TEST REPORT

CONTROL & INSTRUMENTATION

TRANSMITTER: ✘ FLOW
TAG NUMBER: FR-3005- T 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
PRESSURE INDICATOR ✘ SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE MODULE ✘ SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER ✘ SPANNER 9/16, 5/8, 7/8 DE-GREASER
PRESSURE GENERATOR SILICONE GREASE
INJECTOR 4-20 Ma

WORK INSTRUCTION DATE: 29 Jul 2022

INTERLOCK Bypass Dissable ✘ Manual Mode
Describe details:

TEST ✘ IN SITU CALIBRATION WOKRSHOP CALIBRATION TEMPERATURE: HUMIDITY:

SCALE Input Scale: mmH20, InchH20, Bar, mBar
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 75.00 50.00 25.00 0.00
INPUT SCALE ( )
STANDARD VALUE ( mA ) 4.000 8.000 12.000 16.000 20.000 16.000 12.000 8.000 4.000

AS-FOUND MAX ERROR: STATUS: PASS FAIL

MEASURED VALUE ( mA ) 4 7.5 11 15.2 18.3 16.3 12.7 7.2 4.3

ERROR OF SPAN ( % ) 0.000 0.500 1.000 0.800 1.700 -0.300 -0.700 0.800 -0.300
✘
LOOP TEST DCS Indication: Kg/S, Bar, mBar. DP Transmitter Reverse : Injection Well Flowmeter
DP TRANS - NORMAL ( % ) 0.00 6.25 25.00 56.25 100.00 56.25 25.00 6.25 0.00
DP TRANS - REVERSE ( % ) 100.00 93.75 75.00 43.75 0.00 43.75 75.00 93.75 100.00
PRESSURE ( % ) 0.00 25.00 50.00 75.00 100.00 75.00 50.00 25.00 0.00
DCS INDICATION ( ) N/A N/A N/A N/A N/A N/A N/A N/A N/A

ERROR OF SPAN ( % ) N/A N/A N/A N/A N/A N/A N/A N/A N/A

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Main Isolation Valve Tightness, Leakness ✘

TEXT AS FOUND Bleed Valve Tightness, Leakness ✘

Tubing & Connection Tightness, Leakness ✘

MEASURING POINT Manifold Valve Tightness, Leakness ✘

IK11
MEASURING DATA Electronic Housing Cleaness ✘

TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease ✘

Cable Shoe & Termination Tightness, Looseness ✘
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness ✘
Impulse Drain Valve Tightness, Leakness ✘
Plug Drain Valve Tightness, Leakness ✘

AS LEFT CONDITION Normal ✘ Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION ✘ DATE: 29 Jul 2022

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

TRANSMITTER: ✘ FLOW
TAG NUMBER: FR-1017-T 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
PRESSURE INDICATOR ✘ SCREWDRIVER FLAT & PHILIPS MEDIUM SEAL TAPE
PRESSURE MODULE ✘ SPANNER 8, 10, 13, 17, 19 ELECTRICAL TAPE
AMPEREMETER ✘ SPANNER 9/16, 5/8, 7/8 DE-GREASER
PRESSURE GENERATOR SILICONE GREASE
INJECTOR 4-20 Ma

WORK INSTRUCTION DATE: 29 Jul 2022

INTERLOCK Bypass Dissable ✘ Manual Mode
Describe details:

TEST ✘ IN SITU CALIBRATION WOKRSHOP CALIBRATION TEMPERATURE: HUMIDITY:

SCALE Input Scale: mmH20, InchH20, Bar, mBar
INPUT PERCENTAGE ( % ) 0.00 25.00 50.00 75.00 100.00 75.00 50.00 25.00 0.00
INPUT SCALE ( )
STANDARD VALUE ( mA ) 4.000 8.000 12.000 16.000 20.000 16.000 12.000 8.000 4.000

AS-FOUND MAX ERROR: STATUS: PASS FAIL

MEASURED VALUE ( mA ) 4 8 12.3 17.2 19.8 16.8 11.9 8.2 4.1

ERROR OF SPAN ( % ) 0.000 0.000 -0.300 -1.200 0.200 -0.800 0.100 -0.200 -0.100
✘
LOOP TEST DCS Indication: Kg/S, Bar, mBar. DP Transmitter Reverse : Injection Well Flowmeter
DP TRANS - NORMAL ( % ) 0.00 6.25 25.00 56.25 100.00 56.25 25.00 6.25 0.00
DP TRANS - REVERSE ( % ) 100.00 93.75 75.00 43.75 0.00 43.75 75.00 93.75 100.00
PRESSURE ( % ) 0.00 25.00 50.00 75.00 100.00 75.00 50.00 25.00 0.00
DCS INDICATION ( ) N/A N/A N/A N/A N/A N/A N/A N/A N/A

ERROR OF SPAN ( % ) N/A N/A N/A N/A N/A N/A N/A N/A N/A

MEASURING POINT Check Point Condition As Found As Left

IK11
MEASURING DATA Main Isolation Valve Tightness, Leakness ✘

TEXT AS FOUND Bleed Valve Tightness, Leakness ✘

Tubing & Connection Tightness, Leakness ✘

MEASURING POINT Manifold Valve Tightness, Leakness ✘

IK11
MEASURING DATA Electronic Housing Cleaness ✘

TEXT AS LEFT Terminal Cover Thread Cleaness, Dryness : Grease ✘

Cable Shoe & Termination Tightness, Looseness ✘
WORK CENTRE DURATION NAME Support / Stanchion Tightness, Looseness ✘
Impulse Drain Valve Tightness, Leakness ✘
Plug Drain Valve Tightness, Leakness ✘

AS LEFT CONDITION Normal ✘ Removed By Pass Leave as it is

Describe:

TEXT

POST WORK INSTRUCTION ✘ DATE: 29 Jul 2022

CLOSE OUT PTW WORK CENTRE DURATION TEXT DESCRIPTION
RELEASE LOTO
TOOLS CHECK
PPE CHECK ✘

DOCUMENTATION ✘ DATABASE SCAN

TESTED BY: Maryono SIGN: CHECKED BY: SIGN: