JOB SAFETY ANALYSIS (JSA) FORM PMO

PROJECT KDP COOKING DATE : 23-08-2020 JSA NO.:143/KDP/RAPP-APR/TSE/VIII/2020 REV. 0

JSA TEAM
CONTRACTOR PT. TIMAS SUPLINDO
(First Named – JSA Team Leader)
JOB TITLE FLUSHING LINE PIPING DN 2 INCH API,WFL NAME POSITION SIGNATURE

LOCATION COOKING AREA Fudji pidoanto Supervisor

ITEM PIPING EQUIPMENT A.Isa Superintendent

JOB DESCRIPTION:
Siswandi HSSE
FLUSHING LINE PIPING DN 2 INCH API,WFL COOKING 411 Jeorphy J Timas manager

Widi Nugroho Supervisor Mechanical APR

Sutardi HSE PMO / RAPP

Widi Suganda Operation Fibber Line

REFERENCE AND OTHER RELEVANT INFORMATION: JSA Team Leader confirm that the risk for job describe have been reviewed and the controls measures which are recommended reduce
the risk to tolerable level and I consider it is safe so the job can be proceed

 Permit To Work NAME Rudolf Alfonso

 JSA POSITION Site Manager
 APD Standard (Hearing Protection, Heand Protection,Fall
Protection) SIGNATURE Date:
 Radio Communication
 Schematic Flushing line I am satisfied that the controls measures identified when put into place will reduce the risk to tolerable level. The job/action change is
permitted to proceed. CONFIRMED & APPROVED BY PROJECT/SITE MANAGER/HSE MANAGER
 Stop- Work if Unsafe
NAME Zulkarnain/ Yudi
POSITION Manager HSSE/ Supervisor HSSE

SIGNATURE Date:
JSA WORK SHEET
JOB TITLE FLUSHING LINE PIPING DN 2 INCH API,WFL COOKING AREA 411
Hazard Identification Risk Evaluation Risk Control

Seqience of Job Hazard Description Hazard Effect Done by Check

No. Control measures
(Urutan Pekerjaan (Penjelasan Bahaya) (Dampak Bahaya) (Dilakukan Oleh) ()

1 Persiapan pekerjaan Slip,Trip,Fall MTI  Pastikan semua pekerja hadir di Tool Box Fudji Pidianto
 Check alat kerja Meeting
 Check Area kerja Manual Handling  Pastikan semua alat kerja layak untuk di
 Check APD gunakan
 Radio  Gunakan APD yang standard (Ear plug)
Communication  Pastikan area kerja yang akan melakukan
 Check LOTO Flushing agar dibaricade dan pasang Sign
 Check Protector at Board peringatan
end of pipe flushing  Jangan bekerja sebelum permit
ditandatangannin oleh PIC area saja

2 Persiapan melakukan
Flushing line Piping
 Check Area kerja
 Check Hand Tool
 Check line to be
Flushing
3 Menseterilkan Area lokasi
kerja
Slip,Trip,Fall MTI  Pastikan semua alat kerja dalam kondisi Fudji Pidianto
baik
Elektrik Hazard  Memasang dan mensetrilkan area kerja
yang berdekatan dengan area Flushing
 Memberi peringatan kepada semua
pekerja karena ada pelaksanaan Flushing
 Pastikan instruksi kerja Start&Stop hanya
dilakukan satu orang saja
 Pastikan semua peralatan elektronik /
welding engine juga diprotect dari air
yang keluar dari pipa yang diflushing
Bekerja diatas ketinggian Fatality  Pakai safety full body Harness dan Fudji Pidianto
cantolkan dengan benar

Slip,Trip,Fall MTI  Pasang baricade atau sign board

peringatan dilokasi pengangkatan
Material
MTI
 Pakai sarung tangan (Hand Glove).

KDP-HSE-F033 Page 1 of 2
JSA WORK SHEET
JOB TITLE FLUSHING LINE PIPING DN 2 INCH API,WFL COOKING AREA 411
Hazard Identification Risk Evaluation Risk Control

Seqience of Job Hazard Description Hazard Effect Done by Check

No. Control measures
(Urutan Pekerjaan (Penjelasan Bahaya) (Dampak Bahaya) (Dilakukan Oleh) ()

 Pastikan semua Crew menggunakan APD

yang Standard
4 Membuka Valve Sealing Bekerja diatas ketinggian Fatality  Pakai safety full body Harness dan Fudji Pidianto
water cantolkan dengan benar
 Pastikan semua pekerja menggunakan
APD yang standard Earplug /ear muff
MTI  Pakai sarung tangan kulit yang tahan
panas

FAC  Buka Valve line Main Air Instrument

sesuai Instruksi Operation team RAPP
 Cordinasi dengan pihak Proses sampai
kapan Durasi Flushing dilakukan.
 Pastikan lokasi kerja seteril dan tidak ada
pekerja lain yang berada di lokasi
Flushing

7 Membuka Main Valve Bekerja diatas ketinggian Fatality  Pakai safety full body harness dan Fudji Pidianto
Sealing Water perlahan cantolkan dengan benar
sesuai Instruksi Proses MTI  Pakai masker pelindung pernapasan
RAPP
MTI  Pakai sarung tangan dan baju lengan
panjang
Manual Handling FAI
FAI  Pakai kaca mata (Gogles)
 Pasang baricade dan sign board di area
Flushing
MTI
 Pastikan semua pekerja jangan berada
diarea Flushing

KDP-HSE-F033 Page 2 of 2
JSA WORK SHEET
JOB TITLE FLUSHING LINE PIPING DN 2 INCH API,WFL COOKING AREA 411
Hazard Identification Risk Evaluation Risk Control

Seqience of Job Hazard Description Hazard Effect Done by Check

No. Control measures
(Urutan Pekerjaan (Penjelasan Bahaya) (Dampak Bahaya) (Dilakukan Oleh) ()

 Pakai dan Gunakan APD earflug/ear muff

yang standard

8 House Keeping area Slip,Trip,Fall MTI  Kumpulkan semua alat kerja dan kembalikan Fudji Pidianto
ke ware house sambil menunggu perintah
selanjutnya
 Pakai sarung tangan (Hand Glove) ,dan
kemeja yang berlengan panjang
 Pastikan LOTO terlepas /dibuka sesuai
Instruksi
FAC

9 Emergency Response
Slip ,Trip & Fall
LTI  Segera lakukan sosialisasi sesuai prosedur Siswandi
yang berlaku terkait dengan kedauratan Timas HSSE
diaktivitas pekerjaan
 Laporkan ke ERT team or ke fire station,
gunakan laporan emergency extention 1113
atau 0761-491113.
 Jangan panic ,pastikan semua menggunakan
APD saat bekerja
 Segera menuju ke master point terdekat
 Laporkan segera ke pengawas area dan
Safety area PMO

KDP-HSE-F033 Page 3 of 2
Hazard Check List

GENERAL CONFINED SPACE ENTRY PROCESS

N
o
Hazard Description No Hazard Description No Hazard Description
1 Asphyxiation 1 Adequacy of lighting within the CS 1 Asbestos gaskets
2 Barriers/access restrictions √ 2 Adequacy of ventilation 2 Chemical hazards
3 Biological agents 3 Comm. Difficulties within the CS or with the standby man 3 Chemical reactions with cleaning materials
4 Chemical hazard 4 Competency of standby man 4 Chemical reactions with cleaning materials
5 Cold/Heat 5 Danger of falling into CS boots or sumps 5 Electrical risk of using portable tools
6 Collision (impact from moving object to fixed object) √ 6 Disposal of CS cleanings 6 Environmental impact of spills or emissions
7 Electricity 7 Falling from height Residual gases/ vapors 7 Flammable or toxic vapors arising from sludge in vessel
8 Falling from height √ 8 Frequency of gas testing 8 Hazardous substances trapped around bends, linings etc.
9 Falling object/Drop Object √ 9 Ingress of gases/vapors from other nearby activities/systems 9 Inert atmospheres
10 Open flame 10 Ionizing radiation; nucleonic instrumentation 10 Liquids remaining from flushing
11 Flammable gas 11 Location of rescue kits 11 Hazardous Chemical Scale
12 Flammable liquid 12 Hazardous Chemical scale 12 Pyrophoric scale
13 Fume/dust 13 Need for air movers during entry. 13 Residual heat
14 Grit blasting 14 Noise when using power tools 14 Residual pressure
15 Hand tools √ 15 Noise, general 15 Trapped pressure
16 Ignition 16 Oxygen deficiency
17 Impact (force full contact) √ 17 Oxygen enrichment
18 Inert gas 18 Slip hazards within the CS or at the point of entry
19 Sludge which may give rise to vapors/gases when
19 Ionizing Radiation
disturbed
20 Lifting operations √ 20 Standby man communication with the ERP
21 Lighting 21 Temperature effects
22 Machinery √ 22 Use of mechanical tools/power tools/electrical equipment
23 Manual Handling √ 23 Visibility within the Confined Space
24 Mental Stress
25 Noise
26 Potential for ignition
27 Power tools √
28 Pressure
29 Static Electricity
30 Slip, Trip and Fall √
31 Working at height √
32 Bad Weather √