Scribd Logo
Upload

Welcome to Scribd!

  • 5 views

    Form Work Method Statement Nestle 2023

    Uploaded by

    Anisa Zain

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Form Work Method Statement Nestle 2023

    Uploaded by

    Anisa Zain
    5 views2 pages

    Original Title

    5. Form Work Method Statement Nestle 2023

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    5 views2 pages

    Form Work Method Statement Nestle 2023

    Uploaded by

    Anisa Zain

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 2

    Nama Perusahaan:

    Work Method Statement Nama Supervisor:


    Tanggal:

    WHAT WORK will we do?


    LOCATION of work / Lokasi Pekerjaan :

    DESCRIPTION of work / Deskripsi Pekerjaan :

    Start Kerja (Tanggal & Waktu) Durasi Pekerjaan:


    Scope Pekerjaan berdasarkan S & H Ya Tidak
    Risk assessment lengkap dan Di review Ya Tidak
    Nama Kontraktor performing authority

    HOW will we do the work? / Bagaimana penyelesaian Pekerjaan?


    DESCRIPTION of work/Deskripsi Pekerjaan (method and sequence)

    1.

    2.

    3.

    4.

    5.

    6.

    7.

    8.

    9.

    10.

    Lampirkan gambar tahapan pekerjaan apabila dibutuhkan (Use sketches and drawings if possible)

    Sketches and Drawings / Gambar langkah kerja

    WHO will do the work?/ Siapa yang akan melaksanakan pekerjaan?


    DESCRIPTION of work team/ Jelaskan team yang akan bekerja (numbers of people, job tasks, skills)
    1. 6.
    2. 7.
    3. 8.
    4. 9.
    5. 10.

    Version 1.1
    WHAT EQUIPMENT will we use?/Peralatan apa yang akan digunakan ?
    Ladder/ Tangga Hoist
    Mobile Scaffold Tower Material Handling Equipment, eg Forklift
    Mobile Elevating Working Platform (MEWP) Excavator
    Scaffolding Powered Hand Tools (specify below)
    Crane (Tower crane / Mobile crane)

    Additional equipment to be used:/ Tambahan Peralatan yang mungkin akan digunakan :

    Will we need a PERMIT-TO-WORK..? / Apakah membutuhkan Ijin Kerja (PTW)?


    High-
    Confined Hazardous Mode 4 Critical
    Work at Hot hazard Ground
    if Space Line Machinery Lifting Demolition
    Height Work Electrical Disturbance
    required Entry Breaking Intervention Operation
    Work

    What services will need to be ISOLATED..? (Electricity, Compressed Air, Hydraulics, Gravity, Springs, Other stored energy)
    SERVICES TO BE ISOLATED:/ Peralatan yang membutuhkan di isolasi

    How will we prepare BEFORE STARTING THE JOB? / Persiapan pekerjaan


    PRE-JOB MEASURES to be taken: / Tindakan Pre-Job yang akan dilakukan :

    What precautions will we take DURING THE JOB?/ Tindakan pencegahan apa yang akan kita ambil selama
    pekerjaan berlangsung
    PRECAUTIONS required:/ Tindakan pencegahan yang dibutuhkan

    WHAT PPE will we use? / APD apa yang akan digunakan

    if
    required Safety Reflective Eye Face Ear Protective Respiratory Respiratory Personal fall Protective
    Helmet
    footwear vest protection protection) protection gloves protection protection arrest system clothing

    If using gloves or respiratory protection, indicate type:

    How will we PROTECT OTHERS?/ Bagaimana kita akan melindungi orang lain
    Measures to protect OTHERS/ Langkah untuk melindungi orang lain (eg other workers, members of public)

    Measures to prevent POLLUTION / Langkah untuk pencegahan Polusi (eg air, water, land)

    Procedures for DISPOSAL OF WASTES / Prosedur untuk pembuangan limbah

    Sign By

    (Contractor ) (HSE Contractor) (HSE Project ) (Engineer Nestle)

    Version 1.1

    You might also like