZIN KERJA

After complete the documents, subcontractor shall propose all the work permit documents to be reviewed by
Field Superintendent and Chief HSE to ensure that all requirement (documents) work permit has been obey
and job activity can be start with safe. If all the documents comply, Work Permit shall be registered in Permit
Registry (HSE Administrator). Supervisor of Subcontractor propose it to General Superintendent/Construction
Manager of Contractor for Approval Work Permit. If work permit approved, Supervisor of Subcontractor shall
propose it to Owner Representatif for Approval Work Permit. Work Permit Application for work activity in
existing area and related existing area will follow Owner Work Permit System.
Setelah melengkapi semua dokumen, petugas pelaksana / sub-kontraktor mengajukan seluruh dokumen izin
kerja untuk ditinjau oleh Superintendent dan Chief HSE untuk memastikan bahwa semua persyaratan izin kerja
telah dipenuhi dan pekerjaan bisa dengan aman dimulai. Jika semua dokumen telah memenuhi prosedur,
Supervisor subkontraktor harus mengajukan kepada General Superintendent / Manajer Konstruksi untuk
persetujuan izin kerja. Jika izin kerja disetujui, Supervisor subkontraktor mengajukan izin kerja kepada
Perwakilan Pemilik untuk disetujui dan ditandatangani. Pengajuan izin kerja untuk aktivitas pekerjaan di
dalam area existing atau berkaitan dengan area existing akan mengikuti sistem izin kerja Pemilik.
After receive work permit that has been sign, sub-contractor/supervisor shall go to work location to conduct
preparation which obey the work permit requirement and shall be give tool box meeting to the employee.
Setelah menerima work permit yang sudah ditanda-tangani, petugas pelaksana / supervisor akan ke lapangan
untuk memulai penyiapan lokasi dengan mematuhi persyaratan work permit dan juga memberikan tool box
meeting kepada pekerja yang akan melakukan pekerjaan.
During work execution avtivity, Chief HSE or HSE Superintendent conduct monitoring the work permit
requirement compliance in workplace and could STOP the job in any deviation case.
Selama pelaksanaan pekerjaan, Chief HSE atau HSE Superintendent melakukan pengawasan terhadap
pemenuhan peraturan izin kerja di tempat kerja dan dapat menghentikan pekerjaan apabila terjadi
penyimpangan.
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

VII. DISTRIBUTION OF WORK PERMIT / DISTRIBUSI WORK PERMIT

The Approved Work Permit will be distributed to the following:
Distribusi minimum work permit yang sudah disetujui / ditandatangani adalah:
- Original hold by Supervisor / Asli dipegang oleh Supervisor (putih)
- Copy 1 hold by HSE / Copy 1 dipegang oleh HSE (merah muda)
- Copy 2 display in work area / Copy 2 ditempelkan di area kerja (kuning)
- Copy 3 hold by Owner Representative / Copy 3 dipegang oleh Wakil dari pemilik proyek (hijau muda)
- Copy 4 hold in Contractor Construction Manager / Copy 4 dipegang di Manajer Konstruksi kontraktor
(biru muda)
Work Permit which approved by Owner representatif valid until 7 days. Supervisor have to report/extend
regarding the work permit everyday to Construction Manager of Contractor and Owner Representatif before
caryy out the job. After 7 days, the supervisor shall create new permit.
Izin kerja yang disetujui oleh perwakilan pemilik berlaku hingga tujuh hari. Supervisor kontraktor harus
melaporkan/memperpanjang izin kerja setiap hari kepada Manajer Konstruksi Kontraktor dan Perwakilan
Pemilik sebelum melaksanakan pekerjaan. Setelah tujuh hari, supervisor harus membuat izin kerja baru.
VIII. WORK PERMIT NUMBERING / PENOMORAN IZIN KERJA

After reviewed by Superintendent and Chief HSE of Contractor regarding compliance the requirements,
Supervisor of Subcontractor shall register work permit to HSE Administrator for recording in Work Permit
Registry Form before be proposed to General Superintendent or Construction Manager of Contractor and
Owner Representatif.
Setelah ditinjau kelengkapan persyaratan-persyaratan dokumennya oleh Superintendent dan Chief HSE
Kontraktor, Supervisor Subkontraktor harus mendaftarkan Izin Kerja kepada HSE Administrator Kontraktor
untuk dicatat dalam Formulir Pencatatan Izin Kerja sebelum diajukan kepada General Superintendent
Kontraktor atau Manajer Konstruksi Kontraktor serta Perwakilan Pemilik.
The extending of work permit shall be registered by HSE Administrator everyday before be proposed to
General Superintendent / Construction Manager of Contractor and Owner Representatif. After finish the
work, Supervisor of Subcontractor shall report the closing of work permit to HSE Administrator.
Perpanjangan izin kerja harian harus dilaporkan kepada HSE administrator sebelum dilaporkan kepada
General Superintendent kontraktor / Manajer Konstruksi Kontraktor dan Perwakilan Pemilik. Setelah
pekerjaan selesai, Supervisor Subkontraktor harus melaporkan penutupan Izin Kerja kepada HSE
Administrator.
Numbering method procedure as follow:

Metode penomoran Izin Kerja mengacu pada prosedur berikut:
ANPP / / /
Work Permit Number/

Nomor Izin Kerja
Month-Year/ Bulan-Tahun (Jan-Dec)
Type of Work Permit / Jenis Pekerjaan

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

HW : Hot Work/Pekerjaan Panas

CS : Confined Space/Ruang Tertutup
ELV : Working at Elevated Area/Ketinggian
ELECT: Electrical Work/Pekerjaan Listrik
CW : Cold Work/Pekerjaan Dingin
Project Symbol/Symbol project
APPENDIX 1
Flow Chart Work Permit System / Alur Sistem Izin Kerja
Sub-contractor must prepare:

- Job Safety Analysis
- Risk Assessment
- Construction Method
- Drawing Area Activity
- Rigging Plan for Erection Acitvity
Send back to sub-
contractor for repair
Reviewed by Superintendent
Do Not Comply
Reviewed by
Chief HSE GTA
Registered by GTA Comply

HSE Officer
GTA Supervisor
Work Permit Approved, by

CM GTA
Work Permit Approved, by

Main Cont.
Work Stop for repair

base on requirement Work Executed
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

HSE review during execution

Any Deviation (Take Sample:EH & H) No deviation
Work Finish & Closed

By CM GTA& Main Cont.
Registered by GTA HSE Work Continue
APPENDIX 2
GENERAL WORK PERMIT FORM
Doc. No. Rev. No.

PROJECT SERVICES
HSE
Time/
Date/Tanggal : Pukul :
Area : Dept. :
Location of Work :
Uraian Pekerjaan / Detail of Job :
Permit Number : / / /
Type of Work √ Pre Cautions Necessary √

Hot Work Hot Work Certificate
Electrical Cold Work Certificate
Cold Work Confined Space Entry Certificate
Confined Space Entry Electrical Work Certificate
Working at Height Working at Heigh Certificate
Job Safety Analysis
Risk Assessment
Construction Method
Rigging Plan
Drawing Area Activity
As Built Drawing for Excavation
Note:
Supervisor Construction Manager Main Contractor
Pekerjaan TGL JAM

Selesai

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Ditunda
Izin Khusus Supervisor Construction Manager Main contractor
Original : Hold by Supervisor
Copy 1 : HSE
Copy 2 : Display in Work Area
Copy 3 : Main Contractor
Copy 4 : CM GTA
Work Permit Extension Form

Form Perpanjangan Izin Kerja (dibalik Form General Work Permit)
No. Date Time Supervisor CM GTA Main Contractor

1
(..................) (..................... ) (..................)

2
(..................) (..................... ) (..................)

3
(..................) (..................... ) (..................)

4
(..................) (.................... ) (.................. )

5
(..................) (.................... ) (..................)

6
(..................) (.................... ) (..................)

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

APPENDIX 3
HOT WORK CERTIFICATE FORM
PROJECT SERVICES Doc. No. Rev. No.

HSE-GT-DOC-03
HSE
Permit Number : /HW/ /
HOT WORK CERTIFICATE
Date : Time :
Area : Dept :
Pekerjaan /
Location of Work : Detail of Job :
Uraian :
KOLOM KESELAMATAN DIBAWAH INI HARUS DIISI OLEH SUPERVISOR / THIS AREA MUST BE FILL BY SUPERVISOR
Ya Tidak Keterangan/
NO URAIAN / DETAIL OF JOB Yes No Remarks
Apakah pekerja sudah diberi penjelasan secara detail pekerjaan yg akan dilakukan.
A
Does employees have already know detail job what he will done
Apakah pekerja sudah diberi penjelasan tentang bahaya yang ada / dapat terjadi
B terhadap pekerjaan yang akan dilakukan.
Does employee have already know the dangerous of their job
Apakah tindakan pencegahan telah dilakukan guna memastikan tidak ada pekerjaan
lain yang dapat menimbulkan bahaya ketika pekerjaan ini berlangsung.
C
Does any injury precaution have been prepare to ensure that there is no other job,
which can make dangerous when this job on going?
Apakah operator lapangan telah dihubungi bahwa adanya pekerjaan yang akan
D dilakukan
Does field operator has been contact
Bebaskan peralatan yg akan dikerjakan dari gas-gas yg berbahaya dan bertekanan
E (dikosongkan, dipurging, disteaming, diflushing, didrain)
Free the equipment that will use from any dangerous gas and pressure gas
Isolir / amankan peralatan dari sumber bahaya (jarak dari explosive harus 8 meter)
F Isolate the equipment from source of dangerous (distance from explosive area must be
8 meter)
Bebaskan peralatan dari sumber tenaga penggerak
G
Free the equipment from any moving object
Pasang label Locked Out & Tag Out pada peralatan
H
Use locked out and tag out to the equipment
Lakukan pengamanan & pengawasan terhadap percikan api las
I
Monitor the area of job from any spark of fire
Bahan-bahan yang mudah terbakar, perlu dipindah atau dilindungi
J
Move and protect any flammable material
Penutup selokan/sewer/drain dan kerangan pada jarak 15 meter dari tempat pekerjaan
K telah ditutup dengan rapat
Close any sewer / drain with distance 15 meter from the job
Amankan tumpahan minyak, terlebih bocoran gas
L
Clear the area of job from any oil spill and gas spill
Adakah kegiatan lain yang mempengaruhi operasi tersebut
M
Is there any activity that can be influence the job

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Apakah mesin diesel, compressor, pompa telah ditempatkan pada posisi aman
N
Do the diesel engine, compressor and pump have been put in save position
Semua peralatan las telah ditempatkan pada posisi yg aman, dipasang bounding dan
ditanahkan / arde secara aman dan dipasang spark arrestor
O
Does the welding machine has been put in save position, install grounding and spark
arrestor
P Stand By alat pemadam api yang sesuai / Fire extinguisher stand by
Q Stand By petugas pemadam kebakaran / safety man stand by
Semua penggerak utama peralatan listrik telah diisolasi dan diberi label, dan diisolasi
R dari sumber tenaga listrik
S Arah angin perlu diperhatikan / Wind direction need attention
Yakinkan bahwa kondisi tempat / alat yg akan dikerjakan keadaan aman /
T
Ensure that area / equipment that will be use in safe condition
U Apakah diperlukan izin kerja yang lain / Is there any permit need
Izin kerja lain yang diperlukan :
V
Any permits need are:
KOLOM PEMERIKSAAN GAS DAN ALAT PELINDUNG DIRI YANG DIPERLUKAN /
AREA GAS CHECK AND PPE REQUIRE
DIISI OLEH SAFETY OFFICER / INSPECTOR
FILL BY SAFETY OFFICER / INSPECTOR
Pemeriksaan Gas
A Dilakukan / Gas Check B Alat Pelindung Diri Yang Harus Dipakai
Petugas
Pelindung
Tahap / Jam / Combustible O2 Gas % HSE / Paraf/
Helmet Mata / Eye
Step Time Gas % (21%) PIC Sign
Protection
HSE
Pelindung
Sepatu Safety Tubuh / Body
Protection
Pelindung
Ear Plug / Muff Jatuh / Fall
Protection
Pelindung
Dust Musk Muka / Face
Protection
Pelindung
Tangan /
Safety Glass
Hand
Protection
Lain-Lain /
Rubber Shoes
Any others
Pelindung
Pernafasan /
Respirator
Protection
SAYA SUDAH MEMBACA, MENGERTI, MEMERIKSA KONDISI DIMANA PEKERJAAN DAPAT DILAKSANAKAN /
I HAVE READ, UNDERSTAND AND CHECK CONDITION WHERE THE JOB CAN BE DONE
DENGAN AMAN DAN SETUJU UNTUK MEMATUHI DAN MENJAMIN IZIN UNTUK DIMULAINYA PEKERJAAN /
WITH SAVE AND AGREE TO OBEY AND GUARANTEE THE PERMIT FOR THE JOB
Pekerjaan TGL JAM

Selesai
Main
Supervisor Construction Mgr
Ditunda Contractor
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Izin Khusus
Copy 1 : HSE
Copy 4 : CM GTA
(Form Gas Tes, dibalik lembar halaman pertama Hot Work Permit dan Confined Space Permit,
dipegang oleh Supervisor)
Gas
Gas
LEL Toxic Tester
No Date Time O2 (%) Other Tester
(%) (ppm) Signatur
Name
e

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

APPENDIX 4
CONFINED SPACE ENTRY
CERTIFICATE FORM
HSE-GT-DOC-04
QC-HSE
Permit Number : /CS/ /
Tanggal Jam /
/ Date Time
Izin Kerja diberikan kepada / :
This work permit give to
Lokasi Pekerjaan / :
Location of Work
Uraian Pekerjaan / Job :
Description
Jumlah orang (max) dalam bejana :
/ Total Worker
Nama orang yang 1. 2. 3.
Bekerja / berada dalam
bejana / Name worker 4. 5. 6.
Di isi oleh safety inspector / Fill by Yes No Diisi oleh Supervisor / Fill by Yes No
Safety Inspector Supervisor
1. Telah diadakan test terhadap gas 1. Kerangan- kerangan yg
beracun, explosive gas dan kadar berhubungan dgn bejana telah
O2 / Does explosive gas, hazardous ditutup / Does all valve and pipe
gas and O2 gas have been tested that connect to confined space have
been closed.
2. Alat pelindung pernafasan dan tali 2. Kerangan-kerangan yang ditutup
pengaman tersedia / Does respirator telah dipasang safety tag / Does all
equipment and Line Life apply valve and pipe has been install with
lock out and tag out
3. Digunakan alat listrik yg sesuai dgn 3. Sistem sudah bebas dari pressure
Ketentuan / Does electric dan suhu tinggi / Does this system
equipment suitable with has been free from pressure and
requirement high temperature
4. Diperlukan ventilasi buatan / Does 4. Sistem sudah dipurging dan
more ventilation need diflushing / Does this system has
been purging and flushing
5. Telah menugaskan seseorang utk 5. Blind-Blind sudah dipasang dan
menjaga diluar bejana / Does diberi tanda / Doess all blind has
safety man has been appointed been install and give sign
6. Zat-zat berbahaya telah 6. Operator DCS telah dihubungi /
disingkirkan / Does hazardous Does DCS has been call
material has rip off
7. Tersedia sarana seperti: Alat berat, 7. Perintah kerja aman telah
tangga, atau peralatan lainnya / dimengerti oleh pelaksana / Does
Does facility such as: ladder, heavy the supervisor has been understand

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

equipment and so on are apply with the safe operation procedure

8. Lain-Lain / Other: 8. Lain-Lain / Other:
Tindakan khusus yg harus dilakukan / special act:

Saran khusus / special advice:
Sign
Gas Explosive : % (Maximum 0 %) Kesimpulan: Save/ Not
save
Carbon Monoxyde : ppm (Maximum 50 ppm) Kesimpulan: Save/ Not
save
Oxygen : % (19.5 % – 21.5 %) Kesimpulan: Save/ Not
save
________ ________________________ ________________

Supervisor Contruction manager Main Contractor
Pekerjaan TGL JAM
Selesai
Ditunda
Izin Khusus Supervisor Construction Manager Main Contractor

Copy 1 : HSE
Copy 3 :Main Contractor
Copy 4 : CM GTA

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

APPENDIX 6
WORKING AT ELEVATED AREA
CERTIFICATE FORM
HSE-GT-DOC-05
QC-HSE
Permit Number : /ELEVT/ /
WORKING AT ELEVATED AREA PERMIT / IJIN KERJA DIKETINGGIAN ( OVER / DIATAS 2 METER)
Date / Tanggal
Duration / Waktu
Type of Works /
Jenis Pekerjaan
Location / Lokasi
KOLOM KESELAMATAN DIBAWAH INI HARUS DIISI OLEH PENGAWAS PEKERJAAN / FILLED
BY SUPERVISOR
NO DESCRIPTIONS / URAIAN YES NO / REMARKS /
/ YA TIDAK KETERANGAN
1 Apakah pekerja sudah diberi penjelasan secara detail mengenai
pekerjaan yg akan dilakukan / What the employees have been told in
detail about their jobs
2 Apakah pekerja sudah diberi tahu tentang bahaya yang dapat terjadi /
Does the employees have already know the dangerous that could be
happened
3 Apakah pekerja sudah diberi tahu tentang keharusan memakai APD /
Does Employee already know the mandatory PPE
4 Apakah area kerja sudah diamankan dari kemungkinan sumber bahaya
lain disekitarnya / Does the work area have been clear from others
possibility hazard
5 Apakah kondisi kecepatan angin sudah diperhitungkan / Does wind flow
have been consider
6 Apakah area kerja sudah dilengkapi dg Safety Lines / Safety Net / Does
the work area have been provide with safety line or safety nets
7 Apakah Safety Lines / Net sudah dipasang dg kuat dan benar./ Does
safety line has bee proper install
8 Apakah kondisi Safety Lines / Nets masih baik / kuat / tidak rusak /
Does the consdition safety line / net still strong enough / not broken
9 Apakah diperlukan sistem pengaman jatuh yg lain (khusus) / Does any
fall protection system need
10 Apakah tangga untuk naik/turun telah dilengkapi / Does ladder for up
and down have been provide
11 Apakah tangga dalam kondisi baik / memenuhi syarat / Does ladder in
good condition
12 Apakah bagian bawah tangga dilengkapi dg dudukan (shoes) / Does the
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

bottom part of the ladders complete with shoes

13 Apakah tangga diikat dg kuat pada bagian atas dan bawahnya / Does the
ladders have been tight in upper and bottom position
14 Apakah pekerja dilengkapi dg Safety Belts / Harness / Does employee
provide with safety belt / safety harness
15 Apakah Safety Belts / Harness memenuhi syarat / layak pakai / Does tha
safety belt / harness in good condition according to standard requirement
16 Apakah pekerja sudah diberi tahu cara mencantolkan safety belts/
harness dg benar / Does employee have already know how to use install
the safety belt
17 Apakah pekerja harus memakai Safety Belts / Safety Harness tsb / Does
employee shall be use safety belt / harness
18 Apakah pencantolan safety Belt/Harness tsb memungkinkan gerakan
mengayun jika pekerja jatuh / Does connection of the safety belt /
harness in good condition
19 Apakah scaffolding sudah terpasang dengan baik / Does scaffolding
have been install
20 Apakah diperlukan Safetyman stand by / Does safety man need
21 Apakah pekerjaan ini memerlukan Ijin Kerja Aman yang lain, Sebutkan
/ Does any work permit require, if any describe it:
PERALATAN KERJA YANG DIPERGUNAKAN ALAT PELINDUNG DIRI & PENGAMAN YANG DIPERGUNAKAN /
/EQUIPMENT OR TOOLS THAT NEED PPE NEED
Scaffold Mesin Las / Helmet Safety Belts
welding machine Safety Shoes Safety Harness
Crane Compressor
Ladder Ear Plug/Muff Safety Glasses
Rope Dust Mask Safety Gloves
Pekerjaan TGL JAM

Selesai
Ditunda
Izin Khusus Supervisor Construction Manager Main Contractor

Copy 1 : HSE
Copy 4 : CM GTA

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

APPENDIX 7
ELECTRICAL WORK CERTIFICATE
FORM
HSE-GT-DOC-06
QC-HSE
Permit Number : /ELECT/ /
IZIN DIBERIKAN KEPADA / :

Permit Give to
LOKASI PEKERJAAN / Location :
of Work
URAIAN PEKERJAAN / :
Description of Work
KOLOM KESELAMATAN DI BAWAH INI HARUS DIISI OLEH SUPERVISOR / THIS FORM SHALL
BE FORM BY SUPERVISOR
NO URAIAN YA TIDAK KETERANGAN
1 Apakah pekerja sudah diberi penjelasan detail mengenai pekerjaan yg
akan dilakukan / Does employees have already know detail job
2 Apakah pekerja sudah diberi penjelasan tentang bahaya yg ada / dpt
terjadi terhadap pekerjaan yg akan dilakukan. / Does employee have
already know dangerous of job
3 Apakah tindakan pencegahan telah dilakukan guna memastikan tidak ada
pekerjaan lain yg dapat menimbulkan bahaya ketika pekerjaan ini
berlangsung /
Does any injury precaution have been prepare to ensure that there is no
other job, which can make dangerous situation when this job on going
4 Apakah operator yg bertugas telah dihubungi bahwa adanya pekerjaan yg
akan dilakukan / Does field operator has been contact
5 Apakah petugas listrik / instrument telah memeriksa peralatan yang akan
dikerjakan dan area sekitarnya dalam kondisi aman / Does electrical
supervisor has been check the area and equipment in save condition
6 Apakah semua penggerak utama peralatan listrik telah diputuskan
hubungan arus listriknya dari sumber tenaga listrik / Does main electrical
has been disconnected
7 Apakah peralatan yang akan dikerjakan telah dipasang label, locked out
dan tag out / Does the equipment has been install lock out tag out
8 Apakah diperlukan izin kerja lain / Is there any permit need
9 Jenis izin kerja lain yang diperlukan yaitu / other permit:
Hot Work Permit
Cold Work Permit
Entry Permit
10 Lain-Lain (Saran Tambahan) / Adive
11 Instruksi khusus mengenai hal keselamatan dari ahli tehnik / electric dan
instrument supervisor / Special safety instruction from engineer or
supervisor (electrical and instrument)
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

A. Pemeriksaan Gas Dilakukan / Gas Test

TAHAP / JAM/ TIME COMBUSTIBLE GAS (%) OXYGEN GAS (%) PETUGAS SAFETY
STEP
B. Alat Pelindung Diri yang harus dipakai / PPE

Safety Helmet Respirator Protection Googles
Safety Shoes Safety Glass Safey Glasses
Ear Plug / Ear Muff Wear Pack Lain-Lain
Dust Mask Safety Belt
SAYA SUDAH MEMBACA, MENGERTI, MEMERIKSA DIMANA PEKERJAAN DAPAT

DILAKSANAKAN DENGAN AMAN DAN SETUJU UNTUK MEMATUHI DAN MENJAMIN IZIN
UNTUK DIMULAINYA PEKERJAAN / I HAVE READ, UNDESRTAND AND CHECK THE AREA AND
THE CONDITION IS SAVE TO DO THE ACTIVITY
_______________ _____________________ __________________

Supervisor Contruction Manager Main Contractor
Pekerjaan /Work Tgl / Date Jam / Time

Selesai / Finish
Ditunda / Postpone
Izin Habis / Permit Finish
_________________ __________________ _____________________

Copy 1 : HSE
Copy 4 : CM GTA

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

APPENDIX 8
COLD WORK CERTIFICATE FORM

HSE-GT-DOC-06
HSE
Permit Number : /CW/ /
COLD WORK CERTIFICATE
Date : Time :
Area : Dept :
Location of
Work :
Uraian
Pekerjaan /
Detail of Job :
KOLOM KESELAMATAN DIBAWAH INI HARUS DIISI OLEH SUPERVISOR / THIS AREA MUST BE FILL BY SUPERVISOR
Ya Tidak Keterangan/
NO URAIAN / DETAIL OF JOB Yes No Remarks
Apakah pekerja sudah diberi penjelasan secara detail pekerjaan yg akan dilakukan.
A
Does employees have already know detail job what he will done
Apakah pekerja sudah diberi penjelasan tentang bahaya yang ada / dapat terjadi
B terhadap pekerjaan yang akan dilakukan.
Does employee have already know the dangerous of their job
Apakah tindakan pencegahan telah dilakukan guna memastikan tidak ada pekerjaan
lain yang dapat menimbulkan bahaya ketika pekerjaan ini berlangsung.
C
Does any injury precaution have been prepare to ensure that there is no other job,
which can make dangerous when this job on going?
Apakah operator lapangan telah dihubungi bahwa adanya pekerjaan yang akan
D dilakukan
Does field operator has been contact
Bebaskan peralatan yg akan dikerjakan dari gas-gas yg berbahaya dan bertekanan
E (dikosongkan, dipurging, disteaming, diflushing, didrain)
Free the equipment that will use from any dangerous gas and pressure gas
Isolir / amankan peralatan dari sumber bahaya (jarak dari explosive harus 8 meter)
F Isolate the equipment from source of dangerous (distance from explosive area must be
8 meter)
Bebaskan peralatan dari sumber tenaga penggerak
G
Free the equipment from any moving object
Pasang label Locked Out & Tag Out pada peralatan
H
Use locked out and tag out to the equipment
Lakukan pengamanan & pengawasan terhadap percikan api las
I
Monitor the area of job from any spark of fire
Bahan-bahan yang mudah terbakar, perlu dipindah atau dilindungi
J
Move and protect any flammable material
Penutup selokan/sewer/drain dan kerangan pada jarak 15 meter dari tempat pekerjaan
K telah ditutup dengan rapat
Close any sewer / drain with distance 15 meter from the job

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Amankan tumpahan minyak, terlebih bocoran gas

L
Clear the area of job from any oil spill and gas spill
Adakah kegiatan lain yang mempengaruhi operasi tersebut
M
Is there any activity that can be influence the job
Apakah mesin diesel, compressor, pompa telah ditempatkan pada posisi aman.
N
Do the diesel engine, compressor and pump have been put in save position
Semua peralatan las telah ditempatkan pada posisi yg aman, dipasang bounding dan
ditanahkan / arde secara aman dan dipasang spark arrestor
O
Does the welding machine has been put in save position, install grounding and spark
arrestor
P Stand By alat pemadam api yang sesuai / Fire extinguisher stand by
Q Stand By petugas pemadam kebakaran / safety man stand by
Semua penggerak utama peralatan listrik telah diisolasi dan diberi label, dan diisolasi
R dari sumber tenaga listrik
S Arah angin perlu diperhatikan / Wind direction need attention
Yakinkan bahwa kondisi tempat / alat yg akan dikerjakan keadaan aman /
T
Ensure that area / equipment that will be use in safe condition
U Apakah diperlukan izin kerja yang lain / Is there any permit need
Izin kerja lain yang diperlukan :
V
Any permits need are:
A Alat Pelindung Diri Yang Harus Dipakai
Helmet Pelindung Mata / Eye Protection

Sepatu Safety Pelindung Tubuh / Body Protection
Ear Plug / Muff Pelindung Jatuh / Fall Protection
Dust Musk Pelindung Muka / Face Protection
Safety Glass Pelindung Tangan / Hand Protection
Rubber Shoes Lain-Lain / Any others

Pelingdung Pernafasan /
Respirator Protection
Supervisor Contruction Manager Main Contractor
Pekerjaan TGL JAM

Selesai
Ditunda
Main
Supervisor Construction Manager
Izin Khusus Contractor

Copy 1 : HSE
Copy 4 : CM GTA

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD


CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

PROCEDURE OF
ACCIDENT INVESTIGATION]
APPROVED :
DIRECTOR
K. HIROTA
REVIEWED :
PROJECT MANAGER
WARMAN
PREPARED :
HSE DIVISION
ARINA
REVISION HISTORY
Distribution List:
Project Manager
Engineering Manager
QC Division
HSE Division
Document Control

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

TABLE OF CONTENT
Page
1.0 INTRODUCTION 4
2.0 PURPOSE 4
4.0 ACCIDENT INVESTIGATION TEAM 4
5.0 REPORTING OF EVENT 5
6.0 TIMELINESS INVESTIGATION 5
7.0 INVESTIGATION PROCEDURE 5
7.1 Collecting Evidence 5

7.2 Assembling & Considering Evidence 7
7.3 Comparing findings with related specification and standard 7
7.4 Implement corrective actions & tracking progress 7
8.0 ACCIDENT INVESTIGATION FORM 8
9.0 COMMUNICATION 8
ATTACHMENT
1. ACCIDENT INVESTIGATION FORM

2. WITNESS STATEMENT FORM
3. VICTIM STATEMENT FORM

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

1.0 INTRODUCTION
This procedure shall apply throughout the organization and shall cover all types of activities for
investigation accident.
2.0 PURPOSE
To identify both immediate causes and underlying causes, therefore, to determine how to best prevent a
future similar.
The investigation may also provide valuable information in the event of an insurance claim or legal
action.
To set out a procedure covering the investigation of accident.
3.0 RESPONSIBILITY
The Project Manager shall be responsible to the contents of this procedure.
The Construction Managers concerned are responsible to ensure that this procedure is followed within
the worksite and he may designated a team leader to lead the accident investigation.
HSE Manager advice on the administrative of reporting procedure and compliance to legal and other
requirements.
All employees and subcontractors concerned are responsible to comply with this procedure.
4.0 ACCIDENT INVESTIGATION TEAM
The accident investigation team leader should have the knowledge and authority to make
recommendations, and normally the person should be a line General Manager and Manager.
The team leader should have the authority to set up the accident investigation team as required. The
regular members of the team include Human Resources / General Affair, Site HSE Manager, and at least
one member of the HSE Committee. The special members of the team include the department head where
the accident happened and at least one employee who either works on the same job where the accident
happened or has knowledge of that specific job. Other personnel who have relevant expertise, such as
engineer should be involved if necessary.
5.0 REPORTING OF AN EVENT
The purpose of reporting in this program is to make sure that timely investigation is done and corrective
action is taken for preventing recurrence. Not only recordable injuries or illnesses, but also first aid case
and serious near misses, must reported and investigated. It is different from the reporting in the program
of recording related to injury or illness.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

The employee involved in the event must report to the supervisor immediately, if possible. The
supervisor must then initiate an investigation by filling in the accident investigation form.
Injuries involving lost work time must be reported to the construction manager immediately and reported
to the Management Rekayasa within 24 hours.
6.0 TIME OF INVESTIGATION
The investigation should be done as soon as possible after the event. In any case, it must be completed
within 48 hours or by the next scheduled working day. Conditions can be change and people’s memories
can fade, which will affect the accuracy of the investigation and the quality of the improvement actions.
7.0 INVESTIGATION PROCEDURE
Not all events need to be investigated to the same extent or depth. The greatest effort should concentrate
on significant events that either have caused serious injury / illness or have the potential to do so.
To conduct an effective investigation, there are four steps that are explained below:

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

A. Collecting Evidence
Documents
Information from:
- Procedure, Working Instruction, Risk
Assessment / Job Safety Analysis,
Policies, Work permit.
- Records of earlier inspection, tool box
meeting, safety induction, test,
examinations and surveys.
- Training record of concerned employee
Observation
Information from physical

circumstances, including: - Checking reliability, accuracy
- Premises and place of work - Identifying conflicts and resolving
- Access and egress
differences
- Equipment or material in use
- PPE in use - Identifying gaps in evidence
- Location and relationship of
physical parts
- Any post-event tests, checks,
sampling or reconstruction
Clinical Evidence about injured

people
Interviews
Information from:
- Those involved and their line
management.
- Witnesses
- Those observing or involved before
the event, e.g. inspection or
construction / maintenance staff

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

There are three sources and methods to collect evidence:

- Direct Observation is important to obtain important evidence about scene, configuration, relationship
between parts, etc.
- Documents help to establish what should have happened as well as provide evidence of prior risk
assessment / Job safety analysis, inspections, test etc.
- Interviews provide both direct testimony as well as an opportunity to check back on any issues
arising from examination of the physical and documentary evidence.
These three sources complement each other, and provide an opportunity for investigators to check
reliability and accuracy as well as to resolve differences and gaps in evidence.
B. Assembling and Considering the Evidence
Accidents and incidents seldom arise from a single cause. There are usually underlying failures in the
management system it self which have helped create the circumstances leading to the event. Underlying
causes are the management and organisational factors that explain why the event occurred.
For example, in an event of fall from high, the immediately causes could be that the employee is not
properly trained or that necessary PPE is not used. However, there could also be underlying causes that
either the proper safety management programs or training not in place or not enforced.
C. Comparing findings with relevant specifications and standards
The next stage of investigation is to compare the conditions and sequence of event with relevant
specifications or standards which represent either minimum legal requirements or industrial good practice.
This helps to minimise the subjective nature of investigations and to generate recommendations which
have the maximum impact and relevance. The objectives are to decide:
- Whether suitable specifications or standards have been set to control all the factors influencing the
event.
- If specifications or standards existed, were they appropriate and sufficient?
- If the specification or standards were good enough, were they applied and implemented in practice?
- Why any failures occurred?
This approach leads to conclusions which identify:

- Where specifications or standards are absent
- Where specifications or standards are inadequate
- Where specifications or standards are adequate but not properly implemented.
D. Implement corrective actions and tracking progress
The final step is to recommend and prioritise corrective actions. Objectives must be set for each action for
reviewing and tracking progress.
The corrective actions must address both immediate causes and underlying causes. In the example case of
the fall from high, if ineffective enforcement is identified as the underlying cause, then the simple
corrective action of more training to the employees will not eliminate the root cause of the event. In order
to prevent recurrence, actions must be taken to make sure that proper management programs are enforced.
8. ACCIDENT INVESTIGATION FORM

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Following is a list of key data to be covered in the investigation report.
A. The Event
- Details of any injured person, including age, sex, experience, training etc
- A description of the circumstances, including the place, time of day and conditions.
- Details of the event, including:
- Any actions which led directly to the event
- the direct causes of any injuries, illnesses or loss
- the immediate causes of the event
- the underlying causes, e.g. failures in workplace precaution, risk assessment /job safety analysis,
etc.
- Details of the outcomes, including in particular:

- The nature of the outcome, e.g., injuries, illnesses, damage to property,
production disruptions, emission to environment, etc
- The severity of the harm caused
- The immediate management response to the situation and its adequately:
- was it dealt with promptly?
- were continuing risks dealt with promptly and adequately?
- was the first aid response adequate?
- were emergency procedure followed?
- How could the event have been prevented?
9. COMMUNICATION
The result of the accident investigation, particularly the corrective actions, should be made known to all
employees. Employees’ awareness and involvement are necessary for the success of the corrective
actions.
Site HSE personnel and HSE Committee must regularly analyse the common features and trends of the
accident and near miss, identify jobs or activities or group of employees which have the greatest number
of injuries, and discuss the findings in the HSE Committee meeting for improvement.
ATTACHMENT 1:
INVESTIGATION REPORT FORM
FOR HSE COMMITTEE USE ONLY
Reference No. :
A. PERSONAL / DETAILS OF THE VICTIM
NAME EMP. NO./I.C No POSITION
LOCATION AGE DOB: DEPT. /

SECTION
/ /
SEX Male SUPERVISOR NAME EMPLOYEE Full Time
CLASIFICATI Part Time
Female ON Contract
Trainee
WORKER EXPERIENCE
B. BASIS OF EMPLOYMENT
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

WORKING TIME SHIFT ARRANGEMENT NUMBER OF 8 Hours or

HOURS less
More than
or 8 hours
excluding
overtime
C. JOB DETAILS
DESCRIPTION OF
OCCUPATION OR
JOB
MAIN TASK
PERFORM
TRAINING Induction Training Remarks :

PROVIDED
Task Specific Training
Both of the above
Neither of the above
D. DETAIL OF INJURY OR DISEASE

Nature of Injury Bruising Dislocation Other (Specify)
Strain / Sprain Scratch/Abrasion Internal
Fracture Amputation Foreign Body
Laceration / Cut Burn / Scald Chemical Reaction
Injured Part of Body:
Remakrs:
Treatment
First Aid Dr’s Office
Emergency Room Hospitalization
Name and Address of Treating Physician or Fatality:
E. LOST-TIME INJURY / DISEASE

Additional questions to be answered for cases which result in a fatality or permanent disability, or where there was time
lost from work of one or more days / shifts. These questions should be completed as soon as possible after the injury or
disease is reported.
EMPLOYEES TYPE OF EMPLOYEE Permanent
PREFERRED employee
LANGUAGE  WAGE / SALARY-
EARNER Contract
employee
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

 SELF EMPLOYED
Trainee
Contractors
and sub-
contractors
WORKERS PROPOTION OF SHIFT 25% or less
EXPERIENCE IN TASK WORKED DURING THE
BEING CARRIED OUT INCIDENT OCCURRED 26% - 50%
WHEN INJURY OR
DISEASE OCCURRED Years Months 51% - 75%
76% - 100%
Overtime
DETAILS OF PERSON
COMPLETING THIS
FORM Name : Position :
Signature : Date :
F. DAMAGE PROPERTY
Property, Equipment, or Material Object or Substance Inflicting Damage Describe Damage
Damaged:
G. ACCIDENT DESCRIPTION
Describe what happened (attach photographs or diagrams if necessary)
H. ROOT CAUSE ANALYSIS (Check All that Apply)

Unsafe Act Unsafe Condition Management Deficiencies
Improper work techniques Poor workstation design / layout Lack of written procedure / policies
Safety Rule Violation Congested work area Lack of work permit
Operating without authority Hazardous substances Lack of JSA
Failure to warn or secure Fire or explosion hazard Safety rules not enforced
Operating at improper speed Inadequate ventilation Hazard not identified
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

By passing safety devices Improper material storage PPE unavailable

Guard not use Improper tool or equipment Insufficient worker training
Improper loading / placement Insufficient knowledge of job Insufficient supervisor training
Improper Lifting Slippery conditions Improper maintenance
Servicing machinery in motion Poor Housekeeping Inadequate supervision
Horseplay Excessive noise Inadequate Job Planning
Drug or alcohol use Inadequate guarding of hazards Inadequate hiring practice
Unnecessary haste Defective tools / equipment Inadequate tool box meeting
Unsafe act of others Insufficient lighting Inadequate workplace inspection
Other: Inadequate fall protection Inadequate equipment
Other: Unsafe design or construction
Unrealistic scheduling
Poor process design
Other:
I. ACCIDENT ANALYSIS
Using the root cause analysis on the above, explain the cause(s) of the accident in as much detail as possible
How bad could the accident have been? Very serious, Serious, Minor
What is the chance of the accident happening again? Frequent, Occasional, Rare
J. PREVENTIVE ACTIONS
Describe actions that will be taken to prevent recurrence.
K. INVESTIGATION TEAM
Signature Name Position
ATTACHMENT 2:
WITNESS STATEMENT FORM
A. WITNESS BACKGROUND
PLACE OF INTERVIEW DATE TIME
NAME OF WITNESS EMP.NO. POSITION
LOCATION DIVISION DEPT. / SECT
B. DESCRIPTION OF ACCIDENT / INCIDENT

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

NAME OF VICTIM : DATE OF ACCIDENT / INCIDENT :
PLACE OF ACCIDENT / INCIDENT :
DESCRIPTION OF THE ACCIDENT / INCIDENT
(CONTINUE ON BACK OF THE FORM IF MORE SPACE IS NEEDED)
I HAVE READ THE ABOVE OR HAVE HAD THE ABOVE READ TO ME AND IT IS TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE.
Saya telah membaca keterangan di atas atau telah dibacakan kepada saya dan ia adalah benar dan betul di dalam
pengetahuan saya.(TANPA ADA PAKSAAN DARI PIHAK MANAPUN)
INTERVIEWER SIGNATURE WITNESS SIGNATURE
………………………………… …………………………..
( ) ( )
DATE : DATE :
TIME : TIME :
ATTACHMENT 3:
VICTIM STATEMENT FORM
A. VICTIM BACKGROUND
PLACE OF INTERVIEW DATE TIME
NAME OF VICTIM EMP.NO. POSITION
LOCATION DIVISION DEPT. / SECT
B. DESCRIPTION OF ACCIDENT / INCIDENT
DATE OF ACCIDENT / INCIDENT : PLACE OF ACCIDENT / INCIDENT :
DESCRIPTION OF THE ACCIDENT / INCIDENT :
(CONTINUE ON BACK OF THE FORM IF MORE

SPACE IS NEEDED)

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

I HAVE READ THE ABOVE OR HAVE HAD THE ABOVE READ TO ME AND IT IS TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE.
Saya telah membaca keterangan di atas atau telah dibacakan kepada saya dan ia adalah benar dan betul di dalam
pengetahuan saya. (TANPA ADA PAKSAAN DARI PIHAK MANAPUN)
INTERVIEWER SIGNATURE VICTIM SIGNATURE
Tanda Tangan Korban
…………………………………
( ) …………………………..
DATE : ( )
TIME : DATE :
TIME :

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

PROCEDURE OF
EMERGENCY AND EVACUATION
APPROVED :
DIRECTOR
K. HIROTA
REVIEWED :
PROJECT MANAGER
WARMAN
PREPARED :
HSE DIVISION
ARINA
Distribution List:
Project Manager
Project Control Div.
Engineering Manager
Procurement Div.
QC Div.
HSE Div
Document Control

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

TABLE OF CONTENT
Page
1.0 INTRODUCTION 3
2.0 PURPOSE 3
3.0 RULES AND RESPONSIBILITY 3
4.0 EMERGENCY & EVACUATION PROCEDURE 3
5.0 FIRES 4
6.0 MEDICAL EMERGENCY OR SERIOUS INJURY 5
7.0 CHEMICAL SPILLS 6
ATTACHMENT
1. EMERGENCY COMMUNICATION NETWOTK

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

1.0 INTRODUCTION
1.0 This shall be applicable to all personnel and related external parties operating within GTA’s
area during emergency situation.
2.0 PURPOSE
2.1 To ensure that appropriate action has been carried out to eliminate or minimize the impact of
emergency event on the environment and human.
2.2 To ensure everybody in the compound are being protected and also to prevent and control
accident in order to increase effectiveness of operation.
3.0 RULES AND RESPONSIBILITY
3.1 This Procedure is used as a guideline and should also be followed.
3.2 The Construction Manager / Chief HSE have overall responsibility and accountability for
ensuring that the site has developed emergency and evacuation procedures to cover all possible
emergency situations, such as: fire, serious injury, explosion, chemical spills etc.
3.3 The local legislation on all areas related to emergency response must be observed.
3.4 A competent employee or a team of employees may identified to assist the Construction Manager
to implement this procedure and keep records
4.0 EMERGENCY AND EVACUATION PROCEDURE
When developing emergency and evacuation procedures, think about:
- All possible emergency situations

- The worst that could happen if the things go wrong.
The following points should be included in emergency and evacuation procedure:
- Consider what might happen and how the alarm should raise. Do not forget night / weekend
working and times when the site is closed, such as holidays.
- In case of an emergency, all the potential hazards should be considered. For example in case of
fire, the hazards include not only fire, but also smoke, collapsing structures, live electrical
sources, flammable chemical, etc.
- How the person in charge and others should deal with the situations
- Who and how to call emergency services
- Where to go to reach a place of safety. There must be enough emergency exits and clear muster
point area for everyone to escape quickly. All emergency doors, escape routes and muster point
area must be kept clear at all times and clearly marked.
CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

- Plan essential actions such as emergency plant shut down or making processes safe. Clearly label
important items like shut-off valves and electrical isolators etc.
5.0 FIRES
To protect people and property from the danger of fires is every employee’s duty, particularly the
management duty. This is accomplished through fire prevention, fire fighting preparedness and
evacuation.
The emergency response plan for fire is designed to respond to all fires, including fire fighting and
evacuation.
The Construction Manager should become fire emergency team leader or appoint a fire emergency
team leader and establish a fire emergency team. The team should cover all shifts of work. It is
recommended that every shift has its own fire emergency team with a shift team leader.
The responsibilities of the team leader and team members include, but not limited to the following:
Team Leader
- Work with the site management to establish the fire emergency team (s)
- Set up the fire fighting and fire evacuation procedure
- Make clear each team member’s main responsibility as either fire fighting, or the person in charge
of fire evacuation for a specific area, or the person in charge of switching off machinery etc
- Take charge in case of an emergency
- Nominate a deputy in his/her absence
- Conduct regular fire drills
- Make sure all shift team leaders and team members are properly trained
Shift Team Leader
- Assist team leader in all his/her responsibilities

- Take charge in case of emergency during the shift when the team leader is not at work.
- Nominate a deputy in his/her absence and make sure the deputy is fully trained.
Team Member
- Follow the fire fighting and evacuation procedure

- Act in accordance with their main responsibilities
Non professional e.g. PT. Guna Teguh Abadi employees who do not receive fire fighters training
does not allow fight a big fire, there are only allow fight incipient stage fires. An incipient fire is a fire
in the initial or beginning stage which can be controlled or extinguished by portable fire extinguishers.
Once a portable fire extinguisher is used, it must be immediately replaced with a fully charged one.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

All PT. Guna Teguh Abadi site project and building office must include fire evacuation procedures as
part of the emergency response procedure. The fire evacuation procedures must cover at least the
following areas:
- What to do when an employee discover a fire?

- Sound the alarm if apply – detail how
- Call the fire services – list phone number, etc
- Attack the fire – only if possible and if appropriately trained in using the fire extinguisher.
- Make sure that the correct type of extinguisher is used.
- Do not risk lives.
- If the fire develop or under control, leave it and get out immediately.
- What to do when hearing the alarm?

- List the actions the team leader, shift team leader, and emergency team members should
take.
- Leave the building by the nearest exit. The current evacuation routes should posted
throughout each department.
- Do not stop to pick up personal belongings.
- Do not use lifts
- If time permits, switch off equipment and machinery.
- The person in charge of each area (i.e fire warden / safety man of each area)should make sure
that all employees and visitors in his/her area are evacuated. List the name of fire warden /
safety man of each area.
- Once evacuated, everyone must report to the designated assembly point and do not re enter
the building or area under any circumstance until told by someone in authority, such fire
chief or senior manger or Chief HSE, that it is safe to re- enter the building or area
project. List the assembly / muster points.
- In the event of false alarm, only authorized persons may silence the alarms after proper
investigation.
6.0 MEDICAL EMERGENCY OR SERIOUS INJURY
When serious personnel injury takes place, the first founder(s) shall inform GTA’s
Management or supervisor(s) of the outlines of accident immediately and correctly by any possible
means such as telephone, radio, direct delivery to such office, etc.
The report shall make slowly and clearly providing name of a reporter, location and outlines of
accident. Leave the scene as it was for accident investigation.
If the affected (second) accident may be suspected to take place at the original accident scene, all
person shall keep out of the scene or maximum efforts shall be paid to prevent
such affected accident.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

Emergency Call List Form
NO NAME PHONE NO/CALL SIGN

1 Fire Station :
- Owner
- Government
2 First Aid (Ambulance)/ Hospital
3 Owner Safety
4 Owner Construction
5 Rekayasa:
- Construction Manager
- Site Manager
- Chief Security
- Safety Manager
- Chief Administration
- Head Office
7. Police Station
7.0 CHEMICAL SPILLS
Storage stock of strength acids, flammable liquids, or other high hazardous liquids should be stored in
a place with spillage retention, and Material Safety Data Sheet should be there.

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

In addition, an emergency procedure for chemical spills must be prepared. The procedure should
include:
- How to raise alarm and evacuate people

- How to get professional help if necessary
- How to deal with the chemical spills and make the place safe again
- How to report to the local government as required by local legislation
ATTACHMENT 1: EMERGENCY COMMUNICATION NETWORK

CO NO :
PUSRI II-B REV
12-1812/ BA 1066
PROJECT
DATE BY CHKD APVD

HOSPITAL SITE CLINIC FIRE STATION
ACCIDENT
Fire or Injury
First Founder
HSE / Supervisor /
Security
Police
Ad Site Manager Client
Depnaker
Cilegon Office

Hse Plan Pt. Gta Construction

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HSE

PT. GUNA TEGUH ABADI

PROJECT : PUSRI – IIB PROJECT

CLIENT : PT. PUPUK SRIWIDJAJA PALEMBANG

LOCATION : PALEMBANG, SOUTH SUMATRA

DOCUMENT NO. : GTA-HSE-001

CONTRACT NO : 12-1812/ BA 1066

PT. GUNA TEGUH ABADI

TABLE OF CONTENTS/ DAFTAR ISI

No Contents/ ISI Page

1.2. Scope of Work/ Cakupan_________________________________________ 4

1.3. HSE Objective, Goal and Target/Tujuan dan Target K3LL______________ 4

3 Pusri II-B Project Organization Structure/Struktur Organisasi Proyek Pusri II-B 7

4 Workplace Organization/Organisasi Tempat Kerja_______________________ 5

6 Documentation and Data Control/ Dokumentasi dan Manajemen Data_______ 13

Project Health, Safety and Environment Management Program/ Program Pengelolaan

2 Project Environment Policy/ Kebijakan Lindungan Lingkungan Proyek

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 2 of 29

1.1 INTRODUCTION PENDAHULUAN

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 3 of 29

1.2 SCOPE OF WORK RUANG LINGKUP PEKERJAAN

1. Zero Restricted Work Cases Tidak ada kasus kecelakaan

3. Zero Environmental Incidents Damage Tidak ada kasus pencemaran lingkungan

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 4 of 29

Indonesian legislation applicable to the Project is as follows:

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 5 of 29

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 6 of 29

III. PUSRI II-B PROJECT ORGANIZATION STRUCTURE STRUKTUR ORGANISASI PROYEK

3.1 WORKPLACE ORGANIZATION ORGANISASI TEMPAT KERJA

3.2 RESPONSIBILITY TANGGUNG JAWAB

2. Construction Manager / Manajer Konstruksi

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 7 of 29

4. HSE Committee Chairman/ Construction Manager/ Ketua Komite P2K3

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 8 of 29

5 Chief HSE/ Pemimpin K3LL

8 HSE Superintendent / Pengawas Utama K3LL

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 9 of 29

6 HSE Supervisor / Pengawas K3LL

a. To assist Chief HSE./ Membantu Pimpinan K3LL

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 10 of 29

7. Site HSE Committee Member/ Anggota Komite K3LL di Lapangan

8. HSE Auditor/ Auditor K3LL

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 11 of 29

9. HSE Administrator / Administrator K3LL

IV. PPE REQUIREMENT/ PERSYARATAN ALAT PELINDUNG DIRI

V. DOCUMENTATION AND DATA CONTROL/ DOKUMENTASI DAN MANAJEMEN DATA

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 12 of 29

 Legible/ Dapat dibaca, jelas

- Total Man Hour./ Jam Kerja

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 13 of 29

PT. GUNA TEGUH ABADI PUSRI II-B PROJECT Page 14 of 29

PUSRI II-B PROJECT Page 16

PUSRI II-B PROJECT Page 17

PUSRI II-B PROJECT Page 18

PUSRI II-B PROJECT Page 19

VI.12 Safety Awareness Program

PUSRI II-B PROJECT Page 20

VI.15 PROJECT ENVIRONMENTAL OPERATION PROGRAM

Environmental Activity Procedure / Appendix

PUSRI II-B PROJECT Page 21

Environmental Activity Procedure / Appendix

VII. HSE ACTIVITY PLAN PROJECT