TEST REPORT

CONTROL & INSTRUMENTATION

CONTROL VALVE
TAG NUMBER: LIC-3005-CV SERVICE: GAS RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 4.100 6.000 11.600 15.200 17.000 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1.025 0.75 0.96666666667 0.95 0.85

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN:

 TEST REPORT
CONTROL & INSTRUMENTATION
CONTROL VALVE
TAG NUMBER: LIC-3008-CV SERVICE: GAS RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 5.000 7.000 13.000 17.000 19.000 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1.25 0.875 1.08333333333 1.0625 0.95

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN:

 TEST REPORT
CONTROL & INSTRUMENTATION
CONTROL VALVE
TAG NUMBER: FIC-2002-CV SERVICE: STEAM RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 4.500 8.600 13.000 17.200 19.900 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1.125 1.075 1.08333333333 1.075 0.995

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN:

 TEST REPORT
CONTROL & INSTRUMENTATION
CONTROL VALVE
TAG NUMBER: PIC-1023-CV SERVICE: WATER RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 4.000 8.000 14.000 18.000 20.000 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1 1 1.16666666667 1.125 1

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN:

 TEST REPORT
CONTROL & INSTRUMENTATION
CONTROL VALVE
TAG NUMBER: PIC-1006-CV SERVICE: RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 4.800 9.000 15.000 18.000 20.000 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1.2 1.125 1.25 1.125 1

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN:

 TEST REPORT
CONTROL & INSTRUMENTATION
CONTROL VALVE
TAG NUMBER: PIC-1003-CV SERVICE: NATURAL GAS RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 4.60 8.20 12.90 16.80 19.30 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1.15 1.025 1.075 1.05 0.965

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN:

 TEST REPORT
CONTROL & INSTRUMENTATION
CONTROL VALVE
TAG NUMBER: PIC-1002-CV SERVICE: PURGE GAS TO NATURAL GAS FLOW RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 4.000 8.000 12.000 17.000 19.600 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1 1 1 1.0625 0.98

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN:

 TEST REPORT
CONTROL & INSTRUMENTATION
CONTROL VALVE
TAG NUMBER: FRC-1002-CV SERVICE: PURGE GAS TO NATURAL GAS FLOW RANGE:
ORDER NUMBER: WO DESC. ACCURATION: 0.1% OF SPAN
MANUFACTURE MODEL TYPE SERIAL NUMBER

PRE-WORK INSTRUCTION DATE:

DOCUMENT Valid PTW WORK CENTRE NAME DURATION TEXT DESCRIPTION
HIRA LOTO
SAFETY EQUIPMENT
PPE Valid GAS DETECTOR SAFETY PROTECTION
HARNESS APRON LOCK KEY
GLOVES FACE SHIELD TAG OUT
TEST TOOL MODEL & SERIAL NUMBER CAL. DUE HAND TOOLS CONSUMMABLE
SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE INDICATOR SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER SPANNER 9/16, 5/8, 7/8 DE-GREASER
CURRENT SIMULATOR SILICONE GREASE

WORK INSTRUCTION DATE:

INTERLOCK Bypass Dissable Manual Mode
Describe details:

TEST IN SITU WOKRSHOP TEMPERATURE: HUMIDITY:

SCALE STROKE TIME
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 AS FOUND
INPUT SCALE ( % ) 0.00 25.00 50.00 75.00 100.00 OPEN TO CLOSE ( SEC )
I/P CONVERTER OUT VALUE ( PSI ) 3 6 9 12 15 CLOSE TO OPEN ( SEC )
CONTROL VALVE OPENING ( % ) 0 25 50 75 100 AS LEFT
POSITION TRANSMITTER OUT ( mA ) 5.00 9.00 13.00 17.30 19.90 OPEN TO CLOSE ( SEC )
4 8 12 16 20 CLOSE TO OPEN ( SEC )
REMOTE TEST
AS FOUND MAX ERROR: PASS: FAIL LOCKING PRESSURE
CONTROL OUTPUT VALUE ( % ) 0 25 50 75 100 AS FOUND ( BAR )

VALVE POSITION VALUE ( % ) 0 25 50 75 100 AS LEFT ( BAR )

ERROR OF SPAN ( % ) 1.25 1.125 1.08333333333 1.08125 0.995

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Actuator Body Dirties Y
TEXT AS FOUND Bleed Valve Tightness, Leakness N
Tubing & Connection Tightness, Leakness Y
MEASURING POINT Manifold Valve Tightness, Leakness Y
IK11
MEASURING DATA Electronic Housing Cleaness N
TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease N
Cable Shoe & Termination Tightness, Looseness N
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness N
Impulse Drain Valve Tightness, Leakness N
Plug Drain Valve Tightness, Leakness N

AS LEFT CONDITION Normal Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION DATE:

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK
DOCUMENTATION DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN: