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    Work Permit For Construction Site

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    aw

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    © All Rights Reserved
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    Work Permit For Construction Site

    Uploaded by

    aw
    1 views1 page

    Original Title

    WORK PERMIT FOR CONSTRUCTION SITE

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    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    1 views1 page

    Work Permit For Construction Site

    Uploaded by

    aw

    Copyright:

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

    WORK PERMIT FOR CONSTRUCTION SITE

    Doc. No. TA2839-WP02A-MSM-079-R0 Project No. TA2839


    Works Repair Buckling Shell Coordinator
    Nr RA/JSA TA2839-WP02A-JSA-079-R0 Supervisor
    Spesific Location T1A - 15000 MT TF-2 Safety Officer
    Date 8 July 2024 Number of Workers

    PPE to be used
    Standard Gloves
    Safety Harness Face Shield Other :
    Shoes, Hard Hat, High Vis Vest Rubber/Cotton/Leather

    Work Permit - Work Preparation Submittal Documents Checklist


    No. Submittal Items for Approval Approved (Yes/No)* Date Approval Sign Issuer (Consultant) Co-Sign (Client) Remarks**
    1 Work planning and works mapping (layout, sequence)
    2 Work Method Statements
    All Staff Vaccinated.
    3 Safety, Health and Environment Plan (incl C-19 measure)
    Periodic PCR Test
    4 Work inspections previous works (rebar, formwork, et.al.)
    5 Survey report/stake out of the works (planned works)
    6 ITP Inspection Test Plan document for the works (QC)
    7 Material Approval
    8 Workshop/Prefabricator/Factory Inspection (FAT)
    9 Material Delivery, handling, laydown and storage plan
    10 Material Delivery Inspection (Material needs to be on site)
    11 Material sample lab test 3rd party as required by Eng.
    12 Material Test Certificates (from manufacturer/supplier)
    13 Shop design drawings
    14 Equipment planning (hand-tools, tools, heavy equipment)
    15 Equipment testing (operator and equipment certified)
    16 Manpower planning (per activity step, show rate of prog.)
    17 Mock-up approved (if applicable)
    18 Coordination plan (if applicable)
    19 Lifting Plan (if applicable)
    20 Supervision & Quality Control personnel planning

    *If the above are answered with "Yes" and documents and requirements have been fulfilled complete and signed above, please invite Consultant and Client for Pre-Installation
    meeting to present the works and gain approval sign off of this Work Permit before any commencement of works.
    (*Apabila hal di atas dijawab dengan "Ya" dan dokumen serta persyaratan telah dipenuhi secara lengkap dan ditandatangani, silakan undang Konsultan dan Klien untuk rapat Pra-Instalasi
    untuk mempresentasikan pekerjaan dan mendapatkan persetujuan dari Izin Kerja ini sebelum dimulainya pekerjaan.)
    **If Not Applicable (N/A) note under 'Remarks'
    (**Jika tidak, beri catatan di kolom 'Remarks')

    Permit to Work Applicant Work Permit Issuer


    Note Checked & Approved by Acknowledged by
    The contractor is required to attach documents related to the work permit. Contractor CM/SM Contractor Safety Manager
    The work permit will not be approved if the supporting documents are incomplete RHDHV PM/CM/Spv/SHE UOI

    ( ) ( ) ( ) ( )

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