HSE MINIMUM REQUIREMENTS

FOR SUBCONTRACTORS

All subcontractor/ forwarder/ fabricator candidate have to comply

NO ITEM DESCRIPTION

1 CSMS Passed the CSMS process (PQ/ SRM online/ ePro)

2 HSE Plan Subcontractor shall develop a specific HSE Plan for the RDMP Project, which containt but
not limited:
> Objective & Target
> Scope of Work
> HSE Responsibility & Job Description for project, (HSE organization, Top Level
Management responsibility on HSE)
> Man power planning & CV (1 HSE Coordinator + 1 safety man ratio 1:50 worker) and man
power for general houskeeping
> HSE Program, HSE daily meeting, HSE weekly meeting, Equipment & tools inspection ,
Emergency drill, Training, safety induction, etc.
> PPE mandatory for the project refer to JO Contractors HSE Plan. (safety glass, long
sleeves, trousers, safety shoes, welding cap combined with helmet, harness double lanyard)
> Fire Extinguisher plan(APAR)
> Emergency Respone Plan
> HSE Promotion program (banner, safety signage, baricade, safety information board etc)
> Security Plan
> Construction activities plan & method statement
> Medical Check Up arrangement before entering worksite
> HSE Reporting system (daily & weekly)
> Detail JSA
> Detail Risk Assessment
> Environmental Management Plan (Non Hazardous & Hazardous Waste Management -
include the number of waste container for non hazardous waste, temporary storage, and final
disposal, Spillage Prevention, Waste Water and Drainage Management & Air Pollution
Control
> HSE Budget shall be considered by subcontractors
> Maximum age of personnel (staffs or workers) : 55 years old, except for workers who are
considered experts by showing certificates from BNSP

The approved HSE Plan shall be presented on kick of meeting by subcontractor.

3 Premobilization HSE department will conduct premobilization inspection for all machinery, equipment, tools,
Inspection PPE for construction prior it delivered to site. Only approved equipment can be delivered to
project site.

4 Audit Audit:
• Subcontractors Key Performance Indicator (KPI) will be audited on monthly basis
5 Documentation All subcontractor shall submit HSE Report on daily basis (MP & MH), weekly (HSE Program)
6 Communication All subcontractor worker shall be obtain HSE Induction by OWNER & JO CONTRACTOR.

7 Heavy Equipment All heavy equipment & the operator shall be have valid Local Government certificate
(Revalidation Test, SILO and SIO). Completed with fire extinguisher, operation beacon light
and other specific requirement.
All Crane shall be have valid MIGAS (Indonesia Authority for Oil and Gas activities)
certificate (SILO for equipment and SIO for Operator).
8 Portable Toilet Subcontractor shall provide adequate number of portable toilet (1:25), and special
personnel/team for worksite housekeeping.

9 Lifting Rigging All lifting works will require a lifting planfor approval prior to performing the lift. In the lift is
over than 50 metric tons or classified as critical (exceeding 80 % of crane capacity chart, any
two-cranes lift or any lift over operating occupied facilities, process pipe racks or near power
lines), the subcontractors/vendors will submit detailed rigging plan with all applicable
supporting calculations to Contractor or Owner for approval prior to the lift.
Qualified
rigger and signal man shall be have valid MIGAS certificate

10 Electrical All electrical receptacle shall be industrial type with three pin or double insulation, completed
with earthing system (grounding) well protected from UV and rain water

No modification allowed for all electrical equipment unless by certified personnel

Out of service electrical tools/equipment shall be tagged with out of service tag or danger
tag.

Peeled off cable are not allowed covered with masking tape

11 Safety Training Completing all mandatory training prior start working

12 Pressurized gas • All pressurised cylinder shall be stand and tied off/ chained, flammable gasses sign in
place
• Subcontractor shall provide adequate number of cylinder cradle/ trolley
• Subcontractor shall provide Flashback arrestor for all flammable & oxygen gasses
connection
• All cylinder shall be completed with sticker ID.
• All cyllinder shall be completed with cap
• Semua Tabung Gas harus mempunyai troli untuk mobilisasi, rak selama digunakan dalam
lokasi proyek, aman dengan rantai dan dalam posisi tegak.
• MSDS & Fire extinguisher shall be in place.
• Everytime using of Oxygen & acetylene/ LPG shall be completed with Fire Extinguisher.

13 Work Permit Every single activities shall be covered with specific work permit, signed and approved by
authorised personnel from JO member, OWNER reps which completed with JSA, Method
statement , drawing etc.

14 Scaffolding • Material Scaffold harus galvanized, not rusted, bended/ damage as JIS standard
(diameter 48.3 mm, thickness 2.4 mm - 4 mm)• Scaffolding type: Tube
• Hold valid migas certificate scaffolder, the scaffold group lead by 1 certified scaffold
foreman
15 Generator All Generator shall be obtain certificate (SLO) from Disnaker, completed with manual book
operation, secondary containment. Subcontractor have prepare:
• Completed with Safe guard
• Roofing.
• Adequate ventilation.
• Exhaust / emission are not trapped in shelter / room.
• with silencer / sound proof .
• the minimum distance between machine are 1.5m
• operated by authorised operator only (name, photograph of operator attached) fenced

16 Machinery • Welding machine and generator are silent type (with noise reducer).
• Automatic shut off / Emergency shut off shall be in place
• Flame arrestor (for the diesel engine)
17 FUEL STORAGE, 1. Provide fuel storage in according with the safety and environment standard.
WORKSHOP /
BENGKEL 2. All workshops and vehicle washing places must have water and oil separation sites
complete with sewers that drain water to the oil and water separation site.

3. All reservoir locations in large numbers and reservoirs of hydrocarbon materials must have
reservoir embankments according to the relevant standards.

4. All pipes that deliver hydrocarbon materials must be equipped with shelters in the event of
a leak.

5.The storage of hydrocarbon materials must be safe from damage caused by heavy
equipment and small vehicles as well as clear instructions regarding work safety, storage
capacity and types of hydrocarbon materials.

6. All workshops must be equipped with spill or roller suction material and spill handling
materials.

7. Storage of 200-liter drum capacity must be equipped with a shelter embankment.

8. Oil and grease and the like from repairs of heavy and light equipment must be
accommodated.

18 SPILLAGE 1. DRIP PAN must be used in work on portable tools that have the potential to produce spills,
PREVENTION for example: under generator sets, under fuel trucks when filling fuel, under containers / jerry
cans of chemicals and so on.

2. BUNDWALL must be set up on permanent facilities where spills can occur, for example:
B3 material storage area, B3 waste TPS, permanent generator set and so on.

3. SPILL KIT must be prepared in places where potential spills occur, for example: workshop
area, maintenance area, refueling area and so on.

4. OIL ABSORBENT PAD 400 GSM (Natural oils prevent water absorption) must be prepared
before working in jobs that use oil / oil.

5. DRUM BLANK TYPE 1 AND 2 (Type 1: for liquids & Type 2: for solids) must be prepared
19 Hand Tools and •forThe
spillspeed
storage andrpm
of the spilled
discobjects.
grinding is more than the rpm of the grinding machine speed.
Portable Power Tool • Safe Guard must be installed in good condition at all times.
Equipment • All handtools are manufacturers.
• In electrical work, subcontractors must provide hand tools made of insulators
• In flammable areas, subcontractors must provide handtools made of copper / bronze (not
producing sparks)
20 Solid Waste 1. Subcontractors are not permitted to destroy leftover iron and other remaining material on
Management the project or around the project by burning.

2. Separating the disposal of B3 Solid Waste (objects contaminated with chemicals), Non-B3
Solid Waste (Domestic waste, metal residue), and B3 Liquid Waste (Remaining material for
chemical use).

3. TRANSPARAN TRASH BAG jumbo size (<90 x 130 cm) must be prepared for any type of
garbage collection to facilitate monitoring and ensure that waste has been disposed of
according to its classification.

4. Providing trash bins and inside are equipped with jumbo size transparent trashbags with
the following colors:
Red B3 Solid Waste
BLACK metal waste
GREEN Organic Solid Waste
YELLOW Non-Organic Solid Waste
Liquid Waste B3 Stored in a special storage room (max. 60 days) disposed of through a third
party.

5. Make a waste monitoring schedule (solid and liquid)

6. Measuring noise and lighting at the subcontractor's work location

7. Ensure that the housekeeping office and subcon work area are maintained every day and
whose routine is scheduled.

21 Hazardous waste 1. B3 waste must not be mixed. One drum for one type of waste.

2. DRUM B3 + PALET WASTE must be ensured in good condition, not rusty, not dented and
not used from other B3 material or waste of different types.

3. B3 WASTE SYMBOLS & LABELS must be installed according to government regulatory

standards.

4. DRUM POSITION SYMBOL must be installed as a sign of the drum.

22 Hazardous material 1. All hazardous materials must be equipped with MSDS (Material Safety Data Sheet) that
can be obtained from suppliers or made by themselves.
2. Symbols and labels of chemicals must be installed on chemical containers in accordance
with the characteristics of the chemical.
3. Subcontractors must provide a special place for storing the hazardous material, and the
MSDS must be displayed in the storage area, equipped with bundwall to prevent spillage
area widening (if a spill occurs), and fire extinguishers (APAR).
23 WASTE WATER & 1. All types of process water and domestic water (gray water & black water) must be
DRAINAGE accommodated and processed, must not be disposed of directly into the drainage / public
MANAGEMENT canal, and confirmed when disposed of has met the quality standards of water quality of the
local government.

2. SEDIMENT TRAP must be applied to drainage to prevent sediment / sediment from

polluting the water body. Sediment traps can be in the form of a basin or rock pile to block
the sediment rate.

3. RESPONSE / BERM must be applied along the edge of the water body / drainage for the
work of excavating the soil around the drainage, so that the sediment eroded by rain water
does not directly enter the water / drainage body.

4. FAST RAMBAT PLANTS / CROP COVER can be an option as a media for erosion control
on dikes / berms

24 Authorities JO Contractor have authority to stop work if it observed HSE rules breaching or unsafe act &
condition occurs.
25 HSE Golden Rule Worker caught : 1.
Prohibited of carrying weapons or firearms
2. Prohibited of consuming drugs and alcohol
3. Prohibited of working for any subcontractors without having
CSMS certificate (not yet passed CSMS)
4. Prohibited of working without work permit
5. Prohibited of working in confined space without
buddy system 6.
Prohibited of working at height more than 1.8 meters without full body harness and fall
protection 7.
Prohibited of removing LOTO without authority
8. Prohibited of operating heavy equipment without SIO and
SILO 9. Prohibited of
operating company vehicles without SIMPER/authority
at
working area, will be excluded from the project.
26 Punishment If there is a case of death caused by a worker from subcontractor, then the subcontractor will
be excluded from the project and not allowed to take part in the tender process in Contractor
for 2 years.
27 Internal Inspection Conducted periodic inspection for each work equipment (Hand tools, Portable Power Tool,
Machinery, Heavy Equipment, Vehicles,Truck, etc.)
28 MCU All subcontractor personnel shall be passed the MCU. List of Hospital that recommended for
MCU :
Balikpapan : RSPB (Pertamina Hospital Balikpapan); Ibnu Sina; Kusuma; Borneo.
Jakarta : Medika Plaza; RS Pertamina.
Medical examinations that must be carried out refer to Attachment 2.
29 Working Hours
Working hours shall comply with local regulations or area practice. Overtime work
requirements shall be scheduled at least one day in advance and a daily schedule notice of
overtime, description of the Work to be performed, manpower quantity by craft shall be
submitted to Owner.
Contractor may require a second or third shift work program to accelerate some part of the
Works. Contractor shall notify Owner at least fifteen (15) Days prior the start of the new shift
work, manpower requirements and duration of shifts.
30 Transportation
Driver shall be obtain Company driving licence (SIMPER)
Passed premob inspection and regularly inspected
No overload, truck or open cabin vehicle are not allowed for pessanger
Small vehicle max 5 years
Heavy vehicle max 10 years
Diesel engine only
Shall be equipped with Spark/ flame arrestor
31 PPE See Attachment 1 PPE
32 Premobilization Subcontractor shall full fill Premobilization readiness checklist before mobilize to site
33 SIO SIO for Operator shall be issued by MIGAS

Subcontractor's Name PT.................................................................

 PAGE: of

S
NO:

mply to HSE checklist below :

ACTION BY DUE DATE STATUS REMARK
PT. MENARA Dec-18 DONE
PT. MENARA 1 -25 ON
Agustus PROGRES
S

19 August
2019
Mobilization
for
Excavator DONE
and
Operational
Car

PT. MENARA
PT. MENARA
ON
PROCESS
PT. MENARA
9-Aug
ON
PROCESS

PT. MENARA 10-Aug DONE

PT. MENARA
ON
PROCESS

PT. MENARA ON

ON
PT. MENARA
PROCESS

PT. MENARA
NOT YET

PT. MENARA

NOT YET

ON
PT. MENARA
PROCESS

PT. MENARA
PT. MENARA

PT. MENARA

PT. MENARA

PT. MENARA

PT. MENARA
PT. MENARA

ON PROGRESS

PT. MENARA

PT. MENARA
PT. MENARA

PT. MENARA

DONE

PT. MENARA

PT. MENARA

ON
PT. MENARA PROGRES
S

ON
PT. MENARA PROGRES
S

PT. MENARA

ON PROGRESS
PT. MENARA DONE
PT. MENARA DONE
PT. MENARA DONE

Acknowledged by,

( ..............................)
Subcontractor Management Representative
 PPE Minimum Welding Grinding Excavation
ANSI Z89.1 - 2003, Type I ANSI Z89.1 - 2003, Type I class ANSI Z89.1 - 2003, Type I ANSI Z89.1 - 2003, Type
Helmet (yellow color)
class G and E G and E class G and E I class G and E
Safety Glasses ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003

SNI Standard or ASTM F SNI Standard or ASTM F 2413- SNI Standard or ASTM F SNI Standard or ASTM F
2413-2005 Impact 2005 Impact 2413-2005 Impact 2413-2005 Impact

Resistance Class 75 (I/75) Resistance Class 75 (I/75) and Resistance Class 75 (I/75) Resistance Class 75
and Compression Compression and Compression (I/75) and Compression

Resistance Class 75
Resistance Class 75 (C/75) Resistance Class 75 (C/75) Resistance Class 75 (C/75)
(C/75)
Safety Shoes

- ANSI S3.19 - 1974 for NRR - ANSI S3.19 - 1974 for NRR - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for
labeling labeling NRR labeling NRR labeling
Ear Plug
- ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for NRR - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for
NRR testing testing NRR testing NRR testing

- ANSI S3.19 - 1974 for NRR

labeling
Ear Muff
- ANSI S12.6 – 1997 for
NRR testing

NIOSH Title 42 CFR 84-

Respiratory Protection NIOSH Title 42 CFR 84-1995
1995

ANSI Z87.1 - 2003 - High

Face Shield
Impact Level Protection

ANSI Z87.1 2003 - High Level

Welding Helmet
Protection
SCBA
SABA

EN407–2004 for flammability, EN407–2004 for

contact heat, flammability, contact heat,

convective heat, radiant heat, convective heat, radiant

Hand Protection N/A
small splashes heat, small splashes

molten metal or large splashes molten metal or large

of molten metal splashes of molten metal

ANSI Z359.1: Safety

Requirements for Personnel ANSI Z359.1: Safety Requirements for Personnel Fall
Fall
Fall Protection
Arrest Systems,
Subsystems and Arrest Systems, Subsystems and Components (MANDATORY ONLY FOR WORKING ABOVE
Components
Coverall Coveralls Grey Color (100% cotton) with stripe scotchlight shall be worn by all worker and company Name (at front and back of
 Rigging Electrical Confined Space
ANSI Z89.1 - 2003, Type I ANSI Z89.1 2003, Type I ANSI Z89.1 - 2003, Type I
class G and E class E class G and E
ANSI Z87.1 2003 ANSI Z87.1 2003 ANSI Z87.1 2003

SNI Standard or ASTM F ASTM F 2413-2005 Impact SNI Standard or ASTM F

2413-2005 Impact Resistance Class 75 (I/75) 2413-2005 Impact

and Compression
Resistance Class 75 (I/75) Resistance Class 75 (I/75)
Resistance Class 75 (C/75)
and Compression and Compression
with

Resistance Class 75 electrical protection such Resistance Class 75

(C/75) as (C/75)

o Electric shock resistance

(EH) up to 14,000 V or

o Static Dissipative (SD),

106 ohms - 1010 ohms

or
o Conductive (CD), 0-
500,000 ohms

- ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for - ANSI S3.19 - 1974 for
NRR labeling NRR labeling NRR labeling

- ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for - ANSI S12.6 – 1997 for
NRR testing NRR testing NRR testing

NIOSH Title 42-1995

NIOSH Title 42-1995

ASTM D 120–2006
Specification for Rubber
Insulating

Gloves (electrical)

9.1: Safety Requirements for Personnel Fall

Components (MANDATORY ONLY FOR WORKING ABOVE 6 FEET)

worker and company Name (at front and back of coveralls)
 MCU ITEMS
Laboratorium

Muscle strength and

Rontgen thorax
Physical Check
NO JOB POSITION

Ischihara test
Romberg test
Anamnesis

Visus test
refexes

Urine
EKG

CBC
1 Low Risk
Administration √ √ √ √ √ √
Officer √ √ √ √ √ √
2 Medium Risk
Civil & mechanical work √ √ √ √ √ √
Welder/painter √ √ √ √ √ √ √
Electrical cabling √ √ √ √ √ √ √
Plant Operator √ √ √ √ √ √ √
Work exposed to noise √ √ √ √ √ √
Paramedic √ √ √ √ √ √ √
Pest control √ √ √ √ √ √

3 Spesific & High Risk

Working at height √ √ √ √ √ √ √
Security √ √ √ √ √ √ √
Operators (crane,
forklift, heavy √ √ √ √ √ √ √ √ √
equipment, etc), driver
Confined space √ √ √ √ √ √
Diver √ √ √ √ √ √
Fireman & rescue √ √ √ √ √ √ √
Chemical handling √ √ √ √ √ √ √
Work exposed to
√ √ √ √ √ √
radiation
Food handler √ √ √ √ √ √
Expert >55 years old √ √ √ √ √ √ √
 Fasting Glucose

aboratorium

√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Blood
SGPT

√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Creatinin

√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
HbsAg

√
√

√
Anti HAV

√
Stool culture

Colinesterase

√
Blood film

√
√
Spirometri

√
√
√
√
√
√

√
√ Andiometri

√
√
√
√
√
NAPFA test

√
√
NAPZA test

√
Hyperebaric chamber

√
test
Treadmill test

√
√
√
√
√
√
√
√
√
√
√
√
DAILY
CHECK UP
NO EQUIPMENT CERTIFICATION
1 Crane MIGAS / OIL & GAS
2 Truck Mounted Crane (TMC) MIGAS / OIL & GAS
3 Sky Lift MIGAS / OIL & GAS
4 Forklift MIGAS / OIL & GAS
5 Gondola MIGAS / OIL & GAS
6 Excavator DEPNAKER / MINISTRY OF MANPOWER
7 Dozer DEPNAKER / MINISTRY OF MANPOWER
8 Grader DEPNAKER / MINISTRY OF MANPOWER
9 Genset >200 KVA DEPNAKER / MINISTRY OF MANPOWER
Lifting gear such as webbing sling, chain, block,
10 THIRD PARTY
shackle, etc.

NO SIO CLASS CERTIFICATION

1 SIO Class 1/C (Crane >50T) MIGAS
2 SIO Class 2/B (Crane 25 - 50T) MIGAS
3 SIO Class 3/A (Crane < 25T) MIGAS
4 Rigger MIGAS
 LIFTING CALCULATION FORM

Owner : PT. PERTAMINA (PERSERO)

PMC : WorleyParsons Ltd.
Contractor : RDMP Balikpapan JO

Project : RDMP Balikpapan Project

Location : Balikpapan, Indonesia
DATE
PERMIT TO WORK NUMBER
WORKING AREA (ISBL/OSBL)
SUB-UNIT AREA

A. EQUIPMENT/MATERIAL DESCRIPTION
NO. DESCRIPTION
1 Equipment/Material Description :
2 Tag No. :
3 Dimension
- Diameter (mm) :
- Width (mm) :
- Height (mm) :
- Length (mm) :
4 Equipment/Material Weight (Ton) :

B. CRANE DATA
NO. DESCRIPTION MAIN CRANE (TON)
1 Crane Type (Crawler/Mobile) :
2 Crane Capacity :
3 Boom Length (meter) :
4 Fly/Luffing Jib Length (meter) :
5 Working Radius (meter) :
6 Safe Working Load/SWL (Ton) :
7 Hock Block Capacity (Ton) :
8 Crane Configuration (Standard, SSL, etc.) :
9 Super lift weight (Ton) :
 10 Super lift Radius (meter) :

C. LIFTING ACCESSORIES
NO. DESCRIPTION MAIN CRANE (TON)
1 Wire/Webbing Sling :
- Capacity (Ton) :
- Length (meter) :
2 Spreader beam/bar :
- Capacity (Ton) :
- Length (meter) :
3 Shackle :
- Capacity (Ton) :
- Type :
- Brand :
4 Chain Block :
- Capacity (Ton) :
- Brand :

D. LIFTING CALCULATION
NO. DESCRIPTION MAIN CRANE (TON)
1 Equipment/Material Weight (Ton) :
2 Hock Block Weight (Ton) :
3 Wire/Webbing Sling Weight (Ton) :
4 Spreader beam/bar Weight (Ton) :
5 Schackle Weight (Ton) :
6 TOTAL ERECTION WEIGHT (Ton) :
7 SAFE WORKING LOAD/SWL (Ton) :
8 SAFE FACTOR
- Safety Factor :
- Utilization Rate (%) :

E. GROUND BEARING PRESSURE

NO. DESCRIPTION MAIN CRANE (TON)
1 Crane Weight (Ton) :
2 Total Erection Weight (Ton) :
3 TOTAL WEIGHT (Ton) :
4 Steel Plate Area for Crane (m2) :
5 Ground Bearing Pressure (Ton/m2) :

ATTACHMENT shall be attached before lifting activity and this attachment shall be attached in permit to work
1. Marking Area on Plot Plan
2. Crane certificates
3. Lifting Gear certificates
4. Operator and Rigger certificates
5. Load Chart
2. Crane certificates
3. Lifting Gear certificates
4. Operator and Rigger certificates
5. Load Chart

PREPARED BY SUB-CONTRACTOR :
1. Construction SI (Each Discipline)
2. HSE

REVIEWED BY CONTRACTOR :
1. Construction SI (Each Discipline)
2. HSE

APPROVED BY PMC :
LIFTING CALCULATION FORM

:
:
:
:

REMARKS

TAILING CRANE (TON) REMARKS

:
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:
:
:
 :

TAILING CRANE (TON) REMARKS

:
:
:
:
:
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:

TAILING CRANE (TON) REMARKS

:
:
:
:
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:

:
:

TAILING CRANE (TON) REMARKS

:
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hment shall be attached in permit to work document :

DATE :

DATE :

DATE :
 HSE INDUCTION & ID BADGE REQUEST FORM
COMPANY : PT. Menara Prima Persada
WORKING AREA : RDMP RU V
DATE OF REQUEST : 26th August 2019
ATTACHMENT :
Copy Job Seeker Card (AK1) Copy of SKCK
MCU Result
Copy ID (KTP)
Employment
No Name of Personnel Date of Birth Blood Type ID Number (KTP) Address Position
Start (dd/mm/yy) End (dd/mm/yy)
1 Gusti Reza 18 Agustus 2019 O 647102 180897 0001 Jalan Gunung Empat Nomor 30 1-Aug-19 31-Mar-20 Inspector QC
2 Hendra Jaya 06 Oktober 1996 O 647104 061096 0002 Perum GPA Jl. Cisadane No.02 1-Aug-19 31-Mar-20 Supervisor
3 Marinni Nabila 05 Agustus 1996 O 647105 450896 0005 Komp Perum Posindo Blok C No.71 1-Aug-19 31-Mar-20 Admin Teknik
4 Syamsul 15-Sep-76 A 647103 150976 0001 Jalan Inpres II No.01 1-Aug-19 31-Mar-20 CONSTRUCTION MANAGER
5 Rachman Niu 06 Maret 1995 O 647105 060395 0002 Jalan Sepinggan Baru 1 No.56 RT. 19 1-Aug-19 31-Mar-20 CIVIL CREW
6 Safirudin 27 Desember 1981 647105 271281 0001 Jalan Sepinggan Baru 1 No.31 RT.21 1-Aug-19 31-Mar-20 CIVIL CREW
7 Lukman 09 Mei 1999 647105 090599 0006 Jalan Manunggal 1-Aug-19 31-Mar-20 CIVIL CREW
8 Agus Rizal 18 Agustus 1981 647105 180881 0001 Jalan Marsma Iswahyudi RT.20 1-Aug-19 31-Mar-20 CIVIL CREW
9 Laode Sakaroku 20 Oktober 1990 B 64105 201090 0003 Jalan Sepinggan Baru 1 RT.20 1-Aug-19 31-Mar-20 CIVIL CREW
10 Jumansyah 18 Oktober 1980 O 647105 181080 0003 Jalan Sepinggan Baru RT.50 1-Aug-19 31-Mar-20 CIVIL CREW

Submission date: *to be filled by JO RDMP

Proposed By; Received By; Issuance Date: Received By;

Working Area: *Green/ *Brown/ *All (Subcontractor/User)
Entrance Gate:

Construction Manager HSE JO RDMP

Note:
1. MCU Result will be reviewed by JO RDMP Medic Advisor nad have to be submitted 3 days before the induction schedule
2. Only FIT MCU Result Candidates will be allowed to have the HSE Induction, HSE JO RDMP will communicate the result to Subcontractor/User
3. The original document must be shown and verified by HSE JO RDMP prior to HSE Induction