TITLE Prequalification Documents

ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047 HSE PRE-QUALIFICATION QUESTIONAIRES

DATE 18.10.2007

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Company Name : PT.Geoindo Girijaya Work Subject : Long Term Liquid Transportation Project - Land Survey (CS13938047)

SECTION 1 LEADERSHIP AND COMMITMENT 1. Commitment to HSE through leadership a) How are senior managers is top management personally involved in HSE management ? Bagaimana manajer senior yang merupakan manajemen atas secara pribadi terlibat dalam manajemen HSE ? The Managing Director accepts the overall responsibility of the policy. The managing director delegates his responsibility to the technical director who delegates to Head of Departments and the Supervisors in ensuring that the policy, together with the Safety and Health procedural requirements and instruction are read and understood by all employees as well ass conductors and their associates. b) Provide evidence of commitment at all levels of the organization by : Sertakan bukti dari komitmen semua bagian organisasi dengan : (i) Stating this years company targets for HSE performance Sebutkan target kinerja HSE perusahaan tahun ini The Company shall strive to obtain a zero defect target with the following principles: No accident, injury or fatality No operational downtime No loss to Company asset No health-related incidents or health hazards No damage to the environment No lapse in security of personnel, facilities or information (Please See Attachment A HSE Manual Page i regarding notification and circulation of Approval Signatures and Circulation and Distribution Form) (ii) Describing how you ensure that your organization understand and is committed to deliver your company HSE targets Jelaskan bagaimana anda memastikan organisasi saudara mengerti dan berkomitmen untuk mencapai target HSE perusahaan anda In order to achieve these principles, PT Geoindo Survey Services shall implement the following strategies, these are: Create and provide a system that enhances the development, implementation and continuously improves the quality standard of the HSE-MS in order to assure, an excellent business process that will provide consistent value-added service to our client. Develop, communicate and align strategic intentions, policies and principles that are incorporated into Company policies, objectives and procedures to enable and continually improve on performance. Encourage individuals and groups within the organization to understand and fulfil their roles in enhancing teamwork spirit to achieve a first class rated HSE performance. Evaluate risks and opportunities associated with day-to-day activities and develop processes, plans and procedures that may reduce uncertainty in the work area.

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ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

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Plan at all levels of the organization to ensure that resources required to meet all HSE objectives are sufficient for each type of project undertaken. Evaluate individual and group performance against defined criteria in order to confirm that the HSE-MS is being deployed, its policies and objectives fulfilled and to define areas of improvement that may be required for similar situations in other areas. Ensure that the Company is able to demonstrate to the client of compliance with any special HSE requirements that may be enforced at their facility or operational area.

c) How do you promote a positive culture towards HSE matters Bagaimana saudara mempromosikan kebudayaan positif terhadap hal hal yang berhubungan dengan HSE ? - By distribution all HSE manual, HSE policies, HSE procedure and HSE issues - By training to all employees - Demonstrated on the wall d) Provide your current Organization chart Sertakan bagan organisasi saudara sekarang
Managing & Financial Director HSE-Q Management Representative Support Services QA & HSE Rep. Doc Con Rep. HR Finan Secreta D ce rial Rep Rep. Rep. . Logistic Rep. IT Rep. Technical Director

Technical Services Geotechnic CAD/G al / IS Constructio n Field Project Team Rep. Survey Laser Scanning

Maintena Drive nce r Rep. Rep. Office Boy Rep.

Field Modelin Field Drafter Survey Scannin g Rep. or Rep. g Rep. Rep.

Note: Rep. = Representative

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 Apakah perusahaan saudara mempunyai dokumen kebijakan HSE yang dapat diaplikasikan di region ini? (Ya/ Tidak) Jika ya, tolong lampirkan - Yes, there are PT. Geoindo Giri Jaya Policy, Drugs and Alcohol Policy, Smoking Policy, Health and Hygiene. ( Please See attachment B HSE Policies)

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ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

DATE 18.10.2007

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b) Who has overall and final responsibility for HSE in your organization ? Siapa yang mempunyai kewajiban keseluruhan dan final untuk HSE di organisasi saudara? - All personnel have a responsibility for HSE. However overall and final responsibility for HSE are managing Director and / or Technical Director. And if the Managing director / Technical Director is not on office, they delegate to HSE Steering Committee Coordinator. c) How do you ensure HSE Policy compliance and communication at site? Bagaimana saudara meyakinkan kepatuhan dan komunikasi terhadap kebijakan HSE tersebut di lapangan ? - By implementing inspection for site HSE implementation

2.2 Availability of Policy Statements to Employees How do you communicate your companys policy to your employees including any changes? Bagaimana saudara mengkomunikasikan kebijakan perusahaan anda termasuk perubahannya kepada para pegawai? Jika ada perubahan terhadap The changes will be distributed and signed off when read by all employees. The list of names of employees who have read the policy is shown by circulation list that attached to the current document and a signature of the individual is required on the list to acknowledge that the document has been read and understood by the individual.

SECTION 3 ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION 3.1Organization Commitment and Communication a) How is management involved in HSE activities, objective setting and monitoring? Bagaimana manjemen terlibat dalam kegiatan, penetapan tujuan dan pengawasan HSE ? Senior managers and staff are all personally involved in acheveing, developing and improving HSE. He is given the authority and responsibility to ensure that the requirements of the HSE MS are implemented and maintained. He reports directly to the Director and / or Managing Director. He / she responsible for checking, assessing, and approving the HSE - MS. He / she also responsible forimplementing and reviewing the effectiveness of the HSE - MS The responsibility for all personnel is described on HSE Steering Committee Organization chart and Responsibility (Please attachment D HSE Steering Committee Organization Chart) a) What provision does your company make for HSE communication and meetings ? Provisi apa yang perusahaan saudara buat untuk komunikasi dan pertemuan HSE? The HSE communication and HSE meeting are essential part of the HSE process. The companys HSE management Committee is given the task to discuss and agree on methods of implementation of the Policy and monitoring the effectiveness of the HSEMS throughout the organization. PT. Geoindo Giri Jaya holds HSE monthly meeting which attending by all Steering Committee Teams. All meetings are recorded and an attendee list sign by all present. The minutes of the previous meeting will be mentioned at the start for reference and up date of any action that has taken place on what was discuss. 3.2Competence and Training of Managers / Supervisors / Senior Site Staff / HSE Advisor

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ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

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Have the managers and supervisors at all levels that will plan, monitor, oversee and carry out the work received format HSE training in their responsibilities with respect to conducting work to HSE requirements ? (Yes/No) Sudahkah para manajer dan supervisor di semua bagian yang akan merencanakan, mengawasi, melihat dan mengerjakan pekerjaan menerima format pelatihan HSE yang menjadi kewajiban mereka untuk melaksanakan pekerjaan sesuai ketentuan HSE? (Ya /Tidak) Yes, Training is given to Managers, Supervisor (Field team leader) by external training and in house training. Example PPE training (in-house training), Bosiet training (external training). (Please see attachment E PT. Geoindo Training Matrix) 3.3Competence 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? Pengaturan apa yang dilakukan perusahaan saudara untuk memastikan para pegawai, mempunyai pengetahuan terhadap HSE industrial dasar, dan untuk terus memperbarui pengetahuan ini ? Giving HSE training to all employees regularly. Their knowledge is up-dated on a regular basis by regular meetings, seminars and training. In addition, a start of fieldwork all field teams are given a safety briefing / safety induction meeting on site. b) What arrangements does your company have to ensure ALL employees, including sub contractors, also have knowledge of your HSE policies and practices? Pengaturan apa yang dilakukan perusahaan saudara untuk memastikan SEMUA pegawai, termasuk sub kontraktor, juga mempunyai pengetahuan terhadap kebijakan dan implementasi HSE saudara? All new employees and subcontractor employees are given HSE induction meeting/ HSE training before they start to the fieldwork. Their knowledge is up-dated on a regular basis by regular meetings / safety induction meeting on site. And all employees and subcontractors employees have a copy all HSE policies and signed off when they read the policies. Before go the site they have a copy of HSE document, there is: - PT. Geoindo HSE Implementation Scheme for each project (example : see annex HSE Implementation Scheme for Lombok Project)(Please see attachment FHSE Implementation Scheme for Lombok Project) 3.4Specialized Training Have you identified areas of your companys operations where specialized training is required deal with potential hazard? (Yes/No) If yes, please provide the list (e.g. radioactive, asbestos, explosive, diving, etc.) Sudahkah saudara mengidentifikasi operasi-operasi perusahaan saudara dimana pelatihan khusus diperlukan untuk menangani bahaya potensial? (Ya/Tidak) Jika ya, tolong disediakan daftar (e.g. radioactive, asbestos, explosive, diving, etc.) Directors and senior managers have >10 years experience operations. And they have identified potential hazards that are generally common. However PT. Geoindo prepared the HSE / PRO /001 Risk Management Procedure (Please see attachment C No 01 HSE Procedures) to ensure all employees are aware of onsite work risk and guide all employees on do the safety jobs. Specialised training to deal with potential hazards includes: - First Aid training - PPE Training - Fire drill training - Emergency Response Training (Earthquake, Tsunami, Flood and Fires)

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ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

DATE 18.10.2007

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3.5HSE Qualified Staff Additional Training Does your company have HSE specialist (related to your companys services) who can provide training for other employees? (Yes/No) If yes, please attach the curriculum vitae Apakah perusahaan saudara mempunyai spesialis HSE (berhubungan dengan jasa perusahaan anda) yang dapat menyedikan pelatihan kepada pegawai lain ? (Ya/Tidak) Jika ya, tolong disertakan curriculum vitae Yes, Please see attachment G 3.6Assessment of Suitability of Subcontractors a) Do you employ sub-contractor(s) for the intended service? (Yes/No) If No, please go to the question 3.7 Apakah saudara memperkerjakan su-kontraktor untuk pekerjaan ini? (Ya/Tidak) Jika tidak, silahkan pergi ke pertanyaan 3.7 No b) How do you assess your sub-contractor(s) to ensure they comply with your companys HSE plocy and standard? Bagaimana saudara mengevaluasi sub-kontraktor anda untuk memastikan mereka mematuhi kebijakan dan standar HSE perusahaan anda? 3.7Standards a) What kind of HSE regulatory or industrial standards that your company refers to for the intended service? Peraturan HSE atau standar industrial apa yang dijadikan referensi perusahaan saudara untuk pekerjaan ini? 1. Level I Procedure : HSE Manual 2. Level II Procedure : HSE Procedures, these are: - HSE / PRO / 001 Risk Management - HSE / PRO / 002 Job Safety Analysis - HSE / PRO / 003 Hazards Assessment and PPE - HSE / PRO / 004 Hygiene and Housekeeping - HSE / PRO / 005 Permit to Work - HSE / PRO / 006 Safety Briefing - HSE / PRO / 007 Emergency Response - HSE / PRO / 008 Accident / Incident Reporting - HSE / PRO / 009 Safety Working Procedure - HSE / PRO / 010 Audit and Management Review (Please see attachment C HSE Procedures)

b) How do you ensure these are met and verified? Bagaimana saudara memastikan ini sesuai dan terverifikasi? Top Management of PT. Geoindo that delegate to the HSE Steering Committee is responsible for ensure that all HSE activities within PT. Geoindo Giri Jaya are carried out the requirements, rules, and procedures provide in HSE Manual and its associated HSE Procedures and HSE Plans by implementing HSE Inspection, Audit and Management Review. c) How do you update the standard and its dissemination? Bagaimana saudara memperbaharui standard an penyebarannya? We have procedure for controlling the revision of document and the changes made for all PT.Geoindos documents, it is Change Control Procedure that implemented change request form (Please see attachment N QMS/PRO/016 - Procedure Change Control )

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ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

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SECTION 4 HAZARDS AND EFFECT MANAGEMENT

4.1 Hazard and Effect Management

Does your company have procedure for the identification, assessment, control and mitigation of hazards and effects? Apakah perusahaan saudara mempunyai prosedur untuk identifikasi, assessment, control, dan mitigasi dari bahaya dan efeknya? (Please see attachment C No 1 - 3) HSE / PRO / 001 Risk Management HSE / PRO / 002 Job Safety Analysis HSE / PRO / 003 Hazard Assessment and PPE 4.2 Exposure of the Workforce What systems are in place to monitor the hazards exposure of your workforce e.g. chemical or physical agents? Sistem apa yang sudah ada untuk memonitor ekspos bahaya di tempat kerja saudara seperti kimia atau agen fisik? HSE / PRO / 002 Job Safet Analysis - (Please see attachment C No 2) 4.3 Handling of Potential Hazards How is your workforce advised on potential hazards, e.g. chemicals, noise, radiation, etc., encountered in the course of their work? Bagaimana tempat kerja saudara dalam menangani bahaya potensial seperti kimia, bunyi, radiasi, dst., yang dihadapi selama bekerja? It is will be described in the Job Hazards Analysis Form (HSE/FOR/001) (Please see attachment C No 1) 4.4 Personnel Protective Equipment )a What arrangements does your company have for provision and unkeep of protective equipment and clothing, both standards issue, and that required for specialized activities? Pengaturan apa yang dipunyai perusahaan saudara untuk mengusahakan dan menjaga peralatan dan pakaian keselamatan, dalam issue standar, dan yang dibutuhkan untuk aktivitas khusus? - HSE / PRO / 003 Hazard Assessment and PPE (Please see attachment C No )b Do you provide appropriate personal protective equipment (PPE) for you employees? (Yes/No) Please provide a list of the PPE for the scope of work to be performed? Apakah saudara menyediakan perlengkapan pelindung personil yang sesuai (PPE) untuk karyawan-karyawan saudara? (Ya/Tidak) Mohon berikan daftar PPE untuk lingkup pekerjaan yang akan dilaksanakan? (Please see attachment H List of PPE ) )c Do you provide training on how to use PPE ? (Yes/No) Explain the content of the training and any follow up Apakah saudara menyediakan pelatihan tentang bagaimana menggunakan PPE? (Ya/Tidak) Jelaskan isi dari pelatihan dan setiap kegiatan kelanjutannya.

3)

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ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

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Training is provided on issue of PPE by discussion and demonstration by HSE Safety Oficer or project manager on how to use. Case study relevant to each item is explained and during demonstration to ensure employee understands why he needs to wear PPE and what possible consequences if not. Follow up is provided by monitoring use of PPE on site by project manager and site supervisors. PPE is mandatory on site. (Please see attachment I PPE training Material ) )d Do you have a program to ensure that PPE is impacted and maintained? Apakah saudara mempunyai program untuk menjamin bahwa PPE digunakan dan dirawat? Yes, project managers and site supervisors ensure that PPE is used on site as appropriate by all staff (and sub contractor staff, if relevant). 4.5 Waste Management a) What systems are place for identification, classification, minimization and management of waste? Sistem apa yang telah ada untuk identifikasi, klasifikasi, minimisasi dan manajemen limbah? - HSE / PRO / 004 Higyene and Housekeeping. (Please see attachment C no 4)

b) How do you ensure these are imcompliance with local regulation?

Bagaimana saudara memastikan sesuai dengan regulasi lokal? By comparing our regulation to the local regulation, but in business that we adopt, that procedure are not too detailed cause our company didnt produce product with resulting danger waste such chemical or another flammable material that significant to make a fire and destroying environmental.

c) Please provide the number of accidents resulting in environmental damage in the

amount greater than US$50,000 for the last 24 months. Attach copies of any governmental reports submitted Tolong sediakan jumlah kecelakaan dari hasil kerusakan lingkungan yang bernilai lebih dari US$ 50,000 dalam 24 bulan terakhir. Lampirkan semua copy dari laporan pemerintah yang diserahkan. None. d) Do you have procedures for waste disposal? (Yes/No) Apakah saudara mempunyai prosedur prosedur untuk pembuangan limbah? (Ya / Tidak) HSE / PRO / 004 Hygiene and Housekeeping. (Please see attachment C no 4) e) Do you have procedures for spill reporting? (Yes/No) Apakah saudara mempunyai prosedur prosedur untuk pelaporan tumpahan? (Ya / Tidak) HSE / FOR / 007 (Accident / Incident Reporting Form). (Please see attachment C no 7) f) Do you have procedures for spill clean up? (Yes / No) Apakah saudara mempunyai prosedur prosedur untuk pembersihan tumpahan? (Ya / Tidak) No. we dont have spill clean up procedure

g) Please provide details at any of your equipment related to environmental matters. Tolong sediakan detil peralatan saudara yang berhubungan dengan masalah lingkungan

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Our work is survey and laser scanning which has minimal impact on environment. No specialized equipment is required other than use of bin liners or waste containers and shovels for waste burial. We have laser scanner that operated using x ray, but it were guaranted by the laser scanner producer that it is not impacted to the environmental matters. (Please see attachment J Guarantee Letter for HDS 3000 Laser Scanning from Leica) h) Do you assign an expertise to coordinate the environmental and how to ensure his / her competencies? Apakah saudara menugaskan seorang ahli untuk mengkoordinasikan lingkungan dan bagaimana memastikan kapabilitasnya? Yes, we assign an expertise to coordinate the environmental and we also ensure his/her competencies by reviewing his/her skills and experiences

4.6 Industrial Hygiene a) Do you have an industrial hygiene program? (Yes / No) Please describe this process. If yes, please provide the list. Apakah saudara mempunyai program higienis industri? (Ya / Tidak) Tolong deskripsikan proses ini. Jika ya, tolong sediakan daftarnya - Health and Hygiene Statement . Please see attachment K Health and Hygiene Statement b) How do you identify industrial health / hygiene? Bagaimana saudara mengidentifikasi kesehatan / higienis industri? By reviewing our environmental condition related to employee health Provide medical check up for all employee whose will be work at field Provide first aid box at every floor of our office and first aid kit for each field personnel c) If you produce hazardous substances, please explain the process of documentation and its supervision Jika saudara membeli substansi berbahaya, tolong jelaskan proses dokumentasi dan supervisinya The dangerous substances will be kept in the storage with adhering dangerous label or the same thing like that to inform all employees that the substances will give effect if treated wrong as explained in the label. The substances shall completed by MSDS as the references how to treat its as like as the dangerous level of the substances. 4.7 Drugs and Alcohol Do you have a drug and alcohol policy in your organization? (Yes / No) If yes, please attach Apakah saudara mempunyai kebijakan obat-obatan dan alcohol dalam organisasi saudara? (Ya / Tidak) Jika ya, tolong lampirkan Yes, please see attachment B HSE Policies

SECTION 5 PLANNING AND PROCEDURES 5.1 HSE and Operations Manuals a) Do you have HSE procedures manuals? (Yes / No) If yes, please attach the list of content

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ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

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Apakah saudara mempunyai manual prosedur HSE ? (Ya / Tidak) Jika ya, tolong lampirkan daftar isinya Yes, please attachment A HSE Manual 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? Bagaimana saudara memastikan bahwa praktek kerja dan prosedur yang dipakai pegawai saudara di lapangan secara konsisten sesuai dengan tujuan dan pengaturan kebijakan HSE? - by implementing HSE Inspection that conducted in every month or once of every project

5.2 Equipment Control and Maintenance

How do you ensure that plan 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 conditions? Bagaimana saudara memastikan bahwa pabrik dan peralatan yang digunakan dalam daerah, lapangan, atau lokasi lainnya oleh pegawai saudara telah didaftarkan dengan benar, tersertifikasi dengan ketentuan regulasi, diinspeksi, diawasi dan dijaga sehingga berada dalam kondisi yang aman untuk digunakan dalam bekerja? All our equipment has auditable documentation from purchase, maintenance, calibration. Equipment is inspected regularly and also at start/end of fieldworks. Calibration certificates are kept up to date and status of equipment documented. Corrective action regarding equipment repair, replacement or other forms part of the inspection procedure and documentation given to logistics dept. for action. Third party equipment if used by our company is required to have documentation similar to our standards and is fully inspected prior to use by our company. An inspection report is produced and acts as documentation/record which forms part of project file documentation.

5.3Transport Safety Management and Maintenance What arrangement does your company have for vehicle incidents prevention? Pengaturan apa yang digunakan perusahan saudara untuk mencegah kecelakaan kendaraan? HSE / PRO / 009 Working safety Procedure. Please see attachment C

SECTION 6 IMPLEMENTATION AND PERFORMANCE MONITORING 6.1 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 Pengaturan-pengaturan apa yang dilakukan perusahaan saudara untuk memsupervisi dan mengawasi kinerja HSE? Tolong jelaskan kriterianya Top Managements that delegate to HSE Steering Committee teams has responsibility for supervising and monitoring HSE performance. He monitors on monthly basis as well as undertakes 6 monthly audits in the office. The findings and recommendations including non compliances and corrective actions required are identified and raised in monthly, HSE meetings which are then subsequently disseminated to all staff by HSE Steering Committee team and put into action and implemented by all staff who are monitored by divisional heads and HSE Steering Committee teams b) What arrangements does your company have for passing on any result and findings of

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this supervision and monitoring of your : Base management Site employees Pengaturan apa yang dilakukan perusahaan saudara untuk meneruskan hasil dan temuan dari supervise dan pengawasan dari : Manajemen dasar Pegawai lapangan i) Base Management : - results and findings are compiled by HSE Manager for the company and division and this is reported and discussed to divisional heads and directors at HSE monthly meetings. ii) Site employees? these are passed onto site employees via memos sent by email to site team leader who will disseminate this to all site employees via briefing meeting and/or written memo for all to read and sign off. c) Has your company received and award for HSE performance achievement? (Yes / No) Pernahkah perusahaan saudara menerima penghargaan atas keberhasilan kinerja HSE? (Ya / Tidak) No. However, in our service industry this is rare given that our services are generally short term. 6.2 Statutory Notifiable Incidents. Dangerous Occurences, Improvement Requirement and Prohibition Notices Has your company suffered any improvement requirement or prohibition notices on statutory notifiable incidents/dangerous occurrences by the relevant national body, regulatory body for HSE or other enforcing authority or been prosecuted under any HSE legislation in the last five years? (Yes/ No) If yes, please give the number of occurrences and its short description Pernahkah perusahaan sauadra mengalami keperluan perbaikan atau peringatan pelarangan atas kecelakaan / kejadian berbahaya menurut undang undang dari badan nasional yang berhubungan dengan HSE atau otoritas yang berwenang atau telah dilarang berdasarkan legislasi HSE dalam lima tahun terakhir? (Ya / Tidak) Jika ya, tolong beriakn jumlah dan deskripsi singkatnya No, we havent suffered any improvement requirement or prohibition notices on statutory notifiable incidents/dangerous occurrences by the relevant national body, regulatory body for HSE or other enforcing authority or been prosecuted under any HSE legislation in the last five years

6.3 Transport Safety Management and Maintenance 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 Number Frequency (incl. All Contract & subcontract personnel) (based on OSHA) Fatalities Days Away from Work Cases (DAFWC) or LTIs Total Recordable Cases (e.g. Medical Treatment, Restricted Work, Transfer to Another Job, Uncosciousness)

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Tolong sediakan detik statistic dari kinerja HSE saudara selama 3 tahun terakhir (jika tidak dicatat / tidak berlaku tolong ditulis N/R atau N/A Jumlah Total Frekuensi (termasuk semua personnel kontrak & subkontrak) (berdasarkan OSHA) Kejadian Fatal Days Away from Work Case (DAFWC) atau LTIs Total kasus yang dicatat (seperti Perlakuan medis, Pekerjaan yang dibatasi, transfer ke pekerjaan lainnya, Ketidaksadaran Please see attachment L HSE Statistic How is health performance recorded? Bagaimana pencatatan kinerja kesehatan? The health performance are recorded and monitored by HRD department, every PT.Geoindos personnel who will be sent to the field shall conducting medical check up to ensure the personnel healthy is good to work at field. How is environmental performance recorded? Bagaimana pencatatn kinerja lingkungan? The environmental performance are recorded in the HSE Statistic Report that reported in monthly and yearly basis. All accident/incident that impacted to the environmental are recorded 6.4 Incident Investigation and Reporting a) Do you have a procedure for the investigation, reporting and follow up of accidents, dangerous occurrences or occupational illnesses? (Yes/No) Apakah saudara mempunyai prosedur untuk investigasi, laporan dan tindak lanjut kecelakaan, kejadian berbahaya atau penyakit? (Ya / Tidak) - HSE / PRO / 008 Accident / Incident Reporting. Please see attachment C No 6

b)

How are the findings following an investigation, or arelevant incident occurring elsewhere, communicated to your employees? Bagaimana temuan sebagai tindak lanjut investigasi, atau yang berhubungan dengan kecelakaan di lain tempat dikomunikasikan kepada pegawai saudara? - HSE Monthly Meeting - Informed to all personnel through Toolbox Meeting - Demonstrated the accident/incident inestigation in the safety induction meeting HSE c) Do you report lesson learn of any near miss? Apakah saudara melaporkan pelajaran yang didapat dari near miss? Yes

SECTION 7 AUDIT AND REVIEW

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7.1 HSE and Operations Manuals Do you have a written policy on HSE auditing? (Yes / No) Apakah saudara mempunyai kebijakan tertulis tentang audit HSE? (Ya / Tidak) - HSE / PRO / 010 Audit and Management Review. Please see attachment C no 10

b)

How does this policy specify the standards for auditing, including schedule, coverage and the qualifications for auditor? Bagaimana kebijakan ini menjelaskan standar untuk audit, termasuk jadwal, lingkup dan kualifikasi auditor? HSE Manual specifies standard for auditing by use of standard forms. The auditors (generally HSE Manger) are provided training both internally and externally on how to audit. External training involves certification of auditors and are used as qualification documentation c) How is the effectiveness of audit verified and how does management report and follow up audits? Seberapa efektif verifikasi audit tersebut dan bagaimana laporan manajemen dan tindak lanjut audit? The audit is undertaken by HSE manager who analyses records, interviews divisional heads looks at performance and produces a report which is then discussed at HSE Management Review Meetings and then followed up by HSE Manager. The audit is reviewed by all divisions. Discussions, briefings and updated procedures issued in order to implement corrective actions and improvements within the system.

SECTION 8 EMERGENCY RESPONSE PROCEDURE Do you have an emergency response plan? (Yes/No) If yes, please attach. How do you maintain readiness of the plan? And explain the command structure? Apakah saudara memliki rencana tindakan darurat? (Ya / Tidak) Jika ya, tolong dilampirkan. Bagaimana saudara memelihara kesiapan rencana tersebut? Dan jelaskan struktur perintahnya HSE / PRO / 007 Emergency Response Procedure. Please see attachment C No 7

SECTION 9 HSE MANAGEMENT ADDITIONAL FEATURES a) Does your company hold association(s) membership? (Yes/No) If yes, please provide the list. Apakah perusahaan saudara memiliki keanggotaan asosiasi? (Ya / Tidak) Jika ya, tolong sediakan daftarnya Yes, there are KADIN and INKINDO. Please see attachment M Company Association Membership b) Is there any aspect of your HSE performance that you believe diffentiates yourself from your competitors that not described elsewhere in your response to the questionnaire? If yes, please explain Adakah aspek dari kinerja HSE saudara yang saudara percaya mendiferensiasikan perusahaan saudara dari competitor yang ada yang tidak dijelaskan sebelumnya di tanggapan anda di kuesioner? Jika ya, tolong jelaskan.

TITLE Prequalification Documents No.

ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

DATE 18.10.2007

PAGE

QUESTION SECTION E QUALITY SYSTEM E1 Apakah

Pendaftar membenarkan bahwa pendaftar memiliki Sistem Manajemen Kualitas yang terdokumentasi dan diimplementasi sepenuhnya yang menyangkut program Pekerjaan onshore untuk Pekerjaan, yang disertifikasikan sesuai dengan standar ISO 9001:2000 atau sejenisnya? Sudahkah Pendaftar mengajukan, sebagai Lampiran E1, deskripsi rinci mengenai Sistem manajemen Kualitas yang terdokumentasi dan diimplementasi sepenuhnya yang menyangkut program Pekerjaan onshore untuk Pekerjaan, yang disertifikasikan sesuai dengan standarISO 9001:2000 atau sejenisnya? Pendaftar harus memberikan salinan Sertifikasi QMS nya yang masih berlaku? Does Registrant confirm that it has a documented and fully implemented Quality Management System which addresses onshore programs for the subject Work, which is certified in accordance with ISO 9001:2000 or similar?

YES

NO

Not Available

Has Registrant submitted, as Enclosure E1, a detailed description of the documented and fully implemented Quality Mangement System which addresses onshore programs for the subject Work, which is certified in accordance with ISO 9001:2000, or similar standard? Registrant to provide a copy of its current QMS Certification?

Not Available

E 2

Sudahkah Pendaftar mengajukan, sebagai Lampiran E2, salinan halaman depan dan daftar isis Quality Manual, yang baru diterbitkan, untuk setiap perusahaan yang akan

Has Registrant submitted, as Enclosure E2 a copy of the front page and table of contents from the Quality Manual, as currently issued, for each company that would have a role in the

Yes (see attachm ent )

TITLE Prequalification Documents

ConocoPhillips (Grissik) Ltd. Long Term Liquid Transportation Project Land Survey DOCUMENT NUMBER REV CS13938047

DATE 18.10.2007

PAGE

memiliki peran dalam manajemen kualitas kontraktor untuk Pekerjaan? E3 Apakah pendaftar setuju untuk mengijinkan Perusahaan, dengan perjanjian sebelumnya, untuk melakukan penilaian terhadap system kualitas dan pelaksanaannya untuk tiap pihak yang akan menjadi penandatangan kontrak Pekerjaan (sebagai kontraktor utama atau sebagai peserta suatu konsorsium) dengan melakukan inspeksi ke tempat-tempat / lokasi-lokasi dan mewawancarai personilpersonil terkait?

contractors quality management of the Work? Does Registrant agree to allow Company, by prior appointment, to carry out an assessment of the quality system and practices of each party that would be a signatory to a contract for the Work (as the prime contractor, or as a participant in a consortium), by inspecting premises / facilities and interviewing relevant personnel?

Yes

Bagian F Informasi Lain (apabila diperlukan) Pendahuluan Bagian F ini terutama dimaksudkan untuk memberikan kesempatan kepada Pendaftar agar dapat memberikan rincian rincian lebih lanjut yang diyakini akan dapat menjadi hal yang penting bagi Perusahaan di dalam penilaian terhadap saudara sebagai calon yang potensial untuk pekerjaan ini. Para Pendaftar diminta untuk tidak memberikan brosurbrosur pemasaran umum dan bahanbahan serupa lainnya yang tidak secara langsung dan secara khusus terkait dengan proses Prakualifikasi.

Section F Other Iinformation (if required) Introduction This section F is primarily intended to give the Registrant the opportunity to provide any further details that it could be of interest to the Company in our assessment of you as a potential candidate for the Work. Registrants are asked not to provide general marketing brochures and similar material not to provide general marketing brochures and similar material not directly and specifically relevant to the Prequalification process.