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  • KPS-HSES-FR-SF-055 Form Confined Spaces Checklist - 密闭空间进入许可点检表

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    KPS-HSES-FR-SF-055 Form Confined Spaces Checklist - 密闭空间进入许可点检表

    Uploaded by

    jefrisusanto371

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    CONFINED SPACE ENTRY PERMIT

    KALTARA PROJECT
    CHECKLIST 密闭空间进入许可点检表
    PT Kalimantan Aluminium Industry
    PT Kaltara Power Indonesia
    SITE KAI-KPI  BARU/新 Nomor Izin / 许可编号:KPS-HSES-FR-SF-055
     PERPANJANGAN/延期 _____/CS/________/________

    Tanggal Jam /
    /Date/ Time/
    日期 时间

    Izin Kerja diberikan kepada / :


    This work permit give to /
    这工作许可是提供给
    Lokasi Pekerjaan / :
    Location of Work /
    工作地点
    Uraian Pekerjaan / :
    Job Description /
    工作描述
    Jumlah orang (max) dalam bejana / :
    Total Worker /
    最多人员总数

    Nama orang yang 1. 2. 3.


    Bekerja / berada dalam
    bejana / Name worker / 4. 5. 6.
    在密封间工作的人员名
    称

    Di isi oleh safety inspector / Fill by Safety Inspector / Yes No Di isi oleh Supervisor / Fill by Supervisor / Yes No
    由安全检查员填写 是 否 由安全检查员填写 是 否
    1. Telah diadakan test terhadap gas 1. Kerangan-kerangan yg berhubungan dgn
    beracun, explosive gas dan kadar O2 / Does bejana telah ditutup / Does all valve and pipe
    explosive gas, hazardous gas and O2 gas have been that connect to confined space have been
    tested /爆炸性气体、有害气体、氧气是否经过检 closed.
    测 是否所有连接密闭空间的阀门和管道都已
    关闭。
    2. Alat pelindung pernafasan dan tali pengaman 2. Kerangan-kerangan yang ditutup telah
    tersedia / Does respirator equipment and Line Life dipasang safety tag / Does all valve and pipe
    apply / 呼吸器设备和 Line Life 是否适用 has been install with lock out and tag out /
    是否所有阀门和管道都已安装上锁和挂牌
    3. Digunakan alat listrik yg sesuai dgn 3. Sistem sudah bebas dari pressure dan suhu
    Ketentuan / Does electric equipment suitable with tinggi / Does this system has been free from
    requirement /电器是否符合要求 pressure and high temperature/本系统是否
    已没有压力和高温
    4. Diperlukan ventilasi buatan / Does more ventilation 4. Sistem sudah dipurging dan diflushing /
    need /是否需要更多通风 Does this system has been purging and
    flushing/系统是否一直在吹扫和冲洗
    5. Telah menugaskan seseorang utk 5. Blind-Blind sudah dipasang dan diberi
    menjaga diluar bejana / Does safety man has been tanda / Does all blind has been install and
    appointed/是否已安排安全员在外面 give sign/是否所有百叶窗都已安装并给出
    标志
    6. Zat-zat berbahaya telah disingkirkan / Does 6. Operator DCS telah dihubungi / Does DCS
    hazardous material has rip off / 有害物质是否被撕 has been call/是否所有百叶窗都已安装并
    掉 给出标志
    7. Tersedia sarana seperti: Alat berat, 7. Perintah kerja aman telah dimengerti oleh
    tangga, atau peralatan lainnya / Does facility such pelaksana / Does the supervisor has been
    as: ladder, heavy equipment and so on are apply /梯 understand with the safe operation
    子、重型设备等设施是否适用 procedure/主管是否了解安全操作程序
    8. Lain-Lain / Other / 其他: 8. Lain-Lain / Other/其他:

    Controlled Copy, Do Not Duplicate For Internal Use Only


    Tindakan khusus yg harus dilakukan / special act / 特别行动:

    Saran khusus / special advice / 特别建议 :

    CATATAN HASIL PENGETESAN GAS / GAS TEST RECORDED / 气体测试记录


    Gas Explosive 爆炸性气体 : % (Maximum 最高 0 %) Kesimpulan 结论: Safe 安全/ Not safe 不安全
    CO2 二氧化碳 : ppm Kesimpulan 结论: Safe 安全/ Not safe 不安全
    (Maximum 最高 5000 ppm)
    Carbon Monoxyde Kesimpulan 结论: Safe 安全/ Not safe 不安全
    一氧化碳 : ppm
    (Maximum 最高 50 ppm)
    Oxygen 氧气 : % (19.5 % – 21.5 %) Kesimpulan 结论: Safe 安全/ Not safe 不安全

    _____________ ___________ _____________ ____________


    Safety Inspector Supervisor/SI Site Manager/ DH PT KAI-KPI HSES Dept. DH / HSE SH PT KAI-KPI

    Controlled Copy, Do Not Duplicate For Internal Use Only

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