EX01 - PERMIT TO WORK (SPARK POTENTIAL)

section 1 : inspection, installation & test

date : 10 des 2021 bay : Kamar Peserta ? start time : 08.00

performing authory Nama Peserta
task description/carry out safe isolation on LV lighting circuit in the comp-EX workshop
circuit reference RA number
hazard low voltage working at hight flammable gases adverse weather
AA permission to PA acceptance to
Nama Peserta
isolate issolate
issolate proving gas test certificat
Minta Assessor
point number
confirmation of observation
OK
issolate of isolate

section 2 : inspection, installation & test

expiry time : 11.45

task description : carry out suitanillity check of pre-installed d,e,n equipment & associated items, complete installation, conduct appropriate
test, if statisfactory re-enrgize
l, area authority, declare that all hazards have been identified and all specified control measures are in palce and it is now safe for the work
specified on section 2 of the permit to performed

Print : Assessor.......... signed : .......... time : 08.00 ..........

l, performing authority, have read and understood the above conditions and precautions, i accept responsibillity for crraying out work
as specified. I will notify the area authority on completion or interruption of this work

Print : nama peserta.......... signed : .......... time : 08.00..........

Cancellation
l, performing authority, declare that work for which this permite was issued has been properly performed, and that the equipment, plan and
electrical apparature by the work have been left in safe, celar condition
the work is complete the work is incomplete
x
Print : Nama Peserta.......... signed : .......... time : Jam completed atau maksimum 11

l, area authority, have inspected the equipment/work area anf declare test that work for which this permite wa issued has been properly
performed, that all tools and apparatus hav been removed, and that equipment apparatus effected by work have been left in save clean condition

the work is complete the work is incomplete

Print : Assessor.......... signed : .......... time : 11.40..........

comp-EX EX01 competance validation test

candidate name : date :

visual inspecton report
glands (Penjelasan
suitable ( penjelasan Gland yang di install,
item comments and observations
kondisi equipment) jika uncertified
jaawab "Not OK"

JB 1 OK - Special Condition Apply OK

JB 2 OK - Special Condition Apply OK

JB 3 OK - Special Condition Apply OK

sw 1 OK To be Installed

LT 1 OK To be Installed
 - Uncertified Plug Not Ok jika gland
LT 2 OK - Uncertied Gland ( pilihan ini setiap bay berbeda bisa jadi ditemukan di JB1,2,3, LT2? ) Uncertified/ OK jika
Jika ad maka Gland not OK Silahkan Lihat Listnya di table kunci di bawah. Gland certified

schedule of test result

test equipment
make model serial No. calibrated

Fluke Cek Actual Cek Aktual Yes

insullation resistance
circuit continuiy
conductor size
discription Ω
test voltage 1000 VDC
L N PE L-N L-PE N-PE
live CPC
lighting circuit
0.3 Ohm 0.3 Ohm 0.4 ohm >2.2G ohm >2.2G ohm >2.2G ohm
2.5mm 2.5mm

Table Kunci
Correctly Identified UN- Certified Gland EQ ID
BAY/ KAMAR 1 JB 1
BAY/ KAMAR 2 LT 2
BAY/ KAMAR 3 JB 3
BAY/ KAMAR 4 JB 2
BAY/ KAMAR 5 JB 1
BAY/ KAMAR 6 JB 1
BAY/ KAMAR 7 LT 2
BAY/ KAMAR 8 JB 3
BAY/ KAMAR 9 JB 2
BAY/ KAMAR 10 JB 1