PT.

BAYU BUANA GEMILANG

JSA Worksheet Form NO JSA :

Job/Work Title : JSA Team : Reviewed by: Approved By :

Leader : R Job Owner Consultant HES Job Owner :
Brief Description : Member :
L N/A
Consultant :

M
Location (Initial,Date,&Sign) Manager:

H
Equipment / asset (Initial,Date,&Sign) (Initial,Date,&Sign) New Revised

KEBUTUHAN ALAT PELINDUNG DIRI (APD) PERALATAN KESELAMATAN ADMINISTRASI DAN KOORDINASI
Faceshield Safety Harness APAR Stick Lamp Tagging/Locking O/M Department
Beling Shields Ear Protection Tim PMK Barricade Inspection Checklist Hospital/Clinic
Apron Hand Gloves Ambulance Safety Sign Cold Works perit Police
Safety shoes Safety Masker Kotak P3K Traffic Sign Hot Work Permit Customer
Safety helmet Coverall SCBA Safety Fence Toolbox Meeting
Safety googles Gas Detector

No. LANGKAH KERJA POTENSI BAHAYA MITIGASI/PENANGGULANGAN

Do it safely or not at all! There is always time to do it right! Page 1 of 3

 PT. BAYU BUANA GEMILANG
JSA Worksheet Form NO JSA :

Do it safely or not at all! There is always time to do it right! Page 2 of 3

 PT. BAYU BUANA GEMILANG
JSA Worksheet Form NO JSA :

Do it safely or not at all! There is always time to do it right! Page 3 of 3