Form No : FM-SHE-104

LIFTING PLAN Issued No :1

Vopak Terminal Merak

COMPANY : PT. DUTA UTAMA TEHNIK ABADI Name of : Fatoni

Operator

Supervisor in : Togah S Rigger Man : Togah S

Charge

UNIC CRANE INFORMATION MATERIAL WILL BE LIFTED

Capacity : 3 ton Existing security :
Boom length / fly Jib : Sertifikat Terlampir Weight : 500 kg
SWL Chart : Sertifikat Terlampir Dimension : h : mm
Radius area : 4,5 m b : mm
Boom Length Max : 10.80 m s : mm
Type : (Tire / Crawler) : truck crane t : mm
Length : m
Hazardous : (explosive, vapourize, toxic)

Lifting devices used Qty Size SWL Distance from nearest equipment
Sling (wire / belt) 2 2 2T 1. Instrument :
Shackle 2 3/4 “ 4 3/4 T 2. Vessel : -
Spreader bar - - - 3. Structure :
Others (explain) - - - 4. Electrical cable :

Area dari operasi pengangkatan :

Area of lifting operation

LOCATION
 Form No : FM-SHE-104
LIFTING PLAN Issued No :1
Vopak Terminal Merak
 Form No : FM-SHE-104
LIFTING PLAN Issued No :1
Vopak Terminal Merak

Jelaskan rencana gerakan :

Explain the movement plan

Gambar ringkas gerakan, lokasi dan posisi crane ( Jelaskan di lembar lain )
Sketch the movement drawing location and crane position : (explain on the other page)

Note :

 Formulir ini harus dilengkapi oleh Lifting supervisor

This form must be completed by Lifting supervisor.

 Seluruh persyaratan yang ditetapkan harus dipenuhi dan harus mendapat persetujuan terlebih dahulu sebelum
pelaksanaan pekerjaan pengangkatan
All the requirement stated must be completed and have been approved prior to start the lifting execution work
conducted.

Dibuat:/Prepared By : Diperiksa/ Checked By : Disetujui/Approved By:

Tanggal/ Tanggal/ Tanggal/

Date : Date : Date :
Sept,20 Togah Sulistiyo
2019
Nama/Name : Nama/Name : Nama/Name :
 Form No : FM-SHE-104
LIFTING PLAN Issued No :1
Vopak Terminal Merak