PETROGAS (BASIN) LTD.

- PERFORMANCE MANAGEMENT SYSTEM

PERFORMANCE PERIOD: January - December 2024

EMPLOYEE NAME Elyadave Surya Saputra Apalem POSITION Foreman - Health, Safety & Environment

REPORT TO Agus Mochamad Adas POSITION Superintendent - Health, Safety & Environment

DEPARTMENT OPS LOCATION Sorong

KEY JOB RESPONSIBILITIES

1 carry out HSE risk assessments, to prevent incidents from occurring and to maintain HSE performance to achieve the goals of; zero fatalities, minimized occupational injuries and illnesses, zero
environmental pollution, compliance with environmental regulations, zero property damage, and zero complaints relating to safety and the environment.

2 Support and assist in implementing all HSE work programs in all divisions in KMT, which include compliance with applicable HSE policies, applicable standard work procedures, HSE mandatory training,
HSE campaigns, HSE environmental programs, for all workers in the KMT area in accordance with HSE objectives at the FOD and corporate levels.

3 Supervise KMT HSE team members in carrying out every job to always comply with all applicable HSE policies and HSE laws and regulations as well as applicable HSE standards and procedures.

4 Ensure all work carried out by the HSE team is documented both offline and online uploaded into prism, and report all work carried out to superiors both progress and obstacles faced in the field.

5 Participate with the HSE team in following up the audit findings of both internal and external audits that have been carried out as corrective actions in the HSE sector.

6 Conduct incident investigations and root cause analysis, determine corrective actions and implement follow-up corrective actions, and create investigation documents for documentation purposes.

7 Supervise and participate in the emergency response team to carry out fire emergency response, oil spill emergency response, and maintain the readiness of fire emergency response or oil spill
emergency response equipment.

8 Ensure that all safety documents (Permit To Work) are made correctly according to established work procedures so that all work runs safely and ensures safe work.

9 Develop materials and participate in carrying out HSE campaigns in the company environment by making HSE Talk materials and presenting HSE Talk materials to all divisions in the KMT work area.

10 collect and create topics that can be discussed in the HSE bulletin, and organize the editorial of the HSE bulletin.

PART I: GOAL SETTING

1. Please write down your performance goals or targets for one year period
2. Your performance goals shall be obtained from your superior through the cascading process
3. Goals or Targets: Define clear objectives that you aim to achieve. They should be strategic, relevant, and clearly worded to guide actions
4. Action to Achieve Goals: Break down the goals into actionable steps. These should be specific activities or initiatives that will help you reach the goals
5. Success Measure: Determine how you will measure the success of each action. These measures should be Specific, Measurable, Achievable, Relevant, and Time-bound (SMART)
6. Weight: Assign a weight to each goal to indicate its importance in the overall assessment. Min 10% and Total Weight must be 100%
7. End Year Result = End Year Score * Weight

Goals or Targets Actions to Achieve Goals Success Measure (SMART) Weight (%) End-Year End-Year Score End-Year Result (%)
Achievement (%)

1 carry out HSE risk 1. Communicate with workers when 1. Record all communication 10 1. Write down 100,0 100.0 of 10 = 10.0
assessments, to prevent there is a mismatch in work procedures of work procedure Procard more than
incidents from occurring and carried out during work to prevent work discrepancies into Procard, at 2 every month
to maintain HSE performance accidents and environmental impacts. least 2/month, on a
to achieve the goals of; zero continuous basis. 2. Write down
fatalities, minimized 2. Give appreciation to workers who Procard more than
occupational injuries and perform work according to standard 2. Record positive findings of 2 every month
illnesses, zero environmental safety procedures in order to maintain a safe work procedures into
pollution, compliance with safe way of working. Procard, at least 2/month, on 3. Solve the
environmental regulations, an ongoing basis. Create a findings written in
zero property damage, and 3. Review and follow up on findings of total of 96 Procards by 2024. Prisma
zero complaints relating to non-compliance with standard work
safety and the environment. procedures to ensure work is carried out 3. Communicate findings to
safely. relevant divisions to correct
findings and close all audit
findings that can be closed
immediately.

2 Support and assist in 1. Follow applicable work standards 1. Carry out work according 10 1. Work completed 100,0 100.0 of 10 = 10.0
implementing all HSE work to standard procedures that without any
programs in all divisions in 2. Participate in mandatory HSE training apply in the company. incidents
KMT, which include
compliance with applicable 3. develop materials and participate in 2. Have participated and are 2. Passed all
HSE policies, applicable HSE campaigns competent in all HSE training certifications
standard work procedures, held including, fire followed
HSE mandatory training, 4. Participate in the HSE Environment emergency response team
HSE campaigns, HSE program training, over head crane 3. HSE Talk runs
environmental programs, for operator supervisor, oil spill well until
all workers in the KMT area in emergency response team completion
accordance with HSE training, air pollution
objectives at the FOD and responsible officer, water 4. Passed and
corporate levels. pollution responsible officer. have a certificate
of officer in charge
3. Created finger and hand of air and water
safety materials that were pollution
presented in the HSE Talk
campaign and participated in
HSE Talk activities.

4. Have passed and are

competent as air and water
pollution responsible officers
3 Supervise KMT HSE team 1. Give directions during the PreJob 1. PJSM is reported every 10 1. Always do 100,0 100.0 of 10 = 10.0
members in carrying out Safety Meeting, before starting work so day before starting work. PJSM every time
every job to always comply that the work takes place safely. you start work
with all applicable HSE 2. Correct and provide
policies and HSE laws and 2. Reviewing each Job Safety Analyst guidance on safe work 2. There has never
regulations as well as document so that it is made correctly practices when reviewing the been an accident
applicable HSE standards and carried out properly. JSA. on the job
and procedures. reviewed by the
3. Discussing the SOP before starting 3. Discuss the SOP before JSA.
the work starting the work
3. SOP can be
applied properly

4 Ensure all work carried out by 1. Prepare report documents on the 1. create HSE work report 10 1. Report 100,0 100.0 of 10 = 10.0
the HSE team is documented work carried out by the HSE team documents including: completed and
both offline and online including emergency response Emergency response team approved by
uploaded into prism, and equipment inspection reports, reports, equipment maintenance supervisor
report all work carried out to and other documents. reports, emergency response
superiors both progress and team training reports, 2. Documented
obstacles faced in the field. 2. Store work documents both online inspection reports, sidak documents both
and offline reports. online and offline

3. Complete all reports on time 2. HSE documents have 3. Report

been stored both in hard copy approved by
and soft copy, offline and supervisor
online which can be seen in
petrogas prisma. Documents
made into Audit “SIAP
SELAMAT” assessment
which has obtained good
results.

3. Reports that are made,

checked and approved by the
leadership before entering
the archive can be completed
in a timely manner well

5 Participate with the HSE 1. Follow up the findings of the internal 1. Most of the findings were 10 1. Obtained good 100,0 100.0 of 10 = 10.0
team in following up the audit audit “SIAP SELAMAT” and get good resolved with good results. results in the Audit
findings of both internal and results. SIAP SELAMAT
external audits that have 2. Documents required at the that has been
been carried out as 2. Prepare the necessary documents for time of the audit SIAP conducted
corrective actions in the HSE the Audit "SIAP SELAMAT". SELAMAT can be fulfilled
sector. and have good results. 2. Completion of
3. Coordinate with relevant divisions to audit documents
resolve the audit findings of 'SIAP 3. Can establish good received a good
SELAMAT' cooperation between assessment
divisions in coordinating to
resolve audit findings 3. Audit findings
can be resolved
properly and on
time .

6 onduct incident investigations 1. Participate in the incident 1. Provide improvement 10 1. Feedback into 100,0 100.0 of 10 = 10.0
and root cause analysis, investigation team and provide feedback to prevent corrective action
determine corrective actions improvement input recurrence of incidents.
and implement follow-up 2. The
corrective actions, and create 2. Produce incident investigation 2. Prepare incident investigation
investigation documents for documents that are reviewed and investigation documents document can be
documentation purposes. approved by superiors, and maintain approved by management completed on time
both hard and soft copies. and stored in hard copy and with good results .
soft copy for reporting.

7 Supervise and participate in 1. Be part of the emergency response 1. Pass and hold a class C 10 1. Graduated and 100,0 100.0 of 10 = 10.0
the emergency response team, and be certified as a C-level fire extinguisher certification hold a class C
team to carry out fire firefighter. held and participate in firefighter
emergency response, oil spill emrgency response teams. certificate and be
emergency response, and 2. Participate in emergency response included in the
maintain the readiness of fire simulations conducted 2. Participate in emergency emergency
emergency response or oil drills conducted response team.
spill emergency response 3. Prepare a report on the
equipment. implementation of emergency response 3. The emergency response 2. Participate in
simulations that are reviewed and simulation report is approved emergency drill
approved by the leadership. by the management and can every time it is
be completed on time. held
4. Participate in level 1 oil spill response
team certification. 4. Passed the level 1 oil spill 3. Emergency drill
emergency response team report approved
certification. and documented
online and offline .

4. Have level 1 oil

spill emergency
response team
certification .

8 Ensure that all safety 1. Checking the permit to work both 1.work for which Permit to 10 1. 100% no 100,0 100.0 of 10 = 10.0
documents (Permit To Work) HOT PTW and COLD PTW, if it requires work has been approved has incidents occurred
are made correctly according improvement, will discuss and explain never had an incident. on jobs for which
to established work the mitigation of work hazards that will permits to work
procedures so that all work be done. 2. The Permit to Work maker were reviewed.
runs safely and ensures safe understands how to create
work. 2. Explain how to fill in the Permit to and execute a good and 2. Permit to work
work properly. correct Permit to Work. applicants can
understand the
3. Monitor and ensure the validity period 3. Permit to Work is renewed creation of PTW.
of Permit to work every time it expires, and
closed when the work has 3. The PTW that is
been completed. used is always
validated.
 9 Develop materials and 1. Made HSE talk material in the form of 1. HSE Talk material made 10 1. HSE TALK went 100,0 100.0 of 10 = 10.0
participate in carrying out Power point which was campaigned into work safety campaign well until
HSE campaigns in the throughout the division. material presented in all completion
company environment by divisions in KMT.
making HSE Talk materials 2. Participated in presenting the 2. HSE Talk can
and presenting HSE Talk scheduled HSE Talk material 2. Presented the hand and be understood by
materials to all divisions in the finger safety HSE Talk the audience
KMT work area. campaign material that had
been carried out

10 collect and create topics that 1. Create and determine the topics to be 1. During 2024 a Q4 HSE 10 1. During 2024 a 100,0 100.0 of 10 = 10.0
can be discussed in the HSE discussed in the HSE bulletin, and bulletin was published. Q4 HSE bulletin
bulletin, and organize the organize the editorial board for the HSE was published.
editorial of the HSE bulletin. bulletin.

Employee's End-Year Feedback

-

Manager's End-Year Feedback

Good Job....need more effort to learn

PART II: BEHAVIORAL EVALUATION

1. Write your behavior commitment towards the company values (SPIRIT).

2. Your commitment shall be achievable
3. End Year Result = End Year Score * Weight

Behavior Target & Commitment Weight (%) End-Year Achievement End-Year Score End-Year Result (%)
(%)

1 Safety 1. Comply with any safety, health and environmental 20 1. Always adhere to safety, 100,0 100.0 of 20 = 20.0
procedures and remind other workers to comply. 2. health, and environmental
Completed more than 2 Procards per month. procedures

2. Remind other workers to

comply with existing
procedures

3. Create a total of 96 Procards

by 2024.

2 Performance 1. Always be ready for the tasks and responsibilities 20 1.always be ready for the tasks 100,0 100.0 of 20 = 20.0
assigned by the leadership and report every job and responsibilities given by
according to the hierarchy. 2. Committed to the leader and try to complete
completing assigned work tasks well and on time . the task well.

2. Work tasks assigned can be

completed in a timely manner

3 Integrity 1. Maintain confidential company data 2. Coordinate 15 1. Not spreading the 100,0 100.0 of 15 = 15.0
according to the hierarchy 3 Carry out duties and company's confidential data
responsibilities with full responsibility” 2. always coordinate work
related to superiors in
accordance with the hierarchy
3. Always carry out assigned
tasks on time

4 Respect 1. Respect others including employees, vendor 15 1. Always respect all 100,0 100.0 of 15 = 15.0
contractors, and other stakeholders. 2.Establish good employees within the company
relations with all workers in the company environment and establish good
relationships.

2. Get to know everyone who

works within the company

5 Innovation 1. Provide suggestions and feedback on work 15 1. Made some performance 100,0 100.0 of 15 = 15.0
improvements in some routine
work

6 Teamwork 1. Always participate and assist in work that requires 15 1. Participate in teamwork and 100,0 100.0 of 15 = 15.0
teamwork maintain communication
between team members and
superiors

Employee's End-Year Feedback

-

Manager's End-Year Feedback

Good jobs ...more spirit to next years

PART III: DEVELOPMENT PLAN

1. The Superior has to identify the development need for the employee to fill the gap based on the performance result, employee career aspiration, and development for future assignments.
2. If certification training is required and mandatory for employees, please give additional information about the certification for future development plans.

Development Need Development Plan Time Frame Type Required by Regulations Reference for
Certification

k3 Migas Training Sertifikasi K3 Migas Q1 2025 Certification - -

Fire Engineer class B Training Sertifikasi Mandatory Fire Q3 2025 Certification - -

Engineer kelas B

PART IV: RATING

Proposed Overall Rating Employee's Signature First Approval Second Approval Head of Department's Head of HR's Approval
Approval
 3

Agus Mochamad Adas Mustaman

Rating Description

5 Excellent/Role Model
Performance consistently significantly above and beyond the requirement, > 120% of the target
Becomes a role model, consistently performs effective behavior

4 Above Target/Requirement
Perform consistently exceeds requirement, 101-120% of target
Performs effective behavior in exemplary actions

3 Meeting Target/Requirement
Employee achieves 95-100% of the target, meets requirements, and may, on occasion, exceed the target
Performs expected behavior with effective results in the workstation

2 Slightly below target/requirement

Employee achieves 95-100% of the target, meets requirements, and may, on occasion, exceed the target
Performs expected behavior with effective results in the workstation

1 Far below target/requirement

Employee only achieves 75% of target or below, significant performance gaps exist
Perform unexpected behavior, which are against indicative SPIRIT values

FINAL PERFORMANCE APPRAISAL 3