JOB SAFETY ANALYSIS (JSA)

Project Name: CIVIL WORK Company:

Nama Project: Perusahaan: PT. DAEAH E&C

Work Activity: P-FRM-JSA-DEC-

Pekerjaan: GENERAL WORK JSA No: Rev 01
005

Work Location: Date Developed:

Lokasi Kerja: LOTTE-KINE PROJECT -WP 5&7 Dibuat Tanggal: 05-11-2022

Risk Matrix:
CONSEQUENCE
Disciplines will review likelihood and consequences in 1 = Negligible 2 = Slight 3 = Moderate 4 = High 5 = Very High
line with their specific parameters as noted
No injuries requiring any First aid treatment. Medical treatment required, Injuries resulting in; lost time, Single or multiple fatalities.
treatment. Restricted Work Case. permanent disability,
amputation, or surgery.

5 =Very Likely Is expected to occur M-5 H -10 VH-15 VH-20 VH-25

LIKELIHOOD

Will probably occur in most

4=Likely
circumstances
M-4 H-8 H-12 VH-16 VH-20

3=Possible Should occur at some time L-3 M-6 H-9 H-12 VH-15

2=Unlikely Could occur at some time L-2 M-4 M-6 H-8 H-10

1=Very Unlikely May occur only in exceptional L-1 L-2 L-3 M-4 M-5
circumstances
Likelihood (L) 1 = Very Unlikely, 2 = Unlikely, 3 = Possible, 4 = Likely, 5 =Very Likely Consequence (C) 1 = Negligible, 2 = Slight, 3 = Moderate, 4 = High, 5 = Very High
Risk Rating (R) LOW [ 1-3 ] Broadly acceptable - MODERATE [ 4-6 ] Tolerable – With identified HIGH [ 8-12 ] Undesirable - Additional VERY HIGH [ 15- 25 ] Intolerable -
Manage by routine procedures controls fully implemented controls required to reduce risk Do not start activity

Page 1 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Work permit is not in  Criminal Penalties

Preparation accordance with the work (Hukuman Pidana)  Assess the risk in
JSA and Work Permit Creation permit advance of a job
( permit Pekerjaan tidak  The job cannot be carried (Lakukan penilaian
(Persiapan 2 2 4 Supervisor & Safety
sesuai dengan ijin kerja) out resiko terlebih dahulu
Pembuatan JSA dan Ijin Kerja)  Risks cannot be identified ( pekerjaan tidak dapat terhadap suatu
( Resiko tidak bisa di dilaksanakan) pekerjaan)
identifikasi)

 Supervisors are
 Involving workers  Violating Procedures and required to explain work
(Pekerja yang melibatka)
endangering oneself steps and preventive
 work, not understanding the
(Menyalahi Prosedur measures for a job
work plan and the dangers
dan membahayakan diri) (Supervisor
Toolbox meeting of each step of work 2 2 4 Supervisor
diharuskan
( pekerjaan, tidak
menjelasakan langkah-
memahami rencana kerja
langkah kerja serta
dan bahayanya setiap
langkah pencegahan
langkah kerja)
suatu pekerjaan)

 Faulty work tool

 Ensure and Inspect the
(Alat kerja rusak)
Feasibility of the Tool
Preparation of working equipment  Condition of Damaged
before Use Penyimpanan /ware
working tool  Work tools cannot be 3 1 3 House
(Persiapan peralatan kerja) (Pastikan dan inspeksi
(Kondisi Alat kerja Rusak) used
kelayakan alat sebelum
(Alat kerja tidak bisa di
di gunakan)
gunakan)

Page 2 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Make sure the

administration of
equipment
completeness is
completed in advance /
or the demob schedule
 Work hampered is right
 Machine Administration has (Kerja terhambat)
not been Fulfilled (Pastikan Administrasi 3
kelengkapan Alat di 1 3
(Administrasi Alat berat
belum Terpenuhi) lengkapi terlebih
dahulu/ atau jadwal
demob tepat)

 Damage to public  Make sure people are

 Hit People facilities healthy
Mobilisasi/dimobilization 2 3 6 SPV & Safety
(Menabrak Orang) (Kerusakan Fasilitas (Pastikan orang dalam
umum)) keadaan sehat)

 Make sure the route to

be taken is known by
the driver
(Pastikan rute yang
akan dilalui di ketahui
oleh pengemudi)

Page 3 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Manage traffic
3 2 6
(Atur Lalu Lintas)

Page 4 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Make sure the work tool

is checked internally
before use and make
sure it is suitable for
use
(Pastikan alat kerja
diperiksa secara
internal sebelum
digunakan dan
pastikan layak pakai)
 Make sure the hoeing
position is back to back
 Injured Leg ( Minor to each other
 Hoeed, Hoe Eyes Injuries) (Pastikan posisi
Manual digging Detached mencangkul saling
(Kaki Terluka ,Luka 3 2 6 SPV & Safety
(Penggalian manual) (Tercangkul, Mata ringan) membelakangi)
Cangkul Terlepas)  Keep a safe distance
when doing activities
(Jaga jarak aman saat
melakukan aktifitas)

 Ensure excavator
movement guidance by
flagman
(Pastikan panduan
pergerakan excavatot
oleh flagman

Page 5 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Only personnel
involved in excavation
work can tribal the
excavation area
(Hanya personelyang
terlibat dalam
pekerjaan penggalian
yang bisa memasuku
area excavation)
 Only licensed operators
are boleg operating the
appliance
(Hanya operator yang
Excavation Proses  Hit by an excavator  Seriously injured and
even died berlisensi yang boleg 2 3 6 SPV & Safety
( Proses Penggalian) Tertabrak excavator
(Luka berat bahkan mengoperasikan alat)
meninggal)  Use full PPE
(Gunakan APD
lengkap)

 Install Barricade
(Pasang Barricade)

Page 6 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Pay attention to the

sharp side
(Perhatikan sisi tajam)
 Sharp/prominent object
protection
(Proteksi objek yang
tajam / menonjol)
 Use gloves
(Gunakan sarung
 Injured Limbs ( minor tangan)
 Impaled injuries )
Install rebar  Pay Attention to
(Tertusuk) (Anggota Tubuh Terluka) Footsteps 3 3 9 SPV & Safety
(pasang besi)  Stumbling Feet
(Perhatikan Langkah
(Tersandung)
kaki)
 Unobstructed Access
(AKses tidak terhalang)
 Make sure the matrial is
neatly organized
(Pastikan matrial tertata
rapih)

Page 7 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Ensure a working
position
(Pastikan posisi kerja)
 Use proper work tools
(Gunakan alat kerja
Install / disassemble the formwork  Injured Limbs (Minor
yang proper)
(Pasang / bongkar begisting)  Hit Body Part (Hand) Injuries )
 Communication when
(Bagian Tubuh (Anggota Tubuh Terluka 3 3 9
performing work
Terpukul (Tangan) (Luka ringan )
(Komunikasi saat
melakukan pekerjaan)
 Use appropriate PPE
(Gunakan APD yang
sesuai)

 Make Sure Your Steps

(Pastikan Langkah
anda)
 Unobstructed access
 Injured Hands and Feet (Akses jangan
 Stumble (foot) ( Minor Injuries ) terhalang)
(Tangan dan Kaki 3 2 6
(Tersandung (kaki)  Make sure the matrial is
Terluka ( Luka ringan ) neatly organized
(Pastikan matrial tertata
rapih)

Page 8 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Communication with
workers
(Komunikasi dengan
pekerja)
 Injured Hands and Feet  Identification of the
 Pinched In The Hands and ( Minor Injuries )Tangan clamp points
Feet dan Kaki Terluka ( Luka (Identifikasi titik jepit) 3 3 9
(Terjepit Dibagian Tangan ringan / Minor )  Use PPE according to
Dan Kaki)
your job (Gloves)
(Gunakan APD sesuai
pekerjaanya(Sarung
Tangan)

 Pay attention to the

sharp side
 Injured Limbs , minor (Perhatikan sisi tajam)
 Punctured In The Body injuries
 Sharp side protection
(Tertusuk Pada Bagian ( Anggota Tubuh 2 3 6
(Proteksi sisi tajam)
Tubuh) Terluka , luka ringan )
 Use gloves
(Gunakan sarung
tangan)

Page 9 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Make sure the vehicle

has passed inspection
(Pastikan kendaraan
telah lulus inspection)
 Motorists have a
driver's license
according to the type of
 Workers Injured ,
vehicle
Concrete Work  Vehicles hit people Seriously Injured
(Pengendara memiliki
(Kendaraan menabrak ( Pekerja Terluka , Luka 2 3 6
(Pekerjaan Beton) SIM sesuai jenis
orang) parah )
kendaraan)
 The vehicle must be
escorted by a flagman
(Kendaraan harus
dikawal oleh flagman)
 Max speed 20 KM
(Kecepatan max 20
KM)

Page 10 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Make sure the vehicle

has passed the
inspection
Pastikan kendaraan
telah lulus inspeksi
 Asset Losses, Damage
 Motorists have a
To Public Facilities)
driver's license
(Kerugian Aset,
according to the type of
Kerusakan Fasilitas
vehicle
Umum)
(Pengendara memiliki
 Vehicle Hits Public Facility SIM sesuai jenis
(Kendaraan Menabrak kendaraan) 2 3 6
Fasilitas Umum)  Make sure the route
passed is known to the
driver
(Pastikan route yang
dilewati sudah diketahui
oleh pengemudi)
 Manage Traffic
(Atur Lalulintas)

Page 11 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Use good
communication when
( Gunakan komunikasi
yang baik saat )
 Provide clean water to
 Eye and Skin Irritation, wash limbs
 Got Splashed By Concrete
Minor Injuries (Sediakan air bersih
(Terkena Cipratan 3 1 3
(Iritasi mata dan untuk membasuh
Concrete) kulit,Luka ringan) anggota tubuh)
 Use Mandatory PPE &
Gloves
(Gunakan APD
Mandatory & Sarung
Tangan)

Page 12 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Wear a Faceshield
(Gunakan Pelindung
Wajah)
 Avoid slippery areas
(Hindari area licin)
 Ensure access is not
matrial obstructed
(Pastikan akses tidak
 Stumbling ,Missed  Injured Body Part terhalang matrial) 3 1 3
(Tersandung ,Terpleset) (Bagian Tubuh Terluka)  Matrial placement is not
cluttered
(Penempatan matrial
tidak berantakan )
 Use appropriate PPE
(Safety Shoes)
(Gunakan APD yang
sesuai(Sepatu Safety)

Page 13 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Make sure the work tool

is checked internally &
Fit for Use before use
(Pastikan alat kerja
 Injured Leg,( Minor diperiksa secara
Injuries internal & Layak Pakai
( Kaki Terluka,( Luka sebelum digunakan)
ringan )  Make sure the hoeing
position is back to back
 Hooed feet to each other
Manual Backfill / Compacting
(Kaki Tercangkul) (Pastikan posisi
mencangkul saling
membelakangi)
 Keep a safe distance
when doing activities
Jaga jarak aman saat
melakukan aktifitas
 Use PPE
(Gunakan APD)

Page 14 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Pay Attention to
Footsteps
(Perhatikan Langkah
kaki)
 Ensure unobstructed
access
 Injured Leg, Muscle injury (Pastikan akses tidak
/ Minor injury terhalang)
 Stumble (Kaki Terluka, Cedera  Make sure the Matrial is
(Tersandung) otot / Luka ringan ) neatly arranged
(Pastikan Matrial
tersusun rapih)
 House Keeping Work
Area
(House Keeping Area
Bekerja)

Page 15 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Make sure the

appliance is operated
by a competent person
(Pastikan alat
dioperasikan oleh
orang yang kompeten)
 Keep a safe distance
from your feet with a
jumping stamper
 Crushed compecting  Injured Leg, Muscle injury (Jaga jarak aman kaki
machine / Minor injury dengan jumping 2 3 6
(Tertimpa mesin ( Kaki Terluka, Cedera stamper)
compecting) otot / Luka ringan )  Make sure Worker are
healthy
(Pastikan Pekerja
Dalam Keadaan Sehat)
 check machine tools
before use
(Cek Alat Mesin
Sebelum Digunakan)

Page 16 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Make sure access in

and out of the
excavation is available
& provide stair access
from the aluminum
ladder
(Pastikan akses keluar
masuk galian tersedia
& sediakan akses
tangga dari Tangga
alumunium)
 Monitored by
Holewatcher & using
hole watcher vest
 Fainting Workers identity
(Pekerja Pingsan) (Termonitor oleh
Confined Space Entry CSE Holewatcher &
menggunakan identitas
(CSE Entri Ruang Terbatas )  Hydrated,Fatigue Rompi hole watcher) 2 2 4
untuk pekerjaan Penggalian tanah (Dihidrasi,Kelelahan)
 Do a gas test to make
lebih dari 2 Meter sure the oxygen
content is at the rank of
19.5 - 23.5%
(Lakukan gas test
pastikan oxygen
content di rank 19.5 -
23.5 %)
 Worker monitor boards
available in the
excavation
(Tersedia papan
monitor pekerja di
Page 17 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Monitored by
Holewatcher & using
hole watcher vest
identity
(Termonitor oleh
Holewatcher &
 Workers Fainting, Gas menggunakan identitas
Poisoning Rompi hole watcher)
(Pekerja Pingsan,
 Do a gas test to make
Keracunan Gas)
sure the oxygen
content is at the rank of
19.5 - 23.5%
 Exposure to Gas/O2
(Lakukan gas test
Deficiency
pastikan oxygen 2 2 4
(Terpapar Gas/Kekurangan
content di rank 19.5 -
O2)
23.5 %)
 Worker monitor boards
available in the
excavation
(Tersedia papan
monitor pekerja di
dalam galian)
 Make sure the sign is
installed
(Pastikan sign
terpasang )

Page 18 of 20
 JOB SAFETY ANALYSIS (JSA)

Residual
Risk
[L x C=R]
Impact of hazard (Dampak bahaya)
Potential Hazards / Consequences
Activity
(What can go wrong) Control Measures/ Tindakan Persons Responsible
(Basic job steps)
Potensi bahaya/ konsekwensi (Apa yang bisa perbaikan Penanggung jawab
Aktivitas (Langkah kerja)
salah?)

L C R

 Respiratory Disorders,
VisionGangguan  Use a Mask
Pernafasan, Peglihatan (Gunakan Masker)

 Avoid slippery areas

 Injured Leg, Muscle injury (Hindari area licin)
( Minor minor injuries )  Pay Attention to
 Dust Exposure (Kaki Terluka, Cedera Footsteps
(Paparan Debu) otot (Perhatikan Langkah
( Luka ringan minor ) kaki)
 Matrial placement is not
Housekeeping cluttered
 Stumbling, Slipping (Penempatan matrial
(Tersandung ,Terpeleset) tidak berantakan )
 Use PPE
(Gunakan APD)
 Do housekeeping
before and after work
(Lakukan housekeeping
sebelum dan sesudah
bekerja)
 Provide temporary
garbage bins / plastic
waste
(Sediakan bak sampah
sementara / plastik
sampah)
Page 19 of 20
 JOB SAFETY ANALYSIS (JSA)

Sign On: I confirm that the JSA has been explained and its contents are clearly understood. I clearly understand the controls in this JSA must be
applied; otherwise work is to cease immediately.

Saya mengkonfirmasi bahwa JSA telah dijelaskan dan isinya dipahami dengan jelas. Saya memahami dengan jelas kontrol dalam JSA ini harus diterapkan; jika
tidak, pekerjaan akan segera dihentikan

Prepared by : Acknowledge by: Cheked by: Approved by:

Name : HILMI Name : NAM UN DONG Name : MEI TOTOK Name : Name :

Position : HSE MANAGER Position : SITE MANAGER Position : ENGINEER Position : Position :

Page 20 of 20