IPP-PLTG 2X41 MW SENIPAH

PERMIT TO WORK- LIFTHING CRANES

This permit shall be issued whenever a crane is to be used.

Date:

Location of Work:
Details of Work:

Authorised Operator
Authorised Supervisor

Preparation for Work:

Ensure that the following hazards are recognised by all persons taking part and that the controls are in place.
Hazards Controls
Overload of lifting gear Ensure that load does not exceed crane SWL
Ensure that any strops, wires and attachment points
provide sufficient total capacity for the laod
Unstable load Ensure that sufficient strops or wires are used to hoist
the load in a stable condition
Use tag lines and assistants to stabilise the load
while it is aloft
Damage/injury from Warn all personnel in the area to stand clear of and
suspended load or not pass underneath suspended loads
moving boom Use a signaller when the whole lift including pick-up
and set down points cannot be observed by the operator
All personnel involved in the operation are to wear
appropriate PPE
Damage/injury from Hatches in the open position must be secured and all
hatches through hatches must be fenced/guarded
Notify other departments: Camp Engine Room Other:

This Permit is valid from hrs. to hrs. on the date shown

The Authorized Supervisor above is permitted to carry out the work as specified.
Signed:

I undertake to carry out the work as specified and confirm that the above controls are in place.
Signed:
Authorised Supervisor

Extension issued until hrs. Signed:

PTW Crane
The above work was completed safely at hrs. Signed:
The space is clear of personnel & systems have been returned to operational status.

PTW Crane
NIPAH

NG CRANES

ontrols are in place.

Done

nt points

ed to hoist

r of and

g pick-up
the operator
o wear

ed and all

hrs. on the date shown

Captain

PTW Crane
Authorized Supervisor

PTW Crane
 LAND CLEARING PERMIT / IJIN PEMBERSIHAN LA

IPP-PLTG 2X41 MW SENIPAH

This permit shall be issued whenever LANDCLEARING is required.

Date of Issued / Tanggal diterbitkan

Location of Work / Lokasi Kerja :

State here precisely objective and nature of work to be done / Nyatakan dengan jelas tujuan dan jenis pekerejaan yang akan dilakukan

Description of materials and Equipment to be used / Deskripsi dari material dan peralatan yang digunakan

Contractor supervisor in charge execution of the work

Pengawas kontraktor yang betanggung jawab terhadap pelaksanaan perkerjaan

WORK PREPARATION
Yes/Ya
Are there object liable to be :/ Apakah object yang bersangkutan Berbahaya?
What type of digging is permitted /Tipe penggalian apakah diijinkan? Mechanic?
Detection obstacles needed by :/ Peralatan deteksi yg deperlukan Detektor Logam
Is location of work parameter clearly delimited?/Apakah lokasi pekerjaan tanah teridentifikasi, diketahui dengan baik?
Is GPS USE REQUIRED? / Apakah penggunaan GPS diperlukan?
Are soil types and ground condition identified, well Know? / Apakah jenis dan kondisi tanah teridentifikasi, diketahui dengan baik?

Have the risk of watering for personnel and the trench stability been considered?/ Apakah resiko tumpahan terhadap karyawan dan stabilitas parit telah dip

Is shoring /battering / stepping procedure available and attached and attached to this permit? / Apakah prosedur shoring/battering/stepping tersedia dan d

Are barries / Night illumination / warning notice required in place? / Apakah barries / night illumination / warning notice dibutuhkan di tempat ini?

Is there road/ river diversion required? / Apakah penggalian jalan / singuai dibutuhkan?

Are there additional precautions?/ Apakah ada pencegahan tambahan? If Yes, List the main ones / Jika Ya, sebutkan pencegahan-pencegahan utama?

Performing Authority Name:

Signature
Nama wewenang pelaksana
Tanda Tangan

Operating Authority Name Safety Authority Name:

Nama wewenang Operasi Nama Wewenang Safety:

This Permit is valid from hrs. to hrs. on t

The Authorized Supervisor above is permitted to carry out the work as specified.
Signed:

I undertake to carry out the work as specified and confirm that the above controls are in place.
Signed:

Authorised Supervisor

Extension issued until hrs. Signed:

The above work was completed safely at hrs. Signed:

The space is clear of personnel & systems have been returned to operational status.
ARING PERMIT / IJIN PEMBERSIHAN LAHAN

IPP-PLTG 2X41 MW SENIPAH

required.

Permit No:

dengan jelas tujuan dan jenis pekerejaan yang akan dilakukan

ri material dan peralatan yang digunakan

No/Tidak Yes/Ya No/Tdk

Damaged/Rusak?
Hand Clearing/Manual?
Hand Digging/Manual?
dentifikasi, diketahui dengan baik?

si tanah teridentifikasi, diketahui dengan baik?

pakah resiko tumpahan terhadap karyawan dan stabilitas parit telah diperhitungkan?

is permit? / Apakah prosedur shoring/battering/stepping tersedia dan dilampirkan dalam ijin kerja?

/ night illumination / warning notice dibutuhkan di tempat ini?

an?

he main ones / Jika Ya, sebutkan pencegahan-pencegahan utama?

hrs. on the date shown

hrs. Signed:

Authorized Supervisor
 PERMIT TO WORK- HOT WORK
IPP-PLTG 2X41 MW SENIPAH.TELUK PEMEDAS KUTAI KARTANEGARA

IPP-PLTG 2X41 MW SENIPAH

This permit shall be issued whenever hot work is required I.e. welding, cutting and grinding

Date: PTW No.

Location of Work:
Details of Work:

Authorised Contractor HSE Dept,Name :

Authorised Contractor Supervisor,Name :

Ensure that the following hazards are recognised by all persons taking part and that the controls are in place.
Hazards And Controls to be in place
1. Vessel clear of sources of ignition
2. Work area clear of flammables
3. Adjacent compartments vented and gas free
4. The transfer of fuels suspended for the duration of this permit
5. Any flammable liquid lines in area to be isolated
6. Hot work not infringing on/in flammable liquid/solids areas/boundaries
7. All hoses ,leads, valves disks checked for integrity
8. Required PPE checked and in a serviceable condition, aprons goggles etc
9. Adequate fire fighting equipment on site and operating/checked properly
10. Fire watchman posted and briefed/understands his duties
11. Follow Rule JRA and Work Prosedure
12. Third Party approval obtained if required.
13. Fire watch to remain after hot work completed for a minimum of 30 mins
14. Special protection required?
Forced Ventilation Safe belt/Line Warning Signs Barricades PPE

Self Contained Breathing Apparatus Fire Extinguisher

15. Any hazards you find and the precaution you take? Please Write

Notify other departments: Civil Procces Other:

This Permit is valid from hrs. to hrs. on the date shown

The Authorized Supervisor above is permitted to carry out the work as specified.
Signed:
Contractor Authority HSE KPM Oil & Gas Construction KPM Oil &

PTW Hot Work

I undertake to carry out the work as specified and confirm that the above controls are in place.
Signed:
Contractor Authorised Supervisor

Extension issued until hrs. Signed:

The above work was completed safely at hrs. Signed:

The space is clear of personnel & systems have been returned to operational status. Authorized S

PTW Hot Work

 WORK- HOT WORK
AH.TELUK PEMEDAS KUTAI KARTANEGARA

PTW No.

Done

Construction KPM Oil & Gas

PTW Hot Work

Authorized Supervisor

PTW Hot Work

 PERMIT TO WORK- CONFINED SPACES

This permit shall be issued for all work conducted in spaces which may contain a non-respirable or explosive atmosphere.
Any space not continuously ventilated with fresh air, or which may have contained toxic vapours or liquids, paints,
solvents, chemicals or hydrocarbons or where a possibility of ingress from other spaces exists, must be considered
unsafe. A specialist flammability test for vapours may be required before work starts. Other permits may be required,
such as a Hot Work Permit.

Date:

Location of Work:
Details of Work:

Authorized Supervisor

Persons entering enclosed space:

Preparation for Work:

Ensure that the following hazards are recognised by all persons taking part and that the controls are in place.
Hazards Controls
Asphyxiation in non- Space must be clean & ventilated before start
respirable atmosphere Ventilation must be maintained throughout the job
Rescue BA set/s must be at the worksite
Possibility of anoxic, toxic No entry until space has been tested and proved respirable
or explosive atmosphere Appropriate fire fighting equipment must be at the worksite
Ingress from valves Ensure valves to the space are closed
or other spaces of gas, Lock out/tag out the valves concerned
fluids or vapours Inform the relevant departments of closed valves
General Post a safety lookout outside of the space
Ensure good access to/egress from the space
Ensure adequate safe lighting in the space
Ensure good communications between all parties involved
Notify other departments: Camp Engine Room Other:

This Permit is valid from hrs. to hrs. on the date show

The Authorized Supervisor above is permitted to carry out the work as specified.
Signed:

I undertake to carry out the work as specified and confirm that the above controls are in place.
Signed:
Authorised Supervisor

PTW spaces
Extension issued until hrs. Signed:

The above work was completed safely at hrs. Signed:

The space is clear of personnel & systems have been returned to operational status.

PTW spaces
WORK- CONFINED SPACES

h may contain a non-respirable or explosive atmosphere.

h may have contained toxic vapours or liquids, paints,
ingress from other spaces exists, must be considered
ed before work starts. Other permits may be required,

PTW No.

ns taking part and that the controls are in place.

Controls Done

ce has been tested and proved respirable

ghting equipment must be at the worksite

munications between all parties involved

hrs. on the date shown

PTW spaces
Captain

Authorized Supervisor

PTW spaces
 EXCAVATION PERMIT / IJIN PENGGALIAN

IPP-PLTG 2X41 MW SENIPAH

This permit shall be issued whenever EXCAVATION is required.

Date of Issued / Tanggal diterbitkan

Location of Work / Lokasi Kerja :

State here precisely objective and nature of work to be done / Nyatakan dengan jelas tujuan dan jenis pekerejaan yang akan dilakukan

Description of materials and Equipment to be used / Deskripsi dari material dan peralatan yang digunakan

Contractor supervisor in charge execution of the work

Pengawas kontraktor yang betanggung jawab terhadap pelaksanaan perkerjaan

WORK PREPARATION
Yes/Ya No/Tidak
Are there object liable to be :/ Apakah object yang bersangkutan Berbahaya?
What type of digging is permitted /Tipe penggalian apakah diijinkan? Mechanic?
Detection obstacles needed by :/ Peralatan deteksi yg deperlukan Detektor Logam
Is location of work parameter clearly delimited?/Apakah lokasi pekerjaan tanah teridentifikasi, diketahui dengan baik?
Is GPS USE REQUIRED? / Apakah penggunaan GPS diperlukan?
Are soil types and ground condition identified, well Know? / Apakah jenis dan kondisi tanah teridentifikasi, diketahui dengan baik?

Have the risk of watering for personnel and the trench stability been considered?/ Apakah resiko tumpahan terhadap karyawan dan stabilitas parit telah diperhitungk

Is shoring /battering / stepping procedure available and attached and attached to this permit? / Apakah prosedur shoring/battering/stepping tersedia dan dilampirka
kerja?

Are barries / Night illumination / warning notice required in place? / Apakah barries / night illumination / warning notice dibutuhkan di tempat ini?

Is there road/ river diversion required? / Apakah penggalian jalan / singuai dibutuhkan?

Are there additional precautions?/ Apakah ada pencegahan tambahan? If Yes, List the main ones / Jika Ya, sebutkan pencegahan-pencegahan utama?

Performing Authority Name:

Signature
Nama wewenang pelaksana
Tanda Tangan

Operating Authority Name Safety Authority Name:

Nama wewenang Operasi Nama Wewenang Safety:

This Permit is valid from hrs. to hrs. on the date show

The Authorized Supervisor above is permitted to carry out the work as specified.
Signed:

I undertake to carry out the work as specified and confirm that the above controls are in place.

Signed:
 Authorised Supervisor

Extension issued until hrs. Signed:

The above work was completed safely at hrs. Signed:

The space is clear of personnel & systems have been returned to operational status.
N PERMIT / IJIN PENGGALIAN

Permit No:

jelas tujuan dan jenis pekerejaan yang akan dilakukan

rial dan peralatan yang digunakan

Yes/Ya No/Tdk
Damaged/Rusak?
Hand Digging/Manual?
Hand Digging/Manual?
i, diketahui dengan baik?

eridentifikasi, diketahui dengan baik?

siko tumpahan terhadap karyawan dan stabilitas parit telah diperhitungkan?

? / Apakah prosedur shoring/battering/stepping tersedia dan dilampirkan dalam ijin

lumination / warning notice dibutuhkan di tempat ini?

ones / Jika Ya, sebutkan pencegahan-pencegahan utama?

hrs. on the date shown

Authorized Supervisor
 LOADING UNLOADING PERMIT / IJIN MUAT DAN BONGKAR

IPP-PLTG 2X41 MW SENIPAH

This permit shall be issued whenever LOADING UN-LOADING is required.

Date of Issued / Tanggal diterbitkan

Location of Work / Lokasi Kerja :

State here precisely objective and nature of work to be done / Nyatakan dengan jelas tujuan dan jenis pekerejaan yang akan dilakukan

Contractor supervisor in charge execution of the work

Pengawas kontraktor yang betanggung jawab terhadap pelaksanaan perkerjaan

WORK PREPARATION
Yes/Ya No/Tidak
Are there object liable to be :/ Apakah object yang bersangkutan Berbahaya?
What type of loading is permitted /Tipe Muatan apakah diijinkan? Mechanic?
Detection obstacles needed by :/ Peralatan deteksi yg deperlukan Detektor Logam
Is location of work parameter clearly delimited?/Apakah lokasi pekerjaan tanah teridentifikasi, diketahui dengan baik?
Is GPS USE REQUIRED? / Apakah penggunaan GPS diperlukan?
Are soil types and ground condition identified, well Know? / Apakah jenis dan kondisi tanah teridentifikasi, diketahui dengan baik?

Have the risk of watering for personnel and the trench stability been considered?/ Apakah resiko tumpahan terhadap karyawan dan stabilitas parit telah diperhitungk

Is shoring /battering / stepping procedure available and attached and attached to this permit? / Apakah prosedur shoring/battering/stepping tersedia dan dilampirka

Are barries / Night illumination / warning notice required in place? / Apakah barries / night illumination / warning notice dibutuhkan di tempat ini?

Is there road/ river diversion required? / Apakah pemakaian jalan / terowongan sungai dibutuhkan?

Are there additional precautions?/ Apakah ada pencegahan tambahan? If Yes, List the main ones / Jika Ya, sebutkan pencegahan-pencegahan utama?

Performing Authority Name:

Signature
Nama wewenang pelaksana
Tanda Tangan

Operating Authority Name Safety Authority Name:

Nama wewenang Operasi Nama Wewenang Safety:

This Permit is valid from hrs. to hrs. on the date show

The Authorized Supervisor above is permitted to carry out the work as specified.
Signed:

I undertake to carry out the work as specified and confirm that the above controls are in place.
Signed:

Contractor Authorised Supervisor

Extension issued until hrs. Signed:

The above work was completed safely at hrs. Signed:

The space is clear of personnel & systems have been returned to operational status.
ADING PERMIT / IJIN MUAT DAN BONGKAR

ADING is required.

Permit No:

n dengan jelas tujuan dan jenis pekerejaan yang akan dilakukan

Yes/Ya No/Tdk
Damaged/Rusak?
loading /Manual?
Unloading/Manual?
ridentifikasi, diketahui dengan baik?

disi tanah teridentifikasi, diketahui dengan baik?

Apakah resiko tumpahan terhadap karyawan dan stabilitas parit telah diperhitungkan?

this permit? / Apakah prosedur shoring/battering/stepping tersedia dan dilampirkan dalam ijin kerja?

es / night illumination / warning notice dibutuhkan di tempat ini?

ungai dibutuhkan?

the main ones / Jika Ya, sebutkan pencegahan-pencegahan utama?

hrs. on the date shown

Contractor Authorized Supervisor