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    of 1

    DAILY WORK PERMIT RESTRICTED AREA

    REQUEST OFF 3RD RAIL

    NO PERMIT / PERMIT NUMBER 23/LRT-PERMIT/VII/2024


    TANGGAL / DATE 18-Juli-2024
    JAM KERJA / WORKING HOURS 08.00 sampai 20.00 wib ( selesai )

    CONTRACTOR / MANDOR PT INKA (Persero)

    AREA KERJA / WORK AREA


    Area: DEPO LM,TTLM,HM,ATWP,TestTrackHM

    NO ID BADGE NAMA / NAME JABATAN / POSITION TYPE OF WORK ALAT KERJA

    1 Putu Rio A Project Manager 1. Pekerjaan 1.SCD

    2 Agus Staff Penyempurnaan 2. VOLTAGE DETECTOR


    sistem VM Ukur,VM 3. HT
    3 Zainal Arifin Staff
    Derek, VM Inspection 4. TOOL BOX
    4 Yogi Staff
    Bridge, dan Grinding
    Wardoyok Leader 5. LAPTOP
    5 Car ALL VM DEPO LM
    13 Pramono Teknisi 1 6,8,9,10,11 DAN 12
    14 Nandika Teknisi 2 DAN HM. Uji static VM
    Area LM dan
    15 Bima Teknisi 3
    Langsiran Area LM-HM
    17 Faiz Teknisi 4 Power off jam 08.00-
    18 Norfi Teknisi 5 20.00 wib (selesai)
    19 Oki Teknisi 6 2. Pekerjaan dan Uji
    20 Agil Teknisi 7 Statis TRMS
    Calibration di LM1
    21 Akhmat Teknisi 8
    (VM Ukur Mermec
    25 Mega Teknisi 9
    Statis 4 Jam di Jalur
    26 Rudik Teknisi 10 LM1 MULAI JAM
    30 Enggar Teknisi 11 10.00-14.00 WIB)
    31 Mucsin Teknisi 12 Power Off jam 08.00
    38 Dendi Teknisi 13 s.d 20.00 WIB
    39 Risky Safety Officer (Selesai)
    43 Ali Safety Officer
    44 Asep Safety Officer
    45 Ari Safety Officer
    47 Team INKA Team INKA
    48 KAI KAI

    OTORISASI IJIN / AUTHORIZATION PERMIT


    ADHI KARYA RAILWAY SYSTEM CONSTRUCTION MANAGEMENT
    Field Commander HSE Energizing SCC DPKA

    Tanda Tangan / Signature

    Nama / Name
    Tanggal / Date 17-07-2024 17-07-2024 17-07-2024

    PENERIMA IJIN / RECIPIENT PERMIT

    Project Manager PT INKA HSE PT INKA

    Tanda Tangan / Signature

    Nama / Name Putu Rio A Ari Irawan


    Tanggal/ Date
    17-07-2024 17-07-2024

    Notes : Permit harus disubmit setiap hari dan dimintakan tanda tangan satu hari sebelumnya.
    Permits must be submitted every day and signed the day before.
    Permit untuk disubmit paling lambat jam 16:00 setiap sore
    Permit to be submitted no later than 16:00 every evening
    Permit ini diperuntukkan untuk pekerja yang bekerja di area yang sudah bertegangan
    This Permit is for workers who work in energize area
    Wajib melampirkan Permit mingguan atau hand carry permit yang sudah disapprove
    Must attach weekly Permit or hand carry permit that has been approved

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