Energized Work Area Permit V2
KHEN NUHFUS SANJAYA - 2025-05-05
ID 856705 Created by BCEI/DKSH 08:59:59
JKT-02
Select Contractor PMX
Section A. INITIATION INISIASI
Area: DC1-SECOND FLOOR
Location
Zone: DC1
DC1: Second Floor
DC1 Second Floor: 02-002 LVMDB Block BA
Location or Equipment to be Worked on / Lokasi Lvmdb BA-BZ 2nd floor DC 1
atau Perelatan yang akan dikerjakan di atas:
DKSH -
Energize, Burn in test, Alarm test, rectify & cleaning
Description of Work / Deskripsi Pekerjaan: UPS STS Rack battery
Lvmdb BA-BZ 2nd floor DC1
Handtool
Cordless tools
Vacum Cleaner
Equipment and Type / Peralatan dan Jenis: Bustcloth
torque
tangampere
PQA
Permits are valid for 12 hours only / Ijin kerja hanya berlaku selama 12 jam
From: 2025-05-06 To: 2025-05-06 Duration 1 Day
Company: BCEI/DKSH
Worker/ Pekerja:
Name Added Photograph
VAHSYA WAHYUDI 2025-05-06 05:47:55
First Name: VAHSYA
Surname: WAHYUDI
Trade: ENGINEER
Company: BCEI/DKSH
DZAKY RESA RADITYO 2025-05-06 05:48:01
First Name: DZAKY RESA
Surname: RADITYO
Trade: HELPER
1
Company: BCEI/DKSH
MADINA DWI PUTRA 2025-05-06 05:48:07
First Name: MADINA DWI
Surname: PUTRA
Trade: HELPER
Company: BCEI/DKSH
SANDRIY MAULANA 2025-02-12 08:13:05
First Name: SANDRIY
Surname: MAULANA
Trade: PROJECT ENGINEER
Company: BCEI/DKSH
MUMAMAD AJIDAN 2025-02-19 17:14:08
First Name: MUMAMAD
Surname: AJIDAN
Trade: ENGINEER
Company: BCEI/DKSH
DZAKI KHALIF 2025-02-19 17:14:14
First Name: DZAKI
Surname: KHALIF
Trade: HELPER
Company: BCEI/DKSH
M BONDAN WISNU PRAYUDA 2025-02-19 17:14:25
KADIR
First Name: M BONDAN
Surname: WISNU PRAYUDA KADIR
Trade: HELPER
Company: BCEI/DKSH
2
RINAL RIFALDI 2025-02-19 17:14:30
First Name: RINAL
Surname: RIFALDI
Trade: HELPER
Company: BCEI/DKSH
KHEN NUHFUS SANJAYA 2025-02-19 17:14:35
First Name: KHEN NUHFUS
Surname: SANJAYA
Trade: ENGINEER
Company: BCEI/DKSH
MOHAMAD RAMLI 2025-02-22 08:00:48
First Name: MOHAMAD
Surname: RAMLI
Trade: Project Engineer / SPV
Company: BCEI/DKSH
MOHAMAD ZAID 2025-02-22 08:00:53
First Name: MOHAMAD
Surname: ZAID
Trade: ENGINEER
Company: BCEI/DKSH
MATROIS MATROIS 2025-02-22 08:01:16
First Name: MATROIS
Surname: MATROIS
Trade: WORKER
Company: BCEI/DKSH
3
DANI RAMDANI 2025-02-22 08:01:32
First Name: DANI
Surname: RAMDANI
Trade: WORKER
Company: BCEI/DKSH
DENI ZIKO HASIBUAN 2025-02-22 08:01:41
First Name: DENI
Surname: ZIKO HASIBUAN
Trade: WORKER
Company: BCEI/DKSH
MOCH ZAINUDDIN 2025-02-22 08:01:48
First Name: MOCH
Surname: ZAINUDDIN
Trade: WORKER
Company: BCEI/DKSH
FAJAR NUGROHO 2025-02-24 13:40:07
First Name: FAJAR
Surname: NUGROHO
Trade: HELPER
Company: BCEI/DKSH
HIDAYAT HIDAYAT 2025-02-24 13:40:14
First Name: HIDAYAT
Surname: HIDAYAT
Trade: ENGINEER
Company: BCEI/DKSH
4
KHARIS UBAIDILLAH 2025-02-24 13:40:44
First Name: KHARIS
Surname: UBAIDILLAH
Trade: WORKER
Company: BCEI/DKSH
ATHALLA ANDRASAYOGA 2025-03-03 07:10:48
First Name: ATHALLA
Surname: ANDRASAYOGA
Trade: DOCUMENT CONTROL
Company: BCEI/DKSH
DEDE PATMAWATI 2025-03-03 07:10:52
First Name: DEDE
Surname: PATMAWATI
Trade: DOCUMENT CONTROL
Company: BCEI/DKSH
ANDIKA GUSTI ARDANA 2025-03-03 07:11:12
First Name: ANDIKA GUSTI
Surname: ARDANA
Trade: ENGINEER
Company: BCEI/DKSH
ENGGARTYASTO HARIWANGI 2025-03-03 09:07:10
First Name: ENGGARTYASTO
Surname: HARIWANGI
Trade: DOCUMENT CONTROL
Company: BCEI/DKSH
5
BELLA NUR AZIZA 2025-03-11 06:14:58
First Name: BELLA NUR
Surname: AZIZA
Trade: ENGINEER
Company: BCEI/DKSH
TEGAR TRI 2025-03-11 06:16:16
First Name: TEGAR
Surname: TRI
Trade: WORKER
Company: BCEI/DKSH
ALFI BARIR 2025-03-11 06:16:21
First Name: ALFI
Surname: BARIR
Trade: WORKER
Company: BCEI/DKSH
RIDHO SATRIA 2025-03-11 06:16:24
First Name: RIDHO
Surname: SATRIA
Trade: WORKER
Company: BCEI/DKSH
BUCHARY BUCHARY 2025-03-12 20:38:57
First Name: BUCHARY
Surname: BUCHARY
Trade: ENGINEER
Company: BCEI/DKSH
6
NANANG NANANG 2025-03-12 20:39:02
First Name: NANANG
Surname: NANANG
Trade: ENGINEER
Company: BCEI/DKSH
DIDI WAHYUDIANTO 2025-03-12 20:39:47
First Name: DIDI
Surname: WAHYUDIANTO
Trade: WORKER
Company: BCEI/DKSH
ADE CANDRA 2025-03-13 11:39:13
First Name: ADE
Surname: CANDRA
Trade: ENGINEER
Company: BCEI/DKSH
RICKY HIDAYAT 2025-03-13 11:39:33
First Name: RICKY
Surname: HIDAYAT
Trade: ENGINEER
Company: BCEI/DKSH
NABHAN SANDO MUTAZ 2025-03-13 11:39:48
First Name: NABHAN SANDO
Surname: MUTAZ
Trade: ENGINEER
Company: BCEI/DKSH
7
SYAIFUL MUMIN 2025-03-13 11:39:58
First Name: SYAIFUL
Surname: MUMIN
Trade: ENGINEER
Company: BCEI/DKSH
WAWAN GUNAWAN 2025-03-13 11:40:10
First Name: WAWAN
Surname: GUNAWAN
Trade: ENGINEER
Company: BCEI/DKSH
ACEP SONI GUNAWAN 2025-03-17 06:49:10
First Name: ACEP
Surname: SONI GUNAWAN
Trade: ENGINEER
Company: BCEI/DKSH
ALFIAN KHAIRIL FAUZAN 2025-03-19 06:20:35
First Name: ALFIAN KHAIRIL
Surname: FAUZAN
Trade: HSE
Company: BCEI/DKSH
PARULIAN SIMANJUNTAK 2025-03-21 09:15:54
First Name: PARULIAN
Surname: SIMANJUNTAK
Trade: ENGINEER
Company: BCEI/DKSH
8
SARDI SIAGIAN 2025-03-21 09:15:58
First Name: SARDI
Surname: SIAGIAN
Trade: ENGINEER
Company: BCEI/DKSH
LAMPAROHON RAJAGUKGUK 2025-03-21 09:16:04
First Name: LAMPAROHON
Surname: RAJAGUKGUK
Trade: ENGINEER
Company: BCEI/DKSH
HARDIWINATA HARDIWINATA 2025-03-25 06:32:18
First Name: HARDIWINATA
Surname: HARDIWINATA
Trade: ENGINEER
Company: BCEI/DKSH
MUHAMMAD PANJI NUGROHO 2025-04-02 09:31:16
First Name: MUHAMMAD
Surname: PANJI NUGROHO
Trade: HSE
Company: BCEI/DKSH
ANDREAS PUTRA NUGRAHA 2025-04-07 05:00:00
SIAGIAN
First Name: ANDREAS PUTRA
Surname: NUGRAHA SIAGIAN
Trade: ENGINEER
Company: BCEI/DKSH
9
DANI KUSNAEDI 2025-04-07 05:01:37
First Name: DANI
Surname: KUSNAEDI
Trade: WORKER
Company: BCEI/DKSH
DIDIK WIBOWO 2025-04-10 00:10:48
First Name: DIDIK
Surname: WIBOWO
Trade: TECHNICIAN
Company: BCEI / PT. TRAKINDO
ZENAL ABIDIN LUTFI 2025-04-10 00:10:52
First Name: ZENAL
Surname: ABIDIN LUTFI
Trade: ENGINEER
Company: BCEI / PT. TRAKINDO
TATAN SUTRISNO 2025-04-10 00:10:57
First Name: TATAN
Surname: SUTRISNO
Trade: TECHNICAL SUPPORT
Company: PRO-MATRIX/PAWA
GAGAS IMAN MUHAMMADIN 2025-04-10 00:11:01
First Name: GAGAS IMAN
Surname: MUHAMMADIN
Trade: DOCUMENT CONTROL
Company: BCEI/DKSH
10
ANIS KURNAENI 2025-04-10 00:11:05
First Name: ANIS
Surname: KURNAENI
Trade: DOCUMENT CONTROL
Company: BCEI/DKSH
Anggada Arya Palastra 2025-04-11 08:07:41
First Name: Anggada Arya
Surname: Palastra
Trade: PROJECT ENGINEER
Company: BCEI/DKSH
CATUR JALU NUGROHO 2025-04-15 17:39:39
First Name: CATUR JALU
Surname: NUGROHO
Trade: PROJECT ENGINEER
Company: BCEI/DKSH
HASANUDIN HASANUDIN 2025-04-15 17:42:20
First Name: HASANUDIN
Surname: HASANUDIN
Trade: HELPER
Company: BCEI/DKSH
FADLAN FAUZI 2025-04-15 17:42:28
First Name: FADLAN
Surname: FAUZI
Trade: HELPER
Company: BCEI/DKSH
11
ABDUL ROHMAN 2025-04-15 17:42:43
First Name: ABDUL
Surname: ROHMAN
Trade: HELPER
Company: BCEI/DKSH
WAHYU HIDAYAT 2025-04-15 17:42:49
First Name: WAHYU
Surname: HIDAYAT
Trade: PROJECT ENGINEER
Company: BCEI/DKSH
SANDI SANDI 2025-04-16 08:57:01
First Name: SANDI
Surname: SANDI
Trade: HELPER
Company: BCEI/DKSH
MUHAMMAD BUDIMAN 2025-04-23 09:03:54
First Name: MUHAMMAD
Surname: BUDIMAN
Trade: PROJECT ENGINEER
Company: BCEI/DKSH
SIGIT PRABOWO 2025-04-25 09:01:10
First Name: SIGIT
Surname: PRABOWO
Trade: HELPER
Company: BCEI/DKSH
12
Halimun Arhandi 2025-04-26 07:05:56
First Name: Halimun
Surname: Arhandi
Trade: ENGINEER
Company: BCEI/DKSH
M. BAYU CONDRO 2025-04-29 05:59:04
First Name: M. BAYU
Surname: CONDRO
Trade: PROJECT MANAGER
Company: BCEI/DKSH
RACHMAT NURULLAH CANDRA 2025-04-29 05:59:18
First Name: RACHMAT NURULLAH
Surname: CANDRA
Trade: COMMISIONING MANAGER
Company: BCEI/DKSH
MUHAMMAD HARTANTO 2025-04-29 05:59:35
First Name: MUHAMMAD
Surname: HARTANTO
Trade: PROJECT MANAGER
Company: BCEI/DKSH
RICHSON IWANTO 2025-04-29 05:59:46
LUMBANTORUAN
First Name: RICHSON
Surname: IWANTO LUMBANTORUAN
Trade: ENGINEER
Company: BCEI/DKSH
13
Fauzi Hidayat 2025-04-29 05:59:51
First Name: Fauzi
Surname: Hidayat
Trade: ENGINEERING
Company: BCEI/DKSH
Alief Faturazkia 2025-04-29 05:59:55
First Name: Alief
Surname: Faturazkia
Trade: COMMISIONING MANAGER
Company: BCEI/DKSH
Ade kevin Carrillo 2025-05-02 15:54:10
First Name: Ade kevin
Surname: Carrillo
Trade: ENGINEER
Company: PRO-MATRIX/PAWA
Andhika Prasetyohelmi 2025-05-02 15:54:21
First Name: Andhika
Surname: Prasetyohelmi
Trade: ENGINEER
Company: PRO-MATRIX/PAWA
MUHAMMAD RAIHAN MADINA 2025-05-02 15:54:25
First Name: MUHAMMAD RAIHAN
Surname: MADINA
Trade: HSE
Company: BCEI/DKSH
14
AJUN PADILAH 2025-05-05 08:57:59
First Name: AJUN
Surname: PADILAH
Trade: WORKER
Company: BCEI/DKSH
AHMAD BUDIMAN 2025-05-05 08:58:21
First Name: AHMAD
Surname: BUDIMAN
Trade: HELPER
Company: BCEI/DKSH
WAWAN WAWAN 2025-05-05 08:58:33
First Name: WAWAN
Surname: WAWAN
Trade: WORKER
Company: BCEI/DKSH
DIKI ISMAIL 2025-05-05 08:58:58
First Name: DIKI
Surname: ISMAIL
Trade: HELPER
Company: BCEI/DKSH
IRWAN ALDIYANSYAH 2025-05-05 08:59:10
First Name: IRWAN
Surname: ALDIYANSYAH
Trade: HELPER
Company: BCEI/DKSH
Section B. PRE-WORK - INSPECTION AND PRECAUTIONS Sebelum Kerja -
Pemeriksaan dan Tindakan Pencegahan
15
Documents must be attached or the permit will be rejected
Additional Document / Dokumen Tambahan
RAMS
Date: 2025-04-30 04:57:36
SPA
Date: 2025-05-05 08:59:33
Drawing, Layout, etc
Date: 2025-02-12 08:15:43
16
Arc Flash
Identify Risk Associated with This Electrical Work Electric Shock
Mengidentifikasi Risiko Yang Terkait Dengan Manual Handling
Pekerjaan Listrik: Electric Burn
Safety Helmet
Personal Protective Equipment / Alat Pelindung Safety Glasses
Diri: Safety Gloves
Seluruh pekerja dalam kondisi sehat atau fit /All Yes
worker are fit for work
Pekerja telah mendapatkan Briefing tentang
bekerja di area listrik/Workers have received a Yes
briefing about working in the electrical area.
Area kerja telah di survey dan dilakukan
identifikasi potensi bahaya: kabel listrik, atap
rapuh dan potensi bahaya lainnya (dinyatakan Yes
aman)/Work area has been surveyed and
identified potential hazards: electrical wires,
fragile roofs and other potential hazards (safe).
Khusus pekerjaan di area sumber energi harus
dipastikan penerapan isolasi energi
(LOTO)/Especially for work in the area of energy Yes
sources, it is necessary to ensure application of
energy isolation (LOTO)
Area pekerjaan telah di survey dan dilakukan
identifikasi potensi bahaya (kabel listrik,bagian
yang bertegangan)/Work area has been surveyed Yes
and identified potential hazards (electrical cables,
live parts)
Tersedia gambar/denah posisi kabel dan denah
substation pekerjaan berlangsung/There are Yes
drawings/plans of the position of the cable and a
plan of the substation work in progress
Peralatan telah diperiksa dalam kondisi baik
(multitester & high voltage tester)/Equipment has Yes
been checked in good condition (multitester &
high voltage tester).
Tersedia safety line dan papan peringan di sekitar
area yang berpotensi tersengat aliran listrik/There Yes
are safety lines and light boards around areas
that have the potential to be electrocuted
Tersedia HT/signal man di lokasi/HT/signal man Yes
available on site
PIC/Penanggung jawab ada di lokasi Yes
kerja/PIC/person in charge is at work site
Kondisi cuaca diprakirakan baik untuk pekerjaan
area external/Weather conditions are predicted to Yes
be good for external work
Mengetahui bahaya tools/alat yang bersifat
konduktif/Understand hazard of conductive Yes
tools/tools
Koordinasi pada sisi panel atas/bawah saat ada
pekerjaan panel/Coordination on top/bottom side Yes
of panel when there is panel work
Tidak bekerja sendirian/Not working alone Yes
17
Meninggalkan pekerjaan dalam kondisi bersih
(dari material kondukif)/Leave work in a clean Yes
condition (of conductive material)
Other Precautions / Tindakan Pencegahan N/A
Lainya:
Print Name and Signature: Signature
khen
Upload Picture:
Date: 2025-04-29 06:00:56
Upload picture of SPA discussion/ diskusi SPA:
Date: 2025-03-03 08:55:35
18
Energized Work Area Permit - T&C Manager Approval
SETIAWAN ANDRI PRATAMA - 2025-05-05
ID 856807 Created by PRO-MATRIX PTE LTD 09:16:30
Approval Process / Proses Persetujuan
This Permit was checked for this job and is approved below / IZIN KERJA INI ✓
TELAH DILAKUKAN PENGECEKAN DAN DENGAN PERSETUJUAN DI BAWAH INI
Comments:
Print Name and Signature: Signature
setiawan andri
19
Document Amend History
Document ID Title User ID Amend Amend Time
Updated Answer Id:
10982935.
SANDRIY
MAULANA
MUMAMAD
AJIDAN
DZAKI KHALIF
M BONDAN
WISNU PRAYUDA
KADIR
RINAL RIFALDI
KHEN NUHFUS
SANJAYA
MOHAMAD RAMLI
MOHAMAD ZAID
MATROIS
MATROIS
DANI RAMDANI
DENI ZIKO
HASIBUAN
MOCH ZAINUDDIN
FAJAR
NUGROHO
KHEN NUHFUS HIDAYAT
Energized Work 2025-05-06
856705 SANJAYA (User Id: HIDAYAT
Area Permit V2 05:48:20
11869) KHARIS
UBAIDILLAH
ATHALLA
ANDRASAYOGA
DEDE
PATMAWATI
ANDIKA GUSTI
ARDANA
ENGGARTYASTO
HARIWANGI
BELLA NUR AZIZA
TEGAR TRI
ALFI BARIR
RIDHO SATRIA
BUCHARY
BUCHARY
NANANG NANANG
DIDI
WAHYUDIANTO
ADE CANDRA
RICKY HIDAYAT
NABHAN SANDO
MUTAZ
SYA
Updated Answer Id:
KHEN NUHFUS
Energized Work 10982914. 2025-05-06
856705 SANJAYA (User Id:
Area Permit V2 FileName: ; 05:48:19
11869) ImageFileName: ;
20
Queue Move History
Document Reason Date Moved Moved By Moved From Moved To
Energized Work
Area Permit
Energized Work Energized Work
2025-05-05 (Login Id: Submitted -
Area Permit V2 Area Permit -
11:44:51 219941) Pending T&C
(856705) Live
Manager
Approval
Energized Work
Document Area Permit
Energized Work KHEN NUHFUS
Submitted. 2025-05-05 Submitted -
Area Permit V2 SANJAYA -
Submitted from 11:00:19 Pending T&C
(856705) (User Id: 11869)
mobile app. Manager
Approval
21
