Worker name / Siar pekeris
‘Saya ah nga pekeiaan yaa akan dian beseriabahava dan reskonva, dan aan melakukan semua confal yang
Srokomendankan seta man memastaanpraoncacenakan segan san
‘Ona Vakaion -
The Undersigned acrowteder that al precaion | Tatcept the renireent of tis work permit and ready | Aeproalfor
requred nave been plemented, rhe os ready
tobenan
| meetentesinlenenngsttereeuremet, | oertne Work
| ho =
|
(ob nienipion se
[sete a woe vs War PW Be WE HERE
| seamen pana Dek r ah dikhentikan. muh
i Teorey, Tne of sy aoe a fa Sp OW 1
s wu jaan oloh Karena |
|
|
| And may continue on / ‘Thus a New Work Permit must be issued prior to continue the
Date Time Jobs
“Work Bernt Compiation
Tundersign thatthe work fic tis work peri was sve =
oe Sanlu bainksdasaiaekioimestaciclead
tale Sipenre owe Siete
Time
t HSE sPv i HSE SPV
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