WORK PERMIT FOR CIRCULATING

WATER PUMP HOUSE

Comoany :
Day/date : Weather : Clear Cloudy Rain
Project manager : HP :
Safety Manager : HP :
Safety Man : HP :
Construction Manager : HP :

LOCATION WORKING END of TIME MANPOWER Person in REMARK

ACTIVITIES Charge
PW PUMP
HOUSE

TOTAL
HEAVEY SORT of H.E SERIAL NO. OPERATOR REMARK
EQUIPMEN
T

CHECK 1. APD at Working area ( )

POINT 2. Access way for approaching ( )
3. Working method, sequence, contents ( )
4. Safety of Equipmet and Tools ( )
5. Safety facilites around working area ( )
6. Manager & emergency net ( )
7. Housekeeping at the end time ( )
COMMENT
of CONST.
DEPT
COMMENT
of HSE

CONSTRUCTION DEPT GHPE INDO-RAMA

A Construction Project MANAGER Manager Safety
P MGR Manager
P
 DAFTAR MANPOWER
PROJECT PT. WAHANA KARYA KONSTRUKSI

N NAMA NO. ID JABATAN

O
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
19
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