Summary Cross Audit 2022

Enablon Sustainable Development
No Indicator Definition
Questionnaire - Road risk Oct-21
9 Does the company site make it possible to limit 80

commuting?
15 Are driver’s licenses of the employees checked

annually and recorded? 80
17 Is a driver training program implemented in order to

ensure that each employee has the necessary skills in
order to drive according to known risks?
60
18 Is updated training organized according to needs

detected by the risk assessment and the safety events
analyze result? 60
Finding 2021 Jun-22 CA 2022 Finding 2022
Sudah diajuin ke manajemen untuk shuttle bus , namun 80 80 Sudah di ajukan namun belum
menunggu feedback persetujuan ada feedback dari BOD
Updated data SIM karyawan 2021 80 100 Updated data SIM karyawan
2022
implementasi untuk pelaksanaan training safety riding & 80 80 implementasi untuk

safety driving pelaksanaan training safety
riding & safety driving -->
oleh pihak polres kab bekasi
implementasi untuk pelaksanaan training safety riding & 80 80 implementasi untuk

safety driving pelaksanaan training safety
riding & safety driving -->
oleh pihak polres kab bekasi
Status PIC Due Date Action
Open, due to pandemic A Rahman 23-Jun-22
closed Rahman & 30-Jun-22 Submit SIM PPLI &

Hakim Mobile Truck Tangki
Solar
ongoing Rahman & 4 & 5 Jul Akhir agustus
Hakim 2022 dijadwalkan
ongoing Rahman & 4 & 5 Jul Akhir agustus

Hakim 2022 dijadwalkan
SCORE
WORK AT HEIGHT - QUESTIONS

Does your Risk Apakah proses
Assessment process Penilaian Resiko Anda
1 cover all anticipated mencakup semua
working at height pekerjaan di
situations? ketinggian
Are all employees who Apakah semua

are required to work karyawan yang
at height and those diharuskan bekerja di
2 who supervise them tempat tinggi dan yang
trained and mengawasi mereka
competent. (Records terlatih dan kompeten.
required)? (Diperlukan rekaman)?
Apakah ada daftar

Is there a list showing yang menunjukkan
all personnel bahwa semua personil
3 permitted to work at diizinkan bekerja pada
height on potentially ketinggian pada tugas
hazardous tasks? yang berpotensi
berbahaya?
Apakah semua bekerja

pada akses tinggi dan
Is all working at height
access and safety peralatan keselamatan
yang diidentifikasi dan
equipment identified
and tested (with diuji (dengan catatan
4 yang tersedia)
records available) at setidaknya setiap
least annually to
ensure it is suitable tahun untuk
memastikannya sesuai
and fit for purpose? dan sesuai untuk
tujuan?
Apakah semua
Does all work at height pekerjaan di tempat
have a known Safe tinggi memiliki
5 Working Procedure or Prosedur Kerja Aman
is subject to a Permit yang diketahui atau
to Work? dikenai Izin untuk
Bekerja?
Apakah Anda telah

Do you have
established emergency menetapkan prosedur
darurat dan
6
and rescue procedures penyelamatan untuk
to assist those who
membantu mereka
have to work at yang harus bekerja
height?
pada ketinggian?
Apakah tindakan
Do control measures pengendalian untuk
for activities on the
8 roof systematically kegiatan di atap secara
prioritize collective sistematis
memprioritaskan
protection? perlindungan kolektif?
Is a named person Apakah seseorang

responsible for bernama bertanggung
reviewing all working jawab untuk meninjau
10 at height semua pekerjaan di
arrangements pengaturan ketinggian
(program (administrator
administrator)? program)?
Have all roofs, Apakah semua atap,

elevated walkways, jalan setapak yang
15 and platforms been ditinggikan, dan
assessed as safe or platform dinilai aman
unsafe? atau tidak aman?
16
Are the skylights (on Apakah skylight (di
roof) protected? atas atap) terlindungi?
Memiliki semua atap,
Have all roofs, jalan setapak yang
elevated walkways, ditinggikan, dan
and platforms been platform dipelihara
17 maintained to prevent untuk mencegah
corrosion of structural korosi komponen
components (paint, struktural (cat,
leak repair, etc.)? perbaikan kebocoran,
dll.)?
Apakah peralatan
Is fall arrest penahan jatuh tersedia
equipment available
22 and used by all dan digunakan oleh
semua personil pada
personnel on mobile peralatan akses
access equipment? mobile?
Apakah semua tangga

Have all stairways over
3 steps been fitted lebih dari 3 langkah
28
with suitable telah dilengkapi
dengan pegangan
handrails? tangan yang sesuai?
Apakah semua
Have all personnel
working at height on personil yang bekerja
vehicles a safe pada ketinggian pada
29 kendaraan merupakan
operating procedure prosedur operasi yang
which includes safe
access? aman yang mencakup
akses yang aman?
U
C
T
I
O
SCORE SCORE N
LOTO - QUESTIONS 2021 2022 S ACTION PLAN ACTION PLAN 2 RECORDS & COMMUNICATIONS INTERVIEW QUESTIONS OBSERVATIONS
Has a person been nominated as being responsible for the
1 management overview of all plant and equipment isolations on Update SK related Permenaker 38 2016 and logo 126
site
100 100
Apakah seseorang telah dinominasikan untuk bertanggung jawab
atas tinjauan manajemen semua isolasi pabrik dan peralatan di
lokasi?
2
Has the nominated person sufficient information and training to Refresh Training Champion and Co Champion by Boost 240
enable them to manage their responsibilities competently.
100 100
Apakah orang yang dinominasikan memiliki informasi dan
pelatihan yang cukup untuk memungkinkan mereka mengelola
tanggung jawab mereka secara kompeten.
Has a Risk assessment been carried out to identify all situations

Update terkait Dept & machine sub machine
where energy isolation of plant and equipment would be Update LOTO Capability 240
required?
3 80 80
Apakah penilaian Risiko telah dilakukan untuk mengidentifikasi
semua situasi di mana isolasi energi pabrik dan peralatan akan
diperlukan?
Is there a written procedure for the safe energy isolation of all SOP 04 Rev. 05 600
plant and equipment?
4 100 100
Apakah ada prosedur tertulis untuk isolasi energi yang aman dari
semua instalasi dan peralatan?
Have all relevant employees been trained and had supervised Refresh Training 9 June 2022
Need refresh / coaching training for authorized LOTO
practice at implementing the safe energy isolation of the hanya 1 orang yang lulus refresh training--> ganti
600
relevant plant and equipment? metode training to aplikasi lapangan
5 80 80
Apakah semua karyawan yang relevan telah dilatih dan memiliki
praktik yang diawasi dalam menerapkan isolasi energi yang aman
dari pabrik dan peralatan yang relevan?
Is their a list of trained personnel kept and updated on a regular Refresh Training for authorized person, and provide SK
12
basis for authorized person
6 80 80
Apakah daftar personel terlatih mereka disimpan dan diperbarui
secara teratur?
Are there appropriate suitable and sufficient LOTO devices (pad- 600
locks, LOTO tool kits, valve, covers, etc.) available.
7 60 60
Apakah tersedia perangkat LOTO yang sesuai dan memadai
(gembok, kit alat LOTO, katup, penutup, dll.)?
Is there a system and procedure to ensure that the locks of LOTO for authorized person
employees and others cannot be removed without a thorough Refer to 0ne person one Lock, One Key
600
search and investigation by the nominated responsible person.
8 100 100
Apakah ada sistem dan prosedur untuk memastikan bahwa kunci
karyawan dan lainnya tidak dapat dilepas tanpa pencarian dan
penyelidikan menyeluruh oleh orang yang bertanggung jawab
yang ditunjuk.
Has each installation been equipped with suitable and sufficient
energy isolating devices so that equipment can be effectively 600
locked out
9 60 60
Apakah setiap instalasi telah dilengkapi dengan perangkat isolasi
energi yang sesuai dan memadai sehingga peralatan dapat
dikunci secara efektif?
Have all relevant managers and supervisors been trained on the

Refresh Training for all relevant Supervisor and
procedures and their obligations to ensure the safe energy manager 126
isolation of plant and equipment.
10 80 80
Apakah semua manajer dan penyelia yang relevan telah dilatih
tentang prosedur dan kewajiban mereka untuk memastikan
isolasi energi yang aman dari pabrik dan peralatan.
Has the Risk Assessment procedure identified where a Permit to

Work procedure should be applied? ( where more than 3 There is no risk assessment for the hydrant yet 240
isolation points for sources of energy)
11 60 60
Apakah prosedur Penilaian Risiko telah mengidentifikasi di mana
prosedur Izin Bekerja harus diterapkan? (di mana lebih dari 3
titik isolasi untuk sumber energi)
Do your procedures require every employee who is 'at risk'

applies an individual Lockout device to each source of hazardous 600
energy, thereby ensuring his/her personal safety. One Lock - One
Key!
12 100 100
Apakah prosedur Anda mengharuskan setiap karyawan yang
'berisiko' menerapkan perangkat Penguncian individu ke setiap
sumber energi berbahaya, sehingga memastikan keselamatan
pribadinya. Satu Gembok - Satu Kunci!
Have the procedures determined the type and number of safety 240
Lockout and Tag devices required,
13 60 60
Apakah prosedur menentukan jenis dan jumlah perangkat
Lockout dan Tag pengaman yang diperlukan,
Is there a procedure to ensure that all safety Lockout devices are
There is no regular checking of LOTO equipment at the
safely stored in designated locations and condition checked on a LOTO station yet 126
regular basis.
14 60 80
Apakah ada prosedur untuk memastikan bahwa semua
perangkat Pengunci pengaman disimpan dengan aman di lokasi
yang ditentukan dan diperiksa kondisinya secara teratur.
Do your procedures specifically require that stored or residual Complete all LOTO General Placard and Local Placard 600
energy is dissipated or restrained by an approved method?
15 60 80
Apakah prosedur Anda secara khusus mengharuskan energi yang
tersimpan atau energi sisa dihamburkan atau ditahan dengan
metode yang disetujui?
Do your procedures require that isolation is verified by trying to 600

start the equipment after isolation (provided it is safe to do so!)
16 100 100
Apakah prosedur Anda mengharuskan isolasi diverifikasi dengan
mencoba memulai peralatan setelah isolasi (asalkan aman untuk
melakukannya!)
Do your procedures require that a Dynamic Risk Assessment (60
seconds to think) before work commences on isolated Cetak Banner terkait 60 second to think 126
equipment,
17 80 100
Apakah prosedur Anda mengharuskan Penilaian Risiko Dinamis
(60 detik untuk berpikir) sebelum pekerjaan dimulai pada
peralatan yang terisolasi,
Does your procedure require that for any equipment that is

locked out and left unattended, there is a verification check that 126
the locks have not been damaged or removed before work
recommences
18 100 100
Apakah prosedur Anda mengharuskan untuk setiap peralatan
yang terkunci dan dibiarkan tanpa pengawasan, ada pemeriksaan
verifikasi bahwa kunci tidak rusak atau dilepas sebelum
pekerjaan dimulai kembali
Do your procedures require a safety check of the work area to

ensure the safe removal of personnel, equipment and tools from 600
the area before energy is restored.
19 100 100
Apakah prosedur Anda memerlukan pemeriksaan keamanan
area kerja untuk memastikan pemindahan personel, peralatan,
dan peralatan dengan aman dari area tersebut sebelum energi
dipulihkan.
Does your procedure require that all safety components such as
interlocks and guards are fully restored to service before the 600
energy source is reconnected.
20 Apakah prosedur Anda mengharuskan semua komponen 100 100
keselamatan seperti interlock dan pelindung sepenuhnya
dikembalikan ke layanan sebelum sumber energi disambungkan
kembali.
Does your procedure require that all affected employees are

informed that the energy resources have been restored and that 600
the equipment is ready for use.
21 80 100
Apakah prosedur Anda mengharuskan semua karyawan yang
terkena dampak diberitahu bahwa sumber daya energi telah
dipulihkan dan peralatan siap digunakan.
Is there a requirement that all contractors who work under a
Added LOTO Procedure in safety induction for
Lockout/Tagout system have an Authorised Status or are subject Contractors 600
to Permit to Work requirements.
22 80 80
Apakah ada persyaratan bahwa semua kontraktor yang bekerja
di bawah sistem Lockout/Tagout memiliki Status Resmi atau
tunduk pada persyaratan Izin Bekerja.
If Production Emp. will have to make frequent access of short
duration to equipment during normal production without full 600
Lo/To provision, have they received specialised training on safe
working procedures?
23 100 100
Jika Produksi Emp. harus sering mengakses peralatan dengan
durasi singkat selama produksi normal tanpa ketentuan Lo/To
penuh, apakah mereka telah menerima pelatihan khusus tentang
prosedur kerja yang aman?
Is there a procedure to ensure that all temporary staff, agency

Added LOTO Procedure in safety induction for
staff or contractors are informed and trained where necessary Contractors
240
on the local requirements for energy isolation?
24 80 80
Apakah ada prosedur untuk memastikan bahwa semua staf
sementara, staf lembaga atau kontraktor diinformasikan dan
dilatih jika perlu tentang persyaratan lokal untuk isolasi energi?
Do your procedures ensure that Lo/To is continuous for shift and 600
personnel changes
25 100 100
Apakah prosedur Anda memastikan bahwa Lo/To berkelanjutan
untuk pergantian shift dan personel?
Do you have a procedure for the safe removal of Lo/To devices in 240
the event of someone accidentally leaving them in place?
26 100 100
Apakah Anda memiliki prosedur untuk melepas perangkat Lo/To
dengan aman jika seseorang secara tidak sengaja
meninggalkannya di tempatnya?
Have you an audit and review procedure to ensure that all the
requirements of your Plant and Equipment Isolations are 126
effective?.
27 80 80
Sudahkah Anda mengaudit dan meninjau prosedur untuk
memastikan bahwa semua persyaratan Isolasi Pabrik dan
Peralatan Anda efektif?.
OVERALL CROSS AUDIT SCORE 84 87
Score 2021
MACHINERY SAFETY - QUESTIONS
Does the plant have access to all legal and company

1 80
requirements about machinery safety, including guarding?
Does the plant have access to a competent person who can

2 assess the status of machinery safety compliance with legal 80
and company requirements?
Are all machines brought to the site checked by a competent

3 person to ensure that they comply with this standard before 80
they are used?
Does the plant have an inventory list of all machines that may
4 80
require guarding?
Is a record maintained of all formal machinery safety

5 80
inspections? (guards, interlocks, etc.) (date, who did it, etc.)
Is there a system to record, prioritise, implement and track the

6 status of any recommendations from the formal machine 80
inspections?
Have all machines on the site had a recorded risk assessment
7 80
involving operators, taking normal operations into consideration?

8 involving operators, taking process intervention and cleaning into 80
consideration?

9 involving operators and foremen, taking regular or 80
foreseeable maintenance operations into consideration?
For modified machines, are the risk assessments reviewed

10 80
before the machine is put back into operation?
Are all machinery safety risk assessments reviewed at least

11 100
once every year?
Is there a system to ensure that control measures arising from

12 80
risk assessments are prioritised and implemented?
Is there an inspection/ maintenance schedule for all

13 100
machinery safety protection devices?
14 Is there a list of authorised machine operators? 100
Are emergency stops on all powered machinery readily

15 80
accessible to operators?
Is the by-passing of safety devices prohibited without written

16 80
authorisation?
Have all areas where employees could be entrapped,

17 entangled or otherwise harmed by parts of machinery been 80
identified and fitted with appropriate protection devices?
Have all inspection/ access panels to hazardous parts of

machines and process equipment been secured so they
18 require tools to open them, and are there warning notices or 80
protective screens to prevent inadvertent access or exposure
to hazards?
Do all fixed guards require tools to open them? (No

19 100
wingnuts!)
Do all access points to high hazard areas, without physical

20 barriers, have appropriate protection devices, e.g, light 80
curtains?
Do operators carry out recorded visual safety checks of their

21 work areas during every shift? (Generic or machine-specific 100
checklists may be used)
Is there a system to record employees' safety concerns about

22 100
machinery safety?
Do local procedures specify in which conditions the use of
23 LO/TO for maintenance or access inside machines is 80
required?
Is there a list of all machines that require a permit to work for

24 80
maintenance?
Is there a monitoring system to measure the level of

25 80
compliance with the requirements of this standard?
Is the status of machinery safety formally reviewed by the site

26 manager at least once a year before approval of the action 100
plan for the next 12 months?
85
Score 2022
Action Plan 2021
1. Share folder (onedrive) dapat diakses oleh

champion & co-champion,
2. Untuk aspek legal mendapatkan hardcopy 100
3. Sosialisasi dilakukan pada agustus 2021
kepada tim maintenance & produksi
1. Assignment baru untuk champion & co-

champion (Pak Achmad Mahmudi & Ferry 100
Ardiansyah)
2.
Mesin SAP CBT dilakukan inspeksi terhadap 100

machine performance (report commisioning
belum tersedia)
80
Form machinery inventory list tersedia, namun
belum terupdate
80
inspeksi dilakukan rutin, inspeksi per mesin,
juga inspeksi berdasarkan CILT
100
Record dilakukan dikombinasikan dengan

CILT,
80
Konsistensi tindakan perbaikan yang dilakukan
dari hasil review RA
80
Konsistensi tindakan perbaikan yang dilakukan
dari hasil review RA
80
Review risk assessment dilakukan melibatkan
operator, konsistensi pelaksanaan
80
100
RA Maintenance dilakukan review Mar-21,
RA Production dilakukan review Sep-21
Review dari RA, e-tag, MJO untuk tindakan 100

perbaikan yang timbul dari review RA
Jadwal inspeksi maintenance dalam jadwal PM 100

mingguan, bulanan, agenda CILT review
jadwal
100
Data authorized machine operator tersedia
Emergency stop dilakukan inspeksi mingguan

& harian 80
(Kondisi aktual posisi emergency stop
menyusul)
80
Form bypass & WI tersedia (dokumen
menyusul)
80
Mesin dan panel telah dilengkapi protection
devices & guarding
80
Access panel disediakan kunci, mesin
disediakan guarding dan safety signage
100
Tidak ada penggunaan wingnut
80
semua panel & mesin pada area high hazard
dilengkapi pengaman (dokumen menyusul)
80
Tercakup di laporan daily checklist
safety concern dari temuan inspeksi 100

harian/saat mesin beroperasi
80
80
List machine tersedia namun belum secara
keseluruhan terupdate
100
SA dilakukan september 2021, training
dilakukan agustus 2021
100
Review dalam P2K3 dan management review
89
Action Plan 2022
Share Daftar perturan perundang

undangan
Update Inventory List machine
Update Inventory List machine
Follow up by E-TAG & Reliability pillar

Review Risk Assessment related SG Std
and Generic Hazard

and Generic Hazard

and Generic Hazard
Adding bagger machine activity
Update Machinery safety risk assessment

Form Inventory MS
Follow up by E tag
Update Schedule related actual checklist

Data sudah tersedia, perlu update kolom
area dan format SK, serta ditempelkan di
area mesin
Lengkapi checklist machinery safety
E-Tag
SWP for all machine
Update Risk Assessment terkait

kebutuhan PTW
SAINT-GOBAIN SAFETY STANDARD
Forklift Trucks
Question Wording Answer

General questions
Has a person been appointed on the site to be responsible for
1
the implementation and follow up of this standard? Yes
Risk assessment
Do risk assessments cover FLT operation and the mandatory
2 elements set out in Section A (Risk Assessment) of this 100
standard?
Control of risks
Have the group purchasing requirements (standard's appendix)
3
been implemented for new FLTs? 100
Have appropriate speed limits been established on the site in

11
line with the results of the risk assessment ? 80
Is maintenance of FLTs undertaken by a competent person at

regular intervals defined by manufacturer recommendations
7
taking into account the operating environment and local legal 100
requirements ?
Where the physical separation of FLT and pedestrians is not
10 practicable has the site implemented the specific FLT 80
requirements of section B2 (Traffic routes)?
Are hazardous environmental conditions of the section B3
12 (environmental conditions) taken into account in the FLT 80
operating procedures?
Do pedestrian and co-workers respect the mandatory points
21 described in Section B9 (Pedestrians and Coworkers) of this 100
standard?
Does diesel FLT usage comply with section B1 (FLT and

4
Safety equipment) du standard ? 80
Are control measures in place to prevent unauthorised

5
personnel using FLTs ? 100
Is the FLT use consistent with the manufacturer
6
recommendations and the local rules ? 100
Are easily available safety checks undertaken by drivers each
8
work period of every shift ? 100
Are safety critical items on the safety check highlighted to
9
ensure that if they fail the FLT is not used? 100
Is FLT refuelling undertaken by competent operators in an

13 appropriate place (in line with the requirements of the SG 80
Industrial Risk manual) with appropriate PPE easily available?
Is the parking area for FLTs compliant with the requirements of

14
the SG Industrial Risk manual? 80
Are all FLT operations (movement, stacking, loading, unloading
15 of loads etc.) covered by clear working methods and include 100
instruction for drivers if they encounter unsafe conditions?
Are FLT drivers selected based on their suitability (behaviour,

16
maturity) for the role and their medical fitness? 100
Are the correct accessories available to the drivers and

17 maintained in a good condition to allow them to lift loads 80
safely?
Do FLT drivers receive general operational and specific task
18 based training for each type of truck and for different 100
attachments refreshed at least once every 5 years?
Do all FLT drivers on site have written authorisation from site
19
management to drive? 100
Do FLT drivers know and follow the key safe actions described
20
in Section B8 (Drivers) of this standard? 100
Checking compliance with rules

Is there a system of checking compliance with rules covering
22 the use of FLT in line with this standard and correcting non 80
conformances?
NUMBER OF QUESTIONS NOT APPLICABLE 0

CONFORMITY SCORE % 92
Example Evidence for self or external assessment
Update terus RA FLT, berkaitan maintenance FLT
Buatkan form evaluasi berdasarkan kontrak dan standard, follow kontrak

jangka panjang terkait FLT
Speed Limiter FLT rusak, belum ada perbaikan dari vendor dari 16
Maret 2022 dan belum ada perbaikan.
Minta jadwal maintenance dari vendor FLT, dan laporan Service dari vendor
pasang barrier pada jalur pedestriandari office melalu pintu belakang

office (bidding Process)
Pembatas pedestrian di area WH RM
Tambahkan dalam RA terkait "Berkendara dalam gudang yang poor

housekeeping/berantakan/overload/penuh"
Update SWP terkait FLT mengacu pada standard section B3
Update maping dan cetak rambu-rambu untuk pedestrian
repair speed limiter

Konsistensi Checklist
Update WI dan ditempel di area parkir FLT
perlu konsistensi untuk pengisisan log book

Konsistensi, service sesuai jadwal
Konsistensi pengisian ceklist
Konsistensi pengisian ceklist
Cek lapangan terkait pengisian solar, tambahkan dalam WI

pemasangan grounding dari body forklift ke tangki solar,
tentukan lokasi parkir forklift, berikan sign parkir forklift & lengkapkan
dengan APAR
Refresh training untuk operator forklift dilengkapi dengan Post test dan
Praktik
Laporan pemeriksaan fit to work 2x seminggu, tidak ditemukan laporan

MCU tahunan untuk operator FLT
Update WI Penggunaan sepatu forklift & cek lapangan, Tempat sepatu

FLT dan Pin pengunci
Konsistensi, tambahkan materi spesifikasi truck di dalam training
Membuat SK Penunjukan Operator Forklift dan Loader
Sosialisasi FLT golden rules via refresh training, Spanduk atau poster
Updated legal dengan permenaker 8 tahun 2020 menggantikan

peraturan yang lama
Follow up SLO Forklift Loader
vice dari vendor
CONFINED SPACES - QUESTIONS
1
Does the site have access to all legal and company
requirements about confined space management?
Does the site have access to (a) competent person(s) who can
2 assess the Confined Space safety status of the site to legal and
company requirements?
3
Has the site been surveyed by a competent person to identify
all potential confined spaces?
4
Does the site have an inventory list of all confined spaces
including permit and non permit required areas?
5
Has/have (a) competent Permit to Work Responsible Person(s)
been appointed?
6
Has/have (a) competent Permit to Work Issuer(s) been
appointed?
7
Have persons been nominated to enter Permit Required
Confined Spaces?
7
Have persons been nominated to enter Permit Required
Confined Spaces?
Have all the persons nominated to work in confined spaces

8 been suitably trained in the Safe Operating Procedures of such
work including Emergency arrangements?
9
Have persons been trained to carry out the tasks of Confined
Space Attendant or Standby Person?
Have sufficient numbers of personnel been trained to carry

10 out gas testing in confined spaces, which include knowledge of
gas hazards and calibration and use of testing equipment?
11
Do the gas testers know the SG gas limits and about the
requirement to ensure the whole confined space is safe?
12
Have all Permit Required Confined Spaces been suitably visibly
identified at all potential access points?
13
Has the site a suitable range of entry/rescue/ retrieval
equipment for Confined Space Entry?
14
Is the confined space entry/ rescue and retrieval equipment
stored in a suitable location?
Is there a robust communication system and procedure
15 between confined space entrants and the attendant/ standby
person?
Is there a robust communication system and procedure

16 between the attendant and the emergency response
person(s)?
17
Does the emergency response person know what the
Emergency Plans are and how and when to Initiate them?
18
Is there equipment available to ventilate confined spaces if
required?
19
Is there an Emergency Plan for every Permit Required
Confined Space?
20
Does the Confined Space Permit to Work meet all the
requirements of this standard?
21
Have all permits issued in the last 12 months been completed
and closed correctly?
22
Have there been any Confined Space Emergency plan practices
carried out in the last 12 months?
Do the local rules specify that all contractors and sub-

23 contractors have to comply with this standard before entering
a confined space?
Do the local rules specify that all contractors and sub-
23 contractors have to comply with this standard before entering
a confined space?
Are all the documents and records required by this standard

24 and local legislation kept in a secure location for inspection
and auditing?
25
Is there a recorded annual review of all the safety
requirements of this standard and associated local legislation?
Are all personnel aware of the possibility of small rooms,

26 trenches, etc., becoming permit required confined spaces due
to local work or conditions?
OVERALL CROSS AUDIT SCORE

SCORE 2021
Apakah site mempunyai access ke

semua legal dan kebutuhan 80
perusahaan tentang manajemen CS
80
Apakah site mempunyai akses ke
orang yng mempunyai kompetensi
yang dapat mengakses status safety CS
ke legal dan kebutuhan perusahaan
Apakah site telah di survey oleh org 60

yang berkompeten untuk
mengidentifikasi semua potensi CS
80
Apakah site mempunyai list inventory
dari semua CS termasuk area yang
butuh permit maupun tidak.
Apakah ada orang yang bertanggung 100

jawab untuk meminta PTW yang
ditunjuk
100
Apakah ada orang yang bertanggung
jawab untuk mengeluarkan PTW
Apakah ada orang yg ditunjuk untuk

memasuki CS yg butuh permit 100
Apakah ada orang yg ditunjuk untuk
memasuki CS yg butuh permit
Apakah orng2 yg dinominasikan untuk

bekerja di CS sdh mendapatkan 40
pelatihan safe operating procedure
untuk pekerjaan tsb termasuk
pengaturan emergensinya
Adakah orang yg di training untuk 60

menghandel tugas sebagai CS
attendant atau org yg standby
Adakah sejumlah orang yg sdh 60

ditraining untuk mengetes gas
termasuk mempunyai pengetahuan
bahaya gas dan cara kalibrasinya serta
penggunaan alatnya
60
Apakah pengetes gas tahu batasan Gas
dan tentang kebutuhan yang
menyatakan CS tersebut aman
Apakah semua izin yg dibutuhkan oleh 100

CS sudah sesuai dan teridentifikasi
secara visual pada semua titik akses?
60
60
80
80
80
100
80
60
80
40
80
80
100
60
75
Action Plan
FINDINGS 2021
Share folder sudah ada, pelaporan sudah dilakukan
share folder sudah dibuat, harap dilengkapi dengan

peraturan dan file terbaru
SIO Expired Oktober 2020, proses pengajuan PR, PO

- Follow up PR pelaksanaan training
belum dibuat.
- Membuat SK petugas Ruang Terbatas
- list petugas belum ada
Membuat list inventory khusus alat rescue

List Inventory sudah ada ruang terbatas, dan dilakukan checklist
secara teratur
PTW Responsible sudah diupdate di PTW matrix
Matrix PTW Issuer dan Responsible sudah ada, SK

belum dapat ditunjukan
SK Petugas Confined Space

melaksanakan drill evakuasi confined
Drill Belum terlaksana dari rencana tahun 2019
space sesuai dengan rencana
SIO Expired Oktober 2020, proses pengajuan PR, PO

belum dibuat.
- list petugas belum ada
Training external untuk petugas gas

Belum ada training external untuk petugas gas test,
detector dan Melaksanakan refresh
training internal rencana dilaksanakan Desember
training internal kepada petugas gas
2021
detector
Perlu training ulang terkait pembacaan gas detector,

Melaksanakan refresh training internal
rencana training internal dilaksanakan Desember
2021 kepada petugas gas detector
Sudah diberi rambu di setiap acces point, Update

foto di list WAH
Confined Rescue tools masih digabung dengan alat Menyediakan lemari khusus alat rescue
emergency lain, perlu tempat atau lemari tersendiri confined space
Confined Rescue tools masih digabung dengan alat Menyediakan lemari khusus alat rescue
emergency lain, perlu tempat atau lemari tersendiri confined space
Komunikasi menggunakan HT, dan Peluit
Komunikasi menggunakan HT, dan Peluit
Emergency Plans sudah dibuat untuk pekerjaan

confined space
Menyediakan blower untuk pekerjaan confined

space
Emergency plan sudah dibuat untuk pekerjaan

confined space

SIO petugas belum diperpanjang, PR sudah diajukan.
Permit sudah di close
melaksanakan drill evakuasi confined

Drill Belum terlaksana dari rencana tahun 2019
space sesuai dengan rencana
tidak ada pekerjaan confined space yang dilakukan

kontraktor
Upload PTW dan dokumen lainnya di share folder
Continous activities
Diperlukan internal training untuk semua pekerja Refresh training untuk semua pekerja yang
terkait CS awareness terlibat akan bahaya confined space
SCORE 2022 Action Plan
80 Share folder ada
Share folder mencakup kelengkapan

80 peraturan terkait CS
SIO expired dalam pengurusan (pihak PJK3

80 meberikan konfirmasi proses
perpanjangan
List inventory tersedia namun belum

80 update
Checklist dilakukan tiap bulan
PTW Responsible sudah diupdate di PTW

100 matrix
100
100 SK Petugas tersedia

Drill di lakukan feb 2022,
60 Termasuk agar dilakukan refresh training

perpanjangan
80 Training internal dilakukan
80 refresh training dilakukan jan 2022
100
80 CS equipment tersimpan dilemari khusus
80 CS equipment tersimpan dilemari khusus

Direkomendasikan tertuang dalam
80 SWP/WI terkait bentuk komunikasi (HT,
Tali, peluit dll)
Direkomendasikan tertuang dalam

80 SWP/WI terkait bentuk komunikasi (HT,
Tali, peluit dll)
Direkomendasikan SWP/WI untuk

80 emergency plan CS
Menyediakan blower untuk pekerjaan

100 confined space
Emergency plan sudah dibuat untuk

80 pekerjaan confined space

perpanjangan
Permit sudah close namun perlu dipastikan

80 pengecekan kadar udara/gas dalam CS
Drill di lakukan feb 2022,

60 Termasuk agar dilakukan refresh training
tidak ada pekerjaan confined space yang

80 dilakukan kontraktor
Dokumen disimpan/dikelola oleh
80 champion dan beberapa disimpan di share
folder
Continues activity
100 Review tahunan dilakukan MR, P2K3,
Refresh training dilakukan ke personel (CS,

80 gas detector, drill)
83
No
Does the site have access to all legal and company

1
requirements on vehicles and pedestrian management?
Does the site have access to a competent person who can

2 assess Vehicle and Pedestrian safety status with regard to
legal and company requirements?
Are all company vehicles used by employees or others on site

3 checked by a competent person to ensure that they comply
with this standard and local legislation before use?
4
Does the plant have an inventory of all company vehicles and
are records kept of maintenance and safety checks?
Are pre-start safety checks done on all vehicles and the

5
vehicles taken out of service for safety critical faults?
Is there an a system to record, prioritise, implement and track

the status of any recommendations from the inspections of
6
vehicles, vehicle operations and vehicle and pedestrian
routes?
Have all vehicle and pedestrian routes been subject to formal

7 inspections and subsequent risk assessment reviews at least
once per year?
Have all employees and contractors been given suitable

8 instruction on the local requirements for pedestrian
movements?
Have all vehicle operations (see para f on page 2) been
9 subject to regular auditing to ensure that the current safe
operating procedures are suitable and sufficient?
Are one way systems or a suitable mirrors to aid visibility are

10
used in case of sharp or blind bends on vehicle routes.?
Barriers are erected for footpaths around corners of buildings

11 and for Pedestrian routes exiting a building immediately into
vehicle routes and for others in high-risk areas,
High visibility clothing is taken in consideration and is

mandatory in areas where pedestrians and vehicles are
12
mixing. Such areas are clearly designated with appropriate
signage.
Where possible, entrances for vehicles and pedestrians are

13 separate. Where not possible bollards or other barriers are
used.
Are suitable arrangements in place to reduce the risk to

14 visitors from vehicles and vehicle movement in the
workplace.?
Are arrangements in place to ensure that the vehicle and

15 pedestrian routes are kept as safe as possible in adverse
weather conditions such as snow and ice?
Is there a system to ensure that control measures arising from

16
risk assessments are prioritised, actioned and sustained?
Is there an inspection schedule for all pedestrian and vehicle

17
routes?
18 Do stairways have suitable treads and handrails?

Are visiting drivers given appropriate information and advice
19 on health and safety hazards and local procedural
requirements?
Where vehicles have to reverse, are suitable arrangements in

20
place to prevent pedestrians being harmed?
21 Are there clearly identified traffic routes and speed limits?
Is the behaviour of pedestrians and vehicle drivers subject to

22 monitoring and feedback through the use of SMATtype
interviews?
23
Have all employee and contractor drivers been suitably
trained and do they hold appropriate licences ?
Are all industrial type vehicles fitted with suitable lights,

24 reflectors, flashing lights, reversing alarms and other safety
devices as appropriate?
25 Are all vehicles fitted with suitable seating and seat belts?
26
Are all tipping operations subject to a risk assessment and all
appropriate safety control measures put in place?
Are all the documents and records required by this standard

27 and local legislation kept in a secure location for inspection
and auditing?
Are suitable and safe parking and storage arrangements

28
made for all types of vehicle, so that stationary vehicles do not
create a hazard in the workplace? Are reverse parking rules in
place?
Is there a procedure to allow employees and others to raise

29 safety concerns with management about vehicles and vehicle
and pedestrian routes?
Is there a recorded annual review of all the safety
30 requirements of this standard and associated local
legislation?
* The gaps' scores automatically proposed in this table should be re-assessed through a related risk assessment to take
DAFTAR PERIKSA KENDARAAN & PEJALAN LEVEL OF COMPLIANCE Oct
KAKI 2021
Apakah lokasi / situs tersebut memiliki akses ke

semua persyaratan hukum dan perusahaan
80
tentang manajemen kendaraan dan pedestrian
(pejalan kaki)?
Apakah situs tersebut memiliki akses kepada

orang berkompeten yang dapat menilai status
80
keamanan Kendaraan dan Pedestrian berkaitan
dengan persyaratan hukum dan perusahaan?
Apakah semua kendaraan perusahaan yang

digunakan karyawan atau orang lain di lokasi
telah diperiksa oleh pihak / orang berkompeten
80
untuk memastikan bahwa kendaraan tersebut
telah mematuhi standar dan undang-undang lokal
sebelum dipergunakan?
Apakah pabrik memiliki inventarisasi semua

kendaraan perusahaan dan apakah catatan
80
tersebut terus disimpan / dipelihara dan diperiksa
keamanannya?
Apakah pemeriksaan keamanan pra - start (pra

penggunaan) dilakukan terhadap semua
kendaraan dan apakah kendaraan-kendaraan 80
yang mengalami kerusakan / gangguan
keamanan kritis akan dikeluarkan / disisihkan?
Apakah terdapat sistem untuk mencatat,

memprioritaskan, menerapkan dan melacak
status dari setiap rekomendasi yang didapat dari 60
inspeksi kendaraan, pengoperasian kendaraan
dan rute kendaraan dan pedestrian?
Apakah semua rute kendaraan dan pedestrian

harus menjalani review pemeriksaan formal dan
80
penilaian risiko berikutnya yang dilakukan
setidaknya sekali dalam setahun?
Apakah semua karyawan dan kontraktor telah

diberi instruksi yang sesuai tentang persyaratan 100
lokal untuk pergerakan pedestrian / pejalan kaki?
Apakah semua pengoperasian kendaraan (lihat
butir f di halaman 2) harus menjalani audit rutin
untuk memastikan bahwa prosedur 80
pengoperasian yang aman saat ini telah cocok
dan memadai?
Apakah sistem satu jalur atau penempatan

cermin yang sesuai untuk membantu visibilitas /
pandangan telah digunakan pada tikungan- 80
tikungan yang tajam atau buta sepanjang rute
kendaraan?
Penghalang ditempatkan di jalan setapak di

sudut-sudut bangunan dan pada rute pejalan kaki
80
keluar dari gedung menuju rute kendaraan dan
untuk daerah berisiko tinggi lainnya,
Pakaian dengan visibilitas yang tinggi / menyolok

dipertimbangan dan wajib dikenakan di tempat-
tempat di mana pejalan kaki dan kendaraan
100
saling bercampur. Daerah tersebut harus
ditunjukkan secara jelas dengan signage / rambu
yang tepat.
Bila memungkinkan, pintu masuk untuk

kendaraan dan pejalan kaki harus terpisah. Bila
tak memungkinkan maka bollards (tonggak 80
penambat) atau penghalang lainnya harus
digunakan.
Apakah pengaturan yang sesuai telah tersedia

untuk mengurangi risiko bagi pengunjung akibat
80
kendaraan dan pergerakan kendaraan di tempat
kerja?
Apakah tersedia pengaturan untuk memastikan

bahwa rute kendaraan dan pejalan kaki disimpan
60
seaman mungkin dalam kondisi cuaca buruk
seperti salju dan es?
Apakah terdapat sistem untuk memastikan bahwa

langkah-langkah pengendalian yang timbul dari
100
penilaian risiko telah diprioritaskan, ditindaklanjuti
dan dipertahankan?
Apakah terdapat jadwal pemeriksaan untuk

80
semua rute pejalan kaki dan kendaraan?
Apakah tangga-tangga tersebut telah memiliki

injakan dan pegangan tangan yang sesuai / 60
memadai?
Apakah para pengemudi pengunjung (tamu) telah
diberikan informasi dan saran yang tepat tentang
100
bahaya kesehatan dan keselamatan serta
persyaratan prosedural lokal?
Dimana kendaraan harus mundur, apakah

pengaturan yang sesuai telah tersedia untuk 100
mencegah pejalan kaki menjadi terluka?
Apakah rute lalu lintas dan batas kecepatan jelas

80
telah diidentifikasi secara jelas?
Apakah perilaku pejalan kaki dan pengemudi

kendaraan dikenakan pemantauan dan umpan 100
balik melalui penggunaan wawancara tipe SMAT?
Apakah semua pengemudi karyawan dan

kontraktor telah benar-benar terlatih dan apakah 100
mereka memiliki lisensi / izin yang sesuai?
Apakah semua jenis kendaraan industri telah

dilengkapi dengan lampu, reflektor, lampu kedip,
80
alarm untuk mundur dan alat pengaman lainnya
yang cocok dan sesuai?
Apakah semua kendaraan dilengkapi dengan

80
tempat duduk dan sabuk pengaman yang tepat?
Apakah semua operasi tipping telah dikenakan /

melalui penilaian risiko dan semua langkah-
80
langkah pengendalian keamanan yang tepat telah
diberlakukan?
Apakah semua dokumen dan catatan yang

disyaratkan oleh undang-undang setempat dan
100
standar ini telah disimpan di lokasi yang aman
untuk pemeriksaan dan audit?
Apakah pengaturan parkir dan penyimpanan yang

sesuai dan aman telah dibuat untuk semua jenis
kendaraan, sehingga kendaraan stasioner tidak 80
menimbulkan bahaya di tempat kerja? Apakah
aturan parkir mundur telah tersedia / berlaku?
Apakah terdapat prosedur yang memungkinkan

karyawan maupun orang lain untuk mengangkat
kekhawatiran / isu keamanan kepada manajemen 80
terkait dengan kendaraan dan rute kendaraan
dan pejalan kaki?
Apakah terdapat review tahunan yang
terdokumentasi tentang semua persyaratan
80
keamanan dari standar dan peraturan /
perundangan setempat terkait?
83
VEHICLES & PEDESTRIANS

ITEMS COMPLIANT
ITEMS NON COMPLIANT
NOT APPLICABLE
COMPLIANCE SCORE %
ould be re-assessed through a related risk assessment to take into account the control measures effectively put in place, in particu
LEVEL OF COMPLIANCE Aug
Action Plan 2022
2022
Share folder sdh dapat diakses, Tambahkan

Permenhub No. PM 26 tahun 2015 tentang Standar
100
Keselamatan Lalu Lintas dan Angkutan Jalan
Revisi SK, Tambahkan

-Undang – Undang No. 22 Tahun 2009 tentang Lalu
100
lintas dan Angkutan Jalan
-Permenhub No. PM 26 tahun 2015
80
80
80
80 Melalui grup WA & SMAT
100
100
100
Buatkan jalur pemisah masuk antara forklift &

80
pedestrian
80 Area stock pile belakang belum terpasang barrier
100
Buatkan jalur pemisah masuk antara forklift &

80
pedestrian
80 continue to Pedestrian project Phase 3
60
100 Melalui grup WA & SMAT
80 Buatkan format laporan hasil inspeksi
Evacuated ladder from 2nd Floor not yet

60
modified.
100
Pasang Sign Parkir mundur untuk kendaraan

100
pribadi
Ganti Rambu Max kecepatan menjadi 10km/jam

80
di area dekat gate security
100
100 Cek dengan champion FLT
100
Shuttle bus seat bealt only provided in the front

80
seat.
Buatkan WI & sosialisaskikan terkait Tipping

80
Procedure
100 Terdapat dalam Share Folder
Area parkir forklift tersedia, lengkapi dengan

80
sign, APAR
Melalui grup WA & SMAT, Buatkan format laporan

100
hasil inspeksi
100
89
he control measures effectively put in place, in particular when the percentages are 60% and 80%.
Action Plan 2021
Share folder sdh dapat diakses, updated legal list

terbaru
Share folder sdh dapat diakses, SK Champion

tersedia, Co-Champion blm di training
Kendaraan pribadi (motor & mobil) belum terdata
Kendaraan pribadi (motor & mobil) belum terdata
Lakukan pengecekan/inpeksi berkala terhadap

kelengkapan kendaraan pribadi karyawan
Baru berlaku untuk transporter
S
o
l
e
h
Collision map telah diupdated ,
S
u
p
r
i
y
a
d
i
&
R
a
h
m
a
n
H
RA sudah diupdated untuk kegiatan
o Loading/ Unloading
o Tipping
o Coupling / Uncoupling trailers
o Sheeting/ Securing Loads
o Parking
o Mixing traffic with smaller vehicles.
Convex mirror sudah terpasang, pemisahan jalur

antara FLT & pejalan kaki pada daerah Packaging
in the backyard still not yet separate between

pedestrian and vihicles (please attach Photo)
Separation at entry and outgoing gate already

installed. Only at Warehouse and Material not yet
done.
One gate due to limitation of area, only using sign
and portable traffic barrier.
(Please attach Picture)
Pedestrian Improvement Project Phase 2 already

done.
Will continue to Pedestrian project Phase 3.
Motor parking area already been given canopy

partially.
Terkendala izin kawasan jika dibuatkan kanopi.
###
inspeksi kendaraan pribadi belum dilakukan
Please Attach Picture.

Access ladder platform in area workshop
controlled by Organization Control (with WI and
Safety Sign)
Evacuated ladder from 2nd Floor not yet
modified.
Penyeragaman kecepatan kendaraan menjadi
15km/jam
###
terimplementasi menggunakan reflektor pada

tepian kendaraan
Forklift , Loader, and truck already have set belt.
Shuttle bus seat bealt only provided in the front

seat.
already included at RA
Forklift parking area not cleared identified
D
i
a
n
A
y
u
entages are 60% and 80%.
SAINT-GOBAIN SAFETY STANDARD
CONTROL OF CONTRACTORS
Questionnaire
Are all work orders for contractors & externally based SG employees clearly defined with the
scope of the work (job, area time etc..) ?
Do all contractors agree in writing to abide by a defined set of mandatory rules they have to
2
follow when they work inside SG premises?
Within the contract are the EHS management responsibilities clearly defined for all relevant
personnel?
3
Do the contract requirements include a 'method of work/ prevention plan which specifies risks
4 and control measures to eliminate or reduce risk?
5 Have contractors & externally based SG employees been informed in writing of all relevant
site specific hazards and risks that may impact on their employees?
Is there a specific requirement in the contracts that all contract and sub contract employees
& externally based SG employees have sufficient training and experience to carry out their
work safely?
6
Is there a requirement that all tools, equipment and materials brought onto site will be used in
7
compliance with local legal and company requirements?
Is a there a named company representative who is responsible for monitoring and reviewing
8
the EHS arrangements of all contract work?
9 Does the company representative review the Method Statement/ Prevention plan (recorded)
before work on site is started?
10 Does your procedure require that the method statement/ Prevention plan must be reviewed
and approved by the local responsible manager?
11
Is a list of persons in charge of approving the method statement/ Prevention plan clearly
defined and are they trained?
Is an appropriate supervision plan defined according the risk analysis of the work and of the
contractors?
12
Does your procedure require specific supervision according to this standard concerning all
13 activities of work at height or excavation conducted by contractors or external SG
Employees?
14 Are there specific arrangements for the provision of first aid and any other emergency
response that may be required?
Does your procedure require that all significant incidents including personal injury, fire,
15 environmental incidents, exposure to asbestos, vehicle overturns and failures of lifting
equipment etc are reported?
Is there adequate control procedure to ensure that no-one can work on site without an
authorised site safety induction?
16
Are contractors and their employees & externally based SG employees informed (records
17 required) of the types of activities that are prohibited on site without a 'Permit to Work?
Is every contract employee who works on site given a recorded site safety induction by an
18 authorised company representative?
Are there procedures to ensure that temporary or agency staff do not work on contracts
without an appropriate site safety induction?
19
In case of plant equipment shared with a contractor, is there a written authorization with a
20
safety condition check before and after the work ?
Do procedures require appropriate controls to be put in place (such as barriers) to ensure

21 that employees do not enter into hazardous areas whilst contractors are undertaking their
work?
22 Is there a system in place to record who of the contractors team & externally based SG
employees is on site on each day?
23
Is there a risk review of the contract to ensure that relevant SG employees are advised of the
presence of contractors & externally based SG employees and the nature of their work?
Are there records of the monitoring of the work of contractors & externally based SG
24 employees on site to ensure that EHS procedures and requirements are being followed?
(e.g. SMAT's)?
At the end of contract work is there a procedure to ensure that the area has been left in a
25 safe condition?
26 Is there a review of the success or otherwise of the control of contractors & externally based
SG employees procedure as part of the site safety management system?
CONTROL OF CONTRACTORS
COMPLIANCE SCORE %
COMPLIANCE COMPLIANCE
ACTION PLAN 2020
2019 2020
80 100 Item safety compliance already stated on BOQ. STP
100 100
Next can be delegated as dept to convey requirements of

100 100
EHS Aspects to vendor/contractors
Each Project always been completed Method Statement

80 100 and JSA
100 100
Will be confirmed to Bu Upi and Bu One related with

contract agreement with Transporter.
For enhance knowledge regarding CoC, EHS propose
60 80 to Champions and Purchasing to have Boost training
"Management of Contractors"
Already checked for heavy equipment, example STP

Project.
Need enforcement to CoC for indirect (Permanent
80 80 contractor such Transporter, Outsourcing)
SK Champions CoC National and Co Champion are

available.
Already stated on Contract of Project Work (Chapter 8
regarding corespondences and responsibles incharge on
80 100 the field)
Need to be improved to permanent contractor especially
in indirect.
100 100
Will be confirmed to Bu Dian and Pak Rahman Hakim
80 80
Will be confirmed to Bu Dian and Pak Rahman Hakim
80 80
80 80 Explained to contractors when kick off and stated on

MoM, Attendance list.
Need to be improved in indirect purchasing (Transporter,
Vendors.
Socializaiton related CoC for Indirect and RMP
Purchasing need to conducted by EHS.
80 100
100 100
100 100
Checklist Truck and Driver Induction (Please attach

sampling random checklist truck)
80 100
100 100
Please check visitor visit pass form. Plus self assessment

80 100 randomly sampling for contractors
80 100
Please check visitor visit pass form. Plus self assessment
randomly sampling for contractors
20 60 Please check and reconfirm with EHS team
Please attach picture barier to secure area related project

80 100
site area work
EHS PTW Board need to be confirm

80 80
100 100
100 100
Need to be checked to EHS and HRGA
100 100
Always join P2K3 Meeting

100 100
PERCENTAGE %
PERCENTAGE %
85 94
COMPLIANCE
ACTION PLAN 2019 PIC
2021
End user melibatkan EHS di dalam penyusunan

BOQ,BOQ dilengkapi dengan ttd EHS sebagai salah
satu approval BOQ. EHS requirements sudah konsisten
berjalan.
Prosedur pembelian barang/ jasa menyatakan Purchasing 100
keterlibatan EHS di dalam pembuatan BOQ
Contractor menandatangani kontrak dan EHS

Purchasing 40
requirements
Purchasing 100
Implementasi method statement meliputi seluruh proses

pekerjaan proyek, EHS 100
EHS & User 100
EHS Requirement akan direview, dan di detailkan oleh

EHS. Template kontrak untuk divisi RMP,Indirect dan
project, akan ditambahkan segi EHS, untuk menjadi
panduan dari Purchasing. EHS 80

EHS.Termasuk alat berat, dan form2 EHS termasuk
inspeksi alat dilampirkan dalam EHS requirements
EHS 80
Matrix organization / JD dari project manager & field

supervisor disebutkan dalam EHS requirements.
EHS 40
100
Merubah flowchart SOP persetujuan method statement
terkait oleh responsible manager (PM) EHS 60
matriks PIC yang bisa menyetujui method statement
EHS 80
Konsistensi penerapan supervision plan pihak user pada HRGA,End User,EHS 80

setiap pekerjaan oleh kontraktor

EHS.Termasuk alat berat, dan form2 EHS termasuk EHS 100
inspeksi alat dilampirkan dalam EHS requirements
100
100
Reinforce security untuk melaksanakan WI Penerimaan

Tamu dan kontraktor, agar sesuai dengan prosedur EHS
HRGA 100
Penambahan contoh area terlarang di dalam materi

Contractor Safety Induction 100
Reinforce security untuk melaksanakan WI Penerimaan HRGA 100

HRGA 100
Reinforce security untuk melaksanakan WI Penerimaan
Dicantumkan prosedur peminjaman alat MU di dalam

prosedur keselamatan kontraktor atau prosedur
penggunaan fasilitas. Pembuatan form peminjaman alat EHS 60
oleh kontraktor atas approval PM. Peminjaman tanpa
autorisasi berakibat pada paelanggaran EHS dan
disampaikan dalam EHS requirements
Konsistensi peenrapan pemasangan area terlaranf : CS

EHS 100
& RnD
EHS 80
List contractor di EHS Permit board, update materi CSI
100
100
PTW form, untuk dimasukkan dalam WI security saat
100
kontraktor meninggalkan area kerja
EHS & HRGA 40

Purchasing Dept. untuk hadir di P2K3 / MR/EHS meeting
PERCENTAGE %
86
CA 2022 ACTION PLAN 2022
Continues activity keep to ensure all worker that involving

100 3rd party are covered in BOQ according on MU0-SOP-
PRC-01. Rev.8
All contractor (Technical Project; Direct; indirect)

80
agreement should be well managed.
Correspondence for EHS Person In Charge stated at

100
Agreement
RA (Risk Assessment) /JSA (Job Safety Analysis)

100 /Methods Statement included on process before work
started
100
Specific Requirement e.g. Technician Refrigerant (for

Teknisi AC); Gada Pratama (for Security Officer)
for next improvement also need to be checked on
80 Dangerous Goods truck Driver (e.g Diesel Fuel Truck
Tank)
Checklist Contractor Equipment, SILO Forklift /

80 Loader already in place and updated.
Already stated in Procedures and Correspondence need

80 to be standardized either Technical project; indirect and
direct supplier
100
Method statement already reviewed and approved by

80
local responsible manager
List of safety induction on technical project
contractor;
80
For next: list of safety induction of indirect
contractors e.g Security SOS
80 Risk Assesment: Canopy for Beumer Project, Permitt

To Work of it.
Inter-related with other Champion e.g. PTW
Champion, WHL Champion, FLT Champion are
needed to re-cofirm relevant document. Need for
consolidated all SG Standard in one share folder /
Share one drive.
100 PTW WAH
100 rescue plan WAH
100 Include on SOP Emergency response
Checklist to ensure that no-one can work on site without

an authorised site safety induction, include administrative
100 requirement should be meet by Contractor e.g. BPJS
(Work Accident Insurance)
File Safety Induction for Contractor related PTW (Permitt

100
To Work)
100 Attendance List of Safety Induction
Already stated on Procedure MU0-EHS-013 CSMS

100
(Contractor Safety Management System)
Checklist "Peminjaman Alat". Contractor always bring

N/A
their PPE by own.
100 SOP related COC should be linked in one drive on COC
Absensi Outsourcing; Absensi technical Project

100
Contractors
100
100
100
Already include discualification if contractor not meet with

80
performance
ENTAGE %
94
ACTION PLAN 2021
Continues activity
Process to ensure vendor to qualified with EHS

Requirement need to be improve stated Purchasing
Procedure MU0-SOP-PRC-01
Setiap pekerjaan dilengkapi dengan Method statement

dan RA
Induction Contractor
tidak ada share folder terkait Kontrak dan file COC

menyelesaikan SOP Purchasing Procedure
Checklist peralatan kontraktor sudah dilakukan

Risk Assessment sudah ditanda tangani

Belum ditanda tangani oleh local responsible manager,
membuat tempat khusus tanda tangan oleh responsible
manager di method statement
Penjelasan saat aanwijzing oleh EHS terkait bahaya dan
membuat risk assessment sebelum bekerja
Sudah ada form peminjaman alat oleh kontraktor, lebih

diperhatikan implementasi dilapangan
Enablon Sustainable Development
MEDAN / PT CIPTA MORTAR UTAMA
01/01/18
Yearly 2018 - Environment, Health & Safety Standards
Standard: SMAT
The text fields are limited to 4096 characters.
Indicator Definition
Standard: SMAT Reference Score
Is this standard applicable to your entity? D7-2401
Does the SMAT program put in place on the site

cover all the concerned staff (Saint-Gobain D7-2402 60%
employees, temporary workers and contractors)?
Have all the persons who carry out SMATs been

trained according to the Saint Gobain SMAT D7-2403 80%
technical training sheet requirements?
Are SMATs carried out according to the 7 steps

D7-2404 60%
defined in the SMAT standard?
Does the guarantor of the SMAT periodically join

D7-2405 80%
SMATs to check the quality of the process?
Is there an annual schedule (including the name of

the SMAT leader, the names of the SMAT
receivers, and the dates scheduled) that is defined D7-2406 80%
to ensure that every employee on the site is
covered by the SMAT?
Does every SMAT leader carry out a minimum

number of SMATs that is defined according to the D7-2407 100%
Standard (2 - 3 a year)?
Are the results of SMATs integrated in the EHS
D7-2408 100%
action plan?
Are SMAT quantity and quality indicators in place,

followed-up and linked to the targets fixed by the
D7-2409 100%
site management in order to continually improve
the SMAT process?
Has the standard _SMAT_ been assessed by an

individual external to the site (SG employee from D7-2420 Yes
another entity)?
If yes, what was the date of the most recent
D7-2421 28-Jul-20
assessment of _SMAT_?
Which compliance score to the standard _SMAT_

D7-2419 80%
will you achieve within the next six months?
82.22%
2021
Findings PIC Action Plan Due Date Date
update dan
Schedule SMATEE and - SMAT
melengkapi
SMATER, Area Not Rhesa Aug-21 Refreshment
schedule
Completed Training
SMATE
Melakukan
Refreshment Training Hakim Oct-21
training SMAT
Completed WI
WI unavailable Iman SMAT with 7 Oct-21
SMAT STEPS
There is no guarantor
SMAT to
signature to verifiy SMAT Iman Oct-21
eSMAT
Check
Unvavaibality SMAT SMAT

Rhesa Sep-21
Schedule Schedule
24-Aug-21
2022
Score 2022 Action Plan Findings PIC Action Plan
Yes Yes
SOP
pembuatan
100%
standar local
untuk ISO
next schedule
100% 15 agustus
2022
80% WI or SOP
pendampinga
n SMATER
100% oleh leader
SMARguarant
or
Tarikan data
manual
sinkron
80%
dengan
esuite, point
28
Di define
100% dalam SOP
(BOD)
Finding SMAT
di
intregasikan
ke dalam
80%
Annual EHS
action plan
(Singgle
Agenda)
temuan smat
2021
penyelesaian
2022 action
80% plan, smat
manual coba
diinput
menggunakan
account lain
Yes
1-agustus-22
90%
90.00%
Due Date Date
Findings
Dibuat list untuk SMATee Produksi, maintenance, Supply Rekap SMAT untuk Cibitung akan
chain, GA, Security dikonfirmasi ke Pak Rahman.
Refer to monthly Excomm report
Yes, but found five SMATER last training held

on Jan 2015 and Two SMATER held on Jan
2016.
There was inconsistency for conducting

Step#6 (Report of SMAT) of 7 based on
SMAT SOP
put dalam form SMAT pada saat melakukan SMAT Sudah memberikan feedback melalui email,
verbal di SMAT Meeting tentang kualitas
SMAT. Namun Pelaporannya belum
terdistribusi ke 3 pihak terkait.
Dibuat list untuk SMATee Produksi, maintenance, Supply Belum dilakukan

chain, GA, Security
Standard target SMATER mengirim 2 SMAT

per bulan
Dipastikan pada File budget CapEx untuk EHS di identifikasi Sudah, beberapa temuan SMAT yang terkait
source of action plan SG standard sudah terintegrasi ke EHS Action
Plan, Capex Project. Meeting Capex dengan
Pak Evan seminggu sekali. Contoh:
Pedestrian tahap 2 dan Pembelian LOTO,
dan Pembelian Portable Gas Detector.
Untuk di buat papan SMAT di area tertentu Sudah dibuatkan papan SMAT, Updated
monthly basis oleh Champion dan Co
Champion SMAT
Now SG employee from another entity is

through Cross Audit Activities.
PIC Action Plan Due Date
Dian Ayu N Keep Sustain SMAT Meeting

Improve Quaity of understanding level SMATER to
categorize Unsafe Action and Unsafe Condition -->
Refresh Training
Dian Ayu N Refresh Training SMAT on Year 2019
Bofa & Dian
SMAT Report must be given to:

A copy of the completed form is given to:
· the SMAT receiver,
· the local manager, who is in charge of following up the
actions
decided by the SMAT leaders,
· the site manager or his/her deputy, for planning,
quality monitoring
and any other relevant checking, etc.
Bofa & Dian Create WI for 7 step of SMAT.
SMAT reporting and evaluation must be reported to 3
related parties: SMAT Receiver, Dept. Head, Plant
Manager.
Create Annual schedule of SMAT

#VALUE!
80
100
100
80
40
100
80
80
82.5
WAREHOUSE & LOADING - QUESTIONS Pic Date
1 Does the site have access to all legal and Dian Q3, 2019
company requirements on warehousing
and loading/unloading vehicles?
2 Does the site have access to a competent Dian / Ivan Q4, 2019
person who can assess the Warehousing
and Loading/Unloading safety status
against legal and company requirements? Dian / Rahman 30 June 2019
3 Has a comprehensive Risk Assessment

process been completed for the
Warehousing and Loading/Unloading
Areas?
4 Does the Risk Assessment process cover Rahman 24-Jun-19

all hazards within the warehousing and
loading/unloading areas?
5 Are there local rules for visiting drivers Rahman 24-Jun-19

covering traffic routes, speed limits,
parking areas, loading/unloading
locations, reception areas, welfare
facilities, emergency procedures, PPE
requirements and loading/ unloading
safety procedures?
6 Are the local safety rules for visiting
drivers available in an easily
understandable format and available in
appropriate languages?
7 Is there a system to record, prioritise, Supriyadi 24-Jun-19

implement and track the status of any
recommendations for safety improvement
in the warehousing and loading/
unloading areas?
8 If any drivers have to climb onto their Supriyadi & Rahman Q3, 2019
vehicles and/or loads is provision made
for their safe access, and are
arrangements in place where required to
prevent or restrain falls from height, like
fall arrest equipment?
9 Are arrangements in place to prevent Supriyadi & Rahman 24-Jun-19

vehicles being driven or rolling away
during loading or unloading. The
immobilisation should be by chocking,
dock restraints, ignition key, air brake
locks (glad hand locks) or similar
devices?
10 Are drivers and any helpers given clear Rahman 24-Jun-19

instructions where they should and should
not stand or sit whilst the vehicle is being
loaded or unloaded, and is this monitored
and enforced?
11 Are personnel involved in the Supriyadi 24-Jun-19

loading/unloading process trained and
competent in the local safe operating
procedures?
12 Are Fork Lift drivers and operators of

other equipment empowered to stop the
activity if personnel enter the danger zone
or do not follow local procedures?
13 Do employees and other personnel HR GA 24-Jun-19

working or walking in potential vehicle
movement areas wear appropriate PPE
including high visibility clothing?
14 Are personnel loading or unloading Rahman Q2, 2019

vehicles and working in the warehouse,
given appropriate information about any
hazards associated with the loads such
as stability, chemical, biological, fire
hazards or any others?
15 Are there separate entrance doors for
vehicles and pedestrians and is their use
monitored?
16 Are Fork Lift Truck drivers forbidden to

drive forward in areas where there could
be pedestrians or other moving vehicles if
their forward vision is obscured by the
load?
17 Are pedestrian routes clearly marked in Dian Q3, 2019

the warehousing area?
18 Are any storage equipment or areas that Supriyadi & Rahman 30-Jun-19
have limits by weight, dimension, quantity
and stability clearly identified to prevent
incorrect loading?
19 Are mirrors installed for vehicles at blind

corners?
20 Are good 5S type standards established WCM Q3, 2019

and maintained?
21 Are there safe storage standards and Dian Q3, 2019

procedures for all items and materials
stored in the warehouse?
22 Is all storage equipment inspected on a Yanti Q3, 2019

regular basis by competent personnel to
ensure that it complies with legal and
company standards and maintained in a
good safe condition?
23 Is the air quality in the warehouse area Dian & Rahman 30-Jun-19
free from any harmful gases, vapours or
particulates? If not, is the atmosphere
monitored to ensure that it meets local
legal requirements?
24 Is all mobile equipment and machinery Champion FLT 30-Jul-19

used in the warehouse compliant to the
SG standards on Vehicles and
Machinery?
25 Are refueling areas and charging stations

in segregated well-ventilated locations
away from sources of ignition and
segregated from combustible materials?
26 Does the risk assessment process cover Dian & Rahman 24-Jun-19
manual handling and have all identified
high risks been controlled to reduce the
residual risk to an acceptable level?
27 Are all the documents and records Dian & Rahman Q3, 2019
required by this standard and local
legislation kept in a secure location for
inspection and auditing?
28 Is there a procedure to allow employees

and others to raise safety concerns with
management about warehousing, loading
and unloading?
29 Is there a recorded annual review of all

the safety requirements of this standard
and associated local legislation?
Finding
Evidence Needed (Document, Picture, SCORE Action Plan & Finding
Screen Shot) 2021
Screen Shot of share folder that can acces by 80 already have share folder
champion and co champion WHL
Lastest Update SK Champion and Co Champion 100

SK Champion & Co Champion sudah ada,
share evidence training untuk champion
dan co champion
Document Risk Assessment about Warehouse Loading

Unloading Standard, capturing:
80 List Risk assessment belum lengkap,
perlu melengkapi RA terbaru sesuai
• Vehicle/ Pedestrian Collision dengan WHL Standard (memindahkan
• Vehicle/ Vehicle Collision dari format lama ke yang baru)
• Vehicle/ Plant and Equipment Collision
• Operating and driving mobile equipment
o Whole body vibration
o Overturns
o Entrapment in equipment
• Operating warehouse equipment
• Slips/ trips and Falls
o Falls from height
o Slips and Falls at ground level
• Falling or collapsing materials or equipment
• Incidents whilst loading and unloading
• Low levels of lighting
• Fumes from internal combustion engines
• Extremes of Temperature
• Chemical Hazards
• Fire hazards
• Electrical hazards
• Manual Handling
• Refueling Vehicles
• Loading Dock Safety whilst empty and during
loading/unloading activities.
Screen Shot of Risk Assessment related hazard of 80 List Risk assessment belum lengkap,
Battery Charging
dengan WHL Standard (memindahkan
dari format lama ke yang baru)
Document:
- Checklist Truck
80 WI / SWP sudah ada, tetapi belum
dilakukan update
- SOP related warehouse Loading Unloading
- WI/SWP Loading Finish Good
- WI/SWP Loading LB3
- WI/SWP Unloading Raw Material
Picture:
- Parking area
- loading and unloading place (FG, LB3, RM)
- Driver Waiting area
- Sign PPE Requirements
Picture of local safety rules for visiting driver 100 Sign sudah terpasang
in gate area, loading area, and unloading area.
List of recommendation for safety improvement in the 80 Belum ada hasil SMAT terhadap driver,
list high risk project warehouse belum
warehouse and loading unloading (SMAT, Incident,
Observation) ada.
Document WI/ SWP related Working At Height in truck

(Loading and Unloading)
80 WI / SWP sudah ada, tetapi belum
dilakukan update
Picture of ladder and fall arrester equipment in loading
unloading area.
Picture Loading Unloading Area, wheel Stopper or Chock. 80 Sudah terlaksana, monitoring marking cat
parkir
Picture of warning sign, driver waiting room in loading and

unloading area
100 Driver Waiting room tersedia, warning
sign sudah tersedia
Training evidence (Absence and presentation) for TKBM 100 Sudah dilakukan training TKBM
training evidence for Forklift driver and sign forbidden or

danger zone. SIO Internal dan External
100 Sudah dilakukan Refresh training untuk
driver Forklift
Pict of driver wear appropirate PPE

Pict of sign appropriate PPE in Loading and Unloading
100 Driver sudah menggunakan PPE dengan
konsisten
area
Picture of Sign hazard in warehouse area. 80 Hasil SMAT untuk driver

Warehouse Lay out 80 pintu masuk Jalur pejalan kaki area WH
packaging masih sama dengan forklift,
dipisahkan dengan safety cone dan safety
line
latest update training evidence for Forklift driver 100 refresh training sudah terlaksana
Picture for pedestrian route regarding Warehouse 100 Jalur Pedestrian sudah dicat dengan jelas
mapping
Picture of sign limits in storage area 80 Beberapa material additive masih

tercampur, tidak dipisahkan berdasarkan
karakteristik B3
Picture of Mirrors that installed in warehouse. 80 belum dilakukan penambahan mirror, di

area akses masuk RM to PRD
Document Evidence Training 5s and checklist 5s in 80 Training sudah terlaksana, belum

diterapkan secara konsisten
warehouse area
Safe Storage Procedure and Picture of Raw Material 80 Beberapa material additive masih
tercampur, tidak dipisahkan berdasarkan
Storage.
karakteristik B3
Document report Inspection Storage Equipment 100 Pemeriksaan Rack, Forklift, dan Lifeline
Report Monitoring IH in warehouse area 100 Sudah dilakukan pengukuran
Document Checklist form all mobile equipment and

machinery (Forklift & Loader)
80 Checklist sudah dilakukan, dan
pengukuran emisi sudah dilakukan
Document Measuring Forklift & Loader emission
Picture of refueling areas and charging station 80 APAR di area charging station diletakan
tidak pada tempatnya
Screen shot from Risk Assessment Document that
mention about manual handling
80 List Risk assessment belum lengkap,
Screen shot from Risk Assessment Document that dengan WHL Standard (memindahkan
mention about high risk dari format lama ke yang baru)
Picture or screen shot list of required standard and 80 belum semua peraturan diupdate di share
folder
local legislation.
List of recommendation for safety improvement in the 80 Belum ada hasil SMAT terhadap driver
dan TKBM, list high risk project
warehouse and loading unloading (SMAT, Incident,
Observation) warehouse belum ada.
List Of Legal compliance relating warehouse loading 100 Hasil MOM pembahasan pemenuhan
legal terkait WHL
and unloading
88
2
Action Plan SCORE Action Plan & Finding
2022
Pastikan Semua share folder dan file dapat
diakses oleh pihak yang berkepentingan
100 SLF bangunan sudah ada
100
SK Champion & Co Champion sudah ada,
share evidence training untuk champion
dan co champion
80 List Risk assessment tambahkan aktivitas

& resiko terkait dengan kegiatan yang
berhubungan dengan kondisi penerangan
80 List Risk assessment tambahkan aktivitas

& resiko terkait dengan kegiatan yang
berhubungan dengan kondisi penerangan
Melakukan update WI/SWP yang ada. 80 WI & SWP sudah diupdated, perlu
dilakukan implementasi konsistensi
checklist truck terutama truk RMP
100 Sign sudah terpasang
Melakukan SMAT untuk driver dan TKBM,

membuat list prioritas perbaikan di area
100 Melalui SMAT & Grup WA
warehouse
Melakukan update WI/SWP yang ada. 100 WI & SWP sudah diupdated
80 Belum konsistensi untuk memasang

ganjal ban
80 Driver Waiting room tersedia, warning

sign sudah tersedia
100 bukti training TKBM
100 bukti training Forklift
80 Driver RMP tidak taat dalam penggunaan

APD
80 Pasang pictogram GHS pada area

penyimpanan additive
membuat pemisah jalur pejalan kaki secara
permanen.
80 pintu masuk Jalur pejalan kaki area WH
packaging masih sama dengan forklift,
dipisahkan dengan safety cone dan safety
line
100 refresh training sudah terlaksana
80 Modifikasi jalur pedestraian pada area

WH packaging
Membuat rambu penanda untuk material

additive, dan memisahkan berdasarkan
80 Follow up dari hasil temuan Rack
Inspection oleh 3rd party
karakteristik B3 nya
Melakukan penambahan mirror 80 penambahan mirror sudah dilakukan,

modifikasi ketinggian mirror pada
beberapa titik karena terlalu pendek
5
Lakukan Penerapan 5s secara konsisten di
area Warehouse, terutama area loading dan
80 Training sudah terlaksana, belum
diterapkan secara konsisten
warehouse additive
Membuat rambu penanda untuk material

80 Membuat rambu penanda untuk material
karakteristik B3 nya karakteristik B3 nya
100 Follow up dari hasil temuan Rack

Inspection oleh 3rd party
100 Sudah dilakukan pengukuran
Membuat checklist Forklift secara digital agar

lebih mudah melakukan pemeriksaan
100 Checklist sudah dilakukan, dan
pengukuran emisi sudah dilakukan
memasang APAR sesuai dengan peraturan

yang berlaku
80 Pastikan tangki solar terpasang grounding
yang tepat dan tangki solar harus memiliki
ventilasi yang benar
Memindahkan Format Risk Assessment lama
ke format WCM, lalu membuat list risk
80 Dalam RA sudah ada, lakukan ergonomic
assessment pada aktivitas manual
reduction project handling
Update semua peraturan yang berlaku di share

folder WHL
100
Melakukan SMAT untuk driver dan TKBM,

membuat list prioritas perbaikan di area
100 Melalui SMAT & Grup WA
warehouse
100 Hasil MOM pembahasan pemenuhan

legal terkait WHL
90
SAINT-GOBAIN ENVIRONMENTAL STANDARD
Question
General questions
1
2
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
NUMBER OF QUESTIONS NOT APPLICABLE

CONFORMITY SCORE %
SAINT-GOBAIN ENVIRONMENTAL STANDARD
Wording
General questions
Koordinator metode telah ditunjuk di site.
Koordinator dan semua orang yang bertanggungjawab dalam penilaian risiko telah dilatih mengenai metode
penilaian risiko.
Tanggung jawab koordinator dan para manajer yang terlibat dalam penilaian telah terdefinisikan.
Penilaian risiko Kesehatan dan Keselamatan memperhitungkan aktivitas di dalam batasan site dan di luar
site yang masih terkait dengan tanggung jawab Saint-Gobain.
Terdapat jadwal penerapan & pembaruan, yang meliputi seluruh aktivitas yang diperhitungkan dalam
penilaian risiko.
Diagram JOB, work station dan tugas pekerjaan telah ditentukan di site, dengan memperhitungkan aktivitas
rutin dan non-rutin termasuk yang terkait dengan manajemen kecelakaan dan situasi darurat.
Karyawan berpartisipasi secara sistematis dalam analisis risiko yang melibatkan mereka.
Penginventarisasian bahaya di site memperhitungkan daftar bahaya yang tercantum di Lampiran 1 dokumen
ini.
Anggota staf dengan status kesehatan khusus telah diperhitungkan dalam penilaian risiko.
Untuk setiap bahaya yang teridentifikasi pada JOB / work station / Tugas, potensi dampak kecelakaannya
telah diperhitungkan.
Untuk setiap bahaya yang teridentifikasi pada JOB / work station / Tugas, potensi dampak kecelakaannya
akibat operasional normal (Risiko Kronis) telah diperhitungkan
Metode penilaian risiko referensi (Sisa Risiko Awal dan Risiko Kasar) telah dipilih dan terus digunakan
selama proses penilaian.
Site menggunakan metode penilaian risiko yang sesuai standar (P x G or f x P x G) untuk risiko dan
kecelakaan dan parameter Tingkatan/Pengukuran risiko untuk risiko kronis.
Dalam metode penilaian risikonya, site telah menentukan cara yang memperhitungkan metode pengendalian
yang dapat mengurangi probabilitas atau keparahan dari kasus Kesehatan dan Keselamatan.
Penilaian risiko telah dijalankan sesuai dengan level pekerjaan.

Penilaian risiko telah dijalankan untuk semua aktivitas rutin.
Penilaian risiko telah dijalankan untuk semua aktivitas non-rutin.
Penilaian risiko telah dijalankan untuk semua aktivitas terkait manajemen situasi kecelakaan atau darurat.
Rencana kerja EHS tahunan telah memperhitungkan hasil risiko penilaian dan daftar prioritas risiko yang
telah teridentifikasi.
Karyawan memiliki akses terhadap hasil penilaian risiko EHS yang telah terdokumentasi dan diperbarui
dengan baik, serta mengetahui risiko dan cara pengendalian yang telah teridentifikasi pada JOBnya masing-
masing.
Penilaian risiko diperbarui paling tidak sekali setahun dan hasilnya disortir.
Penilaian risiko diperbarui jika perlu setiap terjadi kecelakaan, hampir kecelakaan dan situasi berbahaya
signifikan yang dilaporkan.
Penilaian risiko diperbarui setiap ada modifikasi yang dilakukan (lini, equipment, proses, pengorganisasian
kerja dll.)
Pemeriksaan teknis dan ilmiah yang sesuai dengan risiko Kesehatan dan Keselamatan yang ada di site telah
diterapkan oleh pihak manajemen.
Indikator performa seperti yang tercantum pada standar SG telah tersedia dan ditindaklanjuti selama review
manajemen di site.
NUMBER OF QUESTIONS NOT APPLICABLE

CONFORMITY SCORE %
D
Answer 2020 Answer 2021 SA 2021
100 100 100

100 100 100
60 80 80
60 60 80
60 80 80
80 80 80
80 80 60
80 80 100
80 80 100
80 80 80
80 100 80
100 100 80
100 100 80
80 80 80
80 80 100
100 80 100
80 80 100
80 80 80
80 100 80
80 80 80
100 100 100

80 80 80
60 80 80
60 80 80
80 100 80
0
81 86 86
Action Plan CA 2022
100
100
Update untuk job description di dalam surat penunjukan / 80

Pelaksana Risk Assesment
Journey Risk Assesment TAT dan refresh safety ridinng u/CBT 80

plant have to impelement by Y 2021
Covid 19 RA must input into existing RA 80
Covid 19 RA emergency must input into existing RA 80
To recheck and update staff invlovement with RA Form (from 80

JWL)
To review other hazards natural hazards, neighbour hazards to 80
recheck demonstration activities, etc
Comorbid employee to recheck and include into exisitng RA 100
Alone device 80
100
100
100
Review to existing RA related High risk, prevention program & 80

level score after
100
100
100
Covid 19 RA emergency must input into existing RA 80
100
RA didisplay dan dikomunikasikan di board (for shoopfloor 100

people)
100
100
100
100
100
93
Action Plan
Menanmbahkan scope 3.0 responsibility

untuk sofloor dan spv area terkait MU0-001
Mereview manual K3L terkait point 1.3 dan

6.2
Membuatkan diagram job - dept - line - seg

yang clear
Di implementasikan (realisasi) untuk
keterlibatan staff
Menambahkan atau memindahkan RA ergo
pada RA WCM ke format RA Ergonomic dan
melakukan pengukuran resiko biologi
selain covid yang berkondisi khusus dan

Komorbid belum masuk di RA, baru wanita
hamil & disabilitas
FU segera pengajuan alone worker device
Refresh training untuk PIC RA All Dept
Identifikasi SEG by process flow
Standarisasi aktifitas non rutin (tidak

terjadwal)
Beberapa terkait emergency, di tambahkan
Memastikan semua prioritas dimasukan ke

dalam project risk reduction
Masing - masing bagian di print di berikan
kepada leader untuk disampaikan ke
teamnya
Dipastikan semua di update di RA
PERMIT TO WORK - QUESTIONS SCORE 2020 SA 2021 SCORE 2021 SCORE 2022
Has your Risk assessment identified all high hazard situations where
1
a Permit to Work may be required? 80 80 80 80
Do you have a Hot Work permit system that meets the

2
requirements of the SG Risk Prevention Manual? 80 80 80 100
If you have identified potentially hazardous Confined Spaces do you 100 100 100 100
3
have a suitable Permit to Work Procedure?
Do you have a Permit to Work procedure to cover complex energy 100 100 100 100
4
isolation systems. (Over 3 sources of energy isolation)?
Do you have a Permit to Work for electrical Work on High Voltage

5
or near live electrical equipment? 60 80 60 80
60 80 60 NA
6 Do you have a Permit to Work for excavation work?
100 100 100 100

7 Do you have a Permit to Work for work on unsafe roof?
Have you a Permit to Work procedure to cover other high hazard 80 80 80 80

8
and abnormal work situations?
Do you have Permits to Work for contractors as required by the 80 80 80 80

9
Control of Contractors standard?
Is there a person nominated to be responsible for the Permit to 100 100 80 80

10
Work procedures on the site?
Do the Permits to Work and the Procedures meet the 15 key 100 80 100 100
11
elements listed on Page 3 of the Permit to Work Procedure?
Does the Permit to Work procedure require that the permit to work
for each work on the unsafe roof must be validated by the plant 100 100 100 100
12
manager or his Authorized deputy and the Authorized agent of the
contractors?
Are copies of old Permits to Work retained for at least 2 years to 100 100 100 100
13
enable audits of the system?
Are Permit Issuers suitably trained and authorised in writing that 80 60 80 100
14
they may issue permits?
Does the Permit to Work procedure require that the Permit Holder 100 80 100 100
15
is fully briefed about the requirements of the Permit?
Does the procedure require that all persons working under a permit 80 80 80 100
16
are fully briefed about the potential hazards and the control
measures they are required to follow whilst working under the
Permit?
Does the procedure require the Permit Issuer to be readily available

100 80 80 80
17
on site whilst the Permit is Open
100 100 100 100

18
Does the procedure specify how the Permit to Work may be
transferred from one Permit owner to another?
18
Does the procedure specify how the Permit to Work may be
transferred from one Permit owner to another?
Does the procedure require that if any safety concern is raised, or

19 safety controls are changed or added, the Permit Holder must stop 100 100 100 100
the work and report to the Permit Issuer?
20
Does the procedure require that the permit to work must be 80 80 80 100
updated for every change of condition and at least every day?
Does the procedure require the Permit Issuer to investigate every

Safety Concern raised about the work under Permit and not allow 100 100 100 100
21
the work to continue until he is satisfied that the work may
continue?
Is there a procedure to monitor and audit the use of the Permit to 100 100 100 100
22
Work System?
Does the Safety Management System require an annual review of 100 100 100 100
23
the effectiveness of the Permit to Work system?
OVERALL CROSS AUDIT SCORE
90 89 89 95
SA 2022 Findings/Action Plan Cross Audit 2021 PIC Action Plan
Review hasil risk assessment dikorelasikan dengan situasi high

100 hazard terhadap sistem PTW (Dokumen menyusul)
100 Penerapan ijin kerja panas dilakukan di CBT
100 Tercantum dalam SOP PTW
100 Tercover SOP LOTO
80
Create SOP / WI Excavation
Done
80 Perlunya improve SOP terkait penjabaran secara jelas persyaratan
ijin kerja untuk pekerjaan galian
100 Tidak ada aktifitas pekerjaan di unsafe roof
Review untuk penambahan kondisi bahaya tingkat tinggi yang tidak

80 tercakup dalam SOP
Need to be detailed
Belum konsisten (termasuk perhitungan risk level di dokumen RA),

80 perlu di improve untuk edukasi kepada kontraktor
80 Matriks PTW issuer telah diperbaharui, namun belum divalidasi
100
100
100
100 Permit issuer/responsible has trained & authorized include in DOM

meeting(training evidence tidak dapat ditunjukkan)
List data induction ada dan telah improve penambahan nilai

100 induction
pekerja contractor sudah di induction dan penggunaan ID card,

100 namun SOP penerapan belum diubah
Belum konsisten penerapan permit issuer memastikan area &

80 melingkari status pada kolom inspeksi
100
100 Tercantum dalam SOP-EHS-03 pada item kasus khusus
Improve PTW Information board (penulisan kontraktor yg bekerja -

100 PT. PGN)
100
100 Self assessment dilakukan September 2020 dengan score 89
Termasuk dalam review P2K3 dan sudah di review dalam

100 management review meeting
95
PROCEDURES & INSTRUCTIONS

Summary Cross Audit 2022

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Summary Cross Audit 2022

Diunggah oleh

Hak Cipta:

Format Tersedia

Enablon Sustainable Development

9 Does the company site make it possible to limit 80

15 Are driver’s licenses of the employees checked

17 Is a driver training program implemented in order to

18 Is updated training organized according to needs

implementasi untuk pelaksanaan training safety riding & 80 80 implementasi untuk

implementasi untuk pelaksanaan training safety riding & 80 80 implementasi untuk

Open, due to pandemic A Rahman 23-Jun-22

closed Rahman & 30-Jun-22 Submit SIM PPLI &

ongoing Rahman & 4 & 5 Jul Akhir agustus

WORK AT HEIGHT - QUESTIONS

Are all employees who Apakah semua

Apakah ada daftar

Apakah semua bekerja

Apakah Anda telah

Is a named person Apakah seseorang

Have all roofs, Apakah semua atap,

Apakah semua tangga

Has a Risk assessment been carried out to identify all situations

Have all relevant managers and supervisors been trained on the

Has the Risk Assessment procedure identified where a Permit to

Do your procedures require every employee who is 'at risk'

Do your procedures require that isolation is verified by trying to 600

Does your procedure require that for any equipment that is

Do your procedures require a safety check of the work area to

Does your procedure require that all affected employees are

Is there a procedure to ensure that all temporary staff, agency

MACHINERY SAFETY - QUESTIONS

Does the plant have access to all legal and company

Does the plant have access to a competent person who can

Are all machines brought to the site checked by a competent

Is a record maintained of all formal machinery safety

Is there a system to record, prioritise, implement and track the

Have all machines on the site had a recorded risk assessment

Have all machines on the site had a recorded risk assessment

For modified machines, are the risk assessments reviewed

Are all machinery safety risk assessments reviewed at least

Is there a system to ensure that control measures arising from

Is there an inspection/ maintenance schedule for all

Are emergency stops on all powered machinery readily

Is the by-passing of safety devices prohibited without written

Have all areas where employees could be entrapped,

Have all inspection/ access panels to hazardous parts of

Do all fixed guards require tools to open them? (No

Do all access points to high hazard areas, without physical

Do operators carry out recorded visual safety checks of their

Is there a system to record employees' safety concerns about

Is there a list of all machines that require a permit to work for

Is there a monitoring system to measure the level of

Is the status of machinery safety formally reviewed by the site

Action Plan 2021

1. Share folder (onedrive) dapat diakses oleh

1. Assignment baru untuk champion & co-

Mesin SAP CBT dilakukan inspeksi terhadap 100

Record dilakukan dikombinasikan dengan

Review dari RA, e-tag, MJO untuk tindakan 100

Jadwal inspeksi maintenance dalam jadwal PM 100

Emergency stop dilakukan inspeksi mingguan

safety concern dari temuan inspeksi 100

Share Daftar perturan perundang

Update Inventory List machine

Update Inventory List machine

Follow up by E-TAG & Reliability pillar

Review Risk Assessment related SG Std