Contractor Name : PT.

Krakatau Daya Listrik

PT. Krakatau Nippon Steel Sumikin Date (tanggal) : 17 Januari 2023
Jl. Eropa I Kav. A2 Krakatau Industrial Estate Cilegon TIME REQUIRED ( Waktu yg Diperlukan )
(KIEC) Maximum in 1 Week ( Berlaku Maksimal 1 Minggu )
Cilegon - Banten From (dari) :19 Januari 2023
PT. KNSS To (sampai) :19 Januari 2023

GENERAL WORK PERMIT Permit Number : 4/GA/REC/HESEN/0006

Number of
No. Work Description Date Duration (Hours) Location
Manpower
Pengukuran intensitas cahaya Lampu Highbay area Intermediate,
1 cleaning dan shipping 19/01/2023 5 5 Area Workshop

Special PPE Requirement : SCBA ( Self Contained Breathing Aparatus ) Fullbody Harness
(Except Mandatory PPE) Respirator Mask
Exhaust Fan
Lifeline
Safety Net

Equipments/Tools 1. Lux meter 6.

(Type & Quantity) 2. 7.
3. 8.
4. 9.
5. 10.
Remaks / Comment

Attachments
Shop Drawing MSDS (Material Safety Data Sheet ) Radiography Test Permit
V JSA (Job Safety Analysis) High Energy Electricity Permit Lifting Permit
SOP (Standard Operational Procedure) Working at Height Permit Excavation Permit
Work Method Confined Space Permit Hot Work Permit

KNSS Representative Confirmation Issued By Contractor

Job-related Manager Area Owner

HSE Job Requester
(User-Manager) Representative
Print Name
Tb. Iman Firmansyah
Signature

Date 17 /01/2023

Remarks : Job Requester only start to work after getting approval from all parties as required