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Construction SV Checklists 18 Aug 2022 REV
Construction SV Checklists 18 Aug 2022 REV
Doc. Compliance
Barrier Management Comments / Remarks
Reference YES / NO / NA
Does the task / activity was barricading using the right barricade tape following
TEP specific soft barrier identification such as : Lifting, Scaffolding,
1 Commissioning, Start up etc.?
Apakah aktivitas sudah diberi barikade yang tepat sesuai TEP seperti : Lifting,
scaffolding, Commissioning, Start up, dll.?
Are all the soft barricades completed with proper safety sign with the Warning
word when its been erected?
2
Sudahkah semua soft barikade dilengkapi dengan safety sign yang jelas ketika semua
didirikan?
Does hard barrier for the excavation made of scaffolding or sturdy materials and have the
warning signed available on the barricade?
3
Apakah hard barikade untuk excavation terbuat dari scaffolding dan sudah dilengkapi
dengan tanda bahaya?
Are the barrier installed completed with information of the responsible person of
the activities and include how to contact?
4
Apakah pembatas sudah dilengkapi dengan informasi orang yang bertanggung jawab dan
termasuk bagaimana cara menghubungi?
Does the barrier still in use as protection for activty and completely in good
condition?
5
Apakah pembatas masih dipakai sebagai proteksi untuk aktivitas dan dalam kondisi yang
baik?
Do the workers have a complete WAH checklist when they install barriers for
working at high activity?
6
Sudahkah pekerja melengkapi checklist WAH ketika mereka memasang pembatas untuk
aktivitas bekerja di ketinggian?
Is there an alternative access route provided for the barrier that is installed
blocking public access?
7
Apakah ada rute akses alternatif yang disediakan untuk pembatas yang sudah dipasang
untuk menutup jalur umum?
Are the hard barricades that erected as Fall prevention completed with Toe
board, mid rail and top rails and the height around : 950 mm made of scaffolding tube?
9 Apakah hard barikade yang didirikan untuk mencegah benda jatuh dilengkapi dengan Toe
board, mid rail dan top rails dan dalam ketinggian sekitar : 950 mm terbuat dari
scaffolding tube?
Does radiography barricade complete with safety signs? And are barricade tape provided
with warning light during night shift?
10
Apakah barikade radiography dilengkapi dengan safety sign? Dan pita barikade
dilengkapi dengan warning light pada saat shift malam?
Does safety sign that attached on the barricade details describe about : detail
on any hazards, owner of the barrier, date and time erected, contact of the
owner? And available in 2 languange ( Bahasa indonesia and English ).
11
Apakah tanda keselamatan tertempel di barikade dan menjelaskan : detil dari bahaya,
pemilik barier, tanggal dan waktu didirikan, kontak pemilik? Dan tersedia di 2 bahasa
( Bahasa Indonesia dan Bahasa Inggris )
Was the barricade erected on all sides around the existing hazards?
12
Apakah barikade didirikan di semua area berbahaya?
Does the barricade NOT blocking emergency equipment, such as plant fire
extinguishers, safety showers, etc.? If block do they have permition to the
13 project management and ERT Team ?
Apakah barikade TIDAK menghalangi peralatan darurat, seperti APAR, safety showers
dll.? Seandainya terhalang apakah ada izin dari project management dan tim ERT?
Are the area that being barricade provided with sufficient ilumination for vicibility to
15 acceptable during darkess hours.
Apakah area yang sudah diberi barikade sudah disediakan tanda ketika keadaan gelap?
Are drop zones clearly defined, personnel are outside barriers during lifting?
16
Apakah drop zone sudah jelas diterapkan, personil harus diluar pembatas selama lifting?
RECOMMENDATION
NO ACTION RESPONSIBLE PERSON TARGET DATE
1
2
3
4
5
Location / Lokasi:
Activity / Aktivitas:
Created Openings
Created Openings
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Location / Lokasi:
Activity / Aktivitas:
Excavation Safety
Does the JSA adequately describe the task being carried out
2
hazards and controls?
4 Was a toolbox talk held with the workforce prior to the work s
5 Did the TBT describe the job and reflect the work being carrie
Excavation Safety
describe the task being carried out? Does it identify the relevant
do in an emergency situation?
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Location / Lokasi:
Activity / Aktivitas:
Electrical Safety
14 Are all cable and plug and socket connector in good condition
NO ACTION
1
2
3
Electrical Safety
the activity?
RECOMMEND
ACTION
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Location / Lokasi:
Activity / Aktivitas:
Has the Drop Zone been set up below the working at height a
signed and size was sufficient to allocate the potential bounce
5
Apakah lokasi dibawah area kerja ketinggian telah dibarikade
peringatan dan ukuran yang mencukupi menampung potensi
……………………………………………………….…..)
ACTION
Doc.
Reference
5. Apendix 1.
5.1
5.2
5.2
5.2
5.3
5.4
Comments / Remarks
ENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Location / Lokasi:
Activity / Aktivitas:
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Location / Lokasi:
Activity / Aktivitas:
Risk Assessment
Did the lead talk through the task for the day, emphasizing th
7
personal and process safety hazards?
8 Was the TBT focused, brief and to the point, taking 5-10 mins
Was the team engaged and involved in the TBT? Did the lead
9
questions to encourage participation?
Risk Assessment
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Location / Lokasi:
Activity / Aktivitas:
9 Workers who joint later (if any) are briefed on STARRT card/E
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Location / Lokasi:
Activity / Aktivitas:
For using tripod jack up support, is the tripod jack up are not d
6
soft ground? using proper steel mat or on the concrete floor?
Is the pipe fitter crew are aware on the requirement for ensure
8 are left in the safe condition when leaving it for coffe break or
ask them how they do that to ensure it is in safe condition
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Activity / Aktivitas:
Permit Number / Nomer Permit: The purpose of this Self Verification is to ensure that Work Activity
at the TEP Tangguh Site is executed in line with the Compressed
Name of Verifier / Pemeriksa:
Gas Cylinder Procedure and associated relevant documentation
Persons Interviewed / Orang yang under the CSTS Management System
Diwawancarai:
Sub-Contractor / Subkontraktor:
Has the cylinder received with the good labelled, Colour Coding, Valid
relevant certification? Issued by Ministry Manpower of Republic Indonesia or
any certain valid conformity certificate (Appendix 2 and 3)
Tabung bertekanan dilengkapi dengan Label, Kode warna dan sertifikat yang
1
masih berlaku? Sertifikat yang dikeluarkan oleh Kementrian Ketenagakerjaan 5.1
Indonesia ( appendix 2 & 3 )
Are there protection roof / shed to avoid Compressed Gas Cylinder being
exposed directly to the Sun or any heat source, and is there good ventilation
as well?
3 5.4
Apakah tersedia atap pelindung untuk menghidari tabung gas terpapar
langsung dengan sinar matari atau sumber panas dan mempunyai sirkulasi
udara yang baik?
Does compressed gas cylinder frame attach with proper lifting lugs,
Inspected, color coded and SWL display / Marked?
6 5.1
Apakah keranjang dari tabung gas terpasang titik angkat, dan sudah
diinspeksi, diberikan kode warna dan SWL tersedia?
Are the Pressure regulator maintained with valid certification and manufacture
instruction? - Provide valid certificate on-site.
11 5.9
Apakah regulator tekanan terpasang dan mempunyai sertifikat dan petunjuk
dari pabrikan? (Sertifikat yang sah di lokasi kerja)
Are the Compress Gas Cylinder free from electrical circuit or electrical
cables? (Every Compress Gas Cylinder shall free from any electrical circuit)
13 5.3
Apakah tabung gas terbebas dari jaringan listrik atau kabel listrik? (tabung
gas tidak boleh menyatu dengan kabel listrik )
RECOMMENDATION
NO ACTION RESPONSIBLE PERSON TARGET DATE
1
2
3
4
5
Location / Lokasi:
Activity / Aktivitas:
Painting Coating
Worker use a correct PPE for the job (Respirator, Apron, face
16
google, helmet & gloves right for task) and in good condition
Painting Coating
at work location?
s in place
Doc.
Reference
Comments / Remarks
MMENDATION
RESPONSIBLE PERSON
Compliance
YES / NO / NA
TARGET DATE
Activity / Aktivitas:
Permit Number / Nomer Permit: The purpose of this Self Verification is to ensure that Work
Name of Verifier / Pemeriksa:
Activity at the TEP Tangguh Site is executed in line with the
xxxxx Procedure and associated relevant documentation under
Persons Interviewed / Orang yang the CSTS Management System
Diwawancarai:
Sub-Contractor / Subkontraktor:
Doc. Compliance
Insulation Comments / Remarks
Reference YES / NO / NA
Is everyone is qualified as per tradesman level, e.g Matal fabricator, Wintech opr,
2
Band saw opr, etc.
All Equipment & Tools (Wintech Unit, Band saw, Injection, etc) In good condition
7
and stored with adequate weather protection (eg. Shelter, container, etc)
Pressurized equipment certified giving the maximum safe working pressure and
9
have routine inspection
Housekeeping at area to good standard, free from slip, trip hazards and suitable
10
barriers and signs in place.
Cover area is sufficient for cutting macine Activity (to minimize contamination to
11
other working area)
Correct segregation for hazardous material & waste. Dedicated trash bin
12
available.
Worker use a correct PPE for the job (Respirator, Apron, face shield, safety
16
google, helmet & gloves right for task) and PPE in good order
RECOMMENDATION
NO ACTION RESPONSIBLE PERSON TARGET DATE
1
2
3
4
5