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Hazard Identifications Risk Assessment

Job Safety and Environment Analysis (JSEA)


Facility/ Lokasi : Kelompok :
Job/ Pekerjaan/ Aktifitas : Tanggal/Bulan :
Job Dilakukan oleh (jabatan) : Revisi No :
Ketua Kelompok : :
JSA Number : Disetujui oleh Asisten/Teknisi/Dosen :

Urutan Potensi Akibat yang Tindakan Tingkat


Lokasi/ K3 Rekomendasi
kegiatan pada Bahaya ditimbulkanya. Pengendalian Kemungkinan Akibat Resiko / Peraturan
No. Kegiatan/ L A pengendalian
pekerjaan (Hazard/ ( Consequence yang telah (K) (A) Dampak terkait
Bahan S H tambahan
(Proses) Aspek) /Dampak) dilakukan (K)x(A)

Eliminasi, subtitusi, engineering desain, dengan cara administrasi atau memberlakukan prosedur operasional (Work Instruction) serta fasilitas Alat pelindung diri

Likelihood/ Kemungkinan terjadi Severity/ Kemungkinan besarnya dampak B. Dampak bagi Aset/ Perlengkapan/Lingkungan Tabel Nilai Resiko
1. Rare = practically impossible A. Dampak bagi Personal 1. Insignificant = loss < 500,000.
2. Unlikely = may occur at some time 1. Insignificant = no treatment required, level 2. Minor = 500,001 < loss < 5,000,000. Likeli- Severity of Risk
3. Possible = could occur or “I have heard of it short time injury 3. Moderate = 5,000,001< loss < 50,000,000 hood 1 2 3 4 5
happening” 2. Minor = first aid 4. Major = 50,000,0001 < loss < 100,000,000.
4. Likely = known to occur or “it has happened” 3. Moderate = MTI or LTI by doctor 5. Catastrophic = loss > Rp 100,000,000. 1 L L L M H
5. Almost Certain = occur in most circumstances certificate 2 L L M H H
or repeating occurrence 4. Major = permanent disability or single
fatality 3 L M H H E
5. Catastrophic = multiple fatalities 4 M H H E E
5 H H E E E
Prosedur-QSHE-001/S1 Rev 0

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