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Avinash Joshi
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Avinash Joshi
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Avinash Joshi
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
JSA No. : RDMP / JSA /
JSA Title : HVAC WORK
ATTENDANCE LIST – JSA PREPARATION
NO NAME POSITION COMPANY SIGNATURE
1 Kim Byoung Oh Construction Manager PT. ETI-HVAC
2 Saharuddin HSE Coordinator PT. ETI-HVAC
3 Gun Gun Kamaludin Foreman Plumbing PT. ETI-HVAC
4 Hafidz Sabtari Rifai’i Quality Control PT. ETI-HVAC
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JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
Company : ETI HVAC Prepared By Review by Approved by
Project : RDMP JO Balikpapan SPV Chief/MGR HSE CM
Person in charge name : NAME
Position/ Title job : Site Manager
Job activity : JSA Plumbing SIGNATURE
Area :
Date : DATE
Status Status
NO Permit Registry No Open √ Close √
NO Permit Registry No
Open √ Close √
Sequence of Basic Consequence / Risk Assessment* Result Risk*)
Hazard Risk Recommendation action
NO Job Steps severity
Bahaya Resiko PR SV RR Tindakan Pengendalian PR SV RR
Tahapan pekerjaan Akibat
1. Mobilizaion of - Driving with - Crashing - Injuried 3 3 M - Obey traffic Sign 2 2 L
worker operational vehicle Tertabrak Pekerja Patuhi rambu lalulintas
Mobilisasi Pekerja Berkendara dengan Cidera/terluka - Have Driving License
kendaraan - Fall from Driver harus memiliki
operasional vehicle - Obstructed work SIM (Surat Ijin
Terjatuh Pekerjaan Mengemudi)
terhambat - Using safety belt when
- Damaged drive
vehicle
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
Kendaraan rusak Pastikan sabuk
pengaman terpasang
- Vehicle Inspection
before drive
Periksa kendaraan
sebelum dioperasikan
2. - Toolbox Meeting - Miss - Miss - Not understand of 3 3 M - Give the information of 2 2 L
Toolbox Meeting communication understanding the work work accurate
Miss Komunikasi the information Tidak mengerti Pemberian informasi
Salah pekerjaan yang /materi sesuai dengan
memahami akan dilakukan pekerjaan yang akan
informasi yang dilaksanakan
diberikan - Work hampered - Skilled worker
Pekerjaan Pekerja harus memiliki
terhambat keahlian
- Used PPE Requirement
Menggunakan APD
yang sesuai
3. Pre work (Persiapan Pekerjaan)
a. Preparing tools and - Mobilization tools - Work tools - Work hampered 3 3 L - Bring appropriate work 2 2 L
Equipments and equipments to damage Pekerjaan Tools/equipment
Persiapan Peralatan site Peralatan kerja terhambat Bawa peralatan dan
Kerja Mobilisasi rusak perlengkapan kerja
peralatan kerja ke - Inappropriate sesuai dengan
site work tools pekerjaan yang akan
Peralatan kerja dilakukan
tidak sesuai - Re Check work
Tools/equipment Need
Pastikan dilakukan
pemeriksaan terhadap
semua kebutuhan
peralatan kerja
dilapangan
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
b. Inspection work - Work - Work - Work hampered 3 3 M - Make sure 2 2 L
tools/equipment tools/equipment tool/equipment Pekerjaan tools/equipment
Pemeriksaan damage operation failure terhambat running well
peralatan kerja / Peralatan kerja Alat kerja gagal Pastikan semua
mesin kerja dan lain rusak beroperasi peralatan kerja bekerja
lain - Work equipment - Indicator dengan baik
system does not tools/equipment - Make sure the indicator
operate not working working
System pada Indicator pada Periksa semua indicator
peralatan kerja peralatan kerja pada mesin berjalan
tidak beroperasi tidak berfungsi sesuai fungsinya
- Bring work
tools/equipment as
needed
Membawa peralatan,
kerja yang dibutuhkan
- Operator/worker must
have skills
Operator alat harus
yang memiliki lisensi
atau bersertifikat atau
yang sudah terbiasa
menggunakan peralatan
kerja
- Prepare fire extinguiser
Sediakan APAR
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
c. Socialization to - Miss information - Misunderstood - Work stopped 3 3 M - Coordinating with 2 2 L
related parties Informasi yang information Penyetopan related parties
Koordinasi dengan disampaikan tidak Salah pekerjaan oleh Melakukan koordinasi
pihak terkait akurat memahami warga atau pihak kepada pihak terkait/
informasi terkait pemberi pekerjaan
- Provide accurate and
correct information
Memberikan informasi
yang benar dan akurat
4. (Pelaksanaan Pekerjaan)
Scaffolding
a. a - prepare - Ergonomics - Fatigue 3 3 M - Coordinating with 2 2 L
Installation
a scaffolding to area Ergonomi Kelelahan related parties
Instalasi Scaffolding installation Melakukan koordinasi
mempersiapkan - Scaffolding - Injury kepada pihak terkait/
scaffolding di area falling down Cedera pemberi pekerjaan
pemasangan. Scaffolding
ambruk/terjatuh - Provide accurate and
- Scaffolding assembly correct information
must have the - Hand Pinched Memberikan informasi
procedure from the Tangan terjepit yang benar dan akurat
factory pada saat
Pemasangan pemasangan - PPE Mandatory
(f,safetyhelm,full body
scaffolding harus
harness)
memiliki procedure - Falling down
dari pabrik. from scaffolding APD wajib digunakan
Terjatuh dari (sarung tangan , full
scaffolding body harness)
saat instalasi.
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
b. Pipe Instalation - mark the area to - Ergonomics - Ergonomics 3 3 M - PPE Mandatory (face 2 2 L
Instalasi pipa install the pipe Ergonomi Ergonomi mask,safetyhelm,
menandai area gloves, Safety Glass)
untuk di instal APD wajib digunakan
- drilling the wall to - Ihaling dust - respiratory (pelindung wajah,
install menghirup disorders masker wajah, sarung
hanger/support debu. Gangguan tangan , serta kaca
installation with pernafasan mata)
handgrinder. akibat debu
Mengebor dinding - Splash in the
untuk install eyes
gantungan.. Mata terkena
- Cutting pipe percikan - eyes irritation
Memotong pipa pemotongan Iritasi mata
dengan
menggunakan
gerinda
- Instalation
Instalasi pipa di - cement spill
dinding Tumpahan
semen
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
c. - Manual Handling - Material lifting - Muscle injury - Cause paralysis 3 3 M - Bend your knees and 2 2 L
Pengangkatan exceeds capacity Cidera Otot, Dapat squat position
Manual Pengangkatan keseleo serta mengakibatkan Tekuk lutut, posisikan
manual melebihi gangguan sendi kelumpuhan jongkok
kapasitas dan tulang - Work hampered - Keep your body stable
Pekerjaan to move
terhambat Jaga kestabilan tubuh
untuk bergerak
- Head straight and look
ahead
Pastikan kepala tegak
dan pandangan kedepan
- Ligting does not exceed
capacity
Pastikan tidak
mengangkat melebihi
kapasitas
- Used PPE requirement
Gunakan APD yang
sesuai
5 Housekeeping Bad Housekeeping - Hit by material - Injuried 3 3 M - Tidy up work equipment
Membersihkan area Housekeeping yang Tertimpa Pekerja terluka - Rapikan peralatan kerja
kerja buruk material dan cidera dengan baik dan sesuai
- Slip on - Lost work pada posisinya
Tergelincir Equipment - Tidy up from Used
Peralatan kerja Material
ada yang Bersihkan area kerja
tertinggal /hilang dari material sisa
- Messy work pekerjaan
location Environment clean
Lokasi kerja
- Berantakan
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
Risk Rangking (RR) Recommendation Action
Probability (PR) Severity / consequence Tingkat Risiko Tindakan Pengendalian
x =
Kemungkinan Keparahan
Score Level Tingkat pengendalian Hierarchy of Control
Frequent =5 Catastrophic =5 19-25 Extreme high E= 1+2+3+4+5 1= Elemination
Probable =4 Major =4 13-18 High H= 3+4+5 2= Substitution
Occasional = 3 Moderate / Serious = 3 6-12 Medium M= 4+5 3= Engineering Control
Unlikely =2 Minor =2 1-5 Low L=5 4= Administration
Improbable = 1 Negligible =1 5= PPE
Note : * : Without Control / Tanpa control
*) : With Control / Dengan control
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
ATTEDANCE LIST - JSA SOCIALIZATION
Signature
No Name Position Company
Date: Date: Date: Date: Date: Date: Date:
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JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM
ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071
REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP)
RU-V BALIKPAPAN PROJECT
JSA Number / Nomor JSA : RDMP / JSA / ……………….. / …………………
Status Status
NO Permit Registry No NO Permit Registry No Open √ Close √
Open √ Close √
