HSQE FORM AND CHECKLIST

RISK ASSESSEMENT
JSA FORM
Section : RA.1 Effective date: 01/04/2014 Rev: 00 Page: 1 FROM 1

JSA Number: 022/HW /2023 Date: 12.04.2023

Page: of : Vessel : Java Imperia

Work Area & Activity (Job) :

Main Deck / Dismantle the David ROV, Container at Main deck and welding coring winch
Work Team :
PTK
Supervisor (Print Name) : Signature :

Critical Questions (All must be properly addressed All personnel ready / capable to Potential Environmental issues Worst case scenario has been
and positive before commencing the work) work at this job? have been addressed? addressed?

Basic Job Steps Existing or Potential Hazards How to Eliminate or Control Hazards Responsibility
In sequence
Subsequent fire hazard with potential for skin Ensure fire blanket & correct extinguishers C/O
Cutting, welding & grinding injury are in reach. Wear correct PPE ,Stby fire
hose
Excessive exposure to heat PTW in place before open cutting activity, C/O
Burns, fire, sparks.
Hand Injury. Have fire spotter on hand C/O

In hole pump Correct position during activity and wear C/O

hand glove

PPE required for this job (Check each for applicable requirement)
Hard Hat √ Work Gloves √ Fall Arrest / Safety Harness Full Face Protection
(Suitable for task) (Face shield)
Safety Footwear √ Rubber Gloves Skin Protection Other Apron
(Barrier Cream) (Full Body Protection)
Coveralls √ Hearing Protection Welding Gloves √ Other (Describe)

Flotation Aid Respiratory Protection Welding Mask √ Other (Describe)

(Dust Mask)
Safety Glasses √ Full Respiratory Protection Welding Apron √ Other (Describe)

copyright: No material in here shall be produced in whole or in part without prior written permission from PT. BERKAH INTAN PERKASA