TGI_38K6152101A02_c0v0_REV2.pdf

FOUO

FOUO: Public availability to be determined under 5 USC 552

TASK GROUP INSTRUCTION

AIM REV 20.11.4.0 (OCTOBER 2020)

TGI COMPONENT NAME: TYPE: PHASE: REPEAT: CHANGE:

NO.: TEMPORARY STAGING SY TST A 2 0

SHIP/HULL NO.: SHIP/HULL NAME: SYSTEM: PROJ/WO NO: CASREP CAT:

DDG-115 USS RAFAEL PERALTA 86511 K61

CU PHASE TITLE:

*F/O - INSTL & RMV SCAFFOLDING TO/FROM ZONE-2 CMWD SYS PIPING RPR WORK AREA

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

NAOKI KUROKAWA 231B. 315-243-0108 24-OCT-2025

APPROVED BY: CODE PHONE DATE

RYOUTA TAKAGI 231B. 315-243-4502 24-OCT-2025

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

REASON FOR WORK/NEED FOR CHANGE:

CHANGE INSTRUCTIONS:

SPECIAL REQUIREMENTS:

WORK CERTIFICATION SIGNATURES

COMPLETION OF WORK REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

ACCEPTANCE OF COMPLETED WORK

PHYSICAL INSPECTION PHYSICAL INSPECTION COMPLETED: BADGE NO.: SHOP/CODE: PHONE: DATE:

REQUIRED:☐YES ☒NO

RECORDS REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

TGI NO.: TEMPORARY STAGING SY TST A 2

FOUO

SHIP: DDG-115 CHG/VER: 0/0

LIST OF EFFECTIVE PAGES

SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO.

1-4 J-1 M-1

1. SCOPE/PURPOSE

1.1 Title: Scaffolding for Ship Repair Facility and Japan Regional Maintenance Center (SRF-JRMC) Work; install and remove

1.2 Location of Work:

1.2.1 05 Level Weather, Frames between 158 and 164, Port

1.2.2 04 Level Weather, Frames between 130 and 160, Port

1.2.3 04 Level Weather, Frames between 155 and 160, Starboard (Stbd)

1.2.4 03 Level Weather, Frames between 140 and 165, Stbd

1.2.5 Between 01 Level and 02 Level Weather, Frames between 110 and 115, Port and Stbd

1.2.6 02 Level Weather, Frames between 135 and 140, Stbd

1.2.7 Pilot House (04-130-0-C)

1.2.8 Array Room No. 3 and Electronic Workshop No. 1A (03-158-3-Q)

1.2.9 Array Room No. 4 and Electronic Workshop No. 1B (03-158-2-Q)

1.2.10 Fan Room (03-142-3-Q)

1.2.11 Fan Room (03-142-4-Q)

1.2.12 Commanding Officer Stateroom (02-136-3-L)

1.3 Identification:

1.3.1 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.1 Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.2 Quantity (3 Lot), Scaffolding Assembly

Location: 1.2.2 Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.3 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.3 Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.4 Quantity (2 Lot), Scaffolding Assembly

Location: 1.2.4 Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

FOUO

SHIP: DDG-115 CHG/VER: 0/0

1.3.5 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.5 Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.6 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.6 Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.7 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.7, Frames between 130 and 135, Port Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.8 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.8, Frames between 155 and 160, Stbd Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.9 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.9, Frames between 155 and 160, Port Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.10 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.10, Frames between 148 and 156, Stbd Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.11 Quantity (3 Lot), Scaffolding Assembly

Location: 1.2.11, Frames between 142 and 158, Port Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.3.12 Quantity (One Lot), Scaffolding Assembly

Location: 1.2.12, Frames between 140 and 145, Stbd Remarks: Repair work of countermeasure washdown system piping will be accomplished by SRF-JRMC.

1.4 Security Classification:

1.4.1 Spaces - 1.2.8 and 1.2.9

1.5 Initial Condition: None.

1.6 Contractor Work start date:

1.7 Contractor Work completion date:

2. REFERENCES:

REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

1 NSI FY-26 NAVSEA Standard Items - 1 N 2 LI FY-26 Local Standard Items - ORG N

3 TM 29 CFR

PART

1915.71

Scaffolding or Staging - N

3. APPENDICES:

Kouichi.Yoshida.ja Typewritten Text 10/19/2026

Kouichi.Yoshida.ja Typewritten Text 12/13/2026

FOUO

SHIP: DDG-115 CHG/VER: 0/0

3.1. Appendix “J” TGI Job Summary Information Sheet

3.2. Appendix "M" TGI Material List

3.3. Appendix “D” Deficiency Form

4. GENERAL REQUIREMENTS:

4.1 Not Applicable

5. PROCEDURE:

5.1 Erect/hang scaffolding listed in 1.3.1 through 1.3.12 in accordance with 2.3.

5.2 Remove scaffolding listed in 1.3.1 through 1.3.12 upon completion of the work in accordance with 2.3 when requested by SRF-JRMC via Code 333.

5.3 Notes:

5.3.1 Planner: Code 231B N. Kurokawa, 243-0108

5.3.2 Work Integration Manager (WIM): Code 333 T. Yaginuma, 080-6522-9560

5.3.3 JCN ER04-1265 is related to this TGI.

5.4 Government Furnished Material (GFM): None.

5.5 SRF-JRMC will provide the following service work: (TGI No. 38K6152101S02)

5.5.1 [C740] Crane and crane rigger service.

5.5.2 [C106.1] Safety inspection for SRF-JRMC employees.

5.5.3 [C133] QA inspection for (G) symbol(s).

Kouichi.Yoshida.ja Cross-Out

Kouichi.Yoshida.ja Typewritten Text

1/30/2026 C1209.2 K. YOSHIDA

TGI NO.: TEMPORARY STAGING

SY

TST A 2

FOUO

M-1

SHIP: DDG-115 CHG/VER: 0/0

APPENDIX “M”

TGI MATERIAL LIST

SYSTEM: PLANT NO.: COMPONENT NAME: TYPE: PHASE: REPEAT: CU PH

VERSION:

CASREP

CAT:

86511 TEMPORARY STAGING SY TST A 2 0

CU PHASE TITLE:

*F/O - INSTL & RMV SCAFFOLDING TO/FROM ZONE-2 CMWD SYS PIPING RPR WORK AREA

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

38K6152101 A02

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

NOTES:

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR APPENDIX "D"

DEFICIENCY FORM

☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One)

2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

DDG-115 TEMPORARY STAGING SY TST A 2

4a. ICN: 4b. KEY OP: 5. LOC SPACE/LVL: FRAME: P/S/C: 6. CAUSED BY:

38K6152101 A02

7. DESCRIPTION:

8. ORIGINATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

9. CORRECTIVE ACTION:

10. EVALUATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

FOR NON-NUCLEAR USE ONLY

11. RFD/RFW REQ’D ☐ LAR REQ'D ☐

ILS MOD REQ’D ☐

SRD/PLAN REV REQ'D ☐

DWG NO.: _____________________ S/A NO.: ___________________

12. ISOLATION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.:

SATISFACTORY:

13. SUBSAFE OQE RECORD? SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

YES ☐ NO ☐

14. CORRECTIVE ACTION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE:

15. INSPECTION REQ’D? INSPECTION COMPLETE/SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

_________:YES ☐ NO ☐

16. RECORDS REVIEW SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE (DR ONLY)

DL’s ISSUED

(DR ONLY)

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR Deficiency Form Continuation Sheet ☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One) 2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

DDG-115 TEMPORARY STAGING SY TST A 2