Manyar Smelter Project

Request for Safety Induction

Date : May 14 , 2023th

To : PT. Freeport Indonesia

With this letter, we proposed to get Safety Induction for our crew member that will joined in
Freeport Indonesia Smelter Project as per below details:
Name of Company : PT. Adhi Karya
Proposed Date for Safety Induction : May 14 , 2023 th

Total of Manpower for Safety Induction : 1 (one) Person

To consider our Safety Induction proposal, here we attach some documents as follows:
No Documents Status Remarks
1 Copy of ID Card ✓
2 ID Photo (Without Helmet, Safety Glass & Background: Green ) ✓
3 Health Certificates “Fit for Work” from Occupational Doctor ✓
4 Copy of “BPJS Ketenagakerjaan” of workers ✓
5 Copy of certificate competences ✓
6 Copy of Vaccination Certificate ✓
Attach the Certificate of Employment or Previous Company (If you have worked in a -
7
company within the Manyar Smelter Project before)

Thus, we made this request. Thanks for your help and cooperation.

Proposed by,

Mhd. Sallim Jungjung

Noted:
1. Safety induction must be proposed maximum 3 day before at 03.00 P.M
2. For workers who got competencies (ex. Heavy Equipment Operator, Welder, Safety
Personnel, etc.) should attached certificates from their competencies
3. Safety Induction will be conducted after all documents are submitted completely
4. Certificate of employment attached should be in original paper

Attachment:
Personnel List of Safety Induction
Date of Birth WAH Training Required
No Name Position NIK Discipline Name
(mm/dd/yyyy) (Y/N) Certificates (Y/N)
1SHEANIA ANDRIANI HSE Spv 3308044505990001 05-05-1998 Steel structure y y
Guidance for Discipline Name :

No. Nama ID Card ID Photo BPJS Vaccine

1

1 SHEANIA ANDRIANI
3308044505990001
05-05-1998
 N Nama Nomor Kontak Kontak Darurat Hubungan Certificate Competence or Health Certificate / MCU result
o. Kontak Darurat Certificate of Employment
SHEANIA 0877-8819-0246 0889-7352-6381 HSE Supervisor
ANDRIANI
1
MS-DD-3120-HSE-FRM-9001