GA01.PRD.2406.WAHP.

51
WORK AT HEIGHT PERMIT
REL

1 - Work Request
Permit Preparation Additional Work Permits Required
Date / Time Request : 22/06/2024 / 08:00
Y Hot Work Permit Y Working at Height Permit
Location of work/equipment : (GAI)
Cold Work Permit Electrical Work Permit
PENAMBAHAN
PLATFOR
KATALIS
Plant Supervisors : Lockout Tagout Permit Heavy Lifting Work Permit
Plant Supervisor Designation Confined Space Entry Permit Excavation Work Permit
PAK ASST. HEAD DEPARTMENT Working at height equipment/tools
PAK SAFETY OFFICER
PAK SUPERVISOR
Type Quantity Condition Remark
Full body harness 3 Y

Protective glasses 3 Y

Protective shoes 3 Y

Head 3 Y
protection/helmet

Particulars of Requestor Work to Perform

Company Name : PT. Berkah Kawan Setya Permit Number : GA01.PRD.2406.WAHP.51

Requestor Name : [alfiatus12] Alfiatus Solikhah Title : (GAI) INSTALL BONGKAR SCAFOLDING UNTUK
Designation : PENAMBAHAN PLATFORM
Job Description : (GAI) INSTALL BONGKAR SCAFOLDING
UNTUK PENAMBAHAN PLATFORM
Name of WAH Workers Working at Heights (In Full)
Name Role
PAK SUCHAIMI SPV
PAK ARIFIN F1
PAK TEGUH F2
2 - WAH Preparation Step & Precautions
Job Safety & Environmental Analysis (JSEA) Erecting Scaffold or break-down
Y JSEA reviewed and approved. Scaffolding to be built under supervision or direction of a Qualified Scaffolder
Y Control measures implemented and verified by Permit Authoriser / Verify a firm foundation – Sole-boards & base plates
EHS Officer
High Risk Activity – WAH Permit Checklist reviewed (attached) Engineering sign off required? (Tick for YES)
Meeting related country regulations
Hazard Identification Working from Scaffold
Y Falling objects Y Scaffold has a safety tag to identify status
Y Unprotected edges Y Scaffold decks fully planked ≤50mm gaps
Y Adverse weather (ie wind/ weather extremes) Y Service gap (between scaffold platform’s inside edge & the building facade)
spacing <225mm (when internal guardrails not required) or follow country
specified required dimension - whichever more stringent
Y Slope of surface Y Provide safe ladder/stairway access
Y Overhead electrical cables Y NO works on scaffold following severe weather until checked
Y Overhead pipes/ fixtures Workers to remain within the confines of the scaffold
Y Uneven floor surfaces Verify all guardrails and kick-boards are in place and secure
Fragile or brittle roofing NO modifications - unless by a qualified scaffolder
Vehicles operating in the area Mobile Scaffold - All castors must be lock-able
Overhead electrical cables Mobile Scaffold - Not to be moved with people on board
Hazardous substances/ materials Mobile Elevated Work Platform Use (MEWP)
Working alone or in isolation Machinery inspected and deemed fit for use (registration with cert. of fitness)
Log book checked and completed DAILY
Harness Use MEWP being operated within load limits: WLL:
Y Harness/equipment inspected and fit for use Kg
Y Harnesses being worn correctly Anchor points available (reject equipment if not available)
Confirm anchor point adequate for the load (>22kN) The area is safe to operate the MEWP
Ladder Use The ground is level and firm to support the weight of the MEWP.
Y The ladder is industrial rated and good working condition Controls tested/trial at the ground level.
Y The ladder is on a secure footing & tied off to prevent sliding or a standby person Levelling devices functional and being used if required
holding secure
Y Workers facing the ladder, with 3 points of contact at all times
Non-conductive ladders to be used near electrical equipment
Crane – Man-cage “NON-Preferred Method”
Approval from Site Manager & Wilmar’s Personnel Lifting Standard/ Guideline
reviewed
The ground is safe to operate the crane – Service/ lift plan
Crane/equipment certificates verified and fit-for-purpose

1/2