JOINT OPERATING BODY

PERTAMINA - TALISMAN (OK) LTD.

AIR SERDANG FIELD

ATTENDANCE LIST
STAN DOWN SAFETY MEETING 2011"

Date : Tuesday, October 11, 2022 Time : 14 : 30 PM

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Note :
 Tittle : SACAFFOLDING

Date : February 2, 2011 SCAFFOLDING INSPECTOR & SCAFFOLDER

JPT. (OK) Ltd.

No Name Department Position Scaffolder Scaffolding Inspector Date of Training Signature

1 Ulung Putra Sakti HSE Sr. HSE Supv. - Scaffolding Inspector 15-Oct-10
2 Andi Paizal HSE Sr. HSE Supv. - Scaffolding Inspector 15-Oct-10
3 Natang Sembiring HSE HSE. Supv. - Scaffolding Inspector 15-Oct-10
4 Tugimin Diyono Technical Services Sr. Supervisor - Scaffolding Inspector 15-Oct-10
PT. IKS Labour Supply.
1 Ujang Zaharen HSE HSE Officer - Scaffolding Inspector 15-Oct-10
2 Dedi Suhermanto HSE HSE Officer - Scaffolding Inspector 15-Oct-10
PT. Jimmulya Technical
1 Makmur Technical Services Sr. Supervisor - Scaffolding Inspector 15-Oct-10
2 Waris Technical Services Supervisor Scaffolder - 12-14' Oct 10
3 A . Nung Tjik Technical Services Safety Officer - Scaffolding Inspector 15-Oct-10
4 Zamhari Technical Services Safety Officer - Scaffolding Inspector 15-Oct-10
5 Erick Supriadi Technical Services Foreman Piping Scaffolder - 12-14' Oct 10
6 Edy Jhon Technical Services Carpenter Scaffolder - 12-14' Oct 10
7 Moh. Toha Technical Services Mason Scaffolder - 12-14' Oct 10
8 Sumadi Technical Services Pipe Fitter Scaffolder - 12-14' Oct 10
9 Munawir Technical Services Helper Welder Scaffolder - 12-14' Oct 10
10 Poniman Emot Technical Services Helper Welder Scaffolder - 12-14' Oct 10
11 Slamet Riyadi Technical Services Foreman Piping Scaffolder - 12-14' Oct 10
12 Spinoza Patra Technical Services Helper Carpenter Scaffolder - 12-14' Oct 10
13 Wardi Technical Services Helper Carpenter Scaffolder - 12-14' Oct 10
14 Sutarman Technical Services Helper Welder Scaffolder - 12-14' Oct 10
15 Tabroni Technical Services Helper Welder Scaffolder - 12-14' Oct 10
16 Dedi Rahmanda Technical Services Helper Welder Scaffolder - 12-14' Oct 10

Prepared by, Approved by,

Ulung Putra Sakti Amrullah Muiz

Sr. HSE Supv. Field Manager
 ATTENDANCE LIST
TANDA TERIMA CERTIFICATE SCAFFOLDING & SCAFFOLDER INSPECTOR

Date 10-Oct-22
No Name Department Position Scaffolder Scaffolding Inspector Signature
1 Ulung Putra Sakti HSE Sr. HSE Supv. - Scaffolding Inspector 1 2
2 Andi Paizal HSE Sr. HSE Supv. - Scaffolding Inspector
3 Natang Sembiring HSE HSE. Supv. - Scaffolding Inspector 3 4
4 Tugimin Diyono Technical Services Sr. Supervisor - Scaffolding Inspector
PT. IKS Labour Supply.
1 Ujang Zaharen HSE HSE Officer - Scaffolding Inspector 1 2
2 Dedi Suhermanto HSE HSE Officer - Scaffolding Inspector
PT. Jimmulya Technical
1 Makmur Technical Services Sr. Supervisor - Scaffolding Inspector 1 2
2 Waris Technical Services Supervisor Scaffolder -
3 A . Nung Tjik Technical Services Safety Officer - Scaffolding Inspector 3 4
4 Zamhari Technical Services Safety Officer - Scaffolding Inspector
5 Erick Supriadi Technical Services Foreman Piping Scaffolder - 5 6
6 Edy Jhon Technical Services Carpenter Scaffolder -
7 Moh. Toha Technical Services Mason Scaffolder - 7 8
8 Sumadi Technical Services Pipe Fitter Scaffolder -
9 Munawir Technical Services Helper Welder Scaffolder - 9 10
10 Poniman Emot Technical Services Helper Welder Scaffolder -
11 Slamet Riyadi Technical Services Foreman Piping Scaffolder - 11 12
12 Spinoza Patra Technical Services Helper Carpenter Scaffolder -
13 Wardi Technical Services Helper Carpenter Scaffolder - 13 14
14 Sutarman Technical Services Helper Welder Scaffolder -
15 Tabroni Technical Services Helper Welder Scaffolder - 15 16
16 Dedi Rahmanda Technical Services Helper Welder Scaffolder -
17 Feri S 17
 Tittle : PTW APPOINTMENT Rev-1
Date : November 18, 2010 PTW Appointment

JPT. (OK) Ltd. Fire Watch Signature

No Name Department Position PA SC AA AAA AGT EIA MIA PTWC Circle One
1 Indra Hadi Prianto OPS Prod. & Tech Dev. Coord - SC - - - - - - -
2 Joko Susilarso OPS Prod. & Tech Dev. Coord - SC - - - - - - -
3 Ulung Putra Sakti HSE Sr. HSE Supv. PA - - - AGT - - PTWC -
4 Andi Paizal HSE Sr. HSE Supv. PA - - - AGT - - PTWC -
5 Natang Sembiring HSE HSE Supv. PA - - - AGT - - PTWC -
6 Ika M. Hendra Jaya MTC Maintenance. Supt. PA - AA AAA - EIA MIA - -
7 Windu Rahardjo MTC Electrical Supv. PA - AA AAA - EIA - - -
8 Rafflis MTC Sr. Electrical Supv. PA - AA AAA - EIA - - -
9 Mudakir MTC Instrument Foreman PA - AA - AGT EIA - - -
10 M. Zulkarnaen MTC Instrument Technician PA - AA AAA - EIA - - -
11 S. Partiyanto MTC Sr. Mech. Supv. PA - AA AAA - - MIA - -
12 Puryanto MTC Mechanical Supv. PA - AA AAA - - MIA - -
13 Teguh Baruna MTC Mechanical Supv. PA - AA AAA - - - - -
14 Bomantara Zaelani Production Prod. Supt. PA - AA AAA - - MIA - -
15 F. Wendhy Production Prod. Supv. PA - AA AAA - - MIA - -
16 Febran Asuari Production Prod. Supv. PA - AA AAA - - MIA - -
17 Sumandra Production Prod. Supv. PA - AA AAA - - MIA - -
18 Ibnu Hajar Production Prod. Assistant PA - AA AAA AGT - MIA - -
19 Sukirman Production Prod. Assistant PA - AA AAA AGT - MIA - -
20 Supriyanto Production Prod. Foreman PA - AA AAA AGT
21 Windrato DWO DWO Supv. PA - AA AAA - - - - -
22 Tri Widyatmaka DWO DWO Supv. PA - AA AAA - - - - -
23 N. Purba Admin & Support. Sr. Admin Supv. PA - AA - - - - - -
24 Jumadi Admin & Support. Admin Supv. PA - AA - - - - - -
25 Noeroso Admin & Support. General Services PA - - - - - - - -
26 Bambang Sunardjo Technical Dept. TS Supervisor PA - AA - - - - - -
27 Tonton AS Logistic Sr. Logistic Supv. PA - AA - - - - - -
28 Jeri R Logistic Material Supv. PA - AA - - - - - -
29 Kadir Logistic Gen. Warehouse Assist. PA - AA - - - - - -
30 Supriyanto Finance Jr. Accountant PA - - - - - - - -
31 Noviansyah Security Asst. Sec. Supv. PA - - - - - - - -
32 Erick Amos FS Finance Sr. Field Acountant PA - - - - - - - -
PT. IKS Labour Supply.
No Name Department Position PTW Appointment
1 Dedi Suhermanto HSE HSE Officer - - - - AGT - - - Fire Watch
2 Ujang Zaharen HSE HSE Officer - - - - AGT - - - Fire Watch
3 Masrul HSE HSE Officer - - - - AGT - - - -
4 Gozali MTC Master Mech. Plant PA - - - AGT - MIA - -
5 Asnawi MTC Master Mech. Plant PA - - - AGT - MIA - -
6 Agus Rianto MTC Master Electrician PA - - - AGT EIA - - -
7 Joko Purwanto MTC Master Electrician PA - - - - EIA - - -
8 Radar MTC Sr. MCC Operator PA - - - - EIA - - -
9 SK Supardi MTC Sr. Instrument PA - - - AGT - - - -
10 Arip Harto MTC Sr. Instrument PA - - - AGT - - - -
11 Medio Ramadona MTC Sr. Electric PA - - - AGT EIA - - -
12 Ahmad Supriatna MTC Sr. Electric PA - - - AGT EIA - - -
13 Hendri Susdianto MTC ESP Specialist PA - - - AGT EIA - - -
14 Yosi Giut Prasmono MTC ESP Specialist PA - - - AGT EIA - - -
13 David Irawan MTC Maintenance Mechanic PA - - - AGT - MIA - -
14 Mujono MTC Mechanic - - - - AGT - - - -
14 Imansyah MTC Instrument PA - - - AGT - - - Circle One
15 Basuki Rahmad MTC Maint. Support Tech. PA - - - - - - - -
16 Taufan M. Production Sep. Oil & Gas PA - - - AGT - - - -
17 Aladin Production Well/ Pipe Line Checker PA - - - AGT - - - -
18 Ismail Production Well/ Pipe Line Checker PA - - - AGT - - - -
19 Gatot Sutejo Production Well/ Pipe Line Checker PA - - - AGT - - - -
20 Firman Production Well/ Pipe Line Checker PA - - - AGT - - - -
21 Purwanto Production Well/ Pipe Line Checker PA - - - AGT - - - -
21 Sunardi Production Laboratorium Tech. PA - - - AGT - - - -
22 Mexander Hutagalung Production Laboratorium Tech. PA - - - AGT - - - -
23 Maruli Panjaitan Production Lab. Tecnician - - - - AGT - - - -
24 Suyadi Production B/S Oil & gas Operator PA - - - - - - - -
PT. Jimmulya Technical
No Name Department Position PTW Appointment
1 Makmur Technical Services Sr. Suvp. Technic PA - - - AGT - - - -
2 Waris Technical Services Sr. Suvp. Technic PA - - - AGT
3 Fery Sukmawan Technical Services Ass. Supv. T.S PA - - - AGT - - - -
4 Nana Mulyana Technical Services Surveyor Topography PA - - - AGT
5 Sarbini Technical Services Foreman Technic PA - - - AGT - - - -
6 Erick Supriadi Technical Services Foreman Technic PA - - - AGT - MIA - -
7 Slamet Riyadi Technical Services Foreman Technic PA - - - AGT - MIA - -
8 Zamhari Technical Services Safety Officer - - - - AGT - - - Fire Watch
9 A Nung Tjik Technical Services Safety Officer - - - - AGT - - - Fire Watch
10 Edy Jhon Technical Services Civil PA - - - AGT - - - -
Prepared by Approved by

Ulung Putra Sakti Amrullah Muiz

Sr. HSE Supv. Field Manager