QUALITY CONTROL PLAN (QCP)

& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO EQUIPMENT

EQUIPMENT DESCRIPTION
Comprehensive Maintenace Service Work in 2017 For Paiton Power Plant Unit3
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare PTW √ 1 Hrs

SHUT-DOWN WORK

1 Issued PTW √ √
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Drain √ √
3 Flushing √ √
4 Open Manhole √ W
5 Confined space test √ √ √
6 Install scaffolding for access √
7 Inspection scope work √ Ip Ip
8 Repair / replacement as per scope work √
9 NDT : Radiography Test / Dye Penetrant Test √
10 Air Liquide Test √ √ √
11 Remove Scaffolding etc. √
12 Inspection √ √ √
13 Sign off permit √ √

RE-COMMISSIONING WORK

1
2
3
4
5

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Re-weld Eng./Maint. Spv Refer standard ASME IX & B31.3

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Note :
Attached Document/Figure : YES NO

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor
 Value
nce Criteria As Lef Remark
drawing, and other supporting documents shall

Comments
ny Signature
OSSI

SSI

POSSI

ete Time Complete

t.
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMENT

EQUIPMENT DESCRIPTION
Fit up and welding Water Wall (Existing Tube to New Tube)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POMI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √

Page 11 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection water wall (existing tube to new tube) √ Ip Ip

3 Clarification welding electrode √
4 Cut off & replace water wall (existing tube to new tube) √
5 Beveling, fit-up and install all joint tube √
6 Material traceability & fit-up inspection √ √
7 Weld all joint tube water wall (Existing Tube to New Tube) √
8 Visual weld inspection √ √
9 Radiography Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria
Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Page 12 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Re-weld Eng./Maint. Spv Refer standard ASME IX & B31.3

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

Page 13 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POMI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI

Page 14 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POMI

Verified By
(Plant Engineer) Engineer POMI

Approved By
(Project Enineer) Project engineer POMI

Date Start Time Start Date Complete

Job Duration

Attached Document/Figure : YES √ NO

Note :

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED

Page 15 of 90
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POMI Contractor

Page 16 of 90
 Value
ce Criteria As Lef Remark

Page 17 of 90
awing, and other supporting documents shall

Comments

Page 18 of 90
ny Signature

Page 19 of 90
OMI

MI

POMI

te Time Complete

Page 20 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMENT

EQUIPMENT DESCRIPTION
Fit up and welding Water Wall (Tube to Fin)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √

Page 21 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection water wall (tube to fin) √ Ip Ip

3 Clarification welding electrode √
4 Cut off original fin and new fin replacement √
5 Beveling, fit-up and install all joint water wall (tube to fin) √
6 Material traceability & fit-up inspection √ √
7 Weld all water wall (tube to fin) √
8 Visual welding inspection √ √
9 Dye Penetrant Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4
5

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria

Page 22 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Re-weld Eng./Maint. Spv Refer ASME IX & B31.3 standard
Dye Penetrant Test Eng./Maint. Spv Refer ASME V standard

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

Page 23 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI

Page 24 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Note :
Attached Document/Figure : YES √ NO

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED

Page 25 of 90
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor

Page 26 of 90
 Value
ce Criteria As Lef Remark

Page 27 of 90
rawing, and other supporting documents shall

Comments

Page 28 of 90
ny Signature

Page 29 of 90
OSSI

SSI

POSSI

te Time Complete

t.

Page 30 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMENT

EQUIPMENT DESCRIPTION
Fit up and welding Water Wall (Fin to Fin)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √

Page 31 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection water wall (fin to fin) √ Ip Ip

3 Clarification welding electrode √
4 Cleaning original fin and new fin √
5 Beveling, fit-up and install all fin water wall (fin to fin) √
6 Material traceability & fit-up inspection √ √
7 Weld all water wall (fin to fin) √
8 Visual welding Inspection √ √
9 Dye Penetrant Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4
5

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria

Page 32 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Re-weld Eng./Maint. Spv Refer ASME IX & B31.3 standard
Dye Penetrant Test Eng./Maint. Spv Refer ASME V standard

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

Page 33 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI

Page 34 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Note :
Attached Document/Figure : YES √ NO

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED

Page 35 of 90
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor

Page 36 of 90
 Value
ce Criteria As Lef Remark

Page 37 of 90
rawing, and other supporting documents shall

Comments

Page 38 of 90
ny Signature

Page 39 of 90
OSSI

SSI

POSSI

te Time Complete

t.

Page 40 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMENT

EQUIPMENT DESCRIPTION
Fit up and welding 3ry superheater (existing tube to new tube)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √

Page 41 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection 3ry superheater (existing tube to new tube) √ Ip Ip

3 Clarification welding electrode √
4 Cleaning 3ry superheater (existing tube to new tube) √
5 Beveling, fit-up and install all tube √
6 Material traceability & fit-up inspection √ √
7 Weld all tube 3ry superheater (existing tube to new tube) √
8 Visual welding Inspection √ √
9 Radiography Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria
Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Page 42 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Re-weld Eng./Maint. Spv Refer ASME IX & B31.3 standard

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

Page 43 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI

Page 44 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Attached Document/Figure : YES √ NO

Note :

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED

Page 45 of 90
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor

Page 46 of 90
 Value
ce Criteria As Lef Remark

Page 47 of 90
rawing, and other supporting documents shall

Comments

Page 48 of 90
ny Signature

Page 49 of 90
OSSI

SI

POSSI

te Time Complete

t.

Page 50 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMENT

EQUIPMENT DESCRIPTION
Fit up and welding 2ry superheater (existing tube to new tube)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √

Page 51 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection 2ry superheater (existing tube to new tube) √ Ip Ip

3 Clarification welding electrode √
4 Cut off & replace 2ry superheater (existing tube to new tube) √
5 Beveling, fit-up and install all tube √
6 Material traceability & fit-up inspection √ √
7 Weld all tube 2ry superheater (existing tube to new tube) √
8 Visual welding Inspection √ √
9 Radiography Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria
Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Page 52 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Re-weld Eng./Maint. Spv Refer ASME IX & B31.3 standard

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

Page 53 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI

Page 54 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Note :
Attached Document/Figure : YES √ NO

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED

Page 55 of 90
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor

Page 56 of 90
 Value
ce Criteria As Lef Remark

Page 57 of 90
rawing, and other supporting documents shall

Comments

Page 58 of 90
ny Signature

Page 59 of 90
OSSI

SSI

POSSI

te Time Complete

t.

Page 60 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMEN

EQUIPMENT DESCRIPTION
Fit up and welding front wall lower tube (existing tube to new tube)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √

Page 61 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection front wall lower tube (existing tube to new tube) √ Ip Ip

3 Clarification welding electrode √
4 Cut off & replace existing tube to new tube √
5 Beveling, fit-up and install all tube √
6 Material traceability & fit-up inspection √ √
7 Weld all tube front wall lower tube (existing tube to new tube) √
8 Visual welding Inspection √ √
9 Radiography Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria
Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Page 62 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Re-weld Eng./Maint. Spv Refer ASME IX & B31.3 standard

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

Page 63 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI

Page 64 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Note :
Attached Document/Figure : YES √ NO

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED

Page 65 of 90
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor

Page 66 of 90
 Value
ce Criteria As Lef Remark

Page 67 of 90
wing, and other supporting documents shall

Comments

Page 68 of 90
ny Signature

Page 69 of 90
OSSI

SI

POSSI

te Time Complete

Page 70 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMENT

EQUIPMENT DESCRIPTION
Fit up and welding front wall lower tube (tube to fin)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection front wall lower tube (tube to fin) √ Ip Ip

3 Clarification welding electrode √
4 Cleaning front wall lower tube (tube to fin) √
5 Beveling, fit-up and install all joint tube to fin √
6 Material traceability & fit-up inspection √ √
7 Weld all water wall (tube to fin) √
8 Visual welding inspection √ √
9 Dye Penetrant Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria
Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Re-weld Eng./Maint. Spv Refer ASME IX & B31.3 standard

Dye Penetrant Test Eng./Maint. Spv Refer ASME V standard

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Note :
Attached Document/Figure : YES √ NO

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor
 Value
ce Criteria As Lef Remark
rawing, and other supporting documents shall

Comments
ny Signature
OSSI

SSI

POSSI

te Time Complete

t.
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

QCP REFERENCE NO SHUT DOWN DATE WO NO NTP-ZM04Q00-92110-X001-00 EQUIPMEN

EQUIPMENT DESCRIPTION
Fit up and welding front wall lower tube (fin to fin)
ACTIVITY DESCRIPTION

Inspection by, Name of Inspection Authority

1. Contractor 2. Safety 3. Maint. Supervisor 1. 2. 3. W : Witness
4. Engineer 5. Cond. Mon 6. Production 7. Fuel & Ash 4. 5. 6. 7. Ca : Calibration
8. Third Party 9. I&C Tech 10. Mechanic 11. Electrical Tech 8. 9. 10. 11. St : Setting
Ra : Repair
Overrall √ PVC Suit Goggles √ Crane
Hard hat √ Guns boots Rubber apron Scaffold
Safety shoes √ Acid resistant overall Leather gloves √ Forklif
Face shield √ Safety harness √ Rubber gloves Gondola

Sign
PRE SHUT-DOWN WORK Control Activities Duration
POSSI
Task
Task Description 1 2 3 4 5 6 7 8 9 10 11
No
1 Prepare all document required √ √ 1 hrs
2 Prepare all tool required √ 30 min

SHUT-DOWN WORK

1 Issued PTW √ √ √

Page 81 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

2 Inspection front wall lower tube (fin to fin) √ Ip Ip

3 Clarification welding electrode √
4 Cleaning original fin and new fin √
5 Beveling, fit-up and install all fin to fin √
6 Material traceability & fit-up inspection √ √
7 Weld all front wall lower tube fin to fin √
8 Visual welding Inspection √ √
9 Dye Penetrant Test √
10 Sign off permit √ √ √

RE-COMMISSIONING WORK

1
2
3
4

RESULT
Value
Measurement Responsible
As Found OEM/Acceptance Criteria
Weld Preparation Eng./Maint. Spv Reffer to Applicable WPS

Page 82 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

Re-weld Eng./Maint. Spv Refer ASME IX & B31.3 standard

Dye Penetrant Test Eng./Maint. Spv Refer ASME V standard

Note: All reference of technical information detail such as: clearances, gaps, tolerances and fits, setting values, engineering drawings, cross sectional drawing, cross sectional drawing, and
be attached into this QCP package for control measure of work quality output.

Parts and Consumables (Including other cost) Utilization

Description Qty Stock/PO No Cost

FURTHER ACTION / SUGGESTION :

Page 83 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT

OTHERS:
Other Requirement :

POSSI Personnel Responsibility :

I hereby declare that this QCP has bee physically checked and inspected prior to equipment reassemble/reinstatement.
I also declare that the nature and location of this work, as well as all the warning signs, instruction and mechanical/electrical/instrument
& control isolation (temporary) have been removed/restored and the equipment ready for commissioning.

SIGN OFF
Name Description Dept/Company
Performed By
(Technician/Contractor) PT. TDI

Page 84 of 90
 QUALITY CONTROL PLAN (QCP)
& WORK COMPLETION REPORT
PT. TDI

Checked By
(Supervisor/Engineer Maintenance POSSI

Verified By
(Plant Engineer) Engineer POSSI

Approved By
(Project Enineer) Project engineer POSSI

Date Start Time Start Date Complete

Job Duration

Note :
Attached Document/Figure : YES √ NO

If this form is not adequate to feedback the inspection report, attach the report separately to this document.

PICTURE ATTACHED

Page 85 of 90
QUIPMENT NO

Control Activities
V : Verification P : Programming Sm : Simulation
T : Testing Ip : Inspection M : Modification
N : NDT It : Installation Cl : Cleaning
RI : Replacement A : Adjustment
Water Truck
√ Fire Truck
Leade/Dump Truck/Excevator
√ Special Tools

Sign Sign
Date
POSSI Contractor

Page 86 of 90
 Value
ce Criteria As Lef Remark

Page 87 of 90
awing, and other supporting documents shall

Comments

Page 88 of 90
ny Signature

Page 89 of 90
OSSI

SI

POSSI

te Time Complete

Page 90 of 90