JOB SAFETY ANALYSIS (JSA)

Project Name: KINE PROJECT LOTTE Company:

Nama Project: Perusahaan: PT. DAEAH E&C

Work Activity:
Pekerjaan: Peri up & Scaffolding JSA No: P-FRM-JSA- - Rev 0

Work Location: Date Developed:

Lokasi Kerja: LOTTE-KINE PROJECT -WP5&7 Dibuat Tanggal: 01-09-2022

JSA Participants / Preparation & Review. Peserta pembuat JSA Approval/ Persetujuan
(incl. personnel consulted: e.g. workers, supervisors, foremen, HSE personnel, external parties)
Name Position Company Signature Name Date Signature

HILMI SAFETY PT. DAEAH E&C NAM UN DONG

CONTRUCTION
MR PARK PT. DAEAH E&C
MANAGER
MIE TOTOK H.W ENGINEER PT. DAEAH E&C
Remarks / Notes, Keterangan/ Catatan:

Stop work if it rains (Stop pekerjaan jika Turun hujan)

Type of Permit Required Additional PPE Requirements Special tools or equipment required:
Jenis Perizinan yg Diperlukan: Tambahan Alat Pelindung Diri yang diperlukan Alat-alat Khusus yang Diperlukan:

Lifting Work/Kerja Pengangkatan Safety Helmet Vaceshield Fire Extinguisher

Hot work/ Pekerjaan Panas Safety Shoes Safety Gloves Welding Fire Blangket
Safety Glass Ear Plug/ear muf Tagline
Other/ Lainnya: General Permit Install puri up

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 JOB SAFETY ANALYSIS (JSA)

Risk Matrix:
CONSEQUENCE
Disciplines will review likelihood and consequences in 1 = Negligible 2 = Slight 3 = Moderate 4 = High 5 = Very High
line with their specific parameters as noted
No injuries requiring any First aid treatment. Medical treatment required, Injuries resulting in; lost time, Single or multiple fatalities.
treatment. Restricted Work Case. permanent disability,
amputation, or surgery.

5 =Very Likely Is expected to occur M-5 H -10 VH-15 VH-20 VH-25

LIKELIHOOD

Will probably occur in most

4=Likely
circumstances
M-4 H-8 H-12 VH-16 VH-20

3=Possible Should occur at some time L-3 M-6 H-9 H-12 VH-15

2=Unlikely Could occur at some time L-2 M-4 M-6 H-8 H-10

1=Very Unlikely May occur only in exceptional L-1 L-2 L-3 M-4 M-5
circumstances
Likelihood (L) 1 = Very Unlikely, 2 = Unlikely, 3 = Possible, 4 = Likely, 5 =Very Likely Consequence (C) 1 = Negligible, 2 = Slight, 3 = Moderate, 4 = High, 5 = Very High
Risk Rating (R) LOW [ 1-3 ] Broadly acceptable - MODERATE [ 4-6 ] Tolerable – With identified HIGH [ 8-12 ] Undesirable - Additional VERY HIGH [ 15- 25 ] Intolerable -
Manage by routine procedures controls fully implemented controls required to reduce risk Do not start activity

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 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
Potential Hazards / Consequences Impact of hazard (Dampak bahaya) [L x C=R]
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R

 The work is not in  criminal punishment

(Hukuman Pidana)
accordance with the work  Work does not match
Preparation (permit Pekerjaan tidak sesuai the work permit (Lakukan
Making JSA and Work Permit (Persiapan dengan ijin kerja) penilaian resiko terlebih 2 2 4 Supervisor
 The risk cannot be identified dahulu terhadap suatu
Pembuatan JSA dan Ijin Kerja)
(Resiko tidak bisa di identifikasi)  work can't be done pekerjaan)
(pekerjaan tidak dapat
dilaksanakan)

 Supervisors are
 Workers who involve the  wrong standard required to explain
work, do not understand the procedure and endanger work steps and
work plan and its hazards yourself (Menyalahi Prosedur preventive measures
Toolbox meeting 2 2 4 Supervisor
every step of work (Pekerja dan membahayakan diri) for a job (Supervisor
yang melibatkan pekerjaan, tidak diharuskan menjelasakan
memahami rencana kerja dan langkah-langkah kerja serta
bahayanya setiap langkah kerja) langkah pencegahan suatu
pekerjaan)

 Pastikan dan Inspeksi

Electrical Storing dan
Preparation Tools & Equipment  Kondisi Alat kerja Rusak  Pekerjaan dan Progreas Kelayakan Alat 3 1 3 ware House
Terhambat sebelum Digunakan
 Pekerjaan dan Progreas  Pastikan Administrasi
 Administrasi Alat berat Terhambat kelengkapan Alat di
3 1 3
belum Terpenuhi lengkapi terlebih
dahulu
 Luka Serius  Lakukan Pekerjaan
dengan SOP yang
tepat
 Tertimpa,tersandung ,terjatu
Install puri up 2 3 6 SPV & Safety
h
 Gunakan APD sesuai
dengan janis bahaya
pekerjaan

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 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
Potential Hazards / Consequences Impact of hazard (Dampak bahaya) [L x C=R]
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R

 Gangguan pada otot dan  Lakukan pengangkatan

Persendian manual secara
ergonomis
 Jika pekerjaan malam
 Ergonomi Pekerjaan hari ,penerangan lokasi 3 3 9 SPV&SAFETY
kerja harus cukup

 Pastikan Tidak ada Orang

yang melintas di area
Pengangkatan/Pelepasan manual  Material Menimpa Pekerja 2 4 8 spv dan Safety
 Luka Serius Bahkan pemasangan
cacat Permanen
 make sure the
scaffolder uses the
 Permanent disability and body harness and
Scaffolding installation
 Roboh even death (cacat permanen attaches the hook to a 2 5 10
- Insta / modifikasi scaffolding bahkan meninggal) strong support (pastikan
scafolder menggunakan body
harnes dan mengaitkan hook
pada peopang yang kuat)

 Terbentur Benda tumpul dan  Cedera Ringan

Hosekeeping  Gunakan APD Lengkap
Tajam


 


 

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 JOB SAFETY ANALYSIS (JSA)

Sign On: I confirm that the JSA has been explained and its contents are clearly understood. I clearly understand the controls in this JSA must be
applied; otherwise work is to cease immediately.

Saya mengkonfirmasi bahwa JSA telah dijelaskan dan isinya dipahami dengan jelas. Saya memahami dengan jelas kontrol dalam JSA ini harus diterapkan; jika
tidak, pekerjaan akan segera dihentikan

Nama Jabatan Tanda tangan Tanggal Perusahaan

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