Analisa Keselamatan Pekerjaan

Jobs Safety Analysis (JSA)

PROJECT NAME PREPARED BY DATE
(Nama Proyek) : ____________________________________ (Disiapkan oleh):__________________ (Tanggal):
_____________
_

WORK LOCATION JSA No New/Baru

(Lokasi kerja) : _____________________________________ (No JSA) : _________________ :
Revised/
Diperbaiki :

JSA TEAM MEMBER

(Anggota)

Name (Nama) Position Company (Perusahaan)

____________________________ _______________________ ____________________________________________

____________________________ _______________________ ____________________________________________

____________________________ _______________________ ____________________________________________

____________________________ _______________________ ____________________________________________

TITLE/juduL : AUTHORISING SUPERVISOR : ________________________

JOB DESCRIPTION/uraian pekerjaan :_______________________ PPE Required/APD yang diperlukan:

__________________________________________________________
____
__________________________________________________________
____

Page 1 of 3
__________________________________________________________
____
__________________________________________________________
____ PIC DUE DATE
SEQUENCE OF BASIC JOB STEPS POTENTIAL HAZARDS RISK CONTROL METHODS REQUIRED
(Langkah-langkah dasar pekerjaan) (Penanggung (Tanggal selesai
(Potensi bahaya) (Metode pengendalian resiko yang diperlukan)
Jawab) dilakukan)
Break the job down into steps. Each of the steps Identify the hazards associated with each step. Using the first two columns as a guide, decide what actions are necessary to Person who Date of Risk Control
should accomplish some major task and be logical Examine each to find possibilities that could eliminate or minimize the hazards that could lead to an accident, injury or responsible the shall be completed
lead to an incident occupational illness control are
implemented

Page 2 of 3
Page 3 of 3