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A. THESE ITEMS BELOW MUST BE CHECKED BY SUPERVISOR / KOLOM KESELAMATAN DI BAWAH INI HARUS DIISI OLEH
SUPERVISOR
√)
(√
NO URAIAN YES / NO / REMARKS / KETERANGAN
YA TIDAK
1 Have employees already understood the detail of job ?
2 Have the employees already understood and been aware of the
hazard of the job & relevant JSA?
3 Has any injury precaution been prepared to ensure that there is no
other job, which can create dangerous situation when this job is to be
executed?
4 Has field operator been contacted ?
5 Has electrical supervisor checked the area and equipment and
ensure that they are in safe condition?
6 Have the main electrical power supplies been disconnected?
7 Have the lock out & tag out system been done on the equipment
8 Are there any other permits needed
9 Advice / Lain-Lain (Saran Tambahan)
10 Special safety instruction from engineer or supervisor (electrical and
instrument)
√)
C. PERSONAL PROTECTIVE EQUIPMENT SHALL BE WORN / ALAT PELINDUNG DIRI YANG HARUS DIPAKAI (√
I HAVE READ, UNDERSTOOD AND CHECKED CONDITIONS WHERE THE JOB CAN BE DONE
SAFELY AND AGREE TO OBEY ALL PRECAUTIONS STATED IN THE PERMIT