3.8 HSE Requirements For Subcontractor REV 03

SECTION 8
HSE REQUIREMENTS
FOR
SUB CONTRACTORS
Stage-1 Proposal Technical Document
For LUBE OIL BLENDING PLANT
(LOBP) MARUNDA EXPANSION 2.0
TABLE OF CONTENT
PURPOSE ........................................................................................................................... 4
Project Background ....................................................................................................... 4
Scope and Purpose ........................................................................................................ 4
REFERENCE DOCUMENTS ............................................................................................ 5
COMPANY Reference and Standards .......................................................................... 5
International Codes, Standards and Guideline .............................................................. 5
CONTRACTOR Reference........................................................................................... 5
DEFINITION AND ABBREVIATION ............................................................................. 5
Definition ...................................................................................................................... 5
HEALTH, SAFETY AND ENVIRONMENTAL MANAGEMENT EXPECTATION .... 6
HEALTH, SAFETY AND ENVIRONMENTAL REQUIREMENTS .............................. 6
Health, Safety and Environmental Management Roles ................................................ 7
General Requirements ................................................................................................... 7
Health Certificate .......................................................................................................... 8
Training Requirements .................................................................................................. 8
HSE DOCUMENT TO BE PROVIDED DURING BID STAGE ..................................... 9
HSE Governance ........................................................................................................... 9
HSE Plan Requirements ................................................................................................ 9
HSE Performances ...................................................................................................... 10
Subcontractor Pre-Qualification Form (PQF) ............................................................. 10
HSE DOCUMENT TO BE PROVIDED UPON AWARD.............................................. 10
SPECIFIC HSE REQUIREMENTS DURING EXECUTION PHASE ........................... 11
Project HSE Plan ......................................................................................................... 11
Leadership ................................................................................................................... 11
Emergency Preparedness............................................................................................. 11
HSE Personnel Mobilization ....................................................................................... 11
Commencement of the Work ...................................................................................... 12
Execution of the Work ................................................................................................ 13
SUBCONTRACTOR HSE Representative ................................................................. 13
Transportation ............................................................................................................. 13
Permit to Work ............................................................................................................ 14
Equipment and Tools .................................................................................................. 14
8.10.1. Package Requirements ................................................................................................ 14
8.10.2. Electrical Equipment ................................................................................................... 14
8.10.3. Lifting Devices ............................................................................................................ 14
8.10.4. Lifting Appliances ....................................................................................................... 15
8.10.5. Forklift Truck (if applicable)....................................................................................... 15
PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 2 of 25
8.10.6. Special Equipment....................................................................................................... 15

8.10.7. Pressurized Gas Cylinder ............................................................................................ 16
Surveillance and Inspection ........................................................................................ 16
Chemical Safety .......................................................................................................... 16
Material Packaging and Storage .................................................................................. 17
Near miss, Incident & Accident Investigation and Reporting .................................... 17
Environmental Protection ............................................................................................ 18
HSE Study ................................................................................................................... 18
Reporting and Meeting ................................................................................................ 18
HSE Audit ................................................................................................................... 18
HSE Close Out Audit .................................................................................................. 19

PROJECT HSE REQUIREMENTS FOR SUBCONTRACTOR
PURPOSE
Project Background
Shell Lubricants business in Indonesia has demonstrated strong growth the past couple
of years. The original Marunda LOBP design was for 120ML annual capacity based on
a product portfolio of 42 SKUs (capacity based on 3 shifts/day, 290 working days per
year). The LSC Operations team has been able to stretch the asset to run at a rate of
150ML+ (with triple the number of SKUs).The overall objective of this project is to
double the LOBP capacity to 300 ML pa for 203 SKU by Q3 2021. The expansion also
includes Turbine Oils (Turbo) production which requires dedicated facilities due to its
sensitivity to contamination. LUBE OIL BLENDING PLANT (LOBP) MARUNDA
EXPANSION 2.0 (hereunder called Project) will be constructed at the existing Marunda
LOBP that is located at Marunda Centre Block P1 No.1 Bekasi, West JAVA 17212.
Scope and Purpose

Purpose of this document is to define the minimum Health, Safety and Environmental
(HSE) requirements to be followed and applied by SUBCONTRACTOR during the
execution of project.
Remains as obligation for SUBCONTRACTORS to ensure that adequate safety levels
are maintained and environmental impacts are monitored throughout the PROJECT
execution.
This document collects the main HSE requirements for SUBCONTRACTORS, detailed
addressed in various CONTRACTOR specifications and shall not release
SUBCONTRACTORS from his obligation of fully compliance with the HSE
requirements established in the Contract.
SUBCONTRACTORS or VENDORS who perform their subcontracted work at
CONTRACTOR’s SITE BOUNDARIES are contractually obliged to comply with the
requirements described in this document and shall apply CONTRACTOR’s HSE
Management System.
SUBCONTRACTORS or VENDORS who perform their subcontracted work at their
premises (outside SITE BOUNDARIES) may apply their own HSE Management
System, ensuring it’s aligned to these requirements described in this document.
This document is to be considered a living document and it shall be updated by
CONTRACTOR any time additional or modified requirements (agreed with
COMPANY) regarding Health, Safety and Environment control may arise during the
PROJECT execution.

REFERENCE DOCUMENTS
SUBCONTRACTORS shall comply with all applicable national (i.e. where the
execution of the SUBCONTRACTOR’s scope of work is performed) laws and
regulations throughout the performance of the Contract.
Furthermore they shall comply with all the applicable HSE regulations and requirements
contained in the following, but not limited, reference documents.
In case of conflict between the requirement contained in this document with the reference
rules, codes and standards; the following order of priority shall apply:
1. Applicable Indonesian Laws and Regulations;
2. Contractual HSE Documents;
3. COMPANY Reference and Standards;
4. International Codes and standards;
5. CONTRACTOR Reference;
6. Best Practice, Industry Guidelines and Standards.
The reference codes and standards for each activity are listed in the relevant
specifications.
Unless otherwise specified, reference is made to the latest edition of the relevant rules
and standards.
COMPANY Reference and Standards

This plan covers HSE management that applicable for PROJECT where the operation
consists of engineering, procurement and construction.
International Codes, Standards and Guideline

- OHSAS 18001:2007 “Occupational Health and Safety Management System”
- ISO 14001:2015 “Environmental Management System – Requirement with Guidance
for Use”
CONTRACTOR Reference
This plan covers HSE management that applicable for PROJECT where the operation
consists of engineering, procurement and construction.
- Project HSE Plan
DEFINITION AND ABBREVIATION
Definition
Company PT. SHELL INDONESIA
Contractor PT. TRIPATRA ENGINEERS & CONSTRUCTORS

Project LUBE OIL BLENDING PLANT (LOBP) MARUNDA

EXPANSION 2.0
Site Boundaries Perimeter of the working area (not necessarily geographic)
where CONTRACTOR has the responsibility to set HSE
Standard and directly supervise & enforce their application.
Subcontractor General term to define companies providing services to
CONTRACTOR on the basis of a contract, where
CONTRACTOR has the responsibility to set the HSE standards
or to ensure that SUBCONTRACTOR’s HSE Management
System is in line with CONTRACTOR’s HSE Management
System
Vendor General term to define the vendors of good and/or package on
the basis of a contract, where CONTRACTOR doesn’t have the
responsibility to set the HSE standards, nor directly supervising
the activities. The Vendor applies its own HSE Management
System. The CONTRACTOR might audit the contractor or
Vendor HSE Management system in bidding and execution
phases. Whenever the Vendor require to perform part of the
activities foreseen by contract within the CONTRACTOR SITE
BOUNDARIES, it shall be considered as
SUBCONTRACTOR, therefore different HSE Requirements
shall apply.
HEALTH, SAFETY AND ENVIRONMENTAL MANAGEMENT

EXPECTATION
CONTRACTOR Management is committed to achieving the goal of Zero Incidents on
this Project. We recognize that by achieving this goal, our employees will receive the
benefit of a safe and healthful workplace during work execution.
This standard can only be achieved through the determination and dedication of all
involved CONTRACTOR and SUBCONTRACTOR employees.
It is a core value at all operation activities. CONTRACTOR and its SUBCONTRACTOR
shall apply these values throughout all phases of the work.
HEALTH, SAFETY AND ENVIRONMENTAL REQUIREMENTS

The main rules, which govern the CONTRACTOR – SUBCONTRACTOR relationship
on the subject of Health, Safety and Environmental (hereinafter referred to as HSE)
related aspects, are established in the following chapters.

Health, Safety and Environmental Management Roles

SUBCONTRACTOR shall work with CONTRACTOR in its capacity and will support
CONTRACTOR’s desire to positively promote HSE Management.
The requirement for SUBCONTRACTOR to comply with these Guidelines does not alter
SUBCONTRACTOR’s status as an independent SUBCONTRACTOR, does not change
the rights or obligations SUBCONTRACTOR has as an independent contractor, and does
not amend or restrict SUBCONTRACTOR’s liabilities and indemnities provided in this
Contract. All costs associated with compliance are included in the compensation provided
for under this Contract, and SUBCONTRACTOR has no right to claim any additional
payment not specifically provided for in this Contract because of the requirement for
compliance with these Guidelines.
SUBCONTRACTOR shall communicate these Guidelines as part of
SUBCONTRACTOR’s HSE Plan, prepared as appropriate, to its employees prior to
entering project area. SUBCONTRACTOR shall maintain written documentation of its
actions undertaken to fulfill these responsibilities and maintain a copy of such on site.
SUBCONTRACTOR shall provide CONTRACTOR with the name of its
SUBCONTRACTOR Representative who are responsible for HSE protection and
implementation of SUBCONTRACTOR’s Plan in the project.
CONTRACTOR or its representatives may inspect the performance of the Services in the
project at any time to determine compliance with these requirements and prescribe
measures to SUBCONTRACTOR to achieve compliance. SUBCONTRACTOR shall
implement steps to achieve compliance with these requirements.
General Requirements
The general HSE requirements that SUBCONTRACTOR must comply with are the
following, but not limited to:
• SUBCONTRACTOR shall have in place (or adopt CONTRACTOR Policy) and apply
its own HSE Policy that demonstrates its commitment to HSE within all its business
activities and subcontracted scope of work. This Policy statement has to be dated and
signed by the top management.
• SUBCONTRACTOR shall have in place and apply its own HSE Management System
for subcontracted activities, which should describe the elements, principles and
objectives used in implementing its own HSE policy. SUBCONTRACTOR HSE
Management System should include audits of HSE related aspects and shall be aligned
with CONTRACTOR HSE Management System.
• SUBCONTRACTOR is contractually obliged to observe and comply with all current
applicable legislative requirements and additional specific HSE Requirements (if any)
for this scope of work and all other requirements provided by CONTRACTOR.
• SUBCONTRACTOR shall, at its own costs, provide sufficient number of trained
qualified personnel who will responsible to provide guidance and advice regarding
HSE matters.
• SUBCONTRACTOR shall have a ‘Drug and Alcohol Policy’ for the work and
communicate the requirements of the policy to all personnel during the HSE induction.
In addition, SUBCONTRACTOR shall conduct random drug and alcohol test on its
employees throughout the duration of the contract.
• SUBCONTRACTORS shall develop the HSE Risk Assessment related to the
activities to be performed during the execution of the subcontracted scope and
submitted it to CONTRACTOR for approval.
• SUBCONTRACTOR shall maintain the communication with CONTRACTOR
Representatives in dealing with all HSE issues.
• SUBCONTRACTOR shall participate in the activities performed by CONTRACTOR
related to HSE issues, such as: Kick Off Meeting, HSE Regular Meeting, etc.
Health Certificate
• SUBCONTRACTOR must provide for all its personnel utilized during the Services,
a Health Certificate as proof of their fitness for their respective tasks in relation to
the Services. The said Certificate must be presented to CONTRACTOR’s assigned
representative and also given to its HSE Team (Health Coordinator) on site (if any)
prior to their actual involvement in the Services.
• The Certificate shall include those examinations in compliance with national laws
governed by the Country where the Services are to take place.
• The minimum medical examination/check-up are the following:
1. Pre-employment check up
- Blood and urine
- Health certificate from local doctor/hospital
2. Annual check-up
- At minimum held annually as referring to Kepmenaker Per.2/Men/1980
regarding Employee Health Check
• CONTRACTOR’s representative have right to refuse SUBCONTRACTOR’s
personnel if not in possession of valid certification.
• For specific/high risk activity, SUBCONTRACTOR shall provide additional
examination as needed specific to the job.
Training Requirements
• SUBCONTRACTOR working within SITE BOUNDARIES must follow and attend
CONTRACTOR’s employee orientation program, which includes instructions given
to each new employee, regardless of prior experience. The induction shall be given
to employees prior to start work. A record of this training is to be kept and individuals
are to sign on completion, confirming they are fully conversant with the instructions.

• SUBCONTRACTOR’s employees have to be trained to those subjects pertaining to

local realities/threats/HSE risk factors, in compliance with their professional
position, and scheduled so as to provide a sufficient number of First Aid trained
personnel continuously available on site.
• CONTRACTOR shall conduct the required assistance, supervision, checks and
training for the workers capability to ensure the workers are able to proceed with
the work in the safest manner and safest conditions, and as an effort to prevent
accident TPEC has a right on CONTRACTOR risk to refuse any personnel who
is proven not have adequate competency for performing his work.
HSE DOCUMENT TO BE PROVIDED DURING BID STAGE

During Bid Phase, SUBCONTRACTOR is required to provide details of his approach to
HSE. To this aims the following evidence have to be provided together within its offer.
HSE Governance
• SUBCONTRACTOR working within SITE BOUNDARIES must follow and attend
CONTRACTOR’s employee orientation program, which includes instructions given
to each new employee, regardless of prior experience. The induction shall be given
within the first day of reaching the facility. A record of this training is to be kept and
individuals are to sign on completion, confirming they are fully conversant with the
instructions.
• Submit a copy of HSE Policy
• Submit a copy of HSE Management System Manual
• Copy Organization Chart and Project Organization Chart, specifying the number and
the appointment of HSE Personnel
• Provide details of employee’s orientation program and HSE training program.
• Arrangement for provision and upkeep of PPE, both standard issue and that required
for specialized activities
• Provide details of how do you ensure that plant and equipment used within your
premises, sites or other locations by your employees are correctly registered,
controlled and maintained in a safe working condition.
HSE Plan Requirements

• In accordance with activities to be performed, submit your proposal of PROJECT
HSE Plan that is in compliance with this document and HSE local and international
legislation. The HSE Plan shall address at least the following, but not limited to items:
- HSE Objectives
- Project HSE Organization and Responsibilities
- Risk Management
- HSE Training and Competency Program
- Communication System

- Accident/Incident Investigation and Reporting

- Emergency Response Procedure
- HSE Inspection and Audit
- List of HSE Procedures applicable to the scope of work
• Provide details of your Company system for planning, approval and performing HSE
Audits.
• Provide details if the managers and supervisors at all levels, which will plan,
monitor, oversee and carry out the work, received formal HSE training in their
responsibilities with respect to conducting work from HSE requirements standpoint.
HSE Performances
Provide a list of the last 3 (three) years HSE performance statistics within
SUBCONTRACTOR organization. The list should indicate the number of Fatality,
Worked Man-hours, Lost Time Injury (LTI), Lost Time Injury Frequency Rate (LTIFR),
TRIR (Total Recordable Injury Rate) in 1,000,000 worked Man-hours, Restricted Work
Day Cases, Medical Treatment Cases, First Aid Cases, Occupational Health Diseases
and Near-Misses and how the performance is evaluated and action items done as lessons
learned.
Subcontractor Pre-Qualification Form (PQF)

SUBCONTRACTOR shall complete Subcontractor Pre-Qualification Form (PQF) as
provided in Attachment 2. Rating system is implemented in the evaluation of this Pre-
Qualification, with passing grade 85%. Any gap identified from the tender documents
will need mitigation plan complete with target date. If the action closing deemed not
adequate to accommodate the gap, SUBCONTRACTOR will not pass the Pre-
Qualification process.
Attachment 3 is Green Banding Questionnaire from SHELL which pictures the Client
expectation of SHE Management System which will be applied in the Project.
HSE DOCUMENT TO BE PROVIDED UPON AWARD

Upon Contract Award, the SUBCONTRACTOR is required to provide, within 30 (thirty)
days, the following information and supporting documentation:
a. Project HSE Plan dedicated to the subcontracted activities.
b. Specific HSE Risk Assessment covering the subcontracted activities.
c. HSE Procedures, comprising all the appropriate procedures for the subcontracted
activities.
d. Emergency procedures, covering all the emergency situations that could arise from
the specific of the subcontracted activities.
e. Training and competency program, dedicated to the subcontracted activities.

SPECIFIC HSE REQUIREMENTS DURING EXECUTION PHASE
Project HSE Plan

SUBCONTRACTOR shall develop, implement, and maintain its HSE Plan in which
describes specific details as to how it intends to manage HSE throughout all phases of
the work.
Leadership
SUBCONTRACTOR shall encourage all its members to monitor the unsafe acts or
unsafe conditions throughout the course of the work. Where an employee identifies or
observes an unsafe act or situation, work shall be stopped, reported and/or remedied as
appropriate. It is everyone’s right and responsibility to intervene (i.e. SWA Policy) when
safety is being compromised in order to be safe, look after the safety and well-being of
others.
This mechanism establishes the responsibility and authority of any individual to stop
work when the control of HSE risk is not clearly established or understood. In general
terms, the intervention process involves a stop, notify, correct and resume approach for
the resolution of a perceived unsafe condition, act, error, omission, or lack of
understanding that could result in an undesirable event.
Emergency Preparedness
• SUBCONTRACTOR shall be responsible for the development and implementation
of Emergency Response Plan (ERP), ensuring that the contents of ERP are properly
communicated at all workers. In addition, the principal information shall be displayed
in strategic location of the working area and a specific communication flowchart
(between SUBCONTRACTOR and CONTRACTOR) shall be developed and
submitted for approval to CONTRACTOR.
• SUBCONTRACTORS shall appoint adequate trained personnel for the Emergency
and First Aid Teams (i.e. first aid, fire-fighting, confined space rescue, etc.),
according to the applicable local legislation (i.e. 1 First Aider per 25 workers), as
well as performing adequate drills.
HSE Personnel Mobilization

• As per contractual requirements, SUBCONTRACTOR shall communicate their HSE
Plan and any other significant HSE aspects of the Contract to all key personnel
assigned to the job. Progress meetings shall then be used as a formal method of
reviewing HSE implementation.
• SUBCONTRACTOR shall appoint the following qualified personnel for each
worksite:

Requirements
HSE Coordinator 1 (one) qualified HSE Coordinator for each worksite
HSE Officer 1 (one) qualified HSE Officer per 50 workers
First Aider 1 (one) trained First Aider per 25 workers
Commencement of the Work

• SUBCONTRACTOR, before the actual commencement date, shall carry out and
provide to the CONTRACTOR a site survey to assess working, safety, environmental
and health conditions, to identify hazards and to optimize the lay-out of his equipment
and premises.
• SUBCONTRACTOR shall ensure that the Specific HSE Risk Assessment covering
subcontracted activities shall be completed and approved by CONTRACTOR and no
outstanding actions prior to perform the activities.
• SUBCONTRACTOR shall ensure that the site emergency plans are updated and
available.
• SUBCONTRACTOR shall ensure the medical organization and health facilities
provided at the site are able to ensure an effective first aid, medical assistance and
medical emergency response, and that occupational health requirements are compiled
for according to CONTRACTOR HSE Standards.
• SUBCONTRACTOR shall ensure that training certificates for personnel scheduled
to work or appointed for safety critical jobs are made available to the
CONTRACTOR upon request.
• SUBCONTRACTOR shall provide their personnel and visitors with all items of
equipment and clothing necessary for the safe and healthy conduct of the job; training
or induction sessions on their use shall be conducted and competence or awareness
assessed.
• SUBCONTRACTOR shall provide PPE for all SUBCONTRACTOR’s personnel in
accordance with best practice, SNI or other recognized international standards.
• The following Mandatory PPE must be supplied to each worker as a minimum:
- Safety helmet
- Safety shoes
- Safety glasses
- Working clothing (coverall)
- Additional PPE must be available at each work site and issued to specific task
workers such as welders, grinders, painters etc.

Execution of the Work

• SUBCONTRACTOR shall ensure all relevant information regarding HSE aspects of
the worksite and the contracted job are properly communicated to each employees
and handed over from shift to shift and at the time of the periodical reliefs of the
CONTRACTOR’s Representative on site (if any).
• SUBCONTRACTOR shall ensure the permit-to-work system has been established
before any hazardous work and that these works are assigned to qualified personnel
only.
• Throughout the execution of the contracted job, SUBCONTRACTOR shall provide
and maintain in good operating conditions, all safety critical equipment identified in
HSE risk assessment, all lights, guards, marks, signals and fences.
• SUBCONTRACTOR shall be responsible for disposal of all waste (according to the
applicable environmental laws) from any source under his care, custody or control
and generated through the execution of the subcontracted scope, as well as to keep
detailed records of waste generation, transfer and disposal.
SUBCONTRACTOR HSE Representative

To ensure that all applicable CONTRACTOR’s HSE policies and rules are
implemented:
• SUBCONTRACTOR shall ensure HSE Organization & Responsibilities for the
subcontracted scope are defined in their HSE Plan;
• SUBCONTRACTOR shall appoint a full time SUBCONTRACTOR'S HSE
Representative, this requirement will depend on the complexity of the subcontracted
scope;
• He/she shall have clear responsibilities and duties;
• He/she shall be a competent personnel and hold relevant certificates;
• He/she shall coordinate all HSE aspects at SUBCONTRACTOR's activities and
coordinate with CONTRACTOR Representative;
• A training program shall be established for SUBCONTRACTOR’s HSE
representative, if required.
Transportation
• SUBCONTRACTOR shall ensure all relevant information regarding HSE aspects of
the worksite and the contracted job are properly communicated to each employees
and handed over from shift to shift and at the time of the periodical reliefs of the
CONTRACTOR’s Representative on site (if any).
• SUBCONTRACTOR’s HSE Representative shall ensure all personnel who use or is
involved in transportation shall comply with all relevant regulations, policy,
procedure and standards for transportation.

• SUBCONTRACTOR shall ensure all transportations to be used in the PROJECT are

properly assessed and adequate preventative maintenance is scheduled.
Permit to Work
SUBCONTRACTOR may use its Permit to Work system, as well as its HSE
Management System, upon agreement and approval with CONTRACTOR.
Equipment and Tools

• All equipment brought to the SITE BOUNDARIES by SUBCONTRACTOR must
be in a safe operating condition and no potential for environmental damage.
• The equipment or tools, based on the local regulation or industrial best practice, shall
be certified for fit for use.
• CONTRACTOR retains the right to conduct inspection to any equipment without
necessarily giving prior notice.
• SUBCONTRACTOR’s equipment must be operated only by proper licensed and/or
competent Personnel.
• All SUBCONTRACTOR’s equipment shall not exceed noise level of 85 dBA at the
point source. If noise levels below 85 dBA cannot readily be achieved,
SUBCONTRACTORS shall implement controls to reduce personnel exposure to
85dBA or less.
8.10.1. Package Requirements

SUBCONTRACTOR shall ensure all pressure vessels, tanks, containers or any
equipments brought onto any site are in good condition and have appropriate and
current test certificates and comply with the requirements of all relevant legislation,
regulations, Standards or codes of practice.
8.10.2. Electrical Equipment

SUBCONTRACTOR shall ensure all portable electric equipment used is in good
condition and complies with the requirements of all relevant legislation, regulations,
Standards or codes of practice.
8.10.3. Lifting Devices

• SUBCONTRACTOR shall ensure adequate preventative maintenance is scheduled
for all lifting devices to maintain them in a safe condition.
• SUBCONTRACTOR shall ensure all lifting devices under its direct or indirect
control are registered and certified and that all operators (i.e. riggers, banksman)
hold valid certificates of competency.
• CONTRACTOR has right to verify and hold copy of personnel certificate.

• SUBCONTRACTOR shall ensure that all cranes are in good condition and are
given a safety inspection prior to mobilization. The reports shall be forwarded to
CONTRACTOR Representative.
• All identified corrective actions shall be completed prior to mobilization and
supporting documentation attached to the report.
• Logbooks detailing all inspections, maintenance, calibration and repairs are to be
maintained for all lifting devices
8.10.4. Lifting Appliances

• SUBCONTRACTOR shall ensure all lifting appliances have appropriate and load
test certificates, comply with the requirements of all relevant legislation,
regulations, Standards or codes of practice.
• SUBCONTRACTOR shall ensure all lifting appliances are in good condition and
undergone an inspection program. This inspection shall perform prior to
mobilization by a suitably qualified person as well as MIGAS approved inspection.
• All identified corrective actions shall be completed prior to mobilization and
supporting documentation attached to the report.
• SUBCONTRACTOR shall maintain logbooks detailing all inspections,
maintenance, and repairs for all lifting appliances.
8.10.5. Forklift Truck (if applicable)

• SUBCONTRACTOR shall ensure all forklifts to be used in PROJECT are properly
assessed and adequate preventative maintenance is scheduled.
• SUBCONTRACTOR shall ensure all forklift operators hold valid MIGAS or
DEPNAKER certificates of competency. Copies of certification are to be provided
to the CONTRACTOR Representative.
• SUBCONTRACTOR shall maintain logbooks detailing all inspections,
maintenance and repairs for forklifts.
8.10.6. Special Equipment

• SUBCONTRACTOR shall ensure all special equipment’s used in the PROJECT
are properly assessed and adequate preventative maintenance is scheduled.
• SUCONTRACTOR shall ensure all special equipment must be accompanied with
detailed operating and maintenance manual together with the codes and standards
to which the equipment has been designed and built. Any applicable certificate of
the origin or test certificates must also be provided. This type of equipment
includes, but is not limited to:
- All pipework, vessels, valves and any other equipment to be used under
pressure.
- All electrical and other equipment requiring certification for use in hazardous
areas (Classified Areas).
8.10.7. Pressurized Gas Cylinder

• Pressurized gas cylinders or any dangerous substances will not be accepted upon
delivery unless all the stipulations have been met.
• Any delays caused by rejection due to non-compliance will be at
SUBCONTRACTOR's sole cost.
• All pressurized gas cylinders to be used in the agreement are required to comply
with the following:
- Color coded according to content.
- Content printed clearly on each cylinder body
- Proper label shall be attached to the cylinders
- Each valve must be sealed and provided with a protective cap
- Cylinder must be transported upright in custom built cradles
- Copies of cylinder test certificate shall be provided and have at least one (1)
year before expiry (5 years).
- The expiry date of cylinders must be clearly stamped on each cylinder.
- All electrical and other equipment requiring certification for use in hazardous
areas (Classified Areas).
Surveillance and Inspection

• CONTRACTOR and COMPANY reserves the rights to control and monitor
SUBCONTRACTOR’s activities through meetings, surveillance and inspections.
• SUBCONTRACTOR shall allow and assist CONTRACTOR Representatives in:
- Access to any document relevant to contract;
- Access to any work site where contractual activities are carried out;
- Attendance of any meeting, inspection and formal test session relevant to the
contract and conducted under SUBCONTRACTOR’s responsibility
Chemical Safety
• All chemicals or other dangerous substances to be used for the performance of the
Service or delivered to the SITE BOUNDARIES are required to be suitably handled,
sealed, packaged, clear identification of the substance contained and prominent,
hazard warning signs, label and placard. The label shall conform to Globally
Harmonized System (GHS).
• SUBCONTRACTOR shall provide suitable and specific place for chemical
substance.

• SUBCONTRACTORS shall provide the Material Safety Data Sheet (MSDS) for
chemicals or similar products provided by SUBCONTRACTOR in performance of
the Service.
• Handling and storage of dangerous goods shall be in accordance with all relevant
legislation, regulations, Standards or codes of practice.
• All SUBCONTRACTOR’s Personnel who handle these chemicals shall be trained
on the hazards and proper handling of this chemical including personal protective
equipment required to perform the job.
• Chemical, (including fuel, engine oil, chemical cleaning, etc.) storage and handling
shall have a secondary containment adequate for any potential spillages.
• Spill control kit shall be provided close to chemical storage and handling.
• SUBCONTRACTOR shall record the manifest of hazardous waste disposal in
compliance with local regulation
Material Packaging and Storage

• At mobilization SUBCONTRACTOR shall ensure that all equipment and materials
are properly packed, stacked, crated and/or palletized, or provided in certified transit
basket, or pre-slung with certified wire rope slings as necessary for safe and secure
handling of said equipment and materials. Pallets used should be adequately strong
for the load and have no damage.
• Dangerous goods packaging shall comply with applicable regulations for air and
water transportation. It should have proper label and placards.
• Drums to store chemicals or oils shall be in good condition and provided with
secondary containment and stack away from edges of the drilling unit where it can
spill directly into the sea.
• Drums should have properly labels and signs Drums that are punctured, excessively
rusty, dented and or broken rims shall not be used.
Near miss, Incident & Accident Investigation and Reporting

• SUBCONTRACTOR shall implement and adhere to the CONTRACTOR incident
and accident investigation & reporting procedure that will be communicated upon
contract award.
• SUBCONTRACTOR shall notify CONTRACTOR immediately (within 24 hours) of
any HSE incidents that occur in the performance of the services.
• An incident includes any actual or potential instances of Asset damage, Personnel
injury or illness, or Environmental impact (spillage, etc.).
• SUBCONTRACTORS shall implement a system to report, analyze and remedy HSE
related events.
• CONTRACTOR retains the right to conduct independent investigation on serious

accident, i.e. fatality, serious injury, lost time accident, community conflict,
environmental damage or spillage.
Environmental Protection
• SUBCONTRACTORS are required to identify significant environmental aspects and
impacts from its operations and implement controls to eliminate or minimize these
impacts and submit to the CONTRACTOR.
• SUBCONTRACTOR shall develop waste management plan and submit to
CONTRACTOR for approval.
• Waste management plan shall comply with Indonesian regulation on Hazardous
Waste PP 101/2014 and PERMENLH no 14/2013 “Hazardous Waste Symbol and
Labeling”.
• Any liquid waste discharge overboard or to the environment shall meet the
requirements of Indonesian regulation on Wastewater Standards for Oil and Gas and
Geothermal Operations PP No.4/2007.
• SUBCONTRACTOR shall implement secondary containment policy on any point of
potential accidental discharge. If this is not practical, then a method to contain or
prevent accidental discharge to the environment shall be established.
• SUBCONTRACTOR shall assume all liability for the control and removal of
pollution or contamination of the land or water arising from spills, leaks or discharge
of fuels, lubricants, motor oils, paints, coatings, solvents, ballasts, bilge, garbage,
sewage and other material in SUBCONTRACTOR's possession and/or control.
HSE Study
SUBCONTRACTOR shall be available, upon CONTRACTOR’s request, to attend the
relevant HSE Studies (i.e. HAZID, HAZOP, SIL, Risk Assessment, etc.) and they will
be responsible to implement any action assigned to them.
Reporting and Meeting

SUBCONTRACTOR shall provide detailed HSE statistics report (Leading and Lagging
Indicators) by filling Monthly HSE Report (see attachment 1) and submit the report to
CONTRACTOR on monthly basis not later than the 5th working day of the following
month.
HSE Audit
CONTRACTOR reserves right to conduct HSE audits on SUBCONTRACTOR’s
equipment and working procedures at any time or HSE performance going to adverse
trend, upon previous notification given 7 (seven) days in advance. At the time of such
audits of the HSE System, SUBCONTRACTORS will provide to CONTRACTOR any

assistance necessary to allow checking of the used organizational HSE procedures, their
efficiency and adequacy to work methods, machinery, equipment and legal regulations.
HSE Close Out Audit

SUBCONTRACTOR, after completion of the services, shall issue all the
documents/information stated in:
• Contract Documents,
• Technical Documentation and
• HSE Data & Reports
The work cannot be considered as completed until the above has been received.
The report shall include the HSE Statistics, HSE programs and activities during the
Service.

Attachment 1 Monthly Report Form
MONTHLY SHE PERFORMANCE REPORT
MONTHLY PROJECT SHE PERFORMANCE REPORT
Project :
Job No. :
Periode : (cut off date is the last Friday of the reported month)
A. Industrial Injury
This Month Overall Project
No Description Remarks
Jkt Site Sub-Cont Total Jkt Site Sub-Cont Total
1 Fatalities *) (Number)
2 LTI's *) (Number)
3 Days Lost (Day)
4 MTC (Number)
5 RWDC(Number)
6 First Aids (Number)
7 Near Misses (Number)
8 Work Hours (Manhours)
9 LTI R (number / 1 mio mhr)
10 TRIR (number /200 000 mhr)
B. Accident
No Description This Month Total Overall Project Remarks
Jkt Site Sub-Cont Total Jkt Site Sub-Cont Total
1 Equipment Accident
a. Number
b. Operating hour
c. Frequency
= a x 100,000
b
2 Construction Vehicle accident
a. Number
b. Km driven
c. Frequency
= a x 1,000,000
b
3 Support Vehicle accident
a. Number
b. Km driven
c. Frequency
= a x 1,000,000
b
4 Environmental accident
(number)
Note : Construction Vehicle : Heavy transportation vehicle such as, Dumptruck, trailler truck.
Support Vehicle : Employee's transportation, such as minibus (kijang, panther), bus, etc.
Equipment : Excavator, motor grader, vibro, dozer, etc.
C. List of Accident
No Date Type of Accident Project Description

D. Activities
This Overall
Project This Year
Month Project
Induction
 Total Need
% Completed
Other SHE Training
 Total Need
% Completed
Action Management
 Total Action
% Completed
Medical examination
 Total required
% Completed
Inspection and Audit
 Total Finding
% Completed
Housekeeping
% average score
please provide the detail attached to this report
Prepared by, Approved by,
Project SHE Leader Project Manager

Date:…………………………… Date:……………………………
Distribution :
- SHE Corporate
- Project SHE File
Note: the report shall be submitted to corporate on the 3rd day of the following month reported at the latest
Definitions :
A. 1 Work-related fatality
A. 2 Lost Time Injury (LTI) - w here more than one (1) schedule w ork days are lost
A. 3 Total Day lost related to the LTI
A. 4 Medical Treatment Case (MTC) - w here medical/doctor treatments required
A. 5 Restricted Work Day Case (RWDC) - w here employees are assigned w orking duties other than normal to fully recover from a
w orkplace incident
A. 6 First Aid - eg. Treatment administrated by a first and or from first aid kit
A. 7 Near Miss - w here no injuries/property damage occurred but could have if circumstances w ere slightly different
A. 8 The total number or w ork-related hours.
A. 9 Lost time Injury Frequency = (2) multiplied by 1,000,000 divided by (8)
A. 10 Total Recordable Case Frequency = (2) + (4) + (5) multiplied by 200,000 devided by (8)
*) Include the detail of accident chronologist
Attachment 2 Pre-Qualification Form (PQF)
PT WIKA REKAYASA KONSTRUKSI

CIVIL WORKS EXPANSION OF LOBP MARUNDA
Terlampir Kebijakan K3L PT WIKA REKON yang ditanda-tangi oleh Top Manajemen di dalam folder
6.4 Pra-Qualification Form
Terlampir Struktur Organisasi SHE PT WIKA REKON beserta peran dan tanggung jawab di dalam folder
6.4 Pra-Qualification Form
Terlampir SHE Program Proyek Beserta Kantor Pusat PT WIKA REKON di dalam folder 6.4 Pra-
Qualification Form
Terlampir daftar list Prosedur SHE PT WIKA REKON beserta General Safety Rules di dalam folder 6.4
Pra-Qualification Form
Program SHE PT WIKA REKON untuk meningkatkan motivasi pekerja, dengan diadakan SHE AWARD
kepada setiap Proyek, dan dilakukannya Safety Talk untuk meningkatkan SHE Awareness para Pekerja
Terlampir Dokumentasi Orientasi dan Training, Matrix TNA, evaluasi Training dan Modul Training di dalam
folder 6.4 Pra-Qualification Form
Hazard Identification Risk Assessment and Risk Control (HIRARC) dan Risk Control Audit dilakukan untuk
hazard assessment pada PT WRK. Terlampir HIRARC dan Inspeksi Periodik
Fitness for Duty Program dilakukan rutin pada setiap Safety Talk. Terlampir Peraturan Perusahaan PT WIKA
REKON tentang Medical Check Up Rutin, Hasil MCU & Dokumentasi Fitness for Duty Program
Dokumen WRK-QP-HSE-09 Prosedur Investigasi Kecelakaan adalah Prosedur yang menjelaskan tata cara
apabila terjadi insiden, PAK, dan sumber bahaya. Terlampir WRK-QP-HSE-09 Prosedur Investigasi , Flow
Chart tata cara Pelaporan, dan ERP di dalam folder 6.4 Pra-Qualification Form
Checklist Form SHE penilaian untuk Vendor PT WIKA REKON berlaku kepada vendor u/ menyeleksi,
memonitoring & screening. Terlampir Checklist Form SHE Penilaian untuk Vendor
Terlampir Laporan Proyek Selesai (LPS) di dalam folder 6.4 Pra-Qualification Form
Terlampir Safety Performances PT WIKA REKON tahun 2017, 2018 dan 2019 di dalam folder 6.4 Pra-
Qualification Form
Terdapat pada Safety Performances PT WIKA REKON tahun 2017, 2018 dan 2019
Attachment 3 Green Banding Questionnaire

3.8 HSE Requirements For Subcontractor REV 03

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SECTION 8

8.10.6. Special Equipment....................................................................................................... 15

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 3 of 25

PROJECT HSE REQUIREMENTS FOR SUBCONTRACTOR

Scope and Purpose

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 4 of 25

COMPANY Reference and Standards

International Codes, Standards and Guideline

DEFINITION AND ABBREVIATION

Contractor PT. TRIPATRA ENGINEERS & CONSTRUCTORS

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 5 of 25

Project LUBE OIL BLENDING PLANT (LOBP) MARUNDA

HEALTH, SAFETY AND ENVIRONMENTAL MANAGEMENT

HEALTH, SAFETY AND ENVIRONMENTAL REQUIREMENTS

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 6 of 25

Health, Safety and Environmental Management Roles

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 8 of 25

• SUBCONTRACTOR’s employees have to be trained to those subjects pertaining to

HSE DOCUMENT TO BE PROVIDED DURING BID STAGE

HSE Plan Requirements

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 9 of 25

- Accident/Incident Investigation and Reporting

Subcontractor Pre-Qualification Form (PQF)

HSE DOCUMENT TO BE PROVIDED UPON AWARD

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 10 of 25

SPECIFIC HSE REQUIREMENTS DURING EXECUTION PHASE

Project HSE Plan

HSE Personnel Mobilization

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 11 of 25

Commencement of the Work

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 12 of 25

Execution of the Work

SUBCONTRACTOR HSE Representative

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 13 of 25

• SUBCONTRACTOR shall ensure all transportations to be used in the PROJECT are

Equipment and Tools

8.10.1. Package Requirements

8.10.2. Electrical Equipment

8.10.3. Lifting Devices

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 14 of 25

8.10.4. Lifting Appliances

8.10.5. Forklift Truck (if applicable)

8.10.6. Special Equipment

8.10.7. Pressurized Gas Cylinder

Surveillance and Inspection

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 16 of 25

Material Packaging and Storage

Near miss, Incident & Accident Investigation and Reporting

• CONTRACTOR retains the right to conduct independent investigation on serious

Reporting and Meeting

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 18 of 25

HSE Close Out Audit

PT. TRIPATRA ENGINEERS & CONSTRUCTORS | CONFIDENTIAL Page 19 of 25

MONTHLY SHE PERFORMANCE REPORT

MONTHLY PROJECT SHE PERFORMANCE REPORT

No Date Type of Accident Project Description

please provide the detail attached to this report

Prepared by, Approved by,

Project SHE Leader Project Manager

PT WIKA REKAYASA KONSTRUKSI

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