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    (J1) PTW - Electrical Work - Rev04

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    safetylawas

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    © All Rights Reserved
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    (J1) PTW - Electrical Work - Rev04

    Uploaded by

    safetylawas
    6 views1 page

    Original Title

    [J1] PTW_Electrical Work_Rev04

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    © © All Rights Reserved

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    6 views1 page

    (J1) PTW - Electrical Work - Rev04

    Uploaded by

    safetylawas

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Step 4 PTW Coordinator

    ELECTRICAL WORK Permit No:


    ( All LV and HV Electrical Equipment Date:
    & Others)
    Signature:
    Step 1 By Permit Holder / Diisi oleh permit holder Site Description /deskripsi
    M/S No.: CONTRACTOR NAME/ Nama Kontraktor:
    OTHER RELATED PERMIT NO: TYPE OF WORK:
    WORK LOCATION: Commissioning area: YES NO
    PLANNED START DATE (1 Day):
    DESCRIPTION OF THE WORK TO BE PERFORMED:
    TYPE OF EQUIPMENT TO BE USED:
    SUPERVISOR IN-CHARGE: DATE:

    CONTACT NUMBER: SIGNATURE:


    Electrical Work Permit is required for any operation involving electrical work that can cause electrocution, fire or other incidents.
    Must be posted at the site.
    This permit is not valid unless all appropriate fields are completed
    REQUIRED PERSONAL PROTECTIVE EQUIPMENT (PPE) APD yang dibutuhkan No additional PPE
    Safety glasses, hardhat, safety boots, gloves, traffic vest and long sleeves always required. Bukan tambahan APD
    Face shield/ Pelindung muka Insulating/ Rubber gloves Flame resistance clothing

    Hearing protection/ Pelindung telinga Safety harness/ Pelindung jatuh Arc flashes protective equipment
    Alat pelindung dari sinar arc
    Other/Lain-lain :

    PRECAUTIONS CHECKLIST
    Lock-Out and Tag-Out (LOTO) System is implemented (if required). Correct voltage is used for connections.
    The area of work has been inspected and found free from Work area is free from flammable liquids or water.
    electrical fire hazard. Suitable fire extinguishers are available in the work area.
    ELCBs, Grommets and industrial sockets are use in all DPs. Suitable PPE (including high voltage gloves) are provided and
    Earthing arrangements are ensured. worn as required.
    Suitable safety signs are provided and installed.

    I confirm that all the items defined above have been completely examined and found in compliance with HSE requirements, and that the relevant
    employees are trained/competent enough for safe execution of the work .
    Sub-Contractor’s Electrical Supervisor: Date:

    Step 2 Review and Approve / Memeriksa dan menyetujui

    Approved By/ Disetujui oleh Name/ Nama Signature/ Tandatangan Date/ Tanggal
    Site Manager / Construction Manager

    Step 3 Re-evaluated at worksite / Dievaluasi di area kerja

    Evaluated by Name Signature Date


    Sub-con. Site Manager or Delegate
    SPV / Inspector Person in charge at Area
    EHS Person in charge at Area

    Step 4 Permit Close/ Penutupan Permit

    The Permit is to be signed off 30 minutes prior to the end of the shift at the last valid day of this permit and reported to permit coordinator.
    Permit akan ditandatangani 30 menit sebelum berakhirnya shift dan diakhir masa berlaku permit serta laporkan ke Permit Kordinator.
    Job Complete/Pekerjaan selesai Job Incomplete/ Pekerjaan belum selesai
    I have checked the workplace and declaring that I withdraw all my workforces from the area and it is safe.
    Saya telah memeriksa area kerja dan menyatakan bahwa saya telah menarik semua pekerja saya dari dari lokasi kerja dan aman
    Permit holder Name and Signature/ Date/
    Pemegang Permit dan tandatangan: Tanggal:

    PTW form rev#4

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