Task Level Risk Assessment - TLRA WORKSHEET

HBS-P-11-HSM-22-06

HAZSCAN (Fire System Installation)

Periode : 16-20 Oktober 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)

Periode : 16-20 Oktober 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

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

16 Oktober Agus (SPV of Swahusada) &
1. Sariaman Honeywell Site Manager
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
2. Naufal Swahusada Safety Personal
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
3. Sodik Swahusada Worker
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
4. Maulana Swahusada Worker
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
5. Ghalih Honeywell QC
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
6. Beben Honeywell Worker
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
7. Nurhakim Honeywell Worker
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
8. Dede Honeywell Worker
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
9. Nana Honeywell Worker
2023 Mahmud (Foreman of HON)
16 Oktober Agus (SPV of Swahusada) &
10. Ade Honeywell Worker
2023 Mahmud (Foreman of HON)

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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
16 Oktober 17 Oktober 18 Oktober Site 19 Oktober Site 20 Oktober
1. Sariaman Site Office 2023 Site Office 2023 Site Office 2023 2023 2023
Office Office
16 Oktober 17 Oktober 18 Oktober 19 Oktober 20 Oktober
2. Naufal All Area 2023 All Area 2023 All Area 2023 All Area 2023 All Area 2023
Colo 1 & 16 Oktober Colo 1 & 17 Oktober Colo 1 & 18 Oktober Colo 1 & 19 Oktober Colo 1 & 20 Oktober
3. Sodik 2023 2023 2023 2023 2023
Admin Admin Admin Admin Admin
Colo 1 & 16 Oktober Colo 1 & 17 Oktober Colo 1 & 18 Oktober Colo 1 & 19 Oktober Colo 1 & 20 Oktober
4. Maulana 2023 2023 2023 2023 2023
Admin Admin Admin Admin Admin
16 Oktober 17 Oktober 18 Oktober 19 Oktober 20 Oktober
5. Ghalih All Area 2023 All Area 2023 All Area 2023 All Area 2023 All Area 2023

Colo 2 & 16 Oktober Colo 2 & 17 Oktober Colo 2 & 18 Oktober Colo 2 & 19 Oktober Colo 2 & 20 Oktober
6. Beben 2023 2023 2023 2023 2023
Colo 3 Colo 3 Colo 3 Colo 3 Colo 3
Colo 2 & 16 Oktober Colo 2 & 17 Oktober Colo 2 & 18 Oktober Colo 2 & 19 Oktober Colo 2 & 20 Oktober
7. Nurhakim 2023 2023 2023 2023 2023
Colo 3 Colo 3 Colo 3 Colo 3 Colo 3
Mechplant 16 Oktober Mechplant 17 Oktober Mechplant 18 Oktober Mechplan 19 Oktober Mechplan 20 Oktober
8. Dede 2023 2023 2023 2023 2023
2&3 2&3 2&3 t 2&3 t 2&3
Mechplant 16 Oktober Mechplant 17 Oktober Mechplant 18 Oktober Mechplan 19 Oktober Mechplan 20 Oktober
9. Nana 2023 2023 2023 2023 2023
2&3 2&3 2&3 t 2&3 t 2&3
Mechplant 16 Oktober Mechplant 17 Oktober Mechplant 18 Oktober Mechplan 19 Oktober Mechplan 20 Oktober
10. Ade 2023 2023 2023 2023 2023
2&3 2&3 2&3 t 2&3 t 2&3

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TLRA #