Job Safety Analysis Form

PT. PUNJ LLOYD INDONESIA

HEALTH SAFETY & ENVIROMENTAL DEPT

JOB SAFETY ANALISYS (JSA)

No. Work Steps Hazards Identified Hazards Effect Risk Factor Safety Measures & Prevention Residual Risk
Factor
Basic Steps & Tools How can people get injured use checklist on Type of injury worst case HE P RF Identify the Safety Controls and HE P RF
Used Mitigation Plan, Assign responsible
person for each action (Name)

Location SUMPAL Date 15 JULY 2013 Sheet

Activity WATER FILLING JSA No.
Leader Checked by Sign
Crew Member Approved by Sign

1. Cek areal kerja. Areal terdapat konsentrasi gas hydrocarbon Terhirup gas beracun L L L2 Cek areal menggunakan gas VL L L1
mudah terbakar lebih dari 3% bahaya bila Tersandung detector, pastikan konsentrasi gas
tersambar percikan api dan terdapat hydrocarbon 0% dan pastikan
konsentrasi gas toksik lainnya bahaya bila tidak ada kamdungan gas
terhirup hydrocarbon dan toksik (beracun)
Pastikan peralatan kerja tidak
menghalangin akses jalan
.
2. Check Personil Kerja - Pekerja kurang sehat/fit. - pingsan, M L L - Pastikan seluruh pekerja dalam VL L L1
- Pekerja membawa korek api dan - Kebakaran dan kondisi sehat dan fit, istriahat
penggunaan HP di dalam plant. kerusakan / gangguan bila sakit, sediakan kotak P3K
fasilitas di dalam plant serta isinya lengkap dan layak
pakai
- Seluruh HP dan korek api
dikumpulkan dan dititipkan di
pos security.

Page 1 of 5
 Job Safety Analysis Form

PT. PUNJ LLOYD INDONESIA

HEALTH SAFETY & ENVIROMENTAL DEPT

JOB SAFETY ANALISYS (JSA)

No. Work Steps Hazards Identified Hazards Effect Risk Factor Safety Measures & Prevention Residual Risk
Factor
Basic Steps & Tools How can people get injured use checklist on Type of injury worst case HE P RF Identify the Safety Controls and HE P RF
Used Mitigation Plan, Assign responsible
person for each action (Name)

3. Cek peralatan kerja - Air radiator mesin Pump, oli bahan bakar - luka gores L L L2 - lakukan prejob safety check list VL L L1
mesin (solar ) kering, bahaya mesin pada mesin pump sebelum
terlalu panas beresiko mesin meledak dioperasikan pastikan mesin las
layak pakai
- l akukan projob safety check list,

4. Pemasangn Pump - Tangan tergores, terjepit dan tertimpa - patah tulang / keseleo M L L - Pakai,Hand Glove L L L2
mesin - Gunakan alat bantu pada saat
memasang mesin pump

5. Memasang Hose - Terlepas mengenai pekerja - luka , patah tulang dan M L L - Pastikan hose terpasang dengan L L L2
Connector kematian benar dan kuat, gunakan
pengikat hose atau safety chain.
.
6. Membuka Vent - Terjepit dan semburan air bertekanan - luka dan keseleo M L L - Gunakan sarung tangan dan L L L2
posisi yang aman saat membuka
Vent.

- - VL L L1
- -
- -

Page 2 of 5
 Job Safety Analysis Form

PT. PUNJ LLOYD INDONESIA

HEALTH SAFETY & ENVIROMENTAL DEPT

JOB SAFETY ANALISYS (JSA)

No. Work Steps Hazards Identified Hazards Effect Risk Factor Safety Measures & Prevention Residual Risk
Factor
Basic Steps & Tools How can people get injured use checklist on Type of injury worst case HE P RF Identify the Safety Controls and HE P RF
Used Mitigation Plan, Assign responsible
person for each action (Name)

- -
11 Finishing - Terjepit - Luka, terjepit L L L2 - Posisi tanganyang aman saat VL L L1
. Membuka Connection membuka Connection
Instrument dan Hose Instrument dan Hose
Connection Connection

12 Pekerjaan selesai - Area kerja berserakan - Tersandung L L L2 - Gunakan sarung tangan. VL L L1

( House Keeping) - Luka memar pada kaki. - Rapikan sisa potongan pipa.
- Pastikan keadaan aman seperti
semula.
- Hubungi operator stasiun untuk
mengecek lokasi kerja.

- - -

P = Probability HE = Hazard Effect RF = Risk Fac

Page 3 of 5
 Job Safety Analysis Form

PT. PUNJ LLOYD INDONESIA

HEALTH SAFETY & ENVIROMENTAL DEPT

JOB SAFETY ANALISYS (JSA)

No. Work Steps Hazards Identified Hazards Effect Risk Factor Safety Measures & Prevention Residual Risk
Factor
Basic Steps & Tools How can people get injured use checklist on Type of injury worst case HE P RF Identify the Safety Controls and HE P RF
Used Mitigation Plan, Assign responsible
person for each action (Name)

RISK FACTOR MATRIX

Probability HIGH MEDIUM LOW

Hazard Effect

Very High (VH):

 Multiple Fatality
 Major Facility Damage > $ 5,000,000.
 Environment Major Spill 1,000 – 10,000 bbls H15 H14 H11
High (H):
 Single Fatality
 Significant Facility Damage $ 500,000 - $ 5,000,000.
 Environment Significant Spill > 100 bbls H13 H12 H10
Medium (M):
 Permanent Disability / DAFWC
 Moderate Damage > $ 100,000 - $ 5,00,000.
 Environment Reportable 15 – 100 bbls H9 M8 M4
Low (L):
 Single or Multiple Minor Injuries (Medical Treatment)
 Minor Facility Damage $ 100,000.
 Environment Minor Loss 1 - 15 bbls M7 M6 L2
Very Low (VL):
 Single First Aid

Page 4 of 5
 Job Safety Analysis Form

PT. PUNJ LLOYD INDONESIA

HEALTH SAFETY & ENVIROMENTAL DEPT

JOB SAFETY ANALISYS (JSA)

No. Work Steps Hazards Identified Hazards Effect Risk Factor Safety Measures & Prevention Residual Risk
Factor
Basic Steps & Tools How can people get injured use checklist on Type of injury worst case HE P RF Identify the Safety Controls and HE P RF
Used Mitigation Plan, Assign responsible
person for each action (Name)

 Minor Facility Damage < $ 10,000.

 Environment Slight Loss < 1 bbl.s M5 L3 L1

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