PT. CCT For VPQ and project execution I would like to verify the following.

NO REQUEST STATUS DOCUMENT RECORD PIC TARGET

1 Does your company have a written ADA KEBIJAKAN K3L PROGRAM K3L AK3 / MR 24 MARET 2022
Occupational Health and Safety Program / MANUAL K3L FEBRUARI 2022 KONSULTAN
Manual / Policy? Please submit the copy of
your program, manual and policy.

2 Does your company have a written ADA KEBIJAKAN K3L PROGRAM K3L AK3 / MR 24 MARET 2022
Environmental Program / Manual / Policy? MANUAL K3L FEBRUARI 2022 KONSULTAN
Please submit a copy of your program,
manual and policy.

3 Does your HSSE management systems ADA SERTIFIKAT SERTIFIKAT P.FAROQ 24 MARET 2022
received recognition and/or standard
certification? E.g. ISO 45001 & 14001.
Please submit a copy of your Management
System Certificates (ISO 45001 & 14001)

4 Do you hold regular safety / environmental ADA JADUAL NOTULEN FAROQ 24 MARET 2022
meeting? If yes, please provide the DAFTAR HADIR QODIR
frequency and evidence of minutes of FOTO
meeting.

5 Provide safety / environmental inspections ADA SOP INSPEKSI K3L LAPORAN INSPEKSI KONSULTAN 24 MARET 2022
program? Please submit the inspection JADUAL INSPEKSI BULANAN/HARIAN NAMA PROYEK :
report for reference. SPINDO

6 Provide who are assigned environmental ADA STRUKTUR ORG RECORD STRUKTUR 24 MARET 2022
and safety responsibilities in the K3 MANAJEMEN VISIT ORGANISASI
organization? Specify how many and what JOBDES K3 FOTO PERUSAHAN
percentage of their time is devoted to these
JADUAL
activities?
MANAJEMEN
VISIT
7 Provide list safety awards earned from ADA AWARD AWARD PHILIA 24 MARET 2022
external bodies and clients, and state
nature of awards.

8 Provide occupational health and safety ADA SOP PELATIHAN MATRIKS TRAINING FAROQ 24 MARET 2022
 training program for your employees? If yes, SOP K3L 2022 KONSULTAN
please provide the training program topics KOMUNIKASI PROGRAM TRAINNG
and evidence of training conducted for your
INDUKSI K3L K3L
employees and contractors. E.g. Electrical
Safety, Rigging and Crane Safety, Lockout / KARYAWAN DAN RECORD SAFETY
Tagout, Trenching and Excavation, SUBKONT INDUCTION
Handling of Hazardous Chemicals, PEGAWAU DAN
Emergency Responses, First Aid, Fire PENGENDALIAN SUBKONT
Protection, Scaffolding, Working at height, OPERASI K3 (IK JADUAL SAFETY TALK
Safety Harness and Life Line, use of
K3L)
personal protection equipment’s,
photovoltaic installation, Housekeeping,
environmental protection, security control
measures….
9 Describe key environmental improvement ADA PROGRAM PROGRAM FAROQ 24 MARET 2022
initiatives or programs undertaken (e.g. LINGKUNGAN LINGKUNGAN KONSULTAN
waste minimization/ recycling, energy
conservation, pollution prevention, etc.)

10 Describe security control measure and ADA PANDUAN PANDUAN KEADAAN FAROQ 24 MARET 2022
initiative program implemented in the KEADAAN DARURAT KONSULTAN
workplace. Please provide evidence for DARURAT
verification.

11 Describe the plant & equipment ADA SOP PERALATAN LAPORAN FAROQ 24 MARET 2022
maintenance program or preventive PENGECEKAN
equipment maintenance program BARANG/PERALATAN
implemented in the workplace. Please
provide evidence for verification.

12 Provide list of safe work procedures ADA MASTERLIST IK / SOP K3L KONSULTAN 24 MARET 2022
available.
13 Provide emergency preparedness plan for ADA SOP KESIAGAAN RENCANA KESIAGAAN QODIR 24 MARET 2022
verification. TANGGAP DARURAT
DARURAT DAFTAR ALAT
TANGGAP DARURAT
EMERGENCY DRILL
DOKUMENTASI
LATIHAN APAR
14 Provide incident investigation program for ADA SOP INVESTIGASI LAPORAN NEARMISS FAROQ 24 MARET 2022
 verification. INSIDEN FOTO KONSULTAN
(KECELAKAAN &
NEARMISS)
15 Provide any of your previous project method ADA SOP TANGGAP KEBIJAKAN COVID19 FAROQ 24 MARET 2022
of statement, risk assessment, project DARURAT IZIN KERJA KONSULTAN
health safety security environmental plan COVID19 HIRADC PROYEK
(HSSE), crane lifting plan, Covid-19
SPINDO
management plan, infectious disease
management plan, infringement action plan,
SOP IJIN KERJA
permit to work and roof control measure for SOP ANGKAT
fall prevention. ANGKUT
SOP KETINGGIAN
SOP HYGIENE
PERUSAHAAN
HIRADC
16 Mandatory training requirements, training ADA SOP PELATIHAN MATRIKS KOMPTENSI FAROQ 24 MARET 2022
plan for your employees and training matrix PROGRAM KONSULTAN
for your employees based on roles and PELATIHAN
responsibilities.

17 QA/QC System and capabilities ADA SOP ISO 9001 REKAMAN QODIR 24 MARET 2022
PENGENDALIAN KONSULTAN
MUTU PROYEK :
KURVA S,
PENGENDALIAN
KELUHAN/KOMPLAIN,
LAPORAN PROYEK,
PENGENDALIAN
PRODUK TIDAK
SESUAI