JOB SAFETY ANALYSIS

DOCUMENT NO.
JSA RECORD NUMBER

COMPANY : Konsorsium REKIND-YIN PREPARED BY REVIEW BY APPROVED BY APPROVED BY

PROJECT : Distribusi Lampung (CP7) CONS. SPV HSE MGR CONS. MGR ENGINEER PGN REPS.
PERSON IN CHARGE NAME : NAME
POSITION/ JOB TITLE :
SIGNATURE
JOB ACTIVITY :
DATE : DATE

Sequence of Basic JobSteps Hazard Consequence Risk Ranking RecommendedAction Result of Risk
NO
Tahapanpekerjaan Bahaya Akibat PR SV RR TindakanPengendalian PR’ SV’ RR’

NO Sequence of Basic JobSteps Hazard Consequence Risk Ranking RecommendedAction Result of Risk
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 JOB SAFETY ANALYSIS

DOCUMENT NO.
JSA RECORD NUMBER

Tahapanpekerjaan Bahaya Akibat TindakanPengendalian

PR SV RR PR’ SV’ RR’

Risk Rangking (RR) Recommended Action

Severity / consequence Tingkat Risiko TindakanPengendalian
Probability (PR) x =
Keparahan
Score Level Tingkat pengendalian Hierarchy of Control
Frequent =5 Catastrophic = 5 19-25 Extreme high E= 1+2+3+4+5 1= Eleminasi
Probable = 4 Major = 4 13-18 High H= 3+4+5 2= Substitusi
Occasional = 3 Moderate / serious = 3 6-12 Medium M= 4+5 3= Engineering
Unlikely = 2 Minor = 2 1-5 low L=5 4= Administrasi
Improbable = 1 Negligible = 1 5= APD

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