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Form 05.

71-226 (O/A)

Working Order Form (WO)

Task class : □Emergency □Normal (filled by Civil Engineer)


Applicant Department Submission Date

Applicant Name Contact Number


Work Description:

Received by,

Date: ___ / ___ / ______

Requested Completion Date


Precautions
(filled by applicant)
Safety Engineer at
Implementation Area

Manager at
Implementation Area
Implementation Budget
(filled by the Building Lead
Engineer)

Facility Manager (BU) ME Director

Completion Date
Target
Supervisor (Outsourcing)
(filled by Civil
Engineer)

*) Note:
1. If implementation budget is more than Rp 4.000.000,00, need additional sign by ME Director
before the implementation.
2. Original file is kept by BU. 1st copy for applicant, 2nd copy for outsourcing (monthly payment’s
attachment)

Contact Number
CUC Emergency: ext. 5222
WWTP Emergency: ext. 5135

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