SAGULING POMU 202115164

SURAT PERINTAH KERJA

No Work Order: 202115164 Report Date 28 Mar 2021
Deskripsi: PEMELIHARAAN BULANAN FIRE FIGHTING Scheduled Start 09 Apr 2021 08:00
TEMPERATURE CONTROL FOR E.G. PH
Seksi: Pemeliharaan Kontrol Scheduled Finish: 09 Apr 2021 10:00
Worktype: Preventive Maintenance Target Finish Apr 9, 2021, 10:00 AM
Supervisor: Firdaus Eka Setiawan Status: CLOSE
Safety Plan :
Long Description:

Asset / Location location locdesc

Asset Asset Description Location Location Description
SG00SGY10DT070-001 (EQ.) FIRE FIGHTING TEMPERATURE CONTROL FOR
SG00SGY10DT070-SGPA0E0
E.G. PH FIRE FIGHTING TEMPERATURE CONTROL FOR
E.G. PH-EMERGENCY GENERATOR BUILDING

Task IDs
Task ID Description Estimated Duration Actual Duration Remarks
10 Koordinasi dengan operator 00:10
20 Persiapan Data Teknis, Tool & Material 00:10
30 CEK LAMPU INDIKATOR ( Normal ON ) 00:10
40 CEK SELEKTOR SWITCH ( normal kontak terhubung ) 00:30
50 CEK AUX.RELAY ( Coil tidak putus ) 00:15
60 TERMINASI ( kencang & terhubung ) 00:15
70 BERSIHKAN PANEL ( Bersih dari debu ) 00:30

Planned Labor
Task ID Craft Description Qty Hours Labor ID Labor Name Remarks
SRIC Senior I & C Technician 1 02:00
JRIC Junior I & C Technician 1 02:00
JRIC Junior I & C Technician 1 02:00

Planned Material
Task ID Item Description Storeroom Qty Satuan Remarks

Planned Tool
Task ID Tool Description QTY Hours Remarks
48.034.005.0047 MULTIMETER DIGITAL TIPE 112 MERK FLUKE 1 0.167
48.002.001.0031 TOOL SET S - 10 HOZAN 1 0.25
48.018.003.0046 VACUUM CLEANER TIPE A 2204 MERK KARCHER 1 0.5

Planned Services
Task ID Service Item Description QTY Vendor

FAILURE REPORTING
PREDICTION ACTUAL
Problem : Problem :

Cause : Cause :

Remedy : Remedy :

Additional Remarks :

Supervisor Senior Operasi Remark Teknisi Pemeliharaan Supervisor Senior Pemeliharaan

....................................................
Executor / Lead Executor
(??) ACCEPTED (YES)
(??) REWORK (NO)
Reason For Create Follow Up :
......................................................................................................................
......................................................................................................................
......................................................................................................................
.................................................... ....................................................

8/27/21 11:48 AM
SAGULING POMU 202115164

WORK SAFETY PERMIT

No Work Order: 202115164 ReportDate 28 Mar 2021
Deskripsi: PEMELIHARAAN BULANAN FIRE FIGHTING Schedule Start Date 09 Apr 2021 08:00
TEMPERATURE CONTROL FOR E.G. PH
Seksi: Pemeliharaan Kontrol Schedule Finish Date 09 Apr 2021 10:00
Asset SG00SGY10DT070-001 Target Finish Date Apr 9, 2021, 10:00 AM
(EQ.) FIRE FIGHTING TEMPERATURE CONTROL FOR E.G. PH Worktype: Preventive Maintenance
Location SG00SGY10DT070-SGPA0E0 Supervisor: Firdaus Eka Setiawan
FIRE FIGHTING TEMPERATURE CONTROL
FOR E.G. PH-EMERGENCY GENERATOR
BUILDING

Nama Kontraktor : TINGKAT RESIKO

Pimpinan Kontraktor :
Pengawas Pekerjaan : Firdaus Eka Setiawan
Lama Pekerjaan : 2
Jumlah Pekerja/Pelaksana :

RENDAH SEDANG TINGGI

Klasifikasi Pekerjaan/Classification of Work )*

Pipanisasi/Piping Penyetelan/Setting Instrumentation Konstruksi/construction
Pengelasan/Welding Pemeriksaan/inspection Bekerja di ketinggian (>= 2.5 m) Fabrikasi/fabrication
Pengecatan/Painting pekerjaan di ruang dan Kelistrikan/electricity cleaning service
Isolasi/Isolating atau oksigen terbatas (confined Pemasangan/installing Penggalian/Digging
spaces)

*) Untuk pekerjaan yang memerlukan ijin khusus harus dilengkapi ijin tambahan seperti : Hot Work Permit, Fire Detection Isolation Permit, Hazardous Energies
Work Permit, dan Confined Space Work Permit.

Jenis Potensi Bahaya Terkait Pekerjaan (HAZARDS) :

Hazard Needs (Prec/LOTO) Description
SGL_HZ28 PRECAUTION Bahaya Terpeleset
SGL_HZ32 PRECAUTION Bahaya Tersengat Listrik
SGL_HZ34 PRECAUTION Bahaya Terbentur
SGL_HZ40 PRECAUTION Bahaya tergelincir

Tindakan Pencegahan (PRECAUTIONS)

Hazard Precaution Description
Bahaya Terpeleset SGL01M028 PERGUNAKAN SAFETY SHOES
Bahaya Terpeleset SGL02M028 PERGUNAKAN SAFETY HELMET
Bahaya Tersengat Listrik SGL01EO32 PERGUNAKAN SARUNG TANGAN ISOLASI 20 KV
Bahaya Tersengat Listrik SGL02E032 PERGUNAKAN SEPATU TAHAN TEGANGAN
Bahaya Tersengat Listrik SGL03E032 PERGUNAKAN SARUNG TANGAN ISOLASI 30 KV
Bahaya Tersengat Listrik SGL04E032 PERGUNAKAN SAFETY HELMET
Bahaya tergelincir SGL01M040 PERGUNAKAN SAFETY HELMET
Bahaya tergelincir SGL02M040 PERGUNAKAN SEPATU KARET

Tag Out Procedures

Hazard Tag Out Location To Tag Out Asset To Tag Out Description Required State

Lock Out Operations (bila diperlukan)

Tag Out Location Asset Description Locking Device Apply Remove
Required State Sequence Sequence

Tindakan Pengamanan Tambahan :

......................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................

PENGAWAS K3 SUPERVISOR SENIOR OPERASI PENGAWAS LAPANGAN KONTRAKTOR (Jika Ada)

...................................... ...................................... ..................................... ......................................

8/27/21 11:48 AM
SAGULING POMU 202115164

SURAT PERINTAH KERJA

No Work Order: 202115165 Report Date 28 Mar 2021
Deskripsi: PEMELIHARAAN BULANAN CONTROL E.G. PH Scheduled Start 09 Apr 2021 08:00
Seksi: Pemeliharaan Kontrol Scheduled Finish: 09 Apr 2021 10:00
Worktype: Preventive Maintenance Target Finish Apr 9, 2021, 10:00 AM
Supervisor: Firdaus Eka Setiawan Status: CLOSE
Safety Plan :
Long Description:

Asset / Location location locdesc

Asset Asset Description Location Location Description
SG00XYA10GH010-001 (EQ.) CONTROL E.G. PH SG00XYA10GH010-SGPA0E0 CONTROL E.G. PH-EMERGENCY GENERATOR
BUILDING

Task IDs
Task ID Description Estimated Duration Actual Duration Remarks
30 Koordinasi dengan operator 00:15
40 Persiapan Data Teknis (Manual Book, Drawing, IK, SOP) 00:15
50 CEK LAMPU INDIKATOR ( Normal ON ) 00:15
60 CEK SELEKTOR SWITCH ( normal kontak terhubung ) 00:15
70 CEK AUX.RELAY ( Coil tidak putus ) 00:15
80 TERMINASI ( kencang & terhubung ) 00:15
90 BERSIHKAN PANEL ( Bersih dari debu ) 00:30

Planned Labor
Task ID Craft Description Qty Hours Labor ID Labor Name Remarks
JRIC Junior I & C Technician 1 02:00
JRIC Junior I & C Technician 1 02:00
SRIC Senior I & C Technician 1 02:00

Planned Material
Task ID Item Description Storeroom Qty Satuan Remarks

Planned Tool
Task ID Tool Description QTY Hours Remarks
48.034.005.0047 MULTIMETER DIGITAL TIPE 112 MERK FLUKE 1 0.25
48.002.001.0031 TOOL SET S - 10 HOZAN 1 0.25
48.018.003.0000 VACUUM CLEANER 1 0.25

Planned Services
Task ID Service Item Description QTY Vendor

FAILURE REPORTING
PREDICTION ACTUAL
Problem : Problem :

Cause : Cause :

Remedy : Remedy :

Additional Remarks :

Supervisor Senior Operasi Remark Teknisi Pemeliharaan Supervisor Senior Pemeliharaan

....................................................
Executor / Lead Executor
(??) ACCEPTED (YES)
(??) REWORK (NO)
Reason For Create Follow Up :
......................................................................................................................
......................................................................................................................
......................................................................................................................
.................................................... ....................................................

8/27/21 11:48 AM
SAGULING POMU 202115164

WORK SAFETY PERMIT

No Work Order: 202115165 ReportDate 28 Mar 2021
Deskripsi: PEMELIHARAAN BULANAN CONTROL E.G. PH Schedule Start Date 09 Apr 2021 08:00
Seksi: Pemeliharaan Kontrol Schedule Finish Date 09 Apr 2021 10:00
Asset SG00XYA10GH010-001 Target Finish Date Apr 9, 2021, 10:00 AM
(EQ.) CONTROL E.G. PH Worktype: Preventive Maintenance
Location SG00XYA10GH010-SGPA0E0 Supervisor: Firdaus Eka Setiawan
CONTROL E.G. PH-EMERGENCY
GENERATOR BUILDING

Nama Kontraktor : TINGKAT RESIKO

Pimpinan Kontraktor :
Pengawas Pekerjaan : Firdaus Eka Setiawan
Lama Pekerjaan : 2
Jumlah Pekerja/Pelaksana :

RENDAH SEDANG TINGGI

Klasifikasi Pekerjaan/Classification of Work )*

Pipanisasi/Piping Penyetelan/Setting Instrumentation Konstruksi/construction
Pengelasan/Welding Pemeriksaan/inspection Bekerja di ketinggian (>= 2.5 m) Fabrikasi/fabrication
Pengecatan/Painting pekerjaan di ruang dan Kelistrikan/electricity cleaning service
Isolasi/Isolating atau oksigen terbatas (confined Pemasangan/installing Penggalian/Digging
spaces)

*) Untuk pekerjaan yang memerlukan ijin khusus harus dilengkapi ijin tambahan seperti : Hot Work Permit, Fire Detection Isolation Permit, Hazardous Energies
Work Permit, dan Confined Space Work Permit.

Jenis Potensi Bahaya Terkait Pekerjaan (HAZARDS) :

Hazard Needs (Prec/LOTO) Description
SGL_HZ10 PRECAUTION Bahaya Listrik
SGL_HZ32 PRECAUTION Bahaya Tersengat Listrik

Tindakan Pencegahan (PRECAUTIONS)

Hazard Precaution Description
Bahaya Listrik SGL01E010 PERGUNAKAN SEPATU TAHAN TEGANGAN
Bahaya Listrik SGL02E010 PERGUNAKAN SARUNG TANGAN KARET ISOLASI 20KV
Bahaya Listrik SGL03E010 PERGUNAKAN SARUNG TANGAN KARET ISOLASI 30KV
Bahaya Tersengat Listrik SGL01EO32 PERGUNAKAN SARUNG TANGAN ISOLASI 20 KV
Bahaya Tersengat Listrik SGL02E032 PERGUNAKAN SEPATU TAHAN TEGANGAN
Bahaya Tersengat Listrik SGL03E032 PERGUNAKAN SARUNG TANGAN ISOLASI 30 KV
Bahaya Tersengat Listrik SGL04E032 PERGUNAKAN SAFETY HELMET

Tag Out Procedures

Hazard Tag Out Location To Tag Out Asset To Tag Out Description Required State

Lock Out Operations (bila diperlukan)

Tag Out Location Asset Description Locking Device Apply Remove
Required State Sequence Sequence

Tindakan Pengamanan Tambahan :

......................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................

PENGAWAS K3 SUPERVISOR SENIOR OPERASI PENGAWAS LAPANGAN KONTRAKTOR (Jika Ada)

...................................... ...................................... ..................................... ......................................

8/27/21 11:48 AM
SAGULING POMU 202115164

SURAT PERINTAH KERJA

No Work Order: 202115161 Report Date 28 Mar 2021
Deskripsi: PEMELIHARAAN BULANAN TAIL RACE Scheduled Start 09 Apr 2021 10:00
WARNING SYSTEM
Seksi: Pemeliharaan Kontrol Scheduled Finish: 09 Apr 2021 12:00
Worktype: Preventive Maintenance Target Finish Apr 9, 2021, 12:00 PM
Supervisor: Firdaus Eka Setiawan Status: CLOSE
Safety Plan :
Long Description:

Asset / Location location locdesc

Asset Asset Description Location Location Description
SG00CYC10EG010-001 (EQ.) TAIL RACE WARNING SYSTEM SG00CYC10EG010-SGPA0T0 TAIL RACE WARNING SYSTEM-TAIL RACE

Task IDs
Task ID Description Estimated Duration Actual Duration Remarks
10 Koordinasi dengan operator 00:15
20 Persiapan Data Teknis, Tool & Material 00:15
30 CEK KONDISI ANTENA 00:15
40 CEK POWER SUPPLY 00:15
50 CEK SPEAKER/SOUND 00:15
60 CEK TERMINAL DAN KONEKTOR 00:15
70 CEK RADIO EQUIPMENT 00:15
80 CEK SIRINE 00:15

Planned Labor
Task ID Craft Description Qty Hours Labor ID Labor Name Remarks
JRIC Junior I & C Technician 1 02:00
JRIC Junior I & C Technician 1 02:00
SRIC Senior I & C Technician 1 02:00

Planned Material
Task ID Item Description Storeroom Qty Satuan Remarks

Planned Tool
Task ID Tool Description QTY Hours Remarks
48.034.005.0047 MULTIMETER DIGITAL TIPE 112 MERK FLUKE 1 0.25
48.002.001.0031 TOOL SET S - 10 HOZAN 1 0.5

Planned Services
Task ID Service Item Description QTY Vendor

FAILURE REPORTING
PREDICTION ACTUAL
Problem : Problem :

Cause : Cause :

Remedy : Remedy :

Additional Remarks :

Supervisor Senior Operasi Remark Teknisi Pemeliharaan Supervisor Senior Pemeliharaan

....................................................
Executor / Lead Executor
(??) ACCEPTED (YES)
(??) REWORK (NO)
Reason For Create Follow Up :
......................................................................................................................
......................................................................................................................
......................................................................................................................
.................................................... ....................................................

8/27/21 11:48 AM
SAGULING POMU 202115164

WORK SAFETY PERMIT

No Work Order: 202115161 ReportDate 28 Mar 2021
Deskripsi: PEMELIHARAAN BULANAN TAIL RACE Schedule Start Date 09 Apr 2021 10:00
WARNING SYSTEM
Seksi: Pemeliharaan Kontrol Schedule Finish Date 09 Apr 2021 12:00
Asset SG00CYC10EG010-001 Target Finish Date Apr 9, 2021, 12:00 PM
(EQ.) TAIL RACE WARNING SYSTEM Worktype: Preventive Maintenance
Location SG00CYC10EG010-SGPA0T0 Supervisor: Firdaus Eka Setiawan
TAIL RACE WARNING SYSTEM-TAIL RACE

Nama Kontraktor : TINGKAT RESIKO

Pimpinan Kontraktor :
Pengawas Pekerjaan : Firdaus Eka Setiawan
Lama Pekerjaan : 2
Jumlah Pekerja/Pelaksana :

RENDAH SEDANG TINGGI

Klasifikasi Pekerjaan/Classification of Work )*

Pipanisasi/Piping Penyetelan/Setting Instrumentation Konstruksi/construction
Pengelasan/Welding Pemeriksaan/inspection Bekerja di ketinggian (>= 2.5 m) Fabrikasi/fabrication
Pengecatan/Painting pekerjaan di ruang dan Kelistrikan/electricity cleaning service
Isolasi/Isolating atau oksigen terbatas (confined Pemasangan/installing Penggalian/Digging
spaces)

*) Untuk pekerjaan yang memerlukan ijin khusus harus dilengkapi ijin tambahan seperti : Hot Work Permit, Fire Detection Isolation Permit, Hazardous Energies
Work Permit, dan Confined Space Work Permit.

Jenis Potensi Bahaya Terkait Pekerjaan (HAZARDS) :

Hazard Needs (Prec/LOTO) Description
SGL_HZ22 PRECAUTION Bahaya Terjatuh dari ketinggian
SGL_HZ28 PRECAUTION Bahaya Terpeleset
SGL_HZ32 PRECAUTION Bahaya Tersengat Listrik
SGL_HZ37 PRECAUTION Bahaya digigit Binatang Melata

Tindakan Pencegahan (PRECAUTIONS)

Hazard Precaution Description
Bahaya Terjatuh dari ketinggian SGL01M022 PERGUNAKAN SAFETY SHOES
Bahaya Terjatuh dari ketinggian SGL02M022 PERGUNAKAN SAFETY HELMET
Bahaya Terjatuh dari ketinggian SGL03M022 PERGUNAKAN SAFETY BELT
Bahaya Terpeleset SGL01M028 PERGUNAKAN SAFETY SHOES
Bahaya Terpeleset SGL02M028 PERGUNAKAN SAFETY HELMET
Bahaya Tersengat Listrik SGL01EO32 PERGUNAKAN SARUNG TANGAN ISOLASI 20 KV
Bahaya Tersengat Listrik SGL02E032 PERGUNAKAN SEPATU TAHAN TEGANGAN
Bahaya Tersengat Listrik SGL03E032 PERGUNAKAN SARUNG TANGAN ISOLASI 30 KV
Bahaya Tersengat Listrik SGL04E032 PERGUNAKAN SAFETY HELMET
Bahaya digigit Binatang Melata SGL01H037 PERGUNAKAN SAFETY SHOES
Bahaya digigit Binatang Melata SGL02H037 PERGUNAKAN SHOES KARET
Bahaya digigit Binatang Melata SGL03H037 PERGUNAKAN SAFETY HELMET
Bahaya digigit Binatang Melata SGL04H037 PERGUNAKAN SARUNG TANGAN ASBES

Tag Out Procedures

Hazard Tag Out Location To Tag Out Asset To Tag Out Description Required State

Lock Out Operations (bila diperlukan)

Tag Out Location Asset Description Locking Device Apply Remove
Required State Sequence Sequence

Tindakan Pengamanan Tambahan :

......................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................

PENGAWAS K3 SUPERVISOR SENIOR OPERASI PENGAWAS LAPANGAN KONTRAKTOR (Jika Ada)

...................................... ...................................... ..................................... ......................................

8/27/21 11:48 AM