Master Form JSA

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PT.

AMCOR FLEXIBLES INDONESIA


FORM
Job Safety Analysis FM-QEHS-EHS-055
Disetujui Oleh Tanggal Revisi Halaman
HSE
HSE Manager 2 April 2012 01 1/2

Job Safety Analysis – Analisa Keselamatan Tugas


JSA dilakukan untuk semua pekerjaan non rutin. Dapat juga digunakan untuk membuat atau meninjau SOP yang telah ada.
Buatlah tugas-tugas dasar untuk menjalankan tugas terkait, dengan daftar tugas ini identifikasikan potensi bahaya.
Semua bahaya yang teridentifikasi catatlah pengendalian yang telah diterapkan dan jika perlu catat peringatan-
peringatan atau hal-hal yang harus dihindari.
Nama kegiatan:
No. SOP/SWP*: Tanggal:
Posisi/Jabatan: (Yang menunaikan tugas) Lokasi / Gedung:
Departemen: Bagian / Area:

PERHATIAN KESELAMATAN
LANGKAH DASAR – POTENSI BAHAYA – PROSEDUR WAJIB SAFETY PRECAUTIONS
BASIC STEPS POTENTIAL HAZARDS PROCEDURE TO BE (If procedure does not fully
FOLLOWED (DOs) control risk)
(DON’Ts)

Prepared by: Date:


Approved by: Date:
H&S Rep / Committee Consulted: Date:
Next Review Date < 5 yrs:

* SOP – Standard Operating Procedure; SWP – Safe Work Procedure


PT. AMCOR FLEXIBLES INDONESIA
FORM
Job Safety Analysis FM-QEHS-EHS-055
Disetujui Oleh Tanggal Revisi Halaman
HSE
HSE Manager 2 April 2012 01 2/2

Job Safety Analysis


To be completed for all non-routine tasks. Can also be utilised to develop or review SOPs.
List the basic steps required to undertake the specified task/operation, from these steps list any identified potential hazards.
For all identified hazards record the control to be utilised a nd where necessary record any specific precautions or things
to be avoided.
Title of Operation:
SOP/SWP* No: Date:
Position/Title: (person who does job) Location / Building:
Department: Section / Area:

SAFETY PRECAUTIONS
BASIC STEPS POTENTIAL HAZARDS PROCEDURE TO BE (If procedure does not fully
control risk)
FOLLOWED (DOs)
(DON’Ts)

Prepared by: Date:


Approved by: Date:
H&S Rep / Committee Consulted: Date:
Next Review Date < 5 yrs:
* SOP – Standard Operating Procedure
SWP – Safe Work Procedure

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