Task Level Risk Assessment - TLRA WORKSHEET

HBS-P-11-HSM-22-06

HAZSCAN (Fire System Installation)

Date : 25 September 2023
Management of Change – (Unplanned Event, new activities, or job steps, change in conditions, new hazards/& or controls)
RESPONSIBLE
CONTROLS
TASK STEPS PERSON
HAZARD For each hazard, list the control measures
List the steps required to perform the task in the (List who is
List the potential hazards that could cause harm. required to eliminate or minimise the risk
sequence they are carried out. responsible to
What can harm me, others, or the environment? What must be in place to prevent or minimise
What am I going to do? implement the
harm?
control)
Permit, toolbox meeting, protect of the edge of SM, SPV and
1. Preparation tools and Material Slip Trip Fall, Sharp Object, Ergonomic Risk,
sharp, PPE HSE

Slip Trip Fall, Sharp Object, Ergonomic Risk, Permit, protect of the edge of sharp, PPE, SM, SPV and
2. Moving / transport material and tools
Flying Object maintain 5S HSE

Permit, protect of the edge of sharp, PPE, SM, SPV and

3. Installing metal conduit, Cable pipe, Work at height, falling object, dust, sharp object,
maintain 5S, full body harness, hand tools HSE
devices ergonomic risk, flying object, electric shock
guarding, training arc flash
Permit, maintain 5S, protect of the edge of sharp, SM, SPV and
4. Installing of wiring Sharp object, ergonomic risk, flying object, dust
set clearance area around work area HSE

SM, SPV and

5. System integration Electric Shock Permit, training arc flash, maintain 5S
HSE
SM, SPV and
6. Housekeeping Bad houskeeping Maintain 5S
HSE

Where a change is made, all personnel to re-sign on the daily sign on page.

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TLRA #
 Task Level Risk Assessment - TLRA WORKSHEET
HBS-P-11-HSM-22-06

HAZSCAN (VESDA System Installation)

Management of Change – (Unplanned Event, new activities, or job steps, change in conditions, new hazards/& or controls)

RESPONSIBLE
CONTROLS
TASK STEPS PERSON
HAZARD For each hazard, list the control measures
List the steps required to perform the task in the (List who is
List the potential hazards that could cause harm. required to eliminate or minimise the risk
sequence they are carried out. responsible to
What can harm me, others, or the environment? What must be in place to prevent or minimise
What am I going to do? implement the
harm?
control)
Permit, toolbox meeting, protect of the edge of SM, SPV and
1. Preparation tools and Material Slip Trip Fall, Sharp Object, Ergonomic Risk,
sharp, PPE HSE

Slip Trip Fall, Sharp Object, Ergonomic Risk, Permit, protect of the edge of sharp, PPE, SM, SPV and
2. Moving / transport material and tools
Flying Object maintain 5S HSE

Permit, protect of the edge of sharp, PPE, SM, SPV and

3. Installing metal conduit, Cable pipe, Work at height, falling object, dust, sharp object,
maintain 5S, full body harness, hand tools HSE
devices ergonomic risk, flying object, electric shock
guarding, training arc flash
Permit, maintain 5S, protect of the edge of sharp, SM, SPV and
4. Installing of wiring Sharp object, ergonomic risk, flying object, dust
set clearance area around work area HSE

Pinch, Hit, scratch, ergonomic risk (low back Permit, PPE, good handling material, FBH, SM, SPV and
5. Installing Support Hanger Pipe
pain), drop object, falling, dust exposure maintains 5S HSE

6. Installing Branch Pipe and Join Vesda Pinch, Hit, scratch, ergonomic risk (low back Permit, PPE, good handling material, FBH, SM, SPV and
Pipe pain), drop object, falling, dust exposure maintains 5S HSE

Pinch, Hit, scratch, ergonomic risk (low back Permit, PPE, good handling material, FBH, SM, SPV and
7. Procedure Test & Commisioning
pain), drop object, falling, dust exposure maintains 5S HSE

Pinch, Hit, scratch, ergonomic risk (low back Permit, PPE, good handling material, FBH, SM, SPV and
8. Installing Vesda Panel
pain), drop object maintains 5S HSE

SM, SPV and

9. System integration Electric Shock Permit, training arc flash, maintain 5S
HSE

SM, SPV and

10. Housekeeping Bad houskeeping Maintain 5S
HSE

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TLRA #
 Task Level Risk Assessment - TLRA WORKSHEET
HBS-P-11-HSM-22-06

CONSULTATION AND INITIAL SIGN OFF:

I have conducted a HAZSCAN and believe that all HSE hazards have been identified, and the controls listed have reduced the risk to as low as reasonably practicable and will
enable us to effectively manage the hazards of this task. This TLRA has been communicated to me, I understand it, and I agree to work to its intent to the best of my ability.

TLRA attendance record

Name Company Position Signature Date Name of PIC

25 September
1. Sariaman Honeywell Site Manager Agus (SPV of Swahusada)
2023
25 September
2. Naufal Swahusada Safety Personal Agus (SPV of Swahusada)
2023
25 September
3. Sodik Swahusada Worker Agus (SPV of Swahusada)
2023
25 September
4. Maulana Swahusada Worker Agus (SPV of Swahusada)
2023
25 September
5. Ghalih Honeywell QC Agus (SPV of Swahusada)
2023
25 September
6. Heri Swahusada Worker Agus (SPV of Swahusada)
2023
25 September
7. Misno Swahusada Worker Agus (SPV of Swahusada)
2023

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TLRA #
 Task Level Risk Assessment - TLRA WORKSHEET
HBS-P-11-HSM-22-06

CONSULTATION AND DAILY SIGN OFF:

I have conducted a HAZSCAN and believe that all HSE hazards have been identified and the controls listed have reduced the risk to as low as reasonably practicable and will
enable us to effectively manage the hazards of this task. This TLRA has been communicated to me, I understand it, and I agree to work to its intent to the best of my ability.

TLRA Reinduction Record

Work Work Work Work Work

Name Date Sign Date Sign Date Sign Date Sign Date Sign
location location location location location
27 28 29
25 September 26 September Site Site
1. Sariaman Site Office 2023
Site Office 2023
Site Office September September September
2023 Office 2023 Office 2023
27 28 29
25 September 26 September
2. Naufal All Area 2023
All Area 2023
All Area September All Area September All Area September
2023 2023 2023
27 28 29
Colo 1 & 25 September Colo 1 & 26 September Colo 1 & Colo 1 & Colo 1 &
3. Sodik
2023 2023
September September September
Admin Admin Admin 2023 Admin 2023 Admin 2023
27 28 29
Colo 1 & 25 September Colo 1 & 26 September Colo 1 & Colo 1 & Colo 1 &
4. Maulana
2023 2023
September September September
Admin Admin Admin 2023 Admin 2023 Admin 2023
27 28 29
25 September 26 September
5. Ghalih All Area 2023
All Area 2023
All Area September All Area September All Area September
2023 2023 2023
Mech Mech Mech Mech Mech
27 28 29
Plant 1 & 25 September Plant 1 & 26 September Plant 1 & Plant 1 & Plant 1 &
6. Heri 2023 2023
September September September
Pump Pump Pump 2023 Pump 2023 Pump 2023
Room Room Room Room Room
Mech Mech Mech Mech Mech
27 28 29
Plant 1 & 25 September Plant 1 & 26 September Plant 1 & Plant 1 & Plant 1 &
7. Misno 2023 2023
September September September
Pump Pump Pump 2023 Pump 2023 Pump 2023
Room Room Room Room Room

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TLRA #