BAGIAN 1

LAMPIRAN

KEPEMIMPINAN DAN KOMITMEN

TOP LEVEL MANAJEMEN

Management Meeting
Monthly Meeting
Weekly Meeting
Safety Talk
Bulletin Board, Poster
Struktur Organisasi

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 2

KEBIJAKAN, TUJUAN SERTA

SASARAN

LAMPIRAN

Kebijakan K3
Anggota P2K3
Safety Induction
Buku Saku K3
Kebijakan K3 di Bulletin
Board

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 3

ORGANISASI, TANGGUNG JAWAB,

SUMBERDAYA MANUSIA, STANDAR
DAN DOKUMENTASI

LAMPIRAN

HSE Goal
HSE Planning
HSE Matrix

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 3

ORGANISASI, TANGGUNG JAWAB,

SUMBERDAYA MANUSIA, STANDAR
DAN DOKUMENTASI

LAMPIRAN

Toolbox Meeting
SOP Perbaikan &
Pencegahan

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 3

ORGANISASI, TANGGUNG JAWAB,

SUMBERDAYA MANUSIA, STANDAR
DAN DOKUMENTASI

LAMPIRAN

In-House Training
Sertifikat Pelatihan
Buletin K3

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 3

ORGANISASI, TANGGUNG JAWAB,

SUMBERDAYA MANUSIA, STANDAR
DAN DOKUMENTASI

LAMPIRAN

SMK3 Sub-Kontraktor

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 3

ORGANISASI, TANGGUNG JAWAB,

SUMBERDAYA MANUSIA, STANDAR
DAN DOKUMENTASI

LAMPIRAN

Job Safety Analysis

Report Sosialisasi
CV HSE Manager

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 3

ORGANISASI, TANGGUNG JAWAB,

SUMBERDAYA MANUSIA, STANDAR
DAN DOKUMENTASI

LAMPIRAN

SOP Pemilihan Sub-Kon

Laporan Prakualifikasi
Sub-Kontraktor

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 3

ORGANISASI, TANGGUNG JAWAB,

SUMBERDAYA MANUSIA, STANDAR
DAN DOKUMENTASI

LAMPIRAN

HSE Manual
SOP Safety Induksi
STOP Card

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 4

PENGELOLAAN BAHAYA DAN

DAMPAKNYA

LAMPIRAN

10

HIRA
Form Daily Safety
Inspection
Pengukuran Lingk. Kerja

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 4

PENGELOLAAN BAHAYA DAN

DAMPAKNYA

LAMPIRAN

11

Sertifikat Kalibrasi Alat

SOP Penggunaan PPE
Form Distribusi PPE
Bukti Serah Terima PPE
Training Work at High
MOM Safety Talk PPE
Form Monthly PPE
Inspection

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 4

LAMPIRAN

PENGELOLAAN BAHAYA DAN

DAMPAKNYA

SOP Pengelolaan Limbah

SOP Pelaporan Tumpahan
Minyak
SOP Penanggulangan Tumpahan

12

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 4

LAMPIRAN

PENGELOLAAN BAHAYA DAN

DAMPAKNYA

Perjanjian Kerjasama
Dengan Klinik
MCU Karyawan
Kebijakan Obat-Obatan
dan Alkohol

13

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 5

PERENCANAAN SERTA PROSEDUR-

LAMPIRAN

PROSEDUR

Sertifikat Kalibrasi Alat

SOP Penggunaan PPE
Form Distribusi PPE
Bukti Serah Terima PPE
Training Work at High
MOM Safety Talk PPE
Form Monthly PPE Inspection

14

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 6

PEMANTAUAN IMPLEMENTASI DAN

LAMPIRAN 15

KINERJA

SOP Pelaporan Insiden

dan Investigasi
Dokumentasi HSE
Performance
Form Standown Meeting
Dokumentasi Laporan
Insiden di HSE Board

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 7

AUDIT AND TINJAUAN

LAMPIRAN

SOP Audit Internal

HSE Audit Plan
Report Audit Internal

16

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 8

PROSEDUR TANGGAP DARURAT

LAMPIRAN

SOP Tanggap Darurat

Susunan Tim Tanggap
Darurat Report Simulasi
Tanggap Darurat

17

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES
BAGIAN 9

LAMPIRAN

MANAJEMEN K3L INFORMASIINFORMASI TAMBAHAN

Sertifikat Anggota IAKKI

02 Undangan Munas
IAKKI

18

CONTRACTOR SAFETY MANAGEMENT SYSTEM (CSMS)

QUESTIONNAIRES