JOB SAFETY ANALYSIS (JSA)

ANALIS KERJA AMAN

Date/Time Project Company

During Project PLTMG 30 MW BALOI Dewata Makmur Bersama
Tanggal / Waktu Proyek Proyek

Work Location Supervisor HSE Officer

Sei Baloi Substation Angra P. Royn T. Geruh
Lokasi Kerja Pengawas Petugas HSE
Task / Pekerjaan:
Unstuffing Air Charge Intake

Put a cross sign (X) in the following column □/ Berilah tanda silang (X) pada kolom □ berikut ini:

Area of work involved /Daerah kerja yang terlibat: Tools and equipment involved/ Alat kerja yang terlibat :

☐ At close water/ Di dekat air 1. Lorry Crane

☐ At closing room/ Di ruang tertutup atau
sempit
☐ On the vessel/ Di atas kapal 2. Forklift
☒ At open yard/ Di ruang terbuka
☐ At height / Di ketinggian 3. Hand jack
☐ At Workshop/ Di ruang kerja
☐ …………………………………. 4. Truck
☐ Other/Lain-lain: ………………………

Work Personnel Members/ Anggota Kelompok Kerja

Name Designation Name Designation
No No
Nama Jabatan Nama Jabatan
1 Ahmad Zulfikar Unstuffing Team 7
2 Ahmad Unstuffing Team 8
3 Riskianto Kurniawan Unstuffing Team 9
4 10
5 11
6 12
 JOB SAFETY ANALYSIS (JSA)
ANALIS KERJA AMAN
Completion Date
No/ Job Steps Potential Hazards Risk Control Measures
Tanggal Pemenuhan
No Tahapan Pekerjaan Potensi Bahaya Resiko Tindakan Pengendalian
1 Mob & Demob  Pinched by Heavy  Physical injury and  Use PPE, keep safe
mobilisasi peralatan Equipment hematoma distance
Terjepit alat berat Cedera fisik dan hematoma Gunakan APD, jaga jarak
 Stuck down by equipment (lebam) aman
or tool  Fatality  Work follow sop
Tertimpa peralatan Kematian Bekerja Sesuai SOP
 Work perform by qualified
worker Pekerjaan
dilakukan oleh pekerja
yang terkualifikasi
2 Tool Box Meeting  Incorrect instruction  Physical injury and  Conduct toolbox by responsible
Rapat kerja Salah uinformasi hematoma person
Cedera fisik dan Lakukan toolbox meeting oleh
hematoma (lebam) penanggung jawab kerja
 Fatality / Kematian
3 Truck Crane Inspection  N/A  N/A  Make sure the truck is feasible
check list to operate
(SIO,SILO,SIM,KIR,STNK) Pastikan Truck Crane layak
Pengeckean truck crene beroperasi
4 Preparation  Incorrect method of  Physical injury and  Use PPE, keep safe distance
Persiapan installation hematoma Gunakan APD, Jaga jarak
Salah metode instalasi Cedera fisik dan aman
 Procedure and task not hematoma (lebam)  Work follow sop Bekerja
clear Sesuai SOP
Prosedur kerja tidak jelas
5 Trailler Positioning  Pinched by Heavy  Physical injury and  Use PPE, keep safe
Parkir Truk Equipment hematoma distance
Terjepit alat berat Cedera fisik dan Gunakan APD, jaga jarak
 Stuck down by equipment hematoma (lebam) aman
or tool  Fatality  Work follow sop
Tertimpa peralatan Kematian Bekerja Sesuai SOP
 Work perform by
qualified worker
Pekerjaan dilakukan oleh
 JOB SAFETY ANALYSIS (JSA)
ANALIS KERJA AMAN
pekerja yang terkualifikasi

6 Pulling Panels with  Pinched by Heavy  Physical injury and  Use PPE, keep safe
Forklifts. Equipment hematoma distance
Penarikan pannel Terjepit alat berat Cedera fisik dan Gunakan APD, jaga
 Stuck down by equipment hematoma (lebam) jarak aman
or tool  Fatality/ Kematian  Work follow sop
Tertimpa peralatan Bekerja Sesuai SOP
 Work perform by
qualified worker
Pekerjaan dilakukan
oleh pekerja yang
terkualifikasi
7 Moving From Container to  Pinched by Heavy  Physical injury and  Use PPE, keep safe distance
Storage Equipment hematoma Gunakan APD, jaga jarak
Pemindahan dari container Terjepit alat berat Cedera fisik dan aman
ke Gudang  Stuck down by hematoma (lebam)  Work follow sop
equipment or tool  Fatality/ Kematian Bekerja Sesuai SOP
Tertimpa peralatan  Work perform by qualified
worker
Pekerjaan dilakukan oleh
pekerja yang terkualifikasi
8 Lasing  Pinched by Heavy  Physical injury and  Use PPE, keep safe distance
pengikatan Equipment hematoma Gunakan APD, jaga jarak
Terjepit alat berat  Cedera fisik dan aman
 Stuck down by hematoma (lebam)  Work follow sop
equipment or tool  Fatality/ Kematian Bekerja Sesuai SOP
Tertimpa peralatan  Work perform by qualified
worker
Pekerjaan dilakukan oleh
pekerja yang terkualifikasi
9 Dropping off  Pinched by Heavy  Physical injury and  Use PPE, keep safe distance
Penurunan Equipment hematoma Gunakan APD, jaga jarak
Terjepit alat berat Cedera fisik dan aman
 Stuck down by hematoma (lebam)  Work follow sop
equipment or tool  Fatality/ Kematian Bekerja Sesuai SOP
Tertimpa peralatan  Work perform by qualified
 JOB SAFETY ANALYSIS (JSA)
ANALIS KERJA AMAN
worker
Pekerjaan dilakukan oleh
pekerja yang terkualifikasi

10 Transport  Pinched by Heavy  Physical injury and  Use PPE, keep safe distance
Pemindahan Equipment hematoma Gunakan APD, jaga jarak
Terjepit alat berat Cedera fisik dan aman
 Stuck down by hematoma (lebam)  Work follow sop
equipment or tool  Fatality/ Kematian Bekerja Sesuai SOP
Tertimpa peralatan  Work perform by qualified
worker
Pekerjaan dilakukan oleh
pekerja yang terkualifikasi
11 Stacking  Pinched by Heavy  Physical injury and  Use PPE, keep safe distance
Penyusunan Equipment hematoma Gunakan APD, jaga jarak
Terjepit alat berat Cedera fisik dan aman
 Stuck down by hematoma (lebam)  Work follow sop
equipment or tool  Fatality/ Kematian Bekerja Sesuai SOP
Tertimpa peralatan  Work perform by qualified
worker
Pekerjaan dilakukan oleh
pekerja yang terkualifikasi
 JOB SAFETY ANALYSIS (JSA)
ANALIS KERJA AMAN
Pesonal Protective Equipment and Tools Required to Perform this Job / Alat Pelindung Diri dan Peralatan yang Dibutuhkan untuk Melakukan Pekerjaan ini
Cutting/ Burning/ Heating
01 Safety Helmet √ 09 17 Hand Tools √ 25 Gas Detector
Glasses/ Goggles
02 Safety Glass √ 10 Welding Gloves 18 Lifting Gear √ 26

03 Coverall √ 11 Welding Apron 19 Ladder 27

04 Safety Shoes/ Boots √ 12 Welding Shield 20 Working Platform 28

05 Mask √ 13 Face Shield 21 Lifting Cage 29

06 Hand Gloves √ 14 Fire Blanket 22 Electrical Appliances 30

07 Ear Plug 15 Fire Extinguisher √ 23 Hot Work Tools 31

08 Body Harness 16 Fire Line 24 Machinary 32

Comments by Supervisor Incharge/ Komentar oleh Pengawas yang Bertanggungjawab:

............... ...... .

Prepared By / Dibuat Oleh: Approved By / Disahkan Oleh:

Name/ Nama Angra Name/ Nama ROYN T.G.

Designation/ Jabatan Civ Spv Designation/ Jabatan HSE. Manager

Date/ Tanggal April 14th, 2021 Date/ Tanggal April 14th, 2021

Signature/ Tanda Tangan Signature/ Tanda Tangan