JOB SAFETY HEALTH ENVIRONMENT ANALYSIS (JSA) FR-HSE-S002

Nomor Tugas Nama Tugas Halaman 1 dari 2 Nomor Revisi

Task Number Task Name Page 1 of 2 Revision Number
Nama & Jabatan Nama & Jabatan Supervisor
Occupation & Title Supervisors Name & Title
Disusun Oleh Departemen Tempat Kerja Tanggal
Compiled By Department Work Location Date
Direview Oleh Alat Pelindung Diri (APD) Yang Diperlukan
Reviewed By Required Personal Protective Equipment (PPE)

Urutan Dasar Langkah Tugas

Bahaya Yang Terkait / Aspek Lingkungan Prosedur & Tindakan Direkomendasikan
Sequence of Basic Task Steps
Associated Hazards Recommended Procedure & Safe Actions

Document Number: FORM-49386 Revision: 0 Effective Date: 4-Jan-22

Urutan Dasar Langkah Tugas

Bahaya Yang Terkait / Aspek Lingkungan Prosedur & Tindakan Direkomendasikan
Sequence of Basic Task Steps
Associated Hazards Recommended Procedure & Safe Actions

THIS DOCUMENT CONTAINS CONFIDENTIAL KIMBERLY-CLARK INFORMATION. Printed copies are only valid
on the date printed unless controlled per a manual document control procedure and stamped as such.
Page 1 of 2
 JOB SAFETY HEALTH ENVIRONMENT ANALYSIS (JSA) FR-HSE-S002

Catatan : Dianalisa oleh : Disetujui oleh,

JSA ini harus disampaikan kesemua karayawan yang terkait

(…………...……………….) (…………...……………….)
Supervisor HSE Departement

Document Number: FORM-49386 Revision: 0 Effective Date: 4-Jan-22

THIS DOCUMENT CONTAINS CONFIDENTIAL KIMBERLY-CLARK INFORMATION. Printed copies are only valid
on the date printed unless controlled per a manual document control procedure and stamped as such.
Page 2 of 2