Part 1

JSA No. : 03/TWK/2018 JOB SAFETY ANALYSIS

Company Name : Company Address : Work Activity : Project :
PT. TRI WAHANA KARSA Jl. Karunrung Asri E No. 21, Makassar CUT & FILL GI 150KV TOPOYO – MAMUJU
TENGAH, SULAWESI BARAT

JSA Prepared by : Rifaldy Abdurrachman Reviewed by : Joko Sandra Approved by : Hendy Pratomo

Signature : Signature : Signature :

Task Description : CUT & FILL

Date : 01 – 12 – 2018
High Risk Tasks :
Special precautions must be taken when undertaking non-routine work. Ensure entire team have Start Date : End Date :
Routine task?  Non-routine task?  developed a comprehensive JSA and check requirements for lifting plans; special permits; isolations; 04 – 12 - 2018
services; unexpected hazards; emergency planning and team competencies
Permit / Plan Required : Isolation Required : PPE Required Above Site Standard : Equipment Required :
General / Cold Work  Electricals Helmet / Hard Hat  Safety Gloves  Warning / Hazard Signs 

Hot Work Mechanicals Safety Eye Glasses  Electrical Gloves Soft Barricades / Hard Barricades 

Excavation / Penetration  Erection Zone Oxy Cutting Googles Full Body Harness Safety Life Lines

Working at Height Lifting Zone Chemical Googles Safety Shoes / Boots  First Aid Kit 

Confined Space Live Existing Zone Ear Plug / Ear Muff Rompi  Stretcher / Palanquin (tandu)

Dust Mask / 
Electrical / LOTO Commissioning Zone Arc Flash Lifting Gears / Equipments
Respirator

Lifting Plan / Review Energizing Zone Face Shield Disposable Overalls Fire Extinghuiser / Spill Kit 

Potential Environmental Hazards Hazardous Materials / Substances Manual Handling

Will Hazardous manual Handling be possible during the job? E.G. Lifting, pushing,
This item requires continual review to include the specific area or (List any chemicals and hazardous materials to be used or
pulling, Twisting or bending? If so tick the box that most likely describes the
activities requirements. Please Tick Box present in the work Area. Attach an MSDS for each)
manual handling risk and include the code on each SWMS Job step
Weather  Oil / Flammable Material None There will be no Hazardous Manual handling in this job.

Physical  Gas / Compressed Material MH1 The task may involve high forces. 
Ergonomic / Erosion  Corrosive Material MH2 The task will require repetitive forceful movements 
The task is likely to cause fatigue or soreness due to it’s long
Working at Height / Confined Space Asbestos Material MH3 duration

Environmental factors are likely to increase the chance of
Noise / Dust  Electricity Material MH4 injury.

Joggle / Parallel  Moving Particles  MH5 Awkward posture or movements. 
Lift Review General
Lift review MUST be done on all field and service jobs.
For more complex lifts – use a full detailed lift plan.
 _____
Maximum lift (static) load KG
kg
Sling _____
CHN SYN RND OTHR
Type kg
_____
Lift capacity of sling
kg
Crane condition checked & operation tested
(yes/no)
Protective barrier required for sling, chains
(yes/no)
Lifting Gear Checked Own Equipment
(Yes, No) Tested & Tagged
, good Condition Customer equip.

Rigging Required (yes/no)

Full Lift Plan Required (yes/no)

Lifting Operation Zone     

Probability Consequences Hierarchy of Control

A – Repeating occurrence- People Environment 1 – Eliminate
MATRIX happens on most occasions. 1 – Fatality or Permanent 1 – off site release with major detrimental effect 2 – Substitute
A B C D E common or repeating occurrence Disability 2 – off site release with minor detrimental effect 3 – Isolation
B – Common occurrence-happens 2 – Lost Time Injury or Illness 3 – on site release contained with outside 4 – Engineering
1 H H H M M approx 1 in 10 3 – Medical Treatment assistance 5 – Administration
2 H H M M M C – Could occur-infrequent 4 – First Aid Treatment 4 – on site release immediately contained 6 – PPE
occurrence-happens approx 1 in 5 – Incident Report only 5 – no environmental impact
3 H M M M L 100 Apply in order of preference
4 M M M L L D – Not likely to occur-unusual from 1 to 6 – note control
5 M M L L L occurrence-approx 1in 500 used
E – Practically impossible-occurs
less than 1 in 5000

Hierarchy of Control
When choosing the controls to be used for each of the hazards that exist, it is important to consider the hierarchy of controls in determining the best practicable control.
Consider each hazard and whether there exist a way in which the hazard can be eliminated. If such a control is practicable - nominate the control in the “control” column,
and circle the number 1 in the hierarchy of control column. If elimination is not practicable - consider substitution to reduce the risk of the hazard. If such a control is
practicable put the control in the “control” column then cross out 1 and circle 2 in the hierarchy of control column. Repeat until the best practicable control is determined.
Then repeat for each hazard.

Part 2
 consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury

JOB STEP POTENTIAL HAZARD RESPONSIBLE

Cross out controls not practicable. Circle control used

PERSON
NO. List the steps Against each step list the
Nominate the person
required to perform potential / risk hazards that
who will be required to
the task in the could cause injury / damage
action the control
sequence they are when the task step is
measures

Consequence (1-5)

Consequence (1-5)
carried out performed

Probability (A-E)

Probability (A-E)
Rank (L,M or H)

Rank (L,M or H)
(use hierarchy of controls – at end of
this form)

- Identifikasi potensi bahaya di 123 Logotic atau operator

Terjatuh dari peralatan
Kaki terjepit peralatan
1 Persiapan peralatan
C 4 M area. E 5 L
456 alat berat
- Menggunakan APD
- Jangan tergesa-gesa dan 123 Logotic atau operator
C 4 M E 5 L
tahap demi tahap. 456 alat berat
- Cek peralatan sesuai dengan
permintaan.
- Persiapkan alat sesuai dengan
pekerjaan.

Area tanah yang - Identifikasi potensi bahaya 123

Terkena swing alat berat C 2 H E 5 L Site supervisor
lebih tinggi di lansir diarea kerja. 456
2
ke area tanah yang - Menggunakan APD 123
lebih rendah Terperosok C 4 M - Jangan tergesa-gesa saat E 5 L Site supervisor
456

JOB STEP POTENTIAL HAZARD
NO. List the steps Against each step list the
required to perform potential / risk hazards that
the task in the could cause injury / damage
sequence they are when the task step is
carried out performed
Tertimpa tanah longsor
Alat berat terbalik
Terpeleset
Terkena swing alat berat
Excavation/
3 pekerjaan di mulai
Penggalian
Tertimpa tanah longsor
Kena gas sisa bahan bakar
consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury
RESPONSIBLE
Cross out controls not practicable. Circle control used
PERSON
Nominate the person
who will be required to
action the control
measures
Consequence (1-5)
Consequence (1-5)
Probability (A-E)
Probability (A-E)
Rank (L,M or H)
Rank (L,M or H)
(use hierarchy of controls – at end of
this form)
123
C 2 H E 5 L Site supervisor
456
melakukan pekerjaan. 123
C 2 M - Kordinasikan sebelum E 5 L Site supervisor
456
melakukan pekerjaan.
- Identifikasi potensi bahaya 123
C 4 L E 5 L Site supervisor
diarea kerja. 456
- Memastikan keadaan alat
123
C 2 H tidak ada kendala saat E 5 L Site supervisor
456
123
C 2 H - Jangan tergesa-gesa saat E 5 L Site supervisor
melakukan pekerjaan. 456
- Menggunakan APD 123
C 4 M - Kordinasikan sebelum E 5 L Site supervisor
456
 consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury

JOB STEP POTENTIAL HAZARD RESPONSIBLE

Cross out controls not practicable. Circle control used

PERSON
NO. List the steps Against each step list the
Nominate the person
required to perform potential / risk hazards that
who will be required to
the task in the could cause injury / damage
action the control
sequence they are when the task step is
measures

Consequence (1-5)

Consequence (1-5)
carried out performed

Probability (A-E)

Probability (A-E)
Rank (L,M or H)

Rank (L,M or H)
(use hierarchy of controls – at end of
this form)

123
Alat berat terbalik C 2 M E 5 L Site supervisor
melakukan pekerjaan 456
123
Terkena debu C 3 M E 5 L Site supervisor
- Identifikasi potensi bahaya 4 5 6
diarea kerja.
Terpeleset C 4 L - Pemeriksaan material kerja 1 2 3 E 5 L Site supervisor
sebelum melakukan 4 5 6
pekerjaan.
4 Finishing Cut & Fill. - Menggunakan APD
- Jangan tergesa-gesa saat
melakukan pekerjaan.
- Kordinasikan sebelum
melakukan pekerjaan.
- Menyiapkan ijin kerja.