CHECKLIST

TITLE:
MATERIAL TRANSFER HALLIBURTON MANAGEMENT SYSTEM
BUS.UNIT/SHARED SERVICES REGION: FUNCTION: DOCUMENT NUMBER:
HAL Indonesia FO-IND-HAL-PR-002
OWNER: APPROVED BY: REVISION BY: REV.DATE: REV.NO MAINSTAY: PAGE:

Angel Astaman Adhi Siddharta Putu Agus Widana 24.FEB.20 F 300-Mobilize 2 of 2

Fill necessary items that apply with actual condition MT # -HI-BDK-2021

Sender Receiver
No CHECKLIST
Date: Date:
PROPER MATERIAL TRANSFER TICKET TO BE FILLED OUT
1 YES
Material Transfer Ticket sudah diisi
ARE SLINGS PROPERLY COLOR CODED AND TAGED
2 YES
Apakah sling diberi kode warna dan tanda
SUFFICIENT GREASE APPLIED ON ALL SLINGS. CHECK REFERENCE FOR Cargo Carrying Unit (CCU) CHECKLIST
3 YES
Pelumasan merata pada seluruh sling. Check Inspeksi menurut checklist untuk Cargo Carrying Unit (CCU)
ALL SHACKLES HAVE SAFETY PIN. CHECK REFERENCE FOR Cargo Carrying Unit (CCU) CHECKLIST
4 YES
Semua shackle terdapat pin pengunci. Check Inspeksi menurut checklist untuk Cargo Carrying Unit (CCU)
SWL AND SERIAL NUMBERS ARE VISIBLE ON EQUIPMENT
5 YES
Kapasitas angkat dan nomor seri mudah dilihat
APPROPRIATE LABELS AND MARKING SUCH AS WARNING, CONSIGNEE AND LATEST UPDATE OF SDS ON THE
PACKAGES OF MATERIAL. REFER TO GHS - NOT NFPA
6 YES
Label dan tanda yang sesuai seperti peringatan, tujuan pengiriman, SDS terbaru dsb terpasang di setiap kemasan
dari material. Chek referensi untuk standard GHS, Bukan NFPA
CAUTION : USE NYLON STRAP TO REPLACE CHEMICAL METAL STRAP? Use High Impact Gloves while handling METAL
STRAP
7 YES
PERHATIAN: GUNAKAN Nylon Strap untuk menggantikan strap besi dan pastikan untuk menggunakan Sarung
Tangan - High Impact Gloves
IS DRUMS POSITIONING ON PALLET CORRECT? DRUMS ALWAYS NEED TO PUT VERTICAL / STAND.
8 NA
Apakah drum ditempatkan dengan baik di atas pallet? Pastikan drum selalu dalam posisi tegak
ARE DRUMS/IBC/CANS/PAILS IN GOOD CONDITION (NO Crack, No Bulging/Potential pressurize, NO Discolor /
9 Corroded) NA
Apakah drum/IBC/Cans/pails dalam kondisi baik (tidak retak, tidak menggembung, berubah warna / korosi)
ARE DRUMS/IBC/CANS/PAILS SEAL AVAILABLE FOR DANGEROUS GOODS
10 NA
Apakah seal drum/Ibc/cans/pails tersedia untuk bahan-bahan berbahaya
MATERIALS ARE PACKED PROPERLY AND SECURED (INCLUDING SMALL BAG, DRUMS, PAILS/CANS, IBC)
11 YES
Material telah di kemas dengan baik dan aman (termasuk sacks, drums, pails/cans, ibc)

VISUAL INSPECTION ON MATERIALS (Spare Part, Accessories) AND PACKAGES CONDITION - No visible defects
12 YES
Periksa setiap material dan kondisi kemasan - Tanpa kerusakan
ARE FIFO PROPERLY IMPLEMENTED FOR THIS PARTICULAR SHIPMENT
13 NA
Apakah FIFO proses sudah dilakukan untuk pengiriman ini?
ARE PRODUCT NOT EXPIRED?
14 NA
Apakah product tidak Kadarluarsa
IS VALID COQ / COA POSTED ON EACH PRODUCT PACKAGED
15 NA
Apakah ada COQ atau COA di setiap product paket yang akan dikirim?
IS THERE ANY NOTICEABLE FRAYING OR DAMAGE ON THE LIFTING STRAP of JUMBO BAG
16 NA
Apakah ada kerusakan atau kerapuhan pada tali pengangkat Jumbo Bag
IS THERE NO DEFECT on JUMBO BAG CONDITION (Hole/Torn)
17 NA
Apakah ada kerusakan pada Jumbo Bag (berlubang/Robek)
ARE INCOMPATIBLE HAZARDOUS CHEMICAL PRODUCT HAS BEEN SEGREGATE DURING MOBILIZATION ACCORDING TO ST-GL-
HAL-HSE-0502 REFER TO DG SEGREGATION CHART? SPILL KIT AVAILABLE ON TRUCK?
18 NA
Apakah produk bahan kimia berbahaya yang tidak kompatibel telah dipisahkan selama mobilisasi menurut ST-GL-
HAL-HSE-0502 merujuk pada bagan pemisahan BAHAN BERBAHAYA? Spill Kit Tersedia di truck
Verified by Signature
PSL / Base Manager WHS Driver Recipient

Date Issued Revision No. Summary of Key Revision

22.May.2015 A Original Release

Adding section 12 on checklist - Are product valid expired date

13.Jul.2017 B Changing owner , approve, and revision person document
Changing footnote document contact to be Supply Chain Department

18.Sep.2017 C Adding section 13 on checklist - IS THERE ANY COQ GENERATED FOR EACH OF PRODUCT IN MANIFEST

21.Mar.2019 D Adding Mode of Transportation, Vehicle No and Transporter Name on Form

Adding signature and verified by on the checklist form. Additional question for question 12 and 13 to check drum/IBC/pails/cans condition and seal available for
14.Jun.2019 E dangerous good

Adding section no. 18 to check segregate Incompatible hazardous material during mobilization according to ST-GL-HAL-HSE-0502 refer to DG segregation chart and
24.Feb.2020 F rearrange the CheckList sequence

To obtain a copy of a previous version of this document, please contact Supply Chain Department
 FORM
TITLE:
MATERIAL TRANSFER HALLIBURTON MANAGEMENT SYSTEM
BUS.UNIT/SHARED SERVICES REGION: FUNCTION: DOCUMENT NUMBER:
HAL Indonesia FO-IND-HAL-PR-002
OWNER: APPROVED BY: REVISION BY: REV.DATE: REV.NO MAINSTAY: PAGE:

Angel Astaman Adhi Siddharta Putu Agus Widana 24.FEB.20 F 300-Mobilize 1 of 2

NO. : - HI - BDK - 2021

DATE : 22 Nov 2021 SLI. REF :

SHIP TO : SHIP FROM :

PT. HALLIBURTON INDONESIA PT. HALLIBURTON INDONESIA

Attn. Attn :
HP. HP.

MODE OF TRANSPORT : AIR FREIGHT / SEA FREIGHT / LAND FREIGHT ** ** Cross the unnecessary ones
VEHICLE NO :
TRANSPORTER NAME :
ITEM
SAP No. Batch / Lot No. QTY U/M DESCRIPTION Package/Pallet Weight Remark
NO.

FILLED BY : DATE SHIPPED DRIVER BY: RECEIVED BY: DATE:

GROSS WEIGHT: NET WEIGHT: TARE WEIGHT: DIMENSIONS

NUMBER OF PACKAGE: BOXES ….. CRATES …… .…….PALLETS… .………CARTONS….. .…..……BAG…… ..………..