RISK ASSESSME

Project/Location : PT. Gurit Parta Balsa / Probolinggo

Date of Assessment : 15 Januari 2021

HAZARD IDENTIFICATION

Conditio
n
No Process/Activity/Product H/S/E Potential Hazard
(R,NR,N,
A,E)

1 Receiving hazardous liquid material S 1.1 Injury R

S 1.2 Struck down R

H 1.3 inhale R

H 1.4 Poisoning R
 Leakage of
H 1.5 liquid material R

2 Hazardous liquid material storage S 2.1 Injury R

S 2.2 Struck down R

H 2.3 Inhale R

H 2.4 Poisoning R

Leakage of
H 2.5 R
liquid material
3 Delivering hazardous liquid material S 3.1 Injury R

S 3.2 Struck down R

H 3.3 Inhale R

H 3.4 Poisoning R

Leakage of
H 3.5 R
liquid material

4 Forklift operation S 4.1 Crash R

S 4.2 Collapse R
5 Lifting up container S 5.1 Struck down R

6 Crane operation S 6.1 Crash R

S 6.2 Collapse R

7 Genset operation S 7.1 Electricution R

S 7.2 Fire explotion E

8 Transporter operation S 8.1 Crash R

9 Welding S 9.1 Injury R

S 9.2 Electricution R

Fire due to
S 9.3 E
short circuit

10 Painting H 10.1 Poisoning A

S 10.2 11.3 Fire R

11 Office

Struck down
a. Replace water drinking bottle S 11.1 R
bottle

S 11.2 Slippery R
b. Replace lamp on the roof S 11.3 Fall down R

c. Washing machine S 11.4 Electrocution A

d. Cooking using LPG S 11.5 Fire explotion E

e. Toilet S 11.6 Slippery R

f. Up and down from stairs S 11.7 Slippery R

h. Meals H 11.8 Poisoning R

i. Room cleaning S 11.9 Slippery R

Radiation
j. Working with computer S 11.10 R
form monitor

S 11.11 Electricution R
 Sitting for long
H 11.12 R
time

13.1 Metal
12 Grinding S 12.1 dust spark to R
eye

SE 12.2 13.3 Noise R,N

14.2 Metal
13 Drilling S 13.1 dust spark to R
eye

SE 13.2 14.3 Noise R

14 Maintenance
 S,H 14.1 Long standing R

S,H 14.2 Sun burn R

15 Pest Control H,E 15.1 17.1 Odour N

17.2 Poisoned
H,E 15.2 material A
spillage

17.2 Poisoned
H,E 15.3 N
pets

16 Brazing S 16 19.3 Injury R

17 Digging Hole S 17.1 20.1 Injury R

S 17.2 21.2 Collapse R

18 Pole Installation S 18.1 20.1 Injury R

S 18.2 21.2 Collapse R

19 Chiselling S,H 19.1 Injury R

20 Hammering S,H 20.1 Injury R

 Working with unproper illumination light at IT's Human health
21 S,H 21.1 A
room problem

Working with air conditioner hazards at IT's Human health

S,H 21.2 R
room problem

Likelihood Severity Risk Factor Number - RFN = LxS Note: Prepare JSA when Residu
1 - Rare 1 - Negligible 1 - 2 : Trivial
2 - Unlikely 2 - Minor 3 - 5 : Acceptable
3 - Moderate 3 - Moderate 6 - 9 : Moderate
4 - Likely 4 - Critical 10 - 15 : Substansial
5 - Almost certain 5 - Catastropic 16 - 25 : unaceptable

Condition:
R = Routine
NR = Non Routine
N = Normal
A = Abnormal
E = Emergency

Date of Issued Revision Revised Item

01.06.2012 A -
RISK ASSESSMENT REGISTER

RISK ASSESSMENT

Initial Risk Rating Residual Risk

Existing
Applicable Law Control
Potential Risk
and Regulation Measure
(ECM)
L S RFN L S

Wound, back glove,

Kep Menaker No.
injury, broken 2 3 6 helmet, 2 2
187 Tahun 1999
bone, slice safety shoes

glove,
Death, wound, Kep Menaker No.
2 4 8 helmet, 2 2
broken bone 187 Tahun 1999
safety shoes

Kep Menaker No. mask, glass

Unconcious 4 4 16 2 2
187 Tahun 1999 and uniform

Breathing problem, Keputusan

mask, glass
headache, Presiden No. 22 2 4 8 2 2
unconcious, death Tahun 1993 and uniform
Burn skin,
breathing problem, Kep Menaker No. mask, glass
headache, 187 Tahun 1999 2 4 8 and uniform 2 2
unconcious

Wound, back glove,

Kep Menaker No.
injury, broken 2 3 6 helmet, 2 2
187 Tahun 1999
bone, slice safety shoes

glove,
Death, wound, Kep Menaker No.
2 4 8 helmet, 2 2
broken bone 187 Tahun 1999
safety shoes

Kep Menaker No. mask, glass

Unconcious 4 4 16 2 2
187 Tahun 1999 and uniform

Breathing problem, Keputusan

mask, glass
headache, Presiden No. 22 2 4 8 2 2
unconcious, death Tahun 1993 and uniform

Burn skin,
breathing problem, Kep Menaker No. mask, glass
2 4 8 2 2
headache, 187 Tahun 1999 and uniform
unconcious
Wound, back glove,
Kep Menaker No.
injury, broken 2 3 6 helmet, 2 2
187 Tahun 1999
bone, slice safety shoes

Death, wound, Kep Menaker No. glove,

2 4 8 helmet, 2 2
broken bone 187 Tahun 1999
safety shoes

Kep Menaker No. mask, glass

Unconcious 4 4 16 2 2
187 Tahun 1999 and uniform

Breathing problem, Keputusan

mask, glass
headache, Presiden No. 22 2 4 8 2 2
and uniform
unconcious, death Tahun 1993

Burn skin,
breathing problem, Kep Menaker No. mask, glass
2 4 8 2 2
headache, 187 Tahun 1999 and uniform
unconcious

Peraturan safety
Wound, broken
Menaker No. 5 2 4 8 belt,helmet, 2 3
bone, death
Tahun 1985 safety shoes

Peraturan safety
Wound, broken Menaker No. 5 2 4 8 belt,helmet, 2 3
bone, death
Tahun 1985 safety shoes
 Peraturan safety belt,
Death Menaker No. 5 2 5 10 helmet, 2 3
Tahun 1985 safety shoes

Peraturan safety belt,

Wound, broken
Menaker No. 5 2 4 8 helmet, 3 2
bone, death Tahun 1985 safety shoes

Peraturan safety belt,

Wound, broken
Menaker No. 5 2 4 8 helmet, 3 2
bone, death
Tahun 1985 safety shoes

Peraturan ear plug,

Unconcious, death Menaker No. 4 3 4 12 safety shoes, 2 2
Tahun 1985 uniform

Human health Peraturan

disturbance, air Menaker No. 4 4 5 20 NE-P-HSE-08 2 2
and land pollution Tahun 1985

Safety belt,
Peraturan
Wound, broken safety shoes,
Menaker No. 5 4 4 16 3 2
bone, death helmet,
Tahun 1985 uniform
 mask, gloves,
Wound, slice, back Peraturan glass,
injury, broken Menaker No. 2 3 4 12 uniform, 2 3
bone Tahun 1982 apron, safety
shoes, gogles

Peraturan safety shoes,

Unconcious, death Menaker No. 2 3 4 12 glass, apron 2 3
Tahun 1982 mask, gogles

Human health Peraturan

disturbance, air Menaker No. 2 4 5 20 NE-P-HSE-08 2 3
and land pollution Tahun 1982

Breathing problem, Keputusan mask, gloves,

headache, Presiden No. 22 3 3 9 glass, 2 1
unconcious, death Tahun 1993 uniform

mask, gloves,
Human health SE Menaker No. glass,
disturbance, air 4 5 20 2 2
01 Tahun 1997 uniform / NE-
and land pollution
P-HSE-08

Human health, Undang Undang

3 2 6 sign 2 1
injury No. 1 Tahun 1970

Human health, Undang Undang

injury No. 1 Tahun 1970 3 3 9 sign 3 1
Human health, Undang Undang safety belt,
3 3 9 2 2
injury No. 1 Tahun 1970 stairs

routine check
Undang Undang
Unconcious, death 3 3 9 on electrical 2 2
No. 1 Tahun 1970
installation

Human health
Undang Undang
disturbance, air 4 3 12 NE-P-HSE-08 2 2
No. 1 Tahun 1970
and land pollution

Cleaning and
Human health, Undang Undang
3 3 9 drying floor, 3 1
injury No. 1 Tahun 1970
signage

Human health, Undang Undang Cleaning and

2 3 6 2 2
injury No. 1 Tahun 1970 drying floor

Keputusan
Waste
Unconcious, death Presiden No. 22 2 3 6 1 2
container
Tahun 1993

Undang Undang Cleaning and

Unconcious, death 3 3 9 drying floor, 2 3
No. 1 Tahun 1970 signage

Undang Undang screen

Eye problem 3 3 9 2 3
No. 1 Tahun 1970 protector

Undang Undang
Unconcious, death 3 3 9 Protect cable 2 2
No. 1 Tahun 1970
 Keputusan Break,
Back pain Presiden No. 22 4 3 12 correct sitting 2 3
Tahun 1993 position

Peraturan
gogles, mask,
Eye problem Menaker No. 4 3 3 9 3 2
Tahun 1985 glove

Kepmen LH No. 48
Tahun 1996
ear plug,
Air pollution, ear p Peraturan 4 3 12 3 2
helmet
Menaker No. 4
Tahun 1985

Peraturan
gogles, mas,
Eye problem Menaker No. 4 4 3 12 glove 3 2
Tahun 1985

Kepmen LH No. 48
Tahun 1996
ear plug,
Air pollution, ear p Peraturan 4 3 12 3 2
helmet
Menaker No. 4
Tahun 1985
 Keputusan
Health problem Presiden No. 22 4 3 12 enough rest 3 1
Tahun 1993

Keputusan
Health problem Presiden No. 22 4 1 4 enough rest 2 1
Tahun 1993

Kepmen LH No. 35 spray with air

Air pollution 5 2 10 2 2
Tahun 1993 refreshner

Peraturan
Pemerintah No. 7
Tahun 1973, remove and
Soil contamination Keputusan 3 2 6 clean with 2 2
Menteri Tenaga disinfectant
Kerja No. 187
Tahun 1999

Keputusan remove and

Human health
Presiden No. 22 3 2 6 clean with 2 2
problem
Tahun 1993 disinfectant

Peraturan Use mask,

Skin Burn Menaker No. 2 3 2 6 gloves, glass, 2 1
Tahun 1982 uniform
 Peraturan gloves,helme
Back injury,struck
Menaker No. 2 2 2 4 t, safety 2 1
down
Tahun 1982 shoes

Peraturan gloves,helme
Wound, broken
Menaker No. 5 2 2 4 t, safety 2 1
bone, death Tahun 1985 shoes

Peraturan safety
Back injury,struck
Menaker No. 2 2 2 4 belt,helmet, 2 1
down
Tahun 1982 safety shoes

Wound, broken Peraturan safety

Menaker No. 5 2 2 4 belt,helmet, 2 1
bone, death
Tahun 1985 safety shoes

Eye problem,
breathing problem, Kep Menaker No. gloves,
4 3 12 3 2
hand wound, back 187 Tahun 1999 gogles, mask
Injury

Eye problem,
breathing problem, Kep Menaker No. gloves,
4 3 12 3 2
hand wound, back 187 Tahun 1999 gogles, mask
Injury
 Kep Menaker No. Change
Eye problem 2 3 6 1 3
187 Tahun 1999 proper light

Peraturan Vitamin,
Flu, headache Menaker No. 2 2 3 6 enough rest, 1 3
Tahun 1982 jacket

Note: Prepare JSA when Residual Risk >= 6

Prepared by, Reviewed by:

Date: Date:

Type of Revision
First edition
 RISK CONTROL

Or Additional Risk
Residual Risk
Control
1. Elimination
Risk Category 2. Substitution
3. Engineering
4. Administrative
RFN
5. PPE, Spill Kit

4 Acceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

6 Moderate 4-NE-JSA-001

6 Moderate 4-NE-JSA-001
6 Moderate 4-NE-JSA-002

6 Moderate 4-NE-JSA-002

6 Moderate 4-NE-JSA-002

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

6 Moderate 4-NE-JSA-003
6 Moderate 4-NE-JSA-004

6 Moderate 4-NE-JSA-004

6 Moderate 4-NE-JSA-004

2 Trivial 4-HSE Patrol

4 Aceptable 4-HSE Patrol

2 Trivial 4-HSE Patrol

3 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4-HSE Patrol
3 Aceptable

4 Aceptable 4-HSE Patrol

2 Trivial 4-HSE Patrol

6 Moderate 4-HSE Patrol

6 Moderate 4-NE-JSA-007

4 Aceptable 4-HSE Patrol

6 Moderate 4-NE-JSA-007

6 Moderate 4-NE-JSA-008

6 Moderate 4-NE-JSA-008

6 Moderate 4-NE-JSA-009

6 Moderate 4-NE-JSA-009
3 Aceptable 4-HSE Patrol

4-Maximum direct sun

2 Trivial
exposure 3 hours

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

4 Aceptable 4-HSE Patrol

2 Trivial 4-HSE Patrol

2 Trivial 4-HSE Patrol

2 Trivial 4-HSE Patrol

2 Trivial 4-HSE Patrol

2 Trivial 4-HSE Patrol

6 Moderate 4. JSA-010

6 Moderate 4. JSA-011
3 Aceptable 4-HSE Patrol

3 Aceptable 4-HSE Patrol

Approved by:

Date: