Part 1

JSA No. : 01/TWK/2018 JOB SAFETY ANALYSIS

Company Name : Company Address : Work Activity : Project :
PT. TRI WAHANA KARSA Jl. Karunrung Asri E No. 21, Makassar LAND CLEARING GI 150KV TOPOYO – MAMUJU
TENGAH, SULAWESI BARAT

JSA Prepared by : Rifaldy Abdurrachman Reviewed by : Charles BP Approved by : Hendy Pratomo

Signature : Signature : Signature :

Task Description : LAND CLEARING

Date : 09 – 11 – 2018
High Risk Tasks :
Special precautions must be taken when undertaking non-routine work. Ensure entire team have Start Date : End Date :
Routine task? □ Non-routine task? 🗹 developed a comprehensive JSA and check requirements for lifting plans; special permits; isolations; 12 – 11 - 2018
services; unexpected hazards; emergency planning and team competencies
Permit / Plan Required : Isolation Required : PPE Required Above Site Standard : Equipment Required :
General / Cold Work ✓ Electricals Helmet / Hard Hat ✓ Safety Gloves ✓ Warning / Hazard Signs ✓
Hot Work ✓ Mechanicals Safety Eye Glasses ✓ Electrical Gloves Soft Barricades / Hard Barricades

✓ Oxy Cutting
Excavation / Penetration Erection Zone Full Body Harness Safety Life Lines
Googles

Working at Height Lifting Zone Chemical Googles Safety Shoes / Boots ✓ First Aid Kit ✓
Confined Space Live Existing Zone Ear Plug / Ear Muff Rompi ✓ Stretcher / Palanquin (tandu)

Dust Mask /
Electrical / LOTO Commissioning Zone Arc Flash Lifting Gears / Equipments
Respirator

Lifting Plan / Review Energizing Zone Face Shield Disposable Overalls Fire Extinghuiser / Spill Kit
Manual Handling
Potential Environmental Hazards Hazardous Materials / Substances Will Hazardous manual Handling be possible during the job? E.G. Lifting,
This item requires continual review to include the specific area (List any chemicals and hazardous materials to be used or pushing, pulling, Twisting or bending? If so tick the box that most likely
or activities requirements. Please Tick Box present in the work Area. Attach an MSDS for each) describes the manual handling risk and include the code on each SWMS Job
step
Weather ✓ Oil / Flammable Material None There will be no Hazardous Manual handling in this job. ✓
Physical ✓ Gas / Compressed Material MH1 The task may involve high forces. ✓
Ergonomic / Erosion ✓ Corrosive Material MH2 The task will require repetitive forceful movements ✓
The task is likely to cause fatigue or soreness due to it’s long
Working at Height / Confined Space ✓ Asbestos Material MH3 duration ✓
Environmental factors are likely to increase the chance of
Noise / Dust ✓ Electricity Material ✓ MH4 injury. ✓
Joggle / Parallel ✓ Moving Particles ✓ MH5 Awkward posture or movements. ✓
Lift Review General
Lift review MUST be done on all field and service jobs.
For more complex lifts – use a full detailed lift plan.
 _____
Maximum lift (static) load KG
kg
Sling _____
CHN SYN RND OTHR
Type kg
_____
Lift capacity of sling
kg
Crane condition checked & operation tested
(yes/no)
Protective barrier required for sling, chains
(yes/no)
Lifting Gear Checked Own Equipment
(Yes, No) Tested &
Tagged , good Condition Customer equip.

Rigging Required (yes/no)

Full Lift Plan Required (yes/no)

Lifting Operation Zone ✓ ✓ ✓ ✓ ✓

Probability Consequences Hierarchy of Control

A – Repeating occurrence-happens People Environment 1 – Eliminate
on most occasions. 1 – Fatality or Permanent 1 – off site release with major detrimental effect 2 – Substitute
Disability 2 – off site release with minor detrimental effect 3 – Isolation
MATRIX A – common or repeating 2 – Lost Time Injury or Illness 3 – on site release contained with outside 4 – Engineering
A B C D E occurrence 3 – Medical Treatment assistance 5 – Administration
B – Common occurrence-happens 4 – First Aid Treatment 4 – on site release immediately contained 6 – PPE
1 H H H M M approx 1 in 10 5 – Incident Report only 5 – no environmental impact
2 H H M M M C – Could occur-infrequent Apply in order of preference
occurrence-happens approx 1 in from 1 to 6 – note control
3 H M M M L 100 used
4 M M M L L D – Not likely to occur-unusual
5 M M L L L occurrence-approx 1in 500
E – Practically impossible-occurs
less than 1 in 5000

Hierarchy of Control
When choosing the controls to be used for each of the hazards that exist, it is important to consider the hierarchy of controls in determining the best practicable control.
Consider each hazard and whether there exist a way in which the hazard can be eliminated. If such a control is practicable - nominate the control in the “control” column,
and circle the number 1 in the hierarchy of control column. If elimination is not practicable - consider substitution to reduce the risk of the hazard. If such a control is
practicable put the control in the “control” column then cross out 1 and circle 2 in the hierarchy of control column. Repeat until the best practicable control is determined.
Then repeat for each hazard.

Part 2
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NO. JOB STEP POTENTIAL HAZARD Initial Risk REQUIRED HAZARD rar Risk Assessed RESPONSIBLE
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required to perform potential / risk hazards that P R out r R Nominate the person
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- Identifikasi potensi bahaya di
123 Logotic atau operator
Terjatuh dari peralatan C 4 M area. E 5 L
456 alat berat
- Menggunakan APD
- Jangan tergesa-gesa dan 123 Logotic atau operator
Kaki terjepit peralatan C 4 M tahap demi tahap. E 5 L
1 Persiapan peralatan 456 alat berat
- Cek peralatan sesuai dengan
permintaan.
- Persiapkan alat sesuai dengan
pekerjaan.

123
Tertimpa pohon C 4 M E 5 L Site supervisor
- Identifikasi potensi bahaya 456
diarea kerja.
123
Terperosok C 4 M - Menggunakan APD E 5 L Site supervisor
Membuatan jalan 456
2 - Jangan tergesa-gesa saat
menuju lokasi. melakukan pekerjaan. 123
Tertimpa material C 4 M Kordinasikan sebelum E 5 L Site supervisor
- 456
melakukan pekerjaan.
123
Alat berat terbalik C 2 M E 5 L Site supervisor
456
 123
Terpeleset C 4 M - Identifikasi potensi bahaya E 5 L Site supervisor
456
diarea kerja.
- Memastikan keadaan alat 123
Terkena swing alat berat C 2 H tidak ada kendala saat E 5 L Site supervisor
456
pekerjaan di mulai
Excavation/ 123
3 Tertimpa tanah longsor C 2 H - Jangan tergesa-gesa saat E 5 L Site supervisor
penggalian 456
melakukan pekerjaan.
- Menggunakan APD 123
Kena gas sisa bahan bakar C 4 M E 5 L Site supervisor
- Kordinasikan sebelum 456
melakukan pekerjaan
123
Alat berat terbalik C 2 M E 5 L Site supervisor
456
- Identifikasi potensi bahaya 123
Terkena debu C 3 M diarea kerja. E 5 L Site supervisor
456
- Pemeriksaan material kerja
sebelum melakukan 123
Alat berat terbalik D 4 M E 5 L Site supervisor
pekerjaan. 456
Finishing Land
4 - Menggunakan APD 123
Clearing. Tertimpa tanah longsor D 2 H E 5 L Site supervisor
- Jangan tergesa-gesa saat 456
melakukan pekerjaan.
- Kordinasikan sebelum Site supervisor
melakukan pekerjaan.
- Menyiapkan ijin kerja. Site supervisor

Site supervisor