Job Safety Analysis (JSA) Form SAF_32_JSA FORM_01

SECTION A: BRIEF DESCRIPTION OF THE JOB

Contractor Company: COSMOS - IE Date: 26/7/2022
Prepared by (Name & Job Function): To Conduct a Steam Trap Survey for Acrylics Plant Location of Worksite: Acrylics
MUHAMMAD FARIS AKRAM

SECTION B: JOB DESCRIPTION

Job Specific PPE Person

No. Job Steps No Potential Hazards No Control & Safety Precautions
Requirement Responsible

1 Verify location and check area 1.1 Wrong location of 1.1.1 Site visit with BPC Area Owner N/A Supervisor,
of work to be done work to be done (Lawatan tapak dengan Pemilik Kawasan BPC Workleader
(Sahkan lokasi dan semak (Lokasi kerja yang
kawasan kerja yang hendak salah akan dilakukan)
dilakukan) 1.1.2 Tag location by Contractor and BPC area owner N/A Supervisor,
(Lokasi tag oleh Kontraktor dan pemilik kawasan Workleader
BPC)

1.1.3 Attach with MOC and Drawing approved by BPC N/A Supervisor,
(Lampirkan dengan MOC dan Lukisan yang Workleader
diluluskan oleh BPC)

2 Permit to work 2.1 Misunderstanding on 2.1.1 Proper coordination between contractor and N/A Supervisor,
(Permit untuk bekerja) work description area owner BPC area owner Workleader
(Salah faham (Koordinasi yang betul antara kontraktor dan
mengenai keterangan pemilik kawasan pemilik BPC)
kerja)

Rev 7, Jun 2022

Internal
 Job Safety Analysis (JSA) Form
SECTION A: BRIEF DESCRIPTION OF THE JOB
Contractor Company: COSMOS - IE Date: 26/7/2022
To Conduct a Steam Trap Survey for Acrylics Plant
Prepared by (Name & Job Function): Location of Worksite: Acrylics
MUHAMMAD FARIS AKRAM

2.1.2 Verification of work scope between contractor N/A Supervisor,

and BPC Workleader
(Pengesahan skop kerja di antara kontraktor dan
BPC

2.2 Working without 2.2.1 To perform safety briefing and display PTW,JSA N/A Supervisor,
permit and SSB at site Workleader
(Bekerja tiada permit) (Untuk melaksanakan taklimat keselamatan dan
memaparkan PTW, JSA dan SSB di tapak)

3 Mobilization of equipment 3.1 Accident 3.1.1 Follow speed limit (30kmH) N/A Driver,
using pick up / lori (Kemalangan) (Ikut had laju (30kmH)) Supervisor
(Mobilisasi peralatan
menggunakan lori)
3.1.2 Driver must have a valid driving license N/A Driver
(Pemandu mesti mempunyai lesen memandu
yang sah)

3.1.3 Vehicle must be in a good condition with daily N/A Driver,

visual checking Supervisor
(Kenderaan mesti berada dalam keadaan yang
baik dengan pemeriksaan visual harian)

3.1.4 Do not use walkie talkie while driving N/A Driver,

(Jangan gunakan walkie talkie semasa memandu) Supervisor

Rev 7, Jun 2022 Page | 2

Internal
 Job Safety Analysis (JSA) Form
SECTION A: BRIEF DESCRIPTION OF THE JOB
Contractor Company: COSMOS - IE Date: 26/7/2022
To Conduct a Steam Trap Survey for Acrylics Plant
Prepared by (Name & Job Function): Location of Worksite: Acrylics
MUHAMMAD FARIS AKRAM

3.1.5 Wear seat belt N/A Driver,

(Pakai tali pinggang) Supervisor

3.2 Equipment and tools 3.2.1 All equipment needs to be bind to ensure it stays
damage in place and to avoid sliding N/A Driver,
(Kerosakan peralatan (Semua peralatan perlu diikat untuk memastikan Supervisor
dan alat) ia tetap di tempat dan untuk mengelakkan
gelongsor)

4 To survey steam trap using 4.1 Drop Hazard 4.1.1 Strip device properly with tag line with hand or N/A Supervisor,
TM5N-P device ( Bahaya jatuh ) body Workers
(Untuk meninjau perangkap ( Jalur peranti dengan betul dengan garis tag
stim menggunakan peranti dengan tangan atau badan )
TM5N-P )

4.2 Damage to property 4.2.1 Cable joint must be properly fitted N/A Supervisor,
( Kerosakan kepada ( Sambungan kabel mesti dipasang dengan betul ) Workers
harta benda )

4.3 Personal Injury 4.3.1 No horse playing during work Supervisor ,

N/A
(Kecederaan Diri ) ( Tidak bermain semasa bekerja ) Workers

Hot surface injury

Use semi leather gloves all the time
4.4 (Kecederaan 4.4.1 Supervisor ,
( Gunakan sarung tangan kulit sepanjang masa ) N/A
permukaan panas ) Workers

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Internal
 Job Safety Analysis (JSA) Form
SECTION A: BRIEF DESCRIPTION OF THE JOB
Contractor Company: COSMOS - IE Date: 26/7/2022
To Conduct a Steam Trap Survey for Acrylics Plant
Prepared by (Name & Job Function): Location of Worksite: Acrylics
MUHAMMAD FARIS AKRAM

5 Tools Inspection
( Pemeriksaan Alat )
5.1 Electical shock may 5.1.1 Get approval from BPC inspection on every N/A Supervisor
occurs electronic tool before start survey
( Kejutan elektrik ( Dapatkan kelulusan daripada pemeriksaan BPC
mungkin berlaku ) pada setiap alatan elektronik sebelum
memulakan tinjauan )

5.1.2 Get authories personal for inspect the survey N/A Supervisor,
tools Workers
( Dapatkan pihak berkuasa peribadi untuk
memeriksa alat tinjauan )

6 Climbing Up the surveying 6.1 Slippery 6.1.1 Three-point contact ensure every time using N/A Workers
area by using Permanent ( Licin ) ladder
ladder (monkey ladder) ( Sentuhan tiga titik pastikan setiap kali
( Mendaki kawasan ukur menggunakan tangga )
dengan menggunakan tangga
kekal (tangga monyet)

6.1.2 Body Hardness will use upon Rules of the plant N/A Workers
( Kekerasan Badan akan digunakan mengikut
Peraturan tumbuhan )

Rev 7, Jun 2022 Page | 4

Internal
 Job Safety Analysis (JSA) Form
SECTION A: BRIEF DESCRIPTION OF THE JOB
Contractor Company: COSMOS - IE Date: 26/7/2022
To Conduct a Steam Trap Survey for Acrylics Plant
Prepared by (Name & Job Function): Location of Worksite: Acrylics
MUHAMMAD FARIS AKRAM

6.1.3 Bodyhardness with 2 len yard will using on side Workers

N/A
( Kekerasan badan dengan 2 len yard akan
menggunakan sebelah )

7 House keeping 7.1 Tripping 7.1.1 To perform housekeeping regularly to prevent N/A Workers
(Kebersihan tempat kerja) hazard/falling hazard trip and fall
( Bahaya (Untuk melakukan pengemasan secara berkala
tersandung/bahaya untuk mengelakkan perjalanan dan jatuh)
jatuh )

7.2 Environment hazards 7.2.1 Schedule waste to be disposed properly (BY BPC) N/A BPC
(Bahaya persekitaran) ( Jadualkan sisa untuk dilupuskan dengan betul
(OLEH BPC)

7.3 Personal Injury 7.3.1 Ensure working at safe distance, Do not work N/A Workers
(Kecederaan Diri) beside a pit
(Pastikan bekerja pada jarak selamat, Jangan
bekerja di sebelah lubang)

8 Close work permit
(Penutup Permit)
8.1 Miscommunication 8.1.1 Contractor to communicate with operation about N/A Work leader,
( Salah komunikasi ) the activity and close the permit and return back Supervisor,
with PTW, JSA and SSB
( Kontraktor untuk berkomunikasi dengan
operasi tentang aktiviti dan menutup permit dan
kembali semula dengan PTW, JSA dan SSB )

Rev 7, Jun 2022 Page | 5

Internal
 Job Safety Analysis (JSA) Form
SECTION A: BRIEF DESCRIPTION OF THE JOB
Contractor Company: COSMOS - IE Date: 26/7/2022
To Conduct a Steam Trap Survey for Acrylics Plant
Prepared by (Name & Job Function): Location of Worksite: Acrylics
MUHAMMAD FARIS AKRAM

SECTION C: SAFETY EQUIPMENT REQUIRED FOR THE JOB

Item Yes No Item Yes No Item Yes No
Basic PPE: Face shield X Work Vest X
Safety Helmet X Mono goggle X Tripod X
Safety Glasses X Protective Suit type: HPWJ Suit X
Safety Shoes X Safety Harness X
Earmuff / Ear Plug X Lifeline X
Glove type: Semi Leather X Fire Extinguisher type: ABC X
Respirator type: ___________________ X Warning Signage X
SECTION D: JSA REVIEWAL AND APPROVAL
JSA Leader (Name/Position/Sign/Date): JSA Technical Approver (Name/Position/Sign/Date): JSA Approver (Name/Position/Sign/Date):
MUHAMMAD FARIS AKRAM / 26.7.2022 /

JSA Members (Name/Position/Sign/Date)

1) MUHAMMAD SYAHMISYAMIR / 26.7.2022 / 6)

2) MOHD ARIFF BIN ABDUL RAHMAN / 26.7.2022 / 7)

3) KHAIRUL AMRI / 26.7.2022 8)

4) 9)

5) 10)

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Internal
 Job Safety Analysis (JSA) Form SAF_32_JSA FORM_01
SECTION A: BRIEF DESCRIPTION OF THE JOB
Contractor Company: COSMOS - IE Date: 26/7/2022
Prepared by (Name & Job Function): To Conduct a Steam Trap Survey for Acrylics Plant Location of Worksite: Acrylics
MUHAMMAD FARIS AKRAM

SECTION E: JSA QUALITY ASSESSMENT TOOL Assessment Date:

JSA Quality Assessment Required: Yes (New JSA) No (JSA Renewal, Subsequent correction. If tick No, not require to filling in the assessment)
JSA Approver:
JSA QUALITY ELEMENTS EFFECTIVENESS (1 – 3) COMMENTS
JSA Leader, JSA Technical Approver and adequate JSA Members are
participated in preparation (including site visit) of the JSA
Job Steps section clearly outlines the scope of work and is broken down into
sufficient number of task steps (e.g., Extracted from JMS)
Potential Hazards identified are specific and clearly correspond to each task.

Controls & Safety Precautions for hazards are specific (quantifiable,

observable) for each hazard.
Job Specific PPE Requirements are clearly identified.

Responsible person for each element is properly defined.

JSA Leader demonstrates understanding of hazards for task on JSA

TOTAL SCORE

OVERALL % (100 x Total Score / 21)

Score Effectiveness
3 Meet expectations
2 partially meet expectations and should be improved
1 Does not meet expectations

Rev 7, Jun 2022

Internal