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Contractor HSE Qualification Questionnaires

GENERAL INFORMATION
 Company Name : PT. PGAS Solution
 Address : Complex of PGN, Building C Jl. K.H. Zainul Arifin No.20
Kel. Krukut Kec. Tamansari Kota Jakarta Barat 11140

 Telephone : 021-63867037
 Fax : 021-63854506
 Email : [email protected]
 Company core business : EPCI, Operation and Maintenance, Trading, Workshop
and Warehouse
 Work experience in the : 7 (Seven) Years
current core business
 Contact Person : Darmoko Anggar Setyadi
o Title : Ka. Divisi Komersial
o Telephone : 021-63867037
o Fax : 021-63854506

o Email : [email protected]

SECTION 1 – LEADERSHIP AND COMMITMENT

1. Commitment to HSE through leadership
a) How do senior managers as top management personally involved in HSE management?
Answer: Yes Evidence documents example : Page :
 Page 2 of 20

Senior Manager PT. PGAS Solution is in accordance a. HSE Policy (signed by Senior
with the Management Commitment personally Manager)
involved in HSSE Management, to manage the HSSE
system and pour it into its work practices in every b. HSE meeting attendance list
work done. PT PGAS Solution also made a joint (with senior manager involved)
commitment regarding HSSE and was signed by all
Top Level Management of PT PGAS Solution. c. Site/Management Visit (visit
report, etc)

d. Yearly HSE Program setting

(signed by senior manager)

e. HSE program Audit (audit

report, audit plan)

f. Other specify________

b) Provide evidence of commitment at all levels of the organization by:

Answer : Yes Evidence documents example : Page :
Formulate goals and targets for achievement of
a. HSE commitment signed by
annual HSSE performance ·
workers
Explain how to ensure all members of the company
organization understand and have the same
commitment in achieving the Goals and Targets that b. HSE induction Socializations
have been prepared. (involved all workers)

c. Others (Specify) ________

c) How do you promote a positive culture towards HSE matters?

Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution in promoting a positive culture to a. HSE campaign Program
the HSSE problem, in the form of: by delivering HSSE
b. Behavior Based Safety
information to all Employees who routinely conduct.
• Meeting Management, program implementation
• HSSE Meeting (HSSE Meeting)
c. Photo of HSE signs, posters,
• Safety Talk / ToolBox Meeting
• Safety Induction banners boards events in the
• Use of Safety Sign
workplace
•Any HSSE knowledge via email that is
d. Others (specify) ________
communicated to all employees
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SECTION 2 – POLICY AND STRATEGIC OBJECTIVES

2.1. HSE Policy & Documents
a) Does your company have an HSE policy document that is applied in this region? (Yes/No)
If yes, please attach.
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution has an HSSE Policy document
that has been socialized to all employees and the a. HSE policy (Bahasa Version)
policy is posted in offices and workshops and work b. HSE Policy (English version, if
areas.
expat workforce present)
c. Photo of HSE policy placed in
the working area
d. Others (specify)_______
b) Who has overall and final responsibility for HSE in your organization?
Answer : Yes
Evidence documents example : Page :
Director of PT. PGAS Solution bears the overall
responsibility and final responsibility of the HSSE in a. Organization chart
the Organization it operates. And authorize the duties b. Role & Responsibility /job Des
and responsibilities of daily implementation to the
HSSE General Manager of PT PGAS Solution in c. Others (Specify)
running its business wheels and the HSSE.
c) How do you ensure HSE Policy compliance and communication at site?
Answer : Yes
Evidence documents example : Page :
M. Khoirul Huda as the General Manager of HSSE is a. HSE policy in HSE induction
a person who is given the duty and responsibility to
implement the Company's policy to be run on every b. Photo of HSE policy placed in
area of authority and work location to socialize to all
workers to comply and run it. the working area

c. Others (specify)
d) Named the most senior in the organization (including position) that responsible for the policy
application on the authorized area and employee working location
Answer : Evidence documents example : Page :
The method used by Management as the source of the a. HSE policy signed by the
Policy statement has been socialized to all Employees:
highest position who take
• Meeting Management for socialization Policy to all
employees accountability to HSE.
• Policies are made and posted on the Office and workshop
walls to be read by all employees and guests in Safety
Induction
e) What is the effort to inform employee should regarding any change in policy? (if any)
Answer : Yes Evidence documents example : Page :
a. Socialization slide of policy
Arrangements to notify employees of changes to the
Policy and others, such as the HSSE Policy change changes
by re-socializing to all workers whenever there is a
Policy change. b. Others (specify)

2.2. HSE Strategic Objective(annually)

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a) Does Your company have HSE strategic objective? If yes, please attached evidence
Answer : Yes Evidence documents example : Page :
a. HSE 4 year plan
PT. PGAS Solution has an HSSE strategic goal and
has been socialized to all employees.
b. HSE yearly objective

c. Others (specify)

b) Please describe in detail the methods of communicated to employees understand about Hse
strategic objective?
Answer : Yes
Evidence documents example : Page :
Socializing the Company's Goals and Targets to all a. Communication materials on
workers in the PT. PGAS Solution.
the HSE objectives / target.
b. Others (specify)

SECTION 3 - ORGANIZATION, RESPONSIBILITY, RESOURCES,

STANDARDS AND DOCUMENTATION
3.1. Organizations - Commitment and Communication
a) How is management involved in HSE activities, objective setting and monitoring?
Answer : Yes
Evidence documents example : Page :
Line General Manager has overall responsibility for
HSSE issues to employees of PT. PGAS Solution. a. HSE management visit
They are responsible to the Board of Directors for all b. HSE objectives / target
matters relating to the HSSE on the project / service.
meeting
c. HSE objective review meeting
d. Others (specify)
b) What provision does your company make for HSE communication and meetings?
Answer : Yes
Evidence documents example : Page :
HSSE meetings promote HSSE understanding to all a. HSE campaign program
employees of PT. PGAS Solution
b. Others HSE initiative

c) Is the client and contractors meets (interface) regularly to discuss and follow up on related with the
observation?
Answer :
Evidence documents example : Page :
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PT. PGAS Solution meets clients regularly to discuss a. Sample of MOM during
and follow up on the interface situation.
contractor & client
meeting

3.2. Staff HSE Training Program

a) Have the managers and supervisors at all levels that will plan, monitor, oversee and carry out the
work received formal HSE training in their responsibilities with respect to conducting work to HSE
requirements? (Yes/No)
Answer : Yes
Evidence documents example : Page :
a. HSE training program for staff

b. HSE training matrix

c. HSE training record for all staff

related to the work

d. Training certificate

e. Other (Specify)________

b) If yes, please provide details, if in-house training, please explain the material and length of the
course, including refreshment training for Manager and supervisor. Please provide the training
matrix.(point B shall be allignmed to point A)
Answer : Yes Evidence documents example : Page :
PT. PGAS Solution has provided all its employees with a. Internal training materials
HSSE Management System training and Special
Training and Skill Training for sales and engineers and b. External training course
Managers. HSSE Management System Training is
done in Head Office as well as in Site Office PT. description
PGAS Solution
c. Others (specify)

c) How do you identify the areas of your company's operation that requires special training, such as
training related to health hazards such as radiation, asbestos and chemicals?
Answer : Evidence documents example : Page :
For training related to health hazards such as a. For specific training required
radiation, asbestos and chemicals, PT. PGAS Solution
will schedule according to the needs of the company for the activity done by
and work. company, please provide
description the area operation
of the company.

b. Others (specify)
d) Does your company have HSE specialist (related to your company's services) ?
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Answer : Yes Evidence documents example : Page :

a. Job description of HSE
personnel

b. Professional certificate of HSE

(AK3 Umum, AK3 Migas,
NEBOSH, NIOSH, etc)
e) How does your company provide training specialist for HSE staff?
Answer : Yes Evidence documents example : Page :
a. Professional certificate of HSE
(AK3 Umum, AK3 Migas,
NEBOSH, NIOSH, etc)

3.3. Employee Competence and General HSE Training

a) What arrangements does your company have to ensure employees have knowledge of basic
industrial HSE, and to keep this knowledge up to date?
Answer :
Evidence documents example : Page :
PT. PGAS Solution provides HSSE training, HSSE
Management System, Special HSSE Training to all its a. HSE induction training
employees, as well as carrying out safey induction for program
each new employee and refresing to old employees in
the case of HSSE. b. HSE induction attendance list

c. HSE training refresher

schedule

d. HSE resources training

certificates

e. HSE Hand Book / Pocket book

f. HSE induction training material

g. Other (Specify) ______

b) What arrangements does your company have to ensure ALL employees, including sub contractors,
also have knowledge of your HSE policies and practices?
Answer : Yes
Evidence documents example : Page :
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PT. PGAS Solution will provide Safety Induction

a. Evidence follow up observation
program for all new employees including Sub-
Contractor to understand HSSE Policy and of new employees work
Procedures in PT. PGAS Solution.
b. HSE induction training
program

c. HSE induction attendance list

d. HSE training refresher

schedule

e. HSE resources training

certificates

f. HSE Hand Book / Pocket book

g. Other (Specify) ______

c) what arrangement does your company have to ensure all new employee and subcontractor have
been given new instructions and receive information about specific hazards arising from the nature
of the job?
Answer : Yes
Evidence documents example : Page :
Sub-Contractor working at PT. PGAS Solution will and
should follow the training and safety induction either a. Evidence follow up observation
from the employer which is the requirements of the
of new employees work
field work or from the management of PT. PGAS
Solution.
b. HSE induction training
program

a. HSE induction attendance list

b. HSE training refresher

schedule

c. HSE resources training

certificates

d. HSE Hand Book / Pocket book

e. Other (Specify) ______

3.4. Compliance of HSE Competency

a) Does your company have competence review system? If yes, please explain about scope and
content from competence review system.
Answer : Yes
Evidence documents example : Page :
a. Competency/training matrix
b. Regular review and the
competency applicability
b) What arrangement does your company have to ensure that the HSE knowledge of employees are
now always up to date? If training is given in-house please give details of training materials
Answer : Yes
Evidence documents example : Page :
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Management PT. PGAS Solution will always monitor

and view HSSE activities carried out in the Office and
a.HSE induction training
in the work field through HSSE training for its
employees. Such training is considered very important b.Attendance list
for safe, healthy and safe work processes.
3.5. Assessment of Suitability of Subcontractors
a) Do you employ sub-contractor(s) for the intended service? (Yes/No) If yes , please explain the
process .
Answer : Yes
Evidence documents example : Page :
Sub-contractors working at PT. PGAS Solution will be
assessed first by Management by completing PQ-
a.Process on selection of the
CHSEMS and sub-contractor assessment. PT. PGAS
Solution. vendor / subcontractor
b.Qualification criteria
c. Others(specify)

b) How do you assess your sub-contractor(s) to ensure they comply with your company's HSE policy
and standards?
Answer : Yes Evidence documents example : Page :
a. Process on selection of the
vendor / subcontractor
b. Qualification criteria
c. Others(specify)
c) Where and when the explanation of standard need to be fulfilled by contractor being informed?
Answer : Yes Evidence documents example : Page :
a. Communication from company
to subcontractor on the
company requirement of
qualification (meeting, etc)
d) How do you ensure the standards have been fulfilled and reviewed?
Mention the names of the main subcontractors , at the present time , if there is
Answer: Yes Evidence documents example : Page :
a. Evidence qualification review
score

3.6. HSE Regulations and Standards

a) What kind of HSE standards and regulations that your company refers to for the intended service?
Answer : Yes
Evidence documents example : Page :
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PT. PGAS Solution refers to labor laws and

a. Regulatory and standard
regulations, both government and foreign, in
accordance with international standards regarding compliance procedure
HSSE.
b. List of applicable regulatory
and standard (government
regulation, company
regulation, etc)

c. Others (Specify)______

b) Does your company have procedure to make, revise and distribute HSE standards?
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution refers to SMK3L Ministerial a. Legal compliance
Regulation DEPNAKERTRANS and Government
check
Regulation. In accordance with HSSE standards that
are applied nationally and internationally. b. Others(specify)____

c) Does your company have HSE regulation and standard related with OGP or industrial practice?
Answer : Yes
Evidence documents example : Page :

a. Technical procedure
which refer/adopt
industrial practice
standard
b. Others (specify)_____

SECTION 4: HAZARDS AND EFFECT MANAGEMENT

4.1. Hazards and Effect Management
Does your company have procedure for the identification, assessment, control and mitigation of
hazards and effects? (Yes/No) If Yes, please attach the index/table of content including the sub-index.
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution uses Job Safety Analysis, a. Hazards and effects
Standard Opaerational Procedures (JSA and SOP)
management
and Hazard Identification Risk Assessment Control
(HIRAC) to analyze and identify work hazards before procedure/guideline
doing work, also requesting a Work permit in
b. Sample of HSE hazard and
accordance with the work performed.
effects management
implementation
c. Others (Specify)________
4.2. Exposure of the Workforce
a) Do you have special policy and program regarding specific health hazard such as drug abuse,
blood borne pathogens, malaria, etc
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Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution has a special policy and program a. Communication mechanism
on monitoring of health hazards by conducting (e.g. email, orientation,
Medical Check Up once a year for all its employees.
notice board, safety sign,
etc) to the workforce of the
major hazards that they are
likely to be exposed

b. Result/report of hazards
exposure monitoring
(Chemical, physical and
biological hazards such as
noise, radiation, vapors,
fumes, temperature
extremes etc.)
c. Others (Specify) _________
b) What are the health hazards (chemical, radiation, noise, vibrations, etc.) with regard to the
scope of your work? Please explain how occupational health hazards are identified, assessed
and controlled.
Answer: Yes Evidence documents example : Page :

a. Health risk assessment

c) What are the available systems to control such hazards and monitor the effectiveness of this?
Are monitoring exposure of workers is carried out regularly is part of the system?
Answer : Yes
Evidence documents example : Page :
a. Regular identify any potential
issues such as hearing,etc
b. Others (specify)
4.3. Handling of Potential Hazards (chemical, physical and biological hazards such as noise,
radiation, vapors, fumes, temperature extremes, etc.)
a) What are safety hazards (mechanical guarding, working at height, lifting, confined spaces,
explosive atmosphere, etc) with regard to the scope of your work?
Answer : Yes
Evidence documents example : Page :
The safety hazards that exist in PT. PGAS Solution on a. Description on the company
work between, namely:
main hazards.
• Mechanical Hazards
• Electrical Hazards
• ETC

b) What are the available systems to control such hazards and monitor the effectiveness of this?
Answer : Yes
Evidence documents example : Page :
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a. Safety protection system

document/photo/etc, the
specific hazard

4.4. Logistics activities Hazards

a) What are hazard of logistics activities ((ground transportation, air, marine, material
handling/materials, etc.) with regard to the scope of your work?
Answer :Yes
Evidence documents example : Page :
a. Description hazards of
logistics / transport

b) What are the available systems to control such hazards and monitor the effectiveness of this?
Answer : Yes
Evidence documents example : Page :
a. Safety protection system
document/photo/etc, the
specific hazard

4.5. Environmental Hazards

a) What are the environmental hazards (garage/spills of chemicals, air emissions, waste disposal,
etc.) with regard to the scope of your work?
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution Jaya is always committed to
always care about the environment a. Description hazard of
environmental

b) What are the available systems to control such hazards and monitor the effectiveness of this?
Answer : Yes
Evidence documents example : Page :

a. Safety protection system

document/photo/etc, the
specific hazard

4.6. Security Hazards

a) What are the security hazard (terrorism, kidnapping, robbery, the hostile local population, etc.)

with regard to the scope of your work?

Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution never poses a danger hazard to a. Description hazard of security
security during work. But PT Management. PGAS
Solution is committed to protecting all employees.

b) What are the available systems to control such hazards and monitor the effectiveness of this?
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Answer : Yes
Evidence documents example : Page :
The system is a standard that applies to every a. Safety protection system
business unit. PT. PGAS Solution will follow the
document/photo/etc, the
system and procedures that have been applied by
Client. specific hazard

4.7. Social Aspect Hazards

a) What are social aspect hazards with regard to the scope of your work?
Answer : Yes
Evidence documents example : Page :
The PT. PGAS Solution has never experienced a. Description hazard of social
hazards associated with social aspects such as late
aspect
salary payments, absence of social benefits for
employees and so on.

b) What are the available systems to control such hazards and monitor the effectiveness of this?
Evidence documents example : Page :
a. Safety protection system
document/photo/etc, the
specific hazard
4.8. Personal Protective Equipment
a) What arrangements does your company have for provision and upkeep of protective equipment and
clothing, both standards issue, and that required for specialized activities?
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution has procedures for Personal a. PPE procedures
Protective Equipment that are required to do any
work. The PPE used should be identified in the b. PPE provision contract
specific job risk assessment. Dangers of representing c. PPE inspection
risks must be eliminated, or the risk of being reduced
to practical as much as possible, the use of PPE to d. PPE inventory
reduce the impact of occupational risks that can
protect against the dangers of workplace accidents.

b) Do you provide appropriate personal protective equipment (PPE) for your employees? (Yes/No)
Answer : Yes
Evidence documents example : Page :
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PT. PGAS Solution provides APD / PPE for its a. PPE procedures
employees who are carrying out field work activities in
b. PPE provision contract
accordance with the standards and regulations
determined by Pertamina and oil company. PPE / c. PPE inspection
APD is maintained, maintained and well maintained,
d. PPE inventory
what if expired / expired time of use or already
damaged then PPE / PPE can be requested again
with new and feasible to work.
PPE provided:

• Safety Helmet / Head Protection / Safety Helmet /

Head Shield
• Safety Glasses / Goggles / Safety Glasses
• Ear Plug / Ear Muff / Ear Protector to work on noise
• Mask / dust mask
• Coveral / Werpak / Working Cloth according to the
standard specified (Nomax etc)
• Hand Glove (adjusted for use)
• Full Body Harness to work at height with two (2) line
yards / 2 safety hook straps
• Safety Shoes / Safety Shoes according to the
standards imposed by the client
c) Do you provide training on how to use PPE? (Yes/No)
Explain the content of the training and any follow-up
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution on PPE needs included in Safety a. Training material of PPE
Induction Training and Risk Assessment Meeting.
b. Attendance list

d)Do you have a program to ensure that PPE is impacted and maintained?
Answer : Yes
Evidence documents example : Page :
Employees of PT. PGAS Solution always inspects a. PPE procedures
PPE equipment in the workplace. If it is damaged or b. Standard period of use of
not feasible to use and expired period or expired it will the PPE
be replaced with a new one.

SECTION 5: PLANNING AND PROCEDURES

5.1. HSE and Operations Procedures / Manuals
a) Do you have HSE and Operations procedures manuals? (Yes/No) If Yes, please attach the list of
content
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution has a HSSE guidebook and a. HSE and operations
operational guidance that conforms to the HSSE rules
procedures manual
for the security of scaffolding and lifting equipment
b. HSE Document control
procedure
b) How do you ensure that the working practices and procedures used by your employees on-site are
consistently in accordance with your HSE policy objectives and arrangements?
Answer :
Evidence documents example : Page :
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PT. PGAS Solution will ensure that the workings and a. Audit on the implementation
procedures used by employees in the field are
of the procedure
consistently implemented with the objective of the
HSSE regulations by establishing Standard
Operational Procedures by enclosing the Procedures,
and socialized before the work begins in the HSSE
Meeting.
5.2. Equipment Control and Maintenance
How do you ensure that plant and equipment used within your premises, on-site, or at other locations
by your employees are correctly registered, certified with regulatory requirement, inspected, controlled
and maintained in a safe working condition?
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution conducts Inspection and Audit of a. Certificate / inspection record
work equipment and field work results. Which is done
of the equipment
periodically for once a year.

5.3. Management of Change

How do you manage change and assess risk related such as personnel, equipment, processes,
documentation?
Answer : Yes
Evidence documents example : Page :
a. MOC procedure

b. MOC process and record

5.4. Emergency Response Plan
a) What arrangements does your company have for emergency response plan and what is
included in an emergency structure?
Answer : Yes Evidence documents example : Page :
a. ERP procedure
Arrangement of emergency response plan from PT.
PGAS Solution is available in HSSE manual and
b. ERP business process
HSSE Procedure.
c. Emergency team organization

d. Emergency numbers contact

e. Emergency exercise plan and

implementation

SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

6.1. Implementation HSE Management and Performance Monitoring of Work Activities
a) What arrangement(s) does your company have for supervision and monitoring of HSE performance?
Please explain the criteria. (the lack information of the point may check disqualification from HSE
point view)
Answer : Yes
Evidence documents example : Page :
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PT. PGAS Solution has HSSE performance a. Company HSE performance

monitoring and monitoring arrangements. monitoring system (e.g.
procedure, man hours
recording system, incidents
count and analysis, HSE
performance reward program,
etc)

b. Evidence of HSE
performance recognition from
clients (if any)

c. Others (Specify)_________

b) What does your company to monitor the performance of the HSE? (for example in the event of
incident)
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution always ensures the compliance of a. HSE plan
its employees in implementing HSSE programs b. Incident and investigation
periodically by conducting audits. record

c) How do you report and correct weaknesses identified?

Answer : Yes
Evidence documents example : Page :
HSSE performance monitoring at PT. PGAS Solution a. Corrective action register and
requires all employees to participate in HSSE status
activities by actively participating in the Toolbox b. Others(specify)
meeting / Tailgate Meeting / Safety Talk, establishing
JSA in identifying hazards in the workplace, creating
and reporting events that pose a potential hazard /
work accident, etc.
d) How do you communicate the result of performance monitoring active to relevant personnel?
The results of the monitoring will be discussed in
Evidence documents example : Page :
meetings with employees and the board of directors of a. HSE performance dashboard
PT. PGAS Solution. in presentation slide /
company intranet, etc
6.2. HSE Performance Indicator
a) Please provide statistical details of your HSE performance over the past 3 years (if not recorded/
applicable please mark N/R or N/A)

 Total Man Hours

 Number of fatalities

 Number Lost Time Injuries

 Page 16 of 20

 Number of Lost Workday Cases

 Number of Restricted work day cases

 Number of first aid cases

 Number of nearmiss incidents

 Fatal Accident Rate (per 100 million hours worked)

 Lost Time Injury Frequency (per million hours worked)

 Total Recordable Incident Rate (per million hours worked)

Please include your company regarding the definition of the terms above in a separate sheet
Answer :
Evidence documents example : Page :
PT. PGAS Solution documents activities, notes for any a. Performance statistic
incidents and performance of HSSE in conducting its
business activities.

6.3. HSE Performance Monitoring

a) How is Health performance monitor and recorded?
Answer : Yes
Evidence documents example : Page :
From result of Medical Check up all employees a. Health parameter and target

b. Performance statistic

b) How is environmental performance monitor and recorded?

Answer : Yes
Evidence documents example : Page :
From Report Housekeeping
a. Environment parameter and
target

b. Performance statistic

c) How is security performance monitor and recorded?

Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution will provide full security to its
employees as stated in the management commitment a. Security parameter and target
of PT. PGAS Solution
b. Performance statistic

d) How is the nearmiss reported?

Answer : Yes
Evidence documents example : Page :
Any employee who knows / sees the nearmiss event a. Sample of Nearmiss Report
should make a report to the HSSE so that the
nearmiss event does not occur to another employee (should it under client record)
by taking corrective action

e) How often the Hse performance is reviewed? By whom?

 Page 17 of 20

Answer : Yes
Evidence documents example : Page :
Every 1 year by HSSE Manager and lavel Directors in a. HSE Performing review
conducting safety inspections and audits meeting material
b. HSE performance review
meeting attendance list

f) How is security performance monitor and reported?

Answer : Yes
Evidence documents example : Page :
a. Sample of security event

g) Are the traffic incident recorded?

Answer :
Evidence documents example : Page :
a. Sample of traffic incident
report

6.4. Incident Investigation and Reporting

a) What are criteria’s for incident to be investigated?
Answer : Yes Evidence documents example : Page :
PT. PGAS Solution will conduct investigations a. Evidence reporting &
including:
investigation procedure
• Work accident
• Vehicle Accidents
• Unsafe working environment conditions
b) What is the process to incident investigation?
Answer : Yes Evidence documents example : Page :
a. Evidence reporting &
HSSE incident investigation process in
accordance with HSSE Accident Investigation investigation procedure
Procedure PT. PGAS Solution.

c) Who is doing investigation incident?

Answer : Yes Evidence documents example : Page :
Investigations are carried out by employees a. List of appointed investigator
who have participated in training on
by company
investigations

d) How are the findings following an incident investigation

Answer : Yes
Evidence documents example : Page :
The findings of the findings of the
a. List of corrective action
investigation will be informed to all
employees and follow up so that similar record
incidents do not reoccur. The information can
be obtained from HSSE Meeting, HSSE
information via Email, HSSE Bulletin etc.
e) How are the findings following an investigation, or a relevant incident occurring elsewhere,
communicated to your employees?
 Page 18 of 20

Answer : Yes Evidence documents example : Page :

a. Please attach an example of
investigation reports during
the last 12 months

6.5 An incident that must be reported based on the law and records disobedience
a) Have your company experienced necessity of improvement or notice of prohibition in terms of /
incident scene dangerous that is spatially law by national body relevant , the authorized agency, or
authority of other law enforcement during these past five years ?
Answer : Evidence documents example : Page :
a. Specific incident report to the
relevant natural
body/authorized a years

SECTION 7: AUDIT AND MANAGEMENT REVIEW

7.1 Audit
a) Do you have a written policy on HSE auditing? (Yes/No) if yes, please attached
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution conducts an annual investigation a. Audit procedure
and periodic audit conducted internally
b. Others (specify)____

b) Who is involved in conduct HSE audit? How team members audit chosen that have special
skills and independent of activities in audit ? what are qualification for auditors?
Answer : Yes
Evidence documents example : Page :
PT. PGAS Solution will equip its employees by
including the Training / Training of Auditors of Certified
Late Intansi a. List of appointed HSE auditor

c) How does your company scheduled HSE audit and what of scope audit? For example internal
audit, compliance regulation, supplier/contractor, for implementation of HSE management
system?
Answer :
Evidence documents example : Page :
 Page 19 of 20

PT. PGAS Solution will schedule the implementation a. Audit procedure

of HSSE internal audits and external audits
b. Audit program and
implementation (schedule,
coverage, audit team, report
and follow up, etc
d) How is the management review audit finding and ensure the follow up of review will be effectively
execute
Answer :
Evidence documents example : Page :
Audit effectiveness and follow up:
• Receiving audit findings a. List of corrective action from
• Review improvements on the findings audit
• Provide a report on improvements that have been
made to the auditor
• Make improvements to the findings of the audit carried
out to further improve good results
7.2 Management Review
a) Do you have a written policy on management review ?(yes/No)
Answer : Yes Evidence documents example : Page :
a. Procedure of management
review

b) How often Management review conducted? Who involved in the process ?

Answer : Evidence documents example : Page :
Management reviews for HSSE issues are a. Management review
addressed and discussed at regular operational
meetings in which all aspects of the company's material/presentation
operations are reviewed every 1 year. Those
involved in the process are the ranks of the Manager b. Attendance list
and Director.
c. Minutes of Meeting
Management review

c) How control plan identified and correction recorded and traced to follow up can effectively ?
Answer : Yes Evidence documents example : Page :
a. List of action monitoring
All levels (Board of Directors, managers, and
employees) should be involved in the control plan and raised of Management
improvement efforts can be followed up
Review

SECTION 8: HSE MANAGEMENT – OTHER ACHIEVMENT

8.1 HSE Management system certification
Please provide information on the certification that you have ever received from the Agency's
certification
Answer : Yes
Evidence documents example : Page :
 Page 20 of 20

a. Certification system
management (OHSAS
18001, ISO 14001, ISO
9001, etc)

8.2 Member of association

Explain participation your company on industrial organization relevant , trade and government.
Answer : Yes
Evidence documents example : Page :
a. Membership to the industrial
organization

8.3 Additional Feature

a)Does your company hold association(s) membership? (Yes/No) If yes, please provide the list.
Answer : Evidence documents example : Page :
a. Membership to the
industrial organization

b) Is there any aspect of your HSE performance that you believe differentiates yourselves from your
competitors that not described elsewhere in your response to the questionnaire?
If yes, please explain.
Answer : Evidence documents example : Page :
a. Please specify_______

SECTION 9: COMPANY INFORMATION

This section were not included in the scoring of evaluation of the qualification process . Can you asked
specific information whatever it takes to evaluate a partner of ?
Answer :
Evidence documents example : Page :