WORK

PERMIT
HENDRAJATI
REF : UU NO 1 TAHUN 1970 TENTANG K2 YANG MEMUAT POKOK-POKOK PEMBINAAN & PENGAWASAN
KESELAMATAN DAN KESEHATAN KERJA SEJAK DARI TAHAPAN PERENCANAAN, PELAKSANAAN DAN
PENGENDALIAN DISETIAP TEMPAT KERJA
 WORK PERMIT / PERMIT TO WORK

Adalah sebuah dokumen/izin tertulis yang digunakan untuk mengontrol jenis pekerjaan
tertentu yang berpotensi membahayakan pekerja.

KENAPA PERLU ?
Untuk mengidentifikasi pekerjaan yang akan dilakukan, potensi bahaya yang
berhubungan dengan pekerjaan & tindakan pencegahan/pengendaliannya
 TUJUAN WP

1. Mengidentifikasi siapa yang terlibat dalam pelaksanaan pekerjaan

2. Mengidentifikasi bahaya dan resiko yang terkait dengan pelaksanaan
pekerjaan
3. Memastikan bahwa pekerjaan telah benar-benar aman untuk dilakukan
4. Registrasi Work permit yang telah disetujui
DOKUMEN KERJA K3

WORK PERMIT

JSA/SOP

P5M/TOOLBOX
CHECK LIST
 JENIS-JENIS IJIN KERJA

1. IJIN KERJA PANAS/HOT WORK PERMIT (pengelasan, pengeboran logam,

cutting, sandblasting)
2. IJIN KERJA DINGIN/COLD WORK PERMIT (painting, bangunan,sipil)
3. IJIN KERJA MEMASUKI RUANG TERBATAS (silo, tanki)
4. IJIN KERJA PEKERJAAN LISTRIK (perbaikan, pemeliharaan, pemeriksaan)
5. IJIN KERJA KHUSUS (WAH, Digging, Lifting, Bahan Radioaktif )
 YANG BERWENANG MENGELUARKAN IJIN

SUPERVISOR/PENGAWAS/
PELAKSANA.
 Oxygen
low/over

Paparan
Listrik bahan
kimia/B3

Bekerja di
Penggalian ketinggian
KAPAN IJIN KERJA DIPERLUKAN

Paparan Memasuki
bahan Ruang
kimia/B3 terbatas

Suhu
ekstrem/tekanan
tinggi
INFORMASI DALAM WP

Nama pekerja (> 1) Tindakan pencegahan

Detail lokasi pekerjaan APD

Pekerjaan yang akan dilakukan Emergency tools

Waktu pekerjaan Emergency number/scenario

Daftar potensi bahaya Authority Signed

Daftar Persiapan (peralatan, pengujian Worker Signed

atmosphere, isolasi energi dll)

Urutan prosedur kerja Date of Expired

BERAPA LAMA IJIN KERJA
BERLAKU

1. 8 jam ( 1 shift kerja)

2. 07.00 s/d 17.00
3.Tidak lebih dari satu hari
PROSEDUR PEMBUATAN WP

Rangkap 2-
Dibuat
3
sebelum
(dokumen
kerja
& field)

WP
dikeluarka Seluruh
n oleh
pekerja Monitoring
pihak
kompeten paham

Identifikasi
semua Penangana
bahaya/resik n keadaan
o & potensi darurat
kecelakaan
 PROSEDUR PEMBERIAN WP OLEH
PENGAWAS

Kesehatan kondisi pekerja

Kelengkapan Sarpras + APD

Kondisi berbahaya telah dikontrol

Hasil pemeriksaan dilapangan

FORM WORK PERMIT
 COMMENTS BY SERVICES AOUTHORITIES
EXCAVATION PERMIT
COAL FROM INDONESIA (Permit to Dig)

FOR OFFICE USE

PERMIT NO. AUTHORITY SERVICES SIGNATURE/TITLE
DATE :

APPLICATION CIVIL & FACILITIES

TO : (Manager of work area)
Permission is requested to excavate (Supt. CFM )
LOCATION / Depth. / Surpat. details

DEPTH :

Location plan attached (if posible) YES NO POWER

Reason for excavation
(Supv. Power)
Proposed start date Time Duration
Requested by (Name)
Designation (if applicable)
Dept./Contractor

Signature
COMUNICATION
Date
(Supt. Com Sys.)

APPROVAL
TO :

Your application is / is not approved

* Not approved / is approved subject to FUEL LINE

( Supt. Supply )
Manager Work Area Person Responsible for work KTT(or appointed person by KTT )

Signed : Signed : Signed :

Name : Name : Name :

Designation : Designation : Designation : WORKSHOP AREA

Date : Date : Date :
( Supt. Maintenace )

DIGGING PERMIT OTHER

 AUTHORITY TO WORK IN THE VICINITY OF
ELECTRICAL APPARATUS
COAL FROM INDONESIA

Issue

This authority is issued to : ____________________________ Date: ________________

This person is authorized to work in the vicinity of but not on the apparatus listed.

Apparatus
Type No Voltage Clearance if exposed H.V in vicinity

A sketch of the area involved must be attached

Work description:

Permitted tools/plant:

Safety precautions taken:

Issued by: ______________________________ Date: __________________________

Receipt
I hereby accept this authority and state that I fully understand the nature and position of the
work entailed. I understand that this authority does not permit me to work on any H.V.
apparatus. I have been advised of the nature and position of adjacent live apparatus and the
limits of approach and undertake to instruct the personnel of the working party to observe
the safety precautions as detailed above.

Person in charge: ___________________________ Date: ________________________

Part 1. _____________ 2. _____________ 3. _____________ 4. _____________

Relinquishment
I hereby relinquish this authority and all persons will remain clear of the work referred to.

Person in charge: _______________________ Date: ___________________________

Part 1. _____________ 2. _____________ 3. _____________ 4. _____________

Canceled

Isolator: __________________________________ Date: ________________________

Manage r Work Area KTT ( or appointed person by KTT )

Signed : __________________________________ Signed : ________________________________

Date : __________________________________ Date : ________________________________

TERIMA
KASIH