GA01.PRD.2406.HOWP.

52
HOT WORK PERMIT
REL

Seek an Alternative/ Safer Method If Possible!

This Hot Work Permit is for any operation involving open flame or producing heat and/or spark. This work includes, but is not limited to, welding, brazing, cutting, grinding, soldering, thawing pipe, torch-applied roofing,
or chemical welding. Take note that the permit may not require for hot work at designated area (ie. workshop) and shall not be authorised for hot work at restricted areas (ie. Ex-zone).

1 - Work Request
Permit Preparation Working at height equipment/tools
Date / Time Request : 22/06/2024 / 08:00 Type Quantity Condition Remark
Location of work/equipment : (GAI) Protective glasses 3 Y
PENAMBAHAN
PLATFOR
KATALIS Protective shoes 3 Y

Plant Supervisors :
Fire Extinguisher 3 Y

Head 3 Y
protection/helmet

Fire 3 Y
blankets/sacks

Emergency kit 3 Y
(stretches, first
aid kit)

Plant Supervisor Designation Work to Perform

PAK ASST. HEAD DEPARTMENT
Permit Number : GA01.PRD.2406.HOWP.52
PAK SUPERVISOR
Title : (GAI) PENAMBAHAN PLATFORM
PAK ASST. SUPERVISOR
PAK SAFETY OFFICER
Particulars of Requestor Job Description : (GAI) INSTALL BONGKAR SCAFOLDING
UNTUK PENAMBAHAN PLATFORM
Company Name : PT. Berkah Kawan Setya
Requestor Name : [alfiatus12] Alfiatus Solikhah Soldering Torch Cutting
Designation : Brazing Y Welding
Name of Workers Doing Hot Work (In Full) Y Grinding/ Abrasive work Other
Name Role

PAK SUCHAIMI SPV

PAK ARIFIN F1

PAK TEGUH F2

2 - How Work Preparation Step & Precautions

Job Safety & Environmental Analysis (JSEA) Isolations
Y JSEA reviewed and approved. Y Electrical & mechanical drives Instrumentation
Y Control measures implemented and verified by Permit Authoriser / Process lines Firefighting/ suppression system
EHS Officer
High Risk Activity – Hot Work Permit Checklist reviewed (attached) Services (Air/ Gas/ Water)
Initial Gas & Atmospheric Testing Hot work on enclosed equipment/ tank :
* Record additional readings on the HWP supplementary sheet

O2 (19.5-23.5%) 20.50 % Testing Frequency: The tank or vessel has been prepared in accordance with ‘Preparation for Hot
CO (<30ppm) 0.00 Continuously Work on Tanks Procedure’
H2S (<10ppm) 0.00
Y Periodically Additional PPE
LEL (0%) 0.00
Gas Tester Calibration Date: 20/06/2024 Y Safety glasses Y Welding head shield
Gas Tester Model SNDWAY Y Ear muff/plugs Y Welding gloves
Gas tester S/N# SN7500
Y Welding goggles Welding apron
Other
Additional Work Permits Required Fire Monitoring and Fire Watcher
Y Hot Work Permit Y Working at Height Permit Y Fire watcher trained in use of firefighting equipment and in sounding alarm
Cold Work Permit Electrical Work Permit Fire Watcher Names & Sign:
(Fire watchers are aware of their duties and won’t leave their post.)
Lockout Tagout Permit Heavy Lifting Work Permit
Name : [alfiatus12]Alfiatus Solikhah

Confined Space Entry Permit Excavation Work Permit Phone 087777968738

Department Maintenance
PROCEDURE FOR HOT WORK IN A CONFINED SPACE:
Air quality monitoring, ventilation, lockout, equipment isolation and rescue plan must be established prior to Confirmation 21/06/2024 16:48
hot work in confined space. A Confined Space Entry Permit must be issued and implemented in addition to a
Hot Work Permit before work commenced.

Emergency Equipment
Y Fire extinguisher (Type:powder) Water hose reel Fire blanket
3 - Authorisation & Acceptance
Parmit Valid From : Date : 22/06/2024 Hours Permit Requester Signature:

Maximum for one shift only From : 08:00 I agreed that all hot work precautions and instructions are adhered to
and I fully understand the nature and extend of works undertaken by
my workers and me.
To : 16:30
Permit Accepted by: (Permit Receiver – Wilmar supervisor/ technician/ engineer only/ Maintenance Manager)
I accept this Hot Work Permit and agree to abide by the conditions stipulated. I will instruct all workers on the Hazards and Risks and ensure all controls remain in place until the work is complete.

Permit Authorised by: (Plant/ Factory/ Project)

I certify that I have personally examined this application, the hot work risk assessment, the rescue plan, the work area, checked all precautions, tools and equipment and I am satisfied the controls
are in place and authorise hot work to commence.

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