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    General Permit 15334

    Uploaded by

    Luthfi Mahendra

    Copyright:

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

    General Permit 15334

    Uploaded by

    Luthfi Mahendra
    2 views1 page

    Copyright

    © © All Rights Reserved

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    Copyright:

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

    General Permit 15334

    Uploaded by

    Luthfi Mahendra

    Copyright:

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

    Business Use #

    GENERAL WORK PERMIT FORM


    PT. P&G OPERATION INDONESIA

    Area : Workshop Construction Dept : Facility Construction Validity / Masa Berlaku


    Publisher Date / Tanggal Dikeluarkan : 18/09/2024 From / Dari Date / Tgl 18/09/2024 to 18/09/2024
    Location of Work / Lokasi : Outlaying Workshop Construction Time / Tgl 08:00 to 18:00
    Work Excecutor / Pelaksana Pekerjaan : PT.Jatra Indo Teknik'
    Detail of Job / Uraian Pekerjaan : Perapihan Tanah Galian

    TYPE Of WORK NECESSARY PRECAUTIONS


    YES NO YES NO
    TIPE PEKERJAAN HAL - HAL YANG HARUS DILENGKAPI
    1. Hot Work / Pekerjaan Panas P 1 Hot Work Permit / Ijin Kerja Panas P
    2. Electrical / Listrik P 2 Cold Work Permit / Ijin Kerja Dingin P
    3. Cold Work / Pekerjaan Dingin P 3 Confined Space Entry Permit / Ijin Kerja Ruang Terbatas P
    4. Confined Space Entry / Ruang Terbatas P 4 Electrical Work Permit / Ijin Kerja Listrik P
    5. Working at Height / Bekerja di Ketinggian P 5 Working at Height Permit / Ijin Kerja di Ketinggian P
    6. Excavation / Penggalian P 6 Radiography Permit/ Ijin Kerja Radiografi P
    7. Radiography / Radiografi P 7 Excavation Permit / Ijin Kerja Penggalian P
    8. Line Breaking P 8 Job Safety Analysis / Analisis Keselamatan Kerja P
    9 Risk Assessment / Penilaian Resiko P
    10 Construction Method / Metode Konstruksi P
    11 Lifting & Rigging Plan / Rencana Pengikatan dan Pengangkatan Beban P
    12 Drawing of Area Activity / Gambar Area Aktifitas P
    13 As Build Drawing for Excavation / Gambar Area untuk Penggalian P
    14 Underground Composite Drawing / Gambar Area Bawah Tanah P
    15 LOTO / Lock Out Tag Our P
    PERSONAL PROTECTIVE EQUIPMENT SHALL BE WORN / ALAT PELINDUNG DIRI YANG HARUS DIPAKAI
    Safety Helmet / Helm Safety P Eye Protection / Pelindung Mata / Googles P
    Safety Shoes / Sepatu Safety P Long Sleeve / Baju Lengan Panjang P
    Ear Plug / Muff / Pelindung Telinga Fall Protection / Pelindung Jatuh (Full Body Harness)
    Dust Mask / Masker Debu P Face Protection / Pelindung Muka
    Safety Glass / Kacamata Safety P Hand Protection / Pelindung Tangan P
    Rubber Boot / Sepatu Boot Karet P Safety Vest / Rompi P
    Respirator Protection / Pelindung Pernapasan Others / Lain - lain
    SPECIAL INSTRUCTION / INSTRUKSI KHUSUS :

    I HAVE READ, UNDERSTOOD AND CHECKED CONDITION WHERE THE JOB CAN BE DONE SAFETLY AND AGREE TO OBEY ALL PRECAUTIONS STATED IN THE PERMIT. SAYA SUDAH MEMBACA,
    MENGERTI, MEMERIKSA KONDISI DIMANA PEKERJAAN DAPAT DILAKSANAKAN DENGAN AMAN DAN SETUJU UNTUK MEMENUHI SEMUA KETENTUAN YANG TERTULIS DI IJIN INI

    Name : M Febian Name : M Luthfi Name : Endang Name : Pebri Atmoko Name : Rikky Manalu
    Contractor Representative Contractor HSE HSE P&G CM P&G / Area Manager P&G Representative

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