Doc - No. TA2839-WP3B-BMGP-PTW-005-R0 - Lean Concrete Work Substation Transformer

PT.
BANGUN MITRA GRAHA PERSADA ( BMGP )Ruko Golden Madrid Block G N
FORM OF ISSUE
Client : PT Unilever
Project : Marvel 2
To : Royal HoskoningDVH
Subject : Methode Statetment Civil Lean Concrete For Substation Transformer
Dear BMGP Team,
We hereby issue you the following:
Doc. No. Subject

Refer to File Please refer to the attached drawing list for document breakdown list
Reference & Notes:

Issued by by: Ackowledged by
PT. Bangun Mitra Graha Persada Unilever/Owner
Original to  Addressee
Copy to  Addressee  CM (RHDHV)
 Client  Site Representative (RHDHV)
 PM (RHDHV)
Ruko Golden Madrid Block G No. 10 BSD Tangerang - SelatanPhone & Fax : +62 ( 021 ) 53164882 - 83bmgp2@ymail.com
Tel. Fax. Email
TA2839-WP3B-BMGP-IF-005-R0
Date : 24 Nov 2022

Project no. : TA2839
From : BMGP
Version File Type
Refer to File Exel
Acknowledgement of receipt
Royal HaskonongDVH
WORK PERMIT FOR CONSTRUCTION SITE
Doc. No. TA2839-WP3B-BMGP-PTW-005-R0 Project No. TA2839
Works METHOD STATEMENT CIVIL LEAN CONCRETE Coordinator Ibnu Khaldun
Nr RA/JSA Supervisor Faturochman
Spesific Location SUBSTATION TRANSFORMER Safety Officer Denny Prayogi
Date 24 November 2022 Number of Workers
PPE to be used
Standard Gloves
Safety Harness Face Shield Other :
Shoes, Hard Hat, High Vis Vest Rubber/Cotton/Leather
Work Permit - Work Preparation Submittal Documents Checklist

No. Submittal Items for Approval Approved (Yes/No)* Date Approval Sign Issuer (Consultant) Co-Sign (Client) Remarks**
1 Work planning and works mapping (layout, sequence)
2 Work Method Statements
All Staff Vaccinated. Periodic PCR
3 Safety, Health and Environment Plan (incl C-19 measure)
Test
4 Work inspections previous works (rebar, formwork, et.al.)
5 Survey report/stake out of the works (planned works)
6 ITP Inspection Test Plan document for the works (QC)
7 Material Approval
8 Workshop/Prefabricator/Factory Inspection (FAT)
9 Material Delivery, handling, laydown and storage plan
10 Material Delivery Inspection (Material needs to be on site)
11 Material sample lab test 3rd party as required by Eng.
12 Material Test Certificates (from manufacturer/supplier)
13 Shop design drawings
14 Equipment planning (hand-tools, tools, heavy equipment)
15 Equipment testing (operator and equipment certified)
16 Manpower planning (per activity step, show rate of prog.)
17 Mock-up approved (if applicable)
18 Coordination plan (if applicable)
19 Lifting Plan (if applicable)
20 Supervision & Quality Control personnel planning
*If the above are answered with "Yes" and documents and requirements have been fulfilled complete and signed above, please invite Consultant and Client for Pre-Installation
meeting to present the works and gain approval sign off of this Work Permit before any commencement of works.
(*Apabila hal di atas dijawab dengan "Ya" dan dokumen serta persyaratan telah dipenuhi secara lengkap dan ditandatangani, silakan undang Konsultan dan Klien untuk rapat Pra-Instalasi
untuk mempresentasikan pekerjaan dan mendapatkan persetujuan dari Izin Kerja ini sebelum dimulainya pekerjaan.)
**If Not Applicable (N/A) note under 'Remarks'
(**Jika tidak, beri catatan di kolom 'Remarks')
Note Permit to Work Applicant Work Permit Issuer

The contractor is required to attach documents related to the work permit. Contractor CM/SM Contractor Safety Manager RHDHV PM/CM UOI
The work permit will not be approved if the supporting documents are incomplete
( ) ( ) ( ) ( )
PT. Bangun Mitra Graha Persada
Ruko Golden Madrid 2, Blok G. No 10.BSD
Tangerang Selatan - Jawa Barat Tel.
+62 21 53164882 - 83 Fax.
bmgp2@ymail.com Email
REQUEST FOR APPROVAL TA2839-WP3B-BMGP-MSC-005-R0
Client : PT. Unilever Oleochemical Indonesia Date : 23 November 2022

Project : MCC - MARVEL 2 Project no. : TA2839
To : Royal HaskoningDHV From : PT. BMGP
Subject : Method Statement Civil Lean Concrete For Substation Transformer
We submit the following for your approval:

¨ Method Statement Civil (s)
¨
Description: Method Statement Civil Rebar For Substation Transformer
Attachment and or Reference: JOB SAFETY ANALYSIS RISK ASSESMENT
Signature:
Name: Ibnu Khaldun
To the Contractor, Date:

Your request is:
¨ Approved ¨ Returned for correction
¨ Approved on condition as noted ¨ Disapproved as noted
Notes:
PMC UOI
Signature: Signature:
Name: Name:
Original to ¨ RHDHV's site representative (to be returned to contractor)

Copy to ¨ CM (RHDHV)
¨ Client to be issued after RHDHV's
¨ PM (RHDHV) site representative's decision

MCC - MARVEL 2 PROJECT
PT. Unilever Oleochemical Indonesia
KEK Sei Mangkei - North Sumatera
TITLE OF DOCUMENT :
METHOD STATEMENT CIVIL FOR DEMOLITION WORK
23 November 2022
Document No : TA2839-WP3B-BMGP-MSC-001-R0
Work Package : MCC MARVEL 2 PROJECT CIVIL STRUCTURAL
REV ISSUED DATE STATUS PREPARED BY REVIEWED BY APPROVED BY APPROVED BY

CM / APM / PM
0 BMGP HSE / PC PMC UOI
PMC
TABLE OF CONTENTS
Agreement Sheet .1
Introduction .2
Lay Out Assesment .3
Table Of Contens .4
I. Purpose
II. Scope
III. PERSONIL IN CHARGE AND MANPOWER
IV. EQUIPMENT, TOOLS AND MATERIALS
V. PERSONAL PROTECTIONS
VI. TECHNICAL INSTRUCTIONS
VII. MONITORING
VIII. ATTACHEMENT
2. Introduction
Lean concrete is a job that is usually done in building construction with a fairly complex scope
and enviromental conditions, lean concrete thickness is usually 50 - 100 mm, in this project the
thickness of lean concrete is 50 mm
Substation
Transformer
Location Substation Transformer
Site Plan
I. PORPOSE
Purpose of lean concrete is to make easier for workers to stand on flat, the surface is not dirty and muddy
It is an under layer of reinforcement bars, resistant to the up lift force of the the ground beneath.
II. SCOPE
Scope of work of this method covers :
• Preparation (materials, equipment and tools, manpower)
• Formwork of lean concrete
• Lean concrete
• Reference Shop Drawing
III. PERSONNEL IN CHARGE AND MANPOWER

The personnel in charge responsible for the following work is as follows :
• Construction Manager : Ibnu Khaldun
( Appoint all personnel in charge and number of mainpower )
• Site Supervisor : Marjuki
( Supervision during work on site to comply with approved documents )
• Engineer : Ibnu Khaldun
( Inspection during and after work )
• HSE Officer : Ruslan
( Supervision of safety during work on site to comply with safety requirements )
Personnel in charge above are subject to changes as per registered personnel assigned for the position.
The required amount of manpower for the following work is :
IV. EQUIPMENT, TOOLS & MATERIALS

The required equipments for the following method are :
• Survey equipment and tools
• Carpenter tools
• Hand Trowel
• Stamper
• Hoe
• Wheel Barrow
• thread
V. PERSONAL PROTECTIVE EQUIPMENT

• Helmet + Chin Strip With Face Shield Attached
• Long Sleeve Work Uniform + Long Trousers
• Safety Shoes
• Safety Glass
• Hand Gloves
• Safety Vest ( Bright Green ) With Reflector

VI.1 Preparation
• To measure and mark all area to be excavated as per shop drawing and must
provided survey report also.
• To ensure all equipments and tools to be used are in good condition
• To propose PTW (permit to work) to Consultant prior start the work.
• To Ensure sub base or sub grade fully compacted as specified.
VI.2 Lean Concrete

• Ensure the required elevation for the lean concrete
• Install plastic sheet or similar insulation if the soil is on wet condition, In the dry,
condition the plastic sheet can be used and not, plastic sheet installation is to limit the
concrete layer so that it does not mix with the soil.
• First way is soil compaction completed, degree compaction below the top 200 mm
of the subgrade not to less than 90% (for cohesive material) or 95%
(for cohesive material) or 95%(for cohesionless material) of the maximum dry density
determined in the B.S 1377 compaction test, the surface of soil is clean form mud and
sometime must given the plastic sheet.
• Making formwork around the boundary of the plan lean concrete.
• Lean concrete can be pouring by site mix
• Site mix can also done with ratio that has been approved by consultant, grade for lean
concrete is K - l00
• Pour the lean concrete as required thickness achieved. Level the surface with equal
thickness layer by manual trowel tools
VII. RESPONSIBILITIES
Site Manager
• To arrange and monitor the work as per execution method and work sequence as planning
• To prepare the work to be performed in safe and secure as per standard and work safety
procedure.
• To coordinate and communicate with Engineering Manager and Project Manager
concerning with the work.
• To monitor the performance of work safety system in execution of the work.
• To prepare daily work plan
• To prepare distribution of the work among the supervisors
• To coordinate activities among the suppliers and subcontractors
Engineer
• To prepare work method to be used as reference in the both materials and tools.
• To review work phase
• To prepare shop drawings
• To cooperate with supervisors regarding on mORltoring the work and material supply
• To coordinate technically with the subcontractors
HSE
• HSE together with engineers shall assist to provide safe working place and condition
and to ensure the work is following as per work safety rules and regulations.
• To provide safety inductions to all workers
• To control and perform tool box meeting which are lead by supervisor

• To provide and monitor a safe and secure working environment

• To ensure all equipment and tools are in good conditions
• To ensure all workers follow work safety requirement
Supervisor
Supervisor shall explain to his team of work items and work sequence especially from
work safety and security aspects. Supervisor has to ensure work plan covers :
• To identify work items to be executed
• To identify hazard related to work
• To perform risk assessment
• To identify control measurement
• To develop work method together with engineer
• To communicate all planning together with everyone involve in the work
• To review plan before starting the work and inform field data on any change occur.
• To direct worker to understand about the work and its risks
• To report if any change and problems appear on site during execution.
• To provide suggestion on work implementation if any change/deviance occur
• To coordinate with Site Manager about problems on site
• To conduct tool box meeting prior to start the work
OA/OC Engineer
• To ensure work implementation is in accordance with work method by performing
performing control during work implementation.
• To perform checking and inspection on work result as per ITP statement and to ensure
that work result is properly documented.
• To perform NCR (Non Conformance Report) report if there is a discrepancy in the results
of the work and to follow up by action.
VIII. ATTACHMENT
a. JSA ( Job Safety Analysis )
b. HSE Risk Assesment

TABLE OF CONTENTS
COVER 1
COMMENT RESOLUTION SOLUTION 2
TABLE OF CONTENTS 3
I. PURPOSE
II. SCOPE
III. PERSONIL IN CHARGE AND MANPOWER
IV. EQUIPMENT, TOOLS AND MATERIALS
V. PERSONAL PROTECTIONS
VII. MONITORING
VII. ATTACHEMENT
I. PORPOSE
The following method statement serves as a technical reference for demolition work existing room.
Before the demolition work is carried out, coordinate with the supervisory consultant and the employer,
for demolition materials.
II. SCOPE
The scope of this method statement is the first stage of work implementation that must be carried out,
before work begins.
Before the demolition work is carried out, protection is carried out for the work area.
For materials that have been unloaded, coordination must be made for the placement of unloaded
materials and demolition waste.
III. PERSONNEL IN CHARGE AND MANPOWER

The personnel in charge responsible for the following work is as follows :
• Construction Manager : Ibnu Khaldun

( Appoint all personnel in charge and number of mainpower )
• Site Supervisor : Faturochman

( Supervision during work on site to comply with approved documents )
• Engineer : Ibnu Khaldun

( Inspection during and after work )
• HSE Officer : Denny Prayogi

( Supervision of safety during work on site to comply with safety requirements )
Personnel in charge above are subject to changes as per registered personnel assigned for the position.
The required amount of manpower for the following work is :
• Supervisor :1 Personnel
• Surveyor :1 Personnel
• Foreman :1 Personnel
• Driver :1 Personnel
• Workers ( Preparation of material, tools, ) :6 Personnel
IV. EQUIPMENT, TOOLS & MATERIALS

The required equipments for the following method are :
• Water Pass
• Meter
• Hammer
• Saw
• Hoe
• Nail
• Paint
• Thread
V. PERSONAL PROTECTIVE EQUIPMENT
• Helmet + Chin Strip With Face Shield Attached
• Long Sleeve Work Uniform + Long Trousers
• Safety Shoes
• Safety Glass
• Hand Gloves
• Safety Vest ( Bright Green ) With Reflector
VI.1 Preliminary Works

a. Ensure reference documents ( Method statement, shop drawing ) has been signed,
and approved for construction by Project Management Consultant ( PMC ) for demolition work,
existing room.
b. Prepare the required tools, material, adequate amount of proper safety gear and equipment.
VI.2 Inspection
a. Inspect the implementation of existing room demolition work, to ensure materials and electrical installations
b. Coordinate the placement of materials and demolition work waste so that the room is clean and tidy.
c. Collect data on materials that will be reused and record materials that are not used.
e. Document the inspection reports in Request for Inspection to be Approved : The copy of Approfed
VII. MONITORING
a. Supervisors must monitor and supervise during the process of demolition work.
b. Delimit the construction area from unauthorized personnel by installing safety line barricades,
where necessary.
VIII. ATTACHMENT
a. JSA ( Job Safety Analysis )
b. HSE Risk Assesment

PT. Bangun Mitra Graha Persada
Ruko Golden Madrid 2, Blok G. No 10.BSD
Tangerang Selatan - Jawa Barat Tel.
+62 21 53164882 - 83 Fax.
bmgp2@ymail.com Email
REQUEST FOR APPROVAL TA2839-WP3B-BMGP-JSA-003-R0
Client : PT. Unilever Oleochemical Indonesia Date : 23 November 2022

Project : MCC - MARVEL 2 Project no. : TA2839
To : Royal HaskoningDHV From : PT. BMGP
Subject : JSA & HIRA For Lean Concrete Work For Substation Transformer
We submit the following for your approval:

¨ Job Safety Analysis
¨
Description: Job Safety Analysis
Attachment and or Reference: Job Safety Analysis Lean Concrete Work
Signature:
Name: Ibnu Khaldun
To the Contractor, Date:

Your request is:
¨ Approved ¨ Returned for correction
¨ Approved on condition as noted ¨ Disapproved as noted
Notes:
PMC UOI
Signature: Signature:
Name: Name:
Original to ¨ RHDHV's site representative (to be returned to contractor)

Copy to ¨ CM (RHDHV)
¨ Client to be issued after RHDHV's
¨ PM (RHDHV) site representative's decision

No. Dok
PT.UNILEVER OLEOCHEMICAL INDONESIA No. Doc UOI-HSE-012
FORMULIR JOB SAFETY ANALISA No. Terbitan
(JSA) Issue Date 1:00
JOB SAFETY ANALISYS FORM (JSA) No. Halaman
Page No 1-
No Izin/Permit no : SHE/PTW/JSA/ST/BMGP/XI-2022/005-R0
Dibuat oleh Diperiksa oleh
Perusahaan/Company : PT.BANGUN MITRA GRAHA PERSADA
Tanggal/Date : Prepared by Review by SHE PT.UOI Area Owner
Nama/Name
Waktu/Time : 08.00 - 17. 00 WIB Denny Prayogi
Aktivitas/Activity : Lean Concrete Work TTD/Signature
Lokasi Pekerjaan/Work Location : Substation Transformer TGL/Date
Tahapan Pekerjaan Bahaya Akibat Tindakan Pengendalian
No Action by (PIC)
Sequence of Basic Job Steps Hazard Consequence Recommended Action
1 Melakukan TBM Jarak terlalu dekat Terpapar covid 19 - Pastikan jarak antar pekerja tidak saling berdekatan,min 2 meter Workers, Supervisor,
- Lakukan cuci tangan secara berkala HSE
- Gunakan double masker (Masker kain dan medis)
2 Perencanaan kerja Komunikasi tidak baik ( Montion ) Kegagalan rencana kerja ( FAC ) - Penyampaian materi pekerjaan dengan jelas Workers, Supervisor,
- Penyampaian materi pekerjaan dengan jelas HSE
- Pastikan seluruh pekerja memahami rencana kerja dan gambar kerja
3 Persiapan alat dan material Tersandung Bebatuan Luka memar/ Lebam - Pastikan tidak ada material/alat yg menghalang akses jalan & Pekerjaan Workers, Supervisor,
- Perhatikan langkah kaki saat berjalan di area kerja HSE
- Memastikan pekerja menggunakan APD sesuai kebutuhan
- Pasang safey sign
4 Langsir material Ergonomi Cidera otot - Mengangkat material sesuai kemampuan pekerja Supervisor, HSE,
- Menggunakan alat bantu kerja Mechanic
- Bekerja dengan posisi tubuh dengan baik
Tersandung - Perhatikan langkah
- Bersihkan akses dari material berserakan
Tertimpa material Luka memar/ Lebam - Hindari posisi terjatuhnya material
- Lakukan kordinasi atau aba - aba yang baik saat mengangkat dan meletakan material
5 Perataan tanah dan pemadatan Tergores alat kerja Luka sobek - Periksa alat kerja sebelum digunakan Supervisor, HSE,
- Pastikan peralatan terkunci dengan baik anatar mata cangkul dengan gagang cangkul Mechanic
- Pastikan mesin pemadat / campacktor sudah di periksa dan dinyatakan layak pakai
- Posisikan bagian tubuh pada posisi aman
- Menggunakan APD
Terpapar cuaca panas Dehidrasi, pingsan - Pastikan pekerja dalam keadaan sehat
Dehidrasi, pingsan
- Menyediakan tempat istirahat sementara
- Istirahat berkala
Cuaca gerimis dan hujan Fatality - Menghentikan pekerjaan saat cuaca mendung sebelum turun hujan
- Berteduh di tempat yang aman dari gerimis dan hujan
- Matikan alat komunikasi elektronik saat cuaca hujan dan petir
6 Penggunaan mesin molen Tangan terkena pengaduk mesin moleh Fatality - Desain komponen tambahan pada mesin molen (rekayasa enginer) Supervisor, HSE,
- Pastikan peralatan aman dan sudah di taging layak digunakan Mechanic
- Pastikan pekerja profesional
- Menggunakan APD
Adonan terpercikan ke wajah kulit wajah rusak - mengukan masker
- jaga jarak aman dengan mesin
- sediakan air terdekat untuk membasuhwajah
7 Pengukuran level tanah Tersandung Bebatuan Luka memar/ Lebam - Pastikan tidak ada material/alat yg menghalang akses jalan & Pekerjaan Supervisor, HSE,
- Perhatikan langkah kaki saat berjalan di area kerja Mechanic
- Memastikan pekerja menggunakan APD sesuai kebutuhan
- Pasang safey sign
Terpapar cuaca panas Dehidrasi, pingsan - Pastikan pekerja dalam keadaan sehat
- Menyediakan tempat istirahat sementara
- Istirahat berkala
Cuaca gerimis dan hujan tersambar petir - Menghentikan pekerjaan saat cuaca mendung sebelum turun hujan
- Berteduh di tempat yang aman dari gerimis dan hujan
- Matikan alat komunikasi elektronik saat cuaca hujan dan petir
8 House keeping/clearing Digigit binatang berbisa Luka memar - pastikan area kerja aman Supervisor, HSE,
(bioligi) - Bongkar tumpukan sampah/semak belukar secara perlaha Mechanic
- Gunakan safety boot
- Perhatikan area kerja sekitar
Tergores Luka sobek - Perhatikan matirial tajam saat handing
- gunakan safety glove
RI
Activity / Product / Services

No
Aktivitas / Produk / Jasa Hazard / Bahaya Risk & Severity Prabobility
Opportunities
1 Melakukan TBM Jarak Terlalu Terpapar Covid -19 2 6
dekat (FAC)
( Motion )
2 Perencanaan kerja / rapat kordinasi Komunikasi Kegagalan 2 6

Tidak Baik Rencana
( Motion ) Kerja
(FAC)
3 Persiapan alat dan material Tersandung Luka memar / Lebam 4 6

bebatuan (FAC)
(Motion)
4 Langsir material Ergonomi Cidera otot 4 6

(motion) (LTI)
Tersandung Luka memar 4 4

(motion) (FAC)
Tertimpa Luka memar 4 4
matirial (FAC)
(grafitasi)
Terperosok galian Terkilir/patah tulan 4 6

(montion) (LTI)
5 Perataan tanah dan pemadatan Tergores alat Luka sobek 2 6

kerja (FAC)
Terpapar cuaca Dehidrasi 2 6

(montion) (FAC)
Cuaca gerimis terpeleset/terjatuh 4 6

dan hujan (FAC)
(montion)
6 Penggunaan mesin molen Tangan teknena Fatality 2 6

pengaduk mesin (FAC)
molen
(FAC)
Adonan Kulit wajah rusak 2 6

terpercikan ke
wajah

(montion) (FAC)

dan hujan (FAC)
(montion)
7 Pengukuran level tanah Tersandung Luka memar 4 4

(motion) (FAC)

(montion) (FAC)
dan hujan (FAC)
(montion)
9 House keeping/clearing Digigit binatang Keracuran/Fatality 8 4

berbisa (Singgle Death)
(Biologi)
RISK ASESSMENT AND OPPORTUNITIES
PENILAIAN RESIKO DAN PELUANG
Risk Factor Responsibility Documented Risk & Risk Factor

(PxS) ( Person In Charge ) Information Opportunities Severity Prabobility (PxS)
( Form, SOP, IK )
M DENNY Metod Kerja Delay 1 4 VL
PTW, JSA Only
SHE PLAN
M DENNY Metod Kerja Delay 1 4 VL

PTW, JSA Only
SHE PLAN
M+ DENNY Metod Kerja FAC 2 2 VL

PTW, JSA
SHE PLAN
M+ DENNY Metod Kerja FAC 2 2 VL

PTW, JSA
SHE PLAN
M DENNY Metod Kerja FAC 2 2 VL

PTW, JSA
SHE PLAN
PTW, JSA
SHE PLAN
M+ DENNY Metod Kerja FAC 2 4 L

PTW, JSA
SHE PLAN
M DENNY Metod Kerja FAC 2 4 L

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN

PTW, JSA
SHE PLAN
H DENNY Metod Kerja LTI 4 4 M

PTW, JSA
SHE PLAN
TIES Dibuat oleh/Prepared by
SPV/HSE
G Nama/Name
TTD/Signature
TGL/Date
Apa / What Dimana / Whare Kapan / Whan Siapa / Who Bagaimana /

How
1. Menyampaikan materi Site Offce & Selama Construction Pastikan

dengan jelas Workshop pembuatan Team, HSE pemateri
2. Catat hasil diskusi lalu 9 - Ha Site Office & menguasai
di tanda tangani Workshop PTW, JSA
3. Pastikan seluruh pekerja Work Method
memahami rencana kerja
1. Menyampaikan materi Site Offce & Selama Construction Pastikan

dengan jelas Workshop pembuatan Team, HSE pemateri
2. Catat hasil diskusi lalu 9 - Ha Site Office & menguasai
di tanda tangani Workshop PTW, JSA
3. Pastikan seluruh pekerja Work Method
1. Pastikan tidak ada material / Site Offce & Selama Construction kelengkapan alat
alat yg menghalang akses Workshop pembuatan Team, HSE Work Method
jalan & Pekerjaan 9 - Ha Site Office & PTW, JSA
2. Perhatikan langkah kaki Workshop
saat berjalan di area kerja
3. Memastikan pekerja
menggunakan APD sesuai
kebutuhan
4. Pasang safey sign
1. Mengangkat matirial sesuai Workshop Selama Construction kelengkapan alat

kemampuan pek 9 - Ha pembuatan Team, HSE Work Method
2. Gunakan alat bantu Site Office & PTW, JSA
3. Gunakan APD Workshop
1. Gunakan APD Workshop Selama Construction kelengkapan alat

2. Bersihkan akses 9 - Ha pembuatan Team, HSE Work Method
3. perhatikan langkah Site Office & PTW, JSA
Workshop
2. Pengecekan are kerja 9 - Ha pembuatan Team, HSE Work Method
3. hindari posisi jatuh matirial Site Office & PTW, JSA
Workshop

2.baricade galian 9 - Ha pembuatan Team, HSE Work Method
3.pasang rambu Site Office & PTW, JSA
Workshop

2. Posisi jari aman 9 - Ha pembuatan Team, HSE Work Method
3. pekerja profesional Site Office & PTW, JSA
Workshop
2.Minum air 9 - Ha pembuatan Team, HSE Work Method
3.istirahat Site Office & PTW, JSA
Workshop
2.berteduh 9 - Ha pembuatan Team, HSE Kelayakan alat
Site Office & Work Method
Workshop PTW, JSA
2. pasang baricade 9 - Ha pembuatan Team, HSE Kelayakan alat
3. pekerja profesional Site Office & Work Method
Workshop PTW, JSA
1. Gunakan APD Workshop Selama Construction Work Method

2.Posisi aman 9 - Ha pembuatan Team, HSE PTW, JSA
3. pekerja profesional Site Office &
Workshop
2.Minum air 9 - Ha pembuatan Team, HSE PTW, JSA
3.istirahat Site Office &
Workshop

Workshop PTW, JSA

2. Bersihkan akses 9 - Ha pembuatan Team, HSE Work Method
3. perhatikan langkah Site Office & PTW, JSA
Workshop

2.Minum air 9 - Ha pembuatan Team, HSE PTW, JSA
3.istirahat Site Office &
Workshop
Workshop PTW, JSA
1. Pastikan area kerja aman Workshop Selama Construction kelengkapan alat

2. bongkar tumpukan sampah 9 - Ha pembuatan Team, HSE Work Method
dan semak secara perlahan Site Office & PTW, JSA
3.gunakan safety boots Workshop
No. Dok
No. Doc UOI-HSE-012
No. Terbitan
Issue Date 1:00
No. Halaman
Page No 1-
Diperiksa oleh/Review by SHE PT.UOI
PMC
Tindakan Pencegahan Keterangan

( Preventive ) Remark
1. Melakukan tanya jawab

setelah rapat kordinasi
untuk memastikan pekerja
1. Melakukan tanya jawab

setelah rapat kordinasi
untuk memastikan pekerja
1. pengecekan alat
2. list matirial
3. pengechekan APD
1. Lakukan Tool Box Meeting

2. pasang rambu-rambu
3. pastikan cara pengangkatan
ergonomi sesuai SOP
4. pelatihan manual handling
ergonomi

3. membuat program house
keeping setiap hari untuk
area kerja
area kerja

2. pasang rambu
3. tutp galian yang tidak perlu

2 memilih pekerja yang terampil
3.melatih cara kerja aman

2.penyedian air minum di area
kerja
3.istirahat secara bergantian
2. berhenti bekerja
3.cari lokasi yang aman
(berteduh)
2 memilih pekerja yang terampil
3.melatih cara kerja aman
4. Desain komponen tambahan
pada mesin molen
(rekayasa enginer)
5. jaga jarak aman dengan mesin
6.pasang safety sign
1. mengukan masker
2. sediakan air terdekat untuk
membasuhwajah

kerja

2. berhenti bekerja
(berteduh)

area kerja
kerja
2. berhenti bekerja
(berteduh)

2. Pemasangan Rambu
3. pastikan antidote ada di klinik
terdekat
PT. UNILEVER OLEOCHEMICAL INDONESIA
PENILAIAN RISIKO DAN PELUANG
RISK ASSESSMENT AND OPPORTUNITIES
Risk Assessment Before All Safe Guards In Place
Activity / Product / Risk & Opportunities Risk Factor Documented

Hazard / Responsibility (Person
No Services Aktivitas / Information (Form, SOP,
Bahaya in Charge)
Produk / Jasa Risk Severity Probability IK)
(PxS)/ Significancy
Incomplete documents Miscommunicati on, MEDIUM 4 6 M+ David, Yudia Permit To Work, Working
sanction, lost working day Method, Risk Assessment,
Job Safety
Analisis Approved
Violation of permit sanction, lost working day MEDIUM 4 6 M+ David, Yudia Permit To Work, Working
1 Permit Submission procedure Method, Risk Assessment,
Job Safety
Analisis Approved
Soaking wet, skin irritation, 4 4 Permit To Work, Working

fever Method, Risk Assessment,
Rainfall, strong wind MEDIUM M David, Yudia Job Safety
Analisis Approved
Slips and trips bruises, scratches MEDIUM 4 4 M David, Yudia Permit To Work, Working
Method, Risk Assessment,
2 Hazardous Weather Job Safety
Analisis Approved
Falling bruises, scratches MEDIUM 4 4 M David, Yudia Permit To Work, Working

Job Safety
Analisis Approved
Permit To Work, Working

Finger / limb pinched
Bruises, scratches MEDIUM 4 6 M+ David, Yudia Job Safety
between rebar Analisis Approved
Scratch by rebar surface open wound MEDIUM 4 6 M+ David, Yudia Permit To Work, Working
Job Safety
Analisis Approved
Loading/Unloading
Rebar Fall Object bruises, broken bones MEDIUM 6 4 M+ David, Yudia Permit To Work, Working
Job Safety
Analisis Approved
Air pollution respiratory infection MEDIUM 4 4 M David, Yudia Permit To Work, Working
Job Safety
Analisis Approved
3

Finger / limb pinched on
bruises, open wound MEDIUM 4 6 M+ David, Yudia Job Safety
machine Analisis Approved
Electric shock unconsciousnes s, open MEDIUM 4 4 M David, Yudia Permit To Work, Working
wound Method, Risk Assessment,
Job Safety
Analisis Approved
Catch fire skinburns MEDIUM 6 4 M+ David, Yudia Permit To Work, Working

Job Safety
Analisis Approved
Scratch by rebar surface open wound MEDIUM 4 4 M David, Yudia Permit To Work, Working
Job Safety
Analisis Approved
4 Rebar Fabrication

Finger / limb pinched on
Salah urat, memar MEDIUM 4 6 M+ David, Yudia Job Safety
machine Analisis Approved
Scratch by rebar surface Luka terbuka MEDIUM 4 4 M David, Yudia Permit To Work, Working
Job Safety
Analisis Approved
Rebar Cutting
Electric shock Luka robek, memar MEDIUM 4 4 M David, Yudia Permit To Work, Working
Job Safety
Analisis Approved
Catch fire skinburns MEDIUM 6 4 M+ David, Yudia Permit To Work, Working

Job Safety
Analisis Approved
5

Finger / limb pinched
Bruises, scratches MEDIUM 4 6 M+ David, Yudia Job Safety
between rebar Analisis Approved
Scratch by rebar surface open wound MEDIUM 4 4 M David, Yudia Permit To Work, Working
6 Rebar Installation Job Safety
Analisis Approved
6 Rebar Installation
Falling bruises, scratches MEDIUM 4 4 M David, Yudia Permit To Work, Working

Job Safety
Analisis Approved

Job Safety
7 Housekeeping Slips and trips Luka pada kaki, Keseleo MEDIUM 4 4 M David, Yudia Analisis Approved
High: Significant impact on the strategy or operational activities of the organization

Significant stakeholder concerns. Influence on the quality risk of the products / services produced
Medium: Moderate impact on the strategy or operational activities of the organization
Moderate stakeholder concerns. Influence on the risk of quality of products / services produced, but still entry requirements
Low: Low impact on the strategy or operational activities of the organization

Low stakeholder concerns. Does not affect the quality risk of products / services produced
Dibuat Oleh /Prepared by Diperiksa Oleh/Reviewed by Unilever No Dok.
Reff.
SPV / HSE PMC
Nama/Name
No Terbitan
Issue Date
TTD/Signature
Tanggal/Date Halaman
Page. No
Risk Assessment After All Safe Guards In Place Pengendalian (Control)
Risk & Opportunities Risk Factor Dimana / where Tindakan

Pencegahan
Severity Probability Apa / What Kapan / when Siapa / who Bagaimana / how (Preventive)
(PxS)/ Significancy
LOW 4 2 L Rebar Fabrication Laydown 9 ha prior to installation workers, Supervisor, HSE distribution of drawings and Training of work procedure
method to personnel on site and PTW to supervision
personnel
LOW 4 2 L Rebar Fabrication Laydown 9 ha prior to installation workers, Supervisor, HSE Memastikan PTW telah Promote PTW rules to
diketahui disetujui HSE dan follow by all personnel,
Engineer PMC dan Promote JSA to all
Owner dan juga Area personnel and workers ,
Tool Box Meeting prior to
work
4 2 during installation Suspend all working activity Tool Box Meeting prior to
during rainfall work, PTW fully signed
LOW L Rebar Fabrication Laydown 9 ha workers, Supervisor, HSE beore start working
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE Remove water pond on Housekeeping after rainfall
pathway and in/out access; stop
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE Remove water pond on Housekeeping after rainfall
pathway and in/out access; stop, barricade pathway
Lifting rebar with more than Tool Box Meeting prior to

one person under SPV and work, PTW fully signed
LOW 4 4 M Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE HSE beore start working
supervision
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE Complete PPE, including Tool Box Meeting prior to
hand gloves work, PPE inspection
MEDIUM 6 2 M Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE Sterilize lifting area from all Tool Box Meeting prior to
personnel work, PTW fully signed
beore start working
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE complete PPE, including Tool Box Meeting prior to
face mask work, PPE inspection
HSE and SPV supervision Tool Box Meeting prior to

when working work, PPE inspection
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE
MEDIUM 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE HSE and SPV supervision Tool Box Meeting prior to
MEDIUM 6 2 M Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE HSE and SPV supervision Tool Box Meeting prior to
VERY LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE HSE and SPV supervision Tool Box Meeting prior to
HSE and SPV supervision Tool Box Meeting prior to

MEDIUM 4 2 L Rebar Fabrication Laydown 9 ha during installation Pekerja, Supervisor, HSE
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation Pekerja, Supervisor, HSE HSE and SPV supervision Tool Box Meeting prior to
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation Pekerja, Supervisor, HSE HSE and SPV supervision Tool Box Meeting prior to
MEDIUM 6 2 M Rebar Fabrication Laydown 9 ha during installation Pekerja, Supervisor, HSE HSE and SPV supervision Tool Box Meeting prior to
Lifting rebar with more than Tool Box Meeting prior to

one person under SPV and work, PPE inspection
MEDIUM 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE HSE
supervision
complete PPE, including Tool Box Meeting prior to

safety shoes; housekeeping work, PPE inspection
under SPV
LOW 4 2 L Rebar Fabrication Laydown 9 ha during installation workers, Supervisor, HSE and HSE supervision
Keterangan / Remark

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PT.

BANGUN MITRA GRAHA PERSADA ( BMGP )Ruko Golden Madrid Block G N

Doc. No. Subject

Reference & Notes:

Tel. Fax. Email

Date : 24 Nov 2022

Version File Type

Refer to File Exel

Work Permit - Work Preparation Submittal Documents Checklist

Note Permit to Work Applicant Work Permit Issuer

REQUEST FOR APPROVAL TA2839-WP3B-BMGP-MSC-005-R0

Client : PT. Unilever Oleochemical Indonesia Date : 23 November 2022

Subject : Method Statement Civil Lean Concrete For Substation Transformer

We submit the following for your approval:

Description: Method Statement Civil Rebar For Substation Transformer

Attachment and or Reference: JOB SAFETY ANALYSIS RISK ASSESMENT

To the Contractor, Date:

¨ Approved ¨ Returned for correction

¨ Approved on condition as noted ¨ Disapproved as noted

Original to ¨ RHDHV's site representative (to be returned to contractor)

¨ Client to be issued after RHDHV's

¨ PM (RHDHV) site representative's decision

REV ISSUED DATE STATUS PREPARED BY REVIEWED BY APPROVED BY APPROVED BY

Lay Out Assesment .3

III. PERSONIL IN CHARGE AND MANPOWER

IV. EQUIPMENT, TOOLS AND MATERIALS

VI. TECHNICAL INSTRUCTIONS

Location Substation Transformer

III. PERSONNEL IN CHARGE AND MANPOWER

IV. EQUIPMENT, TOOLS & MATERIALS

V. PERSONAL PROTECTIVE EQUIPMENT

VI. TECHNICAL INSTRUCTIONS

VI.2 Lean Concrete

MCC - MARVEL 2 PROJECT

• To provide and monitor a safe and secure working environment

b. HSE Risk Assesment

COMMENT RESOLUTION SOLUTION 2

III. PERSONIL IN CHARGE AND MANPOWER

IV. EQUIPMENT, TOOLS AND MATERIALS

VI. TECHNICAL INSTRUCTIONS

III. PERSONNEL IN CHARGE AND MANPOWER

• Construction Manager : Ibnu Khaldun

• Site Supervisor : Faturochman

• Engineer : Ibnu Khaldun

• HSE Officer : Denny Prayogi

The required amount of manpower for the following work is :

IV. EQUIPMENT, TOOLS & MATERIALS

VI. TECHNICAL INSTRUCTIONS

VI.1 Preliminary Works

b. HSE Risk Assesment

REQUEST FOR APPROVAL TA2839-WP3B-BMGP-JSA-003-R0

Client : PT. Unilever Oleochemical Indonesia Date : 23 November 2022

We submit the following for your approval:

Description: Job Safety Analysis

Attachment and or Reference: Job Safety Analysis Lean Concrete Work

To the Contractor, Date:

¨ Approved ¨ Returned for correction

¨ Approved on condition as noted ¨ Disapproved as noted