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JOB SAFETY ANALYSIS

JSA Full Scale


Task Risk Assessment (TRA)
Jobtitle/task:

JobSequences

NO.

1
2
3
4
5
6

INSTALLED&DISMANTLING
OFSCAFFOLDING

PJSM(PreJobSafetyMeeting)(Penjabaranlangkah/tahapankerjasebelummemulaipekerjaan)
ToolsandEquipmentpreparation(Persiapanperlengkapan&peralatan)
RigUp/installedofscaffolds(Pemasanganperancah)
Remove/dismantleofscaffolds(Pembongkaranperancah)
Scaffoldsmaterialshandling(Penataanmaterialperancah)
HouseKeeping(PembersihanArea)

Job Risk Assessment Form

JRA:....../JRA.IADS/III/13

Jobtitle/task:
No

AssessmentTeam

MeetingDate

Signature

ReviewTeam

NOTE:MinimalRequirementMembertoConductJSAis3(Three)Parties,ex:Maintenance,ProductionandEHS

ReferenceDocumentsrequired:
RiskAssessmentInputsandReferenceDocuments:

Job Risk Assessment Form

JRA:....../JRA.IADS/III/13

Review
Date

Signature

Task Risk Assessment (TRA)

INSTALLED&DISMANTLING
OFSCAFFOLDING

JOB SAFETY ANALYSIS


JSA Full Scale

Date:

SECTION:

INSTALLED&DISMANTLING
OFSCAFFOLDING

March7th,2013

SUPERVISOR:

ANALYSISBY:

ENG/PROD/EHS

PLANT/LOCATION:

DEPARTMENT:

REVIEWEDBY:

Engineering

JOBTITLE/TASK:

JOB SAFETY ANALYSIS


JSA Full Scale
Task Risk Assessment (TRA)
S:Severity
L: Likelihood
R:Risk

1.Engineering

TASKSTEP

HAZARD

HAZARDEFFECT

CONTROL

PJSM(PreJobSafety
Meeting)
(Penjabaranlangkah/
tahapankerjasebelum
memulaipekerjaan)

Job Risk Assessment Form

NA

NA

PermitTo
Work(PTW)
(SuratIzin
Memulai
Pekerjaan)

JobSafety
Analysis(JSA)
(Analisa
Keselamatan
Kerja)

REVISED

Note:
LOWResidualrisktobeapprovedbyProd.Superintendent
HIGH or MEDIUM Residual risk to be approved by Prod.
Manager/OIM

InitialRisk

APPROVEDBY

REQUIREDANDRECOMMENDEDPERSONALPROTECTIVEEQUIPMENT(PPE)
FULLBODYHARNESS

N0

NEW


1 A

ResidualRisk
ACTIONS

Risk

MakesureallManPowerhavegivensafety
briefingaboutjobandhowtominimizerisk
of accident at each step of work before
starttowork.
(Pastikan bahwa semua pekerja telah
mendapatkan
pengarahan
tentang
pekerjaan dan bagaimana meminimalisir
resiko dari bahaya sebelum memulai
pekerjaan)


1 B

Risk

N0

TASKSTEP

ToolsandEquipment
preparation
(Persiapanperlengkapan
&peralatan)

HAZARD

HAZARDEFFECT

CONTROL

Pinchpointand
impactinjury
(Terjepitdan
megakibatkanluka)

Job Risk Assessment Form

Personalinjury
(Lukapada
orang/pekerja)

Personalinjury
(Lukapada
orang/pekerja)

Ergonomicissue
(Salahposisibekerja
danpengangkatan
manual)

Backinjury
(Lukadansakit
tulangbelakang)

Slip,Trip,andfall
(Terpeleset,
tersandung,dan
terjatuh)

Pinchpoint
(Terjepit)

Ergonomicissue
(Salah
pengangkatan)

Scratchbysharp
object
(Tertusukbenda
tajam)

Personalinjury
(Lukapada
orang/pekerja)
Equipment
damage
(Peralatanrusak)

Personalinjury
(Lukapada
orang/pekerja)

Personalinjury
(Lukapada
orang/pekerja)

Personalinjury
(Lukapada
orang/pekerja)

Risk

PermitTo
Work(PTW)
(SuratIzin
Memulai
Pekerjaan)

Risk

ObtainedPTWandJSAinplace
(PermitdanJSAtersediadilapangan)

Propermanualhandlingpractice
(Melakukandengantatacara
pengangkatanyangbenar)

JobSafety
Analysis(JSA)
(Analisa
Keselamatan
Kerja)

ACTIONS

SlipandTrip
(Terpeleset,dan
tersandung)

ResidualRisk

InitialRisk

2 C M

ProperPPEMandatoryisrequired
(Alatpelindungdiriyangwajib
dipersyaratkan)

2 B

1 B

Manual
Handling
Procedure
(Prosedur
Penanganan
Manual)
PermitTo
Work(PTW)
(SuratIzin
Memulai
Pekerjaan)

JobSafety
Analysis(JSA)
(Analisa
Keselamatan
Kerja)

Manual
Handling
Procedure
(Prosedur
Penanganan
Manual)

Personal
certificationas
ascaffolder
(Personil
bersertifikat

2 C M

ObtainedPTW,JSAinplace
(Permit,PTW&JSAtersediadilapangan)

Ensuretheworksiteisfreefromtrip
hazardbeforethejobsstart.
(Pastikanareakerjaamandaribahaya
tersadungdanterpelesetsebelum
pekerjaandimualai)

Makesurepersonalinrightposition
duringdismantlingofscaffolds
(Pastikansemuapersoneldalamposisi
yangbenarselamapembongkaran
perancah)

Propermanualhandlingpractice
(Melakukandengantatacara
pengangkatabyangbenar)

ProperPPEMandatoryisrequired
(Alatpelindungdiriwajib
dipersyaratkan)

N0

TASKSTEP

HAZARD

HAZARDEFFECT

CONTROL

InitialRisk

Remove/dismantleof
scaffolds
(Pembongkaran
perancah)

Scaffoldsmaterials
handling
(Penataanmaterial
perancah)

Job Risk Assessment Form

Slip,Trip,andfall
(Terpeleset,
tersandung,dan
terjatuh)

Pinchpoint
(Terjepit)

Ergonomicissue
(Salah
pengangkatan)

Scratchbysharp
object
(Tertusukbenda
tajam)

Personalinjury
(Lukapada
orang/pekerja)
Equipment
damage
(Peralatanrusak)

Personalinjury
(Lukapada
orang/pekerja)

Personalinjury
(Lukapada
orang/pekerja)

Personalinjury
(Lukapada
orang/pekerja)

Slip,Trip,andfall
(Terpeleset,
tersandung,dan
terjatuh)

Pinchpoint
(Terjepit)

Ergonomicissue
(Salah

Personalinjury
(Lukapada
orang/pekerja)
Equipment
damage
(Peralatanrusak)

Personalinjury
(Lukapada
orang/pekerja)

Personalinjury
(Lukapada

Risk

sebagai
scaffolder)
PermitTo
Work(PTW)
(SuratIzin
Memulai
Pekerjaan)

JobSafety
Analysis(JSA)
(Analisa
Keselamatan
Kerja)

Manual
Handling
Procedure
(Prosedur
Penanganan
Manual)

Personal
certificationas
ascaffolder
(Personil
bersertifikat
sebagai
scaffolder)
PermitTo
Work(PTW)
(SuratIzin
Memulai
Pekerjaan)

2 C M

JobSafety
Analysis(JSA)
(Analisa
Keselamatan
Kerja)

Manual
Handling

2 B

ResidualRisk
ACTIONS

ObtainedPTW,JSAinplace
(Permit,PTW&JSAtersediadilapangan)

Ensuretheworksiteisfreefromtrip
hazardbeforethejobsstart.
(Pastikanareakerjaamandaribahaya
tersadungdanterpelesetsebelum
pekerjaandimualai)

Makesurepersonalinrightposition
duringdismantlingofscaffolds
(Pastikansemuapersoneldalamposisi
yangbenarselamapembongkaran
perancah)

Propermanualhandlingpractice
(Melakukandengantatacara
pengangkatabyangbenar)

ProperPPEMandatoryisrequired
(Alatpelindungdiriwajib
dipersyaratkan)

ObtainedPTW,JSAinplace
(Permit,PTW&JSAtersediadilapangan)

Ensuretheworksiteisfreefromtrip
hazardbeforethejobsstart.
(Pastikanareakerjaamandaribahaya
tersadungdanterpelesetsebelum
pekerjaandimualai)

Makesurepersonalinrightposition
duringhandlingmaterial
(Pastikansemuapersoneldalamposisi
yangbenarselamamenanganimaterial)

Risk

1 B

1 B

N0

TASKSTEP

HAZARD

HAZARDEFFECT

CONTROL

InitialRisk

pengangkatan)

Housekeepingand
demobilizationalltools
andequipment.
(Kebersihandan
kerapihan,serta
mengembalikansemua
peralatanyang
digunakan)

Job Risk Assessment Form

Scratchbysharp
object
(Tertusukbenda
tajam)

Slip,Trip,andfall
hazards(Bahaya
tersandungdan
terpeleset)
Pinchpointand
impactinjury.
(Terjepitdan
mengakibatkanluka)

orang/pekerja)

Personalinjury
(Lukapada
orang/pekerja)

Personal&back
paininjury(Luka
dansakittulang
belakang/keseleo)
PersonalInjury
(Personalcidera/
terluka)

Risk

Procedure
(Prosedur
Penanganan
Manual)

PermitTo
Work(PTW)
(Suratijin
kerja)
JobSafety
Analysis(JSA)
(Analisa
keselamatan
kerja)
Manual
Handling
Procedure
(Tatacara
pengangkatan
manual)

2 B

ResidualRisk
ACTIONS

Propermanualhandlingpractice
(Melakukandengantatacara
pengangkatabyangbenar)

ProperPPEMandatoryisrequired
(Alatpelindungdiriwajib
dipersyaratkan)
ObtainedPTW,JRA,androadmapin
place
(Permit,JRA,danjalurkendaraan
tersediadilapangan)
Ensuretheworksiteisfreefromtrip
hazardbeforethejobsstart.(Pastikan
areakerjaamandaribahayatersandung
danterpelesetsebelumpekerjaan
dimualai)
ProperPPEMandatoryisrequired
(Alat pelindung diri yang wajib
dipersyaratkan)

1 B

Risk

Assign a JSA Team Leader

Evaluate the Residual Risk (i.e. the


risk assuming all controls and Action
are in place and effective)

User invite the JSA Team

Identify the Step Required (Task Step)

High

Low

Medium

Identify hazards for all


steps of the task

Identify hazards Effect

Is the Residual
Risk High,
Medium or Low?

Yes

Are additional
control measures
required?

No
Describe the Existing control
Complete any actions before starting
work

Evaluate the Initial Risk


Ensure the JSA results are
communicated to those doing the work

Determine the action for Risk


Reduction measure :
Reduce likelihood of event occurring
Reduce severity of consequences

Job Risk Assessment Form

Proceed with work once actions have


been closed-out

Note:

JSA Pictograms can be used in


Safety Toolbox Talks

Job Risk Assessment Form

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