PT PEMBANGKITAN JAWA BALI SERVICES No. Dok. : FM-BT-8.2.2.

82
SIAP − INTEGRATED MANAGEMENT SYSTEM Tgl. Berlaku : 12 Juli 2022
PLTU BOLOK Revisi : 00
FORMULIR KERJA LEMBUR KONTRAKTOR/PIHAK KETIGA Halaman : 01

FORMULIR LEMBUR KONTRAKTOR/PIHAK KETIGA

FORM CONTRACTOR EXAMINATION

Nama Pemohon : .................................................................................................................

Name of Applicant

Perusahaan : .................................................................................................................
Company

No.SPK : ...................................................................................................................
Number of SPK

Nama Pekerjaan : .................................................................................................................

Type of Jobs

Hari, Tanggal : ............................................... Lembur Pada Waktu: Hari Kerja Hari Libur
Date, Day

Waktu Mulai (jam) : ................................................Waktu Berakhir (jam) :.....................................................

Start time End time

Daftar Nama Pekerja (Boleh terlampir apabila tempat tidak mencukupi)

Mengetahui,
Pemohon Direksi Pekerjaan SPV K3

(.................................................) (.................................................) (.............................................)