No Name Position Photo BPJS ID Card

1 Hasbullah Deputi PM Yes

2 Alfiansyah Limbong HSE Yes Yes

3 Muhammad Ikhsan Engineer Yes Yes

4 Agus Misran Surveyor Yes Yes

5 Eko Sujarwo Driver Yes Yes

6 Supriyadi Halim Superintendent Yes Yes Yes

7 Arisal Crane Operator Yes Yes

8 Muchtar Foreman Yes Yes

9 Henry Gunawan Ass. Survey - - Yes

10 Basri Abas Operator Excavator Yes Yes Yes

11 Takdir Syar Operator Excavator Yes Yes

12 Bayhaqi Driver Yes Yes

13 Ibrahim Foreman Stringging Yes Yes

14 Haidir Qc Inspector Yes Yes

15 Beni Setiawan Campboss Yes

16 Deny Faisal Storageman Yes Yes

17 Lukman Safetyman Yes Yes

18 Bambang Sulistiono Drafter Yes

19 Zulianto Foreman Transport Yes Yes

20 Abdul Rifai Rigger Yes Yes

21 Amin Nur Operator Exavator Yes Yes

22 Bustam Operator Sideboom Yes Yes

23 Tuwo Hariyanto Operator Sideboom Yes Yes

24 Mashudi Driver Trailer Yes

25 Purwanto Helper Yes Yes

26 Gazali Rahman Helper Yes Yes

27 Zainal Helper Yes Yes

28 Yudi Kurniawan Paramedic Yes Yes

29

30
 Prepared by,

Denudin Hasan D
HRD
 EPC LAWE - LAWE FACILITIES PROJECT
RDMP RU V- BALIKPAPAN

SUMMARY DATA PEKERJA

As Per 04 April 2021

Police Residential Covid Test

Family Card Certificate
(SKCK) Location Letter Antigen PCR

Balikpapan,
Yes N/A
Kaltim

Yes Yes Banyuwangi Yes

Yes Yes Jakarta (HO) Yes Yes

Yes Yes Medan, Sumut Yes Yes

Kutai,
Yes Yes Kartanegara, N/A Yes
Kaltim

Balikpapan,
Yes Yes N/A Yes
Kaltim

Kutai,
Yes Yes Kartanegara, N/A Yes
Kaltim
 Kutai,
Yes Yes Kartanegara, N/A Yes
Kaltim

Balikpapan,
Yes Yes N/A Yes
Kaltim

Sumedang,
Yes Yes Yes Yes
Jabar

Luwu,
Yes Yes Yes Yes
Sulsel

Penajam,
Yes
Kaltim

Maros,
Yes Yes Yes Yes
Sulsel

Yes Yes Bandung Yes

Yes Yes Kuningan Yes

Yes Yes Jakarta Yes

Yes Yes Penajam Yes

Yes Jakarta Yes Yes

Yes Yes Surabaya Yes

Yes Handil Yes

Yes Yes Bppn Yes

Bppn Yes

Yes Yes Bppn Yes

Yes Yes Kediri Yes

Yes Yes Yes

Yes Yes Yes

Yes Yes Yes

Yes Yes Yes

 MCU
Skill Certification Remark
Date Location Result

Gula darah meningkat

dan creatin
22-Mar-21 RSPB FIT For Work
Konsultasi Dr Spesial
Penyakit Dalam

K3 Migas Operator, Gula darah meningkat

22-Mar-21 RSPB FIT For Work First Aid, Sea dan Konsultasi Dr Spesial
Survival, JSA, etc Penyakit Dalam

Sudah Safety Induction

22-Mar-21 RSPB FIT For Work -
on 03 April 2021

22-Mar-21 RSPB FIT For Work -

Sudah Safety Induction

22-Mar-21 RSPB FIT For Work SIM
on 03 April 2021

Sudah Safety Induction

23-Mar-21 RSPB FIT For Work -
on 03 April 2021

23-Mar-21 RSPB FIT For Work BNSP

 Gula darah meningkat,
creatin dan
23-Mar-21 RSPB FIT For Work - pendengaran menurun
Konsultasi Dr Spesial
Penyakit Dalam

Sudah Safety Induction

23-Mar-21 RSPB FIT For Work -
on 03 April 2021

Sudah Safety Induction

29-Mar-21 Bornmeds FIT For Work
on 03 April 2021

Sudah Safety Induction

29-Mar-21 Bornmeds FIT For Work
on 03 April 2021

Sudah Safety Induction

29-Mar-21 Bornmeds FIT For Work
on 03 April 2021
 Sudah Safety Induction
29-Mar-21 Bornmeds FIT For Work
on 03 April 2021

29-Mar-21 Bornmeds FIT For Work

29-Mar-21 Bornmeds FIT For Work

29-Mar-21 Bornmeds FIT For Work

29-Mar-21 Bornmeds FIT For Work

29-Mar-21 Bornmeds FIT For Work

29-Mar-21 Bornmeds FIT For Work

 Acknowledge by,

Alfiansyah Limbong
HSE
 EPC LAWE - LAWE FACILITIES PROJECT
RDMP RU V- BALIKPAPAN

PROPOSED ID BADGE

USIA COVID TEST

No. NAME POSITION RESINDENTIAL ALAMAT MCU STATUS MCU SUBMIT MCU TO CPP RETURN FROM SAFETY Training PTW ID CARD SKCK DOMISILI SKILL CERTIFICATION ID Badge
(TAHUN) CPP INDUCTION LETTER PCR ANTIGEN
1 ASPAR ABDUL LATIF CONSTRUCTION MANAGER BALIKPAPAN RSPB MUST TO SEE DOCTOR 01 April 2021
2 M. IKHSAN ENGINEER JAKARTA RSPB FIT TO WORK 03 April 2021 √ √ √ √ Done
3 HAIDIR QA/QC INSPECTOR BANDUNG JL DESA, NO 75, RT 03, KIARACONDONG BORNMEDS FIT TO WORK 03 April 2021 √ √ √ √ Done
4 ALFIANSYAH LIMBONG HSE OFFICER BANYUWANGI PERUM DJATI, RT 03, KEC GIRI 46 RSPB FIT TO WORK 01 April 2021 07 April 2021 √ √ √ √ Done
5 LUKMAN SAFETYMAN PASER UTARA JL KROK LAUT, RT 02, KEL. PENAJAM BORNMEDS FIT TO WORK 03 April 2021 06 April 2021 √ √ √ HSE CERTIFICATE Done
6 YUDI KURNIAWAN PARAMEDIC PASER UTARA BORNMEDS FIT TO WORK √ √ √ MEDIC CERTIFICATE Done
7 EMMA PARAMEDIC PASER UTARA SIDOREJO , RT 03, PENAJAM 22 BORNMEDS FIT TO WORK 05 April 2021 √ √ √ BLS, BTCLS Done
8 AGUS MISRAN SURVEYOR MEDAN GG SWADAYA, MEDAN 31 RSPB FIT TO WORK 05 April 2021 √ √ √ √ Done
9 HENRY GUNAWAN ASST SURVEYOR BALIKPAPAN JL SOEKARNO HATTA, MUARA RAPAK 21 RSPB FIT TO WORK 03 April 2021 06 April 2021 √ √ √ √ Done
10 BASRI ABAS OPERATOR EXCAVATOR SUMEDANG DS. JAMBU LANDEUH, RT 03 BORNMEDS FIT TO WORK 03 April 2021 √ √ √ √ SIO Done
11 TAKDIR SYAR OPERATOR EXCAVATOR SULSEL BORNMEDS FIT TO WORK 03 April 2021 √ √ √ √ SIO Done
12 ARISAL OPERATOR SIDE BOOM KUTAI,KALTIM RT 25, KEC MARANGKAYU RSPB FIT TO WORK 03 April 2021 15 April 2021 √ √ √ √ SIO Done
13 BUSTAM OPERATOR SIDE BOOM BALIKPAPAN GG SWADAYA, MEDAN 57 BORNMEDS MUST TO SEE DOCTOR 14 April 2021 15 April 2021 19 April 2021 √ √ √ SIO on process
14 EKO SUJARWO DRIVER KUTAI,KALTIM RSPB FIT TO WORK 03 April 2021 √ √ √ √ Done
15 PURWANTO HELPER SURVEY PASER UTARA BORNMEDS FIT TO WORK 05 April 2021 √ √ √ Done
16 MULIANSYAH HELPER CLEARING PASER UTARA BORNMEDS FIT TO WORK √ √ √ Done
17 SUPRIADI HALIM SUPERINTENDENT BALIKPAPAN RSPB FIT TO WORK 03 April 2021 06 April 2021 √ √ √ Done
18 MUCHTAR FOREMAN KUTAI,KALTIM RSPB MUST TO SEE DOCTOR 14 April 2021 15 April 2021 15 April 2021 √ √ √ Done
19 ABDUL RIFAI RIGGER BALIKPAPAN JL.M.SUTOYONO, RT 37,KLANDASAN 52 BORNMEDS FIT TO WORK √ √ √ Done
20 GAZALI RAHMAN HELPER PASER UTARA BORNMEDS FIT TO WORK 05 April 2021 √ √ √ Done
21 ZAENAL HELPER PASER UTARA BORNMEDS FIT TO WORK 05 April 2021 √ √ √ Done
22 ARDIAN HELPER PASER UTARA BORNMEDS FIT TO WORK √ √ √ Done
23 PANJI AL AMIN HELPER PASER UTARA BORNMEDS FIT TO WORK √ √ √ Done
24 YORDAN HELPER CLEARING PASER UTARA KELURAHAN PE BORNMEDS FIT TO WORK 05 April 2021 √ √ √ Done
25 DIAN MAFALAH HELPER PASER UTARA BORNMEDS FIT TO WORK 05 April 2021 √ √ √ Done
26 M YUNUS OPERATOR SIDE BOOM HANDIL BARU, RT 02, KEC. SAMBOJA RSPB MUST TO SEE DOCTOR 14 April 2021 15 April 2021 BELUM √
27 TUWO HARIYANTO OPERATOR SIDE BOOM BALIKPAPAN HANDIL BARU, RT 05, KEC. SAMBOJA 41 06 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 15 April 2021 √ √ SIO on process
28 HASANUDDIN DRIVER 4X4 PASER UTARA 06 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 √ √ SIM Done
29 IBRAHIM FOREMAN MAROS,SULSEL 06 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 15 April 2021 √ √ √ on process
30 DENY FAISAL FOREMAN COATING BANJARNEGARA 06 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 16 April 2021 √ √ √
31 ZULIANTO FOREMAN TRANSPORT SURABAYA BEJI, RT 01, JENU 46 06 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 15 April 2021 √ √ √ Done
32 UCOK DOUGHLAS ENGINEER BALIKPAPAN KOMPLEK P.U 4 NO 20, RT 02, BALIKPAPAN 07 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 15 April 2021 √ √ √ Done
33 YUDHA MAULANA PROJECT MANAGER JAKARTA 07 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 BELUM √
34 BAMBANG SULISTIONO ENGINEER KARAWANG 07 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 15 April 2021 √ √ Done
35 BASUKI RAHMAT COATING INSPECTOR SAMARINDA 07 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 15 April 2021 √ √ √ Done
36 SAMSUL RIGGER STRINGING 12 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 19 April 2021 √ on process
37 BAY DEDI SAFETYMAN UNLOADING 12 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 19 April 2021 √ on process
38 MASHUDI DRIVER TRAILER WILIS INDAH, RT 23, MOJOROTO 52 12 April 2021 MUST TO SEE DOCTOR 14 April 2021 15 April 2021 19 April 2021 √ on process
39 ILYAS PIPE FITTER 12 April 2021 FIT TO WORK 19 April 2021 √ on process
40 FAIZAL AMIR OPERATOR CRANE 17 April 2021 √ Done
41 CHALID HELPER CRANE 17 April 2021 √ Done
42 AULIA DINATA HSE COORDINATOR ACEH DUSUN MNS TUHA, MUARA DUA 34 02 May 2021 MUST TO SEE DOCTOR 06 May 2021 07 May 2021 19 May 2021 01 January 2021 √ √ on process
43 BUDI SANTOSO WELDER MUST TO SEE DOCTOR 06 May 2021 06 May 2021 18 May 2021 √ on process
44 BAKRI WELDER MUST TO SEE DOCTOR 06 May 2021 06 May 2021 18 May 2021 √ on process
45 ABDULLAH WELDER MUST TO SEE DOCTOR 06 May 2021 06 May 2021 18 May 2021 on process
46 SAMSUL WELDER JL RAHMAT, RT 07, MUARA BADAK MUST TO SEE DOCTOR 06 May 2021 06 May 2021 18 May 2021 √ on process
47 AYATULLOH WELDER MUST TO SEE DOCTOR 06 May 2021 06 May 2021 18 May 2021 on process
48 KENEDI WELDER MUST TO SEE DOCTOR 06 May 2021 07 May 2021 18 May 2021 √ Done
49 PADHIL YASIR HELPER FIT TO WORK
50 ANDI HELPER FIT TO WORK
51 M.BAYHAQI DRIVER FIT TO WORK √ Done
52 M.BAYU R HELPER SIDOREJO, RT 04, PENAJAM FIT TO WORK
53 SABARUDDIN HELPER RT 09, MUARA BADAK MUST TO SEE DOCTOR
54 SUSANTO TRACIBILITY FIT TO WORK
55 FIRMAN FAUZIE OPERATOR EXCAVATOR PETUNG, RT 11, KEC. PENAJAM FIT TO WORK
56 RHINO AGUSTIYONO OPERATOR SIDE BOOM MENDALA, RT 01, KEC. PENINJAUAN FIT TO WORK 10 June 2021 √ Done
57 PURWADI BURHANAN QC MUST TO SEE DOCTOR 07 May 2021 18 May 2021 Done
58 HARUNA FOREMAN KUTAI KARTANEGARA JL S HASANUDDIN, MUARA BADAK 24 May 2021 19 May 2021 √ √ √ Done
59 OPIC HIDAYAT PROJECT MANAGER JL MELATI TUGU, KEC KOJA 18 May 2021 22 May 2021 √
60 SABARUDDIN FIELD ENGINEER JL HASANUDDIN, RT 01, MUARA BADAK 22 May 2021 √ √ √ √ Done
61 M ALFATH RINALDY SAFETYMAN PERUM RAWA INDAH,RT 27, PENAJAM 21 May 2021 FIT TO WORK 22 May 2021
84 OKTAVIANUS FOREMAN SIRING, RT 10, KEC. PORONG 24 May 2021 FIT TO WORK 10 June 2021 √ √
63 HENDRA LESMANA RIGGER GUNUNG SETELENG RT 01, PENAJAM 33 24 May 2021 FIT TO WORK
64 LA BUJU DRIVER Muara Jawa Ulu, RT 22, KUKAR 34 19 May 2021 FIT TO WORK
65 SULISTIYAWATI PARAMEDIC BABULU DARAT, RT 18, PENAJAM 24 May 2021 FIT TO WORK 5 June 2021 2 June 2021 √ √ √ HIPERKES Certificate Done
66 LUKMAN GRINDERMAN 24 May 2021 FIT TO WORK 5 June 2021 2 June 2021 √ √
67 ANDIKA PRATAMA HELPER WELDING 5 June 2021 MUST TO SEE DOCTOR 12 June 2021 16 June 2021 √ √
68 RAHMAT ASIS MULKARIM HELPER WELDING JL PARIWISATA, RT 07, SALOLOANG 5 June 2021 FIT TO WORK 12 June 2021 11 June 2021 √ √
69 MUHAMMAD SABARUDIN HELPER GIRIMUKTI, RT 12, PENAJAM 7 June 2021 FIT TO WORK 12 June 2021 √ √ OPERATOR K3 CERTIFICATE
70 AULIA RAHMAN HELPER JL TAMBA BARU, RT 05, SALOLOANG 20 9 June 2021 FIT TO WORK 14 June 2021 11 June 2021 √ √
71 RUDI SAPUTRA HELPER JL PONDO MARIAM, RT 02, SALOLOANG 9 June 2021 MUST TO SEE DOCTOR 14 June 2021 16 June 2021 11 June 2021 √ √
72 LUTFI MAOLANA HELPER SIDOREJO SIDOREJO, RT 05, PENAJAM 11 June 2021 √ √ √
73 HERWIN HELPER JL PONDO LIMA, SALOLOANG, PENAJAM 9 June 2021 FIT TO WORK 14 June 2021 16 June 2021 11 June 2021 √ √ OPERATOR EXCA CERTIFICATE
74 ABDULLAH SIDIQ COATER KOMP PGB ARASOE, CINA 24 9 June 2021 FIT TO WORK 14 June 2021 √
75 JESKI COATER KAMP. BARU, NO 21, MUARA BADAK 9 June 2021 FIT TO WORK 14 June 2021 √
76 MUHAMMAD FAJRIN COATER JL.NILAM, RT 06, MUARA BADAK 9 June 2021 FIT TO WORK 14 June 2021 √
77 ROSDIANTO COATER JL H ISMAIL, RT 04, MUARA BADAK 9 June 2021 FIT TO WORK 14 June 2021 √
78 SALMON B WELDER 9 June 2021 FIT TO WORK 14 June 2021
79 ISMAIL PIPE FITTER 7 June 2021 MUST TO SEE DOCTOR 14 June 2021 16 June 2021
80 JAMALUDDIN GRINDERMAN JL TAMBA BARU, RT 05, SALOLOANG 48 7 June 2021 FIT TO WORK 14 June 2021
81 ARUARI OPERATOR TWIN ART 9 June 2021 FIT TO WORK 14 June 2021
82 RAMADHAN WELDER 9 June 2021 FIT TO WORK 14 June 2021
83 YUNUS RANNU DRIVER GUNUNG SETELENG, RT 05, PENAJAM 47
84 IRFAN WARDANI GRINDERMAN 14 June 2021 FIT TO WORK 16 June 2021 √ √
85 YOGI KURNIAWAN GRINDERMAN KELURAHAN LAWE-LAWE, RT 03, PENAJAM 14 June 2021 FIT TO WORK 16 June 2021 √ √
86 ABDUL NASIR HELPER
87 SUGIANTO HELPER SIDOREJO SIDOREJO, RT 06, PENAJAM √ √
88 ARMAN
 SUBMIT MCU SOON
11 BAYHAQI DRIVER NIPAH-NIPAH 19 April 2021
13 HELPER STRINGING 19 April 2021
14 HELPER STRINGING 19 April 2021
15 HELPER STRINGING 19 April 2021
16 HELPER STRINGING 19 April 2021
17 SAFETYMAN STRINGING
 EPC LAWE - LAWE FACILITIES PROJECT
RDMP RU V- BALIKPAPAN

PROPOSED ID BADGE
USIA COVID TEST
No. NAME POSITION RESINDENTIAL ALAMAT MCU STATUS MCU SUBMIT MCU TO CPP RETURN FROM SAFETY Training PTW ID CARD FAMILY SKCK DOMISILI SKILL CERTIFICATION ID Badge
(TAHUN) CPP INDUCTION CARD LETTER PCR ANTIGEN
1 OPIK HIDAYAT PM JAKARTA UTARA,
2 YUDHA MAULANA DPM
3 ZUHANDRI PROJECT CONTROL KOMPI PEMDA II, RT 04, MANDIANGIN 19 May 2021 FIT TO WORK 21 May 2021
4 JUMADIN DRAFTER KP NEGLASARI, RT 02, BATUJAJAR 43
5 AULIA DINATA HSE COORDINATOR DSN MNS TUHA, MUARA DUA 34
6 WULANDARI
7 RITA ARISKA ADMIN SAFETY
8 AMIN NUR OPERATOR EXCAVATOR BALIKPAPAN JL RACHMAT, MUARA BADAK 57 BORNMEDS MUST TO SEE DOCTOR 14 April 2021 15 April 2021 √ √ √ √ SIO
9 SYAHRIANSYAH FOREMAN
10 OKPRIYADI FOREMAN
11 ALI WARDANA FOREMAN LAWE-LAWE, RT 07, PENAJAM 37
12 HADI SISWANTO SURVEYOR JL KEMANDORAN, PAMULANG 49 MUST TO SEE DOCTOR 06 May 2021 06 May 2021 18 May 2021 √ on process
13 ANDIRIZAL PARAMEDIC PASER UTARA GIRIMUKTI, RT 14, PENAJAM FIT TO WORK √ Done
14 RAFLI SUGENG DRIVER JL PROPINSI, RT 02, PENAJAM FIT TO WORK √
15 MAULIDDIN WAHYU SAFETYMAN JL.SWADAYA, RT 04, PENAJAM 29 FIT TO WORK √
16 MULYADI WELDER JL.IR.SOEKARNO, RT 19, MUARA JAWA 51 FIT TO WORK 03 June 2021 √ Done
17 JOHAN WELDER JL.GUNUNG SATU, RT 12, BALIKPAPAN 52 FIT TO WORK 21 May 2021 √ √ Welding Certificate Done
18 SABARUDDIN WELDER MUARA BADAK JL.S HASANUDDIN, RT 9, MUARA BADAK 40 FIT TO WORK 21 May 2021 √ √ √ √ Done
19 SAMSUL WELDER JL.RACHMAT, RT 07, MUARA BADAK 55 FIT TO WORK 21 May 2021 √ √ √ Done
20 RAMLI WELDER Muara Badak JL.RACHMAT, RT 01, MUARA BADAK 61 FIT TO WORK 21 May 2021 √ √ √ √ Done
21 ACO SEDI WELDER Muara Badak JL.RACHMAT, RT 05, MUARA BADAK 34 FIT TO WORK 21 May 2021 √ √ √ Welding Certificate Done
22 AMIR WELDER MUARA JAWA ULU, RT 005 03 June 2021 √ Done
23 PATUAN SAMOSIR WELDER HANDIL JL.IR.SOEKARNO,RT 18, MUARA JAWA 53 FIT TO WORK 21 May 2021 √ √ √ √ Done
24 AHMAD BAKAR WELDER Badak Baru JL.S HASANUDDIN, RT 6, MUARA BADAK 49 FIT TO WORK 21 May 2021 √ √ √ √ Done
25 MASTURI WELDER HANDIL JL.IR.SOEKARNO, RT 15,MUARA JAWA 52 FIT TO WORK 21 May 2021 √ √ √ √ Welding Certificate Done
26 DIRWAN OPERATOR EXCAVATOR MUARA JAWA ULU, RT 08 31 FIT TO WORK 18 May 2021 √
27 ARI ERMIANTO SURVEYOR HANDIL HANDIL, RT 13,MUARA JAWA 42 21 May 2021 MUST TO SEE DOCTOR 5 June 2021 5 June 2021 19 May 2021 √ √ Done
29 ARIFUDDIN OPERATOR SIDE BOOM JL MT HARYONO, RT 37, BONTANG 21 May 2021 FIT TO WORK 24 May 2021 19 May 2021 √ √ Done
30 BAYU WINARKO OPERATOR SIDE BOOM JL POROS MUARA,RT 01, MUARA BADAK 47 19 May 2021 √
31 MUNIARDI OPERATOR SIDE BOOM Muara Badak SALO PAREPPA,RT 12, 56 24 May 2021 19 May 2021 √ √ √ √ Done
32 SUCIPTO HADI OPERATOR SIDE BOOM JL PERINTIS, RT 23, MUARA BADAK 53 24 May 2021 19 May 2021 √ √ Operator Certificate Done
33 RAHMAN COATING INSPECTOR KEC. BALEENDAH, BANDUNG 20 May 2021 FIT TO WORK 21 May 2021 √
34 SETIAWAN WELDING INSPECTOR SAMARINDA JL LAMBUNG MANGKURAT, SAMARINDA 30 21 May 2021 √ √
35 M MEGO SENATUNG WELDING INSPECTOR TAMANSARI BUKIT MUTIARA 26 19 May 2021 FIT TO WORK 21 May 2021 19 May 2021 √ Done
36 IRFAN SETIAWAN BRUSHER KP. PENGKOLAN, RT 01, BALEENDAH 20 May 2021 FIT TO WORK 21 May 2021 √
37 SISMANTO FOREMAN TUBAN DSN MOROSEME, RT 01, PLUMPANG 58 24 May 2021 FIT TO WORK 21 May 2021 √ √ √ √ Done
38 SOFYAN FIDIANTORO FOREMAN TUBAN DSN MOROSEME, RT 01, PLUMPANG 39 20 May 2021 FIT TO WORK 22 May 2021 21 May 2021 √ √ √ √ Foreman Certificate Done
39 INDRA KUSUMA PRABOWO FOREMAN PLIWETAN, RT 03, PALANG 35 03 May 2021 FIT TO WORK 22 May 2021 21 May 2021 √ Done
40 HERYANTO FOREMAN Jambi JL LINGKAR BARAT, RT 20, KOTABARU 20 May 2021 FIT TO WORK 21 May 2021 21 May 2021 √ √ √ Foreman Certificate
41 SUDIANTO OPERATOR EXCAVATOR DUSUN 1, PANCA TUNGGAL 20 May 2021 FIT TO WORK 21 May 2021 21 May 2021
42 MAULANA RISKI CIVIL INSPECTOR SEMPAJA TIMUR, SAMARINDA 22 20 May 2021 FIT TO WORK 21 May 2021 22 May 2021 √ √ √ Done
43 MUHAMMAD NUR EFFENDI OPERATOR SIDE BOOM Jombang DSN DOLOK, RT 02, KEC TEMBELANG 52 20 May 2021 FIT TO WORK 21 May 2021 21 May 2021 √ √ √ √ Done
44 M RAMLI MT FOREMAN BENDING Serang KP CIAKAR, RT 16, KEC. CIKEUSAL 20 May 2021 FIT TO WORK 22 May 2021 22 May 2021 √ √ √ √ Done
45 AGUS SUTARJI TIMEKEEPER GUNUNG SETELENG, PENAJAM 34 20 May 2021 FIT TO WORK 24 May 2021
49 JUNAIDI GRINDERMAN JL PROPINSI, PENAJAM 34 24 May 2021 FIT TO WORK 5 June 2021 √ √
50 RAKHMAT FAUZAN GRINDERMAN BALIKPAPAN JL SOEKARNO HATTA, RT 7, KARANGJOANG, BALIKPAPAN 31 27 May 2021 FIT TO WORK 10 June 2021 31 May 2021 √ √ √ Done
51 LUKMAN GRINDERMAN SALOLOANG, RT 08, KEC. PENAJAM 30 02 June 2021 √ √ √ Done
54 DODDY SUHARTO PIPE FITTER CILACAP JL CEMPAKA, JERUK LEGI 28 17 May 2021 FIT TO WORK 5 June 2021 31 May 2021 √ √ √ √ Done
55 NANA SURYANA PIPE FITTER TANGERANG TELAGA SARI, RT 02, BALARAJA 2 June 2021 FIT TO WORK 10 June 2021 31 May 2021 √ √ √ Done
56 RAPIUDDIN OPERATOR SIDE BOOM BONE BENRONGENG, RT 04, LAPPARIAJA 39 03 May 2021 MUST TO SEE DOCTOR 5 June 2021 5 June 2021 31 May 2021 √ √ √ √ Done
57 SOHPIAN OPERATOR SIDE BOOM JL MANGKURAWANG, KEC.TENGGARONG 58 FIT TO WORK 10 June 2021 19 May 2021 √ √ √ Sideboom Operator Certicate Done
58 ANDI TOWADEN RIGGER MUARA JAWA, RT 20 28 May 2021 FIT TO WORK 10 June 2021 02 June 2021 √ Done
60 JAYATULLAH RIDWAN GRINDERMAN JL MAYJEN SUTOYO, WATANG SAWITTO 27 27 May 2021 FIT TO WORK 10 June 2021 02 June 2021 √ √ Done
61 JUNAIDI PIPE FITTER SALOLOANG, RT 05, PENAJAM 34 24 May 2021 MUST TO SEE DOCTOR 5 June 2021 5 June 2021 02 June 2021 √ √ √ Done
62 EDY SUNARTO RIGGER GUNUNG SETELENG, BALIKPAPAN 28 May 2021 FIT TO WORK 10 June 2021 02 June 2021 √
63 WASIS TURSENO COATER LINGKUNGAN KRAJAN, RT 04, KADEMANGAN 51 31 May 2021 MUST TO SEE DOCTOR 11 June 2021 16 June 2021 02 June 2021 √ √ Done
64 SARIFUDDIN COATER LAGOCI, RT 02, LILIRAJA 38 28 May 2021 FIT TO WORK 10 June 2021 02 June 2021 √ √ Done
65 ABDULLAH SAFETYMAN PERUM WARU KARYA, RT 28 5 June 2021 MUST TO SEE DOCTOR 12 June 2021 16 June 2021 02 June 2021 √ √ Done
69 KADAR WELDER JL HASANUDDIN, MUARA BADAK 03 June 2021 √ √ Welding Certificate Done
70 M SALEH Y WELDER JL DELIMA, RT 03, MUARA JAWA 03 June 2021 √ √ Done
72 SAID RUSLIANSYAH GRINDERMAN JL PROPINSI, KM 6, PENAJAM 28 May 2021 FIT TO WORK 10 June 2021 03 June 2021 √ √ √ Done
79 HENDRA GRINDERMAN NIPAH-NIPAH, RT 04 23 2 June 2021 FIT TO WORK 10 June 2021 08 June 2021 √ Done
80 ASRIANSYAH GRINDERMAN NIPAH-NIPAH, RT 05 2 June 2021 FIT TO WORK 10 June 2021 10 June 2021 √ √
81 DYMAS PRATAMA R PARAMEDIC MUARA ADANG II, LONGKALI 34 ex Wahana ex Wahana √ √ Done
82 HERWANDI GRINDERMAN LAWE-LAWE, KEC. PENAJAM 3 June 2021 FIT TO WORK 11 June 2021 08 June 2021 √ √ Done
83 DEDI RAHMAN DRIVER RT 023, MUARA JAWA
84 ANDI KURNIAWAN QC PASAR BAWAH, RT 05, KEC LAHAT 33 24 May 2021 FIT TO WORK 5 June 2021 √ √
85 JUNAIDI SUPER INTENDENT JL POROS,RT 06, RUMBIO JAYA 27 May 2021 FIT TO WORK 5 June 2021 08 June 2021 √ √
86 SURADI MURTI PIPE FITTER AMANRANG, RT 03, KEC BENGO 4 June 2021 FIT TO WORK 12 June 2021 10 June 2021 √ √
88 AHMAD SYAHRAN MEKANIK 08 June 2021 √ √
90 MUHAMMAD RIZAL GRINDERMAN JL SULAWESI, RT 57, KARANG REJO 21 27 May 2021 FIT TO WORK 10 June 2021 03 June 2021 √ √ Done
91 RIYANTO BRUSHER KP BULAK TIMUR, RT 04, DUREN SAWIT 46 7 June 2021 MUST TO SEE DOCTOR 12 June 2021 16 June 2021 10 June 2021 √ √
92 SIDIK COATER KAMP BARU, RT 15, MUARA BADAK 63 7 June 2021 MUST TO SEE DOCTOR 14 June 2021 16 June 2021 10 June 2021 √ √
93 LABISUN OPERATOR EXCAVATOR DUSUN JAMBI, WILANGAN 9 June 2021 FIT TO WORK 14 June 2021 10 June 2021 √ √ Operator Certificate
94 MISTIKO OPERATOR EXCAVATOR DSN GEMUK MAS, KEC.TEMPEH 29 9 June 2021 FIT TO WORK 14 June 2021 10 June 2021 √ √ Operator Certificate
95 DARMA HARI AKBAR OPERATOR EXCAVATOR DSN JANTI, RT 04, MOJOKERTO 36 9 June 2021 FIT TO WORK 14 June 2021 10 June 2021 √ √ Operator Certificate
96 MARGOYONO OPERATOR EXCAVATOR KARANGKATES, RT 24, SUMBERPUCUNG 50 9 June 2021 MUST TO SEE DOCTOR 14 June 2021 16 June 2021 10 June 2021 √ √ Operator Certificate
99 YUDI KURNIAWAN PARAMEDIC PERUM INDAH LESTARI KM 1,5, RT 24, PENAJAM √ Done
100 RIWAYANTO WELDER JL COKROAMINOTO, RT 25, MUARA BADAK 46 √
101 MUCHZIN WELDER JL HASANUDIN, RT 06, MUARA BADAK 46 √
102 H MASE FOREMAN TAMPING, RT 01, ULAWENG CINNONG 58 √
103 MAKRONI FOREMAN √
104 MUH ALFATH RINALDY SAFETYMAN PERUM RAWA INDAH BLOK L, NO 2, PENAJAM 20 FIT TO WORK √
105 RICO TEMPATI √
106 MISRAN HANDIL BARU, RT 04, SAMBOJA 43 √
107 NANANG PUJIONO √
108 DWI KARIANTO √
109 ALOWSIUS GON SAGA √
110 SURYA SUMBADA √
111 SUGENG SUSILO GRINDERMAN JL VICO, RT 02, LAWE -LAWE 4 June 2021 FIT TO WORK 16 June 2021 √
112 MUSTAFA LUTFI GRINDERMAN JL SYAHRUN, RT 03, NIPAH-NIPAH, PENAJAM 27 √
113 ALDI FITRIANSYAH RIGGER STRINGING √
114 TRI SUPRAPTO RIGGER √
115 HENDRA LESMANA RIGGER JL KEROK, RT 01, GUNUNG STELENG, PENAJAM 33 √
116 MUHAMMAD WAHYU DRIVER √
117 AHMAD ZIKRON DRIVER BTN KM 4, RT 09, NENANG, PENAJAM 45 √
118 MUHAMMAD REZA PAHLEVI √
119 DAVID MULYANTO DRIVER QC JL KYAI MOJO, RT 18, GONDANG LEGI 47 √
120 AGUS SOFYAN MECHANIC HANDIL 5, RT 04, MUARA JAWA 51 √
121 WIDIANTO ELECTRIC √
130 MUHAMMAD ALI USMAN FLAGMAN √
131 ARDIAN RAMADHANI FUELMAN √ Done
135 TINTRIM NURWENI MESS GIRL I NIPAH-NIPAH √
136 RESKY HAJERIAH MESS GIRL NENANG √
137 SALAMAH MESS GIRL-MESS 3 JL CEMPAKA, RT 07, BUMI HARAPAN, SEPAKU 34 √
138 FIRYAL QANITAH MESS GIRL-MESS 4 JL PROPINSI, RT 02, PENAJAM 21 √
139 DINDA NABILA MESS GIRL-MESS 5 JL INPRESS, RT 02, GUNUNG SETELENG 21 √
140 MARKAMAH MESS GIRL-MESS 6 NENANG, RT 02, PENAJAM 45 √
141 YULIANSYAH WAKAR KP 1 + 700 √
142 THOMAS WAKAR KP 1 + 700 √
143 APRIANSYAH WAKAR KP 3 + 200 √
144 SUMARLIN WAKAR KP 3 + 200 √
145 HERNAWAN SETYO BUDI WAKAR 4 + 900 NIPAH-NIPAH, RT 08, PENAJAM 40 √
146 OTOK WATCHMAN PIPA KP 3 + 100 √
147 MULYONO WATCHMAN PIPA KP 5 + 700 √
148 M KHAIRUL ALAM WATCHMAN PIPA DEPAN DPRD √
149 JAENUDIN WATCHMAN PIPA DEPAN ISLAMIC √
150 HERMANSYAH WATCHMAN PIPA KP 7 + 900 √
151 ARBAIN WATCHMAN PIPA KP 7 + 900 √
152 HERMAN WAKAR KP 3 + 400 JL PROPINSI, RT 05, LAWE-LAWE, PENAJAM 40 √
153 DASUKI WAKAR KP 8 NENANG JL PROPINSI, KM 6, RT 05, NENANG, PENAJAM 55 √
154 ABDULLAH WAKAR KP 8 NENANG JL PROPINSI, KM 6, RT 05, NENANG, PENAJAM 52 √
 DAFTAR PENGAJUAN REVIEW MCU & SAFET

No Name Position MCU Position

1 Hasbullah Deputi PM done DPM

2 Alfiansyah Limbong HSE 30-Mar-21 HSE
3 Muhammad Ikhsan Engineer 30-Mar-21 ENGINEER
4 Agus Misran Surveyor 30-Mar-21 SURVEYOR
5 Eko Sujarwo Driver 30-Mar-21 DRIVER
6 Supriyadi Halim Superintendent 30-Mar-21 SUPERINTENDENT
7 Arisal Crane Operator 30-Mar-21 CRANE OPERATOR
8 Muchtar Foreman 30-Mar-21 FOREMAN
9 Henry Gunawan Ass. Survey 30-Mar-21 ASST. SURVEYOR
10 Basri Abas Operator Excavator 30-Mar-21 EXCAVATOR OP.
11 Takdir Syar Operator Excavator 30-Mar-21 EXCAVATOR OP.
12 Haidir Qc Inspector 30-Mar-21 QA/QC
13 Lukman Safetyman 30-Mar-21 SAFETYMAN
14 Purwanto Helper 30-Mar-21 HELPER SURVEY
15 Gazali Rahman Helper 30-Mar-21 HELPER CLEARING
16 Ardian Ramdani Helper 30-Mar-21 HELPER
17 Zainal Helper 3-Apr-21 HELPER
18 Abdul Rifai Rigger 3-Apr-21 RIGGER
19 Amin Nur Operator Exavator 3-Apr-21 EXCAVATOR OP.
20 Bustam Operator Sideboom 3-Apr-21 SIDEBOOM OP.
21 Panji Al Amin 3-Apr-21
22 Emma Djayanti 3-Apr-21 MEDIC
23 Dian Malpalah 3-Apr-21
24 Muliansyah 3-Apr-21
25 Yordan Erlangga 3-Apr-21
26 Sulistiyawati Paramedic 24 Mei 2021 MEDIC
27 Lukman
28
29
30
31
32
33
34
35
36
37
38
39
NGAJUAN REVIEW MCU & SAFETY INDUCTION

Send Safety
Return from
MCU Result Application Induction Remark
CPP
Letter Date
30-Mar-21 1-Apr-21 See Doctor
30-Mar-21 1-Apr-21 Fit To Work DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 5-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work masih di handil
30-Mar-21 1-Apr-21 Fit To Work DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 3-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 5-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 5-Apr-21 DONE
30-Mar-21 1-Apr-21 Fit To Work 3-Apr-21 DONE
3-Apr-21 4-Apr-21 Fit To Work 5-Apr-21 DONE
3-Apr-21 4-Apr-21 Fit To Work DONE
3-Apr-21 4-Apr-21 Follow up SJP
3-Apr-21 4-Apr-21 Fit To Work DONE
3-Apr-21 4-Apr-21 Fit To Work DONE
3-Apr-21 4-Apr-21 Fit To Work 5-Apr-21 DONE
3-Apr-21 4-Apr-21 Fit To Work 5-Apr-21 DONE
3-Apr-21 4-Apr-21 Fit To Work DONE
3-Apr-21 4-Apr-21 Fit To Work 5-Apr-21 DONE
24 Mei 2021 4 Juni 2021 Fit To Work 5 Juni 2021 2 Juni 2021
 EPC LAWE - LAWE FACILITIES PROJECT
RDMP RU V- BALIKPAPAN

SUMMARY DATA PEKERJA

As Per 29 Maret 2021

No Name Position

1 2 Alfiansyah Limbong HSE

2 3 Muhammad Ikhsan Engineer

3 4 Agus Misran Surveyor

4 7 Arisal Crane Operator

5 8 Muchtar Foreman
6 10 Basri Abas Operator Excavator

7 11 Takdir Syar Operator Excavator

8 13 Ibrahim Jafar Foreman Stringging

EPC LAWE - LAWE FACILITIES PROJECT
RDMP RU V- BALIKPAPAN

SUMMARY DATA PEKERJA

As Per 29 Maret 2021

KTP REMAKS

Sudah Safety Induction 3

April 2021
Sudah Safety Induction 3
April 2021

Sudah Safety Induction 3

April 2021
No. NAME POSITION RESINDENTIAL ALAMAT USIA (TAHUN) MCU STATUS MCU SUBMIT MCU TO CPP RETURN FROM CPP
1 ABDUL RAHIM HELPER SURVEY JL GUNTUNG, RT 05, API-API 21 May 2021 FIT TO WORK 5 June 2021
2 SLAMET BUDIANTO HELPER GIRIMUKTI, RT 14, PENAJAM 27
3 SAFARUDDIN HELPER JL TEAMBULE, RT 06, PENAJAM 24
4 BERRY ALDIANTO HELPER GIRIMUKTI, RT 10, PENAJAM 26
5 BAMBANG SANTOSO HELPER SIDOREJO, RT 05, PENAJAM 25
6 FAHMI HARIADI HELPER JL.PROPINSI, RT 09, PENAJAM 25
7 DAVID HELPER NENANG, RT 14, KEC PENAJAM 28 May 2021 FIT TO WORK 10 June 2021
8 MOH.RAHMAT AKBAR HELPER NIPAH-NIPAH, RT 05 25
9 SUHUD PUTRA HELPER JL PROPINSI, RT 03, NIPAH-NIPAH 30 31 May 2021 FIT TO WORK 10 June 2021
10 HERMAWAN HELPER SALOLOANG,RT 01, KEC PENAJAM 35 25 May 2021 FIT TO WORK 5 June 2021
11 GERALDO NOVIAN P HELPER JL.PROPINSI, RT 14 , KEC.PENAJAM 19 28 May 2021 FIT TO WORK 10 June 2021
12 RUSLIADY HELPER JL GUSUNG, RT 15, KEC.PENAJAM 32 2 June 2021 FIT TO WORK 10 June 2021
13 MUHAMMAD ALI HELPER JL PROPINSI, NENANG, RT 05 46 ex Wahana
14 HAIRULLAH HELPER JL PROPINSI, KM 5, PENAJAM 31 ex Wahana
15 ARDANI HELPER NIPAH-NIPAH, RT 04 2 June 2021 FIT TO WORK 10 June 2021
16 TEGAR AL AYUBI HELPER RT 04, KEC PENAJAM 20 2 June 2021 FIT TO WORK 10 June 2021
17 ARDANI HELPER NIPAH-NIPAH, RT 04 2 June 2021 FIT TO WORK 10 June 2021
18 ZULKIFLI HELPER MAINLINE LAWE-LAWE, RT 06 14 June 2021 FIT TO WORK 16 June 2021
19 JUMADI HELPER PETUNG JL PROPINSI, KM 18, PENAJAM 5 June 2021 FIT TO WORK 12 June 2021
20 AGUS NARFIN HELPER JL STRAT 5, RT 08, PENAJAM 7 June 2021 FIT TO WORK 12 June 2021
21 DERRY PRATAMA HELPER
22 JUNAIDI HELPER OJEK
23 ROLAS HISAR SITUMORANG HELPER SURVEY
24 YAMAN HELPER SURVEY JL BINA BAKTI, RT 11, GUNUNG SETELENG, PENAJAM 41
25 BADARUDDIN HELPER JL PROPINSI, KM 6, RT 06, NENANG, PENAJAM 31
26 SOFIAN NOR HELPER JL PROPINSI, LAWE-LAWE, RT 02, PENAJAM
27 ABDI WAHYAT DIAT HELPER MEKANIK
28 M EGO DWI HELPER MEKANIK
29 MUHAMMAD RAMADHANI HELPER WORKSHOP
30 SOPHIAN HELPER TRILLER
31 SAYID RAMSYAH HELPER HAULING JL PROPINSI, RT 04, NENANG, PENAJAM 31 4 June 2021 FIT TO WORK 16 June 2021
32 RIDWAN HELPER PETUNG JL PROPINSI, KM 2O, RT 11, PETUNG, PENAJAM 4 June 2021 FIT TO WORK 16 June 2021
33 YANTO HELPER SALOLOANG, RT 04, PENAJAM 33 4 June 2021 FIT TO WORK 16 June 2021
34 AMBO UPE HELPER SALOLOANG, RT 03, PENAJAM 30 4 June 2021 FIT TO WORK 16 June 2021
35 NANANG HELPER NIPAH-NIPAH NIPAH-NIPAH, RT 02, PENAJAM 46 5 June 2021 FIT TO WORK 16 June 2021
36 VIKKIARYANSYAH HELPER GIRIMUKTI JL PARIWISATA, RT 04, GIRIMUKTI, PENAJAM 23
SAFETY INDUCTION Training PTW ID CARD FAMILY CARD SKCK DOMISILI LETTER COVID TEST SKILL CERTIFICATION ID Badge
19 May 2021 √ √
29 May 2021 √ √ √ Done
√ √
29 May 2021 √ √ Done
29 May 2021 √ √ √ Done
29 May 2021 √ √ Done
02 June 2021 √ √ Done
03 June 2021 √ √ √ Done
03 June 2021 √ √ √ Done
03 June 2021 √ √ √ Done
03 June 2021 √ √ Done
10 June 2021 √ √
ex Wahana √ Done
ex Wahana √ √ Done
08 June 2021 √ √ √
08 June 2021 √ √ Experience Certificate
08 June 2021 √ √
08 June 2021 √

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√
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√
√ √ OTOMOTIF CERTIFICATE
√