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Tanggal terbit 07/07/2020
IJIN MELAKSANAKAN PEKERJAAN Halaman 1/1
(WORK PERMIT)

IJIN MELAKSANAKAN KERJA


WORK PERMIT

No. ............................ Petugas .......................................jabatan.....................................................Dok.


Terkait........................................................
.......................................
.......................................
Pekerjaan : ......................................................................................................................
Lokasi :...............................Waktu :
.......................................................................................................................
.......................................................................................................................

APD Dipersyaratkan : Persyaratan Umum :


 Goggles/kacamata  Disyaratkan kualifikasi tertentu / sudah 
Gloves/sarungtangan. sudah mengikuti pelatihan khusus
 Harness
 Gas mask/masker gas Persyaratan K3 lainnya :
 Safety shoes / sepatu safety  APAR/Alat Pemadam Api Ringan
 ...................................  Penanganan limbah B3
 ...................................  ...................................
 ...................................  ...................................

Pemberi Tugas mengetahui,

…………………. Koord K3L

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