Appendix 1. Doc No. MK3L/SHE/PK12 Rev. 2 Date.

01/01/2020

Impact Assessment Criteria SHE&S (Assessment condition) : Risk and Opportunity

The severity of events that affects injuries Or safety in the work process
Table 1
(Safety)
Level of
Level of Risk Opportunity
Violation Descriptions Safety impact Chance Descriptions Safety Opportunity improvement
[R] to Improve
(O)
0 Irrelevant Unconcerned 0- No correlation 0 Irrelevant Unconcerned 0- No correlation
1 Few With minor injuries at first aid level 1-Near miss or injuries (Fire aid case) 1 Few With minor injuries at first aid level 1-Prevent Near miss or injuries (Fire aid case)
There are injuries that require medical treatment (can effect to There are injuries that require medical treatment (can effect to
3 High 3-injuries (Medical treatment case) 3 High 3-Prevent injuries (Medical treatment case)
LTI) LTI)
9-Prevent injuries (Lost time accident Injuries, Death,
9 Very High Having serious injuries or illnesses, having to stop work, or fatality 9-injuries (Lost time accident Injuries, Death, handicapped ) 9 Very High Having serious injuries or illnesses, having to stop work, or fatality
handicapped )

Table 2 The severity of events that affects health (Occupational Health)

Level of
Level of Risk Opportunity
Violation Descriptions Health impact Chance Descriptions Health Opportunity improvement
[R] to Improve
(O)
0 Irrelevant Unconcerned 0- No correlation 0 Irrelevant Unconcerned 0- No correlation
Substances that have been exposed for a short time (i.e.: cause 1- Irritation or minor reversible to health possible. Temporary or Substances that have been exposed for a short time (i.e.: cause 1- Prevent Irritation or minor reversible to health possible.
1 Few 1 Few
irritation) minor may occur. irritation) Temporary or minor may occur.
Substances that have been exposed for a short time cause of 3- Major injury likely unless prompt action is taken and medical Substances that have been exposed for a short time cause of 3- Prevent Major injury likely unless prompt action is taken and
3 Moderate 3 Moderate
injury and need medical treatment. treatment is given. injury and need medical treatment. medical treatment is given.
Substances that have been exposed for a short time causing 9- Life-threatening, major or permanent damage may result from Substances that have been exposed for a short time causing 9- Prevent Life-threatening, major or permanent damage may
9 High 9 Very High
death or severe injury or carcinogenic. single or repeated overexposures. death or severe injury or carcinogenic. result from single or repeated overexposures.

Table 3 The severity of events that affects environment (Environmental)

Level of
Level of Risk Opportunity
Violation Descriptions Environment impact Chance Descriptions Environment Opportunity improvement
[R] to Improve
(O)
0 No Effect No environmental impact. 0- No impact to environmental 0 No Effect No environmental impact. 0- No impact to environmental
Has a slight environmental impact. Can be modified in a short Has a slight environmental impact. Can be modified in a short
1 Few 1- Impact on site ,Recycle or reused on site, containment 1 Few 1- Prevent Impact on site ,Recycle or reused on site, containment
time within the Site. time within the Site.
Affecting the environment within the Site. Can be solved by using 3- consumes significant natural resources, fuel blending by Affecting the environment within the Site. Can be solved by using 3- Prevent consumes significant natural resources, fuel blending
3 Moderate 3 Moderate
resources within the Site. impact on site resources within the Site. by impact on site

Has a very serious environmental impact. Requires resources and 9- Consumes significant natural resources with long period Has a very serious environmental impact. Requires resources and 9- Prevent Consumes significant natural resources with long
9 High 9 High
long time to fix (affecting the community). treatment, Land fill impact off site or communities impact long time to fix (affecting the community). period treatment, Land fill impact off site or communities impact

Table 4 Security requirements (Security)

Level of
Level of Risk Opportunity
Violation Descriptions Security impact Chance Descriptions Security Opportunity improvement
[R] to Improve
(O)
0 No Effect Not related to security systems 0- No requirement security or not concern security 0 No Effect Not related to security systems 0- No requirement security or not concern security
Relating to the security system. Have a chance of insecurity or Relating to the security system. Have a chance of insecurity or
1 Few 1- capable of or susceptible to property (0 - 50,000,000 IDR) 1 Few 1- Prevent capable of or susceptible to property (0-100,000 THB)
property damaged between 0 - 50,000,000 IDR property damaged between 0 - 50,000,000 IDR
Relating to the security system. Have a chance of insecurity. Have 3- capable of or susceptible to being wounded or hurt, as by a Relating to the security system. Have a chance of insecurity. Have 3- Prevent capable of or susceptible to being wounded or hurt, as
3 Moderate been injured or property damaged between 50,000,000 - weapon: a vulnerable part of the body, knowledge, Property 3 Moderate been injured or property damaged between 50,000,000 - by a weapon: a vulnerable part of the body, knowledge, Property
500,000,000 IDR damage (> 50,000,000 - 500,000,000 IDR) 500,000,000 IDR damage (>100,000-1,000,000 THB)

There is a high security risk. Life threatening or property damaged 9- capable of or susceptible to being wounded or hurt, as by a There is a high security risk. Life threatening or property damaged 9- Prevent capable of or susceptible to being wounded or hurt, as
9 High 9 High
more than 500,000,000 IDR weapon: a vulnerable part of the body (> 500,000,000 IDR) more than 500,000,000 IDR by a weapon: a vulnerable part of the body,(>1,000,000 THB)

Table 5 The level of opportunity for the activity ( Activities Frequency)

Level of
Level of Risk Opportunity
Activities Probability of occurrence Activities Probability of occurrence
[R] to Improve
(O)
There is a chance of being difficult, such as never start in a period of 1 year or There is a chance of being difficult, such as never start in a period of 1 year or
1 1 - Seldom (12 months or longer, rarely) 1 1 - Seldom (12 months or longer, rarely)
more. more.
 There is a low chance of occurrence. For example, the frequency of occurrence
2 2 - Intermittently (1 to 11 months, from time to time)
occurs 1 time in more than 1 month to 1 year.
Have a moderate chance of occurrence, such as the frequency of coming occur
3 3 - Regularly (1/week to 1/month, periodic)
more than 1 week to 1 month
Have a high chance of occurrence, such as the frequency of coming occur more
4 4 - Often (1 per day to 1 per week)
than 1 day to 1 week
There is a high likelihood of occurrence such as the frequency of daily births on
5 5 - Repeatedly (daily, happening again and again)
a regular basis
There is a low chance of occurrence. For example, the frequency of occurrence
2 2 - Intermittently (1 to 11 months, from time to time)
occurs 1 time in more than 1 month to 1 year.
Have a moderate chance of occurrence, such as the frequency of coming occur
3 3 - Regularly (1/week to 1/month, periodic)
more than 1 week to 1 month
Have a high chance of occurrence, such as the frequency of coming occur more
4 4 - Often (1 per day to 1 per week)
than 1 day to 1 week
There is a high likelihood of occurrence such as the frequency of daily births on
5 5 - Repeatedly (daily, happening again and again)
a regular basis
 Table 6 Acceptance value of current control
Index (R) Descriptions Effectiveness Index Index (O) รายละเอียด Effectiveness Index
0.01 Control is very effective. No need to update any more. 0.01 = totally effective (no room for improvement) 0.01 Control is very effective. No need to update any more. 0.01 = totally effective (no room for improvement)

There is a clear control and protection system such as storage system if leaking, There is a clear control and protection system such as storage system if leaking,
emergency fire suspension equipment can be used immediately. Have a good emergency fire suspension equipment can be used immediately. Have a good
0.25 0.25 = effective 0.25 0.25 = effective
working regulation and have regular training review. Conform to the SHE working regulation and have regular training review. Conform to the SHE
standards. standards.

There is control and / or protection system but has not been monitored There is control and / or protection system but has not been monitored
0.5 0.50 = somewhat effective 0.5 0.50 = somewhat effective
systematically. Or does not meet all SHE standards. systematically. Or does not meet all SHE standards.

There is control and / or protection system, but not yet as clear as the system, There is control and / or protection system, but not yet as clear as the system,
such as storage system if leaking, emergency fire suspension equipment not such as storage system if leaking, emergency fire suspension equipment not
0.75 0.75 = limited effectiveness 0.75 0.75 = limited effectiveness
enough to use, not ready. Have work regulations but employees are not enough to use, not ready. Have work regulations but employees are not
reviewed etc. reviewed etc.
1 Without any control system 1.00 = no program to address 1 Without any control system 1.00 = no program to address

Table 7 Hazard Risk Rating (Preliminary aspect analysis)

Rating (R) Score Description Score Rate Rating (O) Score Description Score Rate
Low <10 Slight risk Low <10 Low <10 Minor improvement opportunities Low <10
Medium >10-20 Moderate risk Med 10-20 Medium >10-20 Moderate improvement opportunities Med 10-20
High >20 High Risk High >20 High >20 High improvement opportunities High >20

Additional Considerations*

Regulatory Yes
H, do it
Requirement

No

Business Yes Technically Yes Financial Yes

H, do it
critical feasible cost feasible

No No No

L, needs more
L L
evaluation

Yes = < $100 K

No = > $100 K
Additional assessment (Additional Consideration)

Regulatory requirement Legal requirements and standards of the company associated

Business Critical Affecting the business operations of the company such as having to stop the entire production process or partly when that effect occurs

Technically feasible Possible in engineering and management

Financial cost feasible There is an investment possibility

 SHE & S signifi
Description : SHE&S Significant aspect and Management Plan
Reviewed by Department owner
Approved by QSHEMR

SHE-FM-001-3 SHE&S Significant aspect and Management Plan

Aspect NO. Safety, Health, Environment and Security Impacts Risk (R) /
Opportunity (O)

Aspect
(activities that can interact with employee safety/health,
environment or security)

SSL-12 Crane Operation R

SHE & S significant Aspect and ACTION PLAN
Impact (description)
(any change to the safety/health, environment,
or security; either adverse or beneficial)
potential for employee hit by hook / material.
Material spill
Mitigating Controls
List Current Controls
1. Interlock system (crane still operate when
door open for a little) - less effective.
2. Work Instruction "Crane Operation"
3. Operator Capability (with License) and
Effective Manner
4. Routine crane inspection by certified third
party
PLAN

Date: 05-04-2022
Date: 05-04-2022

SHE&S activities Plan

SHE&S activities Plan and Objective Targets Resp.Person

1. Study (Type of hook, length of Des 2022 Emeraldo

webbing sling, air pressure Anul
recommendation)
2. Provide new hook & webbing sling
 SHE & S Aspect
Dept: Production Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : Production Spv/ Process Engineer / Shift Leader Date :: 01/01/2020
Description Production Process Reviewed by: Site Manager / SHE Manager Date :: 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Activities Frequency
Aspect Impact (description)

Regulatory
Residual

Feasibility

feasibility
Conditions Hazard aspect Considerati Aspect to

Technical
Business
(activities that can Risk (R) / (any change to the Risk Legal & Other

Require

Critical
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls Requirements

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E.

Security
environment or security) beneficial) Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N

Health
(Impact x

Safety

Score
Frequency) Hazard x EI High) High)

SPD-01 Transfer from Reactor to R Potential for employee injury A, E 9 0 0 0 9 3 27 1. Pressure Regulator 0.5 13.5 M Y Y Y Y H H No SHE STD 302
Thinning Tank from explosion as well as 2. PPE (Half face respirator, Safety
(Overdrukken). inhalation exposure from glasses)
solvents odor and dust. 3. WI (MK3L/REP/PK01-IK001)
4. Preventive Maintenance

SPD-02 Filtration (Spoelen) R Leaks on pump gaskets that can A, E 6 3 3 0 12 2 24 1. Pressure Indicator 0.5 12 M Y N Y N H H No SHE STD 302
cause fires. Exposure to solvent 2. Secondary Containment
vapors and exposure to 3. PPE (Half face respirator, Safety
materials that have the potential glasses)
to blister. 4. WI (MK3L/REP/PK01-IK003)
5. Preventive Maintenance
SPD-03 Measurement Bubble R Samples (hot materials) are E 3 3 3 0 9 1 9 1. Fume Hood and LEV 0.5 4.5 L Y N N N H M No SHE STD 312
Tube Viscosity exposed to the hands when 2. PPE (Safety gloves, Safety
pouring into a tablet as well as Glasses, Half face respirator)
inhalation exposure from odor. 3. WI (MK3L/REP/PK01-IK005)

SPD-04 Analysis for C1-Proef and R Exposure to solvent vapors and E 3 6 3 0 12 1 12 1. Fume Hood and LEV 0.5 6 L Y N N N H M No SHE STD 312
Methanol (Decanting) exposure to materials that have 2. PPE (Heat ressistant gloves,
the potential to blister. And also safety glasses, half face respirator)
risk on slip/trip/fall when using 3. WI (MK3L/REP/PK01-IK009)
stairs. 4. Safe Platform (Stairs)

SPD-05 Tapping (from Thinning R Pinch point or hit by drums, A, E 6 3 3 0 12 4 48 1. Check Valve 0.25 12 M Y Y Y N H H No SHE STD 302
Tank) to the Drums elerctrical static hazards, and 2. Emergency STOP Button
Exposure to solvent vapors and 3. Grounding / Bonding
exposure to hot materials that 4. Secondary Containment
have the potential to blister. 5. PPE (Heat ressistant gloves,
safety glasses, half face respirator)
6. WI (MK3L/REP/PK01-IK011)
7. ADM Control: Drums Stacking
Rules & Strap

SPD-06 Loading Solid Material via R Exposure from hot material A 3 3 0 0 6 2 12 1. Lifting using Tools or Teams 0.75 9 L Y N N N H M No SHE STD 302
Open-Hatch vapors to skin and respiratory. 2. PPE (Safety gloves, Safety
And also ergonomic issue when Glasses, Half face respirator)
lifting 25 kgs material. 3. WI (MK3L/REP/PK01-IK013)

SPD-07 Discharging Distillation R Leaks or overspill because of A 0 0 6 0 6 2 12 1. Limit Switch for Level at WWTP 0.25 3 L Y N Y N H M No SHE STD 302
Water to WWTP broken pipe or valve, and also 2. Secondary Containment
impact to odor poluttions. 3. PPE (Safety Glasses, Half face
respirator)
4. WI (MK3L/REP/PK01-IK022)
5. Preventive Maintenance

SPD-08 Filling Tegocat LC 248 to R Hot reactor-surface possible N 6 0 3 0 9 2 18 1. Dissolve with Propylene Glicol 0.5 9 L Y Y Y Y H M No SHE STD 302
Reactor cause to fire. and fill with liquid material
2. Heat Detector and Fire Sprinkler
3. PPE (Safety gloves, Safety
glasses, Hal face respirator)
4. WI (MK3L/REP/PK01-IK028)

SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: Production Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : Production Spv/ Process Engineer / Shift Leader Date :: 01/01/2020
Description Production Process Reviewed by: Site Manager / SHE Manager Date :: 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Activities Frequency
Aspect Impact (description)

Regulatory
Residual

Feasibility

feasibility
Conditions Hazard aspect Considerati Aspect to

Technical
Business
(activities that can Risk (R) / (any change to the Risk Legal & Other

Require

Critical
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls Requirements

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E.

Security
environment or security) beneficial) Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N

Health
(Impact x

Safety

Score
Frequency) Hazard x EI High) High)

SPD-09 Taking FG Sample R Slip/Trip/Fall when bring sample A 3 3 3 0 9 3 27 1. Proper stairs with handle and 0.5 13.5 M Y N N N H H No SHE STD 302
via stairs. Inhalation exposure to anti-slip platforms.
vapors and have the potential to 2. LEV to Scrubber
skin contact. 3. PPE (Heat ressistant gloves,
Safety glasses, Half face respirator)
4. WI (MK3L/REP/PK01-IK030)

SPD-10 Loading Liquid Material to R Pinch point or get hit by IBC A, E 6 3 3 0 12 3 36 1. Grounding / Bonding 0.5 18 M Y Y Y Y H H No SHE STD 302
Liquid Hopper from IBC Tank (or forklift), elerctrical static 2. Secondary Containment
via pipe and diapraghm hazards, and Exposure to 3. PPE (Safety glasses, cloth gloves)
pump. solvent vapors and exposure to 4. WI (MK3L/REP/PK01-IK035)
hot materials that have splash
potential. Also there is a chance
for property damage and
release to the environment.

SPD-11 Start / Stop Cooling. R Overpressure impact to A, E 3 0 3 0 6 3 18 1. Pressure Regulator 0.5 9 L Y N Y N H M No SHE STD 302
explostions. Leaks inside the 2. PPE
reactor also impact material 3. JSERA (MK3L/PRO/PK01-IK041-
release to the environment JS001)
4. WI (MK3L/REP/PK01-IK041)
5. Preventive Maintenance
SPD-12 Changing Filter Paper. R Overpressure impact to A 6 0 0 0 6 1 6 1. Pressure Regulator 0.75 4.5 L Y N N N H M No SHE STD 302
explostions. Pinch point when 2. Safety Relief Valve
screw the bolt. 3. PPE (Safety glasses)
4. WI (MK3L/REP/PK01-IK042)
SPD-13 Loading Raw Materials R Material falling. Also for spill of A 3 3 1 1 8 2 16 1. Guarding for Loading Area (No 0.25 4 L Y Y N N H M No SHE STD 302
from Ground Floor to some materials (i.e.: Gum Rosin) personnel inside while loading).
Reactor Area by can melts when exposed to the 2. PPE
Designated Hoist Crane. heat, impact to slip/trip/fall. 4. WI (MK3L/REP/PK01-IK047)
5. Bi-monthly Checklist
6. Preventive Maintenance

SPD-14 Pallet-Truck Usage R Potential for running over other A 3 3 0 1 7 1 7 1. Provided Training for Pallet- 0.25 1.75 L Y N N N H M No SHE STD 300
employees while operating a Truck User
pallet-truck. 2. Shiftly Checklist
3. Preventive Maintenance
SPD-15 Julabo Waterbath Usage R Electrical shorts because of A 3 0 0 0 3 1 3 1. Grounding Systems 0.5 1.5 L Y N N N H M No SHE STD 312
and Settings. groundings or unproper cable. 2. WI (MK3L/REP/PK01-IK055)
3. Preventive Maintenance
SPD-16 Auto-Burrete Usage and R The tool can break if it is too A, E 3 3 3 0 9 1 9 1. PPE (Safety glasses) 0.5 4.5 L Y N N N H M No SHE STD 312
Settings. forced when mounting the 2. WI (MK3L/REP/PK01-IK057)
burette into a glass bottle. In
addition it can cause spills and
splashes from the solution.
Impact to skin (irritant) or eyes.

SPD-17 Handling Regulated R Potential employee exposure N, A 3 1 1 0 5 5 25 1. Temporary bin (with colour 0.25 6.25 L Y N N N H M No PermenLHK 6 /
Hazardous Wastes of from handling waste streams, category) inside the building, 2021
Production Area (Solid or hazardous waste become one in before transfer to Hazardous
Liquid). general waste, releases to the Waste Storage (TPS-B3).
environment from spills. 2. Follow regulation for disposal.
3. Provide training for operators to
handle waste.

SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: Quality Control Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : QC Spv Date : : 01/01/2020
Description FG & RM Analysis Reviewed by: Site Manager / SHE Manager Date : : 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Regulatory
Activities Frequency
Aspect Impact (description) Residual

Feasibility

feasibility
Hazard aspect Considerati Aspect to

Technical
Conditions
Risk

Require
(activities that can Risk (R) / (any change to the
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E. Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N
environment or security) beneficial)

Security
(Impact x

Health
Safety
Hazard x EI High) High)

Score
Frequency)

SQC-01 Routine Laboratory R High potential fire could impact A, E 3 1 1 0 5 5 25 1. SOP, WI 0.25 6.25 L Y N N N H M No
Operations. Handling of in employee injury and also 2. Proper PPE and Fire Extingusher.
Flammables Liquids and asset damage 3. Flammable Cabinet.
Oxidising Chemicals 4. Ex-Proof Materials.
5. L.E.V.

SQC-02 Replacing Compressed R Leakage of toxic, asphyxiating. N, A 1 1 1 0 3 1 3 1. Move out Liquid Nitrogen to the 0.01 0.03 L Y N N N H M No
Gas Cylinders Used at QC And exposure to employees. openned area with proper shades
Laboratory Cylinder fall cause explotion. 2. Hazard signage
3. Prepare chain to lock the
cylinder
4. Daily checklist

SQC-03 Repair, Maintenance, R Electrical shock and broken A, E 1 1 1 0 3 3 9 1. Electrical grounding 0.25 2.25 L Y N N N H M No
Calibration, Electrical, glassware could make employee 2. Install ELCB (Earth Leakage
Mechanical Lab. injury and wound. Circuit Breaker)
Equipment and Glass 3. Proper PPE
Wares
SQC-04 Retain Sample R Spill, leak while in storage, A, E 1 1 1 0 3 3 9 1. Always kept in specific place 0.25 2.25 L Y N N N H M No
Preparation, Transfer, and generation of chemical waste, with DG warning label
Storage exposure to employees, spill to 2. Standby Spill-Kit
the environment, off-site 3. Fire Extinguisher
disposal of retain samples. 4. Eye Wash Station
5. Proper PPE
SQC-05 QC Laboratory Analysis R Generates Chemical Waste (Spill, N, A, E 1 1 1 0 3 5 15 1. SOP, WI, JSERA PK01 & PK02 0.25 3.75 L Y Y Y N H M No
Activities etc.). Vapour exposure to 2. Waste Control and
employees. Management
3. Proper PPE
SQC-06 Spraying the Coating and R Impact respiratory tract and skin A, E 1 1 0 0 2 3 6 1. Create separate area with 0.01 0.06 L Y N N N H M No
Griding the Resins (Spray irritation to employee proper L.E.V.
Booth) 2. Prepare some dust collector
and/or portable vacuum cleaner
3. Proper PPE

SQC-07 Working at Desk R Ergonomic problem N, A 0 1 0 0 1 4 4 1. The position of the eyes on the 0.01 0.04 L Y N Y N H M No
computer screen, the position of
the hand, and feet must be in
accordance with the standard of
anthropometry comfort.
2. Relaxing with walk.

SHE-FM-001-2 Rev.0
 0 0 0 L Incomplete Incomplete

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE-FM-001-2 Rev.0
SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: Application Laboratorium Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : RND Spv / Lab Technician Date : : 01/01/2020
Description Reviewed by: TS Manager / SHE Manager Date : : 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Regulatory
Activities Frequency
Aspect Impact (description) Residual

Feasibility

feasibility
Hazard aspect Considerati Aspect to

Technical
Conditions
Risk

Require
(activities that can Risk (R) / (any change to the
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E. Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N
environment or security) beneficial)

Security
(Impact x

Health
Safety
Hazard x EI High) High)

Score
Frequency)

SAP-01 Coating Application R High potential fire could impact A, E 1 1 1 0 3 4 12 1. SOP, WI 0.25 3 L Y N N N H M No
Substrates with Paint in employee injury. Vapour 2. Proper PPE and Fire Extingusher.
directly to employee. 3. Flammable Cabinet.
4. Ex-Proof Materials.
5. L.E.V.

SAP-02 Repair, Maintenance, R Electrical shock and broken A, E 1 1 1 0 3 3 9 1. Electrical grounding 0.25 2.25 L Y N N N H M No
Calibration, Electrical, glassware could make employee 2. Install ELCB (Earth Leakage
Mechanical Lab. injury and wound. Circuit Breaker)
Equipment and Glass 3. Proper PPE
Wares
SAP-03 Retain Sample R Spill, leak while in storage, A, E 1 1 1 0 3 3 9 1. Always kept in specific place 0.25 2.25 L Y N N N H M No
Preparation, Transfer, and generation of chemical waste, with DG warning label
Storage exposure to employees, spill to 2. Standby Spill-Kit
the environment, off-site 3. Fire Extinguisher
disposal of retain samples. 4. Eye Wash Station
5. Proper PPE
SAP-04 Application Laboratory R Generates Chemical Waste (Spill, N, A, E 1 1 1 0 3 5 15 1. SOP, WI 0.25 3.75 L Y N N N H M No
Analysis Activities etc.). Vapour exposure to 2. Waste Control and
employees. Management
3. Proper PPE
SAP-05 Spraying the Coating and R Impact respiratory tract and skin A, E 1 1 0 0 2 3 6 1. Create separate area with 0.01 0.06 L Y N N N H M No
Griding the Resins (Spray irritation to employee proper L.E.V.
Booth) 2. Prepare some dust collector
and/or portable vacuum cleaner
3. Proper PPE

SAP-06 Solid / Liquid Waste R Spill, vapour. N, A 1 0 1 0 2 2 4 1. Working Instruction 0.01 0.04 L Y N N N H M No
Disposal (Decanting NR.RND.PK01-IK057
Process from Pail to Drum) 2. Proper PPE
3. Standby Spill-Kit
SAP-07 Cleaning GPC R Exposure to chemicals (direct N, A 0 1 1 0 2 3 6 1. Working Instruction 0.01 0.06 L Y N N N H M No
contact or inhalation) when suck MK3L/RND/PK01-IK048
up THF with the syringe and 2. Proper PPE
removing the hose connection 3. Standby Spill-Kit
between the HPLC and column.
In addition there is potential for
spillage.

SAP-08 Working at Desk R Ergonomic problem N, A 0 1 0 0 1 4 4 1. The position of the eyes on the 0.01 0.04 L Y N N N H M No
computer screen, the position of
the hand, and feet must be in
accordance with the standard of
anthropometry comfort.
2. Relaxing with walk.

SHE-FM-001-2 Rev.0
 0 0 0 L Incomplete Incomplete

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE STD 312

SHE-FM-001-2 Rev.0
SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: Logistic Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : Logistic Lead / RM Team Leader / FG Team Leader Date : : 01/01/2020
Description RM & FG Handling Reviewed by: Supply Chain manager / SHE Manager Date : : 05/04/2022

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Regulatory
Activities Frequency
Aspect Impact (description) Residual

Feasibility

feasibility
Hazard aspect Considerati Aspect to

Technical
Conditions
Risk

Require
(activities that can Risk (R) / (any change to the
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E. Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N
environment or security) beneficial)

Security
(Impact x

Health
Safety
Hazard x EI High) High)

Score
Frequency)

SSL-01 Forklift Operations R Potential for employee injury, E 3 1 1 0 5 5 25 1. Site rules (Traffic Management) 0.25 6.25 L Y N N N H M No
damage to plant property from 2. SHE Standard
unsafe behavior of drivers, 3. Operator Capability (with
release to the environment in License) and Effective Manner
the event of an incident. 4. Shiftly Checklist
5. Preventive Maintenance
6. PPE & Safety Belt
7. SHE Training

SSL-02 Loading Bridge (Loading R Potential forklifts / people / A, E 3 0 1 0 4 3 12 1. Ensure that the loading bridge is 0.25 3 L Y N N N H M No
Ramp) Usage goods fall when loading or attached and locked (and also
unloading, can cause serious blocked).
injury or product damage. 2. JSERA (MK3L/LOG/PK01-IK001-
Another potential is a forklift JS001)
crashing into people or other 3. WI (MK3L/LOG/PK01-IK001)
objects. 4. Preventive Maintenance
5. PPE & Safety Belt
6. SHE Training

SSL-03 Weighing Bridge Usage R Potential Tanker can hit property A 1 0 1 0 2 4 8 1. Ensure that the weighbridge 0.25 2 L Y N N N H M No
or people can cause serious clear from people when in used.
injury. The area is also have a 2. JSERA (MK3L/LOG/PK01-IK003-
slight potential in slip/trip/fall. JS001)
Tanker also have a leak-risk 3. WI (MK3L/LOG/PK01-IK003)
especially on valve. 4. Physical check by Security Team
at entrance
5. Proper signage and warning
light
6. SHE Training

SSL-04 Entry and Exit Control of R Potential loss for Site properties A 0 0 0 3 3 5 15 1. Gate pass permit by Security 0.25 3.75 L Y N N N H M No
Products and Raw Material and assets, products, RM's, and Team
customer satisfaction. 2. Delivery note and Invoicing
documents
3. WI (MK3L/LOG/PK01-IKXXXX)
SSL-05 Handling Peroxyde R Strong oxidizer (moderate E 6 3 1 0 10 1 10 1. Specific Cold-Storage Room (16 0.25 2.5 L Y N N N H M No
oxidizer in lower degree C) with Fire System
concentrations). Can be 2. Eyewash Station
corrosive to the eyes, skin, and 3. JSERA (MK3L/LOG/PK01-IK004-
inhalation. This chemical can JS001)
cause burns to the skin and 4. WI (MK3L/LOG/PK01-IK004)
damage to the eyes.

SHE-FM-001-2 Rev.0
 SSL-06 Handling Flammable R Potential for employee injury A 6 3 1 0 10 5 50 1. SHE Standard 0.25 12.5 M Y N N N H H Yes
and/or Combustible Liquid from chemical exposure to skin, 2. Fire Sprinkler Systems
eyes, and respiratory system. 3. Fire Extinguishers
VOC release to the environment, 4. Ventilation Systems
chemical spill, explosions, and 5. Secondary Containment
fire. 6. Grounding Systems
7. Ex. Proof for Equipment
8. JSERA (MK3L/LOG/PK01-IK005-
JS001)
9. WI (MK3L/LOG/PK01-IK005)
10. Preventive Maintenance
11. PPE

SSL-07 RM Preparation to be R Potential flammable hazard, E 3 1 1 0 5 5 25 1. Use handpump cabinet 0.25 6.25 L Y N N N H M Yes
Batches Arrangement inhalation hazard, chemical 2. Secondary Containment
exposure, splash when fall and 3. Fire Extinguisher
releases to the environment 4. JSERA (MK3L/LOG/PK03-IK008-
from spills. JS001)
5. WI (MK3L/LOG/PK03-IK008)
6. PPE
7. SHE Training

SSL-08 Level Checking for RM or R Impact to slip/trip/fall when A 3 3 0 0 6 3 18 1. Fall Arrester 0.25 4.5 L Y N N N H M No
FG Buffer-Tanks operating around the hatch. 2. Guarding Fence
Vapor resulting in shortness of 3. JSERA (MK3L/LOG/PK02-IK015-
breath, eye irritation, and JS001)
dizziness. 4. WI (MK3L/LOG/PK02-IK015)
5. Preventive Maintenance
6. PPE
SSL-09 Manual Crashing Gum- R The body parts (hands, head, A 3 3 1 0 7 2 14 1. Cover for Material before 0.25 3.5 L Y N N N H M No
Rosin to Small Pieces etc.) are hit / scratched by the manual crashing.
equipment. Gum-Rosin flakes or 2. PPE
dust spread around the area and 3. JSERA (MK3L/LOG/PK02-IK005-
can get flicker in the eyes. JS001)
4. WI (MK3L/LOG/PK02-IK005)
SSL-10 Product Delivery R Failure to properly secure the E 1 0 1 0 2 5 10 1. Training inspection of 0.25 2.5 L Y N N N H M No
drum products could result in a packaging
spill or injury to an individual. 2. Blocking and bracing guideline
3.Truck driver training
4. Check from Security Team

SSL-11 3rd Party WH R Product loss and impact to A 1 1 1 1 4 5 20 1. Regular SHEQ Audit 0.25 5 L Y N N N H M No
production planning. Potential 2. Delivery Note and Invoicing
to packaging damage from Documents
unsafe behavior of driver. 3. WH Rules (Gate Pass Permit)
Release to the environment. 4. Follow Allnex's Minimum
Requirements.

SSL-12 Crane Operations R potential for employee hit by A 6 1 1 0 8 5 40 1. Interlock system 0.75 30 H Y N N N H HH Yes
hook / material. 2. Work Instruction "Crane
Material spill Operation"
3. Operator Capability (with
License) and Effective Manner
4. Routine crane inspection by
certified third party

SSL-13 Open yellow gate during R potential for employe fall from A 3 0 0 0 3 4 12 1. Work instructions "picker cart 0.5 6 L N N N N L L No
picker cart operations picker cart operation"

SSL-14 Using stairs on access R Potential for slips and falls A 3 0 0 0 3 4 12 1. Work instructions "picker cart 0.5 6 L N N N N L L No
platform operation"

SHE-FM-001-2 Rev.0
 SSL-15 Potential electrostatic due R Explosion, Chemical exposure, A 3 1 1 0 5 3 15 1. Regular monitoring and 0.25 3.75 L Y N N N H M No
to grounding/bounding injury checking of grounding.
failure 2. Work Instruction relating to
activities that require grounding

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

SHE std. 307

Permenaker 8/2020

SHE STD 113

SHE STD 302

SHE-FM-001-2 Rev.0
 SHE STD 302

SHE STD 113

Permenaker 8/2020

SHE-FM-001-2 Rev.0
SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: Human Resources & General Affair Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : HR Staff Date : : 01/01/2020
Description Reviewed by: HR Manager / SHE Manager Date : : 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index
Activities Frequency

Financial Cost
Aspect Impact (description) Potential Preliminary Additional Significant

Regulatory
Conditions Residual Ability to

Feasibility

feasibility
Hazard aspect Consideratio Aspect

Technical
(activities that can Risk (R) / (any change to the
Aspect No. (Normal (N), Risk influent

Require
Environment

(EI)
interact with employee Opportunity safety/health, environment, or Rating List Current Controls analysis ns*
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E.

Security
environment or security) beneficial)

Health
Safety
(Impact x Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N

Score
Frequency) Hazard x EI High) High)
SHR-01 Off-Job Safety (Travel R Injury to employees due to N 9 0 0 0 9 4 36 1. Defensive Driving / Riding 0.5 18 M Y N N N H M No
From/To the Site) accidents. Training
2. No Cellphone Use Training
3. Seat Belt Use / Helmet Click
SHR-02 Cleaning Toilet R Injury to employees due to N 1 1 1 0 3 1 3 1. Proper PPE 0.25 0.75 L N N N N H M No
accidents impact from the 2. Safety Talk
chemicals or similar with it.
SHR-03 Clean and Polish Floor and R Injury to employees due to N 3 0 0 0 3 1 3 1. Proper PPE 0.25 0.75 L N N N N H M No
Windows accidents impact from the 2. Safety Talk
chemicals. Incidents from 3. Checking the equipment (cable,
electrical cable, stairs, etc. stairs, etc.)
SHR-04 Gardening R Injury to employees due to N 6 0 0 0 6 1 6 1. Proper PPE 0.25 1.5 L N N N N H M No
accidents slip / trip / fall or from 2. Regular Checking the
the mechanical equipment (lawn Equipment
mower, scissors, etc.) 3. Safeworks Training

SHR-05 Working Desks R Strains, repetitive injuries, OSHA N 3 3 0 0 6 5 30 1. Ergonomics training and 0.25 7.5 L N N N N H M No
recordable and lost time injuries. assessments of work stations
2. Routine stretching and walking

SHR-06 Cooking at Kitchen R Employee injury because of fire / N 3 0 9 0 12 1 12 1. Training Safe Practice 0.25 3 L N N N N H M No
hot water / etc. 2. Checking Hoses Gas Properly
(equipped with Flashback
Arrester).
SHR-07 Employee Recruitment R Potentail of accidents and N 0 0 0 1 1 1 1 1. Employee Recruitment and 0.25 0.25 L Y N N N H M No
and Hiring incidents. Hiring Process (Capability Check +
Gap Analysis)
2. Safety Induction Training before
Started Work and Into the Site
3. MoC

SHR-08 Evaluation and O Positive impact : improve N 3 1 3 1 8 3 24 SHE Training Programm 0.25 6 L Y N N N H M No
effectiveness of safety employee knowledge
training
SHR-09 Evaluation of effectiveness O Positive impact : improve N 3 0 0 0 3 2 6 Training Procedure from HR 0.25 1.5 L Y N N N H M No
safety training Behaviour based safety for
employee
SHR-10 SHE Induction O Positive impact : improve safety N 3 3 3 3 12 5 60 SHE induction
awareness of employee, prevent
injury & protect environmental

SHR-11 Overtime R Injury due to accidents N 3 3 3 0 9 4 36 Limit overtime 4 hours per day 0.25 9 L Y N N N L L No
and not exceed 4 consecutive
day

SHE-FM-001-2 Rev.0
 SHR-12 Harrasment & Bullying R Mental Health for employee N 3 3 3 0 9 1 9 HR Programm (OPTUM) for 0.01 0.09 L Y N N N H M No
employee conseling

SHR-13 Pragnancy R Chemical Exposure N 3 3 3 0 9 1 9 Follow SHE513 : Pregnancy and 0.01 0.09 L Y N N N H M No
work

SHR-14 Work load R Fatigue cause accident N 3 3 3 0 9 1 9 Maximum overtime 4hours 0.25 2.25 L Y N N N H M No

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

SHE STD 106

SHE STD 106

SHE STD 106

SHE STD 109

PP 35/2021

SHE-FM-001-2 Rev.0
 SHE STD 520

SHE STD 513

PP 35/2021

SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: WWTP Plant Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : Sr SHE Coordinator / SHE Operator Date : : 01/01/2020
Description WWTP Process Reviewed by: SHE Manager Date : : 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Regulatory
Activities Frequency
Aspect Impact (description) Residual

Feasibility

feasibility
Hazard aspect Considerati Aspect to

Technical
Conditions
Risk

Require
(activities that can Risk (R) / (any change to the
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E. Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N
environment or security) beneficial)

Security
(Impact x

Health
Safety
Hazard x EI High) High)

Score
Frequency)

SWT-01 Drain Solvent from R Potential for slip, trip, fall when N, A, E 6 3 3 0 12 2 24 1. WI & JSERA MK3L/WWT/PK01- 0.25 6 L N N N N H M No
Separator Tank climb up to open the valve; IK002
Another potential for hands to 2. Fall Arrester
be exposed, inhaled and eyes 3. Proper PPE
splashed solvent when opening 4. Secondary Containment
the valve; At drain time, 5. Grounding & Bonding
potential of IBC falls, spills occur, 6. 3-Point Contact at Stairs
the contents of the drum
overflow, inhale, exposure to the
skin and splashes of eyes;
Potential static-electrical shock.

SWT-02 Arrangement of Water R Fall when stepping beside the N, A 3 1 0 0 4 2 8 1. WI & JSERA MK3L/WWT/PK 01- 0.25 2 L N N N N H M No
Circulation in Aeration dikewall; Slip, trip, fall when IK 003
Tank and Bioclarifier Tank. climb up to checking. 2. Fall Arrester
3. Proper PPE
4. 3-Point Contact at Stairs
SWT-03 Operating and Cleaning R Using hydraulic pump if the N, A 3 1 0 0 4 2 8 1. WI & JSERA MK3L/WWT/PK 01- 0.25 2 L N N N N H M No
Filter-Press. pressure exceeds the tool limit IK 005
will break and hit the operator; 2. Using marking (signage) make
Potential to slip when climbing sure the pressure does not exceed
stairs; When cleaning the cake / 400 bar
sludge there is the potential for 3. Proper PPE
pinch point and exposure to 4. 3-Point Contact at Stairs
hazardous substances directly to
the breath.

SWT-04 Batching Process. R Potential head hit the wall when N, A 3 1 0 0 4 3 12 1. WI & JSERA MK3L/WWT/PK01- 0.5 6 L N N N N H M No
checking the bottom valve tank; IK001
Splash and expose from 2. Proper PPE
chemical batch.
SWT-05 Preparing Carbon Active. R Inserting activated carbon N, A 3 3 0 0 6 2 12 1. WI & JSERA MK3L/WWT/PK 01- 0.25 3 L N N N N H M No
powder into the dosing tank can IK010
potentially inhale and can 2. Using good (wide enough)
interfere with breathing; Besides platform with handrail
that it can potentially slip / trip / 3. Proper PPE
fall.
SWT-06 Checking pH at Discharge R Potential for slipping because N, A 3 1 0 0 4 4 16 1. WI & JSERA MK3L/WWT/PK 01- 0.25 4 L Y N N N H M No
Tank the floor is wet when taking IK010
samples; The sound of the 2. Administration Control (signage
blower is too loud resulting in and marking)
hearing loss. 3. Proper PPE

SHE-FM-001-2 Rev.0
 SWT-07 Transfer Water to SIER R When checking the water level, N, A, E 6 1 0 0 7 4 28 1. WI & JSERA MK3L/WWT/PK 01- 0.25 7 L Y N N N H M No
using stairs has the potential to IK010
slip / trip / fall; When taking 2. Administration Control (signage
samples from T12, the potential and marking)
of falling into the pit (drowning). 3. 3-Point Contact at Stairs
4. Proper PPE
5. Prepare a Life-Buoy (floating
device) for emergency situation
6. Using platform with proper
hand-rail

0 0 0 0 L Incomplete Incomplete

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

Waste Water Reg

SIER/2016

SHE-FM-001-2 Rev.0
 Waste Water Reg
SIER/2016

SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: Hazardous Waste Storage Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : Sr SHE Coordinator / SHE Operator Date : : 01/01/2020
Description Hazardous Waste Handling Reviewed by: SHE Manager Date : : 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Regulatory
Activities Frequency
Aspect Impact (description) Residual

Feasibility

feasibility
Hazard aspect Considerati Aspect to

Technical
Conditions
Risk

Require
(activities that can Risk (R) / (any change to the
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E. Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N
environment or security) beneficial)

Security
(Impact x

Health
Safety
Hazard x EI High) High)

Score
Frequency)

SHW-01 Forklift Operations R Potential for employee injury, A, E 3 1 1 0 5 5 25 1. Site rules (Traffic Management) 0.25 6.25 L Y N N N H M No
damage to plant property from 2. SHE Standard
unsafe behavior of drivers, 3. Operator Capability (with
release to the environment in License) and Effective Manner
the event of an incident. 4. Shiftly Checklist
5. Preventive Maintenance
6. PPE & Safety Belt
7. SHE Training

SHW-02 Loading Hazardous Waste R Potential forklifts / people / A, E 3 0 1 0 4 4 16 1. Ensure that every people at 0.5 8 L Y N N N H M No
Material (Solid / Liquids) material fall when loading, can truck using the Full Body Harness
cause serious injury or damage; attached to Fall Arrester.
Another potential is a forklift 2. PPE & Safety Belt
crashing into people or other 3. SHE Training
objects; Potential slip / trip / fall
for every helper above the truck.

SHW-03 Exit Control of Hazardous R Potential unproper dump-truck A 0 0 1 6 7 5 35 1. Gate pass permit by Security 0.25 8.75 L Y N N N H M No
Waste Material (leakage, etc.); Expired license; Team
Another potential is no-manifest 2. Vehicle checking (and
inside the trucking. documents) before entry

0 0 0 L Incomplete Incomplete

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

SHE std. 307

PP RI 22/2021

PP RI 22/2021

SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: SHE Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : Sr SHE Coordinator / SHE Operator Date : : 01/01/2020
Description Emergency Response Reviewed by: SHE Manager Date : : 01/01/2020

Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Regulatory
Activities Frequency
Aspect Impact (description) Residual

Feasibility

feasibility
Hazard aspect Considerati Aspect to

Technical
Conditions
Risk

Require
(activities that can Risk (R) / (any change to the
Aspect No. (Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E. Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N
environment or security) beneficial)

Security
(Impact x

Health
Safety
Hazard x EI High) High)

Score
Frequency)

SER-01 Community O Positive impact : Community N 3 0 3 0 6 2 12 Evacuation Drill periodically 0.5 6 L Y N N N H M No

communication and CSR awareness and understanding
program beetween community and
industry less than adequate

SER-02 Responding to chemical R Potential chemical exposure to E 3 3 3 0 9 2 18 1. Emergency Response Plan 0.25 4.5 L Y N N N H M No
release emergencies or fire employees responding to the Training
release, injury to skin, eyes, and 2. PPE
respiratory system; release to
the environment

SER-03 Responding to R Potential unproper dump-truck A 0 0 1 6 7 5 35 1. Gate pass permit by Security 0.25 8.75 L Y N N N H M No
transportation spill (leakage, etc.); Expired license; Team
Another potential is no-manifest 2. Vehicle checking (and
inside the trucking. documents) before entry

SER-04 Responding to natural R Risk of injury if employees do E 3 3 3 0 9 1 9 1. Evacuation drill 0.25 2.25 L Y N N N H M No
disaster (floods, not follow emergency plans 2. Emergency plans procedure
earthquake) procedure

SER-05 Unsafe action & Unsafe R Potential for employee injury A 3 3 3 0 9 1 9 1. 5S 0.25 2.25 L Y N N N H M No
condition from hot resin exposure to skin, 2. SAFE Program
eyes, and respiratory system,
3. VSL
release to the environment, hot
resins spill.

SHE-FM-001-2 Rev.0
 SER-06 Investigations and actions R Potential recurrence if improper A,E 3 3 3 0 9 1 9 1.UL360 system 0.25 2.25 L Y N N N H M No
identify its root causes and 2.Input from investigator team
actions..

SER-07 Investigations and actions O Improvement program to A,E 3 3 3 0 9 1 9 1.CIRS system 0.25 2.25 L Y N N N H M No
prevent accident 2.Input from investigator team

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

SHE STD 112

SHE STD 110 & 112

Permenaker
187/1999

SHE STD 110 & 112

SHE STD 110 & 112

SHE-FM-001-2 Rev.0
 SHE STD 105

SHE STD 105

SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: Maintenance Ref. no : MK3L/SHE/PK12-FR001 Revision :1 Aspect analysis team : Maintenance Spv Date : : 31-08-2022
Description Maintenance Activity Reviewed by: SHE Manager / Site Manager Addit Date : : 31-08-2022
Safety, Health, ional
Significant
Environment and Mitigating Controls Consi
Aspect
Security Impacts derat
Aspect Impact (description) Regu Finan
Conditions Activi ions* Busin Tech
(activities that can Risk (R) / (any change to the Envir Potential Effective Preliminary lator cial Additional
(Normal (N), Safet Healt Secu ties Residual ess nical Ability to
interact with employee Opportunity safety/health, environment, or onme Score Hazard List Current Controls ness aspect y Cost Consideratio
Aspect NO. Abnormal (A), y h rity Frequ Risk Critic Feasi influent
safety/health, (O) security; either adverse or nt Rating Index (EI) analysis Requ feasi ns*
Emergency E. ency al bility
environment or security) beneficial) ire bility
(Impact x Potential (Low, Med, (Low, Med,
Y/N Y/N Y/N Y/N (Low,High) Y/N
Frequency) Hazard x EI High) High)
SMT-01 N 3 1 1 0 5 3 15 0.25 3.75 L Y N N N H M No

1. Replace damaged guards because if an

abrasive wheel breaks while rotating
1. A short circuit causes an electric
2. Make a guard for sparks and guard from
shock even to death
a rotating grinding stone
2. Grinding stones break, faults hit
3. Wear safety glasses or googles, or a face
the operator and cause intermediate
shield. Gloves, aprons, metatarsal safety
Operating Grinding R to serious injuries and even
boots, hearing protection, and respiratory
accidents
protection may be required, depending on
3. Sparks of grinding sparks can
the work
cause minor injuries in skin, eyes,
4. Make sure the work area is clear of
can lead to fire hazard or accident
flammable materials and that combustible
dust is not allowed to accumulate.

SMT-02 R N 3 1 0 0 4 3 12 1. Installation of guards for drilling 0.25 3 L Y N N N H M No

Operating Drilling
2. Training manual operation of electric
1. The rest of the grams of objects
drill
cause the fingers to be slashed and
3. use safety glass, face shield and cloth
bleed, if it exposure to the eyes can
gloves
affected to blindness
4. Do not leave the work area before the
2. After drilling, make sure the
grinding stone has completely stopped (the
electric drill not connected in
rest of the rotation)
electrical source because it can
5. Remove chips with a brush, never by
cause hands to be cut, slashed and
hand
bleeding if suddenly operate

SMT-03 Operating Welding R 1. Welding fumes exposures can N 3 1 0 0 4 3 12 1. Welding in open space 0.25 3 L Y N N N H M No
causes irritation and lead to 2. Welding helmet, hand shield, or goggles,
shortness of breath Fire/Flame resistant clothing and aprons
2. Physical Hazards : Physical 3. Respirators
hazards that can cause burns, eye 4. Keep a suitable Class ABC fire
damage, cuts, and crushed toes and extinguisher nearby while welding. Make
fingers are ever-present when sure the extinguisher gauge is full. If an
welding extinguisher is not available, be sure to
3. Exposure to Fumes and Gases : have access to fire hoses, sand buckets, or
Overexposure to welding fumes other equipment that houses a fire.
and gases can cause severe health 5. If welding within 35 feet of flammable
problems like respiratory illnesses, materials, put a piece of sheet metal or fire-
cancer, and impaired speech and resistant blanket over the flammable
movement material and have a fire watcher nearby to
4. Electric Shock : The sudden keep track of sparks.
discharge of electricity to the
human body can cause serious
injury and even death
5. Fire and Explosion

SHE-FM-001-2 Rev.0
 SMT-04 Operating Generator R 1. Electric shocks and elctrocution N 1 1 0 0 2 2 4 1. Never attach a generator directly to the 0.25 1 L Y Y Y Y H M No
due to the generator turning on electrical system of a structure
immediately during a power outage 2. Do LOTO on the ATS selector, unplug
2. Fires from improperly refueling a the generator switch key and panel housing
generator or key from the ATS panel so as not to
inappropriately storing the fuel for change the selector from unauthorized
a generator. people.
3. Noise and vibration hazards. 3. Before refueling, shut down the
generator and
allow it to cool. Keep fuel containers away
from generator
4. Wear hearing protection

SMT-05 Operating Compressor R 1. Electrical Hazard: If an outlet N 1 1 0 0 2 3 6 1. Ensure your air compressor is only used 0.25 1.5 L Y N N N H M No
isn’t grounded correctly, it can with outlets that have the proper grounding
result in electrical shocks 2. Ensure that the safety valves on your air
2. Flying particles and debris: tank
Highly pressurized air and 3. Using ear muff while entering the
pneumatic tools can cause flying compressor area
debris. If it strikes an operator, the
pieces can cause bodily injury
3. High pressures: If high-pressure
air is directly injected into the body,
can cause damage in internal organ
or severe injury
4. Noise: The noise from the
compressor machine can lead to
hearing loss.

SMT-06 Operating Low Voltage R Emergency electrical off or failed E 1 1 0 0 2 1 2 Logout Tagout the selector 0.25 0.5 L Y N N N H M No
Panel (LVP) can lead to short circuits hazard or
explosions
SMT-07 Operating fire pump R 1. When the water hydrant runs out, N 1 1 0 0 2 3 6 1. Daily checking the level of water tank 0.25 1.5 L Y N N N H M No
in the situation of fire hazard, it can hydrant or Installation of the sensor
lead to major hazard accident indicator control level
2. Accu water is damaged or 2. Regular checking and replenishment of
depleted causing malfunctions in accu water and spare accu
the firepump so that it cannot 3. Installation of Guard Coupling Fire
extinguish the fire Pump. Using ear muff or ear plug in fire
3. Noise : noise from the coupling pump area
can lead to hearing loss

SMT-08 Operating Main Distribution R Replacement of a damaged MCCB N 1 1 0 0 2 2 4 LOTO MCCB whose path to the MCCB is 0.25 1 L Y N N N H M No
Panel (MDP) can lead to severe injury from a damaged (switch off) so that it does not
short circuit and electrocution shock and does not short circuit and
previously coordinated the department that
was electrified from the MCCB so that no
one was electrocuted, prepare the fire
extinguisher

SMT-09 Operating Medium Volatage R Incorrect operation of the switch N 1 1 0 0 2 2 4 1. the operation of the on/off high volatge 0.25 1 L Y N N N H M No
Panel (MVP) on/off causes short circuits, switch should only be done by people who
electrocutions and fires have been trained
2. Use proper PPE

SMT-10 Operating Tafo R 1. Changing the oil on the N 1 1 0 0 2 3 6 1. Handling changing oil trafo should be 0.25 1.5 L Y N N N H M No
transformer had a possibility in done by the competent
electrocution and lead to serious 2. Using proper PPE
major injury to death
2. If the door of the transformer
house forgets to close after oil
topping up and electricity occurs, it
allows the user to be electrocuted
and may lead to serious injury to
death

SHE-FM-001-2 Rev.0
 SMT-11 Operating Burner R 1. Checking the level of oil N 3 1 0 0 4 3 12 1. Installation of stairs to the top of the 0.25 3 L Y N N N H M No
marlotherm in the expansion tank expansion tank
allows hands and skin to blister 2. Always use PPE properly
(minor to intermediate exposure) 3. Regular operation training of switch on
and fall from height due to hot sequence burner, technical sharing of
surface and height hazard switch on and troubleshooting burner every
2. Opening of the gas inlet valve to day with burner experts
the burner when the overhead valve
position allows the hand to be
sprained and pinched
3. Incorrect sequence operation
when turning on the burner can
cause the burner to explode

SMT-12 Operating Vacuum pump R 1. Replacing the electromotor when N 1 1 0 0 2 3 6 1. Log out tag out on MCB and Coordinate 0.25 1.5 L Y N N N H M No
the motor is on standby and can with related department
rotate if pushed ON allows wounds 2. PPE
on the hands
2. No LOTO would cause electric
hazard to the worker

SMT-13 Handling equipment in Spare R 1. picking up goods at high place N 1 1 0 0 2 3 6 1. Using stairs when picking up goods 0.25 1.5 L N N N N L L No
part storage may lead to fallin from height from a height
hazard 2. immediately clean up the faithfully there
2. spillage of oil or liquid allows is a spill
people to slip and fall

SMT-14 Operating Heat Exchanger R 1. Potential for employees to be N 1 1 0 0 2 1 2 1. Logout and Tagout, Switch off MCB 0.25 0.5 L Y N N N H M
exposed to high-pressure water cooling pump.
when disassembling HE and lead to 2. using tuckles when lifting the flange
injury cause by pressure hazard
2. Improper Lock out and Tagout
can cause potential to electric
hazard
3. Hands have the potential to be
pinched when disassembling the
HE water line flange/outlet

SHE-FM-001-2 Rev.0
S Aspect

Legal & Other

Requirements

SHE STD 304, 309

SHE STD 309

SHE STD 304

SHE-FM-001-2 Rev.0
 SHE STD 309

SHE STD 305

SHE STD 305

SHE STD 309

SHE STD 305

SHE STD 305

SHE STD 305

SHE-FM-001-2 Rev.0
 SHE STD 304

SHE STD 305

SHE STD 309

SHE-FM-001-2 Rev.0
 SHE & S Aspect
Dept: LRA Production Ref. no: Revision 0 Aspect analysis team : Irwanto / Armando / Shift Leader Date :
Description Reviewed by: Mashudi / Adhe Date :

Aspect NO. Safety, Health, Environment and Security Impacts Mitigating Controls Additional Considerations*

Business Critical
Effectiveness Index (EI)

Financial Cost
Potential Preliminary Additional Significant Ability

Regulatory
Activities Frequency
Aspect Impact (description) Residual

Feasibility

feasibility
Hazard aspect Considerati Aspect to

Technical
Conditions
Risk

Require
(activities that can Risk (R) / (any change to the
(Normal (N), Rating analysis ons* influent
interact with employee Opportunity safety/health, environment, or List Current Controls

Environment
Abnormal (A),
safety/health, (O) security; either adverse or
Emergency E. Potential (Low, Med, Y/N Y/N Y/N Y/N (Low,High) (Low, Med, Y/N
environment or security) beneficial)

Security
(Impact x

Health
Safety
Hazard x EI High) High)

Score
Frequency)

0 0 0.5 0 L Y Y Y Y H M No
0 0 0.5 0 L Y N Y N H M No
0 0 0.5 0 L Y N N N H M No
0 0 0.5 0 L Y N N N H M No
0 0 0.25 0 L Y Y Y N H M No
0 0 0.75 0 L Y N N N H M No
0 0 0.25 0 L Y N Y N H M No
0 0 0.5 0 L Y Y Y Y H M No
0 0 0.5 0 L Y N N N H M No
0 0 0.5 0 L Y Y Y Y H M No
0 0 0.5 0 L Y N Y N H M No
0 0 0.75 0 L Y N N N H M No
0 0 0.25 0 L Y Y N N H M No
0 0 0.25 0 L Y N N N H M No
0 0 0.5 0 L Y N N N H M No
0 0 0.5 0 L Y N N N H M No
0 0 0.25 0 L Y N N N H M No
0 0 0 L Incomplete Incomplete

SHE-FM-001-2 Rev.0
& S Aspect

Legal & Other

Requirements

SHE-FM-001-2 Rev.0