KONSEKUENSI KEMUNGKINAN

A B C D E

Pernah terjadi di Pernah terjadi di

Tidak pernah terjadi Pernah terjadi di suatu organisasi, atau lokasi, atau lebih dari Pernah terjadi lebih
di industri sejenis industri sejenis lebih dari satu kali per satu kali per tahun di dari satu kali per
sebelumnya tahun di industri tahun di suatu lokasi
sejenis suatu organisasi
KEPARAHAN

Asset* Di atas rata-rata; tim

Manusia Lingkungan Reputasi Tidak kredibel; Tim Kejadian dapat Di bawah rata-rata; tidak memiliki Mungkin terjadi dan
Biaya tersebut tidak termasuk kehilangan belum pernah dibayangkan tapi kejadian insiden pengetahuan tim memiliki
produksi atau kerusakan pihak ketiga mendengar tentang memerlukan dapat terjadi tetapi
peristiwa yang terjadi beberapa kegagalan dianggap tidak langsung tetapi pengetahuan tentang
di industri sistem dan kontrol mungkin kejadian tersebut kejadian serupa
dapat terjadi

Hampir tak terelakkan

Kombinasi beberapa Kombinasi beberapa Tidak pasti terjadi bahwa insiden akan
faktor yang jarang faktor yang dapat Bisa terjadi dengan tetapi faktor terjadi jika
menghasilkan suatu menghasilkan sebuah faktor tambahan tambahan dapat pembelajaran
insiden insiden menyebabkan insiden sebelumnya tidak
diterapkan

Nihil kecelakaan atau efek kesehatan Tidak ada kerusakan; tanpa biaya
0 pemulihan yang signifikan Tidak ada efek ke lingkungan Tidak ada dampak 1 1 1 1 1

Kecelakaan ringan Dampak Ringan

<$100K Efek Sementara
1 - Perawatan First Aid Rusak ringan, sistem tetap aman untuk Penanganan dalam hitungan hari atau Berdampak pada lokal saja, kegiatan operasi 1 1 2 2 2
- paparan tunggal atau banyak menyebabkan beroperasi minggu
tidak terpengaruh
iritasi tapi tanpa afek kesehatan signifikan

Kecelakaan Minor Dampak Kecil

2 - lebih dari First Aid tapi bukan berat
- paparan berlebih menimbulkan efek
kesehatan tapi tidak menimbulkan cacat
permanen
$100K - $1 million
Kerusakan ringan; sistem memerlukan
perbaikan yang signifikan
Kerusakan Minor
Perlu penanganan kurang dari 3 bulan
Perhatian lokal pada jangka pendek, tuntutan
1 2 2 3 3
finansial yang berdampak kecil, dampak
terhadap reputasi (skala kecil) dan beberapa
dampak pada kegiatan dan aset

Kecelakaan Berat Dampak yang Cukup Besar

- retak tulang; luka bakar derajat 3; luka mata
atau organ dalam; kehilangan kesadaran;
3 amputasi; keracunan berdampak cacat
permanen; hypothermia; kecelakaan
berakibat perawatan rumah sakit > 24 jam
- efek kesehatan menimbulkan cacat
permanen
$1 million - $10 million
Kerusakan besar; sistem membutuhkan
perbaikan besar atau penggantian.
Kerusakan Berarti
Perlu penanganan sampai satu tahun
Perhatian nasional pada jangka pendeh,
tuntutan terhadap reputasi/finansial secara 2 2 3 3 4
substansial, kehawatian daerah sekitar dalam
jangka pendek, pengawasan operasi yang
ketat untuk aset.

Dampak Nasional Utama

$10 million - $100 million
4 Kematian Tunggal Kerusakan yang luas; beberapa sistem
terkena dampak
Kerusakan Berat Keprihatinan nasional jangka menengah;
Perlu penanganan antara 1-5 tahun penuntutan dengan dampak reputasi besar 2 3 3 4 4
keuangan dan / atau nasional; operasi usaha /
asset kecil dibatasi
 Dampak International Utama
>$100 million Kerusakan Parah Keprihatinan nasional secara persisten;
5 Kematian Jamak penuntutan dengan bahan dan / atau 3 3 4 4 4
Hilangnya sebagian atau keseluruhan aset Perlu penanganan lebih dari 5 tahun
dampak reputasi internasional; operasi usaha
/ aset utama sangat dibatasi
 Consequence Likelihood
A B C D E

Has happen in the Has happen in the

Not known to have Known to have Has happened more
organization, or more location, or more then
occurred in the ocurred of in the then once a year in then once per year in once per year in
industry before industry the location
the industry the organization
Severity

Asset* Not credible; team Conceivable but Below average; can Above average: team Likely to occur and
has no direct
People Environment Reputation has not heard of would require postulate a scenario knowledge but event the team have
* Cost of event excluding consequential event occurring in multiple failures of for incident but knowledge of similar
production loss or third party damages industry systems and controls considered unlikely represents credible
scenario event

A rare combination of A combination of Could happen with Not certain to happen Almost inevitable that
an incident would
factors would be factors would be additional factors but an additional
required for an required for an present, otherwise factor may result in occur if previous
incident to result incident to result unlikely to occur an incident learning was not
applied

No detrimental effect to the

0 No Injury or Health Effect No damage; no significant recovery cost environment No impact 1 1 1 1 1

Slight Injury
<$100K Temporary effect Slight impact
1 - First Aid treatment
Slight damage; system remains safe to Local mention only; freedom to operate 1 1 2 2 2
- single or multiple exposure causing irritation but no operate Remediation possible in days/weeks unaffected
significant health effects

Minor Injury Minor impact

$100K - $1 million Minor damage
Short term local concern; prosecution with
2 - more than First Aid but less than major
Minor damage; affected system requires Requires limited (less than 3 months) minor financial and/or short term 1 2 2 3 3
- overexposure resulting in health effects but not significant repair environmental management reputational impact; some impact on asset
leading to permanent disability activities

Major Injury Considerable impact

- fracture [not digit]; 3rd degree burn; injury to eyes $1 million - $10 million Considerable damage Short term national concern; prosecution
or internal organs; loss of consciousness [from an
3 impact]; any amputation; poisoning with risk of Major damage; affected system requires Requires short-term (up to 1 year) with substantial financial and/or local 2 2 3 3 4
permanent health injury; hypothermia; injury reputational impact; short term regional
requiring hospitalization for >24hr major repair or replacement. environmental management concern; close scrutiny of asset level
operations/future
- health impact leading to permanent disability

Major national impact

$10 million - $100 million Major damage Medium term national concern; prosecution
4 Single Fatality Requires significant (1-5 years) environmental with major financial and/or national 2 3 3 4 4
Extensive damage; multiple systems affected management reputational impact; minor venture/ asset
operations restricted

Major international impact

>$100 million
5 Multiple Fatalities
Partial or complete loss of Asset
Catastrophic damage
Persistent national concern; prosecution with
Requires long-term (more than 5 years) material and/or international reputational 3 3 4 4 4
environmental management impact; major venture/ asset operations
severely restricted
JPT OK RACI CHART
SITE TEAM JAKARTA TEAM

Senior Operation Superintendent

Senior HSE Supervisor

Operations Manager
Catogorisation Level of
Category
identified Residual Risk

HSE Co-ordinator

General Manager
Line Supervisor*

Field Manager
LOW RISK
1 Manage through identified C/I R/A
controls
MEDIUM RISK
2 Reduce risks through C R A I
internal verification
HIGH RISK
3 Reduce risks through C C R A C I
independent verification
INTOLERABLE
Do not take risk
4 Develop controls to reach C C C C C R A
ALARP region or Terminate
activity

R Responsible Who owns the problem or project

To whom the responsible person is
A Accountable accountable; who must sign off on or
approve the work before it is implemented
Who has the information and / or
C Consulted
capabilities necessary to guide or coach
Who must be notified of the result but need
I Informed
not be consulted
Note:
* Line Supervisor can be Supervisor or Superintendent in related Department whichever higher
Delegation of authority can only be transferred to one position higher
 PT. Angin Ribut Bogor.
HAZARD IDENTIFICATION, RISK ASSESSMENT AND DETERMINATION CONTROL

Low Risk; Acceptable - Manage through identified controls

Form No: HSE-RA/001. Medium Risk; Acceptable - Demonstrate risk in ALARP

Rev/Date: 07 April 2017. High Risk; Acceptables - Reduce risks to

ALARP through application of further controls
Validity : 2 years Intolerable; Not Acceptable - Do not take this
risk. Seek alternatives in activity and content

DEPT / ACTIVITY / WORK Renovasi Dapur DATE 7-Apr-18

TEAM MEMBER : Donald Trump, Tukul Arwana, Bismi B4.
1 2 3 4 5 6 7 8 9 15 10 11 12
RESIDUAL
INITIAL RISK RISK
Hazard (Anything that has the Causes or Threat (A possible
cause that will release the Recommendation or Barrier (A measure which is put in to
ACTIVITIES (Equal with potential to cause harm, ill Consequence (An
hazard to become a top event- prevent the release of a hazard or to
health event or chain of
Line No

Top Event. The incident prevent the occurrence of a top event once the hazard is
which occurs as a result of and injury, damage to property, events that results includes thermal, biological,
the hazard products or the from the hazard electrical, chemical, kinetic,
released - Critical Task Risk
being released. Example: environment, production losses S L R recommendation or barriers may be physical or non - physical. S L R
being released. climatic,
Lifting or Confined Space) or increase liabilities. Example: Example: Fatality) Example: Lifting plan. Two kind of Barrier i.e. PRO ACTIVE &
radiation or human factors. REACTIVE)
Oxygen deficiency) Example: Excessive lifting)
DEPT / ACTIVITY / WORK Renovasi Dapur DATE 7-Apr-18
TEAM MEMBER : Donald Trump, Tukul Arwana, Bismi B4.
1 2 3 4 5 6 7 8 9 15 10 11 12
RESIDUAL
INITIAL RISK RISK
Hazard (Anything that has the Causes or Threat (A possible
cause that will release the Recommendation or Barrier (A measure which is put in to
ACTIVITIES (Equal with potential to cause harm, ill Consequence (An
hazard to become a top event- prevent the release of a hazard or to
health event or chain of
Line No

Top Event. The incident prevent the occurrence of a top event once the hazard is
which occurs as a result of and injury, damage to property, events that results includes thermal, biological,
the hazard products or the from the hazard electrical, chemical, kinetic,
released - Critical Task Risk
being released. Example: environment, production losses S L R recommendation or barriers may be physical or non - physical. S L R
being released. climatic,
Lifting or Confined Space) or increase liabilities. Example: Example: Fatality) Example: Lifting plan. Two kind of Barrier i.e. PRO ACTIVE &
radiation or human factors. REACTIVE)
Oxygen deficiency) Example: Excessive lifting)

1 Menyiapkan terjepit, tersetrum, People ; tidak fokus, terburu buru, 5 E 4 1. Pro Active ;. A. Pro Active ; 0 A 1
mobil, tergores, terpeleset, - multiple menutup cap mobil tidak 1. periksa kendaraan sebelum di gunakan 1. sertifikat DDT
tersandung, terjatuh, Fatality pas, housekeeping kurang, 2. drver harus berkompeten 2. pre use checklist kendaraan
3. tidak terburu buru 3. membawa surat" lengkap (SIM, STNK)
2 Mengendarai tepapar oli dan air aki, Equipment : kabel mesin terkelupas,
4. harus fokus 4. di lakukan supervisi dan pengawasan
mobil kerumah pusing, terbentur cap major pencahayaan kurang, tidak 4. tidak melakukan aktivitas lain saat mengendarai saat pekerjaan berlangsung
bos, mobil, 'tertabrak, Material : fit, surat" tidak lengkap, 5. membawa surat" yang masih aktif ( SIM, STNK) 5. PTW
terbentur, ditilang, minor menerobos lalu lintas, 6. memakai sabuk pengaman saat mengendarai 6. toolbox meeting
3 mengantar bos tergelincir, menabrak, Environment: kondisi jalan yang rusak, 7. mematuhi lalu lintas
ke bandara, mogok, ban bocor', minor tidak memakai sabuk 8. driver cukup istirahat
9. kondisi driver harus fit B. Reactive ;
backpain, stress Proses : pengaman, kondisi 10. mencari jalan alternatif
4 pulang ke kendaran tidak layak,tidak 1. Menyediakan kotak P3K
11. mengetahui rute yang akan d tempuh
rumah , mengatur jarak aman, 2. Menyediakan nomor darurat
12. melakukan housekeeping
cuaca buruk, pengguna 13. mengatur jarak aman 3. menyediakan pekakas tangan
5 memasukkan jalan lain ugal ugalan driver 14. pencahayaan garasi yang cukup
mobil ke garasi tidak kompeten, jalanan 15. mengatur kecepatan
16. menyiapkan GPS
macet, posisi duduk yang 17. melakukan toolbox meeting sebelum bekerja
salah

'2. Reactive.;
1. Menyediakan kotak P3K
2. Menyediakan nomor darurat
3. menyediakan pekakas tangan
 13
Risk Owner

14
Acceptable/ Not Acceptable
 13
Risk Owner

14
Acceptable/ Not Acceptable
 PT. Angin Ribut Bogor.
HAZARD IDENTIFICATION, RISK ASSESSMENT AND DETERMINATION CONTROL

Low Risk; Acceptable - Manage through identified controls

Form No: HSE-RA/001. Medium Risk; Acceptable - Demonstrate risk in ALARP

Rev/Date: 07 April 2017. High Risk; Acceptables - Reduce risks to

ALARP through application of further controls
Validity : 2 years Intolerable; Not Acceptable - Do not take this
risk. Seek alternatives in activity and content

DEPT / ACTIVITY / WORK Menggali Sumur tua DATE 7-Apr-18

TEAM MEMBER : Donald Trump, Tukul Arwana, Bismi B4.
1 2 3 4 5 6 7 8 9 15 10 11 12
RESIDUAL
INITIAL RISK RISK
Hazard (Anything that has the Causes or Threat (A possible
cause that will release the Recommendation or Barrier (A measure which is put in to
ACTIVITIES (Equal with potential to cause harm, ill Consequence (An
hazard to become a top event- prevent the release of a hazard or to
health event or chain of
Line No

Top Event. The incident prevent the occurrence of a top event once the hazard is
which occurs as a result of and injury, damage to property, events that results includes thermal, biological,
the hazard products or the from the hazard electrical, chemical, kinetic,
released - Critical Task Risk
being released. Example: environment, production losses S L R recommendation or barriers may be physical or non - physical. S L R
being released. climatic,
Lifting or Confined Space) or increase liabilities. Example: Example: Fatality) Example: Lifting plan. Two kind of Barrier i.e. PRO ACTIVE &
radiation or human factors. REACTIVE)
Oxygen deficiency) Example: Excessive lifting)

Menyiapkan Terpeleset, People ; tidak fokus, terburu buru, , 4 d 4 1. Pro Active ;. A. Pro Active ; 0 A 1
peralatan tersandung, terbentur, - Fatality housekeeping kurang, 1. Melakukan toolbox meeting 1. PTW
(penggalian tertimpa peralatan, Equipment : pencahayaan kurang, tidak 2. Bekerja Sesuai Prosedur 2. Sertifikat WAH
1 sumur, confine 3. tidak terburu buru 3. Sertifikat Confine Space
Terjatuh, di gigiti Material : fit, tidak sesuai prosedur,
4. harus fokus 4. di lakukan supervisi dan pengawasan
space, work at binatang, keracunan minor tidak melakukan 4. Di lakukan ketika cuaca tidak buruk saat pekerjaan berlangsung
hight), gas berbahaya, Environment: pengecekan gas 5. Melakukan Pengecekan gas berbahaya 5. Bukti form dan Photo Tollbox meeting
terkena cangkul, ispa, Proses : berbahaya, tidak 6. Memerikasa APD
kekurangan oksigen, optimalnya sirkulasi udara, 7. Memakai APD
tersambar petir, tidak menyediakan air 8. Mengatur jam operator
9. Memberikan sirkulasi udara dengan blower B. Reactive ;
Membuka tutup dehidrasi 'Terjepit, cicin minum, tidak 10. Menyediakan Air minum
sumur, jatuh 'tertimpa material menggunakan apd, 1. Menyediakan kotak P3K
11. melakukan housekeeping
galian, iritasi mata, bekerja pada cuaca 2. Menyediakan nomor darurat
12. Pencahayaan Gudang cukup
Menggali sumur, terpeleset ekstrem, pekerja tidak 13.Pekerja yang kompeten
kompeten
Mengangkut '2. Reactive.;
1. Menyediakan kotak P3K
material galian, 2. Menyediakan nomor darurat
Memasang
cincin sumur,
Kembalikan alat
dan
merapikannya
 13
Risk Owner

14
Acceptable/ Not Acceptable