Date

MENARA ASTRA BOD FLOOR INTERIOR

Page
FIT OUT
1 of 1
Rev.
PT Astra International Tbk PT TeamworX Indonesia Sudirman - Jakarta PT EP-TEC Solutions Indonesia

Ref.

WORK PERMIT
Date
No. Work Description Duration Drawing No.
Start Finish

Number of Manpower

Material(s) 1. 6.
2. 7.
3. 8.
4. 9.
5. 10.

Equipments / Tools 1. 6.
( Type & Quantity ) 2. 7.
3. 8.
4. 9.
5. 10.

Remarks

Attachments

Job Safety Analysis (JSA) Safety Permit related the job (Hot
Work, WAH, Confined Space )
Material Approval (if any)

Site Instruction; Memo Instruction (if any) Request for Inspection (if any)

Work Method / SOP Others

Release Note
Approved Commented & Resubmit
See remarks
Approved with Comment Not Approved

TeamworX Approval Issued By Contractor

Client Approval
HSE Officer Spv / Engineer Supervisor HSE Officer
Print Name
Signature
Date

QF-CM-128 Rev.01
 Date
MENARA ASTRA BOD FLOOR INTERIOR
INDOLITE PRIMA Page
FIT OUT
1 of 1
Rev.
PT Astra International Tbk PT TeamworX Indonesia Sudirman - Jakarta PT INDOLITE PRIMA

Ref.

WORK PERMIT
Date
No. Work Description Duration Drawing No.
Start Finish

###

Number of Manpower

Material(s) 1. 6.
2. 7.
3. 8.
4. 9.
5. 10.

Equipments / Tools 1. 6.
( Type & Quantity ) 2. 7.
3. 8.
4. 9.
5. 10.

Remarks

Attachments

Job Safety Analysis (JSA) Safety Permit related the job (Hot
Work, WAH, Confined Space )
Material Approval (if any)

Site Instruction; Memo Instruction (if any) Request for Inspection (if any)

Work Method / SOP Others

Release Note
Approved Commented & Resubmit
See remarks
Approved with Comment Not Approved

TeamworX Approval Issued By Contractor

Client Approval
HSE Officer Spv / Engineer Supervisor HSE Officer
Print Name
Signature
Date

QF-CM-128 Rev.01
 Date
MENARA ASTRA BOD FLOOR INTERIOR
Page
FIT OUT
1 of 1
Rev.
PT Astra International Tbk PT TeamworX Indonesia Sudirman - Jakarta PT Rotaryana Prima

Ref.

WORK PERMIT
Date
No. Work Description Duration Drawing No.
Start Finish

Number of Manpower

Material(s) 1. 6.
2. 7.
3. 8.
4. 9.
5. 10.

Equipments / Tools 1. 6.
( Type & Quantity ) 2. 7.
3. 8.
4. 9.
5. 10.

Remarks

Attachments

Job Safety Analysis (JSA) Safety Permit related the job (Hot
Work, WAH, Confined Space )
Material Approval (if any)

Site Instruction; Memo Instruction (if any) Request for Inspection (if any)

Work Method / SOP Others

Release Note
Approved Commented & Resubmit
See remarks
Approved with Comment Not Approved

TeamworX Approval Issued By Contractor

Client Approval
HSE Officer Spv / Engineer Supervisor HSE Officer
Print Name
Signature
Date

QF-CM-128 Rev.01
 Date
07/10/22
PURE DATA CENTRES Page

JKT01 - BEKASI 1 of 1
PT Lantera Sejahtera Rev.
PT PDCG INDONESIA ONE
Indonesia
Working Permit Reference Number
WORK PERMIT JKT01-TAT-DC1-00-MS-W-62207

Duration Date
No. Work Description Location Shop Drawing No.
(Days) Start Finish

1. Spiderframe Installation (PPR3 Level GF) Level GF PPR 3 54 07/10/2022 30/11/2022 JKT01-TAT-DC1-00-SCH-W-62120

Number of 11 Man
Manpower Power

Material(s) 1. Unistrut 6.
2. Longdrat 7.
3. Seismic Bracing 8.
4. Beam Clamp & Accessories unistrut 9.
5. 10.
Equipments / Tools 1. Adjustable Wrench & Hammer 6.
( Type & Quantity ) 2. Cutting Girder & Drill Hole Saw 7.
3. Scissors lift 8.
4. Cutting Grinder & Drill hole saw 9.
5. 10.
Remarks

Attachments

(1) Safety Permit related the job (Hot (6) Material Approval (if any)
Work, WAH, Confined Space, etc )
(7) Site Instruction; Memo Instruction (if any)

(2) Job Safety Analysis (JSA) (8) Worker Absences (if any)

(3) Work Method / SOP (9) Others (If any)

(4) Shop Drawing

(5) Request for Inspection (if any)

Release Note
Approved Commented & Resubmit See remarks

Approved with Comment Not Approved

Approval Issued By Contractor

PT. Lantera Sejahtera Indonesia Supervisor HSE Contractor

Print Name
Signature
Date
 Date
18/04/2022
PURE DATA CENTRES Page

PT Lantera Sejahtera
JKT01 - BEKASI 1 of 1
Rev.
PT PDCG INDONESIA ONE
Indonesia
Working Permit Reference Number

WORK PERMIT
Date
No. Work Description Location Duration Shop Drawing No.
Start Finish
Ground Floor
First floor
1. Hot & Cold Water Pipe Installation 1 Mount 18/04/22 18/05/22
Second floor
Upper roof

Number of 20 Man
Manpower Power
Material(s) 1. Copper Pipe ASTM B88 Type K 6. Flare Female Nut Copper
2. Elbow 90 Copper ASTM B88 7. Pipe Installation
3. Tee Copper ASTM B88 8. Pipe Installation Adhesive
4. Reducer Copper ASTM B88 9.
5. Double Nipple Copper 10.
Equipments / Tools 1. Copper Pipe Cutter 6. Oxygen
( Type & Quantity ) 2. Flaring & Swaging Tools 7. Copper Welding Wire
3. Measuring Tape 8. Fix Wrench
4. Welding Tools Set 9. Cutter
5. Acetylene 10. Cleaning Cloth
Remarks

Attachments

(1) Safety Permit related the job (Hot (6) Material Approval (if any)
Work, WAH, Confined Space, etc )
(7) Site Instruction; Memo Instruction (if any)
(2) Job Safety Analysis (JSA) (8) Worker Absences (if any)

(3) Work Method / SOP (9) Others (If any)

(4) Shop Drawing

(5) Request for Inspection (if any)

Release Note
Approved Commented & Resubmit See remarks

Approved with Comment Not Approved

Approval Issued By Contractor

PT. Lantera Sejahtera Indonesia Supervisor HSE Contractor

Print Name
Signature
Date