PENGUMUMAN PRAKUALIFIKASI
JOB PERTAMINA-TALISMAN JAMBI MERANG, Kontraktor Kontrak Kerjasama SKKMIGAS yang mengelola Wilayah Kerja Blok Jambi Merang di
Propinsi Sumatera Selatan mengundang Perusahaan yang mampu untuk berpartisipasi dalam prakualifikasi untuk lelang penyediaan Jasa :
No.
No. Pengadaan
Judul Pengadaan
1.
10002466
Condition Monitoring Services
for 2 (two) Years
Kualifikasi
 Golongan : Bukan Usaha Kecil
 Bidang / Sub Bidang : B.06.18 Perawatan fasilitas Produksi
 Persyaratan TKDN : minimum 35%
Lingkup Kerja :
Melaksanakan pekerjaan Condition Monitoring peralatan rotating (rotating equipment) untuk perawatan Fasilitas Produksi JOB Jambi Merang
Field di Desa Mendis Darat, Kecamatan Bayung Lencir, Kabupaten Musi Banyuasin, Propinsi Sumatera Selatan.
I. Pendaftaran
Perusahaan yang berminat partisipasi dalam Lelang ini diminta untuk melakukan pendaftaran dengan mengirimkan dokumen dibawah ini
pada saat melakukan pendaftaran:
Syarat Administrasi Umum
1. Surat Permohonan Mengikuti Lelang ditandatangani diatas materai Rp. 6.000,- oleh pimpinan tertinggi Peserta Lelang sebagaimana
yang terdapat didalam Akte Pendirian Perusahaan atau Pejabat yang dikuasakan;
2. Surat Pernyataan yang ditandatangani diatas materai Rp. 6.000,- oleh pimpinan tertinggi Peserta Lelang yang menyatakan bahwa
semua informasi yang disampaikan adalah benar dan apabila ditemukan penipuan/pemalsuan atas informasi yang disampaikan maka
bersedia dikenakan sanksi pembatalan calon pemenang;
3. Surat Pernyataan di atas materai Rp 6,000 oleh pimpinan tertinggi Peserta Lelang yang menyatakan Perusahaan tidak sedang dalam
pengawasan Pengadilan Pidana dan/atau Perdata atau dalam keadaan pailit, tidak bangkrut, kegiatan usahanya tidak sedang
dihentikan, tidak sedang menjalani sanksi pidana;
4. Surat Pernyataan di atas materai Rp 6,000 oleh pimpinan tertinggi Peserta Lelang yang menyatakan Perusahaan tidak sedang dalam
proses berperkara di peradilan atau arbitrase dengan Kontraktor KKS bersangkutan dan/atau dengan BPMIGAS;
5. Salinan Akta Pendirian Perusahaan berikut perubahannya yang disahkan oleh instansi/departemen yang berwenang;
6. Salinan Surat Izin Usaha sesuai dengan bidang yang masih berlaku dan diterbitkan oleh pihak yang berwenang;
7. Salinan Surat Keterangan Domisili Perusahaan yang masih berlaku;
8. Salinan NPWP dan bukti pembayaran pajak tahun terakhir dibuktikan dengan salinan bukti pelunasan PPH pasal 25 atau pasal 21/pasal
23 dan PPN;
9. Salinan laporan keuangan terakhir minimal per 31 Desember 2012 yang telah diaudit oleh Akuntan Publik;
10. Daftar pengalaman kerja dalam kurun waktu 7 (tujuh) tahun terakhir sesuai dengan paket pekerjaan diutamakan di lingkungan
Kontraktor Kontrak Kerja Sama SKKMIGAS dengan penjelasan tahun pelaksanaan, jenis jasa, bidang/disiplin pekerjaan, nama pemberi
pekerjaan, lokasi penggunaan dan nilai kontrak yang disertai dengan lampiran kontraknya atau surat referensi dari pemberi pekerjaan.
Syarat Administrasi Khusus
1. Surat pernyataan yang ditandatangani oleh Presiden Direktur atau Pejabat yang berwenang di atas materai Rp 6.000 mengenai
komitmen pencapaian TKDN (Total Kandungan Dalam Negeri) sebesar minimum 35%;
2. Formulir Isian Prakualifikasi yang tersedia pada website (www.jambimerang.com) dan mengembalikan ke kantor JOB Pertamina –
Talisman Jambi Merang selambat-lambatnya pada saat pendaftaran;
3. Melengkapi HSE Questionnaires Form yang tersedia pada website (www.jambimerang.com) dan mengembalikan ke kantor JOB
Pertamina – Talisman Jambi Merang selambat-lambatnya pada saat pendaftaran.
4. HSE Statement Form yang tersedia pada website (www.jambimerang.com) dan mengembalikan ke kantor JOB Pertamina – Talisman
Jambi Merang selambat-lambatnya pada saat pendaftaran.
II. Waktu dan Tempat Pendaftaran serta Pengembalian Formulir Isian Prakualifikasi & HSE Questionnaires :
Hari / Tanggal
: Kamis, 5 Desember 2013 - Selasa, 10 Desember 2013
Waktu
: 09.00 – 15.00 WIB
Tempat Pendaftaran
: JOB PERTAMINA-TALISMAN Jambi Merang,
PHE Tower 12th Floor, Jl. TB Simatupang Kav. 99, Jakarta Selatan 12520
III. Keterangan:
Pengumuman ini bukan undangan untuk mengikuti proses pelelangan. Undangan lelang hanya akan diberikan kepada perusahaan yang
telah lulus proses prakualifikasi.
Jakarta, 5 Desember 2013
PANITIA PENGADAAN
JOB PERTAMINA-TALISMAN JAMBI MERANG
PRE-QUALIFICATION DOCUMENT
FOR
Tender Title : Condition Monitoring for 2 (two) Years
Tender No. : 10002466
JOB PERTAMINA-TALISMAN Jambi Merang
Formulir Kualifikasi
FORMULIR ISIAN PENILAIAN KUALIFIKASI
Yang bertanda tangan dibawah ini :
Nama
: _________________________
Bertindak untuk dan atas nama : _________________________
Jabatan
: _________________________
Alamat
: _________________________
Telepon
: _________________________
Menyatakan dengan sesungguhnya bahwa :
1. Saya secara hukum mempunyai kapasitas menandatangani kontrak/pengadaan barang
berdasarkan surat akta ____________________________________________ (sesuai akta
pendirian/perubahannya/surat
kuasa:
sebutkan
secara
jelas
nomor
akta
pendirian/perubahannya/surat kuasa dan tanggalnya);
2. Saya/perusahaan saya tidak sedang dinyatakan pailit atau kegiatan usahanya tidak sedang
dihentikan atau tidak sedang menjalani sanksi pidana atau sedang dalam pengawasan
pengadilan;
3. Saya tidak pernah dihukum berdasarkan putusan pengadilan atas tindakan yang berkaitan
dengan kondite professional saya;
4. Menjunjung tinggi nilai-nilai Etika Bisnis terhadap kebijakan JOB Pertamina – Talisman Jambi
Merang dan senantiasa menekankan kepatuhan terhadap nilai / norma bisnis untuk mencapai
tingkat kinerja yang profesional dengan penuh tanggung jawab serta menciptakan lingkunan
bisnis yang harmonis, adil, dan sehat.
5. Seluruh
Direksi,
Komisaris,
Pemegang
Saham,
dan
Karyawan
PT
/
CV .............................adalah bukan Pejabat Pemerintah / Pegawai Negeri / BI / BHMN /
BUMN / BUMD / Kontraktor KKS.
6. Memiliki / Tidak Memiliki afiliasi (hubungan istimewa)
(* sebutkan bila memiliki afiliasi (hubungan istimewa) dengan:
a. PT / CV ..........................
b. PT / CV ..........................
7. Seluruh
informasi
dan
dipertanggungjawabkan.
dokumen
yang
diberikan
adalah
benar
dan
dapat
8. Mengisi dan melampirkan Salinan Dokumen Administrasi Perusahaan seperti disebutkan di
bawah ini dan dimasukkan di dalam ”Three Ring Binder” warna Putih ukuran A4: Tinggi
31 cm x Lebar 27 cm x Tebal 5 cm, dan dalam bentuk soft copy (.PDF)
9. Data-data perusahaan saya adalah sebagai berikut:
Page 2 of 6
JOB PERTAMINA-TALISMAN Jambi Merang
Formulir Kualifikasi
A. DATA ADMINISTRASI
1. Umum
1
2
Nama Perusahan ( PT, CV,
Koperasi , Asuransi )
Status Kantor
3
Alamat Lengkap
Pusat atau cabang
Kode Pos
4
Nomor Telepon
Nomor Fax
Contact Person
Nomor Handphone (GSM)
Alamat email 1
Alamat email 2
Status Kantor
Cabang (mohon diisi bila ada)
Alamat Lengkap
Kode Pos
No. Telepon
No. Fax
Contact Person
Nomor Handphone (GSM)
Alamat email 1
Alamat email 2
2. Landasan Hukum Pendirian Perusahaan
1
Akta Pendirian Perusahaan
a. Nomor Akta
b. Tanggal
c. Nama Notaris
2
Akta Perubahan Terakhir
a. Nomor Akta
b. Tanggal
c. Nama Notaris
d. Surat Keputusan Menteri
Hukum & HAM berdasarkan
UU no. 40 tahun 2007
tentang Perseroan Terbatas
Nomor
Tanggal
Ditetapkan
3. Izin Usaha
1
2
Jenis Izin Usaha
Nomor
Tanggal Masa Berlaku
Instansi Pemberi Izin Usaha
SIUP / SIUJK / SIUPAL / Surat Izin Usaha dari BKPM )*
Jenis Izin Usaha
Nomor
Tanggal Masa Berlaku
Instansi Pemberi Izin Usaha
Tanda Daftar Perusahaan (TDP)
s/d
s/d
*coret yang tidak perlu
Page 3 of 6
JOB PERTAMINA-TALISMAN Jambi Merang
Formulir Kualifikasi
4. Domisili Perusahaan
1
Surat Keterangan Domisili Perusahaan
Nomor
Tanggal Masa Berlaku
s/d
5. Susunan Pengurus Sesuai Dengan Akta Terakhir
a. Komisaris (untuk PT)
No.
Nama
No. KTP/KITAS (lampirkan
copy yg masih berlaku)
Jabatan Dalam
Perusahaan
1
2
3
4
5
b. Direksi/Penanggung Jawab/Pengurus Perusahaan
No. KTP/KITAS
No.
Nama
(lampirkan copy yg
masih berlaku)
Jabatan Dalam
Perusahaan
Alamat Email
1
2
3
4
5
6. Afiliasi
Apakah perusahaan Anda memiliki afiliasi (hubungan istimewa) ? Jika ya, sebutkan:
Nama Perusahaan
1.
2.
3.
4.
Bila Perusahaan anda tidak mengakui adanya afiliasi (hubungan istimewa) dengan Perusahaan lain
yang terdaftar di KKKS lain dan suatu saat KKKS lain menemukan adanya afiliasi tersebut, maka JOB
Jambi Merang berhak untuk membatalkan pendaftaran dan/atau transaksi yang sedang berjalan
dengan perusahaan yang bersangkutan.
B. DATA KEUANGAN
1. Susunan Kepemilikan Saham (bagi PT) atau Daftar Susunan Persero (bagi CV)
No. KTP/KITAS
No
Nama
(lampirkan copy yg
masih berlaku)
Warga Negara
Indonesia/ Asing
Prosentase
1
2
3
4
5
Page 4 of 6
JOB PERTAMINA-TALISMAN Jambi Merang
Formulir Kualifikasi
2. Informasi Rekening Bank
Pemegang Rekening
Nomor
Rekening
Mata
Uang
Nama Bank
Alamat
Lengkap Bank
1.
2.
3.
4.
Rekening Bank harus dari Bank Umum Nasional BUMN/BUMD.
3. Neraca Perusahaan Terakhir (Lampirkan fotocopy Laporan Rugi Laba yang telah diaudit akuntan
publik untuk perusahaan Menengah dan Besar)
(per Tanggal __________ Bulan _______________ Tahun ________)
AKTIVA
I
Aktiva Lancar
- Kas
- Bank
- Piutang *)
- Persediaan Barang
- Pekerjaan dalam Proses
Jumlah (a)
II
III
Aktiva Tetap
- Peralatan dan Mesin
- Inventaris
- Gedung- gedung
Jumlah (b)
Aktiva Lain
(c)
IV
Rp.
Rp.
Rp.
Rp.
Rp.
Rp.
Rp.
Rp.
Rp.
Rp.
PASIVA
Utang Jangka Pendek
- Utang Dagang
- Utang Pajak
- Utang Lainnya
Jumlah (d )
V
Utang Jangka panjang (e )
VI
Kekayaan Bersih
(a+b+c) – (d + e)
Rp.
Rp.
Rp.
Rp.
Jumlah
Total
Rp.
Jumlah Total
*) Note
Piutang jangka pendek (sampai dengan enam bulan)
Piutang jangka pendek (lebih dari enam bulan )
Jumlah
Rp.
: Rp ………………………….
: Rp ………………………….
___________________
: Rp ………………………….
4. Pajak
1
2
3
Nomor Pokok Wajib Pajak
Nomor/ Tanggal Bukti Pelunasan
Pajak Tahun Terakhir
Nomor/Tanggal Laporan bulanan
PPH/PPN tiga bulan terakhir
Page 5 of 6
JOB PERTAMINA-TALISMAN Jambi Merang
Formulir Kualifikasi
C. Data Pengalaman Perusahaan
(nilai 3 paket tertinggi pengalaman dibidang/subbidang yang sesuai)
No.
Nama
Paket
Pekerjaan
Bidang/Sub
Bidang
Pekerjaan
Pemberi Tugas/
Pengguna Jasa
Lokasi
Nama
Alamat/
Telepon
Kontrak
Nomor/Tanggal
Nilai
Tanggal Selesai
Menurut
Berita
Acara
Kontrak
Serah
Terima
1
2
3
Demikianlah pernyataan ini kami buat dengan sebenarnya dan penuh rasa tanggung jawab. Apabila
dikemudian hari ditemukan bahwa data/dokumen yang kami sampaikan tidak benar dan ada
pemalsuan, maka kami bersedia dikenakan sanksi administrasi yaitu dimasukan dalam daftar hitam
perusahaan dalam jangka waktu selama 2 (dua) tahun dan sanksi perdata dan pidana sesuai ketentuan
peraturan perundang-undangan yang berlaku.
Jakarta, ________________20___
PT / CV _____________________
meterai Rp.6000,(Nama Jelas )
(Jabatan)
Page 6 of 6
Pernyataan HSE / HSE Statement
KESELAMATAN, KESEHATAN KERJA DAN
LINDUNGAN LINGKUNGAN
KONTRAKTOR
harus
memberikan
maksimum terhadap hal-hal dibawah ini:
1.
perhatian
ACUAN K3LL
HEALTH, SAFETY AND ENVIRONMENT
CONTRACTOR is required
attention to the following:
1.
Selama
pelaksanaan
PEKERJAAN,
KONTRAKTOR harus tunduk pada seluruh
undang-undang dan peraturan-peraturan yang
berlaku atas Keselamatan, Kesehatan Kerja
dan Lindungan Lingkungan yang dikeluarkan
oleh Pejabat Pemerintah yang berwenang
yang berhubungan dengan Proyek ini.
2.
KESEHATAN KERJA
KESELAMATAN KERJA
2.
LINDUNGAN LINGKUNGAN
3.
PROGRAM HSE KONTRAKTOR
KONTRAKTOR harus mengemukakan HSE Plan
yang sesuai dengan undang-undang dan
peraturan-peraturan
yang
berhubungan
dengan lindungan lingkungan yang terkait
dengan PEKERJAAN sesuai dengan Schedule 3
– K3LL.
Materai (RP.6000)
____________
Nama:
Jabatan:
HSE POLICY
HEALTH
SAFETY
The Contractor shall ensure that the Project
will be performed under safe conditions
acceptable to the Company. The Contractor
shall require all employees to obey all
applicable laws concerning safety at work.
4.
KONTRAKTOR harus tunduk pada seluruh
undang-undang dan peraturan-peraturan yang
berhubungan dengan lindungan lingkungan
yang terkait dengan PEKERJAAN.
5.
maximum
All precautions shall be taken by the
Contractor to ensure the health and safety
of its staff and labor. The Contractor shall,
in co-operation ensure that medical staff,
first aid facilities, are available at the Site at
all times.
KONTRAKTOR akan menjamin bahwa Proyek
ini akan dilaksanakan dalam kondisi aman
yang dapat diterima oleh PERUSAHAAN.
KONTRAKTOR harus meminta agar para
pekerja
mematuhi
seluruh
peraturanperaturan keselamatan dalam bekerja.
4.
pay
The Contractor during the performance of
the Work shall be subject to all applicable
safety and health regulations and orders of
any
Government
Authority
having
jurisdiction over the Project.
Tindakan pencegahan harus diambil oleh
KONTRAKTOR
untuk
menjamin
agar
kesehatan dan keselamatan staf dan
pekerjanya. KONTRAKTOR harus menjamin
bahwa staf medis dan fasilitas PPPK tersedia
ditempat kerja sepanjang waktu.
3.
to
ENVIRONMENT
The Contractor shall comply, with all
applicable laws and regulations relating to
environmental protection applicable to the
SERVICES.
5.
CONTRACTOR’S HSE PROGRAM
The Contractor shall propose HSE Plan
which appropriates with all applicable laws
and regulations relating to environmental
protection applicable to the SERVICES as
Schedule 3 - HSE.
Attachment for Prequalification
Daftar Pertanyaan HSE / HSE Questionnaires Form
Bidder is requested to fulfil the following Health, Safety & Environmental questionnaire. For those
who have not fulfilled the HSE questionnaire shall be deemed as unqualified Bidder and will be
excluded from further bidding process.
Supplier/Contractor:
Address:
Tel No:
Fax No:
Services/equipment to be
provided:
Contact Name:
E-mail/website details:
Locations covered by this
questionnaire:
Date:
Vendor Code Ref. :
Instructions to Supplier / Contractor:
1. Please ensure that you read the questions carefully and provide ALL of the information
requested to support your responses. The supporting documents required are listed at the end
of each section and summarized on point No.9. If any of the requested information is not
provided, your submission cannot be assessed properly.
2. It should be noted that the information presented here is part of the FIRST stage of evaluation.
JOB Jambi Merang reserves the right to carry out further assessment and/or audit of your
company’s operating activities to verify the information provided here. Qualification as a
Supplier/Contractor to JOB Jambi Merang may require an audit of your management systems.
For COMPANY use only
Environmental
Name:
Score:
(Print)
Signature:
Health & Safety
Name:
Score:
(Print)
Date:
Signature:
Date:
-1-
1.0
POLICY AND ORGANISATION
1.1
Does your company have documented policies for:
(i) Environmental?
(ii) Health & Safety?
(iii) Quality?
1.2
YES/NO
YES/NO
YES/NO
Does your company have Management a Representative(s) appointed for:
(i) Environmental?
(ii) Health & Safety?
YES/NO
YES/NO
(iii) Quality? YES/NO
Please provide the following supporting documents, where appropriate, for this section:
(a) Organigram(s) showing reporting line(s) for Management Representative(s)
(b) Organigram(s) for Environmental, Health & Safety and Quality Department(s)
(c)
Copies of Policy Statements
2.0
MANAGEMENT SYSTEMS
2.1
ENVIRONMENTAL MANAGEMENT SYSTEM (EMS)
(i)
Does your company operate an EMS?
YES/NO
If YES, please state EMS standard e.g. ISO 14001 ____________________
(ii)
How long has your EMS been in operation?
(iii)
Is your EMS certified?
___________Years
YES/NO
If YES, by which Certification Body? _______________(provide certificate)
(iv)
Please provide a copy of the contents index of the Environmental Manual and a copy of a
recent Internal Audit Report
-2-
2.2
HEALTH & SAFETY MANAGEMENT SYSTEM (SMS)
(i)
Does your company operate a SMS?
YES/NO
If YES, please state SMS model e.g. OHSAS 18001___________________
(ii)
How long has your SMS been in operation?
(iii)
Is your SMS certified?
_________ Years
YES/NO
If YES, by which Certification Body?
(iv)
(provide certificate)
Please provide a copy of the contents index of the SMS Manual and a copy of a recent
Internal Audit Report
2.3 QUALITY MANAGEMENT SYSTEM? (QMS)
(i) Does your company operate a QMS ?
YES/NO
If YES, Please state QMS model e.g. ISO 9000
(ii) How long has your QMS been in operation _____Years
(iii) Is your QMS certified ?
YES/NO
If YES, by which Certification Body?
( Provide certificated )
(iv) Please provide a copy of the contents index of the Quality Manual and a copy of a recent
Internal Audit Report
Please provide the following supporting documents, where appropriate, for this section :
(a) Index of Environmental Manual and copy of recent Internal Audit Report
(b) Index of SMS Manual and copy of recent Internal Audit Report
(c) Index of Quality Manual and copy of Recent Internal Audit Report
(d) Copy of EMS, SMS, and QMS certificates ( as applicable)
3.0
PREVIOUS WORK FOR JOB Jambi Merang
3.1
PREVIOUS EXPERIENCE
(i) Has your company previously
supplied products/services to JOB
Jambi Merang?
YES/NO
Date
Products / Services
JOB Jambi
Merang
Contact:
-3-
4.0
TRAINING AND COMPETENCE
4.1
TRAINING
(i)
Are all new staff and contractors given a formal induction
briefing?
(ii)
Have training standards been established for all key
operational positions?
(iii) Has a system been developed to identify individual training
needs?
(iv) Does training include Hazard Identification and Risk
Assessment Techniques?
(v) Is Safety Leadership included in the training program?
(vi) Are Line Managers trained in Health and Safety
Management?
YES/NO
Procedure
Reference
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
Please provide copy of Training Procedure and Training Matrix
showing latest status
4.2
COMPETENCE
(i)
Has a competence assurance program been established and
implemented?
(ii)
Are competence standards established for all key operational
positions?
If NO please state target date for completion……………………
(iii)
(iv)
YES/NO
Procedure
Reference
YES/NO
Are workplace competence assessments carried out?
i.e. initial assessment, workplace assessment and continual
appraisal?
Is the competence assurance program linked to
-4-
continuous improvement and planning for change under the
management systems?
Please provide a copy of the Competence Procedure and the Assessment
Schedule
YES/NO
YES/NO
Please provide the following supporting documents, where appropriate, for this
section:
(a)
(b)
5.0
5.1
Copy of Training Procedure and Training Matrix showing latest status
Copy of Competence Procedure and Assessment Schedule
ENVIRONMENTAL MANAGEMENT
IMPACTS
(i)
Have environmental impacts of activities, products and services
been identified?
(ii)
What are the most significant environmental impacts
associated with this scope of supply/service?
YES/NO
Procedure
Reference
Please provide list of identified environmental impacts
5.2
PERFORMANCE TARGETS
(i) Have environmental performance targets been established in
relation to the identified impacts?
(ii) Is a program in place for achievement of these performance
targets?
(iii) Are systems in place to measure the level of achievement
towards performance targets?
YES/NO
Procedure
Reference
YES/NO
YES/NO
Please provide copies of environmental performance targets
-5-
5.3
REPORTS
(i) Is an annual environmental report produced and issued?
YES/NO
Procedure
Reference
Please provide copy of last annual environmental report
Please provide the following supporting documents, where appropriate, for this
section:
(a) List of identified environmental impacts
(b) Copy of environmental performance targets
(c) Copy of last environmental report
6.0
SAFETY MANAGEMENT
6.1
RISK ASSESSMENTS
(i)
Has a formal system to identify hazards and assess risks been
implemented?
(ii)
Are risk assessments in place for all work activities?
(iii) Do such risk assessment processes take account of health
related and human factor issues?
YES/NO
Procedure
Reference
YES/NO
YES/NO
Please provide copy of a relevant Risk Assessment
6.2
SAFETY MANAGEMENT
(i)
Have safety performance standards/objectives been
established?
(ii) Is a system in place to measure performance against the predetermined standards/objectives?
(iii) Have Key Performance Indicators (KPIs) been set for these
standards/objectives?
YES/NO
Procedure
Reference
YES/NO
YES/NO
Please provide copy of Performance Standards/Objectives/KPIs
-6-
6.3
ACCIDENTS AND INCIDENTS
(i)
Is a system in place to record all incidents and accidents?
YES/NO
(ii)
Is a system in place for investigation, recommendation and
follow-up of all accidents and incidents?
YES/NO
Procedure
Reference
Please provide details of Accident/Incident performance for the last 5
years
6.4 MEETINGS AND REPORTS
(i)
Are safety committee meetings held regularly?
(ii)
Are safety meetings held? e.g. toolbox talks,
local meetings?
(iii)
Are annual safety reports produced and issued?
YES/NO
Frequency
of Mtgs.
Procedure
Reference
YES/NO
YES/NO
Please provide sample copy of Safety Minutes of Meeting
6.5
STATUTORY REGULATIONS
(i) How is compliance with statutory regulations demonstrated?
Please provide the following supporting documents, where appropriate, for this section:
(a) Copy of a relevant Risk Assessment
(b) Copy of Performance Standards/Objectives/KPI’s
(c) Details of Accident/Incident performance for the past 5 years
(d) Sample copy of Safety Minutes of Meeting
7.0 QUALITY MANAGEMENT
7.1 INTERNAL AUDIT
(i) Is there a current internal audit program?
YES/ NO
Procedure
Reference
-7-
Please provide a copy of the latest internal audit program and
completion status
7.2 QUALITY PLANS
Are Quality plans prepared for major contracts/equipment supply?
YES/ NO
Procedure
Reference
YES/ NO
Procedure
Reference
Please provide a copy of typical Quality plan
7.3 CONTINUOUS IMPROVEMENT
(i) Does your company have a process(s) that demonstrates
Continuous Improvement?
Please provide details of any Continuous Improvement
Initiatives
Please provide the following supporting documents, where appropriate, for this
section :
(a) Copy latest internal audit programme and completion status
(b) Copy of typical Quality Plan
(c) Details of any Continuous Improvement Inivitistives
8.0 EMERGENCY PREPAREDNESS AND RESPONSE (For Contractors supplying key
operational services)
All contractors supplying key operational services to JOB PERTAMINA – TALISMAN
Jambi Merang are expected to have some Emergency Response arrangements in
place. These will vary according to the nature and scale of the operation. For
example, a rig owner should have, as a minimum, comprehensive Emergency
Response Procedures, whereas a service company supplying a limited number of
personnel should at least have procedures for MEDEVAC reception.
Procedure
Reference
8.1 PREPARATION FOR EMERGENCIES
(i)
In connection with the supplier’s key operational activities,
have emergency scenarios, which are reasonably
foreseeable, been identified?
YES/NO
Procedure
Reference
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Please provide list of key operational emergencies
8.2 EMERGENCY RESPONSE
YES/NO
(i)
Has an emergency response plan been established?
Procedure
Reference
YES/NO
(ii)
as an emergency response organisation been established?
(iii) Have emergency response procedures been developed and
issued?
YES/NO
YES/NO
(iv) Is training for emergency response duties included in the
training programme?
Please provide copy of emergency response plan or procedure and
details of emergency response organization.
8.3 DRILLS AND EXERCISES
(i)
Are drills / exercises carried out to test the emergency YES/NO
response plans, organisation and procedures?
Procedure
Reference
Please provide records of last emergency response drill or exercise
Please provide the following supporting documents , where appropriate, for this
section:
(a) List if key operational emergencies
(b) Copy of emergency response plan
(c) Details of emergency response organisation
(d) Records of last emergency response drill or exercise
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9.0
CHECKLIST OF SUPPORTING DOCUMENTS REQUIRED
DOCUMENT TYPE
TICK
COMMENTS
POLICY AND ORGANISATION
(a) ORGANIGRAM(S) SHOWING REPORTING LINE(S) FOR
MANAGEMENT REPRESENTATIVE(S)
(b) ORGANIGRAM(S) FOR ENVIRONMENTAL, HEALTH &
SAFETY AND QUALITY DEPARTMENT(S)
(c) COPIES OF POLICY STATEMENT(S)
MANAGEMENT SYSTEMS
(a) EMS CERTIFICATE OR INDEX OF PROCEDURES AND
RECENT INTERNAL AUDIT REPORT
(b) SMS CERTIFICATE OR INDEX OF PROCEDURES AND
RECENT INTERNAL AUDIT REPORT
(c) QMS CERTIFICATE OR INDEX OF PROCEDURES AND
RECENT INTERNAL AUDIT REPORT
TRAINING & COMPETENCE
(a) TRAINING PROCEDURE AND MATRIX SHOWING LATEST
STATUS
(b) COMPETENCE ASSURANCE PROCEDURE AND
ASSESSMENT SCHEDULE
ENVIRONMENTAL MANAGEMENT
(a) LIST OF IDENTIFIED ENVIRONMENTAL IMPACTS
(b) ENVIRONMENTAL PERFORMANCE TARGETS
(c) LAST ANNUAL ENVIRONMENTAL REPORT
SAFETY MANAGEMENT
(a) EXAMPLE RISK ASSESSMENT
(b) EXAMPLE PERFORMANCE STANDARD/OBJECTIVE/KPIs
(c) DETAILS OF ACCIDENT/INCIDENT PERFORMANCE FOR
LAST 5 YEARS
(d) COPY OF SAFETY MEETING MINUTES
QUALITY MANAGEMENT
(a) EXAMPLE OF INTERNAL AUDIT RESULT
(b) EVIDENCE OF QUALITY PLANS
(c) EVIDENCE OF CONTINUOUS IMPROVEMENT
EMERGENCY RESPONSE (For Contractors supplying key
operational services)
(a) LIST OF INDENTIFIED KEY OPERATIONAL
EMERGENCIES
(b) COPY OF EMERGENCY RESPONSE PLAN
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(c) DESCRIPTION OF EMERGENCY RESPONSE
ORGANISATION
(d) RECORD OF LAST EMERGENCY RESPONSE DRILL /
XERCISE
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