PB Site Inspection Report

Database No.: Contractor: Petronesia Benimel Area:

Site Supervisor: James G. Siahaan ID #: Date:
Location: Inspection by: MI
Scoring: Compliance = 1 Non-Compliance = 0 Not Applicable = N/A

The information in the description section is to assist personnel during the inspection; however, personnel conducting
this inspection must be thoroughly familiar with the information in the following Company manuals:
CPI SHE Guidelines, Volumes I, II, III (HES)
CPI SH&E Work Practices Handbook (1999) (WP)
CPI Safety in Designs (SID)
Item Description Score Remarks
A. GENERAL
01 Access Control. CPI FSWP
- All access control applied as per CPI FSWP
guideline
1
02 General Work Permit or written instructions.
HES-OS.03-09/10, WP-II.7 (CPI initiated)
1
- Work Permit or authorization issued &
current
03 Job Safety Plan SH -0S.34, WP-II.8,
-Contractor JSAs and /or Safe Work Practices or
1
procedures on-site or available

04 Daily Tailgate Meeting HES-OS.03-20.6, WP-I.11

- covers specifics from JSAs/SWP & recorded
1
- any worker concerns noted & addressed
05 Emergency Response / Communication / First
Aid HES-OS.03-13, WP-II.03. TF 000 653 8110
1
- ERP or Emergency communication plan
- qualified first-aider & first aid kit available onsite
or nearby
06 Appropriate PPE: WP-III, HES-OS.03-14
-head/eye/foot/ gloves/body/hearing
1
- respiratory: BA/respirator/dust mask if required
07 Hand tool condition: WP-II-04
- fit for purpose- no major defects
1
- no site made tools
08 Power tool condition: WP-II. TF. 000 653 815 &
000 653 8109
N/A
- Electric / pneumatic/ hydraulic
- extension cords, air hoses, color code tagging in
place
09 Safe Access to work area: SD-01-04.
-walkways/ladders fit for purpose/ secured
1
-Extension ladders have 1.0m above landing
10 Welding & cutting: WP-II-03, TF
- flashback arrestors/reverse flow check valves
N/A
- fire watch, fire extinguisher, welding hood

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11 Gas Celynder Handling: WP-II-03, TF-4.4.I.I
- Gas bottles secured/stored with cap on
N/A
- Safe gas celynder handling.
12 Site organization: WP-II.01, HES-OS.03-15 Sampah bekas sisa makanan berserakan disekitar
-equipment/materials organized/ housekeeping
0 tempat istirahat dan tidak adanya tempat sampah
- facilities -shade / water / toilet / wash supplies
- refer to Waste Management Inspection Report
Section Total 12 Total Possible- 12 3 N/A = 8

B. Traffic Control / Equipment Score Remarks

01 Heavy trucks & equipment: WP-II.04, HES-
OS.03.6 / OS.29, TF 000 653 8108
N/A
- no deep cracks, cuts or gouges in tires
- no oil/fuel leaks
-operators following safe work practices
02 Signalman in place: HES-OS.29
- congested areas, reversing, OH lines
N/A
- maintains visual contact with driver at all times
03 Access to site: HES-OS.24
- overhead power lines Pipeline crossings etc.
N/A
- dust control in place for roads
04 Warning signs/ barriers: OS.24,TF. 000 653
8134, CPI SOP - CONSTRUCTION TRAFFIC
N/A
- OH lines, speed, yield, special instruction
- Road resurfacing, excavations etc.
05 Stationary equipment condition: SD-05-06,
HES-OS.03(17.9)
N/A
-mixers / generators / power plants / storage
containers
-fuel tanks 110% secondary containment/ storage
etc.
Section Total 5 Total Possible- 5 5 N/A = 0

High Risk and

C. Score Remarks
Non Routine Activities (C-10)
01 Excavations : WP-II.-07.b4, TF.000 653 8127
- Excavation permit if over 0.5m in depth
1
-Workers in excavations over 5 ft: SD-12.7,
- Shoring/sloping (Min 1:1) / steps or combination
02 Working at heights over 6 feet: TF.000 653 8118
-scaffolding / plat forms in place SD-08
N/A
-Fall arrest /safety harness if req. WP-III.01
- permit or inspection tag system HES-OS.03
03 Entry into Confined spaces: HES OS.14, TF.000
653 8117
N/A
- written procedures/ Permit WP-II-07.b3
- Gas/oxygen testing /ventilation
- Safe access / lighting has GFCI protection
- safety watch / communications/ rescue plan
04 Electrical: HES-OS(24), WP-II-07.b4/5, WP-II.09
- Permit CPI 3.094 if recuired. TF.000 653 8150
N/A
- isolation and / or lockout in place
- qualified /authorized craftsmen
- Equipment/men working around power lines
safely

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05 Pressure testing: HES-OS.03-10
- Permission obtained from CPI representative
N/A
- identified safe distance from all lines/equipment
under test
- warning signs/barriers at perimeter
06 Removal of old equipment: HES-OS.13,
WP-II.03
N/A
- lines isolated / mechanical lockout
- Line early marked/depressurized/purged
- line removal: GAS FREE
High Risk and
C. Score Remarks
Non Routine Activities (C-10)
07 Lifting / Hoisting: WP-II.04, HES OS.03-6,
TF.000 653 8132
N/A
- Crane inspected /certified/log book current
-Crane operator has appropriate SIO license
- Critical lift plan required for loads over 50% of
crane capacity at required reach or 2 crane lift
- under hook lifting equipment serviceable
-loads secured to prevent slippage or movement
during lifting/movement
- when lift above shoulder height, tag lines are
attached to allow minimum 3m safe distance for
riggers handling load at all times.
-Minimum 5m safe distance maintained by all
others
08 Safe Rigging Practive: CPI SID 7.0, TF HSE
guidelines, WP-11.04.TF.000 653 8109
N/A
- All rigging equipment shal be free from
defects, in good operating condition and
maintained in a safe condition and color
code in place.
09 X-Ray Inspection: WP-II.08, TF.000 653 8162
- warning signs posted at safe distance marker
N/A
- area cordoned off when possible
- authorized personnel only inside hazard area
10 Hazardous Chemicals WP-III.02, WP-II.03(e)
- MSDS On-Site/workers trained
N/A
- Handling/storage safely
-Hydrogen Sulphide (H2S) Requirements WP-
III.02(b) (CPI Initiated)
11 Non-Routine Activity: WP-II.08, HES-FP.05,
TF.000 653 8126
1
Section Total 11 Total Possible: 11 9 N/A = 2

*NOTE: The following Non - Compliance items are to be recorded on Inspection Summary Report:
All High Risk and Non Routine Activities.
Those in Section A & B that cannot be corrected immediately.

SCORING SUMMARY
A. Section Total 12 i. 12
B. Section Total 5 B. Total Possible: 5
C. Section Total 11 C. Total Possible: 11
TOTAL SCORE 28 Total Score Possible: 28

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 FINAL RATING: TOTAL SCORE 28 X 100 = 100 %
Total Score Possible 28

Remarks

Attendees:

CMT-HES-003-AIII Rev 02.1 iv