JOB DESCRIPTION Page 1 of 1 JSA No.

/ / / DATE √ NEW
Uraian Pekerjaan Hal dari No. JSA Tgl. Baru

REVISED
Revisi

AREA/LOCATION Prepared by : Reviewed by :

JOB SAFETY ANALYSIS Areal/Lokasi Direview oleh
Analisa Keselamatan Pekerjaan

TEAM : FACILITY/EQUIPMENT JOB TEAM LEADER Acknowledged by :

Pemilik Fasilitas Fasilitas/Peralatan Penanggung Jawab Pekerjaan Diketahui oleh

REQUIRED / RECOMMENDED PPE Approved by :

PPE Yang Dibutuhkan / Disarankan Disetujui oleh

Concurred by :
Disetujui oleh

BASIC SEQUENCES OF JOB STEPS POTENTIAL HAZARDS RECOMMENDED CORRECTION ACTION

Pe
Urutan Pekerjaan Bahaya Yang Terkait Langkah / Prosedur Yang Disarankan
 BASIC SEQUENCES OF JOB STEPS POTENTIAL HAZARDS RECOMMENDED CORRECTION ACTION
Pe
Urutan Pekerjaan Bahaya Yang Terkait Langkah / Prosedur Yang Disarankan

Note : This JSA should be communicated prior to performing the job and be re-discussed during tailgate meeting end ensure that all concerned have clearly understood their roles and responsibilities
 PIC
Penanggung
jawab
 PIC
Penanggung
jawab

ailgate meeting end ensure that all concerned have clearly understood their roles and responsibilities