BU/DIV Operation Division STRICTLY

OPU/HCU Petronas Carigali CONFIDENTIAL

DEPT Production

PERFORMANCE PLANNING AND APPRAISAL FORM

(FOR NON EXECUTIVE)

Period of Review: From 0 1 0 1 2 0 1 5 To 3 1 1 2 2 0 1 5

1. PERSONAL PARTICULARS.
Please complete items 1.1 and 1.2

1.1 Personal Particulars

Name : Virnanda Adi Satria Staff No. : P-0393 Salary Grade (SG) :

Date Joined PETRONAS : June 01, Date Joined OPU/HCU : June 01, 2014 Name of Appraiser (Immediate Superior) :
2014
Sutik Hardono / Dwi Satriya N / Rafael W

Name of Appraiser’s Superior:

Yernadi Hari Y / Wimbuh Nawa N

1.2 Position(s) in the current period of review* (starting with current position):

1
 Period Position
Section/Department/OPU/HCU
From To Job Grade (JG) Title
January 01, 2015 December 31, OPERATION / PRODUCTION / PETRONAS Non Executive Production Technician
2015 CARIGALI

IMPORTANT NOTICE FOR EMPLOYEE:

Staff must fill up Item 2 and Item 5 prior to any review discussions with superior during performance planning, mid and year end reviews.

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 2. PERFORMANCE PLANNING AND REVIEW
All ratings are subject to People Development Committee (PDC) and group wide consolidation on overall performance standards

PLANNING REVIEW
PERFORMANCE STANDARDS RESULTS ACHIEVED RATING
OBJECTIVE
INDICATORS Base Stretch 2 Stretch 1
1) HSE: Participate  Submit Unsafe Act ● 1 card per ● 2 cards per ● ≥ 2 cards per  Contribute submit for UA/UC, submitting
actively on HSE – Unsafe cycle trip cycle trip cycle trip
>10 cards during assignment at OGT
Program to Condition Note : January – April (Overseas
achieve zero observation card. Assignment)
incident
 Conduct incident ● 1 times ● 2 times ● 3 times
lesson learn sharing sharing sharing  Attended Incident lesson learn and
sharing knowledge lesson learn lesson learn lesson learn sharing safety awareness in Morning
within 2015 within 2015 within 2015
to improve safety meeting at OGT (Onshore Gas Terminal).
awareness on
Kepodang Team

 Conduct  1 times  1 times  1 times

Emergency Drill emergency emergen cy emergency
drill per month drill per 3 drill per 2  Cant attend due to overseas
for Kepodang assignment (January-April 2015)
weeks weeks
Facilities

 Conduct PTW ● 1 times PTW ● 2 times PTW ● More than 2

audit while audit per audit per times PTW  Contribute PTW audit, 10 PTW have been
cycle trip cycle trip audit per audit since Overseas assignment in OGT
implementation
cycle trip (Onshore Gas Terminal).
Petronas PTW
System on
Offshore work Note : January – April (Overseas
Assignment)

2) Kepodang  Working together ● Submit and ● Submit and ● Submit and  Join inspection in Lamongan Shore Base for
Operation with central inventory inventory inventory material incoming and submit report for
Readiness: maintenance team Master list of Master list of Master list of finding on February 2015.
Commissioni Commissioni Commissioni
Active to compile list of
ng Spare ng Spare ng Spare
participate to spare part, part, 1 year part, 1 year part, 1 year
achieve success commissioning spare part, spare part, spare part,

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execution of spare part and consumable consumable consumable
Kepodang make criticality list part, and part, and part, and
tools include tools include tools include
Hydrcabon
criticality criticality criticality
commissioning assessment assessment assessment
on July 2015 on July 2015 on June 2015 on May 2015
and startup on
August 2015.
 Develop, review ● Procedure ● Procedure ● Procedure  Overseas Assignment from January – April
and finalize sign sign sign 2015
Routine approved by approved by approved by .
July 2015 June 2015 May 2015
Maintenance
Procedure for
Kepodang
Equipment

 Develop record ● Form ● Form ● Form

template to be use approved approved and approved  Participate review procedure for document
during normal and ready to ready to and ready to has been developed operation include:
implement by implement by implement by
operation include: - Reading check list
August 2015 July 2015 June 2015
Reading check list, - Handover form
handover form, - Valve Chek List during start up
record file,
- Lock open – closed
temporary repor
and inventory
record.

 Develop record ● Form ● Form ● Form  Overseas Assignment from January – April
template to be use approved approved and approved 2015.
during and ready to ready to and ready to
implement by implement by implement by
commissioning
July 2015 June 2015 May 2015
activities include:
Commissioning
progress report,
finding punch list
by criticality,
action items and
closing date

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 deadline.

 Follow procedure ● Develop ● Develop ● Develop  Overseas Assignment from January – April
3) Kepodang report, report, report,
and execute 2015.
Development: monitor, and monitor, and monitor, and
preservation
Working record of record of record of
program for
Engagement preservation preservation preservation
Kepodang status in status in daily status in
with PMT
facilities daily basis basis, no daily basis,
later than no later than
20:00 o'clock 18:00 o'clock

 Working with ● No deviation ●. No deviation ●. No deviation

respective as per as per as per
engineer during standard in standard in standard in  Overseas Assignment from January – April
preservation preservation preservation 2015.
preservation
procedure procedure, procedure,
stage on and give at and give
Kepodang least one more than
facilities as per positive input one positive
area to improve input to
responsibility to the quality of improve the
close out any preservation quality of
findings. preservation

 Working with ● No carry over ● No carry over ● No carry over

respective punch list punch list punch list
engineer during during hand during hand during hand  Overseas Assignment from January – April
over over and give over and
commissioning 2015
at least one give more
stage on positive input than one
Kepodang so that hand positive input
facilities as per over running so that hand
area smoothly over running
responsibility to smoothly
close out punch
list.

 Perform review ● Sent back ● Sent back ● Sent back  Overseas Assignment from January – April
for document document document
2015
Commissioning review 1 review 5 review 3
week after days after days after
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 procedure as per submission submission submission
Engineering and
Vendor reference
document.

 Perform review ● Conduct ● Conduct ● Conduct  There are not received of Operation
for Operation weekly twice a week three times a Manual Procedure to review since January
Manual discussion discussion week 2015.
and submit and submit discussion
Procedure
monthly monthly and submit
developed by progress progress monthly
ProWrite as per report report progress
Engineering and report
Vendor reference
document.

4) People  Perform ● Conduct ● Conduct ● Conduct  N/A due to Junior Operator Under INSTEP
Development mentoring weekly twice a week three times a Program from January to april.
and Training program discussion discussion week
and submit and submit discussion
between
monthly monthly and submit
Production progress progress monthly
Operator and report report progress
Junior operator report
to speed up
facilities
understanding

 Attend Training ● Attend ● Attend ● Attend  Completed attend certification for AGT
as schedule on training as training as training as Training in Aryadutha Hotel Jakarta on
Kepodang per per per February 25 -26, 2015.
assignment assignment assignment
Training Matrix
schedule schedule,
 Completed attend Vendor Training for
schedule, and
and apply Dresser Rand in Talavera Office on June 03-
apply the
the 05,2015.
knowledge
gained from knowledge
the training gained from
in the the training  Completed attend Vendor Training for Solar
workplace in the Taurus 70 in Talavera Office on June 08-
workplace, 12,2015.
then conduct
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 sharing of
knowledge
that gained
from the
training to
junior
technicians
for close the
gap

 Complete PECAS ● 100% ● 100% ● 100%  Completed PECAS task when Kepodang
task as per complete of complete of complete of Project in Batam (venue Istana Merah
baseline task given task given task given Mcdermott office).
and close and close gap and close
assessment result
gap as per as per gap as per
planned planned planned
faster than faster than
the the
prescribed prescribed
time (3 time (6
month faster) month
faster)

5) Budget  Active participate ● Variance ● Variance ● Variance  Discussed with supervisor to monitor the
Controlling for budget max +5% max +4% from max +3% budget since Overseas program to give cost
spending in area from plan plan from plan effectively and eficiency.
responsibilities . .
during pre ops
activity to
achieve variance
within tolerance

 Submit TAAF one ● Submission ● Submission ● Submission  Committed to submit TAAF one week prior
week prior form and No form and No form and No bussiness trip and also committed to
business trip and deviation deviation deviation reported expense claim on first trip on duty
claim with claim with claim with after business trip to follow company
submit business
company company company
trip report regulation
regulation regulation regulation
(Expense claim) Submit TAAF Submit TAAF
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 on first trip on & Expense & Expense
duty after Claim faster Claim faster
business trip and than the than the
follow company prescribed prescribed
regulation time (Submit time (Submit
TAAF 10 day TAAF 12 day
prior business prior
trip) business trip)

NOTE

* Rating: 1. Far exceeding the agreed standard 2. Exceeding the agreed standard

3. Meeting the agreed standard 4. Below the agreed standard

3. COMPETENCIES DEMONSTRATION REVIEW

The following is the Rating Scales to assess the extent of each competency demonstrated.
LEVELS FREQUENCY AND THE EXTENT OF BEHAVIOURS BEING DEMONSTRATED

Needs Occasionally demonstrates behaviours in some situations; Has not demonstrated sufficient evidence or demonstrates negative evidence
Development against the definition and behavioural indicators.

Developing Usually demonstrate some of the behaviours in most situations; Demonstrate at least 50% of the behavioural indicators.

Effective Demonstrates most behaviours associated with the competency in all situation; Demonstrates at least 75% of the behavioural indicators.

Distinctive Consistently demonstrates exemplary behaviours associated with the competency in all situation across multiple contexts, is seen as a
role model for this particular competency.

Please read the definition for each of the competencies, you may also refer to the reference guidebook on the Behavioral Competencies for Non-
Executives (BCNE) to understand the behaviors required in the competencies. Rate the staff level of competency according to the rating scales
provided by placing a check (√) in the appropriate box. Cite evidences of specific behaviours that had been observed throughout the period of
review.

REMARKS
COMPETENCY
(Describe the actual behaviours demonstrated’/ observed)
DEMONSTRATION

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 COMPETENCY: DEMONSTRATE
PROFESSIONALISM AND
COMMITMENT

Definition: Behave with high standard

of professionalism and deliver on
commitments.

Needs
Development
Developing

Effective

Distinctive

REMARKS
COMPETENCY DEMONSTRATION (Describe the actual behaviours demonstrated’/ observed)

COMPETENCY: UNDERSTAND THE

BUSINESS AND CUSTOMERS

Definition: Know the business and is

personally accountable for responsibilities
relating to the job, company and customers.

Needs
Development
Developing

Effective

Distinctive

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COMPETENCY: STRIVE FOR
INNOVATIVE SOLUTIONS &
IMPROVEMENTS

Definition: Solve work problems with

innovative solutions and persistently
improve work processes, systems and
approaches.

Needs Development

Developing

Effective

Distinctive

REMARKS
COMPETENCY DEMONSTRATION (Describe the actual behaviours demonstrated’/ observed)

COMPETENCY : DELIVER RESULT

Definition: Demonstrate a strong drive and

focus on achieving high quality results
within the established job standards

Needs
Development
Developing

Effective

Distinctive

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COMPETENCY: COMMUNICATE
EFFECTIVELY

Definition: Express self clearly verbally and

in writing, proactively keep people informed
with the relevant work information

Needs
Development
Developing

Effective

Distinctive

REMARKS
COMPETENCY DEMONSTRATION (Describe the actual behaviours demonstrated’/ observed)

COMPETENCY: RELATE WELL WITH

OTHERS

Definition: Develop and maintain effective

and trusting work relationships with others.

Needs
Development
Developing

Effective

Distinctive

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COMPETENCY: WORK AS A TEAM

Definition: Work together with team

members and strengthen collaboration with
other teams.

Needs
Development
Developing

Effective

Distinctive

REMARKS
COMPETENCY DEMONSTRATION (Describe the actual behaviours demonstrated’/ observed)

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COMPETENCY: COMMIT TO LEARNING
AND DEVELOPMENT

Definition: Actively seek out learning and

development opportunities for enhanced
performance and continuous improvement
of self and others

Needs Development

Developing

Effective

Distinctive

4. OVERALL PERFORMANCE REVIEW

All ratings are subject to PDC and group wide consolidation on overall performance standards

4.1 Performance Rating

For the results achieved for all performance objectives as listed in item 2, please indicate the overall result by placing a tick (√) in the
Result column below:
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 Result
Rating Description
Please tick (√)
1 Consistently achieves rating 1 on most objectives. Achieves rating 2 on the remaining objectives.

2 Consistently achieves rating 2 on most objectives. Achieves rating 3 on the remaining objectives.

3 Achieves rating 3 on most objectives.

4 Achieves rating 4 on most objectives.

4.2 Competencies Rating

For the competencies demonstrated for the job as listed in item 3, please indicate the overall result by placing a tick (√) in the Result
column below:

Result
Rating Description
Please tick (√)
Distinctive: Consistently demonstrates exemplary behaviours associated with the competency in all situation across
1
multiple contexts, is seen as a role model for this particular competency.
Effective: Usually demonstrate some of the behaviours in most situations; Demonstrate at least 75% of the
2
behavioural indicators.
Developing: Usually demonstrate some of the behaviours in most situations; Demonstrate at least 50% of the
3
behavioural indicators.
Needs Development : Occasionally demonstrates behaviours in some situations; Has not demonstrated sufficient
4
evidence or demonstrates negative evidence against the definition and behavioural indicators

5. INVOLVEMENT IN INTERNAL AND EXTERNAL ACTIVITIES

Please indicate involvement in any taskforces, societies, clubs or associations which is not related to job function.

No. Taskforce/Clubs/etc. Roles

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Note:
Involvement in internal and external activities may be leveraged on during PDC discussion to determine Employee’s Overall Final Rating.

6. COMMENTS AND SIGNATURES

6.1 Summary by Appraiser

Please summarize the Overall Performance Review (as per item 4).

……………………………………………………………………………………………………………………………………....

………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………

6.2 Appraiser’s recommendation on Overall Final Rating (OFR)*

Please circle one rating only based on the Performance rating in item 4.1 and Competencies rating in item 4.2. All ratings are subject to
PDC and group wide consolidation on overall performance standards.

EXCEEDS
OUTSTANDING MEETS EXPECTATIONS BELOW EXPECTATIONS
EXPECTATIONS
1 2 3 4
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6.3 Employee’s Comments
Please comment on the appraiser’s recommended Overall Rating and indicate your work and career interest.

…………………………………………………………………………………………………………………………………………...

…………………………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………….

Signature

_________________________ _______________________
Signature of Appraiser Signature of Employee
Name: Name:
Designation: Date:
Date:

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 6.4 Comments by Appraiser’s Superior
Please comment on the review and recommendation.

…………………………………………………………………………………………………………………………………………...

…………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………..

Signature

_____________________________

Signature of Appraiser’s Superior

Name:
Designation:
Date:

*Note:

1. Outstanding : Excellent and high quality work. Consistently far exceeds the expectations of the job.
2. Exceeds Expectations : Highly quality work performance. Clearly exceeds the expectations of the job.
3. Meets Expectations : Satisfactory work performance. Clearly meets the expectations of the job.
4. Below Expectations : Unsatisfactory work performance. Do not meet the minimum expectations of the job.

7. FINAL RATING ON OVERALL PERFORMANCE

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 Decision by People Development Committee (PDC)
The overall performance rating is based on the overall accomplishment of objective, level of competencies achieved and participation in
internal/external activities which contributes towards enhancement of PETRONAS’s image.

EXCEEDS
DECISION BY OUTSTANDING MEETS EXPECTATIONS BELOW EXPECTATIONS
EXPECTATIONS

Div/OPU’s/PDC 1 2 3 4

Signature:

_____________________________ _____________________________
HRM Manager Div/OPU’s PDC Chairman
Name: Name:
Designation: Designation:
Date: Date:

8. DEVELOPMENT PLAN
Please indicate the specific and relevant developmental activities.

No. Developmental activities*

*Developmental activities:

Please specify the exact activities (e.g. to attend training on Value of Integrity VOI in PERMATA in Q2 FY XX/YY or to involve in unit initiative to develop unit’s filing
process for FY XX/YY, etc) to be done to close the areas of development identified

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