SCAFFOLDING WORK PERMIT

Revision Date
Document No. Revision No. Class Topic Page No.
(DD/MM/YY)

SFS-DIV–0077 03 03/01/2013 B SSH 1 of 9

APPROVAL SHEET

HISTORICAL OF REVISION
Revision Effective
General Description of Revision
No. Date
0 09/01/1998 Original procedure
1 01/09/2006
2 26/02/2007
3 15/08/2012 Frame scaffolding is not allowed to be used in CAP, re-write into bilingual, add
specification of scafold tubes, and transform into indonesian version.

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Document No. Revision No.
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I. PURPOSE
To provide guidance for scafolder and employees
about: the type and specifications of the scaffold;
erection, inspection, usage and dismantling of
scaffolding safely.
II. SCOPE
The procedure encompases some steps to be
followed in erecting scaffold, starting from the :
inspection of scaffold materials quality,
scaffolding work permit, erection, on-service
safety inspection, utilization and dismantle,
including the types of scaffolding which are
allowed to be utilized in CAP.
III.ABREVIATION
1) CAP : Chandra Asri Petrochemical
2) TAM : Turnd Arround Maintenance
3) SDM : Shutdown Maintenance
4) SFD : Safety and Fire Department
5) AA : Area Authority
6) WEA: Work Execution Authority.
IV. TERM AND DEFINITION
1. Scaffolding is platform made for a temporarily
and used as cantilever for worker, materials and
equipment at every construction work including
maintenance and demolition work.[Ref.
PERMEN TENAGA KERJA DAN
TRANSMIGRASI NO. PER.01/MEN/1980].
2. Master Work Permit (MWP) is the main work
permit system to perform the work in the CAP.
(Example of MWP form, see Attachment-1
and The guideline to fill-out the MWP form, see
Attachment-2)
3. Scaffolding Work Permit [SWP] is a safety
work permit system for erection, utilization and
dismantles of scaffolding in CAP. (example of
SWP form, see Attachment-2 and The
guidelines to fil-out the form,(See Attachment-
4)
4.Standard-scaffolding is scaffolding’s
specification standard that used in the CAP
according to procedure for Scaffolding Work
Permit No. SFD-IDP-0077
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I. TUJUAN
Untuk memberikan petunjuk pada scafolder dan
pekerja tentang : jenis dan spesifikasi perancah;
pendirian, pemeriksaan, penggunaan dan
pembongkaran perancah secara aman.
II. RUANG LINGKUP
Prosedur ini meliputi tahapan-tahapan yang harus
dipatuhi dalam mendirikan perancah, mulai dari
tahapan: inspeksi kualitas material, ijin kerja
perancah, mendirikan, pemeriksaan keselamatan
penggunaan perancah, hingga pembongkaran,
termasuk jenis-jenis perancah yang diizinkan
untuk digunakan di CAP.
III.SINGKATAN
1) CAP : Chandra Asri Petrochemical
2) TAM : Turn Arround Maintenance
3) SDM : Shut Down Maintenance
4) SFD : Safety and Fire Department
5) AA : Area Authority
6) WEA : Work Execution Authority
IV. ISTILAH DAN DEFINISI
1. Perancah (scaffolding) ialah platform yang
dibuat untuk sementara dan digunakan sebagai
penyangga tenaga kerja, bahan-bahan serta alat-
alat pada setiap pekerjaan konstruksi bangunan
termasuk pekerjaan pemeliharaan dan
pembongkaran.[Ref. PERMEN TENAGA KERJA
DAN TRANSMIGRASI NO. PER.01/MEN/1980].
2. Master Work Permit (MWP) adalah sistem
perijinan kerja Utama untuk melakukan pekerjaan
di CAP.(contoh form MWP lihat lampiran-1,
dan Petunjuk untuk mengisi form MWP lihat
lampiran-2)
3. Scaffolding Work Permit [SWP] adalah sistem
perijinan keselamatan kerja pada pekerjaan
pendirian, penggunaan dan pembongkaran
perancah di CAP. (contoh form SWP lihat
lampiran-3 dan Petunjuk untuk mengisi form ini
(lihat Lampiran-4)
4. Standard-Perancah adalah standar spesifikasi
perancah yang digunakan di CAP sesuai
procedure Scaffolding Work Permit No. SFD-
IDP-0077
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5. Scaffolder is a person who has the expertise 5. Scaffolder adalah seseorang yang mempunyai
and certification by DISNAKER in the field of keahlian dan di sertifikasi oleh DISNAKER pada
scaffolding. bidang perancah.

6. Scaffolder Helper is someone who is 6. Scaffolder Helper adalah seseorang yang

experienced to erect and dismantle scaffolding, berpengalaman untuk mendirikan dan
but it does not have a certificate as a scaffolder membongkar perancah, tetapi tidak memiliki
from Labor Department. sertifikat dari Disnaker sebagai scaffolder.

7. Scaffolding Inspector is Scaffolding 7. Scaffolding Inspector adalah Inspector

Inspector from Safety and Fire Department Perancah dari Safety dan Fire Department
(SFD). (SFD).

8. Scaffolding Engineer is some one who has 8. Scaffolding Enginer adalah Adalah orang
capabilty and experienced to planing yang punya keahlian rancang bangun perancah
scaffolding material which needed, dari mulai perencanaan material scaffolding,
calculation strength of scaffolding, to carry gambar perancah, perhitungan kekuatan
out supervise erection and dismantle perancah, pembangunan perancah dan
scaffolding with safely. pembongkaran perancah dengan aman.

9. Area Authority [AA] is a department or section 9. Area Authority [AA] adalah departemen atau
on the area where the scaffolding is being section pada area dimana perancah sedang
erected. dibangun.

10. Work Execution Authority [WEA] is a 10. Work Execution Authority [WEA] adalah
department or section responsible for the department atau section penanggungjawab
erection; utilization and dismantling of scaffold pekerjaan pendirian, penggunaan dan
which typically from MTN, EGD and GAD pembongkaran perancah yang biasanya dari
departments. bagian MTN, EGD dan GAD.

11. Scaffold load consists of : Dead Load
(weight of the scaffold without any other
additional load) ; Live Load (weight of the
scaffold plus other loads such as: worker,
equipment, materials, etc.) and Additional
Load (additional load such as: the wind, rain,
etc.).
12. Maximal Load consists of: dead load, live
load and additional load which can be
accepted by scaffolding.
13. Beban perancah adalah Beban Mati (berat
perancah tanpa tambahan beban lainnya);
Beban hidup (berat perancah ditambah beban
lainnya seperti : manusia, peralatan, material
dll) dan Beban Tambahan (beban tambahan
seperti : dorongan angin, hujan, dll).
14. Beban Maximal adalah beban mati, beban
hidup dan beban tambahan yang dapat
ditanggung perancah.

V.RESPONSIBILITY V.TANGGUNG JAWAB

1) Department AA shall ensure that all 1) Departmen AA harus memastikan bahwa
scaffolding that is erected in his area have semua scaffolding yang didirikan di areanya
been granted permission before erection. telah mendapat ijin sebelum dibangun.

2) SFD department to ensure that the scaffold is 2) Scaffolding Inspector memastikan bahwa
safe to use. perancah aman untuk digunakan.

3) Department WEA to ensure that the 3) Department WEA memastikan bahwa

requirements for: scaffolder, material, persyaratan scaffolder, material, pendirian dan
construction and dismantling of scaffolding pembongkaran perancah telah sesuai dengan
are complying with this procedure. procedure ini.

4) Scaffolder and scaffolder helper responsible 4) Scaffolder dan scaffolder helper

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to erection and dismantle scaffolding with
safely comply CAP specification scaffolding.
VI.PROCEDURE
A. GENERAL POLICY
1) That the acceptable type of scaffolding in CAP
are :
a.Tubular Scaffold (Attachment-5);
b. Mobile Tower (Attachment-6);
While the following types of scaffolds, are not
permitted for use in CAP:
a. Milsystem Scaffold (Attachment No.7);
b. Frame Scaffold (Attachment-8)
c. Wood Ladder (ladder made from wood is
not allowed to be used in CAP.)
2) Any activity at a height of 1.8 meters above
the surface or a depth of 1.2 meters below
the surface should use the standard-scaffold.
3) Scaffolder & scaffolding helper must
properly wear standard PPE (safety shoes,
helmet, safety glass, long sleeve clothes),
body harness double lanyard must be wear
during erection and dismanle scaffolding.
4) To prohibited removing or modification
scaffolding partially or totally without written
permission to safety inspector.
B. SCAFFOLDING WORK PERMIT [SWP]
1) Prior to scaffolding erection, department WEA
must first obtain permission from department
AA, as evidenced by the signature of AA on the
MWP and SWP forms.
2) Validation period of SWP for erection and
utilization is according with planning how long
scaffolding is erected and utilized. It can be
revalidated for extension onces.
3) SWP could be purposed to AA about 1 (one)
month before erection, especially for the
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bertanggungjawab untuk mendirikan dan
membongkar scaffolding seaman mungkin
sesuai dengan CAP spesifikasi scaffolding.
VI.PROCEDURE
A. KEBIJAKAN UMUM
1) Bahwa jenis perancah yang diijinkan di CAP
adalah :
a. Tubular Scaffold (lampiran-5);
b. Mobile Tower (lampiran-6);
Sedangkan jenis perancah berikut, tidak
diijinkan untuk digunakan di CAP :
a. Milsystem Scaffold (Lampiran-7);
b. Frame Scaffold (Lampiran-8)
c. Tangga Kayu. (Tangga yang terbuat dari
kayu tidak dijinkan digunakan di CAP)
2) Setiap aktifitas pada ketinggian 1.8 meter
diatas permukaan atau kedalaman 1.2 meter
dibawah permukaan harus menggunakan
standard- perancah.
3) Scaffolder & scaffolder helper harus memakai
mandatori APD (safety shoes, helmet, safety
glass, baju panjang tangan), body harness
double lanyard selama pembangunan dan
pembongkaran.
4) Dilarang memindahkan atau memodifikasi
perancah sebagian atau seluruhnya tanpa
pemberitahuan tertulis kepada Safety
Inspector.
B.SCAFFOLDING WORK PERMIT [SWP]
1)Sebelum mendirikan perancah, department WEA
harus terlebih dulu mendapatkan ijin dari
department AA, yang dibuktikan dengan adanya
tandatangan AA pada form MWP dan SWP.
2)Masa berlaku SWP untuk pembangunan dan
penggunaan perancah adalah sesuai dengan
perkiraan lamanya waktu pembangunan dan
pemakaian perancah. Masa berlaku tersebut
dapat diperpanjang sebanyak 1 kali.
3) Permohonan SWP dapat diajukan 1(satu) bulan
sebelum pembangunan perancah dan 3 (tiga)

Document No. Revision No.
SFS-DIV–0077 03
TAM/SDM could be applied 3 (three) months in
advance before implementation.
4) The SWP is only valid when the MWP is still
valid. To continue work on the next shift, MWP
shall be revalidated by the next shift employee.
The MWP is only valid for one day (08:00 am -
08:00 am, 24 hours). If the work continues into
the next day, then it must use new MWP.
5) SWP shall be re-purposed to AA when
dismantling scaffolding will be done.
C. SCAFFOLDING COMPONENT
INSPECTION
1) Inspection of the quality of the scaffold
component such as : pipe, coupling, (see
attachment 9). Will be carried-out by WEA and
Scaffolding Inspector; refer to Procedure for
Tools / Equipment Inspection, No. SFD-
IDP-0043
D. REQUIREMENT OF SCAFFOLDING
ERECTION
During scaffolds erection, the following provisions
must be followed:
a. General requirements
b.Specific requirements are scaffolding type
(Attachment 5-7) and standard scaffold
inspection., (Attachment-9)
a. General Requirement
1) Scaffolder to install barricade around
scaffolding, to prevent unauthorized persons
entering into the area.
2) Scaffolder should also hang the tag "NOT
SAFE FOR USE" (See Attachment-10) on
the point that easily visible, since the first
construction and dismantling.
3) The footing or anchorge for scaffolds shall be
stable, solid, rigid, and capable of carrying the
maximum intended load.
4) Do not throw scaffolding materials to prevent
sparking
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bulan sebelumnya untuk TAM/SDM.
4)SWP hanya berlaku ketika MWP masih berlaku.
Untuk melanjutkan pekerjaan di shift berikutnya,
MWP tersebut harus kembali divalidasi ulang
oleh karyawan shift berikutnya. MWP hanya
berlaku untuk satu hari (08:00 am - 08:00 am, 24
jam). Jika pekerjaan dilanjutkan ke hari
berikutnya, maka harus menggunakan MWP
yang baru.
5)SWP harus diajukan atau dibuat kembali saat
pembongkaran perancah akan dilakukan.
C.PEMERIKSAAN KOMPONEN PERANCAH
1) Pemeriksaan kualitas komponen perancah
seperti : pipa, coupler (lihat lampiran 9) akan
dilakukan oleh WEA dan Scaffolding Inspector,
merujuk pada Procedure for Tools/Equipment
inspection, No. SFD-IDP-0043
D.PERSYARATAN PENDIRIAN PERANCAH
Dalam mendirikan perancah ada dua persyaratan :
a. Persyaratan Umum
b. Persyaratan khusus adalah persyaratan
tentang jenis perancah (Lampiran 5 -7) dan
standar inspeksi perancah.(Lampiran-9)
a. Persyaratan Umum
1) Selama pembangunan perancah, Scaffolder
membarikade area sekitar perancah, untuk
mencegah orang yang tidak berkepentingan
masuk kedalam area.
2) Selama pembangunan dan juga
pembongkaran Scaffolder harus
menggantungkan safety tag “NOT SAFE
FOR USE”(Lihat Lampiran-10) pada titik
yang mudah terlihat.
3) Tumpuan atau kaki perancah harus stabil,
padat, keras dan mampu, manahan beban
maksimal.
4) Dilarang melemparkan material perancah
untuk mencegah percikan api.
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5) Do not step or knocking the process 5) Dilarang menginjak atau memukul-mukul

equipment such as: pipes, tools, instruments, peralatan proses seperti : pipa, alat-alat
pumps, valves, vessels, etc.. instrument, pompa, valve, vessels dll.

6) Do not block or impede access to fire 6) Dilarang menutup atau menghambat akses
equipment such as: F/E cylinder, fire hydrant, kepada peralatan-peralatan fire seperti :
fire hose boxes, etc.. tabung F/E, fire hydrant, fire hose box, dll.

7) Perform regular gas test in the process area 7) Melakukan gas test secara teratur pada area
and other places where there are materials that proses dan tempat-tempat lain dimana
are toxic and flammable. terdapat bahan yang beracun dan mudah
terbakar.

8) To report immediately to department AA or 8) Melaporkan dengan segera kepada

WEA when there is process equipment or other department AA atau WEA jikan menemukan
CAP properties is damaged. peralatan proses atau peralatan lainnya milik
CAP yang rusak.

9) For the scaffolding that has a height of 45 9) Untuk perancah yang mempunyai ketinggian
meters and above, must be designed and 45 meter keatas, harus dirancang dan
inspected by a Scaffolding Engineer. diperiksa oleh seorang Scaffolding Engineer.

E.SCAFFOLDING INSPECTION E.PEMERIKSAAN PERANCAH

1. Inspection After Erection Completed 1.Pemeriksaan Setelah Perancah selesai

dibangun

i) Upon completion, the department PA must i) Setelah selesai dibangun, department WEA
request Scafolding-Inspector to inspect and harus meminta Scafold-Inspector untuk
make sure the scaffold has complied with menginspeksi dan meyakinkan bahwa
CAP’s Standard-Scaffolding. perancah telah aman untuk digunakan telah
sesuai dengan Standard-Scaffolding CAP.
ii) If the scaffolding inspections have been ii) Apabila inspeksi perancah telah selesai, maka
completed, Scaffolding Inspector should Scaffolding-Inspector harus menggantungkan
hang on the tag "SAFE FOR USE" tag “SAFE FOR USE”(Lampiran-11) jika
(Attacment-11) when it has complied with sesuai dengan standard atau tag “NOT SAFE
the standards or tag "NOT SAFE FOR FOR USE” jika tidak sesuai dengan standard.
USE" if not comply with.

B. On-Service Inspection 2.Inspeksi Pemakaian

i) The Scaffolding-Inspector must inspect the i) Scaffolding-Inspector harus menginspeksi

scaffolding on a regular basis every 7 days, scaffolding secara rutin setiap 7 hari, atau
or immediately following the extreme weather segera setelah terjadi cuaca ekstrim atau
or earthquakes that could affect to the safety gempa bumi yang dapat berdampak pada
of the scaffold keselamatan perancah.

ii) When scaffold inspection done, then the ii) Saat pemeriksaan perancah dilakukan, maka
scaffolding-inspector shall write the date scaffolding-inspector harus menuliskan
and initials on the tag "SAFE FOR USE" if tanggal dan paraf pada tag “SAFE FOR
the scaffolding is still safe for use or replace USE” jika perancah masih aman untuk
it with the tag "NOT SAFE FOR USE" when digunakan atau menggantikannya dengan tag
it is no longer safe for being used. “NOT SAFE FOR USE” apabila ternyata
sudah tidak aman lagi untuk digunakan.

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F. SCAFFOLDING USAGE
1) Before use scaffolding, every person shall
read validity of scaffolding tag“SAFE FOR
USE”
2) Validaty on service scaffolding must be
complying with time validaty of scaffolding
work permit.
3) Everyone should go up/down through
provided ladder.
4) While working on scaffolding, workers should
always use body-harness correctly.
5) Every person is only allowed to use scaffold
with tag "SAFE FOR USE" and inspection
period is still valid.
6) Any person is PROHIBITED to use scaffold
with tag "NOT SAFE FOR USE" or tag
"SAFE FOR USE" but inspection period has
expired.
7) It is prohibited to remove material or make
any change to the scaffolding that has been
tagged with "SAFE FOR USE" without
acknowledgment of Scaffolding-Inspector.
8) It is prohibited to utilize scaffolding if found
the scaffolding already changed, please
contact scaffolding inspector to re inspect
scaffolding.
9) Validation of scaffolding utilization shall in
accordance with validation times that written
in the Scaffolding work permit and it can be
revalidated once again.
G. SCAFFOLD DISMANTLING
1) Department WEA must dismantle the
scaffolding as soon as is not used anymore by
issuing new SWP & MWP.
2) Before dismatling the WEA must install
barricade around scaffolding and inform
Scaffolding- Inspector for observations.
3) The department WEA should hang tag "NOT
SAFE FOR USE" from start to finish
dismantling the scaffold.
4) Dismantling should be top-down (descending)
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F.PENGGUNAAN PERANCAH
1) Sebelum menggunakan perancah pekerja
harus membaca masa berlaku tag “SAFE FOR
USE”
2) Masa penggunaan perancah harus sesuai
dengan masa berlaku yang tertulis dalam
Scaffolding Work Permit.
3) Setiap orang harus naik/turun melalui tangga
yang tersedia.
i.
4) Selama bekerja diatas perancah, pekerja harus
selalu menggunakan body-harness secara
benar.
5) Setiap orang hanya diizinkan menggunakan
perancah dengan tag “SAFE FOR USE” dan
periode pemeriksaan masih berlaku.
6) Setiap orang DILARANG menggunakan
perancah dengan tag “NOT SAFE FOR USE”
atau tag “SAFE FOR USE” tapi periode
pemeriksaan sudah kadaluarsa.
7) Dilarang memindahkan material atau
melakukan perubahan terhadap perancah
yang sudah di tag ”SAFE FOR USE” tanpa
sepengetahuaan Scaffolding-Inspector.
8) Dilarang menggunakan perancah jika
ditemukan perubahan pada perancah, hubungi
scaffolding inspector untuk pemeriksaan ulang.
9) Masa penggunaan perancah harus sesuai
dengan masa berlaku yang tertulis dalam
Scaffolding work permit dan dapat
diperpanjang sebanyak 1 kali lagi.
G.PEMBONGKARAN PERANCAH
1) Department WEA harus membongkar perancah
segera setelah tidak digunakan lagi dengan
mengajukan SWP dan MWP yang baru.
2) Sebelum pembongkaran dilakukakan maka
WEA harus memasang barricade disekeliling
perancah dan menginformasikan ke Scaffolding
Inspector untuk melakukan observasi.
3) Department WEA harus menggantungkan tag
“NOT SAFE FOR USE” dari awal hingga
pembongkaran perancah selesai.
4) Pembongkaran harus dimulai dari atas ke bawah
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to prevent the scaffold collapsed. (descending) untuk mencegah perancah roboh.

5) Droping the scaffold material down by using 5) Menurunkan material perancah dari atas
lifting equipment or a strong rope. Prohibited dengan menggunakan alat angkat atau tali yang
from throwing/dropping scaffolding material kuat. Dilarang melemparkan/menjatuhkan
from the top. material scaffolding dari atas.

6) Temporary shelter for scaffold material that has 6) Penampungan sementara material perancah
been dismantled should be barricade. yang sudah dibongkar harus di barricade.

7) Scaffolding material has to be removed to 7) Material perancah harus segera dipindahkan ke

storage. If the owner is not CAP, the tempat penyimpanan. Apabila pemiliknya bukan
scaffolding material must be immediately CAP, maka scaffolding material harus segara
carried out of the CAP complex by using Carry- dibawa keluar kompleks CAP dengan
Out Form, in accordance with the Procedure menggunakan Carry-Out Form, sesuai dengan
for Carry-Out No.SSD-IDP-00? Procedure for Carry-Out No.SSD-IDP-00?

H. SANCTION H. SANKSI
Someone who violates the Scaffolding Work Seseorang yang melanggar Prosedur Scaffolding
Permit Procedure will receive sanction based Permit akan diberikan sanksi sesuai dengan
on company regulation. peraturan yang berlaku

VII. ATTACHMENT
Beberapa lampiran dibawah ini merupakan satu kesatuan dan tidak terpisahkan dari prosedur ini

ATT. NO DOCUMENT TITLE TOTAL

PAGES
1 Master Work Permit (MWP) form 1
2 Guideline to fill-out the MWP form 1
3 Scaffolding Work Permit (SWP) form 1
4 Guideline to fill-out the SWP form 1
5 Tubular Scaffold 1
6 Mobile tower/cuplock scaffold 1
7 Milsystem Scaffold 1
8 Frame Scaffold 1
9 Standard-Scaffold Inspection form 1
10 Tag “NOT SAFE FOR USE 1
11 Tag “SAFE FOR USE” 1

VIII. REFERENCES

NO DOCUMENT NO DOCUMENT TITLE LOCATION

1 PER.01/MEN/1980 Peraturan Mentri Tenaga Kerja dan Transmigrasi SFD
tentang Keselamatan dan Kesehatan Kerja pada
Konstruksi Bangunan.
2 SFD-IDP-0043 Procedure for Tools/Equipment inspection, Procedure Portal

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3 LPD1-IDP-0100 Guideline for Work Permit Utilization Portal

4 OSHA 1910.28 Safety Requirement for Scaffolding
5 Coorporate work agreement (PKB) PT CAP HRD

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