Passa amas TTE IRAE BE = TK = ROAT 2 soci Kind * Teal © @NCATHO or mere or more than 8 personne Ia f worker can be crested at te beck fhe JOB LICENSE po9e) roca out 108 DATE = Sia oF work Fst wor [ESA Rober OB LICENSE no ager vans ft Theeapeaton of he vid prod acorance wih he en wok celeb rat he howe 2 There was a sey ot how and mines, f-c There been a change in xcumstances wich could be dangerous to continue he JOB. Safety checks (Wed out by Superintendent HSE, SOW and SGHSEM Yer | Ne [-NA rae Fas te work plan oF wank wetiod besa] [ost naman wo be wed prepared, checked and approved by the] 1 has adequate capacty. and has Jonsutae and owner? ot rope operaton? FH i contoy Cae oon Grid OT fie na a a waa a dae] [te et by nom partes me foreman 1 fooine en proper cnaion” ssoconvacr wine cavoyart? Tove worasteen deatbea taxa al] [eta te sate wma ees tacnJSA) recta or teas? DSO SSNS WS SPST Tis SE [5 Ar er saat aps and 10 FI canes andi agers have atonse? Are evaaton plan Gescoe poco) [a Hee te wari ae 7 vane abel 7] Jans emergency eqment vate? l:crdng ob sty conan (IRADCY? ei te wore K avedy owned, undooo| [5 tere 2 cate passa fo fe bac nsersiood tye workers? | Jesters people rng ho ing process rate] “| Janagement Pant? [Tas he sarocnora canons boon ae Fis Ae alte tet rents eqared bebe | [ands sate (isolation of the work area) to cary jiting process is cared out in accordance wih] | fe acceptance teat ity)? [ete wanes contin Ray BEI [Fare a pperconmnsnon See] 7] Stopping 308 Postion Too MRE ‘Gate Unsaie ae Conner fe Aer Fiaing he JORIOR Sepa co cane Oats Hea A Sty ke SQHSEM, aReesed by Foreman /Su®-COmraCe: Personne Name © eve 3 TARIARA 2 lame ‘ = 6 [Wore oreT ESTO Fah wor Fg: te si ype oT Tas Tr wor plan been Cees 9° ccisse8 ive Geis Dean doe By BON Pa? His threw nocd for nang and te amount fiz he tee ntaton tes (SEEN, “ind water) nthe excavetn” (Wat) secures? 5 Taree norte ba anvare ere? (tach the A) va [pe excavation? nave they been 5: Fave baricacenaring SSD jesse fa. reste eqpmert tobe wed xen checked, i aden and es 8 isthe con he wore Pea {Sry and metal)?Tom PHASES TS ey. 02, uni 2021 (mando/subkon dengan pak wast)? Fr Apaiah pre peter sedan cjeastan bahaya hays yang ada? eutmoman vu Y v Wa eos a aR ana a, (7 vu 7 UA esos See Se 7 aaa pes ee ee eee a emer — ener ee er aaa ar RATT rece [aaa moar, - 7 |9. Apakeh akses tangga sudah dipasang dengan ie arn —_ saa em Safety T_Jssrung tangan tat (heat resistent) TTropeng las my ees ae c= Sateen pene ee eeceeany em ers jee Peart bite psn AS ee BE ae a aaa SS a =e [pena pas orm PIGSE, Sear poker sud meninogalan iad vate) [erran (HN) momen: Fos ala atea een Tek a Tan | Tas Tagan fs se (ere)Tom PWTSETOTS vegeta v0 GDP rewesararasva reneeyoe [here he 221 erase [Retest te rman susoomacor : Personnel Name: 7 WRATER = TAK = ROAT 7 2 SdUKiN + Toni & AGATMO s oa are more han 8 peronna att of wakes cn be rsd at he bak ote 408 LICENSE pape ae 108 eau Fe 105 Start of work: = retreat [esa nora Sine cores e heey pedi aconance it fm gan wa conpaton Bd camel gc Thos bent s iar increases eich co be engmces ocr 208. ‘say check ied uty Sopetondeat SE, Sand SOnSEN fe ra FoF erate weed et Y tes sce pat, and | yf of proper operon? [Fe tron cn, wa a, ae / [omesescepemrcmamt A f Havewotars ben desibeie ar al [7 Has Satara sae Door Jest? tach JSA) Y| |teckea tor feasbaty?” ul | jbo swan wo coma Be wae] [i Ae ie nicer mT eT] I canes) na ne rages havea arse? Fete exact plns(waco eesiaea] 7 [Ae te wary oa 7 os wal 7 lectermnmey ouspren wets? honing to est conct son (HRADCY? ete nak ed ome a] 7] [is tere a ae pose fT tae of [encerstood by the workers? people during the iting process (Trafic) Pant? aR SST 7 5 re a a es Tae re [ars it sate (sctaon ofthe work area) to cary] Process cared out in accordance wih) \/ foro Scepance (rate ay? Te WOT RET aT BTC 7 here 3 per canon TT] erty)? vY Proto 7 Taka Sa a ado Base | Fe Rar ak coir Rae oa fesg ong wes etait? [protective equipment (PPE) Team Gores Tt roam) ing Waker Wine utaer goves enema enter) meet loner teck teen aon) arcane ase (pres chomaty) Jones Pee [Ear mutiear pig _ Cia aa THT Sere Ste ONSE Manager Moor ees aeaad 3 ‘ 6 Hatris wed = Tae Work Pm Wi To Wager be vag F 6. The expiration ofthe vay period fe Tere was 8 Gelay Onn -POUS. f Retange in oreumetances has occured oat -czardance wth the gven work completion list, namely the oo... inatas which cou be dangerous to conbnue the werk, Yes [Wo Ly YS | a ra naan Do TTT rae AT = =o ee Tima area i unt stone === fs ne ran ia (Oy gers are here? (Atach th 5A) af [om rate ne ocr ea, ie Tie tg OPTSRETTORRAT fae bear SIS repatnce #7 [rate YY Sas he non ome od unrsd by woes Jv Jocon checkad et deste, 2nd Ms 3 Y [Sacre enero ee TTR ST| 7 Se Ste Tare ovo oe aS TRE TS PORTE | 7 a A psc eae aaa ORT —| 7 a eS TE ee aint nome Sa oT Sa fs amet? ar ET | eee rai are ES ART TOG rane sey oe aoa (ouecs es) ‘waong gues say Sr are ue Werder a osyoes, fetrrtoomny ree. st nis ems om er Tae Tae ar —| ra eo Se aT Ta eR ane Dh anc’ FRE? 1 ane: fo er! rahe bed me ni PSUR rea TSE wearer = re — Se oe Flt eer ieee sare besRequest for JOB LICENSE (tobe filed in by the SOM or superintendent retated to the work area) Requested byte foreman subconacer Personnel Name 7 = Sonia 3 7. 2 ‘ 6 8 more are more than 8 personnel, a st of workers can be created atthe back ofthe JOB LICENSE page) [Toca oar 108 cm ie oo [Equipment used [Finish work Tes asioatosed [esANonber FO TICENSE @ To Bape Va a Tre exaton oh atc perod in scordance wih fe gen wrk compton nae be hour There was diy of tors and mnaee 10 conve te J08. Far he wank Gan OF wo Bee [ota te camer we ie Prom cin ant srprned ty tol\ frapected, as ademsate capacity, and has a| (‘| Jenson and ower? [fresco proper operation? FE Fas te conrty chek bean creo oii fre tes by bom partes he freman facie na proper conn? I] sconce wih ne cvoyan? [recaanestasnceereenamarma| [Fas he sarang be aad Ener ese vata A) feces or tentay? Ee te operators wh operas [5 Ae here ston psa RS TORIC [canes and me ng have sean? Ae the evasion plan rece proce f& Are ie wang signs 7 sare wate) lecemergenyequoment vate? fcr te etry conta CHRADC? Ft wor Waray owed, Unde] 5. Bere 0 safe passe Tore Vatic. fnsetca ty ne woe? econ Seber aehy/ Pa? [ras sarong conan Saar aa fe re a te ten vans Tana Tare focetoas panes heat om boon [ire pom w cared ow racemes om] \_/] won fre soceptancn (testo gat)? ste wars cation bey Bisa] > [7 rea rer commana GOs OT} andere? bt? | [rar ev ocr baa pana apr [Has Be ak re he as oT a Jherg ing wrt boo stan? Taner goves (a eae Weng Make WG Say Boot utter Joves (choral tenste) ewes Samy lear oak gosces"aucene) earpectoront Wresoat |__|nuater parce ery") mer PPE ting) Ear muftiear plug _ -¢ Aer Fnaing tee JOB008 Stopping Job License Occupational Heath And Safty to be sutra (OWN) /SONSEw=> TOKYU CONSTRUCTION. CO. LTD Foam POSTS Rew 02. ns 2021 SP (PT. WASKITA KARYA (Persero} Tok WORK PERMIT Request for JOB LICENSE (to be filed in by the SOM or superintendent retated to the work area) | Reueste by te foreman sbeonractor anaes WaT TEE 2 Seuinin = TORK = Eom * Toa 6 NEATMO tr mere are more han & personne, ast of workers can be created at the back ofthe JOB LICENSE pape) e cK ek Soe [Tecory ox he JOB J = “ie Co 5 a OB estore Equipment used Cea rich werk —\ SS Matoal used [CSA Nmber S08 LICENSE i no anger vai >There was a delay of 9.2 There hat been achange mereumtances The exsraton of ie val perods in accordance wi the given work complation lm, amy the hour ours and mutes Siu cause cargos corte he 08 No [WA re = WE Let [Fas we epee oo ene’ sane ona sores | | Ss cecmsgcee! tne ete Fs is aca acc — fens oy eae ee oon | [incariecoemonsort 4 |subcontradtor with the clairvoyant)? oe, Eero e maT 17 enc [fects ent? Lo fa Ath an anos an SIS [cmon weapon ars toree? cts cae aman aaa a a pecan ee Leraote be sacycnrisan RAD? Fo ase ey oer SE fice tow toot Saas 0 he tae of fenders by te woars? oe fworters people cuneg the Wing process Tratie] foompeeetrecar ras we sodg cn Tor ca pr now to tat a eed el 7 land ist ste (aolaton of te wok area) ocary| ‘oceds is cared out in accordance wit} = ier paa nant TTS eters cma OT fnsmer yy [eas 4 frre mate ton momar mare SS TS CST ; fecipep ent toertame? eral a mT PET an eee Ra eg wa wns Soy on fee So Goes ann foe So peotietaiee cnet | erin frou aneetatorser? been Patbdy mess Fbor+Rutber doth gloves (ting) [08 TiceNSE AUTHORITY Trapecied By Oncor fave par’ Sting (Sway No& 'PT_WASKITA KARA (Perse) TDK WORK PERDTT 1S T Taian ponpnoeeroe [7 ia aR pa Se tanta eam? | 7 ies nT FF Sine amauta 5 ae worker boosie Sap raisin toe (OS, agree? (tach the 35) ee fs awn et ee Z| crasenareamemmione? | 7 Fre car TS Pa poe wat ody ones i Ha be pupa wwe 5 2etoarundcraned by morte a feces eta ate ao i a ©, TSS TREO OPT TODA ar TOE ee Vv orcas es] mean waaay | 7 rama eeE Te — 4Fas ATR GP PMN AREA Pera Te Sania 05th ‘WORK PERMIT ‘WORK: excavation> 24 x Sola 5 7 « 6 8 besser aaa ji et GK Seat or wa Eauipnent ved Wx rash work: V0 SE ster es a be The Werk Per wre ange be aid ere wos 8 ely of. Range cress han ocued hich cd be dager | Satety checklist (Tiled out by the Superintendent HSE, SOM and Te pre etn ote ay prod acorn wt gre wrk omen thay ee. i crete work, SEM) Ws We Whether the work plan Tas Been checked and ascussed? I operation acceptance cerca / SILO) ? Have chicks een done by both pres? 13. Te tere deep water seepage / Now {5 eter te grounder eve Fave The workers been expaned the dangers there? (Atachng 2SA) TCTs the i space adequate 1 space Tor vwokers? “re workers experienced / eompetercy? TS, We Ware Sle 2s TS to be weed to the excavation ea? Ts te operator operating tool (excavator have & cense? SIC TEs We excavation ei the ast are common cross and available protection? 5 oes the IK work ready owned, anersiood, inderstood by workers. 7 ee Were any means of communication avalable at fed alan safety plan iieancy? Ghysical and mental)? -saciaton pias we eu 15, Re Tee ay meas of communication émroerey 8 oe Be Plies hae (ce) 5. Was been assigned to Keep an eye on? U We Ue IGS wae 51 ue conto ofthe worker Teal [0-15 Hw exaaon waste dance we KI ele) i d<] 8 enough temporary (needed)? 0, Hove Be conditions around The ‘excavation work been checked and iste to | work? (Check sol type & whetherthere are PAL Ts He cont ofthe sk oF Tae ‘nather > 2m excavation work has been fafa? ies) 11. Does embankment ede lneide prtedion |, 7] insta? {FE ABOVE EAL NOT COMPLETED, THE WORK CANNOT BE [ acs THAT HEED TO CONSTR beer . [RS GS TTT SSS Tag a ‘Sepatu Safetyvest }-—{ rubber hand (chemical resistent) Welding glasses Gear Bc sss * (ge ut) esaaaner” Faesinaress Somes crew) (Toner Foe + her a tng) doves amare aby t ase = Supe ‘Sie Opal ae Reo