Form No: FORM-TEP-HSSE-183 Revision No: 04

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Install and Maintenance PVC Plumbing Portable Toilet
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-012
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name : ……………………………
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Rubber Gloves _
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Loading Unloading Material with Manual Handling and Using Heavy Equipment
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : CSTS/O&M-LOG/005/202003
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Double Impact Gloves __
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

WALL PANEL ASSEMBLY
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
O&M Area JSA NO : 003/GAJA-CSTS/1283756
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. EDY F. KWANDO Signature:………………………
1 7 Name : Lawrence Machado.
2. Kathon Hugo A Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Welding Suit / Approns _________
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Repair and Install Blower
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-004
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Rubber Gloves_ _____ ____
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Preventive Maintenance Generator Set Unit
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Generator Set Area JSA NO : O/M-JSA-TEP-014
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Rubber Gloves_ ____ _____
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Repair and Install Pipe, Valve, Flange, Flow Meter, and Vessel
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-019
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. _ _________
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Repair and Install Pump Sections
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-003
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves(electrical Gloves) Barricades PSV 1. Rubber Gloves _ _________
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Repair/Replace, Monitoring & Maintenance Electrical Installation & Equipment
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-005
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. _ _________
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Service and Maintenance Equipments
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-012
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. _ _________
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. ____________________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

Touch Up Painting
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO :
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Medical Mask Lv-2_ ___
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. Ruber Gloves________________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue/Biology Hazard Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

WATER TANK REFURBISHMENT
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-011
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Medical Mask Lv-2_ ___
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. Rubber Gloves_______________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
 Form No: FORM-TEP-HSSE-183 Revision No: 04

Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue/Biology Hazard Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire

pp JOB SAFETY ANALYSIS

Tangguh Expansion Project

WORK ACTIVITY (JOB) TITLE: DATE Open : __ / __ / ____

WATER TANK REFURBISHMENT
Aktivitas Pekerjaan : DATE Close : __ / __ / ____
LOCATION : (Detail) PTW No.
All O&M Area JSA NO : O/M-JSA-TEP-010
Tempat Kerja : TRC No.
TEAM WORK / Anggota Tim: Reviewed by : JSA PREPARED BY:
CSTS Commissioning - Construction JSA Disiapkan Oleh:
1. Signature:………………………
1 7 Name :…………………………….
2. Signature:………………………
2 8 Signature :…………………………….
3. Signature:………………………
3 9
4. Signature:………………………
4 10 CSTS HSSE
5. Signature:………………………
5 11 Name :……………………………..
6. Signature:………………………
6 12 Signature :……………………………..
7. Signature:………………………

CRITICAL QUESTIONS: Everyone Ready/Capable to Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT

 Form No: FORM-TEP-HSSE-183 Revision No: 04

Hard Hats Respirator/ Dust mask Safety Harness Hearing Protection Tools Lanyard Other (List):_____________________
Safety Shoes Electrical Stick Safety Gloves( electrical Gloves) Barricades PSV 1. Medical Mask Lv-2_ ___
Safety Glasses Life Vest / PFD Dosimeter Gás Detector N95 / Level 2 2. Rubber Gloves_______________
Goggles Blower Flame Resistant Clothing Life Line / Yoyo 3. ____________________________
Face Shield SCBA - EEBA Fire Extinguisher Radio ____________________________
Chemicals suit Spill Kit / SOPEP Extraction Device
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
PTW - (CS/HOT/COLD/ CREATED TBT – STARRT Card Ground Scan (underground utilities) WASTE and SPILL Measurement
OPENING / EXCAVATE) Drop Object -Created opening Safety Net – Catch Net Redundant Protection Measures
Energy Isolation / LOTO Checklist. Compressed Gas Cylinder / Toxic gas Control SIMOPS
Written Procedure (MoS/ SOP) Confined Space Identification Commissioning authorization -Access Control Lighting / Illumination Plan
PSSR Doc /Line Checklist Emergency Rescue Plan Chemicals Handling (SDS DOC, etc ) HSE Training Passport
other :
POTENTIAL HAZARDS
Lifting Hazards New Employees Elec. Shock/ Flash (includes utility lines) Dropped Objects Low Lighting Equipment Failure
Fall Potential Water/Drowning Hazard Haz. Chemical Exposure (N2, H2S,CO2 ) Tripping - Slipping Breathing Hazard Other : ________
Skin Irritants Mech. Equip. Hazards Sharp Edge, Hot - Cold surfaces Excavation Hazard Environmental Haz _________________
Confined Spaces Fire/Explosion Potential Pinch/Crush/Striking Hazards Low Level hazard Ionizing Radiation _________________
Elev. Load/Work Foreign Body in the eye Potential Release of Energy ( Mooring Fatigue/Biology Hazard Vehicle Operations _________________
Heat stress High Noise Levels /tensioning sling / Pneumatic test) Biological Hazard Line Of Fire