PT SWADAYA GRAHA Doc. No: Rev.
: 01
FORM JSA WORK SHEET Sheet : 1of 6 Date: 25-10-18
JOB SAFETY ANALYSIS Part 1
Area Location: Air Product Indonesia Equipment Description: (i) 50 tons Mobile Crane
(ii) 100 tons Mobile crane
(iii) 200 tons Mobile Crane
Job No:
Task Description: Lifting Operation of Replacing of Old E-341 with New E-341
Cargo Dimension: (i) L 6.198m x W 2.205m x H 1.067m / weight : 16 tons
(ii) L 2.772m x W 1.084m x H 0.80m / weight : 140 kgs Date:
(iii) Various size of pipe spools
Permit Required: Isolation Required: PPE Required above site standard: Equipment Required:
(indicate by ticking) ( indicate by ticking) (indicate by ticking) (indicate by ticking)
Hot Work Electrical Chemicals Oxy cutting goggles Gloves X Barricading/Signs X
Confined Space X Mechanical High Voltage Chemical Goggles Fall arrest equipment X Electrical Earth Leakage
Unit
Excavation / Penetration Manual Valves Hydraulic Face shield Respirator Fire Extinguisher
Roof or Chimney access Pneumatics Liquids Dust Masks Disposable Overalls Lifting Equipment X
Fire Indicating
Asbestos Removal Heat Gear Safety Glasses X Fans/Extraction
Panel
High Voltage Other : Safety Shoes, Safety helmet Welding Screens
Other _______________ Other __________________
AKNOWLEDGEMENT
Prepared by: Prepared For: Note:
Name Designation Signature & Date AIR PRODUCT
PT SWADAYA GRAHA Doc. No: Rev.: 01
FORM JSA WORK SHEET Sheet : 2of 6 Date: 25-10-18
Probability Consequences Part 2
MATRIX
People Environment
A – common or repeating occurance 1 – fatality or permanent disability 1 – off site release with major detrimental effect
CDE common or repeating occurrence 2 – lost time injury or illness 2 – off site release with minor detrimental effect
1 H H S S M B – known to occur or “It has happened” 3 – medical treatment 3 – on site release contained with outside assistance
A C – could occur, “I’ve heard of it 4 – first aid treatment 4 – on site release immediately contained
B happening” 5 – no environmental impact
5 – incident report only
2 H S S M M D – not likely to occur
3 S S S M L E – practically impossible
4 S M M L L
5 S M M L L
Consequence
Probability
STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL RESPONSIBILITY
NO. List the steps required to perform Against each step list the potential / risk Rank For each hazard identified list the Nominate the person
the task in the sequence they are hazards that could cause injury / control measures required to eliminate who will be required to
L,M,S
carried out. damage when the task step is or minimize the risk of injury. action the control
or H
performed. (use hierarchy of controls) measures.
1.0 Trailer/Mobile crane entering the job Trailer hits object or person within C 2 S Clear the path from any obstruction. Client
site/access vicinity
Provide sufficient area for hydraulic trailer
movement and turning.
Tyre may be punctured by sharp objects D 1 S Clear the ground at job site from sharp Client
that may affect the stability of hydraulic objects.
trailer.
Soft ground condition and uneven terrain D 1 S Check the ground condition. Engineer/ Supervisor
may affect the stability of cargo during
Take necessary action to ensure the ground
transport.
condition is strong and firm.
Communication problem may contribute C 5 M Ensure all crane drivers, supervisor, and Supervisor/ crane
to interpreting wrong instruction. escort team are equipped with walkie operator/ signal-man/
talkie. engineer.
Check the walkie talkie before starting the
PT SWADAYA GRAHA Doc. No: Rev.: 01
FORM JSA WORK SHEET Sheet : 3of 6 Date: 25-10-18
Probability Consequences Part 2
MATRIX
People Environment
A – common or repeating occurance 1 – fatality or permanent disability 1 – off site release with major detrimental effect
CDE common or repeating occurrence 2 – lost time injury or illness 2 – off site release with minor detrimental effect
1 H H S S M B – known to occur or “It has happened” 3 – medical treatment 3 – on site release contained with outside assistance
A C – could occur, “I’ve heard of it 4 – first aid treatment 4 – on site release immediately contained
B happening” 5 – no environmental impact
5 – incident report only
2 H S S M M D – not likely to occur
3 S S S M L E – practically impossible
4 S M M L L
5 S M M L L
Consequence
Probability
STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL RESPONSIBILITY
NO. List the steps required to perform Against each step list the potential / risk Rank For each hazard identified list the Nominate the person
the task in the sequence they are hazards that could cause injury / control measures required to eliminate who will be required to
L,M,S
carried out. damage when the task step is or minimize the risk of injury. action the control
or H
performed. (use hierarchy of controls) measures.
lifting operation to ensure all are in order.
Supervisor should give clear instruction
and explanations in toolbox meeting.
2.0 Install/ dismantling rigging/ lashing Manpower falls to ground during install/ C 1 S Use safety harness. Ensure appropriate Supervisor
gear. dismantling rigging/ lashing gear. preparation had been made so safety
harness can be used safely.
Cargo swing to one side due to unbalance C 1 S Cargo to be well secured with lever hoist Supervisor
rigging during cutting / dismantling prior to cutting / dismantling operation.
operation.
Basic PPE is required during inspection
Loading of cargo onto trailer by using such as Leather Glove, Safety Boots and
3.0 Lifting D 2 M Supervisor
crane Safety Helmets. Supervisor is to monitor
all activities.
Before lifting, check for loose objects.
Objects fall from cargo onto underneath Supervisor/ Crane
C 2 S Ensure only designated personnel are
passer-by during lifting. Operator
allowed in the lifting area with barricade
PT SWADAYA GRAHA Doc. No: Rev.: 01
FORM JSA WORK SHEET Sheet : 4of 6 Date: 25-10-18
Probability Consequences Part 2
MATRIX
People Environment
A – common or repeating occurance 1 – fatality or permanent disability 1 – off site release with major detrimental effect
CDE common or repeating occurrence 2 – lost time injury or illness 2 – off site release with minor detrimental effect
1 H H S S M B – known to occur or “It has happened” 3 – medical treatment 3 – on site release contained with outside assistance
A C – could occur, “I’ve heard of it 4 – first aid treatment 4 – on site release immediately contained
B happening” 5 – no environmental impact
5 – incident report only
2 H S S M M D – not likely to occur
3 S S S M L E – practically impossible
4 S M M L L
5 S M M L L
Consequence
Probability
STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL RESPONSIBILITY
NO. List the steps required to perform Against each step list the potential / risk Rank For each hazard identified list the Nominate the person
the task in the sequence they are hazards that could cause injury / control measures required to eliminate who will be required to
L,M,S
carried out. damage when the task step is or minimize the risk of injury. action the control
or H
performed. (use hierarchy of controls) measures.
tape.
Calculate the imposed load bearing and
check against the allowable/ design load
Road not strong enough to support the bearing.
load bearing from the crane / trailer / C 2 S Prior to work, inspect the lifting area to Engineer/ Supervisor
cargo. ensure no excavation had been done.
Ensure proper reinforcement/ padding is
being used.
The shackle/ lever-hoist/ wire rope and
other equipments are checked periodically
as part of maintenance program.
Lifting-wire snap and shackle give way or
C 2 S Check equipments prior to delivery to Engineer/ Supervisor
slipped.
jobsite and check again before use. Ensure
correct shackle/ lever-hoist/ wire rope is
used at the correct location.
Communicate closely with site
New obstruction to set ground
representative on the schedule and setting
reinforcement such as steel-plates and C 2 S Engineer/ Supervisor
of the equipment on an earlier day prior to
timber-blocks
the arrival of cargo.
PT SWADAYA GRAHA Doc. No: Rev.: 01
FORM JSA WORK SHEET Sheet : 5of 6 Date: 25-10-18
Probability Consequences Part 2
MATRIX
People Environment
A – common or repeating occurance 1 – fatality or permanent disability 1 – off site release with major detrimental effect
CDE common or repeating occurrence 2 – lost time injury or illness 2 – off site release with minor detrimental effect
1 H H S S M B – known to occur or “It has happened” 3 – medical treatment 3 – on site release contained with outside assistance
A C – could occur, “I’ve heard of it 4 – first aid treatment 4 – on site release immediately contained
B happening” 5 – no environmental impact
5 – incident report only
2 H S S M M D – not likely to occur
3 S S S M L E – practically impossible
4 S M M L L
5 S M M L L
Consequence
Probability
STEP JOB STEP POTENTIAL HAZARD Risk REQUIRED HAZARD CONTROL RESPONSIBILITY
NO. List the steps required to perform Against each step list the potential / risk Rank For each hazard identified list the Nominate the person
the task in the sequence they are hazards that could cause injury / control measures required to eliminate who will be required to
L,M,S
carried out. damage when the task step is or minimize the risk of injury. action the control
or H
performed. (use hierarchy of controls) measures.
Trailer or crane hit road curb or other Supervisor or driver’s attendant to ensure
Supervisor/ Crane
thing or fell into pothole during reversing/ D 2 M there are personnel at all side of the trailer/
Operator
maneuvering. crane (back, front and the sides)
Attach guide ropes to cargo prior to lifting. Supervisor
Cargo sways during lifting and may spin
D 2 M Ensure sufficient personnel to guide cargo
and hit boom crane
during lifting.
Ensure cargo weight prior to lifting and
Crane tilts and topple due to overloaded. D 2 M crane capacity and working radius is Engineer
sufficient for the lifting job.
Supervisor should give toolbox talk to Supervisor/ crane
crane operator, signal man and engineer on operator/ signal-man/
the responsibility of each personnel. engineer.
Communication problem may contribute During operation, whistles and walkie
C 5 M
to interpreting wrong instruction. talkie shall be used as tools of
communication during lifting operation.
PT SWADAYA GRAHA Doc. No: Rev.: 01
FORM JSA WORK SHEET Sheet : 6of 6 Date: 25-10-18
