& JSA AND RISK ASSESSMENT FORM. OC-HISE Doc No. 201485— PIPE —JSA~004 [Rev No.0 HSE Date:_20 Nevember aoie Page 1 of 4 [Company __[: [Pr ADHIKARYA (PERSERO), Tok By— Owner Project AMMONIA ‘UREA Il PROJECT PKG Person In Charge Name os | NAME _| Position / Tittle of Job a ob Activity “aie ae fe | StovaruRe Date = DATE p= i= ‘Sequence of Basic . a No | "sob Steps. Hazard Risk Consequence | _Risk Assessment Recommended Aation ek reese Tanapan Pekeriaan Behaye ico Abit pR_| sv | RR aes PR | sv | RR 1 | installaion of ~~ |-Electié shock J Human =Personal injuy [3 3 | 9 | - Tum off gindingreuting wheel 1 3 3 grinding disc or consequences | (cut, Burn and ‘machine & unplugged from the cutting dise death) socket. i 2 " _ - Wearing handgloves S - Hit by grinding |> Human ~ Personal injury | 3 9} Tum off grinding/euting wheel 7 ss disc or cuting | consequences | (cut, brn and machine & unplugged from the disc death) socket ~ Wearing PPE (Personal Protective Equipment) 2 | Function test of | -Electic shock | Human Personal injury z 3] 6 | Ensure the cabie and conection cia |S I grinding machine ‘consequences | (cut, bm and are in good conto or cutting wheel death) = Ensure operation is done in dry machine area. z Hit” by grinding |- Human Personal injury 3 2 6 | - Ensure the safety device is 2 z 4 disc or cutting | consequence | (cut, and burn) installed properly, disc = Use the correct grade of grinding disc or cuting disc; _ ah ot ss - - Wearing PPE _ Grinding work or —|-Electic shock |- Harman + Personalinjuy | 3 3 | 9 | Ensure the cable and conection cia (oan cutting work by consequences | (cut, burn and are in good condition; ceuting whee! deain) + Ensure operation is done in dry machine area -Hit by grinding |- Human Personal injury 3 z 6 | = Ensure the safely device is z 2 4 disc or cutting | consequence; | (cut, and bum) installed propery; dise = Use the correct grade of aoaee - —{ grinding disc or cutting disc | __ | > Materat = Grinding 2 2a]. Wearing Pee: ne ae rn rr consequences | machine or + Ensure the personal familiar 9 with grinding/cutting wheel ‘material broken CS ene& os OC-TSE Doc. No. 201485—PIPE-JSA—004 [Rev No.0 HSE Date:_20 November 2016 Page 2of 4 Scattered grinded [Human 7 -Personaleye | 2] 2] 4] > Wearing ace sheid T7272 ‘material or fying | consequences | injury = Provide eye wash unit atthe material into eye near working area = Uninvolved personnel to keep : _ lca - : away from working area Tum ofF& -Elecrc shock )- Human > Personal 3 [3 | 9 |= Ensure the cable and Ts disconnect the consequences |” injury (cut, conection are in good grinding machine bum and condition; or the cutting death) = Ensure operation is done in dry wheel machine area; : = 2 7 _ = Wearing handglove; Z Hit by grinding |= —auman Personal injury 3 [2 | 6 [= Ensure the safety device is si | 2] 2 a dsc or cut consequences | (cut, and bum) installed propery, disc = Wearing PPE; = Ensure the grinding disc : acta | 7 a1 _|___totation stopped before tum off | Funcion test of |-Tgniton- of euting |- Human Personal injury 2) 6 | > Ensure the cutting a cutting torch torch consequences | (bum) torch hose/ciamp regulator (pressure gauge indicator, flash back arrester, ‘xygenigas isin good Condition & connection; = Wearing PPE, specially for face shield; = Provide First Aid Kit at the near working area; + Ensure the working area is free = 4 from combustible materials; | | | 5 : Burn to near 2 3 | 8 | Ensure the pressure setting to 1 5 consequences | combustible the regulator's comect material ~ Ensure the pereonal famiiar (irefexplosion) wt cuting torch work: ~ Storage and handing the ‘oxygen & gas bottle property; + Ensure the fire hydrant unit is ‘atnear area and in good ‘condition; Ensure the fire monitor unit is at near area and in good = . - | condition& 4JSA AND RISK ASSESSMENT FORM QC- HSE. Doe. No. 201485 — PIPE — JSA~— 009 Rev. No.0 HSE Date_20 November aos Page 3 of 4 ‘Cuting work with ccuting torch lgnition and while working with cutting torch Human consequences Personal injury (bum) 3 27. 6 Waterial ‘consequences ‘Bum to near z ‘combustible material (firefexplosion) Ensure the cutting z torch,hose/clamp regulator (pressure gauge indicator, flash back arrester), ‘oxygenigas is in good condition & connection; Wearing PPE, specially for face shield; Provide First Aid Kit at the near working area; Ensure the working area is free from combustible material Ensure the pressure se the regulator is correct, Ensure the personal familiar with cuting torch work: Storage and handling the oxygen & gas bottle properly: Ensure the fire hydrant unit is at near area and in good condition; Ensure the fire monitor unit is atnear area and in good ‘condition -Fiying material (hot slag) Human consequences Personal eye 3 (or body injury Material consequences ‘Burn to near 2 combustible ‘material (ire explosion) Environtmental consequences ‘Cul material7 aa scrap ‘Wearing PPE, specially for z face shield; Provide eye wash unit at the Rear working area, Ensure the working area is free + {rom combustible materials; Ensure the fire hydrant unit is at near area and in good ‘condition; Ensure the fire monitor unit is 7 at near area and in good condition; Keep clean the working area ‘good housekeeping Installation of ‘welding machine -Electic shock Human ‘consequences Personal injury | 2 (bum and death) off the electric power and | 7 ‘unplugged from the socket, Ensure the cable and ‘conection are in good ‘condition; Ensure operation is done in dry area,JSA AND RISK ASSESSMENT FORM. QC-TISE Doc, No. 201485—PIPE-JSA—00Q___ [Rew No.0 HSE Date: 20 November ois. Page 4 of 4 8 | Welding work |-Electric shock = Human = Personal injury 2 4 8 [= Ensure operation is done in dry T 4 4 consequences | (bum and area; death) ~ Ensure the cable, conection, ‘and grounding are in good : condition “Hot slag > Haran = Personal eye 3 3 | 9 |= Wearing PPE, specialy for 1 3s] 3 ‘consequences | or body injury face shield = Provide eye wash unit at the near working area; eras =~ Material ~~~ Bum to near | 2 Zi alt rere ne ena 2,2 ‘consequences orca ~ Ensure the fire hydrant unit is 5 atnear area and in good Sees) condition; ” I> = Environtmental_|- Spatier 2 | 2 4 | - Ensure the fire monitor unit is. 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