Sheet 1 of 10

JOB NO. REV

PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

JOB SAFETY ANALYSIS (TEMPLATE)

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
PIPING (FRP) WORK
PEKERJAAN PIPA (FRP)
1. Preparation Frequent Physical  W 2 5 M  Safety Supervisor 2 2 L
orkers injury orientation/induction HSE Officer
(Transporting material Berkali-kali Fisik Pengawas,
Pekerja terluka Pengarahan tentang
and equipment)  D keselamatan Petugas
Persiapan amage of  Provide HSE
(Pengangkutan material/ approved and required PPE
equipment Menyediakan Alat Pelindung
material dan Kerusakan Diri (APD) yang dibutuhkan
peralatan) material/peralatan dan disetujui
 F  Conduct
alling hazard Tool Box Meeting
Potensi bahaya Melaksanakan Tool Box
terjatuh Meeting
 H  Confirming
it by permit, working area,
Terkena oleh barricade and required sign
board must be provide first.
Konfirmasi tentang ijin kerja,
tempat kerja, barikade dan
tanda-tanda peringatan yang
dibutuhkan harus disediakan
terlebih dahulu
 Access road
for material/equipment must
be confirmed with MC
Akses jalan untuk
material/peralatan harus
dikonfirmasikan dengan MC
 Follow-up
accepted work procedure
Ikuti prosedur kerja yang
telah disetujui
 Proper
loading and unloading
 Sheet 2 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
method
Metode bongkar dan muat
yang tepat
 Signal man
must be stand by all time
Signal Man harus selalu
berada ditempat kerja setiap
waktu

2. Marking One Time Physical  Hit by 2 1 L  Provide Supervisor 1 1 L

approved and required PPE Pengawas
(Survey work) Sekali Fisik Terkena oleh
Menyediakan Alat Pelindung
Menandai/pekerjaan  Tools Diri (APD) yang dibutuhkan
survei broken dan disetujui
Alat-alat rusak  Conduct
Tool Box Meeting
Melaksanakan Tool Box
Meeting
 Tools and
equipment must be checked
and approved.
Alat-alat dan perlengkapan
harus dicek dan disetujui

3. Working at height Each time Physical  W 4 5 H  Provide Supervisor 2 3 M

Fisik orkers injury approved and required PPE HSE Officer
Bekerja di ketinggian Kadang- to conduct
Pekerja terluka Menyediakan Alat Pelindung
kadang  Falling Diri (APD) yang dibutuhkan periodic
from height dan disetujui check.
Terjatuh dari  Conduct Pengawas,
ketinggian Tool Box Meeting Petugas
 Falling Melaksanakan Tool Box HSE
hazard Meeting melaksana
Potensi bahaya  Post the kan
terjatuh work area with warning signs pengecek
 Stumble and barricades an secara
Tersandung Tempatkan tanda peringatan berkala
dan barikade di tempat kerja
 Safety
 Sheet 3 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
harness must be worn at
height 1.5 meter and above
Ketinggian 1,5 meter lebih
harus memakai Safety Body
Harnnes
 Provide
safety line/life line to hook up
the safety harness
Menyediakan tali pengaman
untuk mencantolkan Safety
Body Harnnes
 Proper
access ladder to be used and
secured
Akses tangga yang akan
digunakan harus layak dan
aman
 Properly
stacking and storage of
materials. Overloading of
materials is prohibited.
Penumpukan dan
penyimpanan material yang
tepat. Dilarang menumpuk
material terlalu berlebihan.
 Tools and
materials shall be secured
properly during working
Material dan alat-alat harus
aman selama pekerjaan
 No blockage
accessibility along the
platform
Tidak ada yang menghalang-
halangi akses jalan
sepanjang papan perancah
 Enough and
sufficient lighting to be
installed for night working.
 Sheet 4 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
Pemasangan penerangan
secukupnya untuk pekerjaan
malam
 Check and
identify all overhead electrical
lines around the scaffolding
Cek dan identifikasi semua
jalur listrik di sekitar
perancah
 Ensure that
the safe distance to the live
overhead electrical lines
Memastikan bahwa jarak
adalah aman dari jalur listrik

4. Installation of Each time Physical  Finger 4 5 H  Provide Supervisor 2 3 M

Fisik injuries approved and required PPE HSE Officer
Scaffolding Kadang- Pengawas,
Jari terluka Menyediakan Alat Pelindung
Pemasangan kadang  Falling Diri (APD) yang dibutuhkan Petugas
perancah hazard dan disetujui HSE
Potensi bahaya  Conduct
terjatuh Tool Box Meeting
 Falling Melaksanakan Tool Box
from height Meeting
Terjatuh dari  Only
ketinggian competent scaffolders are
 Hit by allowed to erect scaffold
Terkena oleh Hanya scaffolder yang
berkompeten yang
diperbolehkan memasang
perancah
 Erection
area need to be barricaded
Area pemasangan harus
dibarikade
 At height 1,5
meter and above, use of
Safety Body Harness
Ketinggian 1,5 meter lebih
 Sheet 5 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
harus memakai Safety Body
Harnnes
 All
scaffolding shall be tagged
and inspected prior to be
used
Semua perancah harus di
tag dan diinspeksi sebelum
digunakan
 Appropriate
signboards need to be in
place
Tanda-tanda peringatan
yang sesuai harus dipasang
ditempat kerja
 Use only
RATCHET to tighten the
clamps
Untuk mengencangkan
kelem hanya menggunakan
kunci ratchet
 Ensure that
scaffolding procedure is
implemented
Memastikan bahwa prosedur
perancah telah dilaksanakan

5. Hot work Each time Physical  W 4 5 H  Provide Supervisor 2 3 M

orkers injury (cut, approved and required PPE HSE Officer
(grinding/cutting, Kadang- Fisik
burn) Menyediakan Alat Pelindung to conduct
welding) kadang Pekerja terluka Diri (APD) yang dibutuhkan periodically
(terpotong, dan disetujui check
Pekerjaan yang
terbakar)  Conduct Pengawas,
berhubungan dengan  Spark and Tool Box Meeting Petugas
fire Melaksanakan Tool Box HSE
panas/api
Percikan api dan Meeting melaksana
(menggerinda/memot api  Tools and kan
 Electrical equipment must be checked pengecek
ong, mengelas)
hazard and approved. an secara
 Sheet 6 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
Potensi bahaya Alat-alat dan perlengkapan berkala
listrik harus dicek dan disetujui
 Obtained
the hot work permit
Mendapatkan ijin kerja yang
berhubungan dengan
panas/api
 Use the
approved industrial cable,
electrical fittings and other
electrical appliance.
Menggunakan kabel
industri , perlengkapan
elektrik, dan alat-alat elektrik
lainnya yang telah disetujui.
 Hot work
area must be barricaded and
signed.
Tempat pekerjaan yang
berhubungan dengan
panas/api harus dibarikade
dan diberi tanda peringatan
 Ensure that
suitable fire extinguisher and
fire blanket shall be used.
Memastikan bahwa alat
pemadam api ringan (APAR)
dan selimut api digunakan
 All
flammable material should be
kept away from the hot work
area.
Semua material yang mudah
terbakar harus dijauhkan dari
area pekerjaan yang
berhubungan dengan
panas/api

6. Installation of FRP Each time Physical  Unic 4 5 H  Provide Supervisor 2 3 M

 Sheet 7 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
pipe using Unic Crane Kadang- Fisik Crane/Crane approved and required PPE HSE Officer
Failure Menyediakan APD yang to conduct
or Cranes kadang Kegagalan Unic dibutuhkan dan diseujui periodically
Pemasangan pipa Crane/Cranes  Conduct check.
FRP menggunakan  Struc Tool Box Meeting Pengawas,
k against by the Melaksanakan Tool Box Petugas
Unic Crane atau
lifted equipment Meeting HSE
Cranes Tertabrak oleh  Ensure the melaksana
peralatan yang Unic Crane/Crane are kan
diangkat positioned on the firm ground pengecek
 Finge Memastikan bahwa Unic an secara
r injuries Crane/Crane berada diposisi berkala
Jari terluka yang benar-benar kuat
 Fallin  Inspect and
g hazard ensure the crane and the
Potensi bahaya lifting gears are in good
terjatuh condition.
 Hit by Memeriksa dan memastikan
Terkena oleh crane dan roda gigi dalam
kondisi bagus
 Signal man
must stand by all time.
Signal man harus selalu
berada ditempat setiap
waktu
 Follow the
rigging calculation.
Ikuti kalkulasi tali-temali
 Experienced
and competent rigger /
signalman to be used for
these lifting activities.
Rigger yang berpengalaman
dan berkompeten yang akan
dipakai pada kegiatan
pengangkatan tersebut
 Close or
barricade the work area and
put warning signage.
 Sheet 8 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
Tutup atau barikade tempat
kerja dan tempatkan tanda-
tanda peringatan
 Only
competent and certified
operator can operate the
crane.
Hanya operator yang
berkompeten dan
bersertifikat yang dapat
mengoperasikan Crane
 Use correct
tools for all tasks
Penggunaan alat-alat yang
tepat untuk semua
tugas/pekerjaan
 Proper
loading and unloading
method
Metode bongkar dan muat
yang tepat

7. House Keeping During work Physical  S 2 2 L  Provide Foreman

tumble approved and required PPE
Kebersihan performed Fisik HSE Officer
Tersandung Menyediakan APD yang
Selama  S dibutuhkan dan disetujui Mandor,
pekerjaan lip off  Appoint Petugas
berlang- Terpeleset some persons to clean during HSE
 S work on going
sung cratch Menunjuk seseorang untuk
Tergores membersihkan tempat kerja
 D selama pekerjaan
ust berlangsung
Debu  Watch the
 D step during cleaning
isturb other Perhatikan langkah selama
parties melakukan aktivitas
Mengganggu pembersihan
aktivitas  Inform other
 Sheet 9 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

Designated Risk Rating after

Risk Rating Recommended Job Procedure
Sequence Of Basic Frequency Person Recommendation
No Hazards Consequences
Job Steps of Activity Prob’ty Severity Ranking Prob’ty Severity Ranking
(1) (2) (1)x(2) (1) (2) (1)x(2)
kelompok yang parties/workers/other
lain. persons that cleaning work is
 W on going
orkers/others Informasikan kepada
persons get kelompok lain, pekerja,
injured bahwa pekerjaan
Pekerja/orang pembersihan sedang
lain terluka berlangsung

Risk = Probability/ Likelihood x Severity/ Consequence

Ranking
Score Level Probability Description Severity Index Description
13-25 High 5 Frequent The event is expected to 5 Catastrophic Death, permanent serious environment
occur in most circumstance damage, multiple facilities damage, toxic
 Sheet 10 of 10
JOB NO. REV
PT. WASA MITRA ENGINEERING
HEALTH, SAFETY AND ENVIRONMENTAL PLAN DOC. NO.:
A
HAZARD IDENTIFICATION RISK ASSESSMENT CONTROL
(MECHANICAL WORK) DATE

release off site, huge financial loss

Lost time accident, permanent/ partial
6-12 Medium 4 Probable Will Occur frequently 4 Major disability, non permanent environmental
damage, high financial loss
Medical treatment required/ work restriction,
1-5 Low 3 Occasional Will occur several time 3 Moderate/ Serious high financial loss, on site released
contained with outside assistance
Unlikely, but can First aid treatment, on site release
2 Unlikely reasonable be expected to 2 Minor immediately contained, medium financial
occur loss
Unlikely to occur, but No affecting work performance, no injury,
1 Improbable 1 Negligible
possible low financial loss