Form Work Request [PDF]

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WORK REQUEST PENGOPERASIAN & PEMELIHARAAN CPP AREA GUNDIH



No.Formulir Tgl.Dibuat No.Revisi Halaman



: : : :



F.OP.CPPG-HSE-00 dd/mm/yyyy 0 0 dari 0



Kolom Permintaan Kerja



Tanggal : No. Work Request : ______________________ Lokasi kerja : ___________________________ Departemen : ______________________ Tag Number : ____________________________ Alasan : _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Lampiran : P&ID Electrical Single Foto MOC



eMOC



Pemohon :



Lain-lain :_________________ Mengetahui :



Menyetujui :



_____________________



__________________



(Nama Terang)



(Leader)



__________________ (Superitendent)



Kolom Persetujuan & Penjadwalan Permintaan Kerja



Tingkatan :



Normal



Sedang



No. Work Order : ________________________



Urgent Rencana kerja tanggal : __________________________ Target akhir tanggal :______________________ Catatan : __________________________________________________________________________________ __________________________________________________________________________________ Menyetujui :



_____________________ (Proses Engineer)



__________________ ( Leader/Superitendent)



__________________ (Maitenance Leader)



Kolom Penutupan Permintaan Kerja



No. Permit :_________________________________________ No. Sertifikat Isolasi : _____________________________ Aktivitas : __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Lain-Lain : __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Material : (Part No).____________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Tanggal : _____________s/d______________ Waktu : ___________s/d________________ Jumlah orang : Nama : _____________________________________________________________________________________ _____________________________________________________________________________________ Dikerjakan Oleh : Mengetahui :



______________________



___________________



(Teknisi)



(Leader Maintenance)



Disaksikan Oleh :



Mengetahui :



______________________



___________________



(Operator)



(Field Leader/Superintendet )



No.Formulir :



WORK REQUEST PENGOPERASIAN & PEMELIHARAAN CPP AREA GUNDIH



Tgl.Dibuat No.Revisi



: : 1



/



/



Halaman



: …… dari…...



Kolom Permintaan Kerja



Tanggal : No. Work Request : ______________________ Lokasi kerja : ___________________________ Departemen : ______________________ Tag Number : ____________________________ Alasan : _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Lampiran : P&ID Electrical Single Foto MOC



eMOC



Pemohon :



Lain-lain :_________________ Mengetahui :



_____________________



__________________



(Leader)



(SI/Kor-Lap)



Menyetujui :



__________________ (Asset IV/PEP)



Kolom Persetujuan & Penjadwalan Permintaan Kerja



Tingkatan :



Normal



Sedang



No. Work Order : ________________________



Urgent Rencana kerja tanggal : __________________________ Target akhir tanggal :______________________ Catatan : __________________________________________________________________________________ __________________________________________________________________________________ Menyetujui :



_____________________ (Maintenance Planner)



__________________ ( Maintenance Leader)



__________________ (SI / Kor-Lap)



Kolom Penutupan Permintaan Kerja



No. Permit :_________________________________________ No. Sertifikat Isolasi : _____________________________ Aktivitas ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Lain-Lain ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Material : (Part No).____________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Tanggal : _____________s/d______________ Waktu : ___________s/d________________ Jumlah orang : Nama : _____________________________________________________________________________________ _____________________________________________________________________________________ Dikerjakan Oleh : Mengetahui :



______________________



___________________



(Teknisi)



(Leader Maintenance)



Disaksikan Oleh :



Mengetahui :



______________________



___________________



(Operator)



(Field Leader/Superintendet )