PRE-MOB CHECK SHEET

(Subcontractor : PT. … )

Owner
Requirement Approval Fulfilment
No Standard Attachments (A) Status by Remark
JKT JKT or Owner (Y/N)
Subject Description
Site
1 METHOD
1.1 List of Documents Attach ( use Project List of HSE Docs. ) o
1.2 HSSE Plan Refer to Project HSSE Plan (in INDRA & Site) o
1.3 HSSE Procedures Refer to Project HSSE Procedures (in INDRA & Site) o
1.4 Organization Chart Prepare (see sample) with adequate HSE personnel o
1.5 Emergency Response Flow Chart Prepare (Refer to CAP SHE Regulations) o
1.6 Journey Management Plan Prepare o
1.7 HIRAC / JSA + Method Statement Prepare (Refer to JOHAN) o
2. MAN
List of Personnel Competencies Prepare, attach all certificatesas per requiremnts
2.1.a o
(Govermental Certification) (AK3U, SIO, First Aider, Schafolder, Lifting ,, etc)
Prepare (Refer ato CAP Training Matrix 2020),
List of Personnel Competencies
2.1.b attach all attendants list as per training matrix o
(Internal Training)
(Induction)
2.2 List of Personnel MCU attach medical certificates, Health Declaration o
3. MACHINE
List of Equipment Prepare (see sample), attach certificates /
3.1 o
Certification/Inspection inspection results as per requirements
3.2 List of PPE Prepare (see sample) o
3.3 Check List of First Aid Kits Prepare (see sample) o
4. MATERIAL
4.1 List of MSDS Prepare (see sample), attach MSDS o
5. ENVIRONMENT
5.1 List of Waste Bins / Storages Prepare (see sample) o

Note :