FR-HSE-K029

Nama Departemen/Kontraktor : PT. TRAFOINDO PRIMA PERKASA

Izin Kerja Umum Department/Contractor Name :
Tanggal Pengajuan : (berlaku maks. 1 minggu)
General Work Permit Submission Date : (valid max. 1 week)
31 / 12 / 2023

dari sampai
PT. Softex Indonesia, Plant Karawang from to

No :
Tanggal
Durasi
Deskripsi Pekerjaan Date Keterangan
No. Durati
Work Description Mulai Akhir Description
on Start End

1. MAINTENANCE TRAFO 14 UNIT

1 Hari 01/01/24 01/01/24 Maintenance Trafo

Jumlah Pekerja (Nama Terlampir)

Total Worker 5 Orang (Attached Name)

Material
1.
Material 6.
2. 7.
3. 8.
4. 9.
5. 10.

Peralatan 1. ToolBox 6. Multimeter

Equipment 2. Alat Tescom 7. Botol DGA
( Tipe & Jumlah ) 3. Alat TTR 8. Naple
( Type & Total ) 4. Alat Megger 9. Alat cleaning
5. Torsi Tekno

Saran : (diisi oleh PT. SOFTEX INDONESIA)

Suggestion : (fille by PT. SOFTEX INDONESIA)

Lampiran
Attachment

Analisa Keselamatan Pekerjaan (JSA) Gambar Teknis

 Job Safety Analysis (JSA) Technical Drawing

Material Approval (jika ada) Laporan Pemeriksaan

Approval Material (if any) Inspection Report

Izin kerja terkait (pekerjaan panas, ketinggian, ruang terbatas

 Related work permit (hot work, working at height, confined space)

Metode Kerja / SOP Dokumen lainnya

Work Method / SOP Other Document

Disetujui Oleh : Diketahui Oleh : Diajukan Oleh :

Approved by : Known by : Submitted by :
User Dept. Owner Area HSE Dept. HSE & Project Supervisor HSE
Nama
Name
TTD
Sign
Tanggal Aditia Mahardika SUHARGO
Date

Document Number: FORM-49546 Revision: 0 Effective Date: Dec 29, 2021

THIS DOCUMENT CONTAINS CONFIDENTIAL KIMBERLY-CLARK INFORMATION. Printed copies are only valid
on the date printed unless controlled per a manual document control procedure and stamped as such.
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