Izin Kerja / Work Permit

PT Rich Products Manufacturing Indonesia

 Basic information

Originator I Gede Ananda Putra Meyge, Nugroho Originate Date 2022-09-10 10:00

Originate OUName User SequenceNo 20220910000452

 Details Work Activity

Working Information Project House Standby Person for I Gede Ananda

/ Covine Space
Project Information

Contractor Info NO. Company Name Worker Name Work Area

1 Thermax Ardi Boiler

2 Thermax Ubay Boiler

3 Thermax Ari Boiler

Date 2022-09-10 Start Time 09:05:57

Scope Of Work
Finishing boiler unit

Equipment used Hand tools

Safety equipment

Key Safety Precaution

1. Apakah Semua Pekerja telah mendapatkan briefing safety ? Yes No

Have all Workers received a safety briefing or training ?

2. Apakah semua Hazards telah di identifikasi ? Yes No

Have All hazards is identified ?

3. Apakah oksigen di area kerja di pastikan aman dan normal ? Yes No

Have Oxygen in working area is safety and normal condition ?

Compliance Declaration

Deklarasi Kesesuaian izin bekerja / Compliance with permit declaration

Yes I Unde No I Don't
Saya telah memahami dan menjamin bahwa kami telah memenuhi ketentuan rstand Understan
bekerja yang aman dan semua syarat yang diperlukan dalam izin surat bekerja d
ini.

I Understand and ensure to Complly with the Term and Conditions to work safet
y and work permit

 Hazzard Potential

Safety Equipment Pakaian Pelindung / Protective Clothes

Mandatory Safety (Helmet, Safety Shoes, Visible, Vest)
Safety Harness

Masker / Mask Lainnya / Other

Safety Precaution Alat Pemadam Api / Fire Extinguisher Tanda Pembatas / Barricade Sign

Penerangan / Lighting Alat Komunikasi / Radio

Lain-lain / Others