A: SAMPLE OF CONTRACTOR HSE ASSURANCE CHECKLIST FOR PRE-MOBILISATION PHASE

Legend:
Y–
Yes N -
No
NA – Not Applicable

CHECK ITEM FINDINGS Y / N / NA REQUIRED CLASSIFICATION

ACTION
PRE-MOBILISATION PHASE (DOCUMENT REVIEW, INTERVIEW)
1 Kick-Off Meeting has been Y

conducted between
Contract Owner and
Contractor.
2 The kick-off meeting should Y

covers activities/deliverables
described in the HSE Plan and the
following items below are
discussed (which ever
applicable):
a. The contractor's e-JHA No: Y
supervisors and workforce i.0021359
are aware of the hazards (Mechanical) ii.0021424
and the major risk (Civil) iii.0021428
controls and mitigation of (Instrument) iv. 0021443
(Mob/ Demob)
the facility
(Pre-tendering Risk
Assessment can be used
as a reference)
b. Owner HSE policy HSE PLAN: Y
1.24.3 ZeTo Rules
statement, basic HSE Compliance Attachment 6
rules (including ZeTo
Rules) and work
procedures.
c. PETRONAS Contractors As per GTR Safety Induction Y
Code of Conduct on
Human Rights
d. The HSE performance HSE PLAN: Y
1.11 HSE Performance
objectives, the key Target(Lagging and Leading
indicators and KPI).
targets
e. The scope and schedule of Refer PEP Project Schedule Y
activities and milestones
f. Owner and contractor EMERGENCY Y
RESPONSE PLAN:
emergency plans, i.PGB-EPM-CORIO-CON-E
alarms and signals, RP-4001 OPTIMAL C3 MS
emergency ii.PGB-EPM-CORIO-CON-E
RP-4002 PDH MTBE C3
communications
procedures
g. Incident reporting and HSE PLAN1.24.2 Accident Y To incorporate
Investigation and Reporting incident and
investigation procedures investigation
Internal
 EMERGENCY RESPONSE reporting in
PLAN:6.4.2 Accident ERP
Investigation and Reporting

Internal
 CHECK ITEM FINDINGS Y / N / NA REQUIRED CLASSIFICATION
ACTION
h. Contact with third parties N/A
to ensure their role in
emergency response
plans is known
i. HSE induction and HSE INDUCTION Y
i.XPRESS
training plans are in place ii. MTBE/PDH
and ready to be iii. OPTIMAL
implemented
j. Briefing of subcontractors Y To conduct HSE
Plan Briefing on
on the HSE Plan and 17/01/2023
requirements
k. Process to report, HSE PLAN: Y
1.11 HSE Performance Target
track and closure of (Lagging and Leading KPI) &
non- compliance and 02.05 L3 Contractor HSE
Management Partners Monthly
action items Performance Report Form

JMS and Work Procedure Y Will be approved

l. Required procedures and
(13/01/2023)
work instructions from
owner and contractor
m. Contractor grievance HSE PLAN: Y To incorporate
1.24.9 Management Of HSE in HSE PLAN
mechanism Grievance

n. Other general and specific N/A

key contract requirements

NOT SPECIFIED above are
communicated and
understood by COMPANY
site personnel, contractor
and sub-contractor.
3 All action items arising from the GTR-EPM-CORIO-MOM-4001 Y

Kick-off Meeting are monitored

and closed.
4 All sub-contractor engaged for
PGB-EPM-CORIO-SC-001 Y

the work are approved by the

contract.
5 HSE plan, including contractor
HSE PLAN: Y HSE PLAN has
PGB-EPM-CORIO- been accepted
owned verification plan is HSE PLAN_Rev 0 with comment ,
pending HSSE
finalized and approved, complete review
with assigned owner, agreed
frequencies and associated KPIs.
6 HSE PLAN: Y
1.5 Legislation
All relevant HSE legislation are
included in Contractors HSE Plan

Internal
 CHECK ITEM FINDINGS Y / N / NA REQUIRED ACTION CLASSIFICATION
A specified budget has been Y
7 allocated to enable all HSE
activities to be conducted
All procedures are reviewed and All included in HSE Y
PLAN, ERP
approved e.g. PLAN and e-JHA
 HSE manual
 Emergency Response Plan
 Site environment
management procedure
 Site specific waste
management plan
 Risk Assessment e.g. JHA,
8
HER
 PTW
 Incident investigation
 Journey Management Plan N/A
 Radiation Safety &
Emergency
 Other relevant HSE
procedures

The HSE interface/bridging N/A

9 document is finalized and

approved (when applicable)
Organization chart including HSE PGB-EPM-CORIO- PM- Y
ORG-4001.
Department specific to the
10 contract has been established
and approved.
The HSE Function reports directly Y To submit EPM HSE
Committee
11 to the highest authority of the Organization
Contractor organization. Chart

Onsite contractor HSE NAZRIN AMREE Y

HQ/19/SHO/00/02218.
representative has been
12 identified to monitor day-to-day
HSE performance.
There are adequate numbers of NAZRIN AMREE Y
HQ/19/SHO/00/02218.
13 safety officers and their
competency have been reviewed.
HSE Committee/Meetings specific N/A To update on HSE Daily
Report.
14 to the contract has been
established.

Internal
 CHECK ITEM FINDINGS Y / N / NA REQUIRED ACTION CLASSIFICATION
HSE PLAN: Y
1.10 Position Roles
Job descriptions of key positions and Responsibilities.
showing competencies and
15
responsibilities have been
established and approved.
Y To attach all the
Competency Cert in
There are adequate competent provided link Shared
16 personnel for all key positions Folder.
during all phases of the
contract
Y
The key/critical positions have
17 been identified and credentials
verified, e.g.:
a. Competent & certified NAZRIN AMREE Y
SN: FA16672/22/25400
first aider
b. Competent & certified medic N/A

c. Competent & certified N/A

forklift operator
d. Competent & N/A

certified crane
e. Competent & certified SAIFUL ADHA BIN Y To finalize name list for
SULONG Scaffolders
scaffolder/ inspector -SCAFFOLDER
INSPECTOR

f. Competent & certified N/A

Non- Destructive
Testing (NDT) Inspector
g. Competent & certified Y By Operation
Authorized Gas Tester
(AGT) and Authorized
Entrant & Standby
Person (AESP)
h. Competent & certified MOHAMAD ZAKARIA Y
BIN MOHD DAUD
charge man & wire
man
i. Competent & certified NAZRIN AMREE Y
HQ/19/SHO/00/02218
Safety Health
j. Competent Helicopter N/A
Landing Officer
k. Competent riggers Y To attend Rigger course
and update in XPRESS
system.

l. Competent fire watcher FIRDAUS ABU BAKAR Y To attend Fire Watcher

course and update in
XPRESS system.

Internal
 m. Competent Emergency Y ERT by PGB-GTR
Response Team (ERT)

Internal
 CHECK ITEM FINDINGS Y / N / NA REQUIRED ACTION CLASSIFICATION
PRE-MOBILISATION PHASE (SITE COMPLIANCE ASSESSMENT)
18 Inspection of contractor’s Y Plan: OPTIMAL on
24/01/2023
equipment/devices has been
completed and accepted fit for use.
Prepared by: Endorsed by:

Signature:
Signature: Name:
Name: NAZRIN AMREE BIN SHOKERI Designation:
Designation: SAFETY & HEALTH OFFICER

Internal