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INSTRUCTION OF MINISTER OF MANPOWER

NUMBER: INS. 11/M/BW/1997
REGARDING
SUPERVISION OF WORK SAFETY AND HEALTH
SPECIAL FOR FIRE PROTECTION
MINISTER OF MANPOWER

Considering:

In view of:

a.

that Fire incidents that occur lately show high number of

incidents with financial loss and victims, which are not a little,

b.

that the duties on establishment/building and supervision of

work safety and heat including fire prevention at workplace
that are the responsibilities of the department of Manpower in
accordance with Law No I not 1970 are have not worked run
at they should have been.

c.

that for the purposes it is necessary to issue the realization of

works Safety and health establishment and Supervision of fire
prevention at workplace.

1.

Law No. 1 of 1970 regarding work Safety;

2.

Regulation of the Minister of Manpower No. Per-14 /Men/

1980 regarding Conditions for Installing and Maintaining
Light Fire Extinguisher;

3.

Regulation of the Minister of Manpower No. Per 02/Men/1983 regarding it Installation of automatic Fire
Alarms;

4.

Regulation of the Minister of Manpower No. Per04/Men/1988 regarding the Validity of National Standard SNI
225 Regulation of Indonesian Electricity Installation at
workplace;

5.

Regulation of Minister of Manpower No. Per-02/Men/1989

regarding the Supervision of the Installation of Lightening
Conductors;

6.

EE Special Regulation concerning work Safety and health

conditions where flammable material are processed, stored or
finished;

7.

K Special Regulation concerning work safety conditions where

explosive materials are processed, stored, or finished.

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INSTRUCTED
TO:

1.

HEADS OF REGIONAL OFFICES OF THE DEPARTMENT OF

MANPOWER ALL OVER INDONESIA
Carry out coordination with related Institutions/ Services to improve efforts in
implementing work safety norms in fire prevention areas, among others:
-

the implementation of work safety and health conditions for permit

mechanism of building license, IPB, HO and so on;

establishment/extension/training in fire hazard prevention;

Inspection/investigation/analysis of fire cases.

2.

Improve inspection intensively at workplaces with high fire hazard protection

potencies by assigning supervisors; particularly those have attended Specialist
Training for fire prevention.

3.

Carry out inspections in the installation of fire protection equipment in building

construction project.

4.

Carry out this instruction with full responsibilities in accordance with the
prevailing stipulations and technical guidelines attached. Report the
implementation to the Minister.
Promulgated in Jakarta
On 21 October 1991
On behalf on the Minister of Manpower
Director General of Industrial relationship
Building and Supervision
MOHD. SYAUFII SYAMSUDIN
NIP. 160008975

Copies are forwarded to:

1.

Minister of Manpower

2.

The Secretary General of the Department of Manpower

3.

The Inspector General of the Department of Manpower

4.

Governors all over Indonesia.

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Appendix

: INSTRUCTION OF THE MINISTER OF MANPOWER

No.

: INS. 11 /M/BW/1997

Date

: 21 October 1997

___________________________________________________________________________
GUIDELINES FOR TECHNICAL SUPERVISIONS OF FIRE PROTECTION
SYSTEM
I.

GENERAL GUIDELINES

Work safety conditions related to fire protection have clearly been outlined in Law
No. 1 of 1970, among others:
-

to prevent, reduce, extinguish fire;

provisions of roads for escaping;

the control of smoke, flame, and gas;

to carry out training for all workers.

Formulation mentioned above with technical approaches can be classifies as follows:

1.

Preventive actions so fire does not take place by eliminating or controlling

various energy forms used should be prioritized on statically prominent
problems causing fire.

2.

Actions to reduce the seriousness level of financial loss and number of victims
can be done by localizing and compartment so fire, smoke, and gas do not
spread to other parts.

3.

Provisions of equipment/fire protection installation such as detection

system/fire alarm and light fire extinguishers, hydrants, sprinklers, or special
installation that are sophisticated and self-supporting through planning,
installation, and maintenance according to standard stipulations.

4.

The availability of roads for escaping that are safe, fast and sufficient in
accordance with the number of people and building construction shape.

5.

Formation of emergency response organization to prevent if fire hazard take

places.

Construction and supervision tasks for work safety for fire prevention area as the
explanation above must be carried out professionally by supervising officials and by
cooperating closely and harmoniously with related institutions/services.

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II.

PLANNING OF FIRE PROTECTION SYSTEM

1.

Every plan for a workplace must consider conditions and stipulations for fire
protection effort, both active and passive protections.
-

A passive fire protection is a technical design for a workplace to restrict or

block the spreads of flame, heat, smoke, and gas both vertically and
horizontally by adjusting the distance between buildings, installing fireproof wall dividers, closing every opening with fire-proof media or with
certain mechanism;

An active fire protection is the implementation of a suitable and

sophisticated system design or detection installation, alarm and fire
extinguishers at a workplace in a building, so it is self-sufficient for its
infrastructure to combat fire hazard.

2.

Planning of fire protection installation must refer to prevailing regulations and

standards and is made by an individual or corporate body that has obtained
approval.

3.

A supervising official that has been appointed as a supervising specialist in fire

protection are has the duty to inspect planning file for fire protection system
and the authority to stipulate conditions for alteration or repair considered
necessary.

4.

Planning file system is made in triplicate and after being examined and
authorized by the supervisor is then sent to the Director of PNKK to be
published for its legalization/approval for the planning blueprint mentioned.

III.

INSTALLATION OF FIRE PROTECTION SYSTEM

1.

The implementations of fire protection installation must be in accordance with

the planned blueprint that has been approved and carried out by appointed
installation.

2.

All installation equipment installed must be in accordance with approved

technical specification.

3.

After the installation work is completed, local inspection and testing must be
carried which is attended by all parties involved, among others:
-

Contractor

Planner (consultant)

Owner (employer)

Manager (building manager)

Manpower Supervising Official (Fire Protection Specialist).

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4.

After the entire inspection and testing are completely carried out, evaluation is
done together. Manpower supervisor provides comments and conditions
considered necessary based on the findings when inspection and testing were
carried out.

5.

As built drawing must be made completely together with the Official Report
regarding the result of inspection and testing, sent to the Director of PNLL to be
issued for legalization.

6.

Owner, manager, contractor is responsible to comply with conditions

determined by the Director of PNKK in accordance with the agreement made in
the contract.

IV.

INSPECTION AND TESTING

1.

Dwelling classification
Dwelling type classification will determine the technical conditions for fire
protection system that must be applied.

2.

Ignition Sources
Notice any potency that can become a trigger source of fire and notice whether
the safety device required is suitable, when the latest inspection is, and whether
the conditions given have been implemented.

3.

Flammable/explosive materials
Notice the types of materials being processed, finished, or stored. Recognize
their physical and chemical properties, whether they contain flammable or
explosive potencies. Notice whether there is a work safety procedure or it is
carried out properly.

4.

Compartment
Notice the conditions of workplace environment concerning the spreads of fire,
heat, and smoke and whether or not there are efforts to control them.

5.

Emergency exits
Notice the evacuation lanes, emergency exits stairs, whether or not there are
barriers that can obstruct, whether there are directional signals, emergency
lights, and the distance to the exits is not more than 36 m for low risk, 30 m for
medium risk, and 24 m for high risk.

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6.

Light Fire Extinguisher

Check whether light fire extinguishers match the types and are sufficient in
quantity, whether the location is easily seen and reached as well as easily
fetched. Also check the effective period of the extinguishing materials as well as
the trial period of their tubes.

7.

8.

Alarm installation
a.

Check whether it has approval and technical documents such as

installation drawing, catalogue, and maintenance guidelines;

b.

Check the latest inspection result, whether the conditions previously

given have been implemented;

c.

Check the indicators on the control panel, whether it is in stand by

position or not;

d.

Carry out testing on equipment function on the panel, whether or not all
equipment and indicators work properly, and zone alarm signaling has
been installed;

e.

Carry out test on the function of operation system by activating manual

buttons and detectors in every alarm zone while synchronizing the
drawing with its implementation. Watch closely the local alarm indication
confirmation and the indication on the panel whether they function in
accordance with their zone numbers. Also watch closely whether the
loudness of alarm sound can be heard (laudable) at the furthest distance at
that zone;

f.

Conduct test on open circuit by opening the resistor in the last detector
circuit.

g.

Record all irregularities found.

Hydrant and Sprinkler Installation

a)

Check whether it has approval, technical documents, such as installation

drawing, catalogue, and maintenance guidelines;

b)

Check the result of the latest inspection, whether the conditions

previously given have been implemented;

c)

Check the indicator on the panel control whether it is in stand by position;

d)

Check the pump room and record technical data of the pump, activator,
and the available equipment, control panel, and so on;

e)

Check the water supply system whether it can guarantee the water
requirement for extinguishing operation in time in accordance with
certain standard time;

f)

Carry out test on pump operation by opening test shell provided in the
pump room and watch closely t6he pump pressure;

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The steps in testing the pump are as follows:

g)

1)

Record the pressure at stand by position;

2)

Record the pump pressure at spur run position;

3)

Close the test-shell and record the pump pressure at spur stop
position;

4)

Reopen the test-shell until the main pump operates and record its
pressure;

5)

Monitor for a certain time the operation pressure of the main pump
and record it.

6)

Closer again the test-shell and let the main pump run. Record the
pressure and monitor whether the safety valve work or not;

7)

Test the spare pump. Record its start and operational pressure as the
steps taken in testing the main pump.

Pump Evaluation
Hydrant pump must have a minimum pressure of 4.5 kg/Cm2 and a
minimum flow of 500 US GPM. Match the pump specification based on
the catalogue with the result of try-out.
Check the pump control circuit, among others:

h)

1)

The electric capacity supply must be pulled from the supply side in
the main panel by using its own switch;

2)

Conductor cable used must be fire-proof type cable or it may be

permitted to use other cable provided it is installed in spiral pipe;

3)

It is forbidden to have other load on the installation circuit of the fire

extinguisher unrelated to the pump operation needs;

4)

The safety device of a pump circuit must have the characteristics to

be capable of being supplied with 125% of its current full load
continuously and at 600% open full load not less than 20 seconds but
not more than 50 seconds;

5)

Between the motor and the control circuit, it is not allowed to install
safety device for extra load.

Hydrant operational testing

1)

Open the closest hydrants point to the pump. Measure to the right
of the spraying opening with pivot pipe and record the pressure on
the manometer in the pump room;

2)

Open the second hydrant point, that is the furthest one and the first
testing point leave open. Measure the pressure at the spraying
opening and manometer pressure in the pump room;

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3)

i)

Open the third hydrant point, that is the middle one and let the first
and second points open. Measure the pressures at the spraying
openings and on the manometer in the pump room.

Evaluation of Operational Testing

The conditions required are that the heaviest pressure is not more than 7
kg/Cm2 and the pressure at the furthest point is not less than 4.5 kg/Cm2.

9.

Special Installation
Certain objects sometimes require special fire protection system with certain
media that are adjusted to the concerned object characteristics. The evaluation
criteria for special installation must refer to the prevailing standard and
technical specification of the equipment from the manufacturer.

Promulgated in: J A K A R T A
On : 21 October 1999
On
behalf
of
MANPOWER

the

MINISTER

OF

Director General of
THE ESTABLISHMENT OF INDUSTRIAL
RELATIONSHIP AND MANPOWER
DIVISION
Signed
MOHD. SYAUFII SYAMSUDDIN
NIP. 160008975

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SYSTEMATIC LEGALIZATION FOR FIRE PROTECTION SYSTEM USE

(At Central)
CONTRACTOR/OWNER
SUBMISSION OF APPLICATION LETTER (63-K FORM)
-

DESCRIPTION OF CRITERIA DESIGN

PLANNING BLUEPRINT
TECHNICAL SPECIFICATION

REGIONAL/LOCAL OFFICE TO BE EXAMINED

NO
COMPLY WITH CONDITIONS?
YES
DIRECTOR OF PNKK
LEGALIZATION OF PLAN DRAWING (64-K FORM)

REGIONAL/LOCAL OFFICE
SUPERVISING OFFICIAL
INSTALLATION BY CONTRACTOR
SUBMISSION OF USE PERMIT ( 65-K FORM)

COMMISSIONING/TESTING AND INSPECTION

-

CONTRACTOR
DESIGNER/ CONSULTANT
OWNER/ EMPLOYER
MANAGER
SUPERVISING OFFICIAL
EVALUATION/ REPORT ( 66-K FORM)

NO
COMPLY WITH CONDITIONS?

REGIONAL OFFICE
LEGALIZATION FOR
TEMPORARY USE ( 67-K FORM)
CENTRAL OFFICE/ DIRECTOR OF PNKK

LEGALIZATION FOR PERMANENT USE (68-K FORM)

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63 K FORM
APPLICATION FOR LEGALIZATION/CERTIFICATION
FIRE PROTECTION INSTALLATION
No. .

Based on Law No. 1 of 1970 and Instruction of the Minister of Manpower No. Inst.
11/M/BW/1997, we herewith submit a legalization/certification application for the
installation of fire protection.
Applicant
Name
Position
Institution/company
Address

:
:
:
:

General Data
Building name
:
Type of business/activity :
Address
:
Owner
Manager
Organizers name
Types of installations :

:
:
:

Consultant
Address

:
:

Contractor
Address

:
:

Implementation schedule :
Explanation
:

.
.
.
.
Phone Fax
.
.
.
.
.
.
.
( ) Alarm installation
( ) Hydrant installation
( ) Sprinkler installation
( ) Special installation *) Please specify
...
.
.
Phone Fax .
.
.
Phone . Fax
.
Details of design criteria, plan drawing, and technical
specification is attached.

To:
The Director of PNKK
Directorate General of the Binawas
Jl. Jend. Gatot Subroto Kav 51
Jakarta

.,
Applicant,

Revenue stamps
Rp.2000

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10

10

64-K FORM
DEPARTMENT OF MANPOWER OF THE REPUBLIC OF INDONESIA
DIRECTORATE GENERAL OF THE ESTABLISHMENT OF INDUSTRIAL
RELATIONSHIP AND SUPERVISION OF MANPOWER
LEGALIZATION OF PLAN DRAWING OF
FIRE PROTECTION INSTALLATION
No. .

The Director General of the Establishment of Industrial Relationship and Manpower

Supervision:
Read

The application letter (63-K form) from:

No:
Date :

Considering:

1.

Law No. 1 of 1970 concerning Work safety;

2.
Regulation of the Minister of Manpower No. Per04/Men/1980 regarding conditions on the installation
and maintenance of light fire extinguisher;
3.
Regulation of the Minister of Manpower No. Per02/Men/1983 regarding the installation of automatic fire
alarm;
4.
Regulation of the Minister of Manpower No. Per04/Men/1988 regarding the validation of Indonesian
National Standard SNI-225-1987 concerning General
Regulations on the installation of Indonesian electricity
of 1987 (PUIL-1987) at workplaces.
DECIDED

To Legalize

Explanation

Planned Drawing for the installation of the fire protection

installation
Building name :
Address
:
....
Organizer
:
Fire protection installations planned constitute:
( ) Light fire extinguishers
( ) Hydrant installation
( ) Sprinkler installation
( )
Designer
: .
Address
: ..
Contractor
: ..
Address
: ..

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64-K FORM
Other requirements that: - The execution of fire protection installation must meet
the approved drawing.
- After installation the owner must report to Manpower
Dept Officer to be conducted an examination and
testing.
On Behalf Of The Directorate General Of
The Establishment of Industrial Relationship and
Supervision of Work Safety and Health Norms
_____________________________________
NIP.

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12

65-K FORM

APPLICATION FOR LEGALIZATION/CERTIFICATION

FIRE PROTECTION INSTALLATION
No.
Based on Law No. 1 of 1970 and Instruction of the Minister of Manpower No. Inst.
11/M/BW/1997, the person who signs below
Name
: .
Position
: .
Institution/company
: .
Address
: .
Phone Fax
Herewith submit an application for certification of Fire Protection Installation
installed at:
Building name
: .
Address
: .
.
Owner
: .
Manager
: .
Organizers name
: .
Types of installations
: ( ) Alarm installation
( ) Hydrant installation
( ) Sprinkler installation
( ) Special installation *) Please specify

Drawing Legalization
: No. :
Date:
Consultant
: .
Address
: .
Phone Fax
Contractor
: .
Address
: .
Phone . Fax
Implementation schedule : .
Explanation
: Enclosed
- As built drawing
- Official Report on the result of internal
inspection/testing
..,
To:
The Applicant,
Director of PNKK Dir.Gen. of the Binawas
Jl. Jend. Gatot Subroto Kav 51
Jakarta

Revenue stamps Rp.2000

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13

65-K FORM
Official Report Form Sample
No:
Date:
PROJECT

OFFICIAL REPORT OF
INSPECTION/TESTING OF FIRE

Sheet quantity:
Sheet No.:

LOCATION
CONTRACTOR
On ...................... date.................................. , I;
Name:
...............................................................................................
Position:
...............................................................................................
Institution: ...............................................................................................
Witnessed by parties signing this official report, it has been
carried out:
....................................................................................................................
....................................................................................................................
....................................................................................................................
..................................................................................................
Results:
....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................
..................................................................................................
Note:
....................................................................................................................
....................................................................................................................
....................................................................................................................
..................................................................................................
Thus this official report is properly made
Name

Position/Occupation

Signature

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66-K FORM
REPORT ON THE INSPECTION AND
TESTING OF FIRE PROTECTION

No.:
Date:
I.

II.

GENERAL DATA
1.
Building name
2.
Type of activity/business
3.
Address

:
:
:

4.
5.
6.

:
:
:

Owner
Manager
Name of organizer

No. of KLUI:

..................................................... .
..................................................... .
..................................................................
..................................................................
..............................................................
..................................................................
..................................................................
..................................................................

BUILDING DATA
1.
Land area
:
................. m2
2.
Building area
:
................. meter
3.
Building Construction
:
..................................................................
- Main structure
:
..................................................................
- Floor structure
:
..................................................................
- Outside wall
:
..................................................................
- Inside wall (isolation)
:
..................................................................
- Ceiling frame
:
..................................................................
- Ceiling cover
:
..................................................................
- Roof frame
:
..................................................................
- Roof cover
:
..................................................................
4.
Building height
:
.. meter
5.
Number of stories
:
..................................................................
6.
Floor area
:
.. m2
7.
Build in (year)
:
..................................................................
8.
Fire protection equipment
8.1. ( ) Light fire extinguisher
8.2. ( ) Automatic fire alarm installation
8.3. ( ) Hydrant installation
8.4. ( ) Sprinkler installation
8.5. ( ) Specific installation*) ..........................................................
8.6. ( ) Evacuation infrastructure
9.

Description of room/working unit

No.

Work unit

Location

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SPECIFICATION OF AUTOMATIC FIRE ALARM

INSTALLATION
No.

Equipment

1.

Control panel

2.

Enunciator

3.

Heat detector

4.

Smoke detector

5.

Flame detector

6.

Gas detector

7.

Manual knob

8.

Bell alarm

9.

Alarm light signal

Trade-Mark/Model

Quantity

66-K(A) Form

Unit

Condition

Note:

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DATA OF ALARM INSTALLATION

Location

Zone No.

(1)

(2)

Detector
ROR
(3)

Fixed
(4)

Sample
(5)

TPM

Fl. Sw.

(6)

(7)

Alarm
Bell
(8)

Lamp.
(9)

STATUS*)
(10)

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RESULT OF INSPECTION AND TESTING OF INSTALLATION

No.

Inspection /Testing

1.

Function of panel operation

2.

Alarm Test

3.

Foult Test

4.

General Alarm;

Result

Conditions

AC Interconnection, LIFT,
PRESS FAN, etc.

Inspected and tested on .............................................................

Name

Position

Signature

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SPECIFICATION OF DETECTION AND AUTOMATIC FIRE

ALARM INSTALLATION
(INTEGRATED SYSTEM)

Extinguishing Media
No.

Protected Room

Room
Volume

Media Type

Quantity

66-K(IS) Form

Application System
Single
Detection /
Cross Zone

Total Flooding
Extinguisher/
Local Protection

RESULT OF INSPECTION AND TESTING

Inspected and tested on ...................................................

Name

Position

Signature

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SPECIFICATION OF HYDRANT INSTALLATION

No.

Concerning

Specification

1.

Water standard source

2.

Ground reservoir

3.

Gravitation Tank

4.

Siamese connection

5.

Spur pump

Q: ..............US GPM
H: ..............Meter
Start Auto./Man :
..................Kg/Cm2
Stop Auto./Man :
..................Kg/Cm2

6.

Main pump

Q: ..............US GPM
H: ..............Meter
Start Auto./Man :
..................Kg/Cm2
Stop Auto./Man :
..................Kg/Cm2

7.

Spare pump

Q: ..............US GPM
H: ..............Meter
Start Auto./Man :
..................Kg/Cm2
Stop Auto./Man :
..................Kg/Cm2

8.

Priming tank

9.

Wind vessel

10.

Pressure relief valve

11.

Test valve

12.

Open electricity indicator

13.

Sucking pipe

14.

Main distributing pipe

15.

Upright pipe

16.

Yard hydrant

17.

Building hydrant

18.

Hose reel

Status

66-K(IS) Form

Explanation

Capacity:.............. Litter
: ............. Kg/Cm2
: ............. Kg/Cm2

Note:

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DATA ON THE INSTALLATION HYDRANT EQUIPMENT

Quantity of Hydrant equipment
No.

In door

Location
2.5

1.5

Status

Out door

Landing valve
1

HP

HM

SC

Note:

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RESULTS OF EXPERIMENT ON HYDRANT PUMP UNIT

No.

Pump

1.

Spur pump

2.

Main pump

3.

Spare pump

4.

Diesel pump

Start

Stop

Automatic/Manual

Automatic/Manual

....... Kg/Cm2

....... Kg/Cm2

Automatic/Manual

Automatic/Manual

....... Kg/Cm2

....... Kg/Cm2

Automatic/Manual

Automatic/Manual

....... Kg/Cm2

....... Kg/Cm2

Automatic/Manual

Automatic/Manual

....... Kg/Cm2

....... Kg/Cm2

Explanation

RESULTS OF HYDRANT OPERATIONAL EXPERIMENT

No.

Experiment

1.

Stand by

2.

1 point of hydrant

3.

2 point of hydrant

4.

3 point of hydrant

Pressure

Status

Explanation

Inspected and tested on ...................................................

Name

Position

Signature

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SPECIFICATION OF SPRINKLER INSTALLATION

No.

Concerning

Specification

1.

Water standard source

2.

Ground reservoir

3.

Gravitation tank

4.

Siamese connection

5.

Spur pump (Electric)

Q: ............. US GPM
H: ............. Meter
Start Auto./Man :
.................. Kg/Cm2
Stop Auto./Man :
.................. Kg/Cm2

6.

Main pump

Q: ............. US GPM
H: ............. Meter
Start Auto./Man :
.................. Kg/Cm2
Stop Auto./Man :
.................. Kg/Cm2

7.

Spare pump

Q: ............. US GPM
H: ............. Meter
Start Auto./Man :
.................. Kg/Cm2
Stop Auto./Man :
.................. Kg/Cm2

8.

Priming tank

Capacity:

9.

Wind vessel

Q : ......................... Litter
:.............. Kg/Cm2
:.............. Kg/Cm2

10.

Pressure relief valve

11.

Test valve

12.

Open electricity indicator

13.

Gong Alarm

14.

Sucking pipe

15.

Main pipeline

16.

Upright pipe

17.

Divider

18.

Service pipe

19.

Head

66-K(SP) Form

Explanation

Litter

Note:

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DATA ON SPRINKLER EQUIPMENT INSTALLATION

Location

Quantity of sprinkler equipment

1)

2)

3)

4)

Note

RESULT OF THE INSPECTION AND TESTING OF SPRINKLER PUMP

No.
1.

Pump
Spur pump

Start

Stop

Automatic/Manual

Automatic/Manual

.......
2.

3.

4.

Main pump

Spare pump

Diesel pump

Explanation

....... Kg/Cm2

Kg/Cm2

Automatic/Manual

Automatic/Manual

....... Kg/Cm2

....... Kg/Cm2

Automatic/Manual

Automatic/Manual

....... Kg/Cm2

....... Kg/Cm2

Automatic/Manual

Automatic/Manual

....... Kg/Cm2

....... Kg/Cm2

Inspected and tested on .........................................................

Name

Position

Signature

_______________________________________________________________________________________________________________________PT. ERM INDONESIA

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RECOMMENDATION ON INSPECTION AND TESTING OF FIRE PROTECTION

INSTALLATION
No.

Concerning/Location

Condition/Finding

Suggestions

Thus the results of inspection and recommendation for perfecting means of fire protection
have been discussed with those signing this report for further consideration.
Compiled in .................... on ..............................................
Name

Position

Signature

_______________________________________________________________________________________________________________________PT. ERM INDONESIA

MM11-1997.PDF

25

67-K FORM
DEPARTMENT OF MANPOWER OF THE REPUBLIC OF INDONESIA
REGIONAL OFFICE IN PROVINCE: ..
TEMPORARY LEGALIZATION
INSTALLATION OF FIRE PROTECTION
No. ...........................................
The Head of Regional office of the Department of Manpower in Province ...
Reading

Application letter (Form 65-K) of :

No.:
Date:

Considering

1. Law No. 1 of 1970, regarding work safety;

2. Regulation of the Minister of Manpower No. Per04/Men/1980, regarding condition for installation and
maintenance of light fire extinguisher;
3. Regulation of the Minister of Manpower No. Per02/Men/1983, regarding the installation of automatic fire
alarm;
4. Regulation of the Minister of Manpower No. Per04/Men/1988, regarding the validity of national standard
SNI-225-1987 concerning general regulation on electric
installation in Indonesia 1987 (PUIL-1987) at workplace

In View of

1. Legalization of plan design for the fire protection installation

No.: ........................................ Date: ................................
2. Report of inspection and testing result (Form 66-K)
No.: ........................................ Date: ................................
DECIDED

To Stipulate

Legalize the use of fire protection installation at:

Building
: ....................................................................
Address
: ...................................................................................
...................................................................................
...................................................................................
Name of organizer : ...................................................................
System of fire protection installation include:
( ) Fire Extinguisher;
( ) Manual/automatic alarm installation;
( ) Hydrant;
( ) Sprinkler;
( ) ...........................................................................................
Designer
: ....................................................................
Address
: ...................................................................................
Contractor
: ....................................................................
Address
: ...................................................................................

_______________________________________________________________________________________________________________________PT. ERM INDONESIA

MM11-1997.PDF

26

67-K FORM
With stipulations :

1. Must implement the condition stipulated in the inspection

sheet.
2. The legalization valid for 3 months since the date of
promulgation while waiting for furthers decision.

......................... , ................................................
Department Of Manpower
Regional Office of Province .
Head,

___________________________
NIP.

_______________________________________________________________________________________________________________________PT. ERM INDONESIA

MM11-1997.PDF

27