IDENTIFIKASI PEMENUHAN PERSYARATAN DALAM PENGELOLAAN RISIKO ASPEK HSSE

Pengawas RISK ASSESSMENT (HIRAC dan atau JSA)

NO AKTIFITAS Perusahaan Pelaksana Pelaksanaan STK/PROSEDUR
(Kontraktor) HIRADC JSA

PT. AKURA BINA CITRA

1 Mobilisasi

1.1 Mobil memasuki workshop PT. AKURA BINA CITRA Inspektor N/A 173/HSE/XI/2017 SOP-HSE-18 Safety Driving

1.2 Loading Peralatan PT. AKURA BINA CITRA Inspektor N/A 173/HSE/XI/2017 HSE-WI-36 Manual Handling

1.3 Pengikatan PT. AKURA BINA CITRA Inspektor N/A 173/HSE/XI/2017 HSE-WI-36 Manual Handling

1.4 Perjalanan Pengangkutan PT. AKURA BINA CITRA Inspektor N/A 173/HSE/XI/2017 HSE-WI-36 Manual Handling

1.5 Unloading PT. AKURA BINA CITRA Inspektor N/A 173/HSE/XI/2017 HSE-WI-36 Manual Handling

Inspection Lifting Gear

1 Preparation

1.1 Melakukan Meeting safety sebelum melakukan pekerjaan PT. AKURA BINA CITRA Inspektor N/A 170/HSE/XI/17 SOP-HSE-05-Komunikasi Partisipasi dan Konsultasi

1.2 Mempersiapkan peralatan yang diperlukan. PT. AKURA BINA CITRA Inspektor N/A 170/HSE/XI/17 - QA-LGI-02 Inspeksi Lifting Set

2 Pre cleaning

Pre-cleaning inspection (remover painting/ coating, brushing and

2.1 PT. AKURA BINA CITRA Inspektor N/A 170/HSE/XI/17 QA-GEN-01
cleaning thread connection)
3 General Inspection
 3.1 Visual and Dimention Inspection PT. AKURA BINA CITRA Inspektor N/A 170/HSE/XI/17 - QA-LGI-02 Inspeksi Lifting Set

4 Non Destructive Test

ABC-MT- 0206 Magnetic Particle Examination Procedure for Steel Structure, Drill S

4.1 MPI/ DPI test (use penetrant or white contrast) (Lifting Gear) PT. AKURA BINA CITRA Inspektor N/A 170/HSE/XI/17

ABC - PT - 0301 Liquid Penetrant Examination Procedure for Steel Structure, Drill Stem

5 Post Inspection Marking

5.1 Marking pipe / tagging mark on pipe and colour code (if applicable) PT. AKURA BINA CITRA Inspektor N/A 170/HSE/XI/17 QA-MARK-05 MARKING CASING, TUBING & PLAIN END DRILL PIPE API RP 5A5

6 Housekeeping
Pengecekan dan pembersihan sampah apabila pada saat job dihasilkan
6.1 PT. AKURA BINA CITRA Inspektor N/A 170/HSE/XI/17 SOP-HSE-14 (Housekeeping)
sampah

Inspection Tubular
1 Preparation

1.1 Conducted Pre job safety meeting PT. AKURA BINA CITRA Inspektor N/A 171/HSE/XI/17 SOP-HSE-05-Komunikasi Partisipasi dan Konsultasi

2 Pre cleaning

Cleaning the critical area as per specified in standard of specification's

2.1 PT. AKURA BINA CITRA Inspektor N/A 171/HSE/XI/17 QA-GEN-01
requirement
3 General Inspection

3.1 Visual and Dimention Inspection PT. AKURA BINA CITRA Inspektor N/A 171/HSE/XI/17 QA-APIRP5A5-01 General Field Inspection New Casing, Tubing & Plain Drill Pipe

3.2 Thickness Check (Casing, Tubing) PT. AKURA BINA CITRA Inspektor N/A 171/HSE/XI/17 QA-APIRP5A5-02 Visual Dan Dimensi Field Inspection New Casing, Tubing & Plain

3.3 Drifting Test (Only Casing, Tubing) PT. AKURA BINA CITRA Inspektor N/A 171/HSE/XI/17 QA-APIRP5A5-03 Hardness Test Field Inspection New Casing, Tubing & Plain Drill P

4 Non Destructive Test

4.1 Electromagnetic Inspection (for Drill Pipe only) PT. AKURA BINA CITRA Inspektor N/A 172/HSE/XI/17 -ABC-MT-2014 Magnetic Particle Examintation Procedure for OCTG Inspection (Co

5 Post Inspection Marking

5.1 Marking pipe / tagging mark on pipe and colour code (if applicable) PT. AKURA BINA CITRA Inspektor N/A 171/HSE/XI/17 QA-MARK-05 MARKING CASING, TUBING & PLAIN END DRILL PIPE API RP 5A5

6 Housekeeping
 Pengecekan dan pembersihan sampah apabila pada saat job dihasilkan
6.1 PT. AKURA BINA CITRA Inspektor N/A 171/HSE/XI/17 SOP-HSE-14 (Housekeeping)
sampah

Demobilisasi

1.1 Mobil memasuki workshop PT. AKURA BINA CITRA Inspektor N/A 174/HSE/XI/2017 SOP-HSE-18 Safety Driving

1.2 Loading Peralatan PT. AKURA BINA CITRA Inspektor N/A 174/HSE/XI/2017 HSE-WI-36 Manual Handling

1.3 Pengikatan PT. AKURA BINA CITRA Inspektor N/A 174/HSE/XI/2017 HSE-WI-36 Manual Handling

1.4 Perjalanan Pengangkutan PT. AKURA BINA CITRA Inspektor N/A 174/HSE/XI/2017 HSE-WI-36 Manual Handling

1.5 Unloading PT. AKURA BINA CITRA Inspektor N/A 174/HSE/XI/2017 HSE-WI-36 Manual Handling
 JSA RECAPITULATION FORM
NO TANGGAL AKTIFITAS NOMOR JSA LOKASI PEKERJAAN PENGAWAS PEKERJAAN RIG SUPT. INCHARGE COMPANY MAN INCHARGE

1
18/11/2017 JSA Lifting Gear 170/HSE/XI/17 Marnasip
2
18/11/2017 JSA Tubular 171/HSE/XI/17
Marnasip
172/HSE/XI/17 Marnasip
3 18/11/2017 JSA Electromagnetik
4
18/11/2017 JSA Mobilisasi 173/HSE/XI/17
Marnasip
5
18/11/2017 JSA Demobilisasi 174/HSE/XI/17
Marnasip
 UPDATE SOP / PROSEDUR KERJA

NO AKTIFITAS KETERSEDIAAN PROSEDUR/SOP/JSA/STK

MOBILISASI
1 Mobil memasuki workshop SOP-HSE-18 Safety Driving
2 Loading Peralatan HSE-WI-36 Manual Handling
3 'Pengikatan HSE-WI-36 Manual Handling
4 Perjalanan Pengangkutan HSE-WI-36 Manual Handling
5 Unloading HSE-WI-36 Manual Handling
Inspection Lifting Gear

1 Preparation SOP-HSE-13 (PPE), SOP-HSE-05-Komunikasi Partisipasi dan Konsultasi

2 Pre cleaning QA-GEN-01

3 General Inspection - QA-LGI-02 Inspeksi Lifting Set
- QA-LGI-03 Inspeksi Alloy Steel Chain Slings
- QA-LGI-04 Inspeksi Synthetic Webbing Slings
- QA-LGI-05 Inspeksi Shackles
- QA-LGI-06 Inspeksi Adjutable Hardware
- QA-LGI-07 Inspeksi Link,Ring, Swivel
- QA-LGI-08 Inspeksi Rigging Block
- QA-LGI-09 Inspkesi Hook
- QA-LGI-10 Inspeksi Hand Chain Operated Hoist
- QA-LGI-11 Inspeksi Manually Lever Operated
Hoist - Chain Type - QA-LGI-12 Inspeksi Manual Jack
- QA-LGI-13 Inspeksi Structural &
Mechanical Lifting Devices

- ABC-MT- 0206 Magnetic Particle Examination Procedure for Steel Structure, Drill Stem
Elements, Hoisting Equipment, Pressure Vessel & Parts Containing Pressure (Yoke - Wet
Particle Non Fluorescent Technique)
4 Non Destructive Test - 'ABC - PT - 0301 Liquid Penetrant Examination
Procedure for Steel Structure, Drill Stem

- QA-MARK-05 MARKING CASING, TUBING & PLAIN END DRILL PIPE API RP 5A5
5 Post Inspection Marking

6 Housekeeping SOP-HSE-14 (Housekeeping)

Inspection Tubular

SOP-HSE-13 (PPE), SOP-HSE-05-Komunikasi Partisipasi dan Konsultasi/HSE – WI – 3

1 Preparation Pertemuan K3L, QA-APIRP5A5-01 General Field Inspection New Casing, Tubing & Plain
Drill Pipe
2 Pre cleaning QA-GEN-01

- QA-APIRP5A5-01 General Field Inspection New Casing, Tubing & Plain Drill Pipe
-
QA-APIRP5A5-02 Visual Dan Dimensi Field Inspection New Casing, Tubing & Plain Drill
3 General Inspection Pipe -
ABC - UT - 0501 Ultrasonic Thickness Measurement Procedure - QA-
APIRP5A5-03 Hardness Test Field Inspection New Casing, Tubing & Plain Drill Pipe

-ABC-MT-2014 Magnetic Particle Examintation Procedure for OCTG Inspection

(Coil – Residual Fluorescent Particle Technique)
- ABC-MT- 0206 Magnetic Particle
Examination Procedure for Steel Structure, Drill Stem Elements, Hoisting Equipment,
4 Non Destructive Test Pressure Vessel & Parts Containing Pressure (Yoke - Wet Particle Non Fluorescent
Technique)
- ABC - MT -
0205 (Electromagnetic Inspection Procedure)
- QA-MARK-05 MARKING CASING, TUBING & PLAIN END DRILL PIPE API RP 5A5
5 Post Inspection Marking

6 Housekeeping SOP-HSE-14 (Housekeeping)

DEMOBILISASI
1 Mobil memasuki workshop SOP-HSE-18 Safety Driving
2 Loading Peralatan HSE-WI-36 Manual Handling
3 'Pengikatan HSE-WI-36 Manual Handling
4 Perjalanan Pengangkutan HSE-WI-36 Manual Handling
5 Unloading HSE-WI-36 Manual Handling
 CERTIFICATE RIG EQUIPMENT
Certificate
No Name of Equipment Brand Type Serial Number Certificate Number Certificate Release Next action
Expiracy
1 AC Yoke Magnaflux YG S 04-ABC-001 ABC/003/CAL/VII/17 02/Aug/17 02-Feb-18
2 DC Coil 11” New Tech RC2-102920121 ABC/002/CAL/IX/17 04-Sep-17 04-Mar-18
3 UV lightmeter Spectroline/DM365XA RC2-102920121 1882019 ABC / 017 / CAL / IX / 17 14-Sep-17 15-Mar-18
4 Gauss Meter Test R. B. Annis 12-1615 ABC / 012 / CAL / VIII / 17 09-Aug-17 09-Feb-18
5 Digital Caliper Mitutoyo CD-12"C 1117947 PAS-SK17-008904 25-Jul-17 23-Jan-18
6 Step Gauge RCM N/A 08-6545 ABC / 017 / CAL / VII / 17 11-Jul-17 11-Jan-18
7 Profile Gauge Gagemaker TP-453 (3 TPF, 5 TPI, V-0.040) D04066 ABC / 019/ CAL / VII / 17
12/Jul/17 01-Nov-18
8 Profile Gauge Gagemaker TP-543 (3 TPF, 4 TPI, V-0.050) D12107 ABC / 020/ CAL / VII / 17 12/Jul/17 12-Jul-18
9 Profile Gauge Gagemaker TP-23-50 (2 TPF, 4 TPI, V-0.038R) B04460 ABC / 021 / CAL / VII / 17 13/Jul/17 14-May-18
10 Profile Gauge Gagemaker TP-542 (2 TPF, 4 TPI, V-0.050) N/A ABC / 022 / CAL / VII / 17 13/Jul/17 13-Jul-18
11 11" DC Coil EMI New Tech VEDAQ 2000-C DPC2-10052011 ABC / 016 / CAL / IV / 17 17-Apr-17 17-Apr-18
12 9" DC Coil EMI New Tech VEDAQ 2000-C DPC1-10052011 ABC / 017 / CAL / IV / 17 18-Apr-17 18-Apr-18
13 12” Steel Ruler Mitutoyo N/A 182-121 N/A N/A N/A
14 OD Gauge+Stick Rod New Tech N/A 11111404S ABC / 033 / CAL / VII / 17 01/Jul/17 01-Jan-18
15 3-1/2" Ref. Std Model VEDAQ 2000-C N/A DPTW3105111 ABC/003/CAL/III/16 02-Mar-16 02-Mar-18
16 5" Ref. Std N/A N/A S09 – ABC – 050 ABC / 005 / CAL / XII / 16 05-Dec-16 05-Dec-18
17 Drift 2 7/8 - 13 3/8 N/A N/A ABC/005/CAL/V/17 29-Apr-17 29-Apr-18

18 Drift Casing 20 " Besmindo N/A N/A 144/COC/III/2017 17-Mar-17 17-Mar-18

 NO NAMA POSISI PERUSAHAAN WORKER TYPE

PT. AKURA BINA CITRA

1 MARNASIP PANDIANGAN INSPECTOR PT. AKURA BINA CITRA National

2 BAYU SETIAWAN INSPECTOR PT. AKURA BINA CITRA National

3 HENDRIYAN H HELPER PT. AKURA BINA CITRA National

4 HENDRA SITUMORANG HELPER PT. AKURA BINA CITRA National
5 NATA HELPER PT. AKURA BINA CITRA National
6 BANGKIT HELPER PT. AKURA BINA CITRA National
 SERTIFIKAT CREW
BOARDING
TYPE SERTIFIKAT NOMER SERTIFIKAT

-Cert. No.: 002/MT-II-ABC/IX/2017 - Cert.:

BACE CAMP ASNT LEVEL II (MT,PT,UT) 001/PT-II-ABC/IX/2017 - Cert.
No.: 005/UTT-II-ABC/I/2014

Cert No.: 018/MT-II-ABC/II/2015

BACE CAMP ASNT LEVEL II (MT,PT) - Cert No.: 010/PT-II-ABC/V/2014 Cert.
No.: 027/UT-II-ABC/IX/2015
BACE CAMP - -
BACE CAMP - -
BACE CAMP - -
BACE CAMP - -
 SUMBER DAYA MANUSIA
MCU SIM L

STATUS MCU
EXPIRED DATE EXPIRED DATE NOMER SIM L
FIT 1 , FIT 2

- 14 September 2022
- 18 September 19-May-18
2022 - 29 Januari
2019
-14 Maret 2022 -
2 Mei 2019 5-Jun-18
- 17 September 2020
- 3-Mar-18
- 18-Oct-18
- 14-Jan-18
- 9-Dec-18
*
DAYA MANUSIA ( SDM )
SIM L

Surat Keterangan Catatan

TANGGAL TERBIT TANGGAL BERAKHIR NOMER HSE PASPOR
Kepolisian (SKCK)

MENYUSUL

MENYUSUL

MENYUSUL
MENYUSUL
MENYUSUL
MENYUSUL
 HSE PASPOR

RIWAYAT PELATIHAN BST

TGL RIWAYAT ORIENTASI
TANGGAL TRAINING NILAI (LULUS JIKA ≥ 80%)

16-Nov-17 91

14-Nov-17 93

16-Nov-17 93
16-Nov-17 91
14-Nov-17 84.6
14-Nov-17 83
 REMARKS
RIWAYAT PELATIHAN LIFTING & RIGGING

TANGGAL TRAINING NILAI (LULUS JIKA ≥ 80%)

16-Nov-17 100

14-Nov-17 100

16-Nov-17 100
16-Nov-17 100
14-Nov-17 96
14-Nov-17 85