s& i rerancn outa paxansa OVERTIME WORK PERMIT FORM ENGINEERING -PROCUREMENT - CONSTRUCTION NEW/ BARU EXTENTION/PERPANJANGAN _ | POP/OT/ Permit Number / Nomor izin pee Area: yesvy xeesvur Dept: Tear we Validity | Masa berlaku Published Date / Tanggal dikeluarkan : 1.0. 20> rom/ Dari | Date/ Tal Net 204 [to] ney Location of Work/ Lokasi: erry vemcue Time / Jam_ 16-00 To] 20-00 Work Executor / Pelaksana Pekerjaan : wreseno Detail of Job /Uraian Pekerjaan: —euaawe caw conrmow = Ruwine cane Fe | [A-DETAILS OF WORK7 | company Name / Nama Perusahaan Fer ate | Tanggal Pew pear [Time F Jam [ie esto 2 125 xact Job to be executed / Pekerjaan yang? —gutine cane conur@ow laksanakan | cerunnse came comreen Number of Workers / Jumlah Pekega [TE eran lame of Supervisor / Nama Supervisor | Abow Oat Phone /Telepon 5, LIST OF WORKER / DAFTAR NAMA PEKERJA Name /Nama No. 1D Wo Name /Wama— We. 10 ay eee ™ 12 Tas ecene aces 2 | exesene ~ 13 wean wevter | 3 [Oem Wace 14 clan WA Veter 4 | Awoer a ween oe ast] forme pase GR 3 | Abus owt eee. Ger 16 = [8 [M4 mvaayriw Ss 17. _ iE T | temteryo wiecvee 18: 8 | gerneco wetee 18 3 axeees Meveoe 20 i 10 arne Wecrve 21 ot a [a Sea Hee 2 ‘SPECIAL SAFETY INSTRUCTON | INSTRUKS! K3 KHUSUS : THAVE READ, UNDERSTOOD AND CHECKED CONDITION WHERE THE JOB CAN BE DONE | Enaoread ‘SAFELY AND AGREE TO OBEY ALL PRECAUTIONS STATED IN THE PERMIT. SAYA SUDAH MEMBACA, MENGERTI, MEMERIKSA KONDIS! DIMANA PEKERJAAN DAPAT DILAKSANAKAN DENGAN AMAN DAN SETUJU UNTUK MEMATUHI SEMUA Ie TUAM Yai ' aT DI WIN INE my ot |@ | HE ame Tae SERCO Wane i aaa EE 1 sanconecer Sapa POP TaETOr ener SipaieniotT | Gan Rosanne | Roseeorsts [_“eereottraper JOB FINISH OR EXTEND / PEKERJAAN SELESAl ATAU DITUNDA-— T | | Accept the work (Completed J Extend)", Work Place Has b clean and safe Yee rPeterman | Datel Tenggel) Time/9m | Saya menerima pekerjaan (selesai / ditunda/diperpanjang)*, “Fema keratin kombal'sman San bers ah so en/na | oo) aero u ro ro ee a ‘Copy ou POP sieader Ssuperntendent/ Client Sepesmame | swevtoreoe | __wse pop ca | earn