SISTEM MANAJEMEN TERPUSAT PT PLN (PERSERO) UNIT INDUK WILAYAH NUSA TENGGARA BARAT Ji Langko No. 25 ~ 27 Ampenan, Mataram, Nusa Tenggara Barat 83114 PLN Telp. : (0370) 643123 Fax. : (0370) 634401 treooimss | na Do a) ERT a v FM-K3-04-01 15 Juli 2019 | 4110 1-2 WORKING PERMIT WIN BEKERJA a 2 denis Pekeraan ‘Pr PLN(PERSERO) UPS BIMA ULP SAPE,ULP DOMPU, ULP WOHA DAN ULP ce oo Tans — reef =e =a aaa Dum kaj ‘Tal. Mutat | 19 Oktober 2023 ree Jam Mulat Bi 08.00 ell eon — pees aos — [ro Snsinanraeae ee Las a — — (Ponta Lee E.LAMPIRAN IZIN KERJA (WAJIB DILAMPIRKAN) {V } identitkas! Bahaya, Peniaiandan Pengendalian Risiko (HIRARC) | [v ]Prosedur Kerja TV ]09b Safety Analysis SA) [1 Seria Kompetens Pekena Keterangan: Form ian Kerja bak dapat itu jka salah satu lampiran tidak ada DISETUIUT OLEH DIPERIKSA OLEH | DIPERIKSA OLEH | PENGAWAS PEKERJAAN ‘ASMAN TEL ‘TLKGL UPS BINA, TLHARWET uP an | | | | | 1 PUTU AGUS WIRYANATA RICKY ALDESSISTEM MANAJEMEN TERPUSAT 2 PT PLN (PERSERO) UNIT INDUK WILAYAH NUSA TENGGARA BARAT Jl. Langko No. 28 - 27 Ampenan, Mataram, Nusa Tenggara Barat 63114 PLN Telp. : (0370) 643123 Fax. : (0370) 634401 Level Dokumen: | No. Dokumen : Tanggal = | Edisi/Revisi: | Halaman: v FM-K3-04.02 15 Juli 2019 L410 1-2 JOB SAFETY ANALYSIS ANALISIS KESELAMATAN KERJA ’AINFORMASI PEKERIAAN Tanggat [20 otober 2028 hci [ppt eas a ey Gs SEM BO [Tovesi PPT. PLN (PERSERO) UPS BIMA ULP SAPE, ULP DOMPU, ULP WOHA DAN ULP BIMA KOTA [Perusahaan Pelaksana Pekereen PT. DUTAINTI PERDANA [Die Pekeraan RIKI DIATNIKA, engawas Pokean PUTU AGUS WIRVANATA | Peloksona Pekera NAMA, TANDA TAVGan {ABDUL NABAS | 2. GUNAWAN | 3. ARIFIN PERALATAN KESELAWATAN N [LAAT PELINDUNG DIRT Lv} Heim {J Earmutt [1Petampung / Life Vest | [sept Soy [sang Tagan Kan -ebng Petron Lv carat {Sang Tengen fret |v ]Pul oa ress rwone {sang Teng 20 [Uta etn ie ee ae 2. PERLENGKAPAN KESELAMATAW & DARURAT IV] Penedim iAP AR ) | Lin, etn r [vipa Keseran [LVR Pa [Lito (eek outtag oa) [1 [i [Rado Komunik a | 6. ANALISIS KESELAMATAN KERJA No LANGKAH PEKERJAAN POTENSI BAHAYA DAN RISIKO TTINDAKAN PENGENDALIAN Pengernudi Merk Sit Fi “Memakal Helm SNI 1. | mengambii Materat dan Berkas Kecelakean Lal Linas Se L “Sek Kesehatan Pengendare Pengemodi Merk Sit 2 | Mand Lola Pearson eceton Lt Lae rete He Nt “ek Kesehatan Pengendars “Worrakal Sepatu Safely 3 | picks: Petnggen atu, Tersongat sti, Trgores serene aay | “Meraksi Peralatan yang SN! “Wornaka’ Sarang Tangan 4 | Mengecek wring dan Pengujan APP Terbentur,Tergres, Tersengat Listk “Mornakai sepa safety “emake Heim Safety‘SISTEM MANAJEMEN TERPUSAT oD PT PLN (PERSERO) UNIT INDUK WILAYAH NUSA TENGGARA BARAT Jl. 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