type of injury Danger Current security measures and remedial measures

□ Fracture (broken bone) mechanical factor job characteristic factors personal protective equipment General and hot works excavation work
Investigation of underground facilities (PIC must
□ Puncture (injury by a sharp object) □ Risk of stenosis (bends, pinches) □ noise, vibration □ Safety glasses □ protector face □ Install drain and OWS body covers around the area □ be present during back fill)

□ bruises □ Hazardous surfaces (cuts, scratches) □ Ultrasound, infrasound □ earmuffs □ seatbelt □ Mark a Blind Location in Drawing or list □ Control access to the workplace

□ truncated □ Fall, fly, collapse, overturn danger □ low or high pressure □ Warning Tape □ Air line masks □ Attach a hazard label to the blind installation location □ Prevention of soil collapse at the excavation site

□ Poisoning, suffocation □ Collision risk □ Choking hazard, lack of oxygen □ dust mask □ gas mask □ Removal of flammable materials within 11 meters of the surrounding area working at height and scaffolding

□ Blisters □ Waterfall (slipped, tripped, tripped) □ hard work □ portable ventilators □ Insulation protective □ Open ventilation and drain valve equipment □ Scaffolding installation standards, material
equipment suitability (certified product)

□ Burnt □ Risk of falling parts (opens, etc.) □ operational tools (manipulation) □ Electrical, chemical, and fire protective gloves/clothing □ Maintain the availability of water around the work area □ Feasibility for scaffolding installation work

Effect of interference with surrounding facilities

□ Frostbite power factor human factor general □ Proper arrangement of fire extinguishers □ during installation

□ Concussion □ Electric shock (exceeding safe □ unsafe behavior □ Secure emergency evacuation routes and familiarize □ Installation of scattering prevention net during welding work □ Fall/drop object precautions (blocking/opening)
voltage) yourself with workers' actions
Prior consultation on content, methods and sequence It is forbidden to work up and down
□ Scratches (wounds) □ arch □ Mistakes by workers, inexperience □ of work □ Damage to grounding and cable sheathing of related devices □ simultaneously

Inaccurate information about the

□ Sink □ static electricity □ job □ Control access to the work area Enter confined space □ Steps to prevent falling from moving ladders

□ Chemical contact chemical factor (substance) □ Non-compliance with work □ Use of specified tools and equipment (including □ Mark a Blind Location in Drawing or list □ Confirmation of permit to use scaffolding
procedures explosion-proof devices)

□ Edema (impaired local blood circulation) □ Hazardous substances, gases or □ Improper working methods □ Physical inspection/appearance of the device □ Attach a hazard label to the blind installation location □ Installing cobra or safety blocks on vertical
reactive substances ladders

□ Hearing disorders □ liquid, fog □ Non-compliance with work □ Disposal of hazardous, flammable and toxic substances □ Manage accessor lists heavy equipment work
regulations in containers/equipment
Not wearing personal protective Heavy equipment work plan (including rigging
□ Impaired vision □ solid (dust) □ equipment □ Isolate pipes/vessels before opening and inserting blinds □ Limited space work program □ plan)

Removing residual pressure and temperature from Control crane working radius and signal man
□ Skin disease □ radiation managerial factors □ piping and facilities □ Use portable gas detectors □ placement

Other (if classification is not possible,

□ write name of injury) □ Fire/explosion hazard □ Unwritten work procedures □ Check the location of the face wash facility and whether □ Provide ropes, ladders and respirators for evacuation □ check the wire rope/sling belt that has not been
or not chemical accident prevention is provided installed

Radiant Heat / Explosive Heavy equipment vehicle safety inspection

□ Overpressure □ lack of education and training □ Electrical blocking (including hazard tags/device locks) □ Provide means of communication with workers □ (safety device status)

work environment factors □ Lack of coaching and supervision of □ Check grounding conditions (except for double □ workers must wear air respirators □ Occupy road bodies (notify and secure when all
workers insulation research) lanes are occupied)

□ Climate / high temperature / cold □ Safety rules, etc. not posted □ Interlock Facility Protection Measures □ Installation of ventilation equipment □ Driver qualifications

Not consistent with conditions at

□ lamp □ work □ Attach tags when using the utility radiation work □ safety measures on the travel route

□ space and motion □ (irrational) □ Material safety data sheet □ Calibration of radiation protection devices and equipment □ Consider routing emergency vehicles such as
fire trucks and ambulances

Instructions are different for each Signal number setting and signal method
□ Working time (deadline shortened) □ supervisor □ Material Safety Data Sheets □ Mark the crew transport vehicles and set their operating times □ unification

□ job specifications or job drawings □ Wear a radiation dosimeter and radiation protective clothing
No : 002 /JSA

Company : PT.

Work Type : Srping -talang

No. Type Step

1.1
1.1

1.2
 1.3

1 Preparation / Persiapan

1.4
1.5
1.6

3.1
2 installation Activity

3.2
 3.3

4 Simop ( open operation ) 4.0

5 Finising / penyelesaian 5.0

5 Finising / penyelesaian 5.0

6 House Keeping 7.1

 Subcontractor
Prepared by (SM) : Review(1st
In charge o

Work Area : PPE : Safety

faceshield.

Sequence

Communication Misscom
Communication Misscom

(License
Document Docum
work )Do
lokasi an
 Equipment d
Work tools (Persiapan Peralatan) used. (Peral

Mobilization of chemical to the location by

using transport Transpor
Mobilisasi cemical ke lokasi
dengan .menggunakan Transport
Trasfer material by manual Memindahkan Fall down ,T
material dengan manual
 U
Fatige / Kelelahan

Working at h
person wou
Work at Height
dapat d
 dapat d

using Main Lift Equipment d

mengunakan Main lift
 installation using Scaffolding
mengunakan Scaffolding

Specific Operataion Area ( Daerah operasi Object ja

terntu ) mengena

leave of workplace , Meninggalkan tempat miss Com

kerja
leave of workplace , Meninggalkan tempat miss Com
kerja

Material sharp
Benda tajam
 Co
Review(1st) :
In charge of displine

PPE : Safety Shoes, Safety Helmet, Safety vest, Safety Gla

faceshield.

Potential Hazard
(Hazard)

Misscommunication. (Kesalahan dalam komunikasi)

Misscommunication. (Kesalahan dalam komunikasi)

(License & supporting document are not on site and

Document not Appropriate with job decription
work )Dokumen perizinan dan supporting tidak ada di
lokasi and Dokument tidak sesuai dengan pekerjaan
Equipment does not function properly (malfunctions) when
used. (Peralatan tidak berfungsi dengan baik (malfunction)
saat digunakan)

Transportation vehicle. ( Alat (Kendaraan) transport

( menabrak atau di tabrak
Fall down ,Triping, slip Terjatuh,terpleset and tersandung,
tergilir.
 Unhealthy workers (Pekerja tidak fit)

Working at height where it is reasonably foreseeable that a

person would be injured in a fall.
Bekerja pada ketinggian di mana
dapat diduga bahwa seseorang yang terjatuh akan
mengalami cidera.
 dapat diduga bahwa seseorang yang terjatuh akan
mengalami cidera.

Equipment damage
alat rusak
 Fall down

Object jatuh dari ketinggian ( baut, grating,slip blind

mengenai orang atau fasilitas extisting di bawahnya

miss Communication Error kesalahan kommunikasi

miss Communication Error kesalahan kommunikasi

Tersandung, terjatuh, terpeleset

 Construct

spline

hoes, Safety Helmet, Safety vest, Safety Glass, Safety Mas

Potential Hazard
(Hazard)

Injury / Property
unication. (Kesalahan dalam komunikasi) failure ( ceder
 Injury / Property
unication. (Kesalahan dalam komunikasi) failure ( ceder

upporting document are not on site and

nt not Appropriate with job decription Work
men perizinan dan supporting tidak ada di
okument tidak sesuai dengan pekerjaan
s not function properly (malfunctions) when Injuries due to u
n tidak berfungsi dengan baik (malfunction) peng
saat digunakan)

on vehicle. ( Alat (Kendaraan) transport Transporttaion

( menabrak atau di tabrak
ing, slip Terjatuh,terpleset and tersandung,
tergilir. injury of par
ealthy workers (Pekerja tidak fit)
Person

ght where it is reasonably foreseeable that a Falling from work a

e injured in a fall. injury
Bekerja pada ketinggian di mana kerja dan kejat
ga bahwa seseorang yang terjatuh akan
mengalami cidera.
ga bahwa seseorang yang terjatuh akan
mengalami cidera.

seriuos Injury for w

mage cederah s
alat rusak
 seriuos Injury for w
Fall down cederah s

h dari ketinggian ( baut, grating,slip blind

rang atau fasilitas extisting di bawahnya . Injury o

unication Error kesalahan kommunikasi

unication Error kesalahan kommunikasi

ersandung, terjatuh, terpeleset Stabbed by

 JOB SAFET
onstruction Team
Review(2nd) :

ss, Safety Mask, Earplug, Equipment / Tool/Ve

machine, impect

Type of
Injury

Injury / Property damage / material due to communication

failure ( cedera / kerusakan property / material akibat
kegagalan komunikasi )
Injury / Property damage / material due to communication
failure ( cedera / kerusakan property / material akibat
kegagalan komunikasi )

Work Stopped (Pekerjaan dihentikan)

Injuries due to use of malfunctioning tools (Cedera akibat
penggunaan alat yang malfunction)

Transporttaion damaged (alat transport rusak dan orang

cedera )
injury of part human Cedera bagian anggota tubuh,
 Personnel Injuri ( Cedera pada pekerja )

ling from work area and falling objects causing serious bodily
ury Jatuh dari tempat
kerja dan kejatuhan benda mengakibatkan cidera serius.
riuos Injury for workers
cederah serius pada pekerja
riuos Injury for workers
cederah serius pada pekerja

. Injury of workers dan pekerja pada pekerja

Injury serious , luka serius

 Injury serious , luka serius

Stabbed by a sharp object (Tertusuk benda tajam.)

AFETY ANALYSIS

CM : PTW Controlor :

ent / Tool/Vehicle : Electrical Equipment ( grinding Machin

impect

Taken Measure Control

(Current)

Tools box meeting before wo

(Toolbox meeting sebelum
pekerjaan )
nication
akibat
nication
akibat
Coordination meeting between work group ( koordi
kerja )

Ensure all work documents are available and v

(Memastikan semua dokumen kerja tersedia da

Material Safety Data sheet available dan displaye

tersedia dan di tampilkan pada tempat

valid Setificate equipment

sertifikate equiment yang masih b

Prepare permit at site

(mempersiapkan permit di lokasi
 Pre-use inspection for tools nowlegde by superviso
yang di ketahui oleh pengaw
a akibat
Elektrikal, dan power tools memiliki valid stiker colo
alat electrical tool dan plant memiliki war

Competent Driver with valid drivin

( Supir yg berpengalaman dan mem
surat ijin )

n orang Respect to road rules and regu

( Mematuhi peraturan peraturan
ketentuan jalan

Make sure vehicles are in good co

(Pastikan kondisi mobil dalam keada
 Follow prosedure of methode m
handling
Ikuti prosedur and cara dari
handling

Where available, place safety caps on can pain be

Bila tersedia, pasanglah tutup pengaman pada
pemindahan

buh,
- perform manual lifting simulataneously
Melakukan manual lifting secara b

Ideally lift objects over 20kg o

mechanically or by team
Pengangkatan benda yang id
lebih dari 20Kg harus mengg
alat bantu mekanis atau dia
secara bersama.
 DCH ( daily check health ) by Safety b
(DCK oleh Safety sebelum bek
Kelelahan di periksa oleh Safe

provide shelter properly Menyediakan tempat

WAH Training compulsory to all workes involved workin

training wajib yang bekerja datas ket

Free fall to be limited to 1.8meters and wear full body ha

Ketinggian jatuh bebas
harness harus di gunakan
Safety NetsTo be as close as practicable to the underside
at least 2.5 meters from the working point
Pengaman Dipasang sedekat mungkin dengan lantai kerj
ious bodily dari titik
ari tempat
serius. provide Restraint System ( Life line ) Limits travel awa
kekang Membatasi pergerakan jauh dari tempat yang
 Training in the use of body harness equipment is to be c
Lakukan pelatihan atas penggunaan perlengkap

Personnel to wear fall protection equipment that is attach

point
mengenakan perlengkapan pelindung jatuh yang ditamb
main lift tersebut.

Mainlift Driver – Conducts Daily pre-use safety chec

Operator mainlift – Melaksanakan Pemeriksaan Har

The mainlift driver is to hold a valid license and certifica

be either experienced or be supervised by an experie
adequately trained in the safe use of plant].
harus memiliki surat ijin dan sertifikat yang masih berl
peralatan tersebut

Body harness 100% tie off at anchor point

harness 100% di cantolkan pada anch

scaffolds are only to be erected by a licensed scaffolder

Perancah bergerak hanya boleh didirikan oleh pe
bersertifikat/orang yang dinyatakan
 No one is to be on scaffold when moved
Dilarang berada di atas perancah yang sedang dipindahk

Scaffold Castor Wheels locked when scaffold in use

Roda perancah harus dikunci saat perancah sed

Body harness 100% tie off at anchor point

harness 100% di cantolkan pada anch

Coordination and communication between com

perusahaan yang terkait

a supervisor stand by on site, pengawas lapangan sela

conducted coordination meeting before start work

group kerja sebelum beker

check list environment inspection, melakuakan p

 inspection by supervisor sorrounding area before
oleh supervisor sebelum meninggalkan

install barricade at area,

Barricade terpasang di daerah pemb

Install safety sign and barriicade Pasang rambu K3

Tidy up of material and tool ,

Rapihkan dan susun kembali alat-alat ke

provided wate bin , Siapkan tempat samp

am.)
provided box for storage tool and clean, Menyediak
(tools box), pastikan alat-alat tidak ada yang bersera
kerja
 HSE Team
Controlor : HSE Manager :

nding Machine, drill Hazardous material : Material

asure Control Risk Assessment

urrent)
F S
eting before work
eting sebelum memulai 2 1
pekerjaan )
group ( koordinasi meeting antara group 3 2
erja )

available and valid on working days 2 1

rja tersedia dan valid di hari bekerja)

le dan displayed at Storage MSDS

pada tempat penyimpanan.

nt yang masih berlaku

ermit at site 3 2
permit di lokasi kerja)
 e by supervisor, pemeriksaan pada alat 3 2
ui oleh pengawas

alid stiker color code Memastikan semua

t memiliki warna pemeriksaan 3 2

with valid driving license

laman dan mempunyai 2 1
at ijin )

rules and regulation

uran peraturan dan 3 2
tuan jalan

are in good condition 2 1

bil dalam keadaan bagus
 of methode manual
handling
and cara dari manual 3 2
handling

on can pain before moving

engaman pada Kaleng Cat sebelum
indahan

neously
lifting secara bersama 2 1

cts over 20kg only

ally or by team lift.
benda yang ideal jika 3 2
g harus menggunakan
ekanis atau diangkat
ara bersama.
h ) by Safety before work
y sebelum bekerja)
eriksa oleh Safety 2 1

diakan tempat istirahat yang layak. 2 1

involved working at height WAH

bekerja datas ketinggian

ear full body harnes must be worn

gian jatuh bebas maksimum 1.8meter Body
us di gunakan
to the underside of the work area and extend
oint Jaring
ngan lantai kerja dan ditambahkan 2.5 meter
ri titik

imits travel away from fall potential Sistem

ari tempat yang berpotensi membuat jatuh
ipment is to be carried out.
unaan perlengkapan pelindung jatuh.

ent that is attached to main lift unit’s anchor

Pekerja harus
tuh yang ditambatkan pada kaitan pada alat
t tersebut.

-use safety checks,

Pemeriksaan Harian sebelum pemakaian

nse and certification to operate the equipment

ed by an experienced person and shall be
t]. Pengemudi derek
yang masih berlaku untuk mengoperasikan
an tersebut

int body
olkan pada anchor point

ensed scaffolder/competent person

didirikan oleh petugas perancah yang
ang dinyatakan trampil
ed
edang dipindahkan.

caffold in use
aat perancah sedang dipergunakan

int body
olkan pada anchor point

between company kordinasi dengan

2 1

s lapangan selalu berada di tempat kerja 2 1

ore start work koordinasi meeting antara

sebelum bekerja 2 1

melakuakan pemeriksaan lingkungan 2 1

ng area before leave pemeriksaan area
meninggalkan temapat kerja 2 1

di daerah pembongkaran 2 1

sang rambu K3 dan barricade area kerja 2 1

2 1
bali alat-alat kerja tempatnya

n tempat sampah diarea kerja. 3 2

an, Menyediakan box penyimpanan alat

da yang berserakan dan tertinggal di area 3 2
erja
m Site M
anager : SM :

al : Material

ssessment
Improved measures
Risk

CIII TBM Routine every morning before work

(TBM Rutin setiap pagi sebelum melakukan peke
 Coordination Routine every morning before work
CI (Coordination Rutin setiap pagi sebelum melak
pekerjaan)

CIII Monitoring and up date validation ,

Informed to painter at TBM

diinformasikan kepada painter di TBM

Monitoring validation document

memantou ke syahkan sertificate

CI Daily PTW validation

CI Monitoring and up date validation

CI monitoring conducted by HSE

weekly inspection Inspe

CIII mingguan

Warning sign displayed

CI peringatan di pasang

CIII Daily check list inspection pengecec

setiap hari
 informed to all worker Safe work pcatice at TBM,
CI di informasikan petunju
am an di TBM

Check properly condition before moving.

Periksa kondisi dengan baik sebelum di pindah

socialisation to worker at TMB disolisasa

CIII ditbm

informed to all worker Safe work pcatice at TBM,

CI di informasikan petunju
am an di TBM
 Daily monitoring pressure blood pemerik
CIII harian tekanan darah

CIII Environment Check list pemeriksaan ling

Recorded attendace WAH training

dicatat dan di monitor training

Monitoring activity on site me

aktivitas dilapangan

Supervisor inspect installation safety Net.

Pengawas memeriksa pemasangan net keselama
submit work training per schedule, men
training WAH setiap orang akan bekerja di keting

Provide aditional anchor point

menambahkan anchor point

Daily inspect equipment

pemeriksaan harian

Monitoring up date document mel

pembahruan dokumen

site Supervisor monitoring function FBH

pengawas memantau pemakaian FBH

site Supervisor monitoring function scaffolding

pengawas memantau pemakaianscaffolding
 Daily coordination meeting,
pertemua harian

Weekly scaffolding inspection by inspector kine

pemeriksaan minggu oleh inspector scaffol

Daily coordination meeting,

pertemua harian

Routine cordination workgroup , Rutine berkomu

CIII antara group

CIII Always, if any activity, selalu, jika ada pekerjaa

Daily coordination meeting,

CIII pertemua harian

CIII

before leave work place

sebelum meninggalkan tempat kerja
 before leave work place
CIII sebelum meninggalkan tempat kerja

CIII

CIII Monitoring performance activity Me

pelaksanaan activity

CIII

CI
Weekly Environment Check list pemer
lingkungan

CI
 Site Manager

Risk Assessment
es
F S Risk

fore work 1 1 CIII

lakukan pekerjaan)
 g before work
belum melakukan 1 1 CII

alidation , 1 1 CIII

ter di TBM

ertificate

on 1 1 CII
alidation 1 1 CII

by HSE 1 1 CII

Inspection
1 1 CII

tanda
ng 1 1 CII

pengececkan alat 1 1 CII

tice at TBM,
asikan petunjuk kerja 1 1 CII

moving.
um di pindahkan

disolisasakann

tice at TBM,
asikan petunjuk kerja 1 1 CIII
 pemeriksaan
ah 1 1 CIII

meriksaan lingkungan 1 1 CIII

ning

memantou
n

afety Net.
net keselamatan
 mengajukan
kerja di ketinggian

point

melakukn
men

n FBH
akaian FBH

caffolding
anscaffolding
 Daily

ector kine
pector scaffolding

Daily

tine berkomunikasi
1 1 CII

a ada pekerjaan 1 1 CII

Daily
1 1 CII

1 1 CIII

mpat kerja
mpat kerja 1 1 CIII

1 1 CIII

Memantou 1 1 CIII
ty

1 1 CIII

1 1 CIII
pemeriksaan

1 1 CIII