KILAWC PEItTAJv\UA JOB SAFETY, HEALTH AND ENVIRONMENT ANALYSIS (JSA)

BALIKPAPAW

JSA JSA Team Members

Engfndenng, Procurement, Construction
( Job Safety Analyaia ) Names
Approval Date signature
Tanggal Pelaksanaan
Pekerjaan 15-Feb-21 Prepared Subcontractor SPV Tiko

Job Executio"n Date

Pelaksana Pekerjaan
PT. KE Contractor SPV / Lead Eng Ryan
Job Responsible Person
Checked
Lokasi Pekerjaan
Tank A Contractor HSSE SPV/Officer Rivan
Job Location
Peralatan & Bahan yang Dipakai
Attached Approved Site Representative/Controller Satria
Equipment & Maferia/s Used
Aktivitas Pekerjaan JSA Team, confirm that the risks for the task described have been reviewed and the
Jod Acfivit/es control which are recomended reduce the risk to ALARP and they consider it is safe
Temporary Facilities Unloading
so the task can proceed & confirm that a work site visit has been conducted prior to
the completion of the risk assessment.
JSA No :
Risk Rank Probability Likelihood Severity Consequence
Score Level Probability / Likelihood Description Severity Index Description
The event is expected to occur Death, Permanent serious environmental damage, multiple fatalities damage, toxic release
13 -25 High 5 - Frequent 5 - Catastrophic of site, huge financial loss.
in most circumstance
Lost time icident, permanent/partial disability, non permanent environmental damage, high
6 - 12 Medium 4 - Probable Will occur frequently 4 - Major
financial loss.
Medical treatment required/work restriction, high financial loss, on site release
1-5 Low 3 - Occasional Will occur several time 3 - Moderate
contained with outside assistance
Unlikely, but it can reasonable
2 - Unlikely 2 - Minor First aid treatment, on site release immediately contained medium financial loss
be expected to occur
1 - Improbable Unlikely to occur but possible 1 - Negligible No affecting work performance, No injury, low financial loss.
Note : Remark :
Our Objectives are Zero Illness, Zero Injury, Zero Property Demage/Loss and Zero Environmental
Damage
 ASSESSMENT AND CONTROL
IDENTIFICATION
Residual Risk
Activity
Person la
Hazard / Aipect Effect / Impact P S R Control Measure
CbaTge
A Equipment & Tools
Kendaraan Ringan 1. Kendaraan mengalami hubungan arus 1. Kendaraan terbakar 2 4 M 1. Periksa kendaraan sebelum digunakan d Pengemudi 2 3 M
(Light vehicle) pendek (Car fire) 2 3 M proyek oleh driver/kompeten, pastikan (Driver) 2 2 L
TMC (The car has e short circuit) 2. Kecelakaan 2 3 M seluruh bagian dan fungsi kendaraan bekerja HSSE 2 2 L
(Truck Mounted Crane) 2. Kendaraan mengalami pecah ban (Accident) 2 4 M dengan Supervisor 2 2 L
++“•e Chain (The car tire broka) 3. Kecelakaan 2 3 M 2 2 L
ShacNe 3. Kendaraan mengalami rem blong (Accident) 2 3 M (Check the vehicle before use on the 2 2 L
Hook (Car Brake melfunchon) 4. Kecelakaan project by fhe drivar/ compefenf, make
Lifitng Tools 4. Tedimpa material & alat ker|e (Accident) sure ell pa/ts end functions of the vert/c/e
(crushed by material & equipment) 5. Kecelakaan a/a working propedy)
5. Unit (Accident) 2. Pastikan kendaraan melalui jalur yang
Terperosok 6. Tidak berfungsi aman
(Collaps) (Not Function) (Make sure the vehicle goes through a
6. Unit tidak siap dipakai / Rusak safa lane)
(Broken) 3. Pastikan kendaraan memuat sesuai
dengan kapasitas dan fungsinya
(i\date sure tho vehicle loads according fa
its capacity end function)
4. Batasi area kelja dengan barricade (
safety
line)
(Limit the work eree with a barricade
{safe/y
5. Pastikan landasan alat bantu kokoh dan
kuat
(Make sure the base of the foo/s is sturdy
end
6. Pastikan AlaVunit digunakan sesuai dengan
kapasitas dan fungsinya
(f/iake sure the tool / unit is used in
1 accordance witfi its cepecily and function)
7. Pastikan alat/unit sudah diinspekeiJayak

(Blake oura /he loo/ / unit is inspected /

suitable for operation)
8. Pastikan Opertor capable dan memilk
Simper yang masih berlaku
(Ensure that the Operator is capable and
has a velid Simper)
9. Pastikan pekerja tidak berada di bawah
area pengangkatan
[Ensure workers ara not under tha liffinq

10. Disediakan APAR pada unit

Peralatan keija tefjatuh mengenai perkeqa Cedera 2 2 L 1. Peralatan kecil dimasukkan dalam tods box Supervisor, 2 2 L
(Work equipment fell on the worker) (Injury) (Light equipment is included in the tools HSSE
box)
2. Cek peralatan sebelum digunakan dan
diben lebel layak pakai oleh orang yang
berkompeten (Chach ttte ®9*!”9 /tt6efore
use and it is
/a6e/ed fff for use by e compefent#e/son}
3. Pemaeangan alat harus sesuai
dengan buku petunjuk
(Installation of the epptianca must de
in aocordanoe with the manual
book)

IDENTIFICATION
1. Pekerja tidak mengerti apa yang akan
Berpotensi terjadinya kecelakaan
dikerjakan
(Potential for accident)
(Workers do not understand what to do)
2. Pekerja tidak memahami potensi bahaya
pekerjaan tersebut
{Workers do not understand lfie
potenfial hazards of the job)
Persiapan
(Preparafion)
3. Pengawas tidak ada di lokasi kerja
(The supervisor is not at the work site)
1. Kecelakaan pada kendaraan
(Accident on a Vehicle)
2. Penumpang terguling
(Tha passenger rolled over)
3. Penumpang tertimpa
(Passenger is crushed)
4. Penumpang terjepit
(Passenger stuck)
Mobilisasi
(Mobilization)
ASSESSMENT AND CORTROI.
Residual Riek
Person ID
P S R Control 3'feasure
Charge
P S R ALARP † Stetus
Pastikan pekerja telah mendapatkan safety
induction
4 4 H (Mako sura workers have got a sefe/y HSSE 3 3 M
induction)
1. Melakukan Safety talk/Tool box meeting
sebelum mulai bekerja
(Conduct safety talk/ Tool box
Berpotensi terjadinya kecelakaan meeting before starting u'ork}
4 4 H 2. Mensosialisasikan JSA kepada pekerja HSSE 3 3 M
(Potential for accident)
(Disseminate JSA to workers)
3. Pekerja dilengkapi dengan APD yang layak
(Workers ere equipped with pfoper PPE)
1. Pastikan pengaman aau yang mewakili
berada di lokasi pekerjaan
(Make sure supe/v/sors or representative sis
stenby on site)
2. Pastikan Perconil HSSE berada di
Berpotensi terjadinya kecelakaan lokaei pekerjaan Supervisor,
4 4 H 3 3 M
(Potential for accident) (Maka sure HSSE stanby on site) HSSE
3. Pastikan ijin kefja konstrukei dan K3L
telah dilangkapi sebelum bekerja
(Ensure that consfrucfion work permits end
K3L have been completed before
working)
CMea 1. Pengemudi harus mempunyai SU yang
masih berlaku
(Drivers must have a valid Driver
Lisence)
2. Pengemudi harus memperhatikan
rambu- rambu lalu lintae di area proyek
(Drivers must pey ettenfion to traffic signs
at tha project site)
3. Selalu gunakan 6abuk pengaman
(Always use a seat belt) Pengemudi
4 4 H 3 3 M
4. Dilarang membawa HP ke lokasi (Driver)
kilang (It is forbidden to ca/zy
callphones fa tha refinery)
5. Dilarang menyetir dalam kondisi mabuk,
pengaruh obatobatan, mengantuk dan
kondisi sakit
(it is prohibited fa drive when drunk,
under fhe influence of drugs,
drowsiness and s/cMass
6. Pemakaian APD yang lengkap dan benar.
(Comptate and correct use of PPE)
 IDENTIFICATION
No.
1. Pekelja teljepit /tertimpa /
terbentur/terpelesetftertabraMerjatuh
(Workers are crushed / bumped /
slipped / hits / fall)
2. Jatuh dari ketinggian
Bongkar Muat Peralatan
4 (Loading and unloading
Residual Rlsk
Effect / Impact P S R Control Measure
1. Ada orang yang berfungsi sebagai
(There are people who function as
d/recfors/ supervisors}
2. Manual handling tidak boleh malibihi 20
kg atau sepertiga dari berat badannya
(Menual handling should not exceed 20 kg
or one third of his body waight)
3. Gunakan teknik mengangkat yang baik dan
memadai
(Use good and adequate Ii#ing
technique)
4. Minta bantuan untuk mengangkat jika
beban terlalu bet
{Gef he/p lifting i/'fhe load is too heavy)
5. Gunakan peralatan pengangkat/pendorong
atau trolley (jika diperlukan)
(Use lifting/pushing equipment or a trolley
(if needed))
6. Pastikan area pembongkaran berada di
atas tanah keras dan bebas hambatan
(Make sure fhe unloading area is on herd
7. Awasi jika terjadi konflik keija
dengan aktivitas lainnya
{Supervise any won conflicts with ofher
8. Area pembongkaran dipasang Supervisor,
(/njt//y, d/sabi/ifiesy
3 3 M rambu keselamatan 2 2 L
Cedera, cacat HSSE
(The demolition eree is installed witfi
(Ini•o', safety
disabilities) ^*9^^)
9. Penggunaan body frames apabila bekerja
minimum 1.8m di atas tanah
(L/se the body harness when working at
leeot 1.8m adove /f/e g/oun4l
10. Pastikan penempatan untuk posisi crane,
berada pada area yang datar & keras untuk
menghindari slip / out rigger kandas
/terbenam (Meke store /ha pleaement for
fhe crene pos'ition, io on a fist & herd
erea to avoid slip/ out rigger
aground/sink)
11. Pastikan kapasitas Unit alat angkat
6esuai dengan SWL beban yang
diangkat
(Make sure file capacity of the lifting
equipment unit is in accordenca with
fhe SWL of the load being lifled)
12. Menggunakan tali pengikat untuk
kendali pengamanan (take line)
(Using straps for safat'y control (take
lina))
13. Pastikan hanya ada satu signal man
yang memberikan kode lifting
(Make sura there is only ona signal
man giving tfie lifting code)
14. Waspadai & antisipasi terhadap
perputaran alat & material
(Bewara 8 entioipefe the /ofefion o/'foo/s
4

i5. Gunakan F-Bt-I den 10t2' Tie OU


MENTD]CAMON
No. Activity
2. Tereambar petir
(Stmck by lightning)
3. Digigit Hewan liar
(Biflen by wild animal)
4. Terusuk duri
(Pierced by a thom)
5. Pekerja kelelahan
(Workers are exhausted)
1. Kecelakaan pada kendaraan
(Accident on a vehicle)
2. Penumpang terguling
(The passenger rolled over)
3. Penumpang tertimpa
(Passenger is crushed)
4. Penumpang terjepit
(Passenger stuck)
Oemobilieasi
6 H
{Demobilization)
5. Bahaya/pencemaran oleh sampah
(Denger/contamination by garbage)
NOTE : IN EVENT OF EMERGENCY, STOP ALL ACTIVITY, TURN OFF ALL EQUIPMENT AND MAKE SAFE AND GO TO
MUSTER
E : Elimination Control
S Substitution Control
G Engineering Control
A : Administration Control
ASSESSMENT AND CONTROL
Residual RisIt
Person In
2ffect / ftapact P S B Control Measure
Charge
1. Jika terjadi hujan aktifXas diberhentikan
terlebih dahulu dan berlindung di tempat yang
aman
(dit reins, tha ectivifies are stopped first
Cedera, Kematian and Supervisor,
2 5 2 3 M
(injury, fatality) take shelter in a safa plaoe) HSSE
M 2. Pemakaian APD yang lengkap dan
benar.
(Complete and cor/set use of PPE)
3. Mempunyai informasi nomor darurat
(Prepared for emergency number)
1. Waspada terhadap aktivñas di sekitar
jika
perlu dihentikan jika ada kegiaan berbahaya
(Be alert to neerby activities if you need
Timbulnya penyakit, cedera, kematian fo stop if fhere is a dangerous activity)
2 › 2 3 M
(sickness, Injury, fatality) M 2. Pemakaian APD yang lengkap dan
benar
(Complete and correct use of PPE)
3. Mempunyai infomasi nomor darurat
(Prepared fâr emergency number)
Pekerja dipastikan dalam kondisi sehat
Kelelahan, pingsan sebelum melakukan aktifitas HSSE
4 2 M (Workers ere ensured fa de in good heelfh /gy ¿ 2 2 L
(fafique, unconscious)
before doing acfiv’ities/
1. Pengemudi harus mempunyai SIM yang
masih berlaku
(Drivers muat hav’e a valid Driver
Lisence)
2. Pengemudi harus memperhatikan
rambu- ramdu lalu lintas di area proyek
(Drivers must pey attention to tralfic signs
at
/+» w i• cf sife}
Cedera 3. Selalu gunakan 6abuk pengaman Pengemudi
( j/tjt//y) 4 4 3 3 M
(Always use e aeat belt) (Driver)
4. Dilarang membawa HP ke lokasi kilang
(It is forbidden to cerry cellphones to ihe
refinery)
5. Dilarang menyetir dalam kondisi mabuk,
pengaruh obat-obatan, mengantuk dan
kondisi
(it is prohibited to drive when dank, under
ltte intluente of dmgo, da›w'siness and
sickness}
6. Pemakaian APD yang lengkap dan benar.
(Complete and correct use of PPE)
Lakukan housekeeping setelah pekerjaan
Keruaakan Lingkungan selesai Seluruh Pekerja
3 2 M 2 2 L
(Enviromental damage) (Do hOUS8ke•P• 8 • ftar work is done) (All Workers)
POINT.
_ Mn l:athepers_on or human t
Fc i: Impact to the fac*ies or progert}/damage
En : Impact to the environment