pekerjaan pembongkaran, pengangkutan dan …

RENCANA KERJA DAN SYARAT - SYARAT

PEKERJAAN PEMBONGKARAN, PENGANGKUTAN DAN PEMUSNAHAN ASBESTOS CONTAINING MATERIALS (ACM) EX MESS PLN UNTUK PROYEK

PENGEMBANGAN DIENG UNIT 2

Nomor : RKS-034-PRO/GDE/VI/2021 Tanggal : 03 Juni 2021

Head Office:

Gedung Aldevco Octagon Lantai 2 Jl. Warung Jati Barat No. 75 - Jakarta Selatan

Tel. (021) 7982925 - Fax. (021) 7982930 www.geodipa.co.id

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PENGESAHAN

Nama Pekerjaan : Pekerjaan Pembongkaran, Pengangkutan Dan Pemusnahan Asbestos Containing Materials (ACM) Ex Mess PLN Untuk Proyek Pengembangan Dieng Unit 2

Mata Anggaran/WBS : GD2-CP-01-10-01-A10 Overhead Cost Dieng - Safeguard - Pembuangan Limbah B3 Dieng GD2-CP-01-09-01-A2 Building

Jakarta, 03 Juni 2021

Disiapkan Oleh:

Ferry Iskandar Procurement Manager PMU

Disetujui Oleh:

Supriadinata Marza General Manager Project

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BAB 1 PENDAHULUAN & JADWAL

1. Nama Pekerjaan

Pekerjaan Pembongkaran, Pengangkutan Dan Pemusnahan Asbestos Containing Materials (ACM) Ex Mess PLN Untuk Proyek Pengembangan Dieng Unit 2.

2. Para Pihak

2.1. Para Pihak yang bertanggung jawab atas pelaksanaan pekerjaan jasa adalah:

No Para Pihak Pejabat Terkait Keterangan

1 Pengguna HSE & Safeguard Manager Perencana Pekerjaan

2 Pejabat Berwenang General Manager Project Pemberi Kerja

3 Direksi Pekerjaan HSE & Safeguard Manager

4 Pengawas Lapangan HSE Superintendent

5 Pelaksana Pengadaan Procurement Manager PMU

2.2. Pemberi Kerja, berwenang untuk:

a. Menyetujui & Menetapkan Pemenang pengadaan. b. Menandangani SKPP, PO dan Perjanjian. c. Menandatangani Berita Acara Serah Terima Pekerjaan (BAST). d. Menyetujui usulan dan menandatangani Addendum Perjanjian.

2.3. Direksi Pekerjaan, berwenang untuk:

a. Mengawasi pelaksanaan pekerjaan. b. Menandatangani Berita Acara Penyelesaian Pekerjaan (BAPP) termasuk memeriksa mutu

pekerjaan. c. Memberikan Surat Peringatan bila diperlukan. d. Mengusulkan Addendum Kontrak jika diperlukan.

2.4. Pengawas Lapangan, berwenang untuk:

a. Melakukan pengawasan pelaksanaan pekerjaan jasa sehari-hari di lapangan.

3. Metoda Pengadaan

Metode Pengadaan adalah:

No Metode Pengadaan Beri Tanda Usulan Nama Penyedia

1 Pelelangan Dengan Prakualifikasi - -

2 Pelelangan Dengan Pascakualifikasi -

3 Pemilihan Langsung - -

4 Penunjukan Langsung - -

4. Jadwal Pengadaan

Jadwal Pengadaan adalah sebagai berikut:

No Tahapan Hari/Tanggal/Waktu Tempat

1 Penjelasan RKS Senin, 14 Juni 2021 pukul 10:00 WIB Online Meeting

2 Kunjungan Lapangan TBA TBA

3 Pemasukan Penawaran Senin, 21 Juni 2021, pukul 14:00 WIB Online Meeting

4 Pembukaan Penawaran Senin, 21 Juni 2021, pukul 14:15 WIB Online Meeting

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5 Klarifikasi dan Negosiasi: TBA TBA

6 Verifikasi Fisik TBA TBA

Alamat:

• Kantor GDE Pusat: PT Geo Dipa Energi (Persero), Gedung Aldevco Octagon, Lantai 2, Jl Warung Jati Barat No.75, Jakarta.

• PLTP Dieng Unit 2: PT Geo Dipa Energi (Persero) Unit Dieng, Jl Raya Dieng Batur PO BOX 01, Banjarnegara, Jawa Tengah.

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BAB 2 INSTRUKSI KEPADA PENYEDIA

5. Syarat Penyedia

5.1. Kualifikasi Penyedia

Penyedia Kriteria

Bentuk Badan Hukum Perseroan Terbatas

Kualifikasi Usaha Kecil/Menengah/Besar

Bidang Sipil dan Pengelolaan Limbah B3

Sub Bidang Pemusnahan dan Pengangkutan Limbah B3

5.2. Ijin usaha yang dimiliki yang masih berlaku:

Ijin Usaha Beri Tanda

SIUP/IUT

TDP/NIB

Domisili

SIUJK

SBU

5.3. Memiliki Pengalaman:

Pengalaman Sejenis Waktu Pelaksanaan Minimal Jumlah & Nilai

Pekerjaan Pembongkaran, Pengelolaan

Dan Pemusnahan Bangunan yang

mengandung Asbestos Containing

Materials (ACM)

2021 - 2015 Minimal 2 Pekerjaan dengan nilai

minimal Rp. 800.000.000,-

5.4. Larangan

Larangan Beri Tanda

Badan Hukum tidak sedang dinyatakan pailit

Kegiatan usaha Badan Hukum tidak sedang dihentikan

Badan Hukum tidak sedang dalam pengawasan pengadilan

Badan Hukum / Pengurus Badan Hukum tidak sedang menjalani sanksi pidana

6. Metode Penyampaian Dokumen Penawaran

6.1. Metode Penyampaian Dokumen Penawaran

Metode Penyampaian Dokumen Penawaran Beri Tanda

1 Tahap 1 Sampul

1 Tahap 2 Sampul -

2 Tahap 2 Sampul -

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6.2. Format Surat-surat

Metode Penyampaian

Dokumen Penawaran

Beri Tanda

Format Keterangan

Surat Pengantar Penawaran

Administrasi & Teknis

Sesuai Lampiran RKS

Surat Pengantar Penawaran

Harga

Sesuai Lampiran RKS • Masa Berlaku Penawaran 60 hari

Jaminan Penawaran x Sesuai Format Bank • Nilai Minimal 1%

• Masa berlaku penawaran harga ditambah 14 hari kalender

Pakta Integritas Sesuai Lampiran RKS

Surat-Surat Pernyataan Sesuai Lampiran RKS

6.3. Dokumen Administrasi Teknis

Dibuat dalam rangkap 2 (dua) yang terdiri dari 1 (satu) asli dalam bentuk hardcopy dan 1 (satu) copy dalam bentuk softcopy disimpan dalam Flash disk, terdiri dari:

No Dokumen Hard File Soft Copy

Pdf

Dokumen Administrasi

1 Surat Pengantar Penawaran Administrasi & Teknis

√ √

2 Surat Pernyataan Bermaterai Bahwa Tidak Sedang Dalam Pengawasan

Pengadilan, Tidak Pailit, Kegiatan Usaha Tidak Sedang Dihentikan Dan Atau

Direksi Yang Berwenang Menandatangani Perjanjian Atau Kuasanya Tidak

Sedang Menjalani Hukuman Penjara.

√ √

3 Surat Pernyataan Bahwa Data Yang Diberikan Adalah Benar Dan Sesuai Dengan

Aslinya

√ √

4 Pakta Integritas √ √

5 Copy Surat Izin Usaha (Siup/Iut) √

6 Copy Surat Domisili Perusahaan √

7 Copy Surat Tanda Daftar Perusahaan (TDP) Atau NIB √

8 Copy Akta Pendirian/Anggaran Dasar Serta Perubahan Akta Terakhir √

9 Copy Surat Pengesahan Badan Hukum Oleh Menteri Kehakiman √

10 Surat Referensi Bank Atau Keterangan Rekening Bank √

11 Copy Nomor Pokok Wajib Pajak (Npwp) √

12 Copy Nomor Pengukuhan Pengusaha Kena Pajak (Nppkp) √

13 Laporan Keuangan Tahun 2019 Audited Oleh Kantor Akuntan Publik (KAP) √

14 Susunan Pengurus Dan Pemilik Modal √

15 Copy SIUJK Dan SBU √

Dokumen Teknis

16 Surat Pernyataan Sedang Tidak Bermasalah Lingkungan √

17 Daftar Pengalaman & Lampiran Bukti SPK/PO/Perjanjian √

18 Memiliki Sertifikat Training Pembongkaran Asbestos √

19 Memiliki Izin Pengangkutan dan Pemanfaatan/Pemusnahan Kode Limbah B3

B102d atau A108d

√

20 Bukti telah terdaftar akun festronik untuk Pengangkutan dan

Pemanfaatan/Pemusnahan Kode Limbah B3 B102d atau A108d

√

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Pdf

21 Memiliki Izin dari Dinas Perhubungan Darat untuk Alat Transportasi

Pengangkutan Limbah B3

√

22 Daftar Key Personil Minimum Dilengkapi dengan CV √

23 Daftar Peralatan Disertai Dengan Foto √

24 Metode Pekerjaan & SOP, Covid-19 Procedure √

25 Program Kerja & Time Schedule √

26 HSE Plan & Contoh Job Safety Analysis (JSA) √

6.4. Dokumen Penawaran Harga


Pdf

1 Surat Pengantar Penawaran Harga √ √

2 Lampiran Surat Penawaran Harga √ √

3 Jaminan Penawaran - -

6.5. Penyampaian Dokumen

a. Surat Penawaran berikut kelengkapannya ini disampaikan di dalam sampul tertutup yang tidak tembus baca, dilem, dan tidak mencantumkan nama dan alamat Perusahaan.

Metode Penyampaian Beri Tanda

1 Tahap 1 Sampul • Seluruh dokumen dimaskukan kedalam satu sampul berisi dokumen administrasi, teknis dan penawaran harga dilengkapi Flash Disk.

1 Tahap 2 Sampul - • Dipisahkan berdasarkan sampul, sampul pertama berisi dokumen administrasi dan teknis dilengkapi Flash Disk serta sampul kedua berisi dokumen penawaran harga dilengkapi Flash Disk. Kedua sampul dimasukan kedalam amplop penutup yang lebih besar.

• Apabila didalam Sampul Penawaran Administrasi dan Teknis Peserta Pengadaan terdapat Data/Dokumen Harga, maka penawaran akan dianggap gugur.

2 Tahap 2 Sampul - • Sampul pertama berisi dokumen administrasi dan teknis dilengkapi Flash Disk disampaikan pada tahap pertama

• Sampul kedua berisi dokumen penawaran harga dilengkapi Flash Disk.

• Apabila didalam Sampul Penawaran Administrasi dan Teknis Peserta Pengadaan terdapat Data/Dokumen Harga, maka penawaran akan dianggap gugur.

b. Surat penawaran ditujukan kepada Panitia Pengadaan/Pejabat Pengadaan PT Geo Dipa

Energi (Persero). c. Dokumen Penawaran disampaikan pada waktu dan tempat yang telah ditentukan. Dokumen

penawaran yang disampaikan melewati batas waktu dan tempat yang telah ditentukan dianggap gugur.

7. Pembukaan Dokumen Pengadaan

7.1. Jumlah Dokumen Penawaran yang masuk dihitung (surat pengunduran diri tidak dihitung sebagai dokumen penawaran) dan dan dibuka dengan disaksikan oleh wakil Pengguna dan wakil Penyedia.

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7.2. Dokumen Penawaran yang sudah disampaikan tidak boleh diubah, ditambah, atau dikurangi, kecuali hanya untuk memenuhi kekurangan pada meterai, tanggal, dan tanda tangan. Penambahan tersebut dilaksanakan seketika pada pembukaan.

7.3. Dalam hal softcopy yang disampaikan oleh Penyedia tidak terbaca, atau tidak dapat digandakan (di copy), Penyedia dapat menyampaikan softcopy dokumen penawaran baik melalui CD/flashdisk, atau dikirim melalui email ke alamat [email protected] pada saat pembukaan penawaran.

7.4. Apabila terdapat perbedaan isi dokumen antara versi hardcopy dan softcopy, dokumen yang diakui dan dianggap sah oleh Panitia Pengadaan adalah versi hardcopy.

8. Metode Evaluasi & Kriteria Evaluasi

8.1. Metode evaluasi yang dipilih adalah:

Metode Evaluasi Beri Tanda Keterangan

Sistem Gugur -

Sistem Nilai Persentase Penilaian Administrasi & Teknis 60%

Penilaian Harga 40%

Sitem Nilai Dengan Passing Grade

Teknis

- Passing Grade Penilaian Teknis %

Persentase Penilaian Administrasi & Teknis %

Persentase Penilaian Harga %

Kombinasi Sistem Gugur dan

Sistem Nilai

- Penilaian Administrasi Sistem Gugur

Passing Grade Penilaian Teknis %

Persentase Penilaian Teknis %

Persentase Penilaian Harga %

Sistem Harga Terendah -

Sistem Tunjuk Langsung -

8.2. Evaluasi Administrasi

Dilakukan pemeriksaan kelengkapan dokumen dan pemenuhan kelengkapan persyaratan administrasi. Penawaran yang memenuhi persyaratan administrasi dan dinyatakan lengkap akan disertakan dalam evaluasi tahap selanjutnya.

8.3. Evaluasi Teknis

Dilakukan pemeriksaan terhadap faktor-faktor teknis dan kesesuaiannya terhadap persyaratan dokumen RKS dan perubahannya. Bilamana diperlukan dalam Evaluasi Teknis dapat dilakukan klarifikasi teknis atau presentasi teknis Penawaran yang memenuhi persyaratan teknis akan disertakan dalam evaluasi tahap selanjutnya.

Aspek yang akan dinilai dalam penilaian ini mencakup berikut namun tidak terbatas pada:

a. Surat Pernyataan Sedang Tidak Bermasalah Lingkungan b. Kemampuan Keuangan c. Pengalaman Perusahaan d. Sertifikasi Training Pembongkaran Asbestos e. Izin Pengangkutan dan Pemanfaatan/Pemusnahan Kode Limbah B3 B102d atau A108d f. Bukti telah terdaftar akun festronik untuk Pengangkutan dan Pemanfaatan/Pemusnahan

Kode Limbah B3 B102d atau A108d g. Izin dari Dinas Perhubungan Darat untuk Alat Transportasi Pengangkutan Limbah B3 h. CV Personil Minimal i. Kelengkapan peralatan

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j. Metode Pekerjaan & SOP, Covid-19 Procedure k. Program Kerja & Time Schedule l. HSE Plan & Contoh Job Safety Analysis (JSA)

8.4. Evaluasi Penawaran Harga

Dilakukan pemeriksaan terhadap struktur harga penawaran dan kesesuaiannya terhadap struktur harga dalam Dokumen RKS dan perubahannya. Dilakukan perbandingan antara penawaran dengan Harga Perhitungan Sendiri (HPS) dan/atau penawaran Penyedia lainnya, serta pemeriksaan kewajaran harga.

8.5. Berdasarkan seluruh hasil evaluasi, dibuat daftar urutan penawaran dengan nilai evaluasi tertinggi sampai dengan terendah.

9. Klarifikasi & Negosiasi

9.1. Klarifikasi Teknis

a. Klarifikasi dapat dilakukan kepada satu, sebagian atau seluruh Penyedia. b. Klarifikasi adalah kegiatan meminta penjelasan kepada Penyedia terkait Dokumen yang

disampaikan. Klarifikasi bersifat memperjelas Dokumen Penawaran tanpa mengubah subtansi penawaran.

c. Klarifikasi dapat dilakukan melalui surat, email atau tatap muka.

9.2. Negosiasi

a. Pelaksanaan dan urutan negosiasi disesuaikan dengan metode evaluasi yang telah ditetapkan.

b. Negosiasi adalah kegiatan untuk mencapai kesepakatan dengan Penyedia terkait Dokumen Penawaran yang disampaikan. Proses negosiasi dapat mengubah substansi penawaran agar tercapai kesepakatan baik terkait teknis maupun harga.

c. Negosiasi dapat dilakukan melalui surat, email atau tatap muka.

9.3. Aspek-aspek yang dapat diklarifikasi dan negosiasi adalah:

a. Rencana Kerja. b. Spesifikasi/Kualitas Material. c. Volume Kegiatan. d. Waktu Pelaksanaan. e. Struktur Harga/Biaya. f. Harga.

10. Verifikasi Fisik

Sebagai bagian dari evaluasi, dapat dilakukan verifikasi fisik terhadap data dan informasi yang

diberikan oleh Penyedia dalam Dokumen Penawaran, termasuk namun tidak terbatas pada

pengecekan dokumen legalitas asli, pengecekan alat berat, pengecekan peralatan kerja, pengecekan

kantor dan lainnya untuk memastikan kesiapan Penyedia jika ditunjuk sebagai pelaksana pekerjaan.

Setiap biaya yang ditumbulkan oleh aktifitas ini menjadi beban PT Geo Dipa Energi (Persero).

11. Penetapan Calon Pemenang Dan Pengumuman Pemenang

11.1. Panitia Pengadaan membuat kesimpulan proses Pengadaan dan dituangkan dalam Berita Acara Hasil Pengadaan (BAHP).

11.2. BAHP disampaikan kepada Pejabat Berwenang untuk mendapatkan persetujuan atas usulan pemenang.

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11.3. Pejabat Berwenang memberikan persetujuan dan pengesahan penetapan pemenang berdasarkan BAHP yang diampaikan Panitia Pengadaan.

11.4. Panitia mengumumkan pemenang pengadaan dan memberitahukan kepada seluruh Penyedia paling lambat 2 (dua) hari kerja setelah diterimanya persetujuan dan pengesahan penetapan pemenang dari Pejabat berwenang.

12. Sanggahan

12.1. Penyedia yang berkeberatan atas penetapan pemenang diberi kesempatan untuk mengajukan sanggahan secara tertulis paling lambat dalam waktu 3 (tiga) hari kerja setelah pengumuman pemenang.

12.2. Sanggahan disampaikan kepada Pejabat Yang Berwenang yang menetapkan pemenang pengadaan.

12.3. Penyedia yang melakukan sanggahan wajib menyampaikan Jaminan Sanggahan berupa uang jaminan sebesar 1% (satu persen) dari nilai penawaran Penyedia yang dikirim ke rekening PT Geo Dipa Energi (Persero).

12.4. Jaminan Sanggahan akan dicairkan dan menjadi milik PT Geo Dipa Energi (Persero) jika sanggahan tidak terbukti benar

12.5. Sanggahan dapat diajukan apabila;

a. Panitia Pengadaan atau Pejabat Yang Berwenang menyalahgunakan wewenangnya; dan atau

b. Pelaksanaan pengadaan menyimpang dari ketentuan yang telah ditetapkan dalam RKS; dan atau

c. Terjadi praktek Korupsi, Kolusi dan Nepotisme (KKN) di antara Penyedia dengan Penyedia, Panitia Pengadaan atau Pejabat Yang Berwenang; dan atau

d. Terdapat rekayasa pihak-pihak tertentu yang mengakibatkan Proses Pengadaan tidak adil, tidak transparan, dan tidak terjadi persaingan yang sehat.

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BAB 3

FORMAT PERJANJIAN

13. Metode, Jangka Waktu Perjanjian & Draft Perjanjian 13.1. Metode Perjanjian & Jangka Waktu Perjanjian

Metode Perjanjian Beri Tanda

Jangka Waktu Perjanjian

Beri Tanda

Single Year Multi Years

Lump Sum -

Unit Price - - -

Unit Price & Kontrak Payung - - -

Gabungan Lump Sum dan Unit Price - - -

Turn Key - - -

Sewa - - -

Sewa Beli - - -

Jenis Perjanjian Lain - - -

13.2. Draft Perjanjian Terlampir

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BAB 4

LINGKUP PEKERJAAN

14. Latar Belakang

PT Geo Dipa Energi (Persero) berencana akan menggunakan area Mess PLN untuk digunakan sebagai

well pad 38 serta area pembangunan PLTP Dieng Unit 2. Sehingga dibutuhkan pembongkaran

bangunan yang tidak terpakai yang diketahui sebagai ex-Mess PLN, di Dieng – Jawa Tengah beserta

pembersihan areanya. Berdasarkan hasil kajian LPPKM FKM UI, material atap mengandung asbestos

sehingga diperlukan pengelolaan khusus Asbestos Containing Materials (ACM).

Sebelum pelaksanaan pembongkaran ACM dilakukan, LPPKM FKM UI akan memberikan pelatihan

terkait lingkup pekerjaan kepada penyedia jasa. Selain itu, selama kegiatan pembongkaran hingga

pemusnahan limbah asbestos, LPPKM FKM UI akan memberikan supervisi, melakukan pemantauan

udara ambien serta paparan terhadap pekerja.

Proses pembongkaran dan pengelolaan ACM harus dilakukan dengan baik dan mematuhi regulasi

serta mendapatkan persetujuan dari Asian Development Bank (ADB) representative, sehingga

mengurangi dampak terhadap lingkungan dan juga dampak terhadap kesehatan masyarakat dan

pekerja. Oleh karena itu, PT Geo Dipa Energi (Persero) memerlukan penyedia jasa profesional yang

berpengalaman di dalam penanganan ACM.

15. Daftar Pekerjaan Yang Akan Dilaksanakan

No Nama Jasa Satuan Jumlah

1 Pembongkaran material asbestos pada atap ex-Mess PLN AU 1

2 Pengemasan dan pengelolaan limbah ACM AU 1

3 Pengangkutan dan pemusnahan / pemanfaatan limbah ACM AU 1

16. Spesifikasi Teknis

16.1. Penyedia harus memastikan bahwa jasa yang dilaksanakan adalah sesuai dengan spesifikasi teknis yang ditetapkan dan pengaturan serta ketetapan lain dalam Perjanjian ini.

16.2. Jasa yang dilaksanakan dalam Perjanjian ini harus sesuai dengan standar (baik nasional maupun internasional) yang ditetapkan dalam Perjanjian ini. Jika dalam Perjanjian ini tidak menetapkan suatu standar rujukan, maka standar yang digunakan terkait pelaskanaan jasa yang dilaksanakan, minimal setara atau lebih baik dari standar resmi yang diaplikasikan di Indonesia.

16.3. Dalam hal dalam Perjanjian ini menetapkan suatu standar rujukan (baik nasional maupun internasional) maka edisi atau revisi standar yang digunakan adalah yang ditetapkan dalam Perjanjian ini. Dalam hal terjadi perubahan edisi atau revisi standar pada saat pelaksanaan pekerjaan, maka perubahan dapat diaplikasikan sepanjang disepakati oleh Para Pihak dan dituangkan dalam Addendum Perjanjian.

16.4. Kecuali jika secara tegas dinyatakan, kewajiban Penyedia mencakup pelaksanaan seluruh pekerjaan jasa termasuk Penyediaan pekerjaan sementara, material, dan hal lainnya yang dibutuhkan untuk menyelesaikan pekerjaan jasa sesuai dengan rencana, prosedur, spesifikasi, gambar, kode, dan dokumen lainnya sebagaimana ditentukan dalam Perjanjian ini.

16.5. Penyedia jasa memiliki pengetahuan dan pengalaman dalam kegiatan pembongkaran, pengelolaan, pengangkutan hingga pemusnahan / pemanfaatan limbah ACM dan dibuktikan dengan sertifikat pelatihan.

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16.6. Penyedia jasa memberikan slot tenaga kerja lokal di area Desa Karang Tengah.

16.7. Penyedia jasa menyediakan HSE Plan dan COVID-19 Plan selama kegiatan berlangsung.

16.8. Penyedia jasa akan melakukan pengelolaan limbah ACM sebagaimana limbah B3, sesuai dengan regulasi terkait.

16.9. Penyedia jasa dalam kegiatan pengangkutan dan pemusnahan / pemanfaatan wajib memiliki perizinan yang masih valid untuk pengelolaan limbah B3, khususnya limbah asbes.

16.10. Spesifikasi Teknis detail dari Jasa yang dilaksanakan adalah sebagai berikut:

No Nama Jasa Deskripsi Teknis Detail Satuan Jumlah

1 Pembongkaran material asbestos pada atap ex-Mess PLN

• Total luasan asbestos ±5983m2, ketebalan ±5mm, dengan rincian sumber material asbestos:

1. Atap bangunan utama 2. Atap barrack 1 3. Atap barrack 2 4. Atap barrack 3 5. Atap laboratorium 6. Atap poliklinik

• Proses pembongkaran harus meminimasi potensi paparan kepada pekerja serta pencemaran udara dan tanah

• Proses pembongkaran akan disupervisi oleh LPPKM FKM UI dan mengacu pada dokumen Asbestos Management Plan

AU 1

2 Pengemasan dan pengelolaan limbah ACM

• Estimasi volume timbulan limbah ACM adalah 5983 m2 * 0,005 m = 29,915m3, atau dibulatkan menjadi ± 30 m3.

• Untuk 1 m3 asbes gelombang beratnya 1300 kg maka total berat 300 * 1.3 ton = 390 ton ACM.

• Pengemasan dan pengelolaan limbah ACM akan disupervisi oleh LPPKM FKM UI dan mengacu pada dokumen Asbestos Management Plan.

AU 1

3 Pengangkutan dan pemusnahan / pemanfaatan limbah ACM

• Pengangkutan dan pemusnahan / pemanfaatan limbah ACM diperbolehkan untuk diserahkan kepada pihak ketiga berizin yang masih valid dan memiliki festronik untuk limbah ACM.

• Certificate of Treatment akan diserahkan kepada PT Geo Dipa Energi (Persero) setelah limbah dimusnahkan / dimanfaatkan.

• Kegiatan pengangkutan dan pemusnahan / pemanfaatan limbah ACM akan disupervisi oleh LPPKM FKM UI dan mengacu pada dokumen Asbestos Management Plan.

AU 1

*Dokumen Asbestos Management Plan akan dilampirkan.

17. Organisasi, Personil, Dokumen dan Laporan Kemajuan Pekerjaan

17.1. Penyedia harus menyediakan bagan yang menunjukkan struktur organisasi yang diusulkan yang untuk melaksanakan pekerjaan jasa dan mencakup identitas para personel kunci. Setiap perubahan atas struktur organiasasi Penyedia harus diberitahukan secara tertulis kepada Pemberi Kerja.

17.2. Personil kunci minimal yang dipersyaratkan berdasarkan Perjanjian ini adalah:

No Personil Kunci Beri Tanda

1 Supervisor lapangan

2 Pelaksana pembongkaran atap mengandung asbestos

3 Helper (tenaga lokal)

4 Transporter (Driver pengangkut limbah ACM)

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17.3. Penyedia harus menyerahkan kepada Pemberi Kerja atau Direksi Pekerjaan yang ditunjuk, dokumen-dokumen berikut sebelum memulai pelaksanaan pekerjaan jasa:

No Dokumen Beri Tanda

1 Phase 3 – Asbestos Management Plan

2 Materi pelatihan dari LPPKM FKM UI

3 Phase 2 – Laporan Survey ACM

17.4. Dalam hal Pemberi Kerja atau Direksi Pekerjaan memberikan catatan atau permintaan perubahan atas dokumen-dokumen tersebut, maka Penyedia harus memperbarui dan merevisi dokumen sebagaimana catatan atau permintaan tersebut dan menyerahkan kembali kepada Pemberi Kerja atau Direksi Pekerjaan.

17.5. Penyedia harus senantiasi memonitor kemajuan pekerjaan jasa sesuai dengan program kerja terperinci yang telah diserahkan dan melaporkan secara berkala kepada Pemberi Kerja atau Direksi Pekerjaan setiap bulan. Laporan kemajuan pekerjaan harus dapat menunjukan:

a. Persentase penyelesaian pekerjaan, termasuk perbandingan persentase penyelesaian pekerjaan aktual dengan rencana dalam program kerja;

b. Aktifitas yang persentase penyelesaian pekerjaan tertlambat dan tidak sesuai dengan program kerja, serta disertai catatan, kemungkinan risiko dan tindakan korektif apa yang akan dilakukan.

18. Peralatan Kerja Penyedia 18.1. Semua peralatan kerja Penyedia yang dibawa oleh Penyedia ke lapangan akan dianggap

dimaksudkan untuk digunakan secara eksklusif untuk pelaksanaan pekerjaan jasa sebagaimana dalam Perjanjian ini.

18.2. Setelah menyelesaikan seluruh pekerjaan jasa sebagaimana dalam Perjanjian ini, Penyedia berkewajiban untuk memobilisasi seluruh peralatan kerja Penyedia dari lapangan termasuk jika terdapat kelebihan bahan/material terkait dengan pekerjaan jasa.

18.3. Peralatan kerja Penyedia minimal yang dipersyaratkan berdasarkan Perjanjian ini adalah:

No Peralatan Kerja Beri Tanda

1 HEPA filter, spray / alat coating dan dokumen perizinan

2 Kemasan limbah B3 (minimal jumbo bag double liner)

3 APD dan semua peralatan yang dipersyaratkan pada Asbestos Management Plan

4 Transportasi

19. Kewajiban Pemberi Kerja

Pemberi Kerja akan menunjuk LPPKM FKM UI untuk melakukan supervisi selama pekerjaan dalam

lingkup Perjanjian ini dilaksanakan.

20. Gambar-Gambar Teknis (Tidak Diperlukan)

20.1. Penyedia harus membuat gambar detail atau gambar kerja (detail/working drawing) berdasarkan gambar dasar (basic drawing) yang diberikan oleh Pemberi Kerja sesuai dengan ketentuan-ketentuan dan standar-standar dalam Perjanjian, atau jika tidak ditentukan, maka dilakukan sesuai dengan praktik rekayasa/engineering yang baik.

15

20.2. Gambar Teknis yang harus disediakan:

No Nama Jasa

Drawing

Beri Tanda

Basic Drawing

Pemberi Kerja

Detail/Working Design

Penyedia

1 [input data] [input data] [input data]



21. Perijinan

Setiap perijinan yang terkait dengan pelaksanaan pekerjaan jasa menjadi tanggung jawab Penyedia.

22. Health, Safety and Environment (HSE)

22.1. Penyedia harus setiap saat mengambil tindakan pencegahan yang wajar untuk menjaga kesehatan dan keselamatan Personil Penyedia serta perlindungan lingkungan. Bekerja sama dengan fungsi HSE yang dimiliki oleh Pemberi Kerja, untuk senantiasi memastikan bahwa akses terhadap fasilitas medis, fasilitas pertolongan pertama, rumah sakit, dan layanan ambulans tersedia setiap saat di lapangan.

22.2. Penyedia harus menunjuk safety officer di lapangan, yang bertanggung jawab untuk menjaga keselamatan dan perlindungan terhadap kecelakaan. safety officer harus memenuhi syarat untuk tanggung jawab ini, dan akan memiliki wewenang untuk mengeluarkan instruksi dan mengambil tindakan perlindungan untuk mencegah kecelakaan.

23. Asuransi

23.1. Seluruh peralatan Penyedia yang digunakan dalam pelaksanaan pekerjaan jasa dalam Perjanjian ini harus diasuransikan untuk memberikan perlindungan atas resiko kerusakan dan kehilangan baik selama proses transportasi, penyimpanan sementara, transit, penerimaan dan penggunaan di lapangan.

23.2. Seluruh tenaga kerja Penyedia yang melaksanakan pekerjaan jasa terkait yang dilaksanakan sesuai dengan Perjanjian ini harus dilindungi minimal dengan asuransi tenaga kerja yang diwajibkan oleh Pemerintah.

24. Garansi

24.1. Penyedia menjamin bahwa setiap pekerjaan jasa yang dilaksanakan adalah bebas dari cacat yang timbul dari tindakan atau kelalaian Penyedia atau sub kontraktornya, atau yang timbul dari desain, bahan baku, dan pengerjaan.

24.2. Jika karena alasan yang menjadi tanggung jawab Penyedia, spesifikasi teknis pelaksanaan pekerjaan jasa yang ditetapkan tidak terpenuhi baik secara keseluruhan atau sebagian, Penyedia dengan biayanya sendiri akan melakukan perbaikan yang mungkin diperlukan untuk memenuhi setidaknya tingkat minimum spesifikasi teknis pelaksanaan pekerjaan jasa tersebut.

16

24.3. Jangka waktu garansi adalah:

Jangka Waktu Garansi Sejak

12 bulan Pekerjaan selesai dilakukan

24.4. Dalam hal terjadi klaim atas garansi oleh Pemberi Kerja, maka Pemberi Kerja harus memberikan

pemberitahuan tertulis kepada Penyedia, yang menyatakan sifat dari setiap cacat atau kerusakan yang terjadi bersama dengan semua bukti yang tersedia. Pemberi Kerja harus memberikan semua peluang dan kesempatan kepada Penyedia untuk memeriksa cacat atau kerusakan tersebut.

24.5. Setelah menerima pemberitahuan tersebut, Penyedia akan, dalam waktu maksimal 7 (tujuh) hari kalender harus segera memperbaiki setiap cacat atau kerusakan atau bagian-bagiannya, dan tanpa biaya tambahan kepada Pemberi Kerja.

25. Jangka Waktu

25.1. Jangka waktu pelaksanaan pekerjaan jasa adalah sesuai dengan jangka waktu sebagai berikut:

No Pekerjaan Jasa Durasi Pelaksanaan

1 Pembongkaran, Pengangkutan dan Pemusnahan Asbestos Containing

Materials (ACM) di Mess PLN untuk Pengembangan Proyek Dieng 2

150 hari kalender

25.2. Perjanjian dianggap tetap berlaku meskipun waktu pelaksanaan pekerjaan jasa telah dilaksanakan atau telah selesai atau terlampaui (termasuk masa garansi dan atau perpanjangan masa garansi bila ada), selama masih terdapat hak dan kewajiban Pemberi Kerja atau Penyedia yang belum dipenuhi oleh masing-masing pihak.

25.3. Tanpa harus dinyatakan secara tegas, Perjanjian dinyatakan secara serta merta berakhir bilamana seluruh hak dan kewajiban Pemberi Kerja dan Penyedia sebagaimana diatur dalam Perjanjian telah dipenuhi.

25.4. Apabila seluruh hak dan kewajiban Pemberi Kerja dan Penyedia sebagaimana diatur dalam Perjanjian telah dipenuhi, maka Pemberi Kerja dan Penyedia wajib menjamin dan membebaskan masing-masing pihak dari segala gugatan dan/atau tuntutan hukum apapun termasuk namun tidak terbatas pada kelalaian kewajiban pembayaran terkait penyelesaian kewajiban Penyedia kepada pihak lain yang menjadi Subkontraktor atau sub vendor atau supplier dan atau pihak lain.

17

26. Perpanjangan Jangka Waktu

26.1. Jika dalam jangka pelaksanaan pekerjaan jasa, Penyedia atau Subkontraktornya atau sub vendornya atau suppliernya harus menghadapi kondisi yang menghalangi pelaksanaan pekerjaan jasa secara tepat waktu, maka Penyedia harus segera memberi tahu Pemberi Kerja secara tertulis tentang adanya keterlambatan tersebut, termasuk durasi keterlambatan yang terjadi dan penyebabnya. Segera setelah menerima pemberitahuan dari Penyedia, Pemberi Kerja harus mengevaluasi situasi tersebut dan dapat memberikan keputusan apakah dapat memberikan perpanjangan jangka waktu pelaksanaan pekerjaan jasa tersebut. Dalam hal perpanjangan jangka waktu diberikan, maka atas perubahan tersebut harus dituangkan dalam Addendum Perjanjian.

26.2. Perpanjangan jangka waktu juga dapat diberikan dalam hal terjadinya peristiwa/kejadian Force Majeure sebagaimana ketentuan Perjanjian ini atau bila terdapat perubahan undang-undang atau adanya regulasi Pemerintah Republik Indonesia yang secara nyata dapat dibuktikan secara signifikan mempengaruhi jangka waktu pelaksanaan pekerjaan jasa. Dalam hal perpanjangan jangka waktu diberikan, maka atas perubahan tersebut harus dituangkan dalam Addendum Perjanjian.

26.3. Kecuali dalam hal terjadinya peristiwa/kejadian Force Majeure atau terdapat perubahan undang-undang atau adanya regulasi Pemerintah Republik Indonesia baru atau dalam hal perpanjangan jangka waktu diberikan, maka setiap keterlambatan dalam jangka waktu pelaksanaan pekerjaan jasa akan dikenakan denda keterlambatan.

27. Denda

27.1. Jika Penyedia terlambat atau gagal untuk melaksanakan salah satu bagian atau seluruh pekerjaan jasa, tanpa mengurangi hak Pemberi Kerja untuk menggunakan solusi lain sesuai dengan pengaturan Perjanjian ini, maka Penyedia akan dikenakan denda yang jumlahnya diatur berdasarkan Perjanjian ini atas setiap hari keterlambatan yang terjadi sampai dengan seluruh pelaksanaan jasa selesai dilaksanakan. Pengenaan denda akan langsung dikurangkan dari pembayaran atas Harga Pekerjaan. Jika nilai denda telah mencapai nilai maksimum yang ditetapkan, maka Pemberi Kerja berhak untuk melakukan terminasi atas Perjanjian ini secara sepihak.

27.2. Pengenaan denda adalah sebagai berikut:

Pengenaan Denda Beri Tanda Nilai Denda

Perhari

Maksimum Hari

Keterlambatan

Maksimum Nilai

Denda

Denda Parsial Tehadap

Bagian Perjanjian - - %

-

Hari Kalender - %

Denda Terhadap

Keseluruhan Perjanjian 0,1 %

50

Hari Kalender 5 %

28. Pembebasan Denda

Pengenaan denda dapat dibebaskan dalam hal keterlambatan atau kegagalan untuk melaksanakan

salah satu bagian atau seluruh pekerjaan jasa terjadi karena hal-hal yang diakibatkan oleh terjadinya

peristiwa/kejadian Force Majeure, terdapat perubahan undang-undang atau adanya regulasi

Pemerintah Republik Indonesia baru yang berdampak pada pelaksanaan pekerjaan jasa, dalam hal

perpanjangan jangka waktu diberikan oleh Pemberi Kerja, atau jika terjadi penundaan pelaksanaan

Perjanjian atas permintaan tertulis dari Pemberi Kerja.

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29. Tahapan Pembayaran

29.1. Tahapan pembayaran sebagai berikut:

No Tahap Pembayaran Persentase Milestones

1 Tahap 1 50%

Pekerjaan Pembongkaran ACM dinyatakan selesai yang dibuktikan dengan diterbitkannya BAPP

2 Tahap 2 50% Pekerjaan dinyatakan selesai yang dibuktikan dengan diterbitkannya BAPP dan BAST serta

Laporan akhir pengelolaan ACM dari LPPKM FKM UI telah disetujui oleh ADB

30. Rekening Bank

30.1. Pembayaran atas Harga dilaksanakan secara transfer ke rekening Penyedia. Biaya transfer menjadi tanggung jawab Penyedia yang dipotong langsung dari pembayaran tersebut.

30.2. Perubahan nomor rekening dapat dilakukan dengan pemberitahuan tertulis.

31. Dokumen Penagihan dan Pembayaran

31.1. Penagihan oleh Penyedia dilakukan secara tertulis, disertai dokumen tagihan dan dokumen terkait lainnya, dengan detai sebagai berikut:

No Dokumen

1 Surat Permohonan Pembayaran

2 Invoice rangkap 4 (empat), 1 (satu) bermaterai cukup dan 3 (tiga) copy

3 Kuitansi rangkap 4 (empat), 1 (satu) bermaterai cukup dan 3 (tiga) copy

4 Faktur Pajak Elektronik rangkap 3 (tiga) sesuai dengan SE-50/PJ/2011 tanggal 3 Agustus 2011 dengan

kode faktur pajak WAPU (030.xxx)

5 Copy NPWP

6 Copy Purchase Order (PO) dan Copy Perjanjian

7 Berita Acara Penyelesaian Pekerjaan (BAPP) ditandatangani oleh Direksi Pekerjaan

8 Service Acceptance (SA)

9 Berita Acara Serah Terima (BAST) barang yang ditandatangani oleh penandatangan Perjanjian

10 Jaminan Pemeliharaan/Perpanjangan Jaminan Pelaksanaan

31.2. Penagihan dialamatkan kepada: PT Geo Dipa Energi (Persero) u.p. Direktur Keuangan.

31.3. Pemberi Kerja akan membayar tagihan dalam waktu 30 (tiga puluh) hari kerja terhitung mulai tanggal seluruh dokumen tagihan dan dokumen terkait lainnya dinyatakan lengkap dan benar.

31.4. Pemberi Kerja berhak menahan atau memotong pembayaran atas tagihan dengan ketentuan sebagai berikut :

a. Menahan

i. Apabila terdapat terdapat kesalahan dan atau ketidaklengkapan dokumen tagihan dan dokumen terkait lainnya.

ii. Apabila diketahui bahwa Jaminan Pelaksanaan yang telah diberikan sudah habis masa berlakunya dan Penyedia belum menyerahkan perpanjangan Jaminan Pelaksanaan.

iii. Apabila terdapat tuntutan ganti rugi dari pihak lain atau sub kontraktor Penyedia yang diterima Pemberi Kerja dan tidak dapat diselesaikan oleh Penyedia.

b. Memotong

i. Apabila terjadi kelebihan pembayaran oleh Pemberi Kerja yang berhubungan dengan pembayaran sebelumnya dalam Perjanjian ini.

19

ii. Apabila terdapat sanksi dan atau denda yang dibebankan kepada Penyedia sesuai dengan Perjanjian ini.

32. Jaminan – Jaminan

32.1. Jaminan Pelaksanaan

a. Penyedia harus menyerahkan Jaminan Pelaksanaan (Performance Security) kepada Pemberi Kerja. Jaminan Pelaksanaan berupa garansi bank (bank guarantee) dengan kondisi unconditional dan irrevocable, harus diterbitkan oleh Bank BUMN, sebesar 5% (lima persen) dari total nilai Harga Pekerjaan termasuk PPN.

b. Jaminan Pelaksanaan wajib diserahkan Penyedia kepada Pemberi Kerja paling lambat 7 (tujuh) hari kerja setelah SKPP diterbitkan. Masa berlaku Jaminan Pelaksanaan adalah sekurang-kurangnya berlaku sejak tanggal diterbitkan sampai dengan 30 (tiga puluh) hari kalender setelah tanggal berakhirnya Jangka Waktu Pelaksanaan Pekerjaan.

c. Penyedia wajib memperpanjang Jaminan Pelaksanaan sampai dengan berakhirnya Jangka Waktu Pelaksanaan Pekerjaan apabila terjadi perpanjangan masa Jangka Waktu Pelaksanaan Pekerjaan. Apabila Penyedia tidak bersedia untuk memperpanjang masa berlaku Jaminan Pelaksanaan dalam hal dibutuhkan perpanjangan, maka Pemberi Kerja berhak tanpa perlu adanya persetujuan terlebih dahulu Penyedia untuk mencairkan Jaminan Pelaksanaan tersebut, serta hasil pencairannya menjadi milik Pemberi Kerja.

d. Jaminan Pelaksanaan dapat dicairkan sewaktu-waktu oleh Pemberi Kerja berdasarkan alasan-alasan yang diatur dalam Perjanjian ini, termasuk jika Penyedia tidak dapat menyelesaikan pekerjaannya baik sebagian atau seluruhnya, tanpa perlu persetujuan terlebih dahulu dari Penyedia.

e. Jaminan Pelaksanaan akan dikembalikan oleh Pemberi Kerja kepada Penyedia setelah Jangka Waktu Pelaksanaan Pekerjaan beserta perpanjangannya (jika ada) telah habis.

32.2. Jaminan Pemeliharaan (Tidak Digunakan)

a. Penyedia harus menyerahkan Jaminan Pemeliharaan kepada Pemberi Kerja. Jaminan Pemeliharaan berupa garansi bank (bank guarantee) dengan kondisi unconditional dan irrevocable, harus diterbitkan oleh Bank BUMN, sebesar 5% (lima persen) dari total nilai Harga Pekerjaan termasuk PPN. Jaminan pemeliharaan dapat berupa Jaminan Pelaksanaan yang diperpanjang masa berlakunya sampai dengan berakhirnya masa garansi.

b. Jaminan Pemeliharaan wajib diserahkan Penyedia kepada Pemberi Kerja bersama dengan permohonan pembayaran. Masa berlaku Jaminan Pemeliharaan adalah sekurang-kurangnya berlaku sejak tanggal diterbitkan sampai dengan 30 (tiga puluh) hari kalender setelah tanggal berakhirnya masa garansi.

c. Jaminan Pemeliharaan akan dikembalikan setelah pelaksanaan masa garansi selesai dan tidak terdapat perpanjangan masa garansi dan ditandai dengan ditandatanganinya Berita Acara Selesai Masa Garansi.

20

LAMPIRAN – LAMPIRAN

33. ASBESTOS MANAGEMENT PLAN PHASE 3

34. PHASE 2 ASBESTOS SURVEY AND SAMPLING REPORT OF EX-PLN BUILDING SITE

35. PRELIMINARY ASBESTOS SURVEY REPORT

1

LPPKM FKM UI

ASBESTOS MANAGEMENT PLAN PHASE 3

DIENG, CENTRAL JAVA PREPARED FOR: PT. GEO DIPA ENERGI (PERSERO) – DIENG UNIT 2 PROJECT

2

LPPKM FKM UI

ASBESTOS MANAGEMENT PLAN PHASE 3

[Subject]

DIENG, CENTRAL JAVA

[Keywords]

Prepared by Prepared for

LPPKM FKM UI PT. GEO DIPA ENERGI (PERSERO) – DIENG UNIT 2 PROJECT

i

LPPKM FKM UI

Table of Content

1. Objective ………………………………………….………... 1

2. Scope of Work ………………………………………….………... 1

3. Asbestos Demolition Activities ………………………………………….………... 2

3.1. Risk Assessment ………………………………………….………... 2

3.2. Preparation ………………………………………….………... 2

3.3. Execution of Work ………………………………………….………... 3

3.4. Clearance ………………………………………….………... 4

3.5. Transportation ………………………………………….………... 4

4. Standard Procedure ………………………………………….………... 6

4.1. Asbestos Containing Material Procedure ………………………………………….………... 6

4.2. Emergency Condition Procedure ………………………………………….………... 12

4.3. Dispose of Personal protective Equipment

(PPE) ………………………………………….………... 12

4.4. Dispose of Asbestos Waste ………………………………………….………... 12

5. Implementation of Training ………………………………………….………... 12

6. Schedule of Asbestos Demolition Activities ………………………………………….………... 13

ii

LPPKM FKM UI

List of Appendix

1. Appendix I - References ………………………………………….………... 14

2. Appendix II - Sub-contractor Criteria ………………………………………….………... 15

3. Appendix III - Personal Protective Equipment ………………………………………….………... 16

4. Appendix IV - SOW of Demolishing Building

Project Dieng 2 for Sub Contractor ………………………………………….………... 18

5. Appendix V - Training material of asbestos

demolish building. ………………………………………….………... 30

6. Appendix VI – Safe Work Method Statement

Removal of Asbestos Containing Material and

Minor Damage of ACM

………………………………………….………... 31

pg. 1

INTERNAL. This information is accessible to ADB Management and staff. It may be shared outside ADB with appropriate permission.

LPPKM FKM UI

1. OBJECTIVE / TUJUAN

Asbestos Management Plan aims to manage Asbestos Containing Material (ACM) in preparation of

any demolition work of building. It also aims to guide in the permanent and safe disposal of ACM in

accordance with Government Regulation No. 101/2014 regarding Hazardous Material Waste

Management and Regulation of Ministry of Manpower No. 5/2018 regarding Occupational Health and

Safety in the Workplace.

Asbestos Management Plan ditujukan untuk kegiatan pengelolaan Asbestos Containing Material

(ACM) yang meliputi perencanaan, pelaksanaan pekerjaan pembongkaran, pewadahan dan

pengangkutan limbah material Asbestos Containing Material (ACM) ke pembuangan akhir sesuai

dengan aturan atau tata cara yang direkomendasikan oleh Peraturan Pemerintah No. 101/2014 tentang

Pengelolaan Limbah Bahan Beracun dan Berbahaya dan Peraturan Menteri Ketenagakerjaan No. 5

Tahun 2018 tentang Keselamatan dan Kesehatan Kerja Lingkungan Kerja.

2. SCOPE OF WORK / RUANG LINGKUP PEKERJAAN

This Asbestos Management Plan applies to all ACM handling activities which are identified in PT. Geo

Dipa Energi. The scope of work of this asbestos management plan are:

Setting up of the plan for preparation of demolition, execute of ACM demolition activity,

sampling, and clearance activity in accordance with Minister of Manpower Regulation No. PER-

03-/MEN/1985 on occupational safety and health in the use of asbestos and international

practice. (Note: UI Lemtek consultant prepared the document for ACM plan and will supervise

activity of asbestos demolition.)

Setting up of the Scope of Work (SOW) on transportation of ACM waste to final disposal in

accordance to guidelines or regulation recommended by Government Regulation No. 101/2014

regarding Hazardous Material Waste Management and Government Regulation No. 22/2021

regarding Implementation of Environmental Protection and Management.

Setting up of Scope of Work (SOW) of preparation of demolition activity, execution of demolition

and clearance activities for sub contractor.

Criteria requirement for third party sub contractor who will execute the ACM demolition and

clearance activities.

Training materials and conduct of training regarding demolition activities for sub contractor.

Work equipment and manpower for building demolition activities on Project Dieng 2 site area.

Asbestos Management Plan berlaku untuk semua penanganan ACM yang ada di PT. Geo Dipa Energi.

Ruang lingkup Asbestos Management Plan ini antara lain:

Menyusun rencana kegiatan persiapan demolish, pelaksanaan demolish ACM, pengambilan

sampel, serta kegiatan setelah demolish bangunan (clearance) sesuai dengan Peraturan

Menteri Ketenagakerjaan No. 03-/MEN/1985 tentang Keselamatan dan Kesehatan Kerja

Pemakaian Asbes dan standard internasional (Catatan: Konsultan UI Lemtak menyiapkan

dokumen untuk rencana kegiatan pembongkaran ACM dan akan mensuperbisi kegiatan

pembongkaran ACM).

pg. 2


LPPKM FKM UI

Menyusun Scope of Work (SOW) transportasi limbah ACM ke pembuangan akhir sesuai

dengan aturan atau tata cara yang direkomendasikan oleh Peraturan Pemerintah No.

101/2014 tentang Pengelolaan Limbah Bahan Beracun dan Berbahaya dan Peraturan

Pemerintan No. 22/2021 tentang Penyelenggaraan Perlindungan dan Pengelolaan Lingkungan

Hidup.

Menyusun scope of work (SOW) kegiatan persiapan, pembongkaran dan kegiatan setelah

pembongakaran (clearance) untuk sub kontraktor.

Menyusun persyaratan kriteria sub kontraktor.

Menyusun materi pelatihan dan melaksanakan kegiatan pelatihan tentang kegiatan demolish

bangunan bagi sub kontraktor.

Menyusun daftar peralatan kerja dan tenaga kerja untuk kegiatan pembongkaran bangunan

Project Dieng 2.

3. Asbestos Demolition Activities/ Kegiatan Pekerjaan Demolish Asbes

3.1. Risk Assessment/ Penilaian Risiko

Risk assessment is carried out prior to start of mobilization activities to plan and prepare the

work equipment and tools, identify the site management plans for erecting scaffolding and

carrying out demolition activities, design the sampling and measurement of air samples,

personal samples and soil samples of ACM, and plan the transportation of asbestos waste as

well as demobilization activities. A presurvey report and survey report have been prepared

based on the results of the risk assessment containing the qualification criteria for the

company to be selected or engaged in asbestos removal. This qualification criteria is in

Appendix II.

Melakukan kajian risiko untuk setiap tahapan pekerjaan mulai dari kegiatan mobilisasi,

persiapan peralatan dan perlengkapan kerja, pemasangan perancah, pelaksanaan demolish,

pengukuran sampel asbes di udara, pekerja dan tanah, dan kegiatan transportasi limbah

asbes serta kegiatan demobilisasi. Laporan Presurvey dan Laporan Pelaksanaan Survei telah

disiapkan berdasarkan hasil penilaian risiko yang berisi kriteria kualifikasi untuk Perusahaan

yang dipilih atau terlibat dalam kegiatan demolish asbes. Kriteria kualifikasi tercantum pada

Lampiran II.

3.2. Preparation/ Persiapan

3.2.1. Mobilization of Work Equipment

Mobilisasi Peralatan Kerja

Sub contractor will carry out mobilization of work equipment in the project area. The list

of work equipment can be referred from Appendix IV (SOW Demolishing Building

Project Dieng 2 for Sub Contractor). For AMP, prior approval is GDE is needed.

Sub kontraktor melaksanakan mobilisasi peralatan kerja di lokasi project. Daftar

peralatan kerja terlampir di Lampiran IV (SOW Demolishing Building Project Dieng 2

pg. 3


LPPKM FKM UI

for Sub Contractor).

3.2.2. Preparation of Equipment and Tools/ Persiapan Peralatan dan Perlengkapan

The work equipment and tools placed at certain location in project area location.

Peralatan dan perlengkapan ditempatkan pada lokasi yang ditentukan di lokasi

proyek.

Prepare the equipment which will be used for erect the scaffolding.

Menyiapkan peralatan yang akan dipergunakan untuk memasang perancah.

Prepare work tools such as PPE and others.

Menyiapkan perlengkapan kerja seperti APD dan lainnya.

Prepare generator set for power needed and water for spraying the dust.

Menyiapkan genset untuk kebutuhan listrik dan air untuk penyemprotan debu.

Prepare vaccum HEPA filter, assembly tarpaulin surrounding work area, utility set

and bowplank, carry out excavation, hoarding, stamper for soil compaction, as well

as disposal of soil and silica

Menyiapkan Vacuum HEPA filter, memasang terpal disekitar area kerja, utility set

and bowplank, melakukan penggalian, penimbunan, pemadatan tanah,

pembuangan tanah dan silika

3.2.3. Erection of Scaffolding, Temporary Bluesheet Fence, Work Platform & handrail,

Temporary Habitat, Space Isolation wall/ Pemasangan Perancah, Temporary

Bluesheet Fence, Work Platform & handrail, Temporary Habitat, Space Isolation wall

Conduct the work on scaffolding erection, as well as erection of Temporary

Bluesheet Fence, Work Platform & handrail, Temporary Habitat, Space Isolation

wall

Melaksanakan pekerjaan pemasangan perancah, serta pemasangan Temporary

Bluesheet Fence, Work Platform & handrail, Temporary Habitat, Space Isolation

wall

Set up the tarpaulin/cover, blower and exhaust.

Pemasangan terpal/penutup, blower dan exhaust.

3.3. Execution of Work/ Pelaksanaan Pekerjaan

3.3.1. Carry out the work to remove ACM at roof.

Pekerjaan melepaskan ACM pada atap

3.3.2. Set up the removed ACM at the predetermined location in accordance to procedure

Menyusun bahan ACM yang sudah dilepas di lokasi yang telah ditentukan sesuai

prosedur

3.3.3. Wrap the ACM with Polyethylene (plastic) to prevent potential of asbestos fibre

release to the air that could cause exposure and hazards to workers.

Membungkus ACM dengan plastik Polyethylene untuk mencegah potensi serat

asbes terbang dan memapar pekerja

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3.3.4. Measure asbestos concentration on air by collecting 8 samples in the predetermined

location

Pengukuran konsentrasi asbes di udara sebanyak 8 sampel di lokasi yang telah

ditentukan

3.3.5. Measure asbestos concentration on 12 samples at workers through Accredited

Laboratory (KAN).

Pengukuran konsentrasi asbes personal sebanyak 12 sampel pada sampel pekerja

yang telah ditentukan dan analisis laboratorium adalah laboratorium terakreditasi.

3.3.6. Measure asbestos soil sample as much as 2 samples in the predetermined location

Pengukuran konsentrasi asbes di tanah sebanyak 2 sampel di lokasi yang telah

ditentukan

3.4. Clearance/ Kegiatan Pembersihan

3.4.1. Carry out clearance work from debris in the location

Pekerjaan pembersihan lokasi dari puing-puing bangunan

3.4.2. Conduct measurement of air sampling of asbestos as much as 8 samples in the

predetermined location

Pengukuran konsentrasi asbes di udara sebanyak 8 sampel pada lokasi yang telah

ditentukan

3.4.3. Conduct measurement asbestos soil sample as much as 2 samples in the

predetermined location

Pengukuran konsentrasi asbes di tanah sebanyak 2 sampel pada lokasi yang telah

ditentukan

3.4.4. Demobilization of work equipment from project area

Demobilisasi peralatan kerja dari lokasi proyek

3.5. Transportation of ACM to Disposal/ Transportasi ACM ke Pembuangan Akhir

The packed asbestos waste will be sent to PPLI/TLI in accordance to applicable regulation

or procedure (Government Regulation No. 22/2021 regarding Implementation of

Environmental Protection and Management). PPLI and TLI are company which has

permission/license from Government to treat hazardous material in accordance to

Government Regulation No. 22/2021 regarding Implementation of Environmental Protection

and Management). Sub contractor who carry out ACM waste transportation to final disposal

are required to submit formal application to the MOEF and complete the requirements

accordance with Article 311 paragraph 3 of the Government Regulation No. 22/2021. The

ACM transport application should contain the following details:

a. Applicant’s identity;

b. Establishment of business entity;

c. Proof of the ownership and guarantee fund for restoration of the area and surrounding

environment;

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d. Proof of equipment transportation; and

e. Hazardous waste transportation documents.

Sub contractor should complete the Hazardous Material Waste Transportation Document

(Article 311 paragraph 4 of Government Regulation No. 101/2014) which includes:

a. Type and number of transportations/trips;

b. Source, name and characteristics of hazardous material waste which being

transported;

c. Hazardous material waste management procedure in emergency conditions;

d. Equipment for handling hazardous material waste; and

e. Procedures for loading hazardous material waste.

The sub-contractor is required to complete the Hazardous Waste Transport Document (ACM

waste) in accordance with Article 311 paragraph 4 of Government Regulation No. 22/2021,

which includes:

a. type and number of equipment transportation;

b. the source, name and characteristics of the hazardous waste being transported;

c. hazardous waste management procedures in emergency conditions;

d. equipment for handling hazardous waste; and

e. procedures for loading hazardous waste.

Sub contractor is required to secure a recommendation letter of hazardous material waste

transportation which issued by Ministry of Environment and Forestry prior to the conducting

of transporting ACM waste, in accordance with Article 312 paragraph 3 (a) of Government

Regulation No. 22/2021. Recommendation as referred to in Article 312 paragraph 3 (a) of

Government Regulation No. 22/2021 are:

a. The manifest code of the hazardous material waste transporter

b. The name of ACM (chrysotile) and characteristics of hazardous material waste which

will be transported; and

c. Recommendation validity period.

Limbah asbes yang sudah dikemas dilakukan pengiriman ke PPLI/TLI sesuai dengan

regulasi maupun prosedur yang berlaku (Peraturan Pemerintah No. 22/2021 tentang

Penyelenggaraan Perlindungan dan Pengelolaan Lingkungan Hidup). PPLI ataupun TLI

merupakan perusahaan yang sudah memiliki ijin dari Pemerintah terkait pengelolaan limbah

B3 sesuai dengan Peraturan Pemerintah No. 22/2021 tentang Penyelenggaraan

Perlindungan dan Pengelolaan Lingkungan Hidup. Sub kontraktor yang melaksanakan

transportasi limbah B3 ke pembuangan akhir harus mengajukan permohonan secara tertulis

kepada Menteri dan dilengkapi dengan persyaratan sesuai dengan pasal 311 ayat 3 PP No.

22/2021) yang meliputi:

a. identitas pemohon;

b. akta pendirian badan usaha;

c. bukti kepemilikan atas dana penjaminan untuk pemulihan fungsi lingkungan hidup:

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d. bukti kepemilikan alat angkut; dan

e. dokumen Pengangkutan Limbah B3

Sub kontraktor harus melengkapi Dokumen Pengangkutan Limbah B3 (limbah ACM) sesuai

pasal 311 ayat 4 pada Peraturan Pemerintah No. 22/2021 yang memuat antara lain:

a. jenis dan jumlah alat angkut;

b. sumber, nama, dan karakteristik Limbah B3 yang diangkut;

c. prosedur penanganan Limbah B3 pada kondisi darurat;

d. peralatan untuk penanganan Limbah B3; dan

e. prosedur bongkat muat limbah B3.

Sub kontraktor harus mendapatkan surat rekomendasi pengangkutan limbah B3 (limbah

ACM) yang diterbitkan oleh Kementerian Lingkungan Hidup dan Kehutanan sebelum

pelaksanaan pengangkutan limbah B3 (limbah ACM) sesuai dengan pasal 312 ayat 3 (a)

pada PP No. 22/2021. Rekomendasi sebagaimana dimaksud pada pasal 312 ayat 3 (a) pada

PP No. 22/2021 memuat:

a. kode manifes Pengangkut Limbah B3;

b. nama ACM (chrysotile) dan karakteristik limbah B3 yang diangkut; dan

c. masa berlaku rekornendasi.

4. STANDARD PROCEDURE / PROSEDUR STANDAR

4.1. ACM General Procedure / Prosedur Umum ACM

4.1.1. Removal of ACM is conducted to all building which located in Project Dieng 2 area.

Asbestos Management Plan is to be implemented for all such work.

Pembongkaran ACM dilakukan pada seluruh bangunan yang berada di area Project

Dieng 2. Asbestos Management Plan dapat diimplementasikan untuk semua pekerjaan

tersebut.

4.1.2. Sub-contractor selection will be based on experience and competence to carry out the

demolition work. Sub-contractor selection should refer to sub-contractor criteria in

Appendix II.

Pemilihan sub kontraktor akan didasarkan pada pengalaman dan kompetensi untuk

melaksanakan pekerjaan pembongkaran (demolish). Pemilihan sub kontraktor harus

merujuk pada Kriteria Sub Kontraktor di Lampiran II

4.1.3. A Risk assessment shall be completed by consultant and reviewed or approved by the

Technical Director & EHS manager before any work can commence and, thereafter sent

to the EHS Department for Work Permit Collection. An integral part of the risk assessment

is registered to identify control measures and the PPE required for the work. Consultant

will provide training regarding work method for preparation, execution and after demolition

work. Material of training must address all relevant safety risks including working at height

and walking on fragile roofs.

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Penilaian risiko dilakukan oleh konsultan dan direview atau disetujui oleh Direktur Teknik

dan Manajer EHS sebelum pekerjaan dapat dimulai dan setelah itu dikirim ke Departemen

EHS untuk pengumpulan ijin kerja. Penilaian risiko yang menyeluruh

dibutuhkan/diperlukan untuk mengidentifikasi tindakan pengendalian dan PPE yang

dibutuhkan. Konsultan akan memberikan pelatihan mengenai metode kerja untuk

persiapan, pelaksanaan, dan pasca pembongkaran.

Materi pelatihan mencakup semua risiko keselamatan yang relevan, termasuk bekerja di

ketinggian dan berjalan diatap yang rapuh

4.1.4. The EHS Department shall assess the competence of the workers to execute the job. If If

the competency requirements are appropriate, the sub-contractor must provide the PPE

needed as attached in Attachment III. Safety briefing will be given by EHS Department

which will include a discussion on all hazards associated with the work including working

at height.

EHS Departemen akan menilai kompetensi para pekerja untuk melakukan pekerjaan itu.

Jika telah memenuhi persyaratan kompetensi, maka sub kontraktor harus menyediakan

APD yang diperlukan seperti yang terlampir pada Lampiran III. Briefing keselamatan kerja

akan diberikan oleh Departemen EHS yang akan mencakup diskusi tentang semua

bahaya yang berhubungan dengan pekerjaan termasuk bekerja di ketinggian

4.1.5. Sub-contractors should create ACM work permit. The work permit is granted if approved

by the Project Manager & EHS Manager. Afterwards it is, sent to The Technical

Department. The contractor can then start the work upon reception for his work permit.

Sub kontraktor harus membuat Izin untuk Pekerjaan Penanganan ACM. Izin kerja

diberikan apabila disetujui oleh Manajer Proyek dan Manajer EHS. Setelah itu dikirim ke

Departemen Teknik, kontraktor dapat memulai bekerja setelah izin kerja disetujui atau

diterima.

4.1.6. Before any work can commence, the sub-contractor must provide and install a police line

around the work area and marked “ACM job is being carried out, Do Not Enter,

Authorized Personnel Only”. Before entering the ACM area all people need to be briefed

by the EHS Department about the nature of the ongoing works and need to be equipped

for the duration of the works with appropriate PPE.

Sebelum pekerjaan dapat dimulai, sub kontraktor harus menyediakan dan memasang

barikade di sepanjang area kerja dan diberi tanda "Pekerjaan ACM Sedang Dilakukan,

Tidak Boleh Masuk, Hanya Petugas yang Berwenang". Sebelum memasuki area ACM

semua orang perlu pengarahan oleh Departemen EHS tentang sifat dari pekerjaan yang

sedang berlangsung dan selama pekerjaan harus dilengkapi dengan APD yang sesuai.

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4.1.7. Appropriate PPE’s should be use at all times including disposable coveralls, hazmat,

safety googles, safety footwear, N-100 mask, body harness, and gloves (annex III).

APD yang tepat harus dipergunakan setiap saat termasuk pakaian kerja lengkap

(coverall), hazmat, kacamata keselamatan, sepatu keselamatan, respirator N-100, body

harness, dan sarung tangan (lampiran III).

4.1.7.1. Disposable coveralls should be used once to prevent the contamination. The used

disposable coverall should be bagged to predetermined container

Hazmat hanya digunakan sekali pakai untuk mencegah terjadinya kontaminasi.

Setelah dipakai, pakaian tersebut harus dibuang ke tempat penampungan yang

telah disediakan

4.1.7.2. Safety helmet and disposable gloves should also be worn.

Menggunakan helm dan sarung tangan sekali pakai saat pekerjaan berlangsung.

4.1.7.3. Cleanes the coverall from dust by using vaccum cleaner.

Bersihkan pakaian dari debu yang menempel dengan menggunakan vaccum

cleaner

4.1.7.4. After the work is completed, do vacuuming of coveralls and remove coveralls as

ACM waste

Setelah pekerjaan selesai, lakukan vacuum atau penyedotan pada pakaian dan

dibuang setiap hari diperlakukan seperti limbah asbes.

4.1.8. Before any work can commence, the entire area (building) must be cleaned of all debris

and dust. This must be conducted by using vacuums fitted with fibre filter and all debris

must be double bagged and disposed as asbestos waste. It is prohibited to brushed or

use of water.

Sebelum pekerjaan dilakukan, seluruh area (bangunan) harus dibersihkan dari semua

kotoran dan debu. Hal ini harus dilakukan dengan menggunakan Vacuums dilengkapi

dengan filter serat dan semua puing-puing harus dibungkus secara ganda dan dibuang

sebagai limbah asbes. Tidak diijinkan untuk disikat atau menggunakan air.

4.1.9. Before any roof sheets, ceiling and any others ACM are demolished the entire floor of the

building must be covered with a plastic sheet (with the thickness is 0,5 mm) and all joints

taped. All debris falling on to the plastic sheets after the roof work commences must be

treated as asbestos waste and handled accordingly.

Sebelum lembaran atap, plafon dan material ACM lainnya dibongkar seluruh lantai

bangunan harus ditutupi dengan lembaran plastik (dengan ketebalan 0,5 mm) dan semua

sambungan diisolasi. Semua puing-puing jatuh ke lembaran plastik setelah pekerjaan

atap dimulai harus diperlakukan sebagai limbah asbes dan ditangani sesuai prosedur.

4.1.10. Before removal the ACM sheets shall be sprayed with a water into both surfaces to bind

any loose fiber to the sheet thereby preventing its release. Both sides of the sheets should

be sprayed using water and special attention needs to be given to damaged areas/broken

comers as they are most sensitive for fiber release.

Sebelum pembersihan, lembaran ACM harus disemprot dengan air di kedua sisi nya

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untuk mengikat setiap serat longgar pada lembaran sehingga mencegah pembebasan

serat atau kontaminasi dengan udara. Kedua sisi dari sheet harus disemprot dengan air

dan perhatian khusus harus diberikan kepada bagian-bagian yang rusak / patah karena

bagian-bagian tersebut yang paling sensitif untuk terjadi pembebasan serat.

4.1.11. Power tools should never be used to release the sheets from their fixings. This should

only be done using a hand tool and be caution to not damage the sheets.

Daya listrik tidak boleh digunakan untuk melepaskan lembaran dari perlengkapannya. Ini

hanya harus dilakukan dengan menggunakan peralatan tangan dan berhati-hati untuk

tidak sampai merusak lembaran/sheet

4.1.12. When removing the sheets particular attention must be given to the overlaps as there may

be a buildup of fibers in these areas. Overlaps should be vacuumed with a vacuum fitted

with a fibre filter as the sheets are being removed. (Shadow vacuuming).

Do not damage material on purpose, do not drop material, do not throw material from

ladders or roof and do not drive over material. The method of removal cannot shatter,

crumble, pulverize, or reduce the material to dust. Place the ACM material on the ground

in a non-work area or in separate containers.

Saat melepas sheet, perhatian khusus harus diberikan kepada sheet yang berlapis

karena mungkin terjadi penumpukan serat. Pelapisan disedot dengan vacuum dilengkapi

dengan filter serat seperti lembaran yang sedang dibersihkan (shadow vaccum).

Jangan merusak material, jangan jatuhkan material, jangan membuang material dari

tangga atau atap dan tidak berjalan di atas material. Metode pembongkaran tidak bisa

dengan cara penghancuran, meruntuhkan, pelumatan, atau menghancurkan material

menjadi debu. Tempatkan material lembaran (sheet) ACM di tanah pada area non-kerja

atau dalam wadah terpisah.

4.1.13. When removing ACM roof sheets, the ACM sheets should be stacked on top of pallet to

eaves level and supported using a teleporter or other suitable pallet handling machine.

Ketika melakukan pembongkaran atap, lembar ACM harus ditumpuk di atas palet

diangkat ke atap dan didukung menggunakan teleporter atau penanganan pallet mesin

lainnya yang sesuai

4.1.14. These should then be lowered to ground level for double wrapping and labeling prior to

storage in a designated area.

Kemudian harus diturunkan sampai permukaan tanah untuk dibungkus ganda dan diberi

label sebelum penyimpanan di area yang telah ditentukan

4.1.15. This designated waste storage area should be properly cordoned off and suitable signs

erected to advise all of the contents and risks

Area limbah penyimpanan yang ditunjuk harus benar-benar diblok atau dipagari dan

diberi tanda untuk menginformasikan mengenai isi/konten dan risikonya.

4.1.16. At the end of each working day the debris falling on to the plastic sheets on the floor

must be removed for double bagging and storage prior to disposal. This should be

done using a vacuum fitted with fibre filter. Larger pieces of debris should be double

pg. 10


LPPKM FKM UI

bagged and evacuate to the assigned area for storing. This work area will be cleaned

by using vacuum mounted with HEPA filter.

Pada tiap pekerjaan selesai dilakukan, puing-puing yang jatuh ke lembaran plastik di

lantai harus dibersihkan untuk dibungkus ganda dan disimpan sebelum dibuang. Hal ini

harus dilakukan dengan menggunakan vakum dilengkapi dengan filter serat. Potongan

yang lebih besar harus dibungkus ganda dan pindahkan ke area yang telah disediakan

untuk menyimpan. Area tersebut harus dibersihkan dengan cara di vakum yang memakai

HEPA filter

4.1.17. A Quarantined place to temporarily store the old ACM sheets should be identified and

cordoned off.

Sebuah tempat sementara untuk meletakkan sisa/bekas penggantian ACM harus

diidentifikasi.

4.1.18. Walking on the roof sheets is strictly prohibited. Walking on the roof shall be done strictly

with aid of crawling boards / walkway constructed of either timber or aluminum and

completed with a hand rail. Workers who work at a height above 1.8 meters are required

to wear a full body harness. Before the demolition work start, a safety net should be

installed to prevent drop object/materials falling into the ground and can harm the workers

on the ground.

Berjalan pada lembaran atap sangat dilarang. Berjalan di atas atap harus dilakukan

secara ketat dengan bantuan papan pijakan / jalan terbuat dari kayu atau aluminium dan

dilengkapi dengan pegangan tangan. Pekerja yang bekerja pada ketinggian diatas 1.8

meter diwajibkan memakai full body harness. Jaring pengaman dipasang untuk

mencegah bahan material yang langsung jatuh ke bawah dan dapat membahayakan

pekerja yang berada di bawah sebelum pekerjaan pembongkaran dimulai dimulai.

4.1.19. The crawling boards / roof walkway shall be wide enough to enable the work to be carried

out safely and must be fitted with a hand rail, had space from the ACM sheets being

removed to conduct the work easier.

Papan pijakan harus cukup lebar untuk memungkinkan pekerjaan yang harus dilakukan

dengan aman dan harus dilengkapi dengan hand rail, ada jarak dari lembaran ACM yang

akan dilakukan pembongkaran agar memudahkan pekerjaan

4.1.8. A safe means of roof access and egress must be provided to minimize the risk of people

falling from height.

Sebuah cara aman utuk akses pada atap harus disediakan untuk meminimalkan risiko

pekerja jatuh dari ketinggian.

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4.1.9. Photographs of various activities shall be taken by sub contractor for record purposes,

ACM waste must be properly wrapped in double plastic, labeled symbol and labeled as

ACM waste on the container. The full project documentation must be kept for 60 years

and all ACM works must be added to the ACM register and kept in original in the EHS

Department as well as in copy by the HR/legal department.

Dokumentasi berbagai kegiatan harus diambil oleh sub kontraktor untuk keperluan

rekaman, limbah ACM harus benar dibungkus plastik ganda, diberikan simbol dan label

limbah ACM pada kemasan. Dokumentasi harus disimpan untuk 60 tahun kedepan dan

semua pekerjaan ACM harus ditambahkan atau di perbaharui di daftar ACM. Dokumen

asli dipegang oleh Departemen EHS dan salinan nya dipegang oleh Departemen

HR/Legal

4.1.10. Evacuated ACM is stored temporarily in the assigned place and the storage shall be

organized by the Technical department and EHS Department. The ACM sheets shall be

covered with tarpaulin and alerted with a safety line tied around metal poles awaiting

evacuation to the dump site.

Evakuasi ACM disimpan sementara di tempat yang sudah ditentukan dan dilakukan oleh

Departemen Teknik dan Departemen EHS, lembaran ACM harus ditutupi dengan terpal

dan diberi tanda/garis pembatas dan menunggu evakuasi selanjutnya.

4.1.11. All ACM handling at PT. Geo Dipa Energi have permanent supervision by EHS team to

check compliance with the ACM guidelines

Semua penanganan ACM di PT. Geo Dipa Energi harus mendapatkan pengawasan

langsung oleh Tim EHS untuk memeriksa kesesuaian dengan pedoman penanganan

ACM

4.1.12. When the work is completed the polythene cover on the floor must be cleaned and shall

be removed and disposed of as asbestos waste.

Ketika pekerjaan telah selesai, lapisan polythene di lantai yang telah dibersihkan harus

dibuang sebagai limbah asbes.

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4.1.13. After the demolition work has done, it is required to conduct air monitoring same as before

conducting of demolition work.

Setelah pekerjaan pembongkaran selesai, wajib melakukan montoring udara kembali

sama seperti sebelum dilakukannya pekerjaan pembongkaran

4.2. Emergency Condition Procedure / Prosedur Keadaan Darurat

In case of Emergency such as when the roof (which contains ACM) falling or briittle in the building

area which executing of demolition work, following some treatment must be applied;

Dalam keadaan darurat seperti ketika atap (yang mengandung ACM) jatuh atau rapuh di area bangunan

yang sedang dilakukan pembongkaran (demolish), berikut beberapa perlakuan yang diterapkan;

4.2.1. Sub-contractor workers must immediately contact the EHS

Pekerja sub kontraktor harus segera menghubungi EHS

4.2.2. EHS Department should immediately install the safety line (barricade) around ACM debris

Departemen EHS harus segera memasang barikade disekitar area runtuhan ACM

4.2.3. Sub-contractor provide required PPE for ACM handling

Sub kontraktor menyediakan seluruh peralatan pelindung diri untuk penanganan ACM

4.2.4. EHS Department make sure that the ACM removed to ACM Storage Area

Departemen EHS memastikan bahwa ACM dipindahkan ke Area Penyimpanan ACM

4.3. Dispose of PPE

For handling and containment of used PPE, container is required. For disposal of PPE which has been

used during the survey will be transported to PPLI/TLI (as accordance to Government Regulation No.

101/2014 regarding Hazardous Material Waste Management).

Untuk penanganan dan pewadahan APD yang telah dipakai, perlu disediakan wadah. Sementara

untuk pembuangan akhir APD yang telah digunakan akan dikirimkan ke PPLI/TLI (sesuai dengan

Peraturan Pemerintah No, 101 Tahun 2014 tentang Pengelolaan Limbah B3).

4.4. Dispose of asbestos waste

Asbestos waste will be handled, transported and disposed by sub-contractor (PPLI/TLI).

Limbah ACM akan dikelola, ditransportasikan dan dibuang oleh sub kontraktor (PPLI/TLI).

5. Implementation of Training/ Kegiatan Pelatihan

The training material, in detail regarding:

Materi pelatihan meliputi:

5.1. Procedure of demolition activities, starting to preparation phase, demolish activity phase,

and clearance phase.

Prosedur tentang kegiatan demolish, mulai dari tahap persiapan, pelaksanaan demolish

dan clearance

5.2. Procedure working at height

Prosedur bekerja di ketinggian

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5.3. The use required PPE

Penggunaan APD

5.4. Risk assessment of demolition asbestos.

Penilaian risiko untuk kegiatan asbestos demolish.

6. Schedule of Asbestos Demolition Activities

Activities February March April Mei June 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

Asbestos management plan

Procurement Process

Training

Asbestos demolition activities

Asbestos sampling

Asbestos analysis laboratory

Transportation ACM waste to disposal waste

Draft Report

Presentation

Final Report

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Appendix I/ Lampiran I

REFERENCE / REFERENSI

1. Safe Work Australia – Demolition Work: Code of Practice:

Safe Work Australia – Demolition Work: Code of Practice:

2. Managing Asbestos Guidelines, Sydney Australia

Managing Asbestos Guidelines, Sydney Australia

3. NIOSH Manual of Analytical Methods (NMAM) 7400 for asbestos air sampling and NIOSH Manual

of Analytical Methods (NMAM) 9002 for asbestos bulk sampling

NIOSH Manual of Analytical Methods (NMAM) 7400 untuk sampel asbes di udara and NIOSH

Manual of Analytical Methods (NMAM) 9002 untuk sampel asbes bulk

4. Government Regulation No. 101/2014 regarding Hazardous Material Waste Management

Peraturan Pemerintah No. 101 Tahun 2014 tentang Pengelolaan Limbah Bahan Berbahaya dan

Beracun

5. Government Regulation No. 22/2021 regarding Implementation of Environmental Protection and

Management

Peraturan Pemerintah No. 22 Tahun 2021 tentang Penyelenggaraan dan Pengelolaan Lingkungan

Hidup

6. Regulation Ministry of Manpower No. 3/1985 regarding Occupational Health and Safety the Use of

Asbestos

Peraturan Menteri Ketenagakerjaan No. 3 Tahun 1985 tentang Keselamatan dan Kesehatan Kerja

Pemakaian Asbes

pg. 15


LPPKM FKM UI

Appendix II/ Lampiran II

Sub-contractor Criteria

Kriteria Sub Kontraktor

1. Sub-contractor should have experience in carrying out asbestos demolition work in accordance to

Safe Work Australia – Demolition Work: Code of Practice and HSE UK HSG264 Asbestos: The

Survey Guide.

Sub kontraktor telah memiliki pengalaman melaksanakan pekerjaan demolish asbes sesuai

dengan Safe Work Australia – Demolition Work: Code of Practice dan HSE UK HSG264 Asbestos:

The Survey Guide.

2. Sub-contractor is required to involve the local workers during demolition activities. Local workers will be

trained by sub contractor and supervised by consultant (LPPKM FKM UI)

Sub kontraktor wajib melibatkan tenaga kerja lokal dalam pekerjaan demolish (pembongkaran). Pekerja

lokal akan diberikan pelatihan oleh sub kontraktor dan dalam pelaksanaan pekerjaan akan diawasi oleh

konsultan (LPPKM FKM UI).

3. Sub-contractor is required to requirement in the Scope of Work Demolishing Building Porject Dieng 2

For Sub-Contractor (Appendix IV).

Sub kontraktor wajib mengikuti persyaratan yang tertuang pada Scope of Work Demolishing Building

Project Dieng 2 For Sub-Contractor (Lampiran IV).

4. Sub-contractor should have work experience working at height.

Sub kontraktor memiliki pengalaman pekerjaan dengan bekerja di ketinggian.

5. Sub contractor should conduct demolition ACM work by follow Safe Work Method Statement (SWMS) in

this Appendix VI.

Sub kontraktor wajib melaksanakan pekerjaan demolish ACM dengan mengikuti Safe Work Method

Statement (SWMS) pada Lampiran VI

6. Sub-contractor should provide certified resources which refer to Scope of Work Demolishing Building

Porject Dieng 2 For Sub-Contractor, they are:

Safety Officer : Certified AK3 Umum

Scaffolder : Certified by Disnaker

Lifting Operator : Certified by Disnaker(K3 License/SIO)

Post Frame, Scaffolding pipe : JIS Standard

Runner Frame, Scaffolding pipe : JIS Standard

Diagonal Frame, Scaffolding pipe : JIS Standard

Sub kontraktor memiliki sumberdaya yang memiliki sertifikat merujuk pada Scope of Work Demolishing

Building Project Dieng 2 For Sub-Contractor, yaitu:

Safety Officer : Sertifikat AK3 Umum

Scaffolder : Sertifikat oleh Disnaker

Lifting Operator : Sertifikat oleh Disnaker (Lisensi K3/SIO)

Post Frame, pipa perancah : JIS Standard

Runner Frame, pipa perancah : JIS Standard

Diagonal Frame, pipa perancah : JIS Standard

pg. 16


LPPKM FKM UI

Appendix III / Lampiran III

Personal Protective Equipment / Alat Pelindung Diri 1. Respirator Using HEPA Filter / Masker menggunakan HEPA Filter

Ex : 3M 6000 Series Using HEPA Filter or 8233 Disposable Respirator P1 or P2

2. Disposable Coveralls (Hazmat) / Pakaian sekali pakai (Hazmat)

3. Rubber Boots / Sepatu Karet

pg. 17


LPPKM FKM UI

4. Cotton Rubber Glove / Sarung Tangan Kain Karet

5. Full Body Harness

6. Safety Helmet / Helm Keselamatan

7. Safety Googles/ Kacamata Keselamatan

pg. 18


LPPKM FKM UI

Appendix IV / Lampiran IV

SOW of Demolishing Building Project Dieng 2 for Sub Contractor.

Lingkup Pekerjaan Kegiatan Demolish Bangunan Asbes Proyek Dieng 2 untuk Sub Kontraktor

pg. 19


LPPKM FKM UI

SCOPE OF WORKS

DEMOLISHING BUILDING PROJECT DIENG 2

FOR SUB-CONTRACTOR

pg. 20


LPPKM FKM UI

Background

PT Geo Dipa Energi “GeoDipa” (Persero) or GDE

is State-owned Company of Geothermal that

committed to occupational health, safety and

environment management in company operational

activities. The development of Unit Dieng 2 and

Patuha, GDE committed to comply with

government regulation, environmental Impact

Analysis and IEE from the results of the ADB

study. Asbestos Containing Material (ACM) is

hazardous material which can cause asbestosis if

inhaled to the lung, and can caused mesothelioma

(lung cancer) for long term exposure.

PT. Geo Dipa Energi (Persero) planned to conduct

demolition work of ACM at ex-mess PLN building

(abandoned building) in Dieng, West Java, and

clearance the area for construction of Geothermal

Power Plant Unit Dieng 2. The building material is

suspected to contain asbestos. The ACM

management is required and the asbestos waste

management is required to manage in compliance

with MOEF regulations to minimize the impact to

environment and minimize the risk to the workers

and community. In ACM management, it is

required that a management plan and procedure

as guidelines for demolition work needs approval

by GDE and ADB.

PT. Geo Dipa Energi (Persero) needs assistance

from third party who has experience and

competency on asbestos demolition work

management. This asbestos demolition work

should comply to the international good practice

standard and to Indonesia regulation and standard

Latar Belakang

PT Geo Dipa Energi “GeoDipa” (Persero) atau GDE

sebagai Badan Usaha Milik Negara (BUMN) panas

bumi yang berkomitmen kepada pengelolaan

Kesehatan dan keselamatan kerja serta lindung

lingkungan didalam kegiatan operasional perusahaan.

Didalam pengembangan unit 2 Dieng dan Patuha

GDE berkomitmen untuk mengikuti pengelolaan

lingkungan sesuai dengan regulasi pemerintah,

Dokumen Amdal dan juga IEE hasil kajian ADB.

Asbestos containing material (ACM) merupakan

bahan berhaya yang dapat mengakibatkan asbestosis

apabila serat asbestos masuk kedalam paru – paru

yang dalam jangka waktu lama dapat mengakibatkan

mesothelioma (kanker paru).

PT Geo Dipa Energi (Persero) berencana untuk

melakukan demolition bangunan yang tidak terpakai

yang di ketahui sebagai ex mess PLN, di Dieng Jawa

Tengah dan pembersihan area untuk pembangunan

PLTP unit 2 Dieng. Material Bangunan dimungkinkan

mengandung asbestos / Asbestos Containing

Material. Pengelolaan ACM dalam demolish

diperlukan dan pengelolaan limbahnya yang di

lakukan dengan baik sesuai regulasi akan mengurangi

dampak terhadap lingkungan dan juga dampak

terhadap kesehatan masyarakat dan pekerja. Dalam

pengelolaan ACM diperlukan management plan dan

prosedur sebagai acuan dalam pelaksanaan yang di

setujui oleh GDE dan juga representative ADB.

Untuk itu PT Geo Dipa Energi (persero) memerlukan service dari pihak ketiga sub kontraktor yang mempunyai pengalaman didalam penanganan demolish asbestos. Pekerjaan ini harus mengikuti standar good practice standard international dan complience terhadap peraturan dan standard Indonesia.

pg. 21


LPPKM FKM UI

Objective

In this term of reference, asbestos demolition work

covers preparation, mobilization and

demobilization activities plan, transportation of

material/ work equipment, preparation, execution

and after demolishing activities (clearance); as

well as marking the area where the activity will be

carried out.

List of Job to be Carried Out

The activities that will be conducted for asbestos

demolition work are:

1. Preparation of demolition work

Sub-contractor should plan all work

equipment/material which will be used

for demolition work, as attached in

Appendix I – List of Work Equipment

and Manpower for Demolition Work of

Project Dieng 2.

Sub-contractor should conduct

erection of Scaffolding & Temporary

Bluesheet Fence, Work Platform &

handrail, Temporary Habitat, Space

Isolation wall for demolition work.

Sub-contractor should prepare

Vacuum HEPA filter, Work Platform,

Temporary terpaulin fence arround of

working site, Utility set and bowplank,

excavation, back fill, compaction of soil

surface, soil and silica disposal.

2. Execution of demolition work

Sub-contractor should conduct ACM

removal at roof; to avoid the release of

asbestos fiber, the asbestos

connecting tacks are sprayed with

water before its cutting.

Sub-contractor should provide a

quarantined place to temporarily store

the ACM.

Tujuan

Dalam kerangka acuan kerja ini adalah pekerjaan

asbestos demolish meliputi perencanaan persiapan

kegiatan mob demob, transportasi material/ peralatan

kerja saat persiapan, pelaksanaan, dan setelah

pekerjaan demolish (clearance); serta pemberian

tanda/ barikade dimana pekerjaan akan dilakukan.

Daftar Pekerjaan Yang Akan Dilaksanakan

Pekerjaan yang dilakukan untuk kegiatan asbestos

demolish adalah sebagai berikut;

1. Persiapan pekerjaan demolish

Sub kontraktor akan melakukan mob

demob semua peralatan/perlengkapan

kerja yang akan dipergunakan pada

pekerjaan asbestos demolish, seperti

terlampir pada Daftar Peralatan Kerja dan

Tenaga Kerja untuk Pekerjaan Demolish

Bangunan Project Dieng 2.

Sub kontraktor melakukan pemasangan

Scaffolding & Temporary Bluesheet Fence,

Work Platform & handrail, Temporary

Habitat, Space Isolation wall untuk

pekerjaan demolish bangunan.

Sub kontraktor mempersiapkan Vacuum

HEPA filter, memasang terpal disekitar area

kerja, utility set & bowplank, melakukan

penggalian, penimbunan, pemadatan

tanah, pembuangan tanah dan silika.

2. Pelaksanaan pekerjaan demolish

Sub kontraktor melakukan pembongkaran

material atap bangunan yang mengandung

asbes, untuk menghindarkan timbulnya

serat asbes maka paku payung

penyambung asbes disemport air terlebih

dahulu sebelum dilakukan pemotongan

Sub kontraktor menyediakan tempat

sementara untuk meletakkan material yang

mengandung asbes.

pg. 22


LPPKM FKM UI

Sub-contractor should ensure ACM waste is collected and removed for double bagging, labeled with symbol and labeled as ACM waste.

Sub-contractor should ensure the ACM sheets are covered with tarpaulin and alerted with a safety line tied around metal poles awaiting collection and final disposal of hazardous waste material and ACM waste through PPLI and TLI (final disposal). A Certificate of treatment will be issued by PPLI/ TLI.

Sub-contracture should ensure

handling and containment of used

PPE, plastic bag. The disposal of PPE

which has been used during the survey

will be transported to PPLI/TLI. A

Certificate of Treatment will be issued

by PPLI/TLI.


clearance of the area after demolition

work is done.

3. After Demolition Work (Clearance)


demobilization of work equipment.

4. Sub-contractor is required to comply HSE

rules, such as Job Safety Analysis (JSA),

work permit, safety induction, cit in duty,

procedures, etc.

5. Sub-contractor is required to enroll training

from consultant regarding demolition work

procedures before the work is conducted.

Phase of Work

The demolition work will be conducted gradually,

starting from 1st phase, i.e. main building and

laboratory, and will continue to 2nd phase parallelly

barrack 1 and barrack 2. The 3rd phase is barrack

3 building, polyclinic and security post.

Sub kontraktor memastikan limbah ACM harus

dikumpulkan dan dibungkus plastik ganda,

diberikan simbol dan label limbah ACM.

Sub kontraktor memastikan lembaran ACM

harus ditutupi dengan terpal dan diberi

tanda/garis pembatas dan menunggu

evakuasi selanjutnya (pembuangan akhir).

Sub kontraktor memastikan bahwa

penanganan dan pewadahan APD yang telah

dipakai ditempatkan dalam kantong plastic,

dan untuk pembuangan akhir APD yang telah

digunakan akan dikirimkan ke PPLI/TLI.

Sub kontraktor melakukan pembersihan area

setelah pekerjaan demolish.

3. Setelah Pekerjaan Demolish (Pembersihan)

Sub kontraktor melakukan demobilisasi peralatan

kerja.

4. Sub kontraktor diwajibkan untuk mematuhi

dokumentasi HSE, seperta Analisis Kerja Aman

(JSA), ijin kerja, induksi keselamatan, cit in duty,

prosedur, dan lainnya.

5. Sub kontraktor wajib mengikuti pelatihan dari

konsultan mengenai prosedur kerja pembongkaran

(demolish) sebelum pekerjaan dilaksanakan.

Tahapan Pekerjaan

Pekerjaan demolish dilaksanakan secara bertahap

dimulai dari tahap 1 yaitu bangunan utama dan

laboratorium, kemudian dilanjutkan tahap 2 secara

bersama-sama/paralel bangunan barrack 1 dan barrack

2. Tahap 3 adalah barrack 3, bangunan poliklinik dan pos

keamanan.

Work Material, Equipment and Manpower Peralatan dan Perlengkapan Kerja serta SDM

pg. 23


LPPKM FKM UI

Sub-contractor is required to provide work material

and equipment as well as manpower which

needed for demolition of ACM at each phase and

must complete the work of each phase according

to predefined schedule. The list of equipment and

manpower is enclosed in Appendix IV in this SOW.

Schedule of Work

Sub-contractor is required to complete the

demolition work according to predefined schedule

Sub Kontraktor wajib menyiapkan peralatan dan

perlengkapan kerja serta SDM yang diperlukan

untuk pekerjaan demolish ACM pada masing-

masing tahapan dan menyelesaikan pekerjaan

masing-masing tahap sesuai dengan jadwal yang

telah ditetapkan. Daftar peralatan kerja dan SDM

mengacu pada Lampiran IV dalam SOW ini.

Jadwal Pekerjaan

Sub kontraktor wajib menyelesaikan pekerjaan

demolish sesuai dengan jadwal yang telah

ditetapkan.

pg. 24


LPPKM FKM UI

Schedule of Demolition Work

Phase of Work February 2021 March 2021 April 2021 May 2021 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

Appointment of Sub Contractor

Preparation, Execution and Clearance of demolition work as well as demobilization:

1. Main building 2. Laboratory 3. Barrack 1 4. Barrack 2 5. Barrack 3 6. Polyclinic 7. Security post

pg. 25


LPPKM FKM UI

APPENDIX

LIST OF WORK EQUIPMENT, MANPOWER DEMOLISHING BUILDING WORK PROJECT DIENG 2

NO. DESCRIPTION QTY UNIT

SCOPE OF WORKS

REMARKS Sub-

Contractor PPLI or TLI

PT. Geo Dipa Energi

DEMOLISHING BUILDING PROJECT DIENG 2

1

Measuring & Marking

a. Main Building 180 m √

b. Barrack 1 56 m √

c. Barrack 2 57,8 m √

d. Barrack 3 58 m √

e. Laboratory 28 m √

f. Polyclinic 73,5 m √

g. Security Post 8 m √

2 Transportation, Material Delivery & Mob Demob

1,00 Ls √

3

Project Management Team (SPV, HSE)

1,00 Ls √

- Supervisor 1 person √ Not Certified ACM removal

- Safety Officer 2 person √ Certified AK3

Umum

- Scaffolder 4 person √ Certified by Disnaker

- Lifting Operator 2 person √ Certified by Disnaker(K3 License/SIO)

- Workers 1,00 Ls √

4 Astek/ BPJS 1,00 Ls √

5

Personal Protective Equipment (PPE) ;

1,00 Ls √

* Coverall √

* Safety Shoes √

* Safety Glasses (ANSI Z87.1-1989)

√

pg. 26


LPPKM FKM UI


SCOPE OF WORKS

REMARKS Sub-


PT. Geo Dipa Energi

* Safety Helmet MSA c/w chinstrap (ANSI Z89.1-1986)

√

* Mask Medium Masker Gas 3M 8233, N100

√

* Cotton hand glove √

* Hazmat √

* Full Body Harness √

6 HSE Programs ; 1,00 Ls √

B BUILDING PROJECT DIENG 2 (ASBESTOS-CONTAINING MATERIAL/ ACM REMOVAL)

1

Scaffolding & Temporary Bluesheet Fence

1,00 lot √ Temporary Habitat, Space Isolation wall for ACM Removal ;

* Post Frame, Scaffolding pipe 6m lght

√ JIS Standart,

rent

* Post Frame, Scaffolding pipe 4m lght

√ JIS Standart,

rent

* Runner Frame, Scaffolding pipe 6m lght

√ JIS Standart,

rent

* Diagonal Frame, Scaffolding pipe 6m lght

√ JIS Standart,

rent


√ JIS Standart,

rent


√ JIS Standart,

rent

* Work Platform √ Rent

* Jack Base (base √ Rent

pg. 27


LPPKM FKM UI


SCOPE OF WORKS

REMARKS Sub-


PT. Geo Dipa Energi

plate)

* Rigid Clamp √ Rent

* Swivel Clamp √ Rent

* Temporary terpaulin fence arround of working site ;

√ Rent

* Blower 2 pcs √ Rent

* Exhaust 2 pcs

2

Vacuum HEPA filter 1,00 lot √

- Rent Vacuum w/ HEPA Filter

√

3

Dismantle & dispose existing Roof Cover

m2 √

Main Building 2.500,00 m2 √

Barrack 1 620,00 m2 √

Barrack 2 1.090,00 m2 √

Barrack 3 640,00 m2 √

Laboratory 280,00 m2 √

Polyclinic 780,00 m2 √

Security Post 73,00 m2 √

- Chemical coating or sealing for existing roof, 2-sided

√

- Dismantling

existing roof √

- Wrapping for dismantled roof & ridge

√

4 Dismantling existing wooden roof frame & support

√

5 Dismantling existing ceiling

553,56 m2 √

pg. 28


LPPKM FKM UI


SCOPE OF WORKS

REMARKS Sub-


PT. Geo Dipa Energi

- Chemical oating or sealing for existing roof,work at an altitude

√

- Dismantling

existing plafond √

- Wrapping for dismantled plafond

√

6 Dismantling existing wall, Partition

- - - √

7 Dismantling existing doors & windows

- - - √

8 Dismantling existing Concrete (beam, column)

- - - √

9 Demolish existing floor - - - √

10

Removal of sanitation facility (septic tank, closet, etc)

- - - √

- Septictank (empty out)

- - - √

- Closet - - - √

- fill the septic tank with sand

- - - √

11 Removal of electrical panel at main building

√

C LAND PREPARATION

1 Access entrance to building

√

2 Silica temporary dumpsite cleaning at Main Building

√

3

Leveling and compaction of ground for scaffolding of foothold around the building

√

pg. 29


LPPKM FKM UI


SCOPE OF WORKS

REMARKS Sub-


PT. Geo Dipa Energi

D Electrical Power (generator set)

2 set √

E Asbestos Waste Transportation and Disposal

√

pg. 30


LPPKM FKM UI

Appendix V / Lampiran V

Training material of asbestos demolish building.

Materi pelatihan tentang kegiatan demolish bangunan yang mengandung asbes

pg. 31


LPPKM FKM UI

Appendix V I/ Lampiran VI

Safe Work Method Statement – Removal of Asbestos Containing Material and Minor Damage of ACM

Safe Work Method Statement – Removal of Asbestos Containing Material and Minor Damage of ACM

pg. 32


LPPKM FKM UI

pg. 33


LPPKM FKM UI

LPPKM FKM UI

PHASE 2 ASBESTOS SURVEY AND SAMPLING REPORT OF

EX-PLN BUILDING SITE [Subject]

DIENG, CENTRAL JAVA

PREPARED FOR:

PT GEO DIPA ENERGI (PERSERO) – DIENG UNIT 2 PROJECT

2

LPPKM FKM UI

PHASE 2 ASBESTOS SURVEY AND SAMPLING REPORT OF

EX-PLN BUILDING SITE [Subject]

DIENG, CENTRAL JAVA

-- REPORT OR PROJECT ID --


LPPKM FKM UI PT GEO DIPA ENERGI (Persero) –

DIENG UNIT 2 PROJECT

3

LPPKM FKM UI

REPORT CONTENTS

1. EXECUTIVE SUMMARY ........................................................................................ 5

2. INTRODUCTION .................................................................................................... 7

2.1 BACKGROUND ....................................................................................................... 7

2.2 OBJECTIVES .......................................................................................................... 7

2.3 SURVEY TEAM AND SCHEDULE ...................................................................... 8

2.4 LIMITATIONS OF THIS REPORT ............................................................................ 8

3. SAMPLING AND LABORATORY ANALYTICAL METHODS.............................. 9

3.1 ASBESTOS CONTAINING MATERIAL ...................................................................... 9

a. Sampling Location ............................................................................................ 9

b. ACM Samples Collected .................................................................................. 9

c. Laboratory Analysis ............................................................................................. 9

3.2 ASBESTOS ANALYSIS IN AMBIENT AIR ............................................................ 9

3.3 ASBESTOS ANALYSIS IN SOIL ............................................................................... 11

4. ASBESTOS ANALYTICAL RESULTS ................................................................ 12

4.1. SAMPLING AREA AND INFORMATION .......................................................... 12

4.2. ASBESTOS IN BULK SAMPLES ...................................................................... 13

4.3. AMBIENT AIR ANALYTICAL RESULTS ............................................................ 14

4.4. SOIL ANALYTICAL RESULTS .......................................................................... 14

5. CONCLUSIONS AND RECOMMENDATIONS ................................................... 15

4

LPPKM FKM UI

LIST OF FIGURES

LIST OF TABLES TABLE 1. SURVEY TEAM AND SCHEDULE ………………………………………………. 8

TABLE 2. BULK SAMPLE ANALYSIS RESULT

……………………………………………… 13

TABLE 3. AIR SAMPLE ANALYSIS RESULT

……………………………………………… 14

TABLE 4. SOIL ANALYTICAL RESULT ……………………………………………… 14

FIGURE 1. ASBESTOS SAMPLING LOCATIONS

WITHIN THE EX-PLN BUILDING SITE, DIENG …………………………………………. 5

5

LPPKM FKM UI

1. EXECUTIVE SUMMARY

The ‘Lembaga Pelayanan dan Pengabdian Kesehatan Masyarakat (LPPKM) - Fakultas

Kesehatan Masyarakat Universitas (FKM), Universitas Indonesia’ (UI) in Depok was

commissioned by PT. Geo Dipa Energi (Persero) in September 2020 to conduct a survey and

sampling of asbestos containing materials (ACM) that may exist in the building’s components

used at the ex-PLN building site in Karang Tengah village, Dieng in Central Java. The survey

and sampling of ACM is conducted in the following steps and reporting:

(i) Developing the preliminary asbestos survey proposal (Phase 1 survey);

(ii) Reporting the results of Phase 1 survey (dated 16 November 2020);

(iii) Developing the asbestos sampling and analysis proposal (Phase 2 survey);

(iv) Reporting the results of Phase 2 survey (“this report dated 22 December 2020”);

(v) Developing an asbestos management plan (AMP) as reference for GDE and its

contractor to conduct a safe demolition and removal of asbestos wastes.

Prior to conducting the asbestos surveys, the surveyors and GDE representatives reviewed

with the Asbestos Survey/Sampling Proposal to which ADB safeguard consultant provided

some inputs. These survey/sampling proposal and reporting reflects best industry practice,

enabling asbestos materials and wastes managed in systematic and sound manner. This report

presents the results of the Phase 2 survey, whereas the report of Phase 1 survey is reported

separately. Roof, ceiling, indoor and outdoor ambient air, and soil samples within the ex-PLN

buildings were collected for analysis using accredited laboratory as shown in Figure 1.

Note: 1: Ex-main building, 2: Ex-laboratory, 3: Ex-barrack 1, 4: Ex-barrack 2,

5: Ex-barrack 3, 6: Ex-polyclinic, 7: Ex-security post

Figure 1: Asbestos Sampling Locations within the ex-PLN building site, Dieng

6

LPPKM FKM UI

The samples were analyzed to detect the presence of Chrysotile asbestos in those samples1.

The analytical results of these samples indicate the following:

• 6 (six) samples collected from the roof of the ex-PLN buildings in Dieng i.e., the main

building, Barrack 1, Barrack 2, Barrack 3, laboratory, and polyclinic contain Chrysotile

asbestos. This amounts to approximately 6,000 m2 of asbestos roof.

• 6 (six) samples of ceiling from the ex-PLN buildings mentioned earlier do not contain

Chrysotile asbestos.

• 6 (six) indoor ambient air samples collected from the ex-main building, barrack 1, 2, 3,

laboratory, and clinic as well as 2 (two) outdoor ambient air samples collected from the ex-

main building and barrack 3 indicate 0.001 – 0.003 fibers/cc of air. The number of fibers

detected is well below the threshold value of 0.1 fiber/cc stipulated in the Ministry of

Manpower Regulation No. 5/2018 on Occupational and Health and Safety Standard.

• 2 (two) soil samples collected from near the main building and barrack 3 are not detected

to contain Chrysotile asbestos.

Based on the above result, an asbestos management plan shall be developed as reference for

GDE and its contract to conduct best practices and regulatory compliant demolition and disposal

of asbestos wastes from the ex-PLN buildings as the future site of Dieng power plant unit 2.

1 Chrysotile asbestos is the main type of asbestos reportedly exists in Indonesia (reference: Regulation of Ministry

of Manpower No. 5/2018 regarding Safety and Health of Work Environment, National Indonesia Standard (SNI) 1027-

2015 regarding Flat Cement Sheet and SNI 2050-2015 regarding Corrugated Cement Sheet, and Regulation of

Ministry of Health No.70/2016 regarding Environmental Health Standard at Industrial)

7

LPPKM FKM UI

2. INTRODUCTION

2.1 BACKGROUND

The ‘Lembaga Pelayanan dan Pengabdian Kesehatan Masyarakat (LPPKM) - Fakultas

Kesehatan Masyarakat Universitas (FKM), Universitas Indonesia’ (UI) in Depok was

commissioned by PT. Geo Dipa Energi (Persero) in September 2020 to conduct a

survey and sampling of potential asbestos containing materials (ACM) that may exist in

the building’s components used at the ex-mess PLN site in Karang Tengah village,

Dieng in Central Java. The asbestos survey was undertaken in two phases:

• The preliminary asbestos survey (PAS) or Phase 1 survey was conducted on 8 – 10

October based on the preliminary asbestos survey plan prepared by LPPKM-FKM UI

dated 3 October 2020 and approved by GDE on 5 October 2020. The key objective

of the PAS is, among other, to obtain accurate information on the location, amount,

and condition of suspected ACM, considering that GDE’s documentation on this

matter is lacking.

• The Phase 2 asbestos survey, involving sampling and analyzes of asbestos sample,

ambient air quality and soil, was conducted on 22 – 25 November 2020. The key

objective of this survey is, among other, to confirm the type of ACM present in the

roof and ceiling of the ex-mess PLN buildings and identify whether the ambient air

and soil within the site contain ACM. This report presents the results of this Phase 2

survey.

2.2 OBJECTIVES

The objectives of the Phase 2 asbestos survey are:

• to collect samples of the suspected asbestos containing materials (ACM) from the

roof and ceiling of the ex-mess PLN buildings;

• to collect ambient air quality and soil samples and analyze them for ACM;

• to analyze the samples using the laboratory accredited by the Indonesian

Accreditation Commission (Komisi Akreditasi Nasional);

• to obtain accurate information which parts of the building’s materials containing

asbestos or not; and

• to develop an appropriate asbestos management plan that will guide GDE and the

contractor (to be appointed) to safely demolish and remove the ACM based on the

results presented in this report.

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2.3 SURVEY TEAM AND SCHEDULE

The Phase 2 asbestos survey was conducted on behalf Lembaga Pelayanan dan

Pengabdian Kesehatan Masyarakat (LPPKM) FKM UI, Depok by key experts as follows:

• Lead asbestos surveyor : Dr. Sjahrul M. Nasri, MSc., Ind. Hyg.

• Leader of Sampling Team : Mr. Heickel, S.ST

• Technical assistance : Mr. Imam Santoso

The implementation of the Phase 2 asbestos survey was undertaken based on the

following schedule.

Table 1: Phase 2 Survey and Sampling Schedule in 2020

Activities November December January

3 4 1 2 3 4 1

Visit Project Area Dieng

Discussion and interview representative of PT. Geo Dipa Energi at Project Area Dieng

Site visit to collect samples of the suspected asbestos containing materials (ACM) for laboratory analyses

Laboratory analysis result

Report development

Submit the Phase 2 asbestos survey and sampling report to GDE

2.4 LIMITATIONS OF THIS REPORT

This survey of asbestos containing building materials was carried out in a professional

manner by experienced personnel. However, the extent of the survey was bound by the

limits of non-destructive methods which preclude any major physical damage to

equipment, walls, floors, partitions, etc. During this survey, every attempt was made to

inspect all ex-mess PLN buildings. This report contains approximate estimations of

quantities of ACMs only and not to be treated as specific or accurate measurements.

Drawings presented in this report are for illustration only and therefore not presented in

accurate scale.

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3. SAMPLING AND LABORATORY ANALYTICAL METHODS

3.1 ASBESTOS CONTAINING MATERIAL

Based on the results included in the PAS report (dated 16 November 2020) submitted

to GDE, the surveyors have taken roof and ceiling parts as samples of ACM. The

samples have been collected for analysis at the Industrial Hygiene and Occupational

Health Agency Laboratory – Ministry of Manpower, Jakarta. The accreditation certificate

of the laboratory is included in Appendix III.

Only small portions of the samples have been collected, as much as possible, without

causing any damage to the materials at a diameter size of approximately 3 – 5 cm.

However, the sampled material could not be replaced, and small damages could have

been caused during sampling. The hole possibly created in the material was attached

by using tape and/or spray glue. The equipment used for the ACM sampling are water

sprayer or sealant, duct tape, cutter, pliers, and plastic bag.

a. Sampling Location

The ACM samples, called bulk sampling, were collected from the roof and ceiling at all

ex-mess PLN buildings in Dieng as shown in Appendix II.

b. ACM Samples Collected

1 (one) ACM sample was taken of the roof and 1 (one) ACM sample was taken of ceiling

from each of the building, hence a total of 12 ACM samples were collected. The samples

were collected from:

• Roof Main Building

• Roof Barack 1

• Roof Barack 2

• Roof Barack 3

• Roof Laboratory

• Roof Clinic

• Ceiling Main Building

• Ceiling Barack 1



• Ceiling Laboratory

• Ceiling Clinic

c. Laboratory Analysis

The bulk sample analysis was performed by Polarized Light Microscope (PLM) of

NIOSH Manual of Analytical Methods (NMAM) 9002.

3.2 ASBESTOS ANALYSIS IN AMBIENT AIR

The ambient air sampling was conducted by using static sampling. The equipment

used are:

1. Sampling pump.

2. Asbestos media, three-piece cassette with ca. 50-mm electrically conductive

extension cowl and cellulose ester filter, 0.45-to 1.2-µm pore size, and backup pad.

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3. Flow calibrator

4. Tripod

5. Phase Contras of Microscope (PCOM), with Graticule, Walton-Beckett type

6. Acetone vaporization hot block.

• Pre-sampling

1. Make sure that the battery in the pump is enough for measurement for 8 hours.

2. Place the filter cassette (asbestos media) in the filter holder.

3. Connect the filter holder with the personal pump.

4. Perform calibration pre-flow by:

5. Connect the personal pump with the flow calibrator.

6. Activate the pump and flow calibrator, by pressing the ON button.

7. Set the air flow rate at 2 Liters per minute (LPM) +/- 5%.

8. After obtaining the flow rate as desired, record the flow rate as pre-flow calibration,

and turn off both devices.

9. Equipment are ready to use.

• Measurement

1. Place the ambient air sampling equipment at the designated sampling point

2. Activate the pump. Note: measurement location, start time

3. Sampling is carried out for 8 hours

4. When finished, turn off the equipment. Note: Time of measurement completion.

5. Perform post-flow calibration as during pre-flow calibration, note: the results of flow

rate measurements are post-flow calibration.

6. Remove the filter (asbestos media) from the filter holder, and close both ends.

7. Paste the information label on the cassette filter.

8. Send samples to the laboratory.


The ambient air samples were collected from eight locations (i.e., indoor and outdoor)

within ex-mess PLN building site in Dieng as shown in Appendix II.

b. Ambient Air Samples Collected

Ambient air sampling was collected indoor and outdoor due to the different condition

each part inside the roof and ceiling. In course of air sampling in buildings (indoor),

due to different conditions of the inside of the roof and ceiling, the possibility of

asbestos fibers can be released in each building also different, hence 1 (one) sample

of ambient air was collected from each building. For the outdoor air sampling, due to

the homogeneous environmental condition only 2 (two) outdoor air sampling samples

were taken, i.e., at the main building and barrack 3.

A total of 8 (eight) ambient air samples were collected, in details:

• 1 Outdoor Main Building with Volume Sampel = 812 L

• 1 Outdoor Barack 3 with Volume Sampel = 807 L

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• 1 Indoor Main Building with Volume Sampel = 809 L

• 1 Indoor Barack 3 with Volume Sampel = 816 L

• 1 Indoor Barack 2 Volume Sampel = 808 L

• 1 Indoor Barack 1 with Volume Sampel = 816 L

• 1 Indoor Laboratory with Volume Sampel = 813 L

• 1 Indoor polyclinic with Volume Sampel = 813 L


The ambient air sample analysis was performed by Phase Contrast Microscope (PCM)

method used Indonesia National Standard (SNI) 16 – 7059 – 2004 and NIOSH Manual

of Analytical Methods (NMAM) 7400.

3.3 ASBESTOS ANALYSIS IN SOIL

Soil sampling are carried out by taking a small part of the soil using a cement

taper/trowel and put in a plastic bag, then labeled.


The sampling location for the soil are outside the main building and outside the

barrack 3 building as shown in Appendix II.

b. Soil Samples Collected

A total of 2 (two) soil sample were collected as a representative of all the building

location, due to it is assumed that the roof, soil, and vegetation conditions at outside

of all buildings are relatively homogeneous.


The soil analysis was performed by Polarized Light Microscope (PLM) NIOSH

Manual of Analytical Methods (NMAM) 9002.

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4. ASBESTOS ANALYTICAL RESULTS

4.1. SAMPLING AREA AND INFORMATION

The following buildings at the ex-mess PLN site, covering an area of approximately 6

hectares were inspected:

• Main building (roof, ceiling, wall, floor and, surrounding of building).

• Barrack 1, 2 and 3 (roof, ceiling, wall, floor and, surrounding of building)

• Laboratory building (roof, ceiling, wall, floor and, surrounding of building)

• Polyclinic building (roof, ceiling, wall, floor and, surrounding of building).

• Security post (roof, ceiling, and surrounding of building).

Estimated areas of the buildings including related components are as follows:

a. Main building

• Roof : 2,500 m2

• Ceiling: 216 m2

• Wall : 720 m2

• Floor : 1,008 m2

b. Barrack 1

• Roof : 620 m2

• Ceiling : 67.20 m2

• Wall : 320 m2

• Floor : 20 m x 8 m = 160 m2

c. Barrack 2

• Roof : 1,090 m2


• Wall : 320 m2

• Floor : 170.98 m2

d. Barrack 3

• Roof : 640 m2


• Wall : 320 m2

• Floor : 20.70 x 8.3 = 171.81m2

e. Laboratory building

• Roof : 280 m2


• Wall : 160 m2

• Floor : 48 m2

f. Polyclinic building

• Roof : 780 m2

• Ceiling : 88.2 m2 • Wall : 400 m2

• Floor : 270 m2

g. Security post

• Roof : 73 m2


• Wall : 6 m2

• Floor : 4 m2

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4.2. ASBESTOS IN BULK SAMPLES

A complete list of all analytical results of the bulk samples from the roof and ceiling of

all ex-mess PLN buildings are displayed in the following table. The laboratory results

confirm that all samples collected from the roof contain chrysotile asbestos and,

therefore considered as hazardous wastes if these materials are to be demolished and

safely disposed. All samples collected from the ceiling do not indicate the presence of

Chrysotile asbestos.

Table 2: Asbestos Analytical Result in Bulk Samples

Building Sampling Location

Product Type Analytical Result Quantity

Roof

Roof Main Building Administrative office building (temporary storage of silica scale)

Solid corrugated roof

Chrysotile asbestos detected

2,500 m2

Roof Barrack 1 Roof building Solid corrugated roof


620 m2



1,090 m2



640 m2

Roofing laboratory Laboratory room Solid corrugated roof


280 m2

Roofing polyclinic Polyclinic room Solid corrugated roof


780 m2

Total roof area 5,910 m2

Ceiling

Main Building Main building Flat Sheet Ceiling material

No chrysotile asbestos detected

216 m2

Outer Ceiling Barrack 1

Room building Flat Sheet Ceiling material


67.20 m2




69.36 m2




69.6 m2

Outer Ceiling laboratory



33.6 m2

Outer Ceiling Polyclinic

Polyclinic room Flat Sheet Ceiling material


88.2 m2

Total ceiling area 543.96 m2

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4.3. AMBIENT AIR ANALYTICAL RESULTS

The laboratory analytical results of ambient air collected at eight locations within the ex-mess

PLN buildings in Dieng indicate asbestos contents of 0.001 to 0.003 fibers/cc. This number

of fibers detected in the ambient is well below the threshold value of 0.1 fiber/cc stipulated in

the Ministry of Manpower Regulation No. 5/2018 on Occupational and Health and Safety

Standard.

Table 3: Ambient Air Analytical Result

No. Location Sampling Location

Analytical Result

(fibers/cc) Methods

Fiber Concentration TLV (fibers/cc)

1 Main building Indoor 0.001 SNI. 16 – 7059 - 2004 0.1

2 Main building Outdoor 0.002 SNI. 16 – 7059 - 2004 0.1

3 Barrack 1 Indoor 0.002 SNI. 16 – 7059 - 2004 0.1

4 Barrack 2 Indoor 0.003 SNI. 16 – 7059 - 2004 0,1

5 Barrack 3 Indoor 0.001 SNI. 16 – 7059 - 2004 0.1

6 Barrack 3 Outdoor 0.001 SNI. 16 – 7059 - 2004 0.1

7 Laboratory Indoor 0.002 SNI. 16 – 7059 - 2004 0,1

8 Polyclinic Indoor 0.001 SNI. 16 – 7059 - 2004 0.1

4.4. SOIL ANALYTICAL RESULTS

The laboratory analytical results indicate no chrysotile asbestos content in the soil samples collected outside the main building and barrack 3 at the ex-PLN building site.

Table 4: Soil Analytical Result

No. Sampling location Samples Analytical Result

1 Outside main building Surface soil No chrysotile asbestos detected

2 Outside barrack 3 Surface soil No chrysotile asbestos detected

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5. CONCLUSIONS AND RECOMMENDATIONS

The conclusions drawn from the Phase 2 asbestos survey, including sampling and laboratory analysis, are as follow:

• 6 (six) samples of roofing sheet collected from the ex-PLN buildings in Dieng i.e., the main building, Barrack 1, Barrack 2, Barrack 3, laboratory, and polyclinic contain Chrysotile asbestos.

• 6 (six) samples of ceiling from the ex-PLN buildings mentioned earlier do not contain Chrysotile asbestos.

• 6 (six) indoor ambient air samples collected from the ex-main building, barrack 1, 2, 3, laboratory, and clinic as well as 2 (two) outdoor ambient air samples collected from the ex-main building and barrack 3 indicate 0.001 – 0.003 fibers/cc of air. The number of fibers detected is well below the threshold value of 0.1 fiber/cc stipulated in the Ministry of Manpower Regulation No. 5/2018 on Occupational and Health and Safety Standard.

• 2 (two) soil samples collected from near the main building and barrack 3 are not detected to contain Chrysotile asbestos.

Based on the above conclusions, the roof in all of the ex-PLN buildings in Dieng, when demolished, must be managed according to the requirements of Government Regulation (Peraturan Pemerintah) No. 101/2014 regarding Hazardous and Toxic Waste Management. Therefore, an asbestos management plan according to the requirements of HSE UK Asbestos: The Survey Guide HSG 264 and the aforementioned government regulation as guideline for GDE and its contractor to conduct a safe demolition and removal of asbestos wastes.

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APPENDIX I APPROVED JOB SAFETY ANALYSIS

Job Safety Analysis (JSA) for Site and Building Inspection

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Job Safety Analysis (JSA) for Working at Height

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Job Safety Analysis (JSA) for Asbestos Bulk Sampling

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Job Safety Analysis (JSA) for Soil Sampling

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Job Safety Analysis (JSA) for Air Sampling

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APPENDIX II SAMPLING LOCATIONS

- Main Building

- Laboratory

- Barrack 1

Indoor air Sampling point

Outdoor air Sampling point

Soil (bulk) sampling point

Roof bulk sampling Ceiling

bulk sampling


Roof bulk

sampling

Ceiling bulk sampling


Roof bulk sampling


Entrance

Entrance

Entrance

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- Barrack 2

- Barrack 3

- Polyclinic



Soil Sampling Outdoor air Sampling point


Roof bulk sampling


Entrance

Entrance

Roof bulk sampling


Roof bulk sampling


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APPENDIX III LABORATORY ANALYTICAL RESULTS

Bulk Sampling Analysis

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Air Sampling Analysis

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APPENDIX IV LABORATORY ACCREDITATION CERTIFICATE

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-

APPENDIX V

PHOTOS TAKEN DURING THE FIELD SAMPLING

No. Location Photos

1 Bulk sample at main building

2 Bulk sample at barrack 1


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No. Location Photos


5 Bulk sample at laboratory

6 Bulk sample at clinic

7 Indoor air sampling

main building

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No. Location Photos

8 Outdoor air sampling main building

9 Indoor air sampling barrack 1


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No. Location Photos


12 Outdoor air sampling barrack 3

13 Indoor air sampling laboratory

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No. Location Photos

14 Indoor air sampling clinic

15 Soil sample outside the main building

16 Soil sample outside barrack 3

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No. Location Photos

17 PPE for Sampling

LPPKM FKM UI

PRELIMINARY ASBESTOS SURVEY REPORT

PT. GEO DIPA ENERGI – PROJECT DIENG 2

DIENG, CENTRAL JAVA

PREPARED FOR:

PT GEO DIPA ENERGI – PROJECT DIENG 2

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PRELIMINARY ASBESTOS SURVEY REPORT

PT. GEO DIPA ENERGI – PROJECT DIENG 2

DIENG, CENTRAL JAVA

-- REPORT OR PROJECT ID --


LPPKM FKM UI PT GEO DIPA ENERGI – PROJECT

DIENG 2

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INDEX

REPORT CONTENT

1. EXECUTIVE SUMMARY ........................................................................................ 6

2. INTRODUCTION .................................................................................................... 8

2.1. BACKGROUND ....................................................................................................... 8

2.2. OBJECTIVE AND THE SCOPE OF THE PRELIMINARY ASBESTOS SURVEY ........ 8

2.3. SURVEY TEAM AND SCHEDULE ...................................................................... 9

2.4. LIMITATIONS OF THE SURVEY/REPORT ............................................................ 9

3. METHODOLOGY/REPORTING OF THE PRELIMINARY ASBESTOS SURVEY10

3.1. EHS RISK ASSESSMENT TO CONDUCT THE SURVEY ............................... 10

3.2. SITE AND BUILDING INSPECTION ..................................................................... 10

3.3. MATERIAL ASSESSMENT AND PRIORITY ASSESSMENT OF SUSPECTED ACM

10

4. PRELIMINARY ASBESTOS SURVEY RESULT ................................................ 11

4.1. SITE EQUPIMENT AND INFORMATION ......................................................... 11

4.1.1. Desk research ............................................................................................. 13

4.1.2. Interview Results ......................................................................................... 14

4.2. SUSPECTED ASBESTOS CONTAINING MATERIALS ................................... 15

4.3. NOT SUSPECTED ASBESTOS CONTAINING MATERIAL ............................................. 23

4.4. INVENTORY OF SUSPECTED ACM ................................................................ 27

4.5. MATERIAL ASSESSMENT AND PRIORTY ASSESSMENT ........................... 27

5. PROPOSED SAMPLING METHODS .................................................................. 38

5.1. SAMPLING METHOD........................................................................................ 38

5.2. TOTAL SAMPLE(S) ........................................................................................... 38

5.3. SAMPLING LOCATION ..................................................................................... 38

5.4. SCHEDULE FOR SAMPLING ........................................................................... 41

5.5. EXPERTISE ....................................................................................................... 41

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LIST OF TABLES TABLE 1. SURVEY TEAM AND SCHEDULE ………………………………………………. 9

TABLE 2. NON-SUSPECTED ASBESTOS CONTAINING MATERIAL ……………………………………………… 23

TABLE 3. MATERIAL ASSESSMENT ALGORITHM ……………………………………………… 27

TABLE 4. PRIORITY ASSESSMENT ALGORITHM

……………………………………………… 29

TABLE 5. SUMMARY OF RESULT OF MATERIAL ASSESSMENT AND PRIORITY ASSESSMENT

……………………………………………… 31

TABLE 6. SUSPECTED ASBESTOS CONTAINING MATERIAL SUMMARY ……………………………………………… 32

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LIST OF FIGURES

FIGURE 1. SITE PLAN OF DIENG PROJECT 2

…………………………………. 13

FIGURE 2. MAIN BUILDING AND LABORATORY

…………………………………. 14

FIGURE 3. BARRACK 1 AND BARRACK 2

…………………………………. 14

FIGURE 4. BARRACK 3 …………………………………. 14

FIGURE 5. POLYCLINIC

…………………………………. 14

FIGURE 6. SECURITY POST

…………………………………. 14

FIGURE 7. MAIN BUILDING, ROOF OF MAIN

BUILDING

…………………………………. 16

FIGURE 8. CEILING MAIN BUILDING, SILICA

TEMPORARY DUMPSIT

…………………………………. 16

FIGURE 9. LABORATORY, ROOF OF LABORATORY,

CEILING OF LABORATORY

…………………………………. 17

FIGURE 10. BARRACK 1, ROOF OF BARRACK 1,

CEILING OF BARRACK 1

…………………………………. 18



…………………………………. 19



…………………………………. 20

FIGURE 13. POLYCLINIC, ROOF OF POLYCLINIC,

CEILING OF POLYCLINIC

…………………………………. 21

FIGURE 14. SECURITY POST …………………………………. 22

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1. EXECUTIVE SUMMARY

The ‘Lembaga Pelayanan dan Pengabdian Kesehatan Masyarakat (LPPKM) - ‘Fakultas

Kesehatan Masyarakat Universitas (FKM), Unversitas Indonesia’ (UI) in Depok was commissioned

by PT. Geo Dipa Energi (Persero) or GDE to conduct an asbestos survey at the ex-mess PLN

building site in Dieng, Central Java, Indonesia.

The ex-mess PLN building suspected contains asbestos containing materials (ACM), primarily in

its roofs and ceiling, and this building will be demolished as part of land clearing required for

construction of future Dieng Unit 2 power plant. The ACM is generally recognized as hazardous

materials and its wastes must be managed according to the requirements of Government

Regulation No. 101/2014. Therefore, asbestos survey and sampling are required to enable

development and execution of asbestos demolition plan to meet ADB’s requirements as well as

comply with the prevailing regulations in Indonesia.

The objectives of the PAS are to obtain accurate information project on the location, amount and

condition of suspected asbestos-containing materials (ACMs); to identify the location of suspected

ACM to be sampled and the number of samples required; to identify all the suspected ACMs to be

removed before demolition work; to assess the level of damage or deterioration in the suspected

ACMs; and to develop an asbestos algorithm and priority.

The PAS was carried out in a professional manner by experienced LKPPM – FKM of UI personnel

using non-destructive method i.e., visual observations. Surveyors conducted the preliminary

survey based on job safety analysis (JSA) which have been made before site visit.

Prior to conducting the PAS, the surveyors and GDE representatives reviewed the survey plan to

which ADB safeguard consultant provided some inputs. The PAS plan was then revised and

mutually approved by the surveyors and GDE on 5 October 2020. Based on this approval, the

surveyors mobilized to Dieng and conducted the site/building inspection on 8 to 10 October 2020.

Survey methodology involving desk research, conduct interview the PT. GDE representative from

head office and representative of Dieng Project, and observation by visit the project area.

In the course of the visit it, the surveyors developed an inventory and sampling plan for any material

being eventually suspicious of ACM. Every set of building material appears similar and performs

the same function is grouped together under the denomination “Homogeneous Sample Group”

and presented as a “source”. The surveyors made a photographic report to incorporate the

images to the report for every source (group of homogeneous samples), as well as for any

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especially relevant event, such as breakages, damages by water, very much crumbled materials,

etc.

Based on preliminary survey result, the suspected area ACM are roof and ceiling of each building

from total 7 buildings, i.e.: roof of main building 2.500 m2, ceiling of main building 216 m2, roof of

barrack (1) 620 m2, ceiling of barrack (1) 67,20 m2, roof of barrack (2) 1.090 m2, ceiling of barrack

(2) 69,36 m2, roof of barrack (3) 640 m2, ceiling of barrack (3) 69,6 m2, roof of laboratory 280 m2,

ceiling of laboratory 33,6 m2, roof of polyclinic 780 m2, ceiling of polyclinic 88,2 m2, roof of security

post 73 m2, and ceiling of security post 9,6 m2. Meanwhile, the area suspected non ACM are wall

and floor parts of each building from total 7 buildings.

In the surrounding of building are plantation/vegetable farms, meanwhile in main building still has

active electrical box panels and is used by GDE as temporary dumpsite for silica scaling. While

conducting survey, there were not found of isolation of services, gas, chemicals, working

machinery or plant, and presence of underground ducts or shafts.

The material which assessed due to suspected ACM are roof and ceiling. Material assessment

itself explained: (1) Material assessment algorithm, i.e. to obtain the product type; extent of

damage or deterioration; surface treatment; and asbestos type; (2) Priority assessment Algorithm,

involve: Normal occupant activity, Likelihood of disturbance, Human exposure potential,

Maintenance activity.

The condition of roof and ceiling are severely damage, crack, and friable, it has possibility the

suspected asbestos fibres release into the ambient air. It is recommended to take bulk sampling

for roof and ceiling materials, and also recommended to take air sampling and soil sampling.

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2. INTRODUCTION

2.1. BACKGROUND

The ‘Lembaga Pelayanan dan Pengabdian Kesehatan Masyarakat (LPPKM) - ‘Fakultas

Kesehatan Masyarakat Universitas (FKM), Unversitas Indonesia’ (UI) in Depok was

commissioned by PT. Geo Dipa Energi (Persero) or GDE to conduct an asbestos survey at the ex-

mess PLN building site in Dieng, Central Java, Indonesia. The asbestos survey will be conducted

in stages, with the preliminary asbestos survey (“the PAS”) was performed on 8 to 10 October

2020. The survey was conducted based on the preliminary asbestos survey plan prepared by

LPPKM-FKM UI (dated 3 October 2020) and approved by GDE on 5 October 2020.

The ex-mess PLN building suspected contains asbestos containing materials (ACM), primarily in

its roofs and ceiling, and this building will be demolished as part of land clearing required for

construction of future Dieng Unit 2 power plant. The ACM is generally recognized as hazardous

materials and its wastes must be managed according to the requirements of Government

Regulation No. 101/2014. Therefore, asbestos survey and sampling are required to enable

development and execution of asbestos demolition plan to meet ADB’s requirements as well as

comply with the prevailing regulations in Indonesia.

2.2. OBJECTIVE AND THE SCOPE OF THE PRELIMINARY ASBESTOS SURVEY

The objectives of the PAS are to:

• to obtain accurate information project on the location, amount and condition of suspected

asbestos-containing materials (ACMs);

• to identify the location of suspected ACM to be sampled and the number of samples required;

• to identify all the suspected ACMs to be removed before demolition work;

• to assess the level of damage or deterioration in the suspected ACMs; and

• to develop an asbestos algorithm and priority.

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LPPKM FKM UI

2.3. SURVEY TEAM AND SCHEDULE

This preliminary survey conducted on behalf Lembaga Pelayanan dan Pengabdian Kesehatan

Masyarakat (LPPKM) FKM UI, Depok.

Personnel which conducted this survey are:

1. Lead asbestos surveyor : Dr. Sjahrul M. Nasri, MSc., Ind. Hyg.

2. Surveyor : Fiori Amelia Putri, SKM

3. Technical assistance : Imam Santoso

Table 1

Survey Team and Schedule

Activities October

1 2 3 4

Visit Project Area Dieng

Discussion and interview representative of PT. Geo Dipa Energi at Project Area Dieng

Site visit to:

• obtain accurate information project on the location, amount and condition of suspected asbestos-containing materials (ACMs);

• identify the location of suspected ACM to be sampled and the number of samples required;

• identify all the suspected ACMs to be removed before demolition work;

• assess the level of damage or deterioration in the suspected ACMs; and

• develop an asbestos algorithm and priority

Report development

Submit preliminary report

2.4. LIMITATIONS OF THE SURVEY/REPORT

The results of the PAS described in this report include: survey methodology; suspected ACM

information as obtain based on building inspection; and develop an asbestos algorithm and priority.

The PAS was carried out in a professional manner by experienced LKPPM – FKM of UI personnel

using non-destructive method i.e., visual observations. However, the extent of this PAS was bound

by the limits of non-destructive methods which preclude any major physical damage to equipment,

walls, floors, partitions, etc. Thus, while the surveyors are confident that all suspected ACM have

been identified and assessed, no guarantees are made that the surveyed ex-mess PLN building

is absolutely free of asbestos. Future demolition activities may well reveal asbestos containing

materials in areas inaccessible by the surveyors.

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3. METHODOLOGY/REPORTING OF THE PRELIMINARY ASBESTOS SURVEY

3.1. EHS RISK ASSESSMENT TO CONDUCT THE SURVEY

Surveyors conducted the preliminary survey based on job safety analysis (JSA) which have

been made before site visit. JSA enclosed in Appendix I.

3.2. SITE AND BUILDING INSPECTION

- Prior to conducting the PAS, the surveyors and GDE representatives reviewed the survey plan

to which ADB safeguard consultant provided some inputs. The PAS plan was then revised

and mutually approved by the surveyors and GDE on 5 October 2020. Based on this approval,

the surveyors mobilized to Dieng and conducted the site/building inspection on 8 to 10 October

2020.

- The field works started with an inspection visit throughout the building perusing the drawings,

in order to visually ascertain the existence of suspected ACM. All mechanical systems, floors,

walls, ceilings, and insulation of any kind were inspected as far as they were visible and

accessible.

- In the course of the visit it, the surveyors developed an inventory and sampling plan for any

material being eventually suspicious of ACM. Every set of building materials appears similar

and performs the same function is grouped together under the denomination “Homogeneous

Sample Group” and presented as a “source”. The surveyors made a photographic report to

incorporate the images to the report for every source (group of homogeneous samples), as

well as for any especially relevant event, such as breakages, damages by water, very much

crumbled materials, etc.

3.3. MATERIAL ASSESSMENT AND PRIORITY ASSESSMENT OF SUSPECTED ACM

The material assessment including: (1) Material assessment algorithm, i.e. to obtain the product

type; extent of damage or deterioration; surface treatment; and asbestos type; (2) Priority

assessment Algorithm, involve: Normal occupant activity, Likelihood of disturbance, Human

exposure potential, Maintenance activity.

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4. PRELIMINARY ASBESTOS SURVEY RESULT

4.1.SITE EQUPIMENT AND INFORMATION

The following buildings at the ex-mess PLN site, covering an area of approximately 6

hectares were inspected:

- Main building (roof, ceiling, wall, floor and, surrounding of building).

- Barrack 1, 2 and 3 (roof, ceiling, wall, floor and, surrounding of building)

- Laboratory building (roof, ceiling, wall, floor and, surrounding of building)

- Polyclinic building (roof, ceiling, wall, floor and, surrounding of building).

- Security post (roof, ceiling, and surrounding of building).

Estimated areas of the buildings including related components are as follows:

a. Main building

• Roof : 2,500 m2

• Ceiling : 216 m2

• Wall : 720 m2

• Floor : 1,008 m2

b. Barrack 1

• Roof : 620 m2


• Wall : 320 m2

• Floor : 20 m x 8 m = 160 m2

c. Barrack 2

• Roof : 1,090 m2


• Wall : 320 m2

• Floor : 170.98 m2

d. Barrack 3

• Roof : 640 m2


• Wall : 320 m2

• Floor : 20.70 x 8.3 = 171.81m2

e. Laboratory building

• Roof : 280 m2


• Wall : 160 m2

• Floor : 48 m2

f. Polyclinic building

• Roof : 780 m2


• Wall : 400 m2

• Floor : 270 m2

g. Security post

• Roof : 73 m2


• Wall : 6 m2

• Floor : 4 m2

The buildings in the ex-mess PLN complex were constructed around 1985 and suspected to

use ACM roofing and harplex ceiling. All 6 (six) buildings in the complex are abandoned, were

not maintained, and most of building are severely damaged, such as roofing, ceiling, wall, and

floor condition. The number of building are 6 building in total with the number of rooms:

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• Main building : 21 rooms ● Barrack 3 : 4 rooms

• Barrack 1 : 4 rooms ● Laboratory : 1 room

• Barrack 2 : 4 rooms ● Polyclinic : 3 room

• Security post : 1 room

- In the surrounding of building are plantation/vegetable farms such as cabbage, potato, and

carrot of surrounding people.

- The main building still has active electrical box panels and is used by GDE as temporary

dumpsite for silica scaling generated by the operation of Dieng Unit 1 power plant.

- On course of the PAS, the followings were not found: isolation of services, gas, chemicals,

working machinery or plant, and presence of underground ducts or shaft.

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4.1.1. Desk research

The following information was available for desk-research:

- Site maps

Figure 1

Site Plan of Dieng Project 2

2

3 4

6

7

5

1

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Figure 2

1. Main Building

2. Laboratory

Figure 3

3. Barrack 1

4. Barrack 2

The following information was taken using satellite, i.e. some parts of building are suspected

contain asbestos containing material (ACM), such as roofing and ceiling.

4.1.2. Interview Results

The following interviews were conducted at head office and on site:

- Mr. Andhika Yudiaji, HSE Assistance Manager Corporate

- Mr. Cahyo, Superintendent Project of Dieng

- Mr. Sholimin, EHS Officer of Dieng

The following information were conducted with Mr. Andhika:

- Area of ex-mess PLN will be used for geothermal power plant construction.

- Roofing part material use harplex material for roof and ceiling.

- Area and building in Project Dieng location will be demolished for geothermal power

plant construction Project Dieng 2.

The following information were conducted with Mr. Cahyo

Figure 4

5. Barrack 3

Figure 5

6. Polyclinic

1

2

3 4

6

7

Figure 6

7. Security post

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- In the end of year 2020 will be started the land clearing activities demolished for

geothermal power plant construction Project Dieng 2.

The following information were conducted with Mr. Sholimin

- The main building is using as silica temporary dumpsite.

- In the surrounding of building are plantation/vegetable farms such as cabbage, potato,

and carrot of surrounding people.

- There was electrical current to electrical panel box at the main building.

There were no isolation of services, gas, chemicals, working machinery or plant, presence of

underground ducts or shafts, and no access area of pathway to building.

4.2. SUSPECTED ASBESTOS CONTAINING MATERIALS

A complete list of all suspected contain asbestos materials are displayed in this report In this

report are the results of the visual inspection. Pictures in the report are also included for the

visualization the examined materials.

The location of the suspected ACM in the pictures, the following color codes:

- Pictures showing a red color, is suspected asbestos material.

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Main building layout:

Suspected ACM for roofing and ceiling

Figure 7

(left) Main building, (right) roof of main building

Figure 8

(left) ceiling main building, (right) silica temporary dumpsite

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Laboratory layout:


Figure 9

(left) laboratory, (center) roof of laboratory, (right) ceiling of laboratory

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Barrack 1 layout:


Figure 10

(left) barrack 1, (center) roof of barrack 1, (right) ceiling of barrack 1

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Barrack 2 layout:


Figure 11


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Barrack 3 layout:


Figure 12


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Polyclinic building layout:


Figure 13

(left) polyclinic, (center) roof of polyclinic, (right) ceiling of polyclinic

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Security post layout:


Figure 14

Security post

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4.3. NOT SUSPECTED ASBESTOS CONTAINING MATERIAL

Surveyors identification wall and floor parts. Walls are from red brick covered by aggregate

cement (mixing cement and sand), meanwhile floor used ceramic tiles. It is clear wall and floor

parts are not suspected ACM. The locations of suspected non-ACM’s are also displayed in this

below:

Table 2

Non-Suspected Asbestos Containing Material

No. Existing Location Picture

1 Wall Main Building

2 Floor Main Building

3 Silica temporary dumpsite

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4 Wall Barrack 1

5 Floor Barrack 1

6 Wall Barrack 2

7 Floor Barrack 2

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8 Wall Barrack 3

9 Floor Barrack 3

10 Wall Laboratory

11 Floor Laboratory

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12 Wall Polyclinic

13 Floor Polyclinic

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4.4. INVENTORY OF SUSPECTED ACM

• Suspected ACM conditions and description at each building at the ex-mess PLN site

The suspected ACM at ex-mess PLN building are roof and ceiling part. The condition of roof

are locally cracking and abrasive on specific area (severely damage), as well as ceiling

condition are Locally cracking and abrasive on specific area (severely damage).

• Areas inaccessible for the survey; possible hidden ACM.

On course of survey, all areas are accessible.

• Areas suspected to contain ACM

The area suspected to contain ACM are the roof and ceiling of main building, barrack 1, barrack

2, barrack 3, laboratory, polyclinic and security post.

• Area not suspected to contain ACM

The area not suspected to contain ACM are the wall and floor of main building, barrack 1,

barrack 2, barrack 3, laboratory, polyclinic and security post.

4.5. MATERIAL ASSESSMENT AND PRIORTY ASSESSMENT

4.5.1 The risk assessment includes a material assessment and a priority assessment. The

combined material and priority assessment results should be used to establish the priority

for those ACMs needing remedial action and the type of action that will be taken.

1. Material Assessment Algorithm

The four main parameters which determine the amount of fibre released from an ACM when

subject to disturbance are: (1) product type, (2) extent of damage or deterioration, (3) surface

treatment; and (4) asbestos type. In the material assessment process, the main factors

influencing fibre release are given a score which can then be added together to obtain a

material assessment rating.

Table 3

Material Assessment Algorithm

A) PRODUCT TYPE B) EXTENT OF DAMAGE OR DETERIORATION

Score Description Score Description

1 Asbestos reinforced composites (plastics, resins, mastics, roofing felts, vinyl floor tiles, semi-rigid paints or decorative finishes, asbestos cement etc.).

0 Good condition, no visible damage.

2 Asbestos insulating board, millboards, other low density insulation boards, asbestos textiles, gaskets, ropes and woven textiles, asbestos paper and felt.

1 Low damage, a few scratches or Surface marks, broken edges on boards, tiles etc.

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3 Thermal insulation (e.g. pipe and boiler lagging) sprayed asbestos, loose asbestos, asbestos mattresses and packing.

2 Medium damage, significant breakage of materials or several small área where material has been damaged revealing loose asbestos fibres.

3 High damage or delamination of materials, sprays and termal insulation. Visible asbestos debris.

C) SURFACE TREATMENT D) ASBESTOS TYPE


0 Composite material containing asbestos; reinforced plastics, resins, vinyl tiles.

1 Chrysotile.

1 Enclosed sprays and lagging, AIB (with exposed fase painted or encapsulated), asbestos cement sheets etc.

2 Amosite, Tremolite, Actinolite or Anthopyllite

2 Unsealed AIB, or encapsulated lagging and sprays.

3 Crocidolite.

3 Unsealed lagging and sprays.

TOTAL MATERIAL SCORE= A+B+C+D

Materials with assessment scores of 10 or more are rated as having a high potential to release

fibres, if disturbed. Scores of between 7 and 9 are regarded as having a medium potential,

and between 5 and 6 a low potential. Scores of 4 or less have a very low potential to release

fibres.

Based on survey, the material score for main building roof as below:

• Score of product type of roof (A) : 1 (asbestos cement)

• Score of extent of damage or deterioration (B): 3 (Visible asbestos debris)

• Score of surface treatment (C) : 1 (asbestos cement sheets/corrugated)

• Score of asbestos type (D) : 1 (chrysotile)

• All the score above added and total score are 6.

• The type, surface treatment, condition, and the level of damage of roof for other

buildings (barrack 1, barrack 2, barrack 3, laboratory, polyclinic and security post) also

obtain an equal score

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2. Priority Assessment Algorithm

There are 4 main sections. Within each subsection, choose the most appropriate description

and take the associated score. Average the scores for each subsection. Add the normal

occupant activity score to the three average scores from the likelihood of disturbance, human

exposure potential and maintenance activity sections to get a total priority score.

Table 4

Priority Assessment Algorithm

A) NORMAL OCCUPANT ACTIVITY

A1) MAIN ACTIVITY A2) SECONDARY ACTIVITIES


0 Rare disturbance activity (e.g. Little used store room)

0 Rare disturbance activity (e.g. Little used store room)

1 Low disturbance activities (e.g. office type activity).

1 Low disturbance activities (e.g. office type activity).

2 Periodic disturbance (e.g. industrial or vehicular activity which may contact ACMs)

2 Periodic disturbance (e.g. industrial or vehicular activity which may contact ACMs)

3 High levels of disturbance (e.g. fire door with AIB sheet in constant use)

3 High levels of disturbance (e.g. fire door with AIB sheet in constant use)

B) LIKELIHOOD OF DISTURBANCE

B1) LOCATION B2) ACCESSIBILITY B3) EXTENT/ AMOUNT

Score Description Score Description Score Description

0 Outdoors 0 Unusually inaccessible or unlikely to be disturbed

0 Small amounts or items (e.g. strings, gaskets)

1 Large rooms or well ventilated areas>100 m2

1 Occasionally likely to be disturbed

1 ≤10m2or ≤10m pipe run

2 Rooms up to 100m2. 2 Easily Disturbed. 2 >10 to <50m2 or>10 to <50 m pipe run

3 Confined Spaces 3 Routinely disturbed 3 >50m2 or >50m pipe run.

C) HUMAN EXPOSURE POTENTIAL

C1) NUMBER OF OCCUPANTS

C2) FREQUENCY OF USE C3) AVERAGE TIME EACH USE

Score Description Score Description Score Description

0 None 0 Infrequent 0 <1 hour

1 1 – 3. 1 Monthly 1 >1 to <3 hours.

2 4 – 10 2 Weekly. 2 >3 to <6 hours

3 >10 3 Daily 3 >6 hours

D) MAINTENANCE ACTIVITY

D1) TYPE OF MAINTENANCE ACTIVITY D2) FREQUENCY OF MAINTENANCE ACTIVITY


0 Minor disturbance (e.g. possibility of contact when gaining access)

0 ACM unlikely to be disturbed for maintenance.

1 Low disturbance (e.g. changing light bulbs in asbestos ceiling).

1 ≤1 per year

2 Medium disturbance (e.g. lifting one or two AIB ceiling tiles to access a valve)

2 >1 per year

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3 High levels of disturbance (e.g. removing a number of AIB ceiling tiles toreplace a valve or for recabling)

3 >1 per month

TOTAL PRIORITY SCORE = A+B+C+D Where A=(A1+A1)/2; B=(B1+B2+B3)/3; C=(C1+C2+C3)/3; D=(D1+D2)/2

Based on survey, the priority score for main building roof as below:

• Score of normal occupant activity (A): main activity part i.e. 1 (Low disturbance activities);

B. secondary activity i.e. 1 (Low disturbance activities). The average score are 1.

• Score of likelihood of disturbance (B): location part i.e. 2 (Rooms up to 100m2);

accessibility i.e. 2 (easily disturbed); extent/amount i.e. 3 (>50m2). The average score are

2,3

• Score of human exposure potential (C): number of occupants i.e. 1 (1-3 occupants);

frequency of use i.e. 2 (weekly) average time each use, i.e. 1 (>1 to <3 hours.). The

average score are 1,3

• Score of maintenance activity (D): type of maintenance activity i.e. 1 (low disturbance);

frequency of maintenance activity i.e. 0 ACM unlikely to be disturbed for maintenance).

The average score are 0,5.

• The total of priority score are 5,1.

• The occupant activity, likelihood of disturbance, human exposure potential, and

maintenance activity of roof for other buildings (barrack 1, barrack 2, barrack 3, laboratory,

polyclinic and security post) also obtain an equal score.

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Table 5

Summary of Result of Material Assessment and Priority Assessment

No Location Location area /machinery

description Product Type Analysis result Quantity

Material Scoring

Priority Scoring

1. Roof Main Building Administrative Office – building, silica temporary dumpsite

Suspected ACM corrugated No laboratory analysis yet

2.500,00 m2 6 5,1

2. Outer Ceiling Main Building Main building Suspected ACM sheet No laboratory analysis yet

216 m2 6 5,1

3. Roof Barrack 1 Roof building Suspected ACM corrugated No laboratory analysis yet

620,00 m2 6 5,1

4. Outer Ceiling Barrack 1 Room building Suspected ACM sheet No laboratory analysis yet

67,20 m2 6 5,1


1.090,00 m2 6 5,1


69,36 m2 6 5,1


640,00 m2 6 5,1


69,6 m2 6 5,1

9. Roofing laboratory Laboratory room Suspected ACM corrugated No laboratory analysis yet

280,00 m2 6 5,1

10. Outer Ceiling laboratory Room building Suspected ACM sheet No laboratory analysis yet

33,6 m2 6 5,1

11. Roofing polyclinic Polyclinic room Suspected ACM corrugated No laboratory analysis yet

780,00 m2 6 5,1

12. Outer Ceiling Polyclinic Polyclinic room Suspected ACM sheet No laboratory analysis yet

88,2 m2 6 5,1

13. Roof Security Post Security room Suspected ACM corrugated No laboratory analysis yet

73,00 m2 6 5,1

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Table 6 Suspected Asbestos Containing Material Summary

No. Building, Floor& Room

Location Area /machinery description

Product type description

Quantity m2

(specify UoM) General condition of

the roof (incl. Accessibility)

Type of asbestos

Recommendation Overall Risk Assessment

I

Main Building

1. Roof Main Building

Administrative Office – building, silica temporary dumpsite

Wave Roof material

2.500,00 m2 Locally cracking and abrasive on specific area (severely damage)

Suspected ACM

To be identificated low risk

2. Outer Ceiling Main Building

Main building Flat Sheet Ceiling material

216 m2 Locally cracking on specific area (severely damage)

Suspected ACM

To be identificated low risk

3. Wall Main Building

Main building Building material : red brick

720 m2 Locally abrasive on specific area (severely damage)

Non ACM Recommended to

be removed

low risk

4. Floor Main Building

Main building Building material : Ceramic Tile

1.008 m2 Locally cracking on

specific area (severely

damage)


be removed

low risk

II

Barrack 1

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1. Roof Barrack 1 Roof building Building material : wave roof

620,00 m2 Locally cracking and

abrasive on specific

area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

2. Outer Ceiling Barrack 1

Room building Building material : Flat Sheet



area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

3. Wall Barrack 1 Room building Building material : red Brick



area (severely

damage)


be removed

low risk

4. Floor Barrack 1 Room building Building material : Ceramic Tile

160 m2 Locally cracking and


area (severely

damage)


be removed

low risk

III

Barrack 2


1.090,00 m2 Locally cracking and


area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

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Room building Building material : Flat sheet



area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

3. Wall Barrack 2 Room building Building material : red brick

320 m2 Locally cracking and


area (severely

damage)


be removed

low risk

4. Floor Barrack 2 Room building Building material : Ceramic tile



area (severely

damage)


be removed

low risk

IV

Barrack 3




area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk





area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

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3. Wall Barrack 3 Room building Building material : red brick

320 m2 Locally abrasive on


damage)


be removed

low risk

4. Floor Barrack 3 Room building Building material : CeramicTile

171,81 m2 Locally cracking on


damage)


be removed

low risk

V

Laboratory

1. Roofing laboratory Laboratory room Building material : wave roof



area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

2. Outer Ceiling laboratory




area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

3. Wall laboratory Room building Building material : red Brick



damage)


be removed

low risk

4. Floor laboratory Room building Building material : Ceramic Tile

48 m2 Locally cracking on


damage)


be identificated

low risk

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VI Polyclinic

1. Roofing polyclinic Polyclinic room Building material : wave roof



area (severely

damage)

Suspected ACM

Recommended to

be identificated

low risk

2. Outer Ceiling Polyclinic

Polyclinic room Building material : Flat sheet



area (severely

damage)

Suspected ACM

Recommended to

be removed

low risk

3. Wall Polyclinic Polyclinic room Building material : red brick



damage)


be removed

low risk

4. Floor Polyclinic Polyclinic room Building material : Ceramic Tile

228 m2 Locally cracking on


damage)


be removed

low risk

VII Security Post

1

Roofing Post

Security Post room

Building material : Wave roof

73,00 m2

Locally cracking on


damage)

Suspected ACM

Recommended to

be identificated

low risk

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4.5.2. Remedial/Maintenance Actions Required.

The objective of project Dieng 2 is to identification whether there are ACM at ex-mess

PLN building in Dieng, and if obtain ACM, the ACM will be demolished, hence in this

project will not conduct remedial/maintenance action to the buildings.

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5. PROPOSED SAMPLING METHODS

Based on the PAS, the primary ACM found at the buildings of ex-mess PLN are in the roof and ceiling parts,

hence to ensure about this, needed the identification of those materials. The condition of roof and ceiling are

severely damage, crack, and friable, it has possibility the suspected asbestos fibres release into the ambient

air. Beside take bulk sampling for roof and ceiling materials, it is also recommended to take air sampling and

soil sampling.

5.1. SAMPLING METHOD

For each building will be taken bulk sample from roof and ceiling, as well as take sample for each

building, i.e. 1 (one) air sampling inside the building, and 1 (one) air ambient sampling outside the

building. For soil, sample will be taken only one sample as representative of all buildings, due to the

potential for suspected asbestos fiber released from the building roof is assumed to be in same pattern.

It is because all material roofing for all building comes from the same manufacture and was established

in the same year, i.e. around 1985s, hence all soil condition are homogeneous, samples are planned to

be taken in main building.

Bulk sample analysis will be performed by Polarized Light Microscope (PLM) NIOSH Manual of

Analytical Methods (NMAM) 9002. The air sample analysis will be performed by Phase Contrast

Microscope (PCM) used NIOSH Manual of Analytical Methods (NMAM) 7400.

5.2. TOTAL SAMPLE(S)

- Bulk sample of roof : 6 samples

- Bulk sample of ceiling : 6 samples

- Air sampling inside building : 6 samples

- Air ambient sampling outside the building : 6 samples

- Soil sampling (bulk sample) outside the main building: 1 sample

5.3. SAMPLING LOCATION

- Main Building


Outdoor air

Sampling point

Soil (bulk) sampling point

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- Laboratory

- Barrack 1

- Barrack 2







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- Barrack 3

- Polyclinic

- Security Post







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5.4. SCHEDULE FOR SAMPLING

The schedule to take samples will be conducted on 5 to 7 November 2020.

5.5. EXPERTISE

• Consultant : Dr. Sjahrul M. Nasri, MSc., Ind. Hyg.

• Leader of Sampling Team : Heickel, S.ST

• Sampling Team Member : Fiori Amelia Putri, SKM

• Technical Assistance : Imam Santoso

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APPENDIX I

Job Safety Analysis (JSA) Site and Building Inspection

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Job Safety Analysis (JSA) Working at Height

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-

APPENDIX II

DOCUMENTATION OF SURVEY

No. Existing Location

Picture Note

1 Main Building

2 Silica temporary dumpsite

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Picture Note

3 Vegetable plant near main building

4 Barrack 1

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Picture Note

5 Vegetable plant near barrack 1

6 Barrack 2

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Picture Note

7 Vegetable farm near barrack 2

8 Barrack 3

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Picture Note

9 Vegetable farm near barrack 3

10 Laboratory

11 Vegetable farm near laboratory

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Picture Note

12 Polyclinic

13 Vegetable farm near polyclinic

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Picture Note

14 Security post

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