DISPENSATION REQUEST

F-PHEONWJ-Q-TKO-00259-001
No. :
Date : 23 Januari 2024
Location : Menara Standard Chartered
Requestor : Iwan Budiarto
Description of Exception : (Circle it)

Condition Operation Installation or activity with deviation on:

1 Protective instrumentation to sense potential hazards to prevent the escalation (SSV/SCSSV/PSHL/LSHL)
2 Devices to prevent equipment design limit being exceeded (PSV/PRV)
3 Ignition prevention measure(Ex/Junction Box)
4 Fire Gas Detection and associated alarm/interlocks/trips
5 Emergency shutdown or blow down system (ESD/BD)
6 Fire Protection Facilities (Fire Pump/Sprinkler/Deluge/Water Mist/ Hose Reel/Foam/CO2 Sys/Fire Monitor
7 Escape and survival equipment (Life Boat/Life Raft/Donut, etc)
8 Over Personnal on Board (POB)
9 SIMOPS
10 CoW Implementation
11 Environment regulation
12 Other, please describe: 4 (four) Procedures
Note: Risk must consider: Cost, Schedule, HSSE & Reputation
Pedoman Lifting Assurance & Management sytem PHEONWJ-G-PED-0007
Tata Kerja Organisasi Lifting Operation PHEONWJ-G-TKO-0100
Tata Kerja Individu Pedoman Uji Kompetensi Operator Dan Petugas Pesawat Angkat Dan Angkut PHEONWJ-G-TKI-5123
Tata Kerja Individu Lifting Audit Standard PHEONWJ-G-TKI-0158
Tata Kerja Individu Lifting Assurance PHEONWJ-U-TKO-0005
Tata Kerja Individu Scaffolding Assessment PHEONWJ-U-TKI-0004
Tata Kerja Organisasi Scaffolding Operation PHEONWJ-G-TKO-5100

Why Deviation Required?

7 (seven) Procedures has been expired in Th 2022
it required dispensation due to in progress for revalidation documents to Regional format

What are the risk and risk level? Cost Schedule HSSE Reputation

What are the mitigation?

Extend this procedures

Attachment
Operation Risk Assessment Isolation Risk Assessment
Engineering justification Isolation Confirmation Certificate
CoW Roles Implementation Emergency Response Plan
v Other, please mention:_______________________________
cover procedure

Validity Request Effective Start Date Expiry Date 1st Revalidation Expiry Date 2nd Revalidation Expiry Date

23-Jan-24 23-Jul-24

DISPENSATION REVIEW AND APPROVAL

I am satisfied that the controls identified when in place will redure the risk level to ALARP. The deviation is permitted to proceed.

Sr Engineer Surface
Engineer Surface Facility OSF Manager
Facility
1st Issuance
Name:
Date: Iwan Budiarto Michael Oktavianes Karyadi Junedi