JOB TITLE OR OPERATION

JOB SAFETY
ANALYSIS
WORKSHEET Safety Valve Certification

COMPLETED BY EMPLOYEE/ OPERATOR

Asep Sudrajat /
Name : 1 Nata Sign
Marnasip

Position : Inspector 2 Horas Sign

3 Sign

Sign :

4 Sign

COMPANY/ ORGANIZATION WORK SECTION / DEPARTMENT

PT. AKURA BINA CITRA FIELD SERVICE DEPARTMENT

REQUIRE RECOMMENDED PERSONAL PROTECTIVE

Yes, PPE & Safe Work Permits are recommended,

PPE : Helmet (MSA V Guard) Safety shoes

Safety glass/ google Hand Glove (Mechanic

Cover all / Wearpack Gas Leak Detector

BASIC JOB STEP, IN SEQUENCE POTENTIAL HA

No. A. Job Planing

 Not attandance and un
plan, Unclear voice, an
1 Pre Job Meeting (PJM)
Misscomunication beca
understand the langua

Equipment failure, par

2 Prepare all tool & equipment needed personnal injuries (spr

Defective of PPE, unst

3 Asses PPE requirements
and improper PPE for t

4 Prepare work location Slip, trip, and fall

 BASIC JOB STEP, IN SEQUENCE POTENTIAL HA

B. Job Ca

5 Gas Leak Detection Activities 1. Slip, trip, and fall

2. Equipment drop and

3. Gas Leak Incident

Implementation of a pressure test with

6 1. Slip, trip, and fall
nitrogen media

2. Couplant Material Is

3. Gas Leak Incident

 C. Job Co

Bad Housekeeping
Loosing tools and equi
7 Housekeeping and Post Job Meeting
Mis-communication wi
equipment (about prog
 LOCATION JOB NO. ISSUED DATE NO DOC.

10/HSE-
Cikarang Listrindo Yard TBA 16 02 2017
JSA/II/17

LOYEE/ OPERATOR REVIEWED AND APPROVED BY

Signature :
Name : M. Maskur

Position : Akura HSEO

Signature :
Name : Andi Setyo B

Position : QHSE Manager

Signature :
ECTION / DEPARTMENT Name :

SERVICE DEPARTMENT Position :

ERSONAL PROTECTIVE EQUIPMENT/ SAFE WORK PERMITS

Safety shoes Barricade

Hand Glove (Mechanical Impact) Scaffolding ( if Required )

Gas Leak Detector Warning Light & Blower

POTENTIAL HAZARDS RECOMMENDED PREVENTIVE MEASURES

A. Job Planing / Preparation

 (1) Loud & clear during submit all job plan
& risk assesment, (2) Inspector must
Not attandance and unkown job
understand used english language and
plan, Unclear voice, and
must explain to crew, (3) Ensure all crews
Misscomunication because don't
will involved in the job attanded the PJSM
understand the language
and understood with job plan

(1) Prepare all neceseary tools /

equipment as per required on the job, (2)
Check & inspect tools/equipment will be
Equipment failure, pared cable, dan
use, (3) Ensure the condition of tools, (4)
personnal injuries (spraining)
Modification tools not allowed to be use
and follow right way of manual handling
practices. (5) Instal barrier before work
perform.

(1) Review minimum PPE requirement

Defective of PPE, unstandard PPE
and improper PPE for the job
consider:(Safety halmet, glasses,
handgloves,shoes, coverall, additonal PPE
i.e body harness, scaffolding etc), (2)
check condition of PPE, and checks the
condition.

(1) Ensure work site is safe for conducted

the job, & no conflicting activities with
other during job in progress. (2) Avoid
laying object on walk way or leaving
Slip, trip, and fall
equipment where they may present a trip
hazard. (3) Install baricade to avoid
unauthorized person get in work area.
 POTENTIAL HAZARDS RECOMMENDED PREVENTIVE MEASURES

B. Job Carry Out

(1) Ensure work site is safe for conducted

the job, & no conflicting activities with
other during job in progress. (2) Avoid
laying object on walk way or leaving
1. Slip, trip, and fall
equipment where they may present a trip
hazard (3) Install baricade to avoid
unauthorized person get in work area.

(1) Ensure gas leak detector attached on

body by securing device such as rope and
2. Equipment drop and damage
hanging on neck or clamped on proper
area on coverall
(1) Prepare evacuation route during
3. Gas Leak Incident
emergency
(2) Stop all activities that can lead to
sparking an arching
(3) Install breathing apparatus, evacuate
area and report to authorized PIC

(1) Ensure work site is safe for conducted

the job, & no conflicting activities with
other during job in progress. (2) Avoid
laying object on walk way or leaving
1. Slip, trip, and fall
equipment where they may present a trip
hazard (3) Install baricade to avoid
unauthorized person get in work area.

(1) Ensure using couplant from water base

2. Couplant Material Issues and avoid couplant from hydrocarbon
base ( Oil Base )

(1) Prepare evacuation route during

3. Gas Leak Incident
emergency
 (2) Stop all activities that can lead to
sparking an arching
(3) Install breathing apparatus, evacuate
area and report to authorized PIC
(4) Make sure there are no leaks while
testing
C. Job Completion

Bad Housekeeping (1) Ensure all tools and equipments are

Loosing tools and equipment return the proper place, (2) Ensure there
Mis-communication with owner of are not misscomunication with owner of
equipment (about progress job) equipment (for status job)
 NO DOC.

10/HSE-
JSA/II/17

REVIEWED AND APPROVED BY

Signature :

Signature :

Signature :

SAFE WORK PERMITS

Barricade

Scaffolding ( if Required )

Warning Light & Blower

RECOMMENDED PREVENTIVE MEASURES

(1) Loud & clear during submit all job plan
& risk assesment, (2) Inspector must
understand used english language and
must explain to crew, (3) Ensure all crews
will involved in the job attanded the PJSM
and understood with job plan

(1) Prepare all neceseary tools /

equipment as per required on the job, (2)
Check & inspect tools/equipment will be
use, (3) Ensure the condition of tools, (4)
Modification tools not allowed to be use
and follow right way of manual handling
practices. (5) Instal barrier before work
perform.

(1) Review minimum PPE requirement

consider:(Safety halmet, glasses,
handgloves,shoes, coverall, additonal PPE
i.e body harness, scaffolding etc), (2)
check condition of PPE, and checks the
condition.

(1) Ensure work site is safe for conducted

the job, & no conflicting activities with
other during job in progress. (2) Avoid
laying object on walk way or leaving
equipment where they may present a trip
hazard. (3) Install baricade to avoid
unauthorized person get in work area.
 RECOMMENDED PREVENTIVE MEASURES

(1) Ensure work site is safe for conducted

the job, & no conflicting activities with
other during job in progress. (2) Avoid
laying object on walk way or leaving
equipment where they may present a trip
hazard (3) Install baricade to avoid
unauthorized person get in work area.

(1) Ensure gas leak detector attached on

body by securing device such as rope and
hanging on neck or clamped on proper
area on coverall
(1) Prepare evacuation route during
emergency
(2) Stop all activities that can lead to
sparking an arching
(3) Install breathing apparatus, evacuate
area and report to authorized PIC

(1) Ensure work site is safe for conducted

the job, & no conflicting activities with
other during job in progress. (2) Avoid
laying object on walk way or leaving
equipment where they may present a trip
hazard (3) Install baricade to avoid
unauthorized person get in work area.

(1) Ensure using couplant from water base

and avoid couplant from hydrocarbon
base ( Oil Base )

(1) Prepare evacuation route during

emergency
(2) Stop all activities that can lead to
sparking an arching
(3) Install breathing apparatus, evacuate
area and report to authorized PIC
(4) Make sure there are no leaks while
testing

(1) Ensure all tools and equipments are

return the proper place, (2) Ensure there
are not misscomunication with owner of
equipment (for status job)