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    Form Permit Restricted Work R5 12 Jan 2022

    Uploaded by

    kyntaqient24
    This document is a daily work permit for a restricted area near the third rail. It requires information such as the contractor, work area, employee names and positions, type of work, and authorization signatures. The notes specify that the permit must be submitted and signed the day before, by 4 pm, and is for workers in energized areas who must attach an approved weekly permit.

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    Form Permit Restricted Work R5 12 Jan 2022

    Uploaded by

    kyntaqient24
    5 views1 page
    This document is a daily work permit for a restricted area near the third rail. It requires information such as the contractor, work area, employee names and positions, type of work, and authorization signatures. The notes specify that the permit must be submitted and signed the day before, by 4 pm, and is for workers in energized areas who must attach an approved weekly permit.

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    0. Form Permit restricted work R5 12 Jan 2022

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    This document is a daily work permit for a restricted area near the third rail. It requires information such as the contractor, work area, employee names and positions, type of work, and authorization signatures. The notes specify that the permit must be submitted and signed the day before, by 4 pm, and is for workers in energized areas who must attach an approved weekly permit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    5 views1 page

    Form Permit Restricted Work R5 12 Jan 2022

    Uploaded by

    kyntaqient24
    This document is a daily work permit for a restricted area near the third rail. It requires information such as the contractor, work area, employee names and positions, type of work, and authorization signatures. The notes specify that the permit must be submitted and signed the day before, by 4 pm, and is for workers in energized areas who must attach an approved weekly permit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    DAILY WORK PERMIT RESTRICTED AREA

    REQUEST OFF 3RD RAIL

    NO PERMIT / PERMIT NUMBER


    TANGGAL / DATE :
    JAM KERJA / WORKING HOURS
    CONTRACTOR / MANDOR
    AREA KERJA / WORK AREA

    NO ID BADGE NAMA / NAME JABATAN / POSITION TYPE OF WORK ALAT KERJA

    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20

    OTORISASI IJIN / AUTHORIZATION PERMIT

    ADHI KARYA RAILWAY SYSTEM CONSTRUCTION MANAGEMENT


    Field Commander HSE Energizing SCC DPKA

    Tanda Tangan / Signature

    Nama / Name
    Tanggal / Date

    PENERIMA IJIN / RECIPIENT PERMIT

    Supervisor Supervisor HSE


    Tanda Tangan / Signature

    Nama / Name
    Tanggal/ Date

    Notes : Permit harus disubmit setiap hari dan dimintakan tanda tangan satu hari sebelumnya.
    Permits must be submitted every day and signed the day before.
    Permit untuk disubmit paling lambat jam 16:00 setiap sore
    Permit to be submitted no later than 16:00 every evening
    Permit ini diperuntukkan untuk pekerja yang bekerja di area yang sudah bertegangan
    This Permit is for workers who work in energize area
    Wajib melampirkan Permit mingguan atau hand carry permit yang sudah diapprove
    Must attach weekly Permit or hand carry permit that has been approved

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