WORKING at HEIGHT RESCUE PLAN Date :26 Decernber,2019 Job Description : Boy CERTIFICATION PV Inspection and Take Picture Using RAT 1 night Location: GRISSIK PLANT Rescue Plan scenario: (space is available on 2nd page of this Form) Site Emergency Contact Rescue Equipment Site Rescue Team Leader (Name & Ext.ft) Equipment Location ALEX. (4169 ) HE iscder - METERING AREA Medical (Name & Ext. #) 1 Rescue Pole/Tripod. SAPTO / MULYAD| ( 4282) HE RescueRope:) YA EYE OG Wet OF crane/winch, : DD seaffoia Method of Contact : (Fill in as Appropriate) (1 Arial vift/Cherry Picker___ 1 Public Address First Aid Kit__GRISSIK ccR I verbal / Face to Face HB medical Toot kit, GRISSIK, ccR Bh radio channel C1 Respiratory Protection Device BB steetcher GRISSIK ccR Phone Number Other rescue equipment: HH rescue kit (RAT) 1 Set Standby O other o oO Critical Rescue Factors Describe critical rescue factors such as: anchor point, landing area, obstruction hazard, ete, oO See Attatch oO 1. Rescue plan and Retrieval Methodes: o 2. alternative rescue plan and retrieval methods at piping Gg 2. alternative rescue plan and retrieval methods at platform oO a o o Rescue Team Member at Work Place (Tick as Applicable, Full Name) [MM team Leader (ast a [IM Back-up Rescuer: hb We tale oer ¢ io Sf Sane es others: Fupoate [PREPARED att (Work ate |APPROVED By (Issuer/Site Checker) cwvsaruTa 26 ["] 9INDUSTRIAL SERVICES ~ ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN RESPEATRANEC SEVENTY espera ‘CONOCO PHILLIPS - GRISSIK PLANT |_ClientHost: fc Het [ Nare of Work UT THICKNESS FOR INSPECTION VESSEL USING RAT METHODE ] Job stospectic | aco a T, Tae es Location: FILTER, COALESCING SALES GAS ( 42-F-101A ) Date: 3 ecemer, [erw.numoer | Validity Sheet | prepare By RY spate Reknowedse BY =" Neop UAAG Signature : Signature Date__: YH. Xpe “Do | Date ate ca + ‘Approved By Iasuer / Site Checker By ‘Approved HSE ss py Sraure es rau YW “ely owe Uy bate Fem wi PT.SPEKTRA MEGAH SEMESTA IRATA Personnel i Roles Name Date: | IRATALS | RICKY SAPUTRA lhe tee | IRATA Technician (2 | HENDRA PRATAMA, | 2btee-m0 IRATA Technician Lt IDO SANDRI Vo. Ver 29. Emergency Information i a Radio Chanel :8 PT-Spekira Compary | PT.SPEKTRA offee cor ContactName & Phone +6221 22763643 / 45 Emergency: 4190 / 4191 ‘Agus Sabvial ext. 109 __+62812 198 10454 | Emergency ‘Access to Site Akses Emergency ke Lapangan Introduction Where and how will Emergency Response Services reach the workale? Dimana dan bagamere Emergency Response akan dapat mencapaiternpat kerja? Allareas are acoessibie by Ratio or elenhone (Gatronics) wile used for coordination to the CONOCOPHILIPS Emergency Response Team. ‘Soma aoa dapat cicapa melalin walkway’. Racio dan telephone (Getroncs) akan digunakan untuk | Keorginas! dengan CONOCOPHILLIPS Emergency Response Team. No work at height should be undertaken without first having identfied a rescue plan as past of the risk assessment procedure, provision for rescue in term of manpower, equipment and competence is vital to any rope access aciivty. PT. Spekira Megah ‘Semesta personnel all trained in rescue techniques as part of their basic and ongoing training. Lv.3 trained and assessed advanced rescue techniques. Page 1of 5, ‘SMS-S00-F-012 WORK AND RESCUE EXECUTION PLAN,INDUSTRIAL SERVICES ~ ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN —fIAVENIRIVEC\HURNT) Work Plan [ Full Description of _Werkitasks undertaken FRope-Access work plan Methods “Tadividval Personal Protective Equipment Peralatan Rope Access [Team Communication | Komunikasi Team “Equipment Too! Management ‘Worksite Access 7 Hazard Zone ‘Akses Tempat Kerja/ Daerah Banaya Rescue Plan PRESSURE VESSEL FILTER COALESCING SALES GAS (42F-101A ) USING RAT METHODE © Standard practices outined in PT.SPEKTRA MEGAH SEMESTA Rope access Safe working Manual Seriakan sketch’ gambar ka memungkinkan, Rope Access technique yang digurakan menurut PT:Spektra Megah Semesta operating manual: SMS-900- 001 and IRATA Inlematonal Code of Practice edlion March 2014 Stestep encana kerja RAT: Identikas|apakah ada pekera ain dlares kerja RAT. 2, Pesanp bortade dan ranbefanbu dgketiry are kere RA. 3 Pasang 2 sel anchor point secaraterpisah uniukverical tal (al Kerja dan tall pengaman) pada stuktur yang Kokoh,pipa suport atau di strukur deck tersebut yang dapat diangkau. Jka tidak dapat djangkau {Gunakan teknit ai cmp dengan menggunaken beam atau stuklur deck tersebul, alau menggunakan Pipa yang diametemya 6” Keates. Jka anchor point dak lersedia, unakan terik ac climbing melal Stukturbeam, atau pipa dengan diamater bese. 4. Jag ager tal erhindar dari permukaan taiam, panas, kasar dan gunakan ope protector pada tall keika kontak dengan beam, deck/gratings atau lainnya 5. Technician akan nak (ascend) menggunakan Gua lll independen vertkal, kemudian berganti (change over da ascender(Crol) meniad descender devices (STOP/ID'SRIG) dan mulal manuver untuk urun. Ketika soles keri, beranjak turun dengan periahan menggunakan “Descencer device” (STOPIID's). House keeping | Helmet EY Eye protecton [) Foot protection [1] Gloves Protective clothing | Cl Retlective Clahing C} Respiratory protecton L] Hearing Pretecton [1 Other EP Ropes length and quantity) VEdge Protection [BRigaing Slings C.Connectors [Harness EY Descender (Stop) C] Belay Device (Gr-Gr) | 2 Backup Devices EA Lanyards LY Pulleys [] headlamp (] Mult-ool | [5 Other «Ropes Protector i} Ei Visual (Hand Sign other 1 Other..(describe... attach additional pages if necessary) CiVerbal (unassisted) ’Racio (Note Channelfctal channel) ‘Amankan dengan lanyards! kat semua peralatan- Secured with lanyarésie‘of al ools "Describe hazard zone and method to mark and secure eniry and to protect public or other workers selaskan daerah bertahaya dan metode untuk menandakan sera mengamarkan untuk metncUungl orang ian. ‘Reter to L2 Risk Assesment! and permit to work Place barrier tapsign( Sot baricade) for al atfectedor Working areas of the rope access operations. PT.Spektre Megah Semesia Rope access spsciic Risk assessien must be atactied ‘Mengacu tethadap L2 Risk Assessment dan Work permi. Tempatkan Barer tape sign(penandaysoft baricade), untuk selurun area yang terpengaruh dengan pekerjaan rope access. Risk Assessment khusus rope aczess harus dicantumkan. Page 2 0f 5 ‘SMS-900-F-012 WORK AND RESCUE EXECUTION PLANINDUSTRIAL SERVICES ~ ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN _PISPEAIRYVEGAHAFEST) Alternative Rescue plan and Retrieval Methods At Vessel/ Fank DBNANY loging Sytem as anchor pore at RATLV “Tm Erergenay Resperse ConocePhip Saga an permchacn sl Penvournatan Dalam situasi emergency dimana casually mendapatkan trauma suspension: = Penyelamatan menaikkan’menurunkan korban = Anchor point menggunakan Rigging system pada mini crane = Lv.3 standby pada anchor point untuk segera menurunkan atau menaikkan dengan merlis kedva ID secara bergantia dengan memperhatikan 1 Fall Factor sampai casually berada di ground level. = Standby man siep untuk membantu memposisikan casualty pada posisi aman Page 4 of 5 S1S-900--012 WORK AND RESCUE EXECUTION PLANAlternative Rescue plan and Retrieval ‘Methods At Vossell Tank INDUSTRIAL SERVICES — ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN —_/L\EATRIVECANAMRNT, DANO D ‘apna Syn a ute ee Tatkena RATS “Tat Backop Tan Emargancy Response ConeesPnizs Sigs can rmemontorheasaon Dalam situasi emergency dimana casualty mendapetkan trauma suspension: + Penyelamaten menaikken/menurunkan korban: = _ Anchor point menggunakan Rigging system pada mini crane = Lv.3 standby pada anchor point untuk segera menurunkan atau menaikkan dengan merlis Kedua ID secara bergantla dengan memperhatikan 1 Fall Factor sampai casualty berada di ground level = Standby man siap untuk membantu memposisikan casually pada posis! aman Page 4 of 5 ‘¥S-800-F-012 WORK AND RESCUE EXECUTION PLAN,UL 8 INDUSTRIAL SERVICES - ROPE ACCESS «7? heced WORK PLAN AND RESCUE EXECUTION PLAN. SJEATRIVECANWVESTY ogre Sen ternative Rescue lan and Fretreval Methods At Vessel Fane Conoeomiips Sage ean ‘remontorkeadean Sormckaan slams poser Benjelomatan| Dalam situasi emergency dimana casually mendapatkan trauma suspension: + Penyelamatan menaikkan/menurunkan korban = Anchor point menagunakan Rigging system pada mini crane = Lv.3 standby pada anchor point untuk segera menurunkan atau menaikkan dengan merlis kedva ID secara bergantia ‘dengan memperhatikan 1 Fall Factor sampai casualty berada di ground level = Standby man siap untuk mombantu momposisikan casualty pada posisi aman. Page 4of5 'SMS-500-F-012 WORK AND RESCUE EXECUTION PLANternative Fescue. man Raetrieval Methoos A Vecse Fane Page 4 of 5 INDUSTRIAL SERVICES - ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN Talkers 4r-R-lold PRENAUN Fggng Syser Seanchor pont stant pipe ConaeaPhiipe Sige don ‘memontrkeadsan Dalam situasi emergency dimana casualty mendapatkan trauma suspension: + Penyelamaian menaikkerv/menurunkan korban: Anchor point menggunakan Rigging system pada mini crane Lv.3 standby pada anchor point untuk segera menurunkan atau menaikkan dengan meri kedua ID secara bergantia dengan memperhatiken 1 Fall Factor sampai casualty berada di ground level Standby man siap untuk membantu memposisikan casualty pada posis! aman. S§5-800-F-012 WORK AND RESCUE EXECUTION PLANINDUSTRIAL SERVICES ~ ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN Alternative Rescue plan and Retrieval Methods AtVessel/ Tank CConeesPriipe Siaga dan mementor seainan i pemstan soars Dalam situasi emergency dimana casually mendapatkan trauma suspension: Penyelamatan menaikkanmenurunkan korban: = Anchor point menggunakan Rigging system pada mini crane LLv.3 standby pada anchor point untuk segera menurunkan atau menaikkan dengan merils kedua ID secara bergantia dengan memperhatikan 1 Fall Factor sampai casually berada ¢i ground level. = Standby man sigp untuk membantu memposisikan casualty pada posisi aman, Post-Job Debrief Page 4 of 5 ‘SMS-800-F-012 WORK AND RESCUE EXECUTION PLANINDUSTRIAL SERVICES - ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN Alternative Rescue planand Retrieval Methods At Vessel! Tank Rigging Sytem “im Emergony Response ConecoPhipe Sg can ermukaan slama poses Dalam situasi emergency dimana casualty mendapatkan trauma suspension: = Penyelamatan menaikkan/menurunkan korban: = Anchor point menggunakan Rigging system pada mini crane * Lv.3 standby pada anchor point untuk segera menurunkan atau menaikkan dengan morilis kedua ID secara bergantia dengan mempernatikan 1 Fall Factor sampai casualty berada di ground level. = Standby man sigp untuk membantu memposisikan casuslty pada posisi aman Page 4 of 5 ‘SMS-00-F-012 WORK AND RESCUE EXECUTION PLANINDUSTRIAL SERVICES - ROPE ACCESS WORK PLAN AND RESCUE EXECUTION PLAN I. FEATRIVEC\R WENT) Post-Job Debrief __ = an = a Debrief Prepared (Time Complete: | ey | | | RICKY SAPUTRA | Gommenss Safety | Were adequate safety measures taken to insure the satety of personnel and public? panera ‘Note any addtional safety measure taken or recommended. Pertimbangan | Dimana tindekan pengamanan (Safety measures) diambil untuk memestiken | keselametan | keselamatan personel serta unum? | | Catatjka 2catindakan tambehan atau rekomendast | | Near Miss or" Deseibe any near misses or accidents none, we none”. Allach edtional pages i Accidents "| ! pag Kejadian hampir | MECeSSAry colakal Kecolakaan | lelaskan sogala kojadian “near misses. Jika tidak ada, tuis ‘None. Tambahakan | lampiran tambahan jka diperiukan. Page 5 of 5 ‘SIS-800-F-012 WORK AND RESCUE EXECUTION PLAN