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  • Contoh Form Jsa

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    Wahyu Febrianto
    63 views3 pages
    This document is a job safety analysis for a workplace task. It contains sections for reviewing previous safety analyses, getting signatures to confirm understanding of safety procedures, approving supervisor information, describing the workplace/task, identifying potential hazards and corresponding control measures and protective equipment, and reviewing and recommending improvements after the job is completed. The document number, analysis author, process steps, hazards, responsible parties, and review details are to be filled in.

    Original Description:

    FORM JSA

    Original Title

    CONTOH FORM JSA

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    This document is a job safety analysis for a workplace task. It contains sections for reviewing previous safety analyses, getting signatures to confirm understanding of safety procedures, approving supervisor information, describing the workplace/task, identifying potential hazards and corresponding control measures and protective equipment, and reviewing and recommending improvements after the job is completed. The document number, analysis author, process steps, hazards, responsible parties, and review details are to be filled in.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    63 views3 pages

    Contoh Form Jsa

    Uploaded by

    Wahyu Febrianto
    This document is a job safety analysis for a workplace task. It contains sections for reviewing previous safety analyses, getting signatures to confirm understanding of safety procedures, approving supervisor information, describing the workplace/task, identifying potential hazards and corresponding control measures and protective equipment, and reviewing and recommending improvements after the job is completed. The document number, analysis author, process steps, hazards, responsible parties, and review details are to be filled in.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 3

    Document number : .............

    JOB SAFETY ANALYSIS


    Review conducted of previous JSA/SOP’s for similar jobs (this should be before the job, in order to identify any potential improvements): Yes √ No N/A
    Signatures of all Working Party Members certifying that they understand the details of the JSA and their responsibility in following the hazard control measures prior to commencing work:

    Name of supervisor approving the use of this JSA: Signature:

    Workplace/Tempat bekerja: Task Description/Uraian Tugas: Date:


    −
    Plant Number:
    Plant Location:
    Analysis by/dianalisa oleh:

    PERSON(S) RESPONSIBLE FOR


    HAZARD CONTROL MEASURES &
    CONTROL MEASURE / Orang yang
    POTENTIAL HAZARDS/Bahaya yang PPE / Cara untuk menghilangkan
    PROCESS STEPS/Langkah Kerja bertanggung untuk
    mungkin timbul bahaya & APD
    melaksanakannya

    No. Form : 15/BWK-PRA-003/A 1 of 3


    Document number : .............

    PERSON(S) RESPONSIBLE FOR


    HAZARD CONTROL MEASURES &
    CONTROL MEASURE / Orang yang
    POTENTIAL HAZARDS/Bahaya yang PPE / Cara untuk menghilangkan
    PROCESS STEPS/Langkah Kerja bertanggung untuk
    mungkin timbul bahaya & APD
    melaksanakannya

    No. Form : 15/BWK-PRA-003/A 2 of 3


    Document number : .............

    Review (This should be done after the job, in order to identify any potential improvements to this JSA)

    Recommended improvements to this JSA:

    Reviewed By: Review Date:

    No. Form : 15/BWK-PRA-003/A 3 of 3

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