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TEP-900-PLA-OP-BP4-0048

TEP Self Verification Record Sheet Rev. B03


Date / Tanggal: 5-Nov-21 Purpose
Location / Lokasi: Train 3 - 31004
Activity / Aktivitas: Inject N2 - Dry Air The purpose of this Self Verification is to ensure that Work
Permit Number / Nomor Permit: GTA-TEP-49396 Activity at the Tangguh Greenfield Site is executed in line with
the Preservation Management Plan TEP-900-PLA-OP-BP4-0002
Verifier / Pemeriksa: Fernando Arya N
and associated relevant documentation under the CSTS
Persons Interviewed / Orang yang
Diwawancarai:
Bayu Saputro Management System
Subcontractor / Subkontraktor: GTA

Compliance
SV-COMM-TEP-023 - Preservation Comments / Remarks
YES / NO / NA

GENERAL

Has the individual read and understood the procedure?


1 Explained clearly YES
Apakah individu membaca dan memahami prosedur?

Is any specific PPE required for the task?


2 No specific PPE for this task/activities YES
Apakah terdapat spesifik PPE yang dibutuhkan untuk pekerjaan?

How often is the validation frequency of the activity?


3 JSA vaildation will update every 2 weeks YES
Seberapa sering frekuensi test untuk validasi?

SPECIFIC

Is the preparation (readiness) for preservation activities (document,


procedure, tools, consumable) completed?
4 SBC personnel should be check pressure gauges calibration date for injection activites NO
Apakah persiapan untuk aktifitas preservasi (dokumen, prosedur, alat, dan
habis pakai) tersedia?

Has the preservation manpower been initiated as per planning?


5 3 Personnel YES
Apakah manpower preservasi tersedia sesuai dengan perencanaan?

Have the preservation elements been assigned correctly and in line with
Vendors requirements?
6 Yes as per Vendor requirement YES
Apakah perencanaan kegiatan preservasi dilakukan sesuai dengan
persyaratan vendor?

Has the preservation work been carried out as planned and in line with
7 Vendors requirements? Yes man power allocation is aligned with preservation procedure YES
Apakah kegiatan preservasi dilakukan sesuai dengan persyaratan vendor?

Has preservation inspection been carried out as planned? Regular inspection is carried out as per planned and instruction from CSTS
8 YES
Apakah preservasi dilakukan sesuai dengan perencanaan? Preservation team

Has the preservation work been recorded in WinPCS and preservation label
(equipment) correctly?
9 Regular preservation are recorded and reported to WinPCS Administrator YES
Apakah catatan preservasi telah diinput ke WinPCS dan label preservasi
tepat?

For the case of preservation handover between CONST and COMM, is the
handover document available and signed by all parties?
10 Not yet started NA
Untuk kasus handover preservasi dengan COMM/CONST,apalah dokumen
handover tersedia dan ditandatangani?

Percentage of Implementation 88,89%


RECOMMENDATION
NO ACTION RESPONSIBLE PERSON TARGET DATE
(Point 4) Hold GTA Personnel (Bayu Saputro) 6-Nov-21
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