RA, To Copies to After completing this form, please forward to Att. Bpk TYAS/Bpk Samsudin Workshop Manager Corrective Action Request Form Control Number: QA/QC-CAR-001 : PT. PGAS SOLUTION ( Departement Manufactur & Repair ) PT. PGAS SOLUTION ( PIR ) PGN/PMO Representative SECTION 1: To be completed by the requestor Today’s Date Person(s) Requesting Corrective Action: ‘QA/OC Inspector ; Zainal Abidin : ENGINEER: ARDIKA/A Rasyid so Location/Dept : PT. PGAS SOLUTION /Dep' Manufactur & Repair Location : Workshop Klender Date: July 17,2019 Fabrikasi pipe spool MRS sbb: 1 Fabrikasi 7 unit MRS P3E1 ( Area Palembang ) 2. Fabrikasi MRS G16 ( PT. Siloam Internasional Hospial ) Berdasarkan Visual check dan pengukuran bahwa Jarak pengelasan (welding seam) sangat berdekatan,kurang dari $ mm tidak sesuai dengan standard PGN berdasarkan Panduan Konstruksi Baja no, Doc. PKP-CTE-ON-CS-001 Bab X ( Pengelasan ) para. 10.10.10 ,, Jarak minimal antar seam harus 5 x tebal pipa atau 50 mm tergantung, ‘mana yang lebih besar Dan juga desain drawing yang di ajukan belum disetujui oleh pihak PMO-PGN namun konstruksi/ fabrikasi pipe spool MRS telah dilakukan Berdasarkan hal terscbut maka hasil fabrikasi pipe spool tidak bisa diterima ( Reject ). Oleh karena itu PGAS Solution harus membuat baru sesuai standard PGN, THIS SECTION TO BE COMPLETED BY THE CORRECTIVE ACTION REVIEW TEAM ONLY: Type of CAR: [ X ]Process Correction [JRemedial [Customer Concern Action [ ]Prev. Action [ ]Work Order Responsible person(s) to complete section 2: Dept. M&R Date sent : 19 July 2019Ze psn Corrective Action Request Form 001 energy for lite Control Number: QA/QC-CA\ SECTION 2: Process Correction Action Plan ~ To be completed by the responsible person(s) Please respond to the originator within five (5) working days of receipt. ‘What is causing the problem or concern recorded in Section 1 to oceur? — ‘Use adional pape as necesany_ATtach any relevant ecors or documents ‘What action has been, or will be taken to correct the identified problem or concern? Use akitional papers necessary. Attach any relevant records or documents Implementation Date of the Above Stated Action: (If Applicable) Date: ‘ompleted form or contact PMO by the required response date: SECTION 3: Verification & Closeout Information. For Corrective Action Team Use Only. Has the documented action been implemented and is effective? [] Yes []No Is the original requestor satisfied with the outcome of the action taken? [] Yes [] No Notes Verified and Closed-out by: Date: