Potential Risk Control Measures Checklis

THE TASK
Determine if all tasks involved are needed.
Review the sequence of the tasks, is there a safer order?
Decide whether critical tasks can be performed in a different manner.
Review whether amended timing would be safer (e.g. during a partial or total shutdown
5 Substituting hazardous methods with less hazardous methods (cold cutting versus flame cutti
6 Containing the hazardous effects (e.g. water curtain, isolating).
THE PEOPLE INVOLVED
7 What are the requirements for rules, job instruction, competencies and training?
8 What are the requirements for specific supervision?
9 Are the people at risk and do they require specific protection?
10 Reduction of the number of persons exposed.
11 Reduction of the exposure period.
12 Ensuring personnel involved in the job are properly protected.
THE TOOLS AND EQUIPMENT USED
13 What are the potential hazards?
14 Can the potential hazards be eliminated or reduced?
THE MATERIAL USED
15 Is elimination or substitution possible?
16 Can the hazard potential arising from the material itself be reduced? (reduce,quantity,confinem
etc..)
1
2
3
4

THE WORKING ENVIRONMENT

In addition, it is necessary to identify suitable monitoring activities (e.g. Appropriate measurement

purge flow or build up of hazardous atmosphere).
17 Is there a threat by adverse weather conditions?
18 Is better housekeeping possible during the job?
19 Is adverse interaction with other jobs possible (e.g. adjacent hot work)?
20 Are people restricted in escape possibilities?
21 Are other error-inducing conditions present?
22 is the environment sensitive and therefore likely to be affected?
PROCEDURES
23 Are they prepared sufficiently in advance and communicated to all personnel involved ?
24 Have they been reviewed and approved by relevant Authorities?

ures Checklist

al shutdown
ng versus flame cutting

ning?

USED

ce,quantity,confinement,

opriate measurement of a

nel involved ?

yes

No

Work Permit Audit & Monitoring / Audit & Pemantauan Izin Ker

Name / Dept of person carrying out audit / Nama / Dept pelaku audit : ________________________ / ___

Type / Number of Work Permit / Jenis / Nomer Izin Kerja : _________________________________ / ________

Description of Work / Deskripsi pekerjaan : ________________________________________________________

Working Location / Lokasi kerja : __________________________________________________________________

Date / Time of audit / Tanggal / Jam dilakukan audit : ___ / ___ / ___ ; ___ / ___

Name of Performing Authority at site / Nama Wewenang Pelaksana di lokasi kerja : ________________

Name of Operating Authority at site / Nama Wewenang Operasi di lokasi kerja : ___________________

Name of Contractor's Company working at site / Nama Perusahaan Kontraktor yang bekerja di loka
If Complimentary Permit(s) is/are implemented, relevant ques
Jika ijin pelengkap diberlakukan, pertanyaan-pertanyaan yang sesuai berlak

Monitoring points / Pokok-pokok pemantauan

NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Is the Work Permit form displayed at job site in a plastic pocket?

Apakah formulir ijin kerja ditampilkan di lokasi pekerjaan dan ditempatkan dalam kantong plastik?
Does the permit clearly describe the work and match with actual work done at site ?
Apakah jenis pekerjaan ditulis dengan jelas dan sesuai dengan pekerjaan yang sedang berlangsung?
Is relevant Complimentary Permit attached to Main Work Permit?
Apakah Ijin Pelengkap terkait dilampirkan di Ijin Kerja Utama?
Is the work location clearly described and match with actual work place?
Apakah lokasi kerja ditulis dengan jelas dan sesuai dengan lokasi kerja yang sebenarnya?
Has the work permit been signed by the authorized persons?
Apakah ijin kerja yang digunakan sudah ditandatangani sesuai dengan tingkat kewenangan masing2 pihak?
Is the column of " Hazardous Condition" matching with the actual work at site?
Apakah keterangan pada kolom "Keadaan Yang Membahayakan" sesuai dengan kenyataan di tempat kerja?
Have the "Precautions" been implemented during doing the work?
Apakah persyaratan pada kolom "Pencegahan" telah dipenuhi selama pekerjaan berlangsung?
Is appropriate PPE used by workers?
Apakah Alat Pelindung yang digunakan pekerja sudah sesuai?
Is pre-job meeting conducted before starting the work?
Apakah pre-job meeting dilakukan sebelum pekerjaan dimulai?
Has the work permit been validated accordingly and match with the procedure?
Apakah izin kerja telah disahkan sesuai dengan prosedur?
Has each copy of work permit been distributed and kept by each parties accordingly and match with procedure ?
Apakah pembagian dan penyimpanan masing-masing lembar izin kerja sesuai dengan prosedur ?
Does Operating Authority at site know the scope of work being done?
Apakah Wewenang Operasi di lapangan memahami lingkup pekerjaan yang sedang dikerjakan?
Is Operating Authority at site able to control the work efficiently?
Apakah Wewenang Operasi di lapangan dapat mengawasi pekerjaan dengan efisien?
Is Performing Authority at site able to supervise the work efficiently?
Apakah Wewenang Pelaksana di lapangan dapat mengawasi pekerjaan dengan efisien?
Does Performing Authority have a clear knowledge about work permit system?
Apakah Wewenang Pelaksana memiliki pemahaman yang betul tentang izin kerja?
Is the escape way to Muster Point available/ not obstructed?

16
17
18
19
20
21
22
23

Apakah jalan menuju Tempat Berkumpul telah tersedia dan tidak terhalang?
Do the workers know about alert system and action plan in case of Emergency?

Apakah para pekerja memahami tentang sistem alarm dan tindakan yang harus ditempuh pada saat terjadi keadaan dar
If gas test is required, is it done properly and recorded in work permit?

Apabila pengetesan gas diwajibkan pada pekerjaan tsb, apakah pengetesan dilakukan dengan benar dan di catat pada iji
Have all 'electrical' tools/equipments been checked?
Apakah peralatan bantu listrik sudah diperiksa?
Has the isolation procedure been properly implemented and marked (lock-out/tag-out)?
Apakah prosedur isolasi sudah dilakukan sesuai prosedur dan diberi tanda?
Has Operating Authority reported to Control Room about the starting of work at site?

Apakah Wewenang Operasi telah melaporkan ke Ruang Kontrol tentang dimulainya pekerjaan yang dilakukan dilapangan
Is there any other work at the same work place?
Apakah dilokasi kerja yang sama ada pekerjaan lain?
If your answer of item 22 above is YES, is there any conflict of work among them?

Apabila jawaban anda pada item no.16 adalah YA, apakah terjadi konflik kepentingan kerja antara masing-masing pekerja

SUGGESTION / USULAN :

PLEASE SUBMIT THE AUDIT REPORT TO SITE S&E FOR REGISTRATION HASIL
AUDIT HARAP DISERAHKAN KEPADA SITE S&E DI

Pemantauan Izin Kerja

No WPA :...........

_________________ / _____________________________

____________ / _____________________________

_________________________________________

______________________________________

erja : ____________________________________________

a : _______________________________________________

r yang bekerja di lokasi : _____________________________

mented, relevant questions apply to both Permits
an yang sesuai berlaku untuk ijin kerja utama & ijin pelengkap
Remarks /
Yes / Ya
No/tidak
pemantauan
keterangan

angsung?
Apabila tidak sesuai, harap
dikosongkan

masing2 pihak?

di tempat kerja?

ng?

atch with procedure ?

an?

pada saat terjadi keadaan darurat

Apabila tidak sesuai, harap
dikosongkan

an benar dan di catat pada ijin kerja?

Apabila tidak sesuai, harap

dikosongkan
Apabila tidak sesuai, harap
dikosongkan

an yang dilakukan dilapangan?

Apabila tidak sesuai, harap

dikosongkan

antara masing-masing pekerjaan?

VISA AUDITOR:
PARAF PENGAUDIT:

N KEPADA SITE S&E DI LOKASI KERJA UNTUK DIDAFTAR

VISA AUDITTEE
PARAF TERAUDIT: