Risk Assessment Work Sheet Subcont logo

Project Title: LINE PROJECT CILEGON

Risk Assessment No. Permit No.
Job Title Tightening bolt at height (Beam)
JEL/SMP2/RA/0012 Revision Date 5/22/2023 No. 1

Work Location LINE WP - 01 Subcontractor PT JEL-SMP2 Project Discipline STEEL STRUCTURE

Prepared by (RA Team) Name Position Date Signature

Subcontractor Discipline Manager / Engineer Bonang F.K Engineer 5/22/2023

Subcontractor HSE Engineer / Supervisor Andry K HSE 5/22/2023

Subcontractor Discipline Supervisor Bati Supervisor 5/22/2023

Checked by (Preliminary Review) Name Position Date Signature

Discipline Manager / Engineer J E Bae Construction Manager 5/22/2023

Discipline Supervisor / Engineer J.H Choi Senior Engineer 5/22/2023

HSE Manager / Engineer H.S Lee HSE Manager 5/22/2023

HSE Supervisor / Engineer Hendra. G / M. Afif HSE 5/22/2023

 Risk Assessment Work Sheet Subcont logo
Project Title: LINE PROJECT CILEGON
HSE equipment / facilities
Equipment & Tools to be used Materials to be used Inspection required Training / competency required
required
1 Man lift 1 Bolt 1 Tools work 1 Training PTW 1 Mandatory PPE
2 Wrench 2 Baji 2 Full Body Harness 2 Training Working at Height 2 Full body harness
3 Hammer 3 3 3 HSE Induction 3 Hard baricade
4 Radio comunication 4 4 4 4 Safety net
5 Reamer 5 5 5 5
6 6 6 6 6
7 7 7 7 7
8 8 8 8 8
9 9 9 9 9
10 10 10 10 10

Number of Worker 7 Discipline Supervisor 1 Safety Supervisor

personnel required Other (Operator/Rigger/Signalman) Discipline Foreman 1 Safety Officer / Inspector 1

Risk Assessment Matrix (RAM) and Hierarchy of Control

PROBABILITY [1 - 3] Can proceed with the task
HSE Risk Assessment of Incident Rare (1) Possible (2) Likely (3) Of ten (4) Frequent (5)
Encountered
in industry
Has occurred Has occurred
in HEC in HEC
Occurs Occurs
sev eral times sev eral times
[4 - 10] Can proceed with the task. Consider more controls.
SEVERITY People Assets Environment Reputation
but not in project within project within a y ear in a y ear at this
HEC projects last 5 y ears last 3 y ears HEC projects project [12 - 25] Stop work. Change work method or put more controls
Slight injury Slight ef f ect Slight ef f ect
or health (less than 500 (less than 50
1-Insignificant
ef f ects USD liter oil/
Slight impact 1 2 3 4 5
(FAC) Damage) Chemical)
Minor ef f ect Minor ef f ect
Minor injury or
(500 ~ 10,000 (less than 100
2-Minor health ef f ects
USD liter oil/
Minor impact 2 4 6 8 10
(MTC)
Damage) Chemical)

Major injury or Local damage Localized

health ef f ects (10,000 ~ ef f ect (100 ~ Considerable
3-Moderate (RWC; LTI <7 100,000 USD 200 liters of impact 3 6 9 12 15
day s) Damage) oil/Chemical)

Single f atality Major damage Major ef f ect

or permanent (100,000 ~ (200 ~ 1000 National
4 -Major disability or 500,000 USD liters of impact 4 8 12 16 20
LTI > 7 day s Damage) oil/Chemical)

Extensiv e Massiv e
damage ef f ect (more
Multiple International
5-Catastrophic
f atalities
(more than than 1000
impact 5 10 15 20 25
500,000 USD liters oil/
Damage) Chemical)
 Risk Assessment Work Sheet
Project Title: Tightening bolt at height (Beam)

Initial Risk Action Residual Risk

Description of Work
No. Potential Hazards & Consequences Control and / or Recovery Measures Responsible
Step S P R S P R
Person

Every work activity as per site condition should be

discussed at TBM prior to start and when deemed
necessary (Setiap aktivitas kerja sesuai kondisi lapangan
harus didiskusikan di TBM sebelum dimulai dan bila
dianggap perlu)

Clear information regarding the work must be explained in

details (Informasi yang jelas mengenai pekerjaan harus
dijelaskan secara rinci)

All work force must be well informed regarding the RISK

existed all the site (semua tenaga kerja harus mendapat
informasi yang baik tentang RISIKO yang ada di semua
lokasi)
Lack of information and awareness (Kurangnya
2 3 6 Supervisor must be aware and understand of the SPV, Worker, HSE 2 1 2
informasi dan kesadaran)
permitting system implementation of "No Permit, No
Work" system (Supervisor harus mengetahui dan
memahami penerapan sistem perijinan sistem “No
Permit, No Work”)

Acquired permit to work (Memperoleh izin untuk bekerja)

Work Preparation
1 Permit to work must be available on site, with
(Persiapan pekerjaan)
attachments required (izin untuk bekerja harus tersedia di
lokasi, dengan lampiran yang diperlukan)

Supervisor must be more attentive and responsible

(Pengawas harus lebih perhatian dan bertanggung jawab)

Ensure the potential hazard have been informed to the

Mobilization and Preparation Tools/equipment
Mobilisasi dan persiapan alat
kerja /peralatan
worker through TBM (Pastikan potensi bahaya telah
diinformasikan kepada pekerja melalui TBM)
Ensure all tools to be used passed internal inspection
(Pastikan semua alat yang akan digunakan lulus inspeksi
internal)
2 3 6 Ensure no material blocking work access (Pastikan tidak SPV, Worker, HSE 2 1 2
ada material yang menghalangi akses kerja)
Install barricade and signage (Pasang barikade dan
rambu rambu)

Wearing proper PPE, and ensure wear helmet with chain

strip (Mengenakan APD yang tepat, dan pastikan helm
menggunakan tali dagu)

Slipped, pinched feet or hands
(Terpleset, terjepit kaki atau tangan)
Drop object (Benda jatuh)
Tightening bolt at height
2
(beam)
Unskill Person (Pekerja tidak terlatih)
Block access (Akses terhalang)
Ensure the potential hazard have been informed to the
worker through TBM (Pastikan potensi bahaya telah
diinformasikan kepada pekerja melalui TBM)
Avoid pinch points (Hindari titik jepit)
All workers involve shall have to wear body harness with
two lanyards and tie off policy shall be adhered, and
ensure 100% double hook tie off (semua pekerja yang
3 3 9 terlibat harus memakai body harness dengan dua lanyard SPV, Worker, HSE 2 1 2
dan ketentuan pengikatan harus dipatuhi, dan pastikan
100% double hook dicantolkan)
Take your time and pay attention to the area around.
(Luangkan waktu Anda dan perhatikan area sekitar)
Wear appropriate PPE, and hand gloves (Kenakan APD
yang sesuai, dan sarung tangan)
Good coordination and communication during tightening
bolt with radio (Koordinasi dan komunikasi yang baik
selama pengencangan baut dengan radio)
Barricade the work area so that unauthorized persons do
not cross the work area (Barikade area kerja agar orang
yang tidak berkepentingan tidak melintas di area kerja)
Tools/equipment should be tied with a lanyard and
3 3 9 attached to anchor point to prevent hem from falling when SPV, Worker, HSE 2 1 2
used (Alat/perkakas harus diikat dengan tali lanyard dan
dikaitkan di anchor points untuk mencegah terjatuh ketika
digunakan)
Use approved canvas bag with SWL 20kgs to carry
material to prevent fall off and blocking access when
working (Gunakan tas canvas yang sudah disetujui
dengan SWL beban maks 20kg untuk membawa material,
untuk mencegah jatuh dan blokir akses saat bekerja)
Ensure that workers to perform the task are well trained,
competent and knowledgeable (Pastikan bahwa pekerja
untuk melakukan tugas terlatih dengan baik, kompeten
dan berpengetahuan)
3 3 9 Proper and clear instructions must be given to workers on SPV, Worker, HSE 2 1 2
what tools and equipment are going to be used, RA, must
be informed during tightening bolt process (Instruksi yang
tepat dan jelas harus diberikan kepada pekerja tentang
alat dan perlengkapan apa yang akan digunakan, RA,
harus diinformasikan saat proses pengencangan baut)
Remove obstacles from your path and always keep the
area clear from any hazards. (Singkirkan rintangan dari
jalur Anda dan selalu jaga agar area tersebut bersih dari
bahaya apa pun)
Do housekeeping before and after work (Melaksanakan
2 3 6 bersih-bersih sebelum dan sesudah melakukan SPV, Worker, HSE 2 1 2
pekerjaan)
Do not put material which possible block an access (Tidak
menempatkan material yang memungkinkan menghalangi
akses)

3 Anchorage points
4 Adverse/unsafe condition
Sharp materials at working site, hand tools is not
5 Housekeeping
Webbing sling broke (Webbing sling rusak)
Severe heat (Panas yang parah)
Dust concentration (Debu)
Wind Speed (Kecepatan Angin)
Rain (Hujan)
in proper place, and lost items in ground
Tools/equipment should be inspected and checked before
use (Tools/equipment yang akan digunakan diinspeksi
dan dicek terlebih dahulu sebelum memulai pekerjaan)
2 3 6 SPV, Worker, HSE 1 2 2
Put 2 anchorage points as a backup if one sling is broke
(Menempatkan 2 anchorage points sebagai backup jika
salah satu sling rusak)
Cool drinking water should be available near site at all
times (Air minum dingin harus tersedia di dekat lokasi
setiap saat)
Rest shelter should be available near the work area
2 3 6 (Tempat peristirahatan harus tersedia di dekat area kerja) SPV, Worker, HSE 1 2 2
If symptoms occur due to heat stress immediately seek
first aid / medical assistance (jika timbul gejala akibat
stress panas segera cari pertolongan pertama /
pertolongan medis)
Water shall be sprayed to minimize the dusts (Air harus
disemprotkan untuk meminimalkan debu)
Necessary protection for crew shall be provided to control
inhalation of dust : like dust mask (Perlindungan yang
diperlukan untuk pekerja harus disediakan untuk
2 3 6 mengendalikan penghirupan debu: seperti masker debu) SPV, Worker, HSE 1 2 2
Poor visibility administrative control should be apply if the
situation getting worse, work shall be stopped
(Pengawasan administratif visibilitas yang buruk harus
diterapkan jika situasi semakin buruk, pekerjaan harus
dihentikan)
Monitor wind speed max 10m/s working at scaffolding,
and 7m/s working with mainlift and mainbasket (Monitor
2 3 6 SPV, Worker, HSE 1 2 2
kecepatan angin maks. 10m/s untuk bekerja di scaffolding
dan maks 7m/s bekerja di mainlift/mainbasket)
Provide shelter (Menyediakan tempat berlindung)
2 3 6 SPV, Worker, HSE 1 2 2
If the situation getting worse, work shall be stopped (jika
keadaan semakin parah, pekerjaan akan dihentikan)
Proper instruction giving at TBM (Pemberian instruksi
yang tepat di TBM)
Everyday housekeeping on site (Bersih-bersih setiap hari)
2 3 6 SPV, Worker, HSE 2 1 2
Properly maintain hand tools (Rawat handtools dengan
baik)
Providing waste bin at site (Menyediakan tempat sampah
di lokasi)
 Risk Assessment Work Sheet
Project Title: Tightening bolt at height (Beam)

Initial Risk Action Residual Risk

Description of Work
No. Potential Hazards & Consequences Control and / or Recovery Measures Responsible
Step S P R S P R
Person

Every work activity as per site condition should be

discussed at TBM prior to start and when deemed
necessary (Setiap aktivitas kerja sesuai kondisi
lapangan harus didiskusikan di TBM sebelum dimulai
dan bila dianggap perlu)

Clear information regarding the work must be

explained in details (Informasi yang jelas mengenai
pekerjaan harus dijelaskan secara rinci)

All work force must be well informed regarding the

Lack of information and awareness (Kurangnya
2 3
informasi dan kesadaran)
RISK existed all the site (semua tenaga kerja harus
mendapat informasi yang baik tentang RISIKO yang
ada di semua lokasi)
6 Supervisor must be aware and understand of the SPV, Worker, HSE 2 1 2
permitting system implementation of "No Permit, No
Work" system (Supervisor harus mengetahui dan
memahami penerapan sistem perijinan sistem “No
Permit, No Work”)

Acquired permit to work (Memperoleh izin untuk

bekerja)
Work Preparation
1 Permit to work must be available on site, with
(Persiapan pekerjaan)
attachments required (izin untuk bekerja harus tersedia
di lokasi, dengan lampiran yang diperlukan)
Supervisor must be more attentive and responsible
(Pengawas harus lebih perhatian dan bertanggung
jawab)

Ensure the potential hazard have been informed to the

Mobilization and Preparation Tools/equipment
Mobilisasi dan persiapan alat
kerja /peralatan
worker through TBM (Pastikan potensi bahaya telah
diinformasikan kepada pekerja melalui TBM)
Ensure all tools to be used passed internal inspection
(Pastikan semua alat yang akan digunakan lulus
inspeksi internal)
2 3 6 Ensure no material blocking work access (Pastikan SPV, Worker, HSE 2 1 2
tidak ada material yang menghalangi akses kerja)
Install barricade and signage (Pasang barikade dan
rambu rambu)

Wearing proper PPE, and ensure wear helmet with

chain strip (Mengenakan APD yang tepat, dan pastikan
helm menggunakan tali dagu)

Slipped, pinched feet or hands
(Terpleset, terjepit kaki atau tangan)
Drop object (Benda jatuh)
Tightening bolt at height
2
(beam)
Unskill Person (Pekerja tidak terlatih)
Ensure the potential hazard have been informed to the
worker through TBM (Pastikan potensi bahaya telah
diinformasikan kepada pekerja melalui TBM)
Avoid pinch points (Hindari titik jepit)
All workers involve shall have to wear body harness
with two lanyards and tie off policy shall be adhered,
and ensure 100% double hook tie off (semua pekerja
3 3 9 yang terlibat harus memakai body harness dengan dua SPV, Worker, HSE 2 1 2
lanyard dan ketentuan pengikatan harus dipatuhi, dan
pastikan 100% double hook dicantolkan)
Take your time and pay attention to the area around.
(Luangkan waktu Anda dan perhatikan area sekitar)
Wear appropriate PPE, and hand gloves (Kenakan
APD yang sesuai, dan sarung tangan)
Good coordination and communication during
tightening bolt with radio (Koordinasi dan komunikasi
yang baik selama pengencangan baut dengan radio)
Barricade the work area so that unauthorized persons
do not cross the work area (Barikade area kerja agar
orang yang tidak berkepentingan tidak melintas di area
kerja)
Tools/equipment should be tied with a lanyard and
3 3 9 attached to anchor point to prevent hem from falling SPV, Worker, HSE 2 1 2
when used (Alat/perkakas harus diikat dengan tali
lanyard dan dikaitkan di anchor points untuk mencegah
terjatuh ketika digunakan)
Use approved canvas bag with SWL 20kgs to carry
material to prevent fall off and blocking access when
working (Gunakan tas canvas yang sudah disetujui
dengan SWL beban maks 20kg untuk membawa
material, untuk mencegah jatuh dan blokir akses saat
bekerja)
Ensure that workers to perform the task are well
trained, competent and knowledgeable (Pastikan
bahwa pekerja untuk melakukan tugas terlatih dengan
baik, kompeten dan berpengetahuan)
Proper and clear instructions must be given to workers
3 3 9 on what tools and equipment are going to be used, RA, SPV, Worker, HSE 2 1 2
must be informed during tightening bolt process
(Instruksi yang tepat dan jelas harus diberikan kepada
pekerja tentang alat dan perlengkapan apa yang akan
digunakan, RA, harus diinformasikan saat proses
pengencangan baut)

3 Anchorage points
4 Adverse/unsafe condition
Block access (Akses terhalang)
Webbing sling broke (Webbing sling rusak)
Severe heat (Panas yang parah)
Dust concentration (Debu)
Wind Speed (Kecepatan Angin)
Rain (Hujan)
Remove obstacles from your path and always keep the
area clear from any hazards. (Singkirkan rintangan dari
jalur Anda dan selalu jaga agar area tersebut bersih
dari bahaya apa pun)
Do housekeeping before and after work
2 3 6 (Melaksanakan bersih-bersih sebelum dan sesudah SPV, Worker, HSE 2 1 2
melakukan pekerjaan)
Do not put material which possible block an access
(Tidak menempatkan material yang memungkinkan
menghalangi akses)
Tools/equipment should be inspected and checked
before use (Tools/equipment yang akan digunakan
diinspeksi dan dicek terlebih dahulu sebelum memulai
2 3 6 pekerjaan) SPV, Worker, HSE 1 2 2
Put 2 anchorage points as a backup if one sling is
broke (Menempatkan 2 anchorage points sebagai
backup jika salah satu sling rusak)
Cool drinking water should be available near site at all
times (Air minum dingin harus tersedia di dekat lokasi
setiap saat)
Rest shelter should be available near the work area
(Tempat peristirahatan harus tersedia di dekat area
2 3 6 SPV, Worker, HSE 1 2 2
kerja)
If symptoms occur due to heat stress immediately seek
first aid / medical assistance (jika timbul gejala akibat
stress panas segera cari pertolongan pertama /
pertolongan medis)
Water shall be sprayed to minimize the dusts (Air
harus disemprotkan untuk meminimalkan debu)
Necessary protection for crew shall be provided to
control inhalation of dust : like dust mask
(Perlindungan yang diperlukan untuk pekerja harus
2 3 6 disediakan untuk mengendalikan penghirupan debu: SPV, Worker, HSE 1 2 2
seperti masker debu)
Poor visibility administrative control should be apply if
the situation getting worse, work shall be stopped
(Pengawasan administratif visibilitas yang buruk harus
diterapkan jika situasi semakin buruk, pekerjaan harus
dihentikan)
Monitor wind speed max 10m/s working at scaffolding,
and 7m/s working with mainlift and mainbasket
2 3 6 (Monitor kecepatan angin maks. 10m/s untuk bekerja SPV, Worker, HSE 1 2 2
di scaffolding dan maks 7m/s bekerja di
mainlift/mainbasket)
Provide shelter (Menyediakan tempat berlindung)
2 3 6 If the situation getting worse, work shall be stopped SPV, Worker, HSE 1 2 2
(jika keadaan semakin parah, pekerjaan akan
dihentikan)
 Ensure scaffolding on green tag (Pastikan scaffolding
di tag hijau)
Provide adequate lighting on working area and access
(Sediakan penerangan yang layak di area kerja dan
akses)
Good cable management (Pengaturan kabel yang
baik)

Buddy system implemented (Implementasikan buddy

system)

Install safety net (mandatory) on each elevation

(Pasang safety net (diwajibkan) di setiap elevasi)
Wear body harness correctly and 100% tied off
(Mandatory) (Memakai body harness dengan bear dan
100% dicantolkan)
Provide clear safety glass (Sediakan kacamata safety
yang bening)
All hand tools must have lanyard to avoid drop object
Tightening bolt at night (Semua handtools harus menggunakan lanyard untuk
Slipped, pinched feet or hands
5 shift (Working at height 2 3 6 menhindari benda jatuh) SPV, Worker, HSE 1 2 2
(Terpleset, terjepit kaki atau tangan)
or using manlift)
Install hard barrier under working at height area to
avoid unauthorized person passing through (Pasang
hard barricade dibawah area kerja WAH untuk
menghindari orang yang tidak berkepentingan
melintas)

Safety signs installed "Working at height area" and

"Only Authorized Person" (Safety signs dipasang
"Bekerja di ketinggian" dan "Hanya orang yang
berkepentingan")

Stop work if bad weather (Hentikan pekerjaan jika

cuaca buruk)

Power tools inspected (Power tools sudah diisnpeksi)

Ensure steel plate under equipment (Pastikan alas

baja dibawah peralatan)

Ensure good lighting on equipment and access

Sharp materials at working site, hand tools is not
6 Housekeeping 2 3
in proper place, and lost items in ground
(Pastikan penerangan yang baik di peralatan)
Proper instruction giving at TBM (Pemberian instruksi
yang tepat di TBM)
Everyday housekeeping on site (Bersih-bersih setiap
hari)
6 SPV, Worker, HSE 2 1 2
Properly maintain hand tools (Rawat handtools dengan
baik)
Providing waste bin at site (Menyediakan tempat
sampah di lokasi)
 Risk Assessment Work Sheet Subcont logo
Project Title: LINE PROJECT CILEGON
Page Permit No.
Job Title Man lift Operation
11 of 11 Revision Date 3/28/2024 No.

Work Location LINE WP - 01 Subcontractor PT JEL-SMP2 Projeckt Discipline STEEL STRUCTURE

Briefing and Sign :

Saya mengkonfirmasi bahwa RA telah dijelaskan dan isinya benar-benar dapat dipahami dan diterima
(I confirmed that the JSEA has been explained and totally understandable and acceptable)
Saya benar-benar memahami kontrol-kontrol dalam RA ini harus diterapkan sebagaimana yang didokumentasikan; apabila tidak, pekerjaan dihentikan segera
(I totally understood these controls in JSEA should be implemented as documented; otherwise, the work will be stopped immediately)

No Name Position Company Signature Date

1
2
3
4
5
6
7
8
9
10
11
12
13

Name Position Date Signature

Subcontractor Discipline Manager / Engineer

Subcontractor HSE Engineer / Supervisor

Subcontractor Discipline Supervisor