JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

Doc. No. 26071-JO-HSE-014

ENGINEERING PROCUREMENT CONSTRUCTION FOR REFINERY Effective Date 13 January 2021
DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-V BALIKPAPAN PROJECT
Revision No. 001

Project : RDMP JO By
Prepared Reviewed By Approved By
Company : Field Coordinator
PT. JAYA PROYEK SERVISChief/HSE Manager CM
Scope of Work/Pkg : Nondestructive Test(Yoke-AC)
JSA No. : RDMP /
JSA / ............. / ...............
Position : QA/QC-Department
Job Activity : Magnetic Particle Examination
Area : ISBL and OSBL Area
Date : Jun-23,2023

Name MUHAMAT ISNANDAR Chang-Soo,Kang

Signature

Date Jun-23,2023

Status
Status
No Permit Registry No
Open 🗸 Close 🗸

Permit Registry No
Open 🗸 Close 🗸

No
 JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

Doc. No. 26071-JO-HSE-014

ENGINEERING PROCUREMENT CONSTRUCTION FOR REFINERY Effective Date 13 January 2021
DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-V BALIKPAPAN PROJECT
Revision No. 001

Risk
Sequence of Basic Consequence / Result Risk*) PIC
NO Hazard Risk Assessment* Recommendation action.
Job Steps severity
PR SV RR PR SV RR
1 Preparation of Permission Not yet Careless handling Injury 3 4 M Before used checking to 1 4 L Muhamat
Examination approved. of low-pressure can. expired date and use Isnandar
Aerosol Can and temperature. Coodinator
Yoke Equipment
Check the batch Damage to 3 4 M Using after calibration
number and Examination and equipment checked. 1 4 L
appearance product.
condition.

Power cable and Injuries and 3 4 M Checking the power 1 4 M

connecting Hazards. cable and connecting
conditions (Short conditions (Short and
and peeling) peeling)

2 Examination Time Permission Not yet Don’t using to PPE Injuries and 3 4 M Tech PPE-Use methods 1 4 L Muhamat
approved. (Hard hat, safety Hazards. and Always recheck at Isnandar
glasses or goggles, TBM. Coodinator
hi-viz jacket,
overalls, coated
gloves, safety
shoes,mask)

3 Examination Time Fire. Fire caused by short Injuries and 3 4 M ●Removal of flammable 1 4 L Muhamat
Electric shock. circuit. Hazards. materials at the Isnandar
Electric shock inspection site. Coodinator
And Operator
●Don’t work on rainy day
and time.
●Check for short-
circuited wires, impact
 JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

Doc. No. 26071-JO-HSE-014

ENGINEERING PROCUREMENT CONSTRUCTION FOR REFINERY Effective Date 13 January 2021
DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-V BALIKPAPAN PROJECT
Revision No. 001

points, etc. at any time.

●Use insulated or coated
gloves.
●No impact on the
product used.
●Ventilate the enclosed
or narrow place.
●If necessary, oxygen
concentration should be
measured

4 Examination after Permission Not yet Cans are not Injuries and 3 4 M Be sure to collect and 1 4 L Muhamat
approved. collected after use. Hazards. dispose of it in a Isnandar
designated pleace. Coodinator
4 And Operator
Failure of Injuries and 2 2 L Equipment failures and 1 L
equipment and Hazards. defective electrical
short circuit of cables are repaired
wires. immediately.
5 Covid-19 Protokol Covid-19 Virus Exposed Covid-19 Unable to do work. 2 2 L Pay attention to the use 1 2 L Muhamat
Virus of masks. Isnandar
Coodinator
Ensure all workers And Operator
adhere to health
protocols (maintaining
distance, wahing hands,
wearing masks).

6 Housekeeping Material scattered Tripping and Falling Injury 2 2 L Pay attention in stepping. 1 2 L Muhamat
on the floor and Isnandar
other unstable Make sure all tools have Coodinator
surfaces. been tidied up and And Operator
placed in a safe position,
use PPE.
 JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

Doc. No. 26071-JO-HSE-014

ENGINEERING PROCUREMENT CONSTRUCTION FOR REFINERY Effective Date 13 January 2021
DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-V BALIKPAPAN PROJECT
Revision No. 001

Severity / Risk Rangking (RR) Recommendation Action

Probability (PR) Tingkat Risiko Tindakan Pengendalian
x consequence =
Kemungkinan
Keparahan Score Level Tingkat pengendalian Hierarchy of Control
Frequent =5 Catastrophic =5 19-25 Extreme high E= 1+2+3+4+5 1= Elemination
Probable =4 Major =4 13-18 High H= 3+4+5 2= Substitution
Occasional =3 Moderate / Serious = 6-12 Medium M= 4+5 3= Engineering Control
3
Unlikely =2 Minor =2 1-5 Low L=5 4= Administration
Improbable = 1 Negligible =1 5= PPE

Note : * : Without Control / Tanpa control

*) : With Control / Dengan control