Printed 28/02/2024

Indonesia - Corridor - Suban

WORK ACTIVITY NOTIFICATION - WAN0000019483

8311202

Area Plant - Chemical Storage Work Center IDSSMCVL - SSM CIVIL

Activity/Location Description PM Clean UP Drainage at Utility area Suban Plant.

Functional Location ID-N-SB

SUBAN

Work Order 1100193591

2024:FOLLOW UP ACTION REGISTER

Instructions

- Work Scope : PM Clean UP Drainage at Utility area Suban Plant.

- Major Hazard : Pitch Point, Slip, Trip, & Fall, Manual Handling, Benda Tajam
- Worker : 1 work leader & 2 team member
- Procedure : MRA Civil Procedur IDMSCVL

Refer to Model Risk Assessment for relevant Work Center to identify Hazards and Control Measures
Approval

Approved by (Authorizer) SANDY ISWANTO 28/02/2024

Issued Sign Name Date/Time

Issued by (Issuer) ____________________ _______________________ ___________________

Accepted by

Accepted by (Work Leader) ____________________ _______________________

1
 Printed 28/02/2024
Indonesia - Corridor - Suban

WORK ACTIVITY NOTIFICATION - WAN0000019483

8311202

On Completion of reading and understanding of this WAN and associated Model Risk Assessment all users are to sign/initialise
Initial Issues
PJSM

Re-issues
Date Time Issuer Work Leader PJSM

Return Signed Name Date/Time

Returned by (Work Leader) __________________ __________________

__________________
__ __ __
Accepted by (Issuer)
__________________ __________________
__ __
WAN can be renewed daily, subject to conditions of issue remaining valid, by all parties