Go-No Go Document by Jatra

PT.
HUTAMA KARYA (PERSERO)

CIVIL ENGINEERING & GENERAL CONTRACTORS
GO-NO-GO VOIDED SLAB AND PCI GIRDER ERECTION

BY PT.JATRA SEJAHTERA
SSHE
PT.HUTAMA KARYA (PERSERO)
NO Classification SECT. REQUIRED DELIVERABLES REQUIRED AVAILABLE STATUS Remarks
1 SSHE
1 SSHE Plan RH
2 PPE for workers (based on PPE list) √ JS
3 First Aider is dedicated at the worksite RH

4 First Aid Kit is available at the site √ JS
5 Safety Area barricade available at site √ JS

6 Safety Signs available at site √ JS
Working Signs √ JS
Working at Height Signs √ JS
Working at Height Boat N/A
Authorized Worker Signs N/A
Safety Bulletin Boards √ JS
7 Employee Badge
ID Badge √ JS
Work at height training √ JS
Scaffolder training
Confined space training
Defensive Driving Course for
Operators and Drivers RH
8 Inspections
Welding transformer/machine and
cables √ JS
Crane / Lifting Equipment √ RH
Lifting Gear (inspected, records, and
color-coded) √ JS
Power tool (with GFCI, i fused
outside) √ JS
Generator set (with proper size
grounding rod) √ JS
Hand tools √ JS
Scaffolding (inspector and builder
certifications checked) N/A
Fire extinguisher N/A
Gas detector (calibrated) N/A
Ladder √ JS
Eye wash √ JS
Full Bodyhardness √ JS
Special PPE (face shield, special
gloves, clothing) N/A
9 Health and Hygiene
shelter /shed area √ JS
fresh drinking water √ JS
trash bin √ JS
toilet √ JS
sosec : engagement with local partners

10 started early and issues resolved RH
Coordination
11 Emergency Response Plan with RH
Prepared by Approved by Acknowledged by MCL
PT. JATRA SEJAHTERA SSHE/QUALITY/CONSTRUCTION SSHE/QUALITY/CONSTRUCTION

1. SSHE PLAN
Safety, Health & Environment Commitment
PT. JATRA SEJAHTERA ensure and careful the PT. JATRA SEJAHTERA bertekat dan hati-hati
safety and healthful working environment also untuk menyediakan tempat dan lingkungan
free from recognized hazard for its employees. kerja yang aman dan sehat untuk karyawan.
Each employees, sub-contractor will have a Setiap karyawan dan sub-contractor akan
thorough knowledge of the Safety Health mendapatkan pengalaman dan pengetahuan
Environmental Plan and therefore, we will be yang mendetail tentang keselamatan kerja dan
responsible for the safe performances of the oleh karena itu, kami akan bertanggungjawab
work as an integral part of the assigned duties. untuk mengawasi keselamatan kerja sebagai
bagian penting dari pekerjaan yang diberikan.
Our commitment are : Tanggung jawab / kewajiban kami adalah :

1. Managememnt always commit that 1. Manajemen selalu yakin bahwa
Health, Safety and Environment persyaratan Keselamatan, Kesehatan
requirement is important thing dan Lingkungan merupakan hal yang
penting.
2. Ensuring a safe work environment and 2. Memastikan agar semua lingkungan

proper equipment to perform each pekerjaan aman, serta penggunaan
task peralatan yang layak untuk
mengerjakan setiap pekerjaan.
3. Management will conducting regularly 3. Manajemen akan mengadakan inspeksi

scheduled safety and health inspection keselamatan kerja secara rutin untuk
to identify and eliminate unsafe work mengenal, menetapkan dan
conditions and/or practices, to control mengurangi setiap kondisi yang tidak
health hazard, and to comply fully with aman, dengan tujuan untuk
the safety and health requirements of mengontrol bahaya terhadap
every task kesehatan kerja, dan tunduk secara
penuh pada ketentuan keselamatan
kerja dari setiap pekerjaan.
4. Management will develop and 4. Manajemen akan menjaga dan

maintain the culture of Safety and meningkatkan budaya sehat dan aman.
Health
5. Management will provide training and 5. Manajemen menyelenggarakan

motivating supervisors to instruct their training dan memberi motivasi kepada
personnel thoroughly in all safety supervisor untuk menginstruksikan
aspects of their work secara langsung kepada pekerja
mengenai segala aspek keselamatan
kerja yang berhubungan dengan
pekerjaan mereka.
6. Management will investigate , 6. Manajemen akan mengadakan

promptly and thoroughly , every investigasi secara tepat dan langsung
accident, incident, and near miss pada setiap kejadian kecelakaan yang
involving Contractor, Subcontractor berhubungan dengan Contractor
personnel to determine the cause and dan/ataupun sub kontrak untuk
remedial action required preventing menentukan penyebab kecelakaan
recurrence serta tindakan pencegahan yang
diperlukan untuk mencegah supaya
tidak terulang lagi.
7. Management will manage the 7. Manajemen akan mengelola

operation to minimize environment / operasional untuk meminimalkan
human impact and provide workplace dampak negatif lingkungan dan
free of recognized hazard menyiapkan tempat kerja yang
terbebas dari bahaya.
8. Management will monitor, evaluate 8. Manajemen akan memantau,

,report and audited all performance in mengevaluasi, melaporkan, dan
Health, Safety and Environment mengaudit setiap kinerja dari program
program regularly. pelaksanaan perlindungan lingkungan,
keamanan, dan kesehatan kerja secara
berkala.
PT. JATRA SEJAHTERA
BAMBANG WARSITO
Direktur Utama
2. PPE FOR WORKERS
3. FIRST AIDER IS DEDICATED AT THE WORKSITE
COVER BY RH
4. FIRST AID KIT

5. SAFETY AREA BARRICADE
6. SAFETY SIGNS
7. EMPLOYEE BADGE
ID Badge for employee still on process
8. TOOLS INSPECTION
No Description Merk Type Fitur Qty Status

1 Gantry fabrikasi Electricity 120 Ton 2
2 Crane Sumitomo 2
3 Launcher fabrikasi Electricity 120 ton, 48 m 1
4 Power fabrikasi Diessel 125 kVA 1
generator
5 Measuring tape Local 3
6 hammer Local 2
7 ladder Local 2
8 Welding Focus Manual 400 A 2
machine &
cable
9 Wrench set Local 1
10 pliers Local 2
11 cutter Local 2
12 Screwdriver Local 4
13 Scissor Local 2
a. Hand tools
b. Welding machine set
c. Power Generator
d. Launcher
e. Gantry
9. HEALTH AND HYGIENE


QUALITY PLAN

2 QUALITY
12 Quality Plan √ RH
13 ITP (Inspection Test Plan) √ RH
14 WPS PQR N/A
15 Welder List + Certificates N/A
16 Certificate of QC Personnel N/A
17 Readiness NDT Company N/A
18 Forms Record/Report √ JS
19 Procedures √ JS
Prepared by Approved by Acknowledged by MCL
PT. JATRA SEJAHTERA SSHE/QUALITY/CONSTRUCTION SSHE/QUALITY/CONSTRUCTION

12. QUALITY PLAN
ITP QC CIVIL
MATERIAL
TOOL CONTROL SITE INSPECTION LABORATORY
CONTROL
1. AFI/Log sheet 1. AFI 1. AFI 1. AFI

2. Calibration report 2. Inspection check 2. Inspection check 2. Inspection check
3. Sampling
REPORTING
QC ADMIN
13. ITP (INSPECTION and TEST PLAN
ITP STILL IN PROCESS

18. FORM RECORD / REPORTS
19. PROCEDURES

CONSTRUCTION

3 CONSTRUCTION
20 Required IFC Drawing
1. Structural Plan View, Elevation
View & Section View √ JS
2. Structural Element Details √ JS
3. Architectural Layout & Schedule
(Door & Window, Finishing, etc) N/A
4. Equipment Layout (HVAC,
Mechanical, Piping, Telecom/IT,
Instrument) N/A
5. Electrical SLD, Panel &
Receptacle Layout N/A
6. Construction Sequence √ JS
21 CWP √ RH
Site Organization chart (with phone
22
numbers) √ JS
23 Level 4 Construction Schedule √ JS
Structural √ JS
Civil & Architectural N/A
MEP & Instrument N/A
Telecom & Security N/A
24 Welding map N/A
Workday start and end times; days per
25 week N/A
26 List which CEP’s are required
1. Civil and Structural Works √ RH
2. Architectural Works N/A
3. Mechanical &Instrument Works N/A
4. Electrical & Telecom Works N/A
5. Commisioning, Completion & As-
built works N/A
27 Authorized Worker List for each area (site) √ JS
28 Permit
PTW √ RH
Confined space N/A
Working on the roof permit (if any) N/A
29 JSA (Job Safety Analysis) √ JS
30 SOP (Standard Operating Procedure) √ JS
Dosier (All data completed collected for
31
mechanical completion) N/A
20. IFC DRAWING
A. PLAN VIEW OF VOIDED SLAB ERECTION 1ST STAGE

B. PLAN VIEW OF VOIDED SLAB ERECTION 2ND STAGE

C. PLAN VIEW OF VOIDED SLAB ERECTION 3rd STAGE

D. ELEVATION VIEW OF VOIDED SLAB ERECTION

E. RIGGING DETAIL VIEW OF VOIDED SLAB ERECTION

F. PLAN VIEW OF GIRDER ERECTION

G. ELEVATION DETAIL VIEW OF GIRDER ERECTION

H. RIGGING DETAIL VIEW OF GIRDER ERECTION

21. CWP
IN PROGRESS
22. SITE ORGANIZATION CHART
Project Manager
Samsul
082141868000
Adm & Logistik Site Manager Engineering

Sunarto
081332052633
Man Power
23. CONSTRUCTION SCHEDULE
BULAN KE-01 BULAN KE-02

ITEM PEKERJAAN VOLUME SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
A. ZONE 2
a. PREPARATORY WORK
1. Gantry Setting
2 UNIT
2. Trial
b. PCI GIRDER ERECTION= 3

X 12 SPAN
1. P20 - P21
3 bh
2. P21 - P22 bh
3
3. P22 - P23 bh
3
4. P23 - P24 bh
3
5. P24 - P25 bh
3
6. P25 - P26 bh
3
7. P29 - P30 bh
3
8. P30 - P31 bh
3
9. P31 - P32 bh
3
10. P32 - P33 bh
3
11. P33 - P34 bh
3
12. P34 - P35 bh
3
B. ZONE 1
a. VOIDED SLAB ERECTION =
12 X 11 SPAN
1. P1 -P2
12 bh
2. P2 -P3 bh
12
3. P3 -P4 bh
12
4. P4 -P5 bh
12
5. P5 -P6 bh
12
6. P6 -P7 bh
12
7. P7 -P8 bh
12
8. P8 -P9 bh
12
9. P9 -P10 bh
12
10. P10 -P11 bh
12
11. P11 -P12 bh
12
C. ZONE 3
a. PREPARATORY WORK
1. Launcher Setting
1 UNIT
2. Trial
b. PCI GIRDER ERECTION = 5

X 6 SPAN & 6 X 4 SPAN
1. P14 - P15
5 bh
2. P15 - P16
5 bh
3. P16 - P17
5 bh
4. P17- P18
5 bh
5. P18 - P19
5 bh
6. P12 - P13
6 bh
7. P13 - P14
6 bh
8. P27 - P36
6 bh
9. P28 - P37
6 bh
26. CONSTRUCTION EXECUTION PLAN
IN PROGRESS
27. AUTHORIZED WORKER LIST FOR EACH AREA
ID Badge for employee still on process
28. PERMIT
29. JOB SAFETY ANALYSIS
30. STANDARD OPERATION PROCEDURE

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PT.

HUTAMA KARYA (PERSERO)

GO-NO-GO VOIDED SLAB AND PCI GIRDER ERECTION

NO Classification SECT. REQUIRED DELIVERABLES REQUIRED AVAILABLE STATUS Remarks

2 PPE for workers (based on PPE list) √ JS

3 First Aider is dedicated at the worksite RH

5 Safety Area barricade available at site √ JS

sosec : engagement with local partners

Prepared by Approved by Acknowledged by MCL

PT. JATRA SEJAHTERA SSHE/QUALITY/CONSTRUCTION SSHE/QUALITY/CONSTRUCTION

Safety, Health & Environment Commitment

Our commitment are : Tanggung jawab / kewajiban kami adalah :

2. Ensuring a safe work environment and 2. Memastikan agar semua lingkungan

3. Management will conducting regularly 3. Manajemen akan mengadakan inspeksi

4. Management will develop and 4. Manajemen akan menjaga dan

5. Management will provide training and 5. Manajemen menyelenggarakan

6. Management will investigate , 6. Manajemen akan mengadakan

7. Management will manage the 7. Manajemen akan mengelola

8. Management will monitor, evaluate 8. Manajemen akan memantau,

PT. JATRA SEJAHTERA

2. PPE FOR WORKERS

3. FIRST AIDER IS DEDICATED AT THE WORKSITE

4. FIRST AID KIT

5. SAFETY AREA BARRICADE

ID Badge for employee still on process

No Description Merk Type Fitur Qty Status

b. Welding machine set

9. HEALTH AND HYGIENE

GO-NO-GO VOIDED SLAB AND PCI GIRDER ERECTION

NO Classification SECT. REQUIRED DELIVERABLES REQUIRED AVAILABLE STATUS Remarks

Prepared by Approved by Acknowledged by MCL

PT. JATRA SEJAHTERA SSHE/QUALITY/CONSTRUCTION SSHE/QUALITY/CONSTRUCTION

12. QUALITY PLAN

1. AFI/Log sheet 1. AFI 1. AFI 1. AFI

13. ITP (INSPECTION and TEST PLAN

ITP STILL IN PROCESS

18. FORM RECORD / REPORTS

GO-NO-GO VOIDED SLAB AND PCI GIRDER ERECTION

NO Classification SECT. REQUIRED DELIVERABLES REQUIRED AVAILABLE STATUS Remarks

20. IFC DRAWING

A. PLAN VIEW OF VOIDED SLAB ERECTION 1ST STAGE

B. PLAN VIEW OF VOIDED SLAB ERECTION 2ND STAGE

C. PLAN VIEW OF VOIDED SLAB ERECTION 3rd STAGE

D. ELEVATION VIEW OF VOIDED SLAB ERECTION

E. RIGGING DETAIL VIEW OF VOIDED SLAB ERECTION

F. PLAN VIEW OF GIRDER ERECTION

G. ELEVATION DETAIL VIEW OF GIRDER ERECTION

H. RIGGING DETAIL VIEW OF GIRDER ERECTION

22. SITE ORGANIZATION CHART

Adm & Logistik Site Manager Engineering

23. CONSTRUCTION SCHEDULE

BULAN KE-01 BULAN KE-02

b. PCI GIRDER ERECTION= 3

b. PCI GIRDER ERECTION = 5

26. CONSTRUCTION EXECUTION PLAN

27. AUTHORIZED WORKER LIST FOR EACH AREA

ID Badge for employee still on process

29. JOB SAFETY ANALYSIS

30. STANDARD OPERATION PROCEDURE

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