Form Identifikasi Aspek K3L & Pengujian Resiko Rev~01

Form : 001
IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO
Lokasi : Boiler House, Turbine Building, Fabrication, ESP, Jetty Referensi : Dept/Area : Construction
Aktivitas/Kegiatan : Welding & Cutting works during fabrication / instalation of pipe - structure - support Tanggal Pengujian :
Tingkat Tingkat Tingkat Resiko Dpt Tingkat Tingkat Tingkat Resiko Dpt
Pengendalian
No Bahaya / Dampak Keparahan Kemungkinan Resiko Ditoleransi Pengendalian Yang Disyaratkan Keparahan Kemungkinan Resiko Ditoleransi
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Burns Available 3 4 12 N 01. Only certified welder shall perform welding job 3 1 3 Y
2 Ultraviolet rays Not Avail 2 5 10 N 02. Grease and oil must never be used near Oxygen Bottles 2 1 2 Y
3 Open Flames Not Avail 3 3 9 N 03. Color coding of Cylinders shall be recognized by welders & other workers 3 1 3 Y
4 Electric shock Available 4 3 12 N 04. Store oxidizers away from flamable cylinders 4 1 4 Y
5 Fire / Explosion hazards Available 3 3 9 N 05. Provide "Danger, No Smoking, Open Flame" warning signs in Oxygen - Acetylene storage areas. 3 1 3 Y
6 Respiratory hazards (welding) Available 2 3 6 N 06. All welding equipment shall be examined before & after use and regularly maintained. 2 1 2 Y
7 Development of toxic vapor from Available 2 3 6 N 07. All welding and cutting equipment shall be of approved type 2 1 2 Y
welding by-product/fumes in poorly
vertilated area / confined spaces 08. Prohibit smoking or other sources of fire near welding or cutting equipment.
8 Conjunctival iritation/foreigh body Available 2 3 6 N 09. Provide each welding/cutting set with Fire Extinguisher
9 Flash back Available 3 3 9 N 10. Electrical tools must be plugged into GFCI (Ground Fault Circuit Interrupter) during all 2 1 2 Y
welding/cutting operations.
10 Associated Asphyxiant (Argon Gas) Available 2 3 6 N

11. Appropriate PPE's (welding masks & Caps, masker, sleeves, leggings, safety foot wear) must be worn 3 1 3 Y
11 Newly welded large pipes subject to accidental Available 2 2 4 Y
entry
12. Protect all nearby plant facilities from falling of hot spatters (cable, gauges, valves, etc.) with non 2 1 2 Y
12 Noise (due to Welding, Gouging, Cutting) Available 2 4 8 N combustible materials, i.e. : Fire Blanket.
13. Adequate fire blankets are required to fully contain weld area (underneath and sidings).
14. Assisting personnel shall position upwind to prevent conjunctival iritation and respiratory hazards.
15. Acetylene valve wrench shall be kept available at the cylinder valve.
16. Pressure gauges and hoses to be bled off after use and disconnected from the cylinder at the end of
working hours / shift.
17. Cutting goggles plus face shield to be used for cutting work
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Form : 001
Aktivitas/Kegiatan : Welding & Cutting works during fabrication / instalation of pipe - structure - support Tanggal Pengujian :
Pengendalian
No Bahaya / Dampak Keparahan Kemungkinan Resiko Ditoleransi Pengendalian Yang Disyaratkan Keparahan Kemungkinan Resiko Ditoleransi
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
18. Flashback arrestors shall be installed at oxygen-Acetylene cutting outfit.
19. Empty cylinders to be marked "empty" and segregated from full cylinders.
20. 15 psi/g maximum pressure of acetylene shall be observed/never to be exceeded.
21. Lifting of compressed cylinders (where required) shall be done by material basket / trolley, never by
slings
22. Work areas shall be kept totally clear of combustible materials before & during hot work operations.
23. Oxy-Acetylene/Argon cylinders are to be kept upright & secured and capped when not in use.
24. Avoid direct exposure to welding fumes. Never enter newly welded internal joints of pipe / confined
or poorly ventilated area.
25 Use ear plug
Catatan:
Keparahan: ( R ) Kemungkinan (L) Tingkat Resiko, Rt = R x L
1 = No/trivial effect (hampir tidak ada efeknya) 1 = almost impossible (hampir tidak mungkin) Yang Dapat Ditoleransi = Rt < 6
2 = minor injury (injury kecil) 2 = very unlikely (kecil kemungkinannya) Tindakan Mendesak= > 10
3 = lost time injury (injury menimbulkan waktu kerja hilang) 3 = possible (mungkin)
4 = incapacity (hampir fatal) 4 = probable (sangat mungkin)
5 = fatality (fatal) 5 = certain (Pasti)
Ketika resiko dipertimbangkan tidak dapat ditoleransi, proses pengujian harus diulang
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Form :
Lokasi : Boiler House, Turbine Building, Fabrication, ESP, Jetty Referensi : Dept/Area : CONSTRUCTION
Aktivitas/Kegiatan : LIFTING / CRANE WORK Tanggal Pengujian :
Pengendalian Keparahan Kemungkinan Resiko Ditoleransi Keparahan Kemungkinan Resiko Ditoleransi
No Bahaya Pengendalian Yang Disyaratkan
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Serious or Fatal Injury Available 5 4 20 N 01. Only licensed and competent crane operator will be allowed to operate the crane 5 1 5 Y
2 Major equipment damage Available 5 4 20 N 02. Only competent / experienced rigger to handle rigging. And only one person to 5 1 5 Y
give signal (Signalman).
3 Fall hazards Available 5 4 20 N
03. No lifting allowed under harsh weather condition (wind > 20 mph / raining / 5 1 5 Y
4 Failure of lifting equipment and Available 5 4 20 N stormy / foggy, etc.).
accessories
04. Visible contact between rigger & operator to be maintained. 5 1 5 Y
5 People underneath load Available 4 3 12 N
6 Equipment failure Available 4 3 12 N 05. Control taglines in use 4 1 4 Y
7 Shock load Available 3 3 9 N 06. Operating radius (1.5 x operating boom length) clear of unnecessary personel 4 1 4 Y
and barricaded off.
8 Two blocking Available 3 3 9 N
07. Crane with valid certification from authorized government body (Depnaker). 3 1 3 Y
9 Caught in-injuries when setting the Available 2 4 8 N
equipment / pinch points hazards 09. Load chart and crane hand signals to be posted at operator's cab and adhered to 3 1 3
10 Material slippage during lifting Available 4 4 16 N

10. Critical lift plan (where required) completed, approved and available in hand 2 1 2 Y
11 Unpaved / unstable ground Available 3 3 9 N prior to lifting work.
12 Tifting / toppling of crane when Available 4 3 12 N 11. Slings, shackles are of approved type and their SWL's clearly marked. Also color 4 1 4 Y
loaded end it under no load when coded as per schedule.
outriggers are not fully extended.
12. Load Test certificates of rigging equipment (slings, shackles, lifting beams if 3 1 3 Y
any) shall be available.
13. No aluminum ferrule wire rope slings will be used. Only steel ferrule type wire 4 1 4 Y
rope sling allowed.
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Form :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
14. All lifting equipments / accessories pre-inspected.
15. Anti two block device installed and properly operating
16. Slings softener / protection from sharp edges to be provided
17. Nylon slings not allowed for steel plates and similar sharp loads.
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Form :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
18. Multiple inclined slings do not exceed 90 degree included angle. Maintain 60
degree angle.
19. Load being lifted in equlibrium position.
20. Hands off from pinch points when setting the load
21. No People at anytime under the load / no anauthorized persons to be involved.
22. Cross check boom length / reach / angle calculation by rigging supervisor /
engineering form heavier loads.
23. Outrigger pads to be use on both paved and unpaved areas.
24. Proper hitch arragement to be observed.
25. Operator to conduct walk around to ensure proper setup of crane (i.e.wheels of
the ground; outriggers on safe surface. Etc.)
26. Comply with safety requirement prescribed under in items cranee and rigging
equipment.
Catatan:
5 of 56
Form :
Lokasi : Fabrication, Construction Site, Moving Area Referensi : Dept/Area : RIGGING & EQUIPT.
Aktivitas/Kegiatan : USE OF MOBILE HEAVY EQUIPMENT (Crane, Trailler, Forklift, etc.) Tanggal Pengujian :
for routine materials delivery, handling, loading/unloading, etc.
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Traffic Available 4 2 8 N 01. Comply with relevant safety requirement of Truba Jurong Engineering (THE) 4 1 4 Y
collision while
moving on 02. Only licensed and competent equipment operators will be allowed 3 1 3 Y
2 Machine
roadway failure Available 3 2 6 N
03. Back up alarm @ 90 dB in all heavy equipment to be provided 3 1 3 Y
3 Machine burn Available 3 2 6 N
04. Equipment spotter during equipment maneuvering/reversing to be posted. 3 1 3 Y
4 Unpaved / unstable ground (when Available 3 3 9 N
parking) 05. Preventive maintenance by mechanic observed.
06. Daily Check up by operator
07. At last 1 (one) Dry Chemical (ABC) fire extinguisher is maintaned on each
equipment.
08. Warning flag on protruding loads/materials shall be installed during transport.
09. No riders allowed in forklift, crane and similar mobil equipment.
10. No equipment in operation shall be left unattended.
11. Escort personnel will be provided during transport of heavy equipment /

material or on traveling cranes.
12. Overheads hazards l.e. pipe briges/pipe racks shall be closely attended to
during transport of mobile crane. Boom shall be fully retracted (for
telescopic crane) or kept as low as possible (for lattice boom crane) and
hook blocks secured. Vertical clearance
13. Positioning / parking of equipment shall be kept of road adges.
14. Equipment shall be pulled out from work site and parked at designated
parking area at the end of working hours/shift. No equipment shall be left
anywhere at the field except in approval & secured parking.
15. Telescopic crane booms shall be fully retracted and their hook properly
secured at the end of working hours/shift and during which they are not in
use.
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Form :
Lokasi : Fabrication, Construction Site, Moving Area Referensi : Dept/Area : RIGGING & EQUIPT.
Aktivitas/Kegiatan : USE OF MOBILE HEAVY EQUIPMENT (Crane, Trailler, Forklift, etc.) Tanggal Pengujian :
for routine materials delivery, handling, loading/unloading, etc.
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
16. Posted speed limits shall be strictly observed.
Catatan:
7 of 56
Form :
Lokasi : Elevated Working Areas & Scafolding at Isolated Locations Referensi : Dept/Area : Construction
Aktivitas/Kegiatan : USE OF ACCESS LADDERS (as means of agress/ingress to and from elevated or below ground working area. Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Accidental fall when ascending / Available 5 3 15 Y 01. Both hands shall be free of object when ascending / descending ladders 4 1 4 Y
descending ledders
02. Inclined ladders sel @ approximately 75 0 with the horizontal. 3 1 3 Y
2 Failure of ladder Available 4 3 12 Y
03. Ladders to be secured by siderails not by rungs. 3 1 3 Y
3 Electric shock when using weld or Available 5 4 20 Y
metal ladder near energized electrical 04. Top of ladders to be extended at least 3 feet (1 meter) beyond stepping off 3 1 3 Y
equipment. points / access fending.
4 Fall of ladder when improperlty Available 4 3 12 Y 05. Defective ladders to be readily marked and remove
secured
06. Ladders shal not be used to support material/loads
07. Metal/wet wooden ladders shall not be used or an energized electrical

equipment.
08. Access ladders must be continuous from highest / farthes point of work
location to discharge points on the ground.
09. Ladders of more than 30 fest (10 meters) long / high shall have
intermediate access landing.
10. Safety belt / body hamess lanyard shall not be hooked onto ladders/rungs
11. Inspection required before each use.
Catatan:
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Form :
Lokasi : Elevated Working Areas & Scafolding at Isolated Locations Referensi : Dept/Area : RIGGING & EQUIPT.
Aktivitas/Kegiatan : SCAFFOLDING ERECTION & DISMANTLING WORK AT ELEVATED WORK AREAS Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Fall Hazards Available 5 4 20 N 01. All employess erecting and dismantling scafolds shall wear shall protection device 5 1 5 Y
2 Falling materials, tools, debris Available 4 4 16 N 02. Scaffold erection/dismantling areas are to be barricaded off, clear personal and 4 1 4 Y
provided with conspicuous warning notice, i.e. : "Danger, Men working above"
3 Scafolding failure Available 4 3 12 N 4 1 4 Y
4 People equipment below Available 4 3 12 N 03. Toe board and guard rails are required on all scaffolds over 6 feet (1.8 meters) 4 1 4 Y
high.
5 Uneven / loose ground Available 3 3 9 N 3 1 3 Y
04. All scaffold shall be erected and dismantled only by competent & skilled
scaffolders.
05. Appropriate scaffold tags/labels (for inspection purpose) shall be instailed on all
scaffolds.
06. No throwing of couplers, tools, plank or tubes shall be allowed. Lowering

/ascending material shall be by rope.
07. Moving of mobile scaffolds with persons on platform shall not be allowed
08. Damage scaffold materials shall be marked "Do Not Use" & Immediately
disposed of from the site.
09. Identify and mark nearby hot pipes (if any) before starting scaffolding work.
10. Safety belts lanyard shall be not hooked onto hot pipes or existing lines
11. Wooden sole plates provides at hydrocarbon facilities and on anpaved areas.
12. Load bearing couplers shall be used on all scaffold's structural connection i.e.
ledger / standard connection; standard / transorn connection and shall be
security fixed.
13. Scaffold wrenches shall be string tied to prevent slippege / accidentall fall
14. Maximum height = 4 times the minimum base width for mobile type scaffold
shall be observed.
15. Protect underneath/near by equipment from possible physical damage.
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Form :
Lokasi : Elevated Working Areas & Scafolding at Isolated Locations Referensi : Dept/Area : RIGGING & EQUIPT.
Aktivitas/Kegiatan : SCAFFOLDING ERECTION & DISMANTLING WORK AT ELEVATED WORK AREAS Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
16. Follow scaffold erection checklist
17. Scafolld tubes shall not obstruct permanent / existing access ways / ladders.
Catatan:
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Form :
Lokasi : Elevated work location at work site Referensi : Dept/Area : CONSTRUCTION

Aktivitas/Kegiatan : USE OF PERSONAL BASKET Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Slings / Sheckies failure Available 5 4 20 N 01. Comply with permit procedure for using the basket 5 1 5 Y
2 Pincg points Available 3 3 9 N 02. Certified / competent crane operator. 3 1 3 Y
3 Two blocking Available 4 3 12 N 03. 500 lbs (1.000 kg) maximum SWL observed. 4 1 4 Y
4 Fall Hazard Available 5 4 20 N 04. Full body harness in use 5 1 5 Y
5 Nearby overhead facilities : pipes, Available 4 3 12 N 05. Operators shall never leave his crane with person in basket. 4 1 4 Y
cables, power lines, etc.
06. Wired shcakles
6 Personnel Injury Available 5 3 15 N
07. PT. Truba Jurong Engineering (THE) Certified Manbaket. 5 1 5 Y
08. Dummy lift to be observed.
09. Sling, shackles of PT THE's approved type end inspected before & after
each use.
10. Crane inspection sticker & certification is valid.
11. Grab rails provided
12. Manbasket operation not allowed under harsh westher / poor visibility
condition
13. 4 (four) wire rope steel formule slings and shackles permanently dedicated
to manbasket.
14. Hoisting / lowering manbasket shall be as slow as possible.
15. Outer edges of manbasket subject to physical contact with existing

structure / pipe. Etc. shall be provided
16. Anti two blocking device must be ensured properly operating.

Catatan:
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Form :
Lokasi : Vessel, Tanks, Reformer, Boller Cavity - Drums, Pipes Referensi : Dept/Area : CONSTRUCTION
Aktivitas/Kegiatan : CONFINED SPACE ENTRIES / OPERATIONS Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Heat Exhaustion Available 3 1 3 Y 01. Comply with section Established Confined Space Permit Procedure 5 1 5 Y
2 Electric Shock Available 5 3 15 N 02. An actual survey of connecting lines to the equipment containing confined 3 1 3 Y
spaces where in work will be carried out shall be jointly made by
3 Hazardous Atmosphere Available 5 3 15 N responsible supervisor and operation representative prior to commencing 4 1 4 Y
work/entry to make sure they're property isolated (physically disconnected
4 Explosion from improper lights Available 3 3 9 N or blinded), locked & tagged out. 5 1 5 Y
5 Asphyxiation Available 2 2 4 Y 03. Any confined space to be entered shall first be dedared totally gas free and 4 1 4 Y
safe for entry by the safety officer before any work begins.
6 Personnel Injury Available 4 3 12 N
04. Atmospheric test shall be performed at immediate point of entry, middle &
7 Fire Available 4 3 12 N bottom as required by location activity. 5 1 5 Y
05. The initial atmospheric test shall be conducted just before the actual
personnel entry and with the mechanical vantilating equipment shutdown in
order to have an equilibrium internal atmospheric condition to ensure an
accurate test result.
06. Follow up atmospheric test shall be done perisscally during the course of
internal work to monitor air quality / detect atmospharic development.
07. Crafts working inside the confined space should rotate to reduce heat
exhaustion in hot weather.
08. A standby man must be present immediately outside of man-way to

continuosly monitor and document status of each entrant thru confined
space in/out log. He must be equipped with: "Aerosol type hand held air
horn or whistle; Portable Fire Extinguisher; Life / Retriaval Line.
09. A wooden ladder or equivalent non conductive material to be used as a

means of egress / ingress.
10. Number of entrans & quantity of materials / tools inside confined space
shall be kept to a minimum.
11. Full body hamess to be worn by entrants and if pratically possible, attechec
to a lifeline.
12. Clear safety glasses & disposible coveralls to be worn. Wet suils and rubber
boots where required to be provided and worn also.
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Form :
Lokasi : Vessel, Tanks, Reformer, Boller Cavity - Drums, Pipes Referensi : Dept/Area : CONSTRUCTION
Aktivitas/Kegiatan : CONFINED SPACE ENTRIES / OPERATIONS Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
13. Explosion proof lighting shall be of low voltage (12 vol AC rated or 120 v AC
fed through GFCI).
14. Continuous forced ventilation to be maintained while entrants are at work.
15. Housekeeping to be continuously observed.
16. Warning notices posted are entry points.
17. Supervisor/Foreman has to conduct Pre-Job Safety Instruction prior to

commencing any confined space work.
Catatan:
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Form :
Lokasi : All Working Areas Outdoors Referensi : Dept/Area : All

Aktivitas/Kegiatan : ALL OUTDOOR ACTIVITIES (Exposure of Workers to Harsh Weather Condition). Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Hest stress / disorders Available 1 2 2 Y 01. Ensure sufficient supply of potable drinking water in all work areas during 1 1 1 Y
hot season.
2 Dehydration Available 2 2 4 Y
02. A. permanent crew will be assignated for continuous site delivery of 2 1 2 Y
3 Impaired bodily coordination / poor Available 1 2 2 Y drinking water to all groups.
reflexes (during hot / dry season)
03. Sun protection shed of non combuslible materials will be installed (where 1 1 1 Y
4 Increased climatical strassors Available 1 2 2 Y allowed) for outdoor stationery crew.
5 Increased susceptibility to socident Available 3 3 9 N 04. Rehydration fluids shall be made available al site first aid clinic during hot
season.
05. Medical and safety staft will be on extra preparedness to act on 1 1 1 Y

emergencies during harsh weather periods.
06. Emergency transport vehicle (ambulance) will be ansured conssiantfy 3 1 3 Y

available at project site.
07. Extra precautionary measures shall be exercised by all site personnel during
extremly hot / cold season.
08. Appropriate issues / safety topics on acclimalization will be discussed during

safety talks.
Catatan:
14 of 56
Form :
Lokasi : Off-Site On-Site Roads Referensi : Dept/Area : TRANSPORT / RED

Aktivitas/Kegiatan : DRIVING TO AND FROM THE PROJECT SITE DAILY Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Traffic hazards Available 3 3 9 N 01. Drivers in possesion of valid Indonesian Driver's Licenses 3 1 3 Y
2 Motor vehicle collision /accident Available 3 3 9 N 02. Observe defensive driving 3 1 3 Y
3 Slippery roads (during strormy Available 3 3 9 N 03. Obey posted speed limits and all traffic signs 3 1 3 Y
weater)
4 Unsafe act by others Available 3 3 9 N 04. Wear seat belts
5 Blow up tires from exoestive pressure Available 3 3 9 N 05. Reduce speed under hazardous weather condition 3 1 3 Y
06. Fire extinguisher available in each vehicle. 3 1 3 Y
07. Warning devices carried in vehicle.
08. No riding at the back of pickups / trucks
09. Vehide with current PT. Truba Juring Engineering (TJE) inspection sticker.
10. Maintain recommended tire pressure
11. No riding / descending buses while in motion or thru emergency / back

doors
12. Bus emergancy exit doors shall be kept operable/not locked.
Catatan:
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Form : 001
Lokasi : Fabrication Shop / Construction Field Referensi : Dept/Area : CONSTRUCTION

Aktivitas/Kegiatan : USE OF ROTATING MACHINES Tanggal Pengujian :
(i.e. : Electri Grinding-Drilling-Cutting Machines)
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Caught in / crushing injury hazards Available 3 3 9 N 01. The Machine shall be inspected prior to using for its cable and electrical 3 1 3 Y
devices are safe for use.
2 Electric Shock Available 4 3 12 N
02. On / Off switch of the machine shall be provided / kept properly operable. 4 1 4 Y
03. Safety awareness sign i.e. "Danger, Rotating machine; Danger, Electrical
Shock" etc. will be posted.
04. Safety guard / Cap installed
05. Machine operator shall be continuously attentive on job.
06. Pre-Job Safety instruction by foreman / Supervisor to be conducted.
07. Long slesves, shall be buttoned.
Catatan:
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Form :
Lokasi : All Site Employees Referensi : Dept/Area : CONSTRUCTION

Aktivitas/Kegiatan : ERGONOMIC HAZARDS (attributed to routine manual handling/lifting materials/objects or exposure to repetitive task) Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Back atrains / injuries Available 3 2 6 N 01. Observe proper lifting techniques 3 1 3 Y
2 Cumulative Trauma Disorders (CTD's) Available 3 2 6 N 02. Minimazed prolonged static posture 3 1 3 Y
3 Hernia Available 3 2 6 N 03. Observe kinetic handling 3 1 3 Y
04. Ask for assistence when lifting / handling heavy loads
05. Topics on proper lifting to be discussed by Site Safety Peronnel during

regular safety talks.
06. Visual aids / posters on proper lifting to be displayed.
Catatan:
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Form :
Lokasi : Approved Sand Blasting Area Referensi : Dept/Area : Sandblasting - Painting

Aktivitas/Kegiatan : SANDBLASTING WORK Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Accidental sandblasting of exposed Available 3 3 9 N 01. All operators shall wear a shot resistance appron, safety boots, proper 3 1 3 Y
body parts. gloves, sand blasted coveralls hood with airlines with required fillters.
2 Breathing sand, dust and abraded Available 3 3 9 N 02. Hearing protection shall be worn by line operator and attendant. 3 1 3 Y
materials (respiratory hazards)
03. Workers who are handling materials manualy shall wear an approved dust
3 Slipping hazard (abraded materials) Available 2 2 4 Y fillter respirator.
4 High noise/hearing impairment Available 3 5 15 N 04. Work area shall be barricaded off & sign posted i.e. "Caution, Sandblasting 2 1 2 Y
in Progress". High Noise Area, Wear Ear Protection". Etc. 3 1 3 Y
5 Building of static charge Available 2 3 6 N
05. Work area shall be located down wind & away from the crowd & facilities. 2 1 2 Y
6 Hose rupture/disconnection Available 2 3 6 N
06. Attendant to position upwind 2 1 2 Y
7 Foreign body Available 3 3 9 N
07. The blasting nozzle shall have a "Dead Man" switch operates properly and 3 1 3 Y
8 Fail/displacement of pipes/spools from Available 2 3 6 N nozzle is grounded to earth.
pipes stands
08. Air hoses to be properly fixed with hose couplers & doubly seccured with 2 1 2 Y
safety wire in each connections.
09. Abraded grits shall not accumulate on paved ground. Immediate

housekeeping required.
10. Replacement of air filter cartridge shall be regular / maximum 3 months

interval
11. Only competent sandblaster shall be allowed to perform the job.
12. No unauthorized person allowed to perform the job.
13. Air receivers shall be pre-tested.
14. Periodic breathing air quality monitoring to be obseved.
15. No frayed hose to be allowed
16. Pipe stands to have stopper at each end proper damage installed.
17. Preventive maintenance of compressor by mechanic shall be

observed.
18. Relevant requirement under in item Abrasive blasting end
18 of 56
Form :
Lokasi : Approved Sand Blasting Area Referensi : Dept/Area : Sandblasting - Painting

Aktivitas/Kegiatan : SANDBLASTING WORK Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) Relevant requirement under in item Abrasive blasting end (R) (L) ( Rt) (Y/N)
painting / coating of the approved, shall be complied with.
Catatan:
19 of 56
Form : 001
Lokasi : Referensi : Dept/Area : Construction

Aktivitas/Kegiatan : Painting Works Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Respiratory Hazard 1. Memakai masker yang sesuai standar. 4 1 4 Y
2. Posisi pengecatan searah arah angin
2 Kebakaran 1. Dilarang merokok

2. Penempatan material flammable jauh dari sumber api
3. Tidak boleh ada hot work
3 Over pressure
1. Pengecekan peralatan kompressor
2. Matikan valve sebelum mencabut hose.
4 Irritation 1. Gunakan peralatan alat pelindung diri sesuai standar
5 Pencemaran lingkungan 1. Memastikan packaging atau botol-botol tempat painting

2. Housekeeping
6 Jatuh dari ketinggian 1. Gunakan safety belt / Full body Harness.
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Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
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Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
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Form : 001

Aktivitas/Kegiatan : Insulation Works Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Sesak Napas 1. Memakai masker yang sesuai standar. 4 1 4 Y
2 Luka tusuk dan gores 1. Pin harus di bengkokan setelah terpasang, housekeepng,safety shoes.
3 Iritasi kulit 1. Baju lengan panjang dan sarung tangan
4 Kebakaran 1. Jauhkan dari sumber api.
5 Jatuh dari ketinggian 1. Pemasangan temporary scaffolding atau safety belt atau safety nets
6 Electric shock 1. Gunakan alat pelindung diri
23 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
24 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
25 of 56
Form :
Lokasi : Work Site Weld Joint Referensi : Dept/Area : Quality Control

Aktivitas/Kegiatan : NON DESTRUCTIVE TEST (NDT) by Approved NDT Service Personenel For Welded Joints. Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Exposure to X-Ray Radiation Available 2 5 10 N 01. Comply with Radiography Permit Procedure and Relevant safety 2 2 4 Y
requirement
02. Only PT. TJE's approved NDT service personnel to conduct radiographic
test.
03. Comply with the approved procedure by Client.
04. Advance coordination between Quality Control Section and Construction

Section for x-ray work required.
05. Only competent / well trained & certified personnel are involve in
radiographic work.
06. Radiation area roped off and manned by designated Watchman.
07. Safe distance to be established with a survey meter.
Radiographers are wearing pocket desimeter and film badge /

08. TLD.
09. Adequate blinkers at night provided.
10. Warning notices i.e. "Danger, Radiation Area" shall be installed
11. Proper coordination with all affected personnel / other contractor (if any) is
required prior to activity.
12. Radiographic test should be conducted after regular work hours or during
knock off time.
Catatan:
26 of 56
Form :
Lokasi : On Site / Fiel Areas Referensi : Dept/Area : All

Aktivitas/Kegiatan : CONSTRUCTION ASSOCIATED ON SITE / PLANT ACTIVITIES Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Possible plant disasters / emergencies Available 4 3 12 N 01. Obtain appropriate Safe Work Procedure / Manual from Client comply with 4 1 4 Y
e.g. fire, explosion, flooding, mass all requirements.
disturbing, etc.
02. Constant awareness of plant Emergency Procedure Construction Alarm.
Immediate action to be taken, location of pre-determined assembly areas is
a must.
03. Before starting work, check at least two (2) nearest locations of assembly
areas (in opposite direction), where the crews can proced into in case of
surprise emergency.
04. Check prevailing wind direction all the start of work shift & from time to
time during the course of work.
05. Foreman / Supervisor to maintain accurate attendance / personnel list in his

area to ensure an accurate head count when needed.
06. Anticipate alternate assembly area at the start of work shift for emergency,
in case the pre-determined / designated locations become impratically
accessible.
Catatan:
27 of 56
Form :
Lokasi : Commissioning Area Referensi : Dept/Area : BOILER - TURBINE

Aktivitas/Kegiatan : TIE-IN WORK Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Injury to personnel due to accidental Available 4 3 12 N 01. Follow permit to work within procedure & relevant safety requirement of 4 1 4 Y
opening of lines / released of store PT. TJE.
energy (i.e. water, air)
02. Lines to be worked on shall be properly identified before work
2 Fire hazards starts.
03. Proper coordination with all responsible parties required.
04. Ensure subject lines are physically de-energized and stored pressure 3 1 3 Y
completely bled off prior to commencing tie-in work.
05. Only trained / experlenced personnel will be allowed to perform the job.
06. All electrical tools/lighting (where required) will be GFCI

protected.
07. Welding machines shall be properly grounded
08. Close supervision by competent supervisor to be ensured.
09. Pre-job safety instruction by the foreman / supervisor to be observed.
10. Follow prescribed safety requirements under in item plants operation
Catatan:
28 of 56
Form :
Lokasi : Fabrication Yard & Construction Work Site Referensi : Dept/Area : BOILER - TURBINE
Aktivitas/Kegiatan : HYDRO TESTING OF PIPES / SPOOLS Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Over Available 3 3 9 N 01. Comply with approved work method and relevant safety requirement 3 1 3 Y
pressure
2 Blind flange rupture Available 3 3 9 N 02. Use of pressure relief valve (s) to be ensured. 3 1 3 Y
3 Pressure gauge rupture. Available 3 3 9 N 03. Vants of adequate pressure rating 3 1 3 Y
4 Hydraulic shock Available 3 3 9 N 04. Valves of adequate pressure rating 3 1 3 Y
5 Personnel Injury Available 3 3 9 N 05. Lines and joints under test adequately restrained 3 1 3 Y
6 Damage to nearby existing equipment Available 3 3 9 N 06. Block valve provided on the line from the test pump to the equipment 3 1 3 Y
under test
7 Valve passing Available 3 1 3 Y 07. Lines under pressure identified
08. No unauthorized personnel allowed in the area.
09. Head, eye & face protection worn by pressure monitoring/test crew
10. Test area property barricaded and clear of unauthorized personnel
11. Traffic restricted near ----- / equipment under test
12. Warning notice i.e. "Coution, pressure Test in Progress" etc. adequately
posted.
13. Temporary support & braces structurally stable / pre-checked before

commencing hydrotest.
14. Test gauges property calibrated
15. De-pressurizing of system under test to be observed before any repair or

--- tightening is done to stop leak (except, specially approved in the written
test procedure).
29 of 56
Form :
Lokasi : Fabrication Yard & Construction Work Site Referensi : Dept/Area : BOILER - TURBINE
Aktivitas/Kegiatan : HYDRO TESTING OF PIPES / SPOOLS Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
16. Pre-Job Safety Instruction conducted by Foreman / Supervisor.
17. Inspect & Test the valves before Installation.
Catatan:
30 of 56
Form :
Lokasi : Work Site Commissioning Area Referensi : Dept/Area : BOILER - TURBINE

Aktivitas/Kegiatan : AIR FLUSHING (Cleaning of pipes) Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 High Noise Available 2 4 8 N 01. Wear ear plug / ear muff to protect from the noise. 2 1 2 Y
2 Failure of support Available 2 2 4 Y 02. Ensure structural sound temporary support of entire length of pipe subject 2 1 2 Y
to air pressure.
3 Torsional effect Available 2 2 4 Y
03. Inject air pressure per procedure. 2 1 2 Y
04. No unauthorized person allowed. Affected area barricaded
05. Discharge end of pipe to be well secured againts torsional movement.
06. Break board to be installed opposite discharge end to contain blown

impurities upon discharge.
Catatan:
Form :
Lokasi : Worlk Site Commissioning Area Referensi : Dept/Area : BOILER - TURBINE

Aktivitas/Kegiatan : Steam Blowing (Cleaning of pipes) Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 High Noise Available 2 4 8 N 01. Wear ear plug / ear muff to protect from the noise. 2 1 2 Y
2 Failure of support Available 2 2 4 Y 02. Ensure structural sound temporary support of entire length of pipe subject 2 1 2 Y
to air pressure.
3 Torsional effect Available 2 2 4 Y
03. Inject Steam pressure per procedure. 2 1 2 Y
4 Hot Steam Spraying (burns) Available 5 2 10 N
04. No unauthorized person allowed. Affected area was barricaded
5 Fire Available 5 2 10 N
05. Discharge end of pipe to be well secured againts torsional movement.
06. Break board to be installed opposite discharge end to contain blown

impurities upon discharge.
07 Remove flamable materials from steam blow lines/area.
Final Inspection prior to steam Blow (bolt tightening, insulation,

08 temporary lines, etc.)
Catatan:
Form :
Lokasi : Work Site / Equipment Yard - Workshop Referensi : Dept/Area : RIGGING & EQUIPT.
Aktivitas/Kegiatan : EQUIPMENT REFUILING / FUEL STORAGE AREA Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Fire / explosion hazards Available 5 4 20 N 01. Switch-off engine of equipment before and during refueling 5 1 5 Y
02. Refueling not permitted near or below hot work.
03. Fuel tanker not allowed near open flame or source ignition.
04. No refueling allowed underneath piperack overhead activities where hot

works & fall hazards exist.
05. Fuel storage area shall be at least 50 ft. away from heat sources /
combustible materials.
06. Drip pan shall be provided at storage area
07. Refueling to be done at the start of work shift before not works
start and during knock off time
08. Adequate portable Dry Chemical Powder or Chamical Foam fire extinguisher
shall be maintaned at the fuel storage area and in the fuel tanker.
Catatan:
Form : 001
Aktivitas/Kegiatan : Storaging, Handling, mixing, chemical application, drain/Chemical Cleaning Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Phisical Contact/Iritation Available 5 4 20 N 1 Sesuai Prosedur Penyimpanan, Penempatan & Penggunaan Bahan Beracun
dan berbahaya (B3)
2 Respiratory Hazard Available 5 3 15 N 2 Pake Sarung Tangan
3 Spilling/Spraying on equipment & Body Available 5 3 15 N 3 Masker dengan "breathing apparatus"
4 Environmental Pollution Available 5 3 15 N 4 Mantel/Jaket Pelindung
5 Sepatu Karet
6 Taging pada Valves & Pasang barikade dengan safety line pada area yang di
"chemical cleaning"
7 Provide Flush Water
8 Material Safety Data Sheet (MSDS)
9 WI Penanganan Waste Hasil Chemical Cleaning & Packaging Chemicalnya.
Catatan:
34 of 56
Form : 001
Aktivitas/Kegiatan : Storaging, Handling, mixing, chemical application, drain/Chemical Cleaning Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
35 of 56
Form : 001
Lokasi : Whole Plant Referensi : Dept/Area : Construction

Aktivitas/Kegiatan : Commissioning & Test Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Electrical Shock Available 5 4 20 N 1 Gunakan peralatan yang kering

Kontrol terhadap peralatan yang akan di gunakan
2 Fan Suction & Blowing Hazard Available 5 4 20 N Jangan gunakan kabel yang terkelupas.
3 Personal Injuries due to mechanical/ Available 5 3 15 N 2 Barricade sekitar lokasi commisioning

Rotating Equipment Lengkapi peralatan yang berputar dengan pelindung
Catatan:
36 of 56
Form : 001
Lokasi : Warehouse & Construction Area Referensi : Dept/Area : Construction

Aktivitas/Kegiatan : Gas Handling & Utilisation (LPG, Acetylene, Argon, O2)/Welding & Cutting works during Construction Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Kebocoran Gas Available 5 3 15 N Sesuai Prosedur Penyimpanan, Penempatan & Penggunaan Gas
2 Kebakaran & Ledakan Available 5 4 20 N
Catatan:
37 of 56
Form : 001
Lokasi : Warehouse & Construction Area Referensi : Dept/Area : Construction

Aktivitas/Kegiatan : Gas Handling & Utilisation (LPG, Acetylene, Argon, O2)/Welding & Cutting works during Construction Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
38 of 56
Form : 001
Aktivitas/Kegiatan : Bolt Tightening Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Jatuh 1. Gunakan Alat Pelindung Diri (Safety shoes, sarung tangan, ear plug) 4 1 4 Y
2 Noise / Bising 2. Peralatan harus di ikat pada structure.
3 Kejatuhan
39 of 56
Form : 001
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
40 of 56
Form : 001
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
41 of 56
Form : 001
Lokasi : Construction Area, Fabrication Area, Site Office Jetty Referensi : Dept/Area : Construction
Aktivitas/Kegiatan : Electrical Work Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Electrical shock dan Kebakaran Ada 5 3 15 N 1. Memastikan bahwa tidak ada kabel terkelupas 5 1 5 Y
2. Memastikan sambungan telah terisolasi dengan baik
3. Pemasangan breaker sesuai standar
4. Memastikan grounding
5. Jauhkan kabel dari genangan air
6. Penataan kabel yang rapi
7. Inspeksi rutin.
42 of 56
Form : 001
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
43 of 56
Form : 001
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
44 of 56
Form : 001

Aktivitas/Kegiatan : Passenger Lift Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Jatuh 1. Hindari over load. 4 1 4 Y
2 Tersambar petir 2. Inspeksi rutin terhadap safety device
3 Terjepit
4 Equipment failure 3 Hindari pemakai pada waktu hujan
4. Maintenance rutin
5. Operator harus mempunyai sertifikat.
5 Kejatuhan material 1.Lantai kerja harus bersih
45 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
46 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
47 of 56
Form : 001
Lokasi : Construction/Fabrication area Referensi : Dept/Area : Construction

Aktivitas/Kegiatan : Preheat / PWHT Works Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Electric shock 1. Pasang barricade / tanda - tanda. 4 1 4 Y
2 Burn 2. Inspeksi rutin
3 Kebakaran 3. Pemasangan kabel / penataan kabel yang baik
4. Penggunaan sumber arus / tenaga harus DC.
5. Operator harus qualified dan harus selalu berada ditempat kerja
48 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
49 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
50 of 56
Form : 001
Lokasi : Kantor Pusat, RED & Proyek Referensi : Dept/Area : Construction

Aktivitas/Kegiatan : Canteen Waste Management Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Kesehatan ada 4 2 8 N a. Monthly Inspection 4 1 4 Y
1. Kebersihan dapur
2. Hygiene material
3. Kebersihan peralatan
4. Kebersihan ruang makan
2 Limbah ada 3 4 12 N a. Sampah bekas makanan dimasukan ke kantong plastik, dibuang keluar TJE 4 1 4 Y
51 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
52 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
53 of 56
Form : 001

Aktivitas/Kegiatan : Site Temporary Facilities,House Keeping,Cleaning,Waste Tanggal Pengujian :
Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
1 Kesehatan 1. Ruangan tertutup harus ber AC/ventilasi 4 1 4 Y
2. Penerangan yang cukup
3. Tidak merokok di ruang tertutup
4. Tata ruang, sarana MCK yang mencukupi
2 Kebakaran 1. Instalasi kabel listrik yang baik

2. APAR (Alat Pemadam Api Ringan)
3. Pemasangan penangkal petir sesuai standar.
4. Pintu darurat
54 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
Catatan:
55 of 56
Form : 001

Yang Ada
(R) (L) ( Rt) (Y/N) (R) (L) ( Rt) (Y/N)
56 of 56

Form Identifikasi Aspek K3L &amp; Pengujian Resiko Rev~01

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Form Identifikasi Aspek K3L &amp; Pengujian Resiko Rev~01

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Form : 001

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

10 Associated Asphyxiant (Argon Gas) Available 2 3 6 N

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

20. 15 psi/g maximum pressure of acetylene shall be observed/never to be exceeded.

25 Use ear plug

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

6 Equipment failure Available 4 3 12 N 05. Control taglines in use 4 1 4 Y

10 Material slippage during lifting Available 4 4 16 N

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

15. Anti two block device installed and properly operating

16. Slings softener / protection from sharp edges to be provided

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

19. Load being lifted in equlibrium position.

21. No People at anytime under the load / no anauthorized persons to be involved.

23. Outrigger pads to be use on both paved and unpaved areas.

24. Proper hitch arragement to be observed.

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

06. Daily Check up by operator

08. Warning flag on protruding loads/materials shall be installed during transport.

09. No riders allowed in forklift, crane and similar mobil equipment.

10. No equipment in operation shall be left unattended.

11. Escort personnel will be provided during transport of heavy equipment /

13. Positioning / parking of equipment shall be kept of road adges.

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

07. Metal/wet wooden ladders shall not be used or an energized electrical

11. Inspection required before each use.

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

06. No throwing of couplers, tools, plank or tubes shall be allowed. Lowering

15. Protect underneath/near by equipment from possible physical damage.

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

Lokasi : Elevated work location at work site Referensi : Dept/Area : CONSTRUCTION

2 Pincg points Available 3 3 9 N 02. Certified / competent crane operator. 3 1 3 Y

4 Fall Hazard Available 5 4 20 N 04. Full body harness in use 5 1 5 Y

08. Dummy lift to be observed.

10. Crane inspection sticker & certification is valid.

11. Grab rails provided

14. Hoisting / lowering manbasket shall be as slow as possible.

15. Outer edges of manbasket subject to physical contact with existing

16. Anti two blocking device must be ensured properly operating.

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

08. A standby man must be present immediately outside of man-way to

09. A wooden ladder or equivalent non conductive material to be used as a

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

14. Continuous forced ventilation to be maintained while entrants are at work.

15. Housekeeping to be continuously observed.

16. Warning notices posted are entry points.

17. Supervisor/Foreman has to conduct Pre-Job Safety Instruction prior to

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

Lokasi : All Working Areas Outdoors Referensi : Dept/Area : All

05. Medical and safety staft will be on extra preparedness to act on 1 1 1 Y

06. Emergency transport vehicle (ambulance) will be ansured conssiantfy 3 1 3 Y

08. Appropriate issues / safety topics on acclimalization will be discussed during

Lokasi : Off-Site On-Site Roads Referensi : Dept/Area : TRANSPORT / RED

2 Motor vehicle collision /accident Available 3 3 9 N 02. Observe defensive driving 3 1 3 Y

06. Fire extinguisher available in each vehicle. 3 1 3 Y

07. Warning devices carried in vehicle.

08. No riding at the back of pickups / trucks

10. Maintain recommended tire pressure

11. No riding / descending buses while in motion or thru emergency / back

12. Bus emergancy exit doors shall be kept operable/not locked.

IDENTIFIKASI ASPEK K3L, PENGUJIAN RESIKO DAN PENGENDALIAN RESIKO

Form Identifikasi Aspek K3L & Pengujian Resiko Rev~01

Form Identifikasi Aspek K3L & Pengujian Resiko Rev~01