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    Form Material Gate Pass (00000002) Extruder Screw

    Uploaded by

    Rony Wicaksono
    This document is a gate pass form for material being transported out of a facility. It provides details about the goods, including that an extruder screw measuring 25mm in diameter and 70cm in length that is broken needs to be inspected and repaired at an external workshop. The form lists the necessary approvals from relevant roles including the requestor, transporter, person in charge, security manager, and division manager/general manager. Space is also provided to record the return of goods if it is a temporary carry-out and gate pass.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form Material Gate Pass (00000002) Extruder Screw

    Uploaded by

    Rony Wicaksono
    93 views1 page
    This document is a gate pass form for material being transported out of a facility. It provides details about the goods, including that an extruder screw measuring 25mm in diameter and 70cm in length that is broken needs to be inspected and repaired at an external workshop. The form lists the necessary approvals from relevant roles including the requestor, transporter, person in charge, security manager, and division manager/general manager. Space is also provided to record the return of goods if it is a temporary carry-out and gate pass.

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    Copy of Form Material Gate Pass (00000002) extruder screw

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    This document is a gate pass form for material being transported out of a facility. It provides details about the goods, including that an extruder screw measuring 25mm in diameter and 70cm in length that is broken needs to be inspected and repaired at an external workshop. The form lists the necessary approvals from relevant roles including the requestor, transporter, person in charge, security manager, and division manager/general manager. Space is also provided to record the return of goods if it is a temporary carry-out and gate pass.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    93 views1 page

    Form Material Gate Pass (00000002) Extruder Screw

    Uploaded by

    Rony Wicaksono
    This document is a gate pass form for material being transported out of a facility. It provides details about the goods, including that an extruder screw measuring 25mm in diameter and 70cm in length that is broken needs to be inspected and repaired at an external workshop. The form lists the necessary approvals from relevant roles including the requestor, transporter, person in charge, security manager, and division manager/general manager. Space is also provided to record the return of goods if it is a temporary carry-out and gate pass.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 1

    Attachment 1 Page 1 of 1

    E0910-F0003-02 Procedure No E0910-P0003-02

    Material Gate Pass SCY No :

    Day/ Date : Wed / 21 jul 21 Time : 10:30 Location : PP lab Pass Type COR
    GMR to

    Owner of Goods Chandra Asri SMI Contractor/ Private


    (Please tick √ ) (name)

    Type of Carry-out Permanent Temporary : 4 August 2021 Vehicle No.:


    (Please tick √ ) (estimated date of return)

    Type of Goods : Machine,Parts, Tools/Equipment Product Samples Office Equipment PC / LAPTOP

    (Please tick √ ) Industrial Wastes Grass and Domestic Waste Project Material Excess *) Refilled/replaced

    Purpose : To be inspect and fabricate in external workshop


    Emergency Reason*) :
    *) Fill-out in case of emergency condition only

    FOR TERMPORARY COR / GMR Only


    [Fill-out When returning the goods]
    NO DESCRIPTION OF GOODS TOTAL UNIT
    TOTAL REMAIN
    RETURN (if any)

    1 Extruder screw dia 25 mm, 70 cm in length 1 Pcs


    (Condition broken)

    GRAND TOTAL 1 Pcs


    APPROVAL SHEET
    (Based on Request Approval Matrix)
    No Position Name ID No. Signature Date / Hours

    1 Requestor Rony Wicaksono 3797 21 Jul 21 / 10:30


    2 Transporter /
    3 Witness :
    a). Person In Charge (User) Rony Wicaksono 3797 21 Jul 21 / 10:30
    b). Security /
    4 SM Incharge Irwan Saleh 1848 /
    5 DM / GM Incharge Busra Irawan 0550 /
    7 Security Head/ Coordinator /

    VERIFICATION OF TEMPORARY COR / GMR AT THE TIME OF ESTIMATED DATE OF RETURN


    APPROVAL WHEN RETURNING OF GOODS
    NOT RETURNED YET

    HAD BEEN RETURNED, on


    date of return The Person who return the goods SM In Charge Security Coordinator

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