Part 1

JSA No. : 06/TWK/2019 JOB SAFETY ANALYSIS

Company Name : Company Address : Work Activity : Project :
PT. TRI WAHANA KARSA Jl. Karunrung Asri E No. 21, Makassar PEMBUATAN DINDING GI 150KV TOPOYO – MAMUJU
PENAHAN TANAH TENGAH, SULAWESI BARAT

JSA Prepared by : Rifaldy Abdurrachman Reviewed by : Joko Sandra Approved by : Hendy Pratomo

Signature : Signature : Signature :

Task Description : PEMBUATAN DINDING PENAHAN TANAH Date : 20 – 01 – 2019

High Risk Tasks : Working At Hight
Special precautions must be taken when undertaking non-routine work. Ensure entire team have developed Start Date : End Date :
Routine task?  Non-routine task?  a comprehensive JSA and check requirements for lifting plans; special permits; isolations; services; 20 – 01 - 2019
unexpected hazards; emergency planning and team competencies
Permit / Plan Required : Isolation Required : PPE Required Above Site Standard : Equipment Required :
General / Cold Work  Electricals Helmet / Hard Hat  Safety Gloves  Warning / Hazard Signs 

Hot Work Mechanicals  Safety Eye Glasses  Electrical Gloves Soft Barricades / Hard Barricades 

Excavation / Penetration  Erection Zone  Oxy Cutting Googles Full Body Harness  Safety Life Lines

Working at Height  Lifting Zone  Chemical Googles Safety Shoes / Boots  First Aid Kit 

Confined Space Live Existing Zone  Ear Plug / Ear Muff Rompi  Stretcher / Palanquin (tandu) 
Dust Mask / 
Electrical / LOTO Commissioning Zone Arc Flash Lifting Gears / Equipments
Respirator

Lifting Plan / Review  Energizing Zone Face Shield Disposable Overalls Fire Extinghuiser / Spill Kit 

Potential Environmental Hazards Hazardous Materials / Substances Manual Handling

Will Hazardous manual Handling be possible during the job? E.G. Lifting, pushing,
This item requires continual review to include the specific area or (List any chemicals and hazardous materials to be used or
pulling, Twisting or bending? If so tick the box that most likely describes the manual
activities requirements. Please Tick Box present in the work Area. Attach an MSDS for each)
handling risk and include the code on each SWMS Job step
Weather  Oil / Flammable Material None There will be no Hazardous Manual handling in this job.

Physical  Gas / Compressed Material MH1 The task may involve high forces. 
Ergonomic / Erosion  Corrosive Material MH2 The task will require repetitive forceful movements 
The task is likely to cause fatigue or soreness due to it’s long
Working at Height / Confined Space  Asbestos Material MH3 duration

Noise / Dust  Electricity Material MH4 Environmental factors are likely to increase the chance of injury. 
Joggle / Parallel Moving Particles  MH5 Awkward posture or movements. 
Lift Review General
Lift review MUST be done on all field and service jobs.
For more complex lifts – use a full detailed lift plan.
 JSA No. : 06/TWK/2019 JOB SAFETY ANALYSIS
Company Name : Company Address : Work Activity : Project :
PT. TRI WAHANA KARSA Jl. Karunrung Asri E No. 21, Makassar PEMBUATAN DINDING GI 150KV TOPOYO – MAMUJU
PENAHAN TANAH TENGAH, SULAWESI BARAT
_____
Maximum lift (static) load KG
kg
Sling _____
CHN SYN RND OTHR
Type kg
_____
Lift capacity of sling
kg
Crane condition checked & operation tested
(yes/no)
Protective barrier required for sling, chains
(yes/no)
Lifting Gear Checked Own Equipment
(Yes, No) Tested & Tagged ,
good Condition Customer equip.

Rigging Required (yes/no)

Full Lift Plan Required (yes/no)

Lifting Operation Zone     

Probability Consequences Hierarchy of Control

A – Repeating occurrence-happens People Environment
1 – Eliminate
MATRIX on most occasions. 1 – Fatality or Permanent 1 – off site release with major detrimental effect
2 – Substitute
A – common or repeating Disability 2 – off site release with minor detrimental effect
A B C D E 3 – Isolation
occurrence 2 – Lost Time Injury or Illness 3 – on site release contained with outside
4 – Engineering
1 H H H M M B – Common occurrence-happens 3 – Medical Treatment assistance
5 – Administration
approx 1 in 10 4 – First Aid Treatment 4 – on site release immediately contained
2 H H M M M 6 – PPE
C – Could occur-infrequent 5 – Incident Report only 5 – no environmental impact
occurrence-happens approx 1 in
3 H M M M L Apply in order of preference
100
4 M M M L L from 1 to 6 – note control
D – Not likely to occur-unusual
used
5 M M L L L occurrence-approx 1in 500
E – Practically impossible-occurs
less than 1 in 5000

Hierarchy of Control
When choosing the controls to be used for each of the hazards that exist, it is important to consider the hierarchy of controls in determining the best practicable control.
Consider each hazard and whether there exist a way in which the hazard can be eliminated. If such a control is practicable - nominate the control in the “control”
column, and circle the number 1 in the hierarchy of control column. If elimination is not practicable - consider substitution to reduce the risk of the hazard. If such a
control is practicable put the control in the “control” column then cross out 1 and circle 2 in the hierarchy of control column. Repeat until the best practicable control is
determined. Then repeat for each hazard.

Part 2

Cross out controls not practicable. Circle control used consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury

JOB STEP POTENTIAL HAZARD RESPONSIBLE

PERSON
NO. List the steps Against each step list the
Nominate the person
required to perform potential / risk hazards that
who will be required to
the task in the could cause injury / damage
action the control
sequence they are when the task step is
measures

Consequence (1-5)

Consequence (1-5)
carried out performed

Probability (A-E)

Probability (A-E)
Rank (L,M or H)

Rank (L,M or H)
(use hierarchy of controls – at end of
this form)

Jari atau tangan tergores - Identifikasi potensi bahaya di Logotic atau penjaga
123
C 4 M tools werehause area. E 5 L
peralatan. 456 gudang
- Jangan tergesa-gesa dan
tahap demi tahap. 123 Logotic atau penjaga
Persiapan peralatan Kaki terjepit peralatan C 4 M - Cek peralatan sesuai dengan E 5 L
456 gudang
COP,WE-05. COP, peruntukannya.
1
WE-06. COP,WE-08. - Persiapkan alat sesuai dengan
COP, PPE 01. pekerjaan.
- Memastikan alat yang 123 Logotic atau penjaga
Kaki tertimpah peralatan C 4 M E 5 L
digunakan yang sudah di 456 gudang
lakukan pemeriksaan
(register).

JOB STEP POTENTIAL HAZARD
NO. List the steps Against each step list the
required to perform potential / risk hazards that
the task in the could cause injury / damage
sequence they are when the task step is
carried out performed
Terpeleset
Terkena swing alat berat
Excavation/penggali
2 - Jangan tergesa-gesa saat
an Tertimpa tanah longsor
Kena gas sisa bahan bakar
Alat berat terbalik
3 Pemasangan Tertimpa material
scaffolding scaffolding
Cross out controls not practicable. Circle control used consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury
RESPONSIBLE
PERSON
Nominate the person
who will be required to
action the control
measures
Consequence (1-5)
Consequence (1-5)
Probability (A-E)
Probability (A-E)
Rank (L,M or H)
Rank (L,M or H)
(use hierarchy of controls – at end of
this form)
123
C 4 M - Identifikasi potensi bahaya E 5 L Site supervisor
456
diarea kerja.
- Memastikan keadaan alat
123
C 2 H tidak ada kendala saat E 5 L Site supervisor
456
pekerjaan di mulai
123
C 2 H E 5 L Site supervisor
melakukan pekerjaan. 456
- Menggunakan APD
- Kordinasikan sebelum 123
C 4 M E 5 L Site supervisor
melakukan pekerjaan 456
123
C 2 M E 5 L Site supervisor
456
D 4 H - Identifikasi potensi bahaya 123 E 5 L Site supervisor
diarea kerja. 456
 Cross out controls not practicable. Circle control used consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury

JOB STEP POTENTIAL HAZARD RESPONSIBLE

PERSON
NO. List the steps Against each step list the
Nominate the person
required to perform potential / risk hazards that
who will be required to
the task in the could cause injury / damage
action the control
sequence they are when the task step is
measures

Consequence (1-5)

Consequence (1-5)
carried out performed

Probability (A-E)

Probability (A-E)
Rank (L,M or H)

Rank (L,M or H)
(use hierarchy of controls – at end of
this form)

- Memeriksa kembali 123

Terjepit material scaffolding C 4 M kelengkapan dan kekuatan E 5 L Site supervisor
456
scaffolding.
- Kordinasikan sebelum 123
Terjatuh dari ketinggian D 4 H E 5 L Site supervisor
melakukan pekerjaan, dengan 456
COP, PPE-01. COP, scaffolder dan pengawas
WH-05. COP WH-04. pekerjaan.
COP, WE-07. COP, - Menyiapkan ijin kerja.
WE-06. Scaffolding roboh - Hanya scaffolding yang
123
D 4 H bersertifikat yang dapat E 5 L Site supervisor
456
memasang scaffolding (COP
Scaffolding/WAH).
- Menggunakan FBH.

- Menggunakan scaffolding yg 123

4 terjatuh D 4 H E 5 L Site supervisor
aman 456
 Cross out controls not practicable. Circle control used consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury

JOB STEP POTENTIAL HAZARD RESPONSIBLE

PERSON
NO. List the steps Against each step list the
Nominate the person
required to perform potential / risk hazards that
who will be required to
the task in the could cause injury / damage
action the control
sequence they are when the task step is
measures

Consequence (1-5)

Consequence (1-5)
carried out performed

Probability (A-E)

Probability (A-E)
Rank (L,M or H)

Rank (L,M or H)
(use hierarchy of controls – at end of
this form)

Pemasangan - Memakai fullbody harness 123

Tertimpa material C 4 M - Pastikan perancah sudah di E 5 L Site supervisor
material dinding 456
penahan inspeksi oleh yg berkompeten
- Melakukan komunikasi yg 123
Tersayat material C 4 M E 5 L Site supervisor
COP WE-07,WH.05, benar ketika melakukan 456
WP. 02 D 4 M pengangkatan manual 123 E 5 L
Tergores material Site supervisor
456
 Cross out controls not practicable. Circle control used consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury

JOB STEP POTENTIAL HAZARD RESPONSIBLE

PERSON
NO. List the steps Against each step list the
Nominate the person
required to perform potential / risk hazards that
who will be required to
the task in the could cause injury / damage
action the control
sequence they are when the task step is
measures

Consequence (1-5)

Consequence (1-5)
carried out performed

Probability (A-E)

Probability (A-E)
Rank (L,M or H)

Rank (L,M or H)
(use hierarchy of controls – at end of
this form)

- Tempatkan material diposisi

yang aman
- Jangan meletakkan material
di akses
- Menghindari daerah tajam
material
- Menggunakan sarung tangan
- Pastikan peralatan listrik telah
 Cross out controls not practicable. Circle control used consideredHierarchy of Controls
Initial Risk
Assessment
without REQUIRED HAZARD
Controls
CONTROL
For each hazard identified list the Risk Assessed
control measures required to with Controls
eliminate or minimize the risk of
injury

JOB STEP POTENTIAL HAZARD RESPONSIBLE

PERSON
NO. List the steps Against each step list the
Nominate the person
required to perform potential / risk hazards that
who will be required to
the task in the could cause injury / damage
action the control
sequence they are when the task step is
measures

Consequence (1-5)

Consequence (1-5)
carried out performed

Probability (A-E)

Probability (A-E)
Rank (L,M or H)

Rank (L,M or H)
(use hierarchy of controls – at end of
this form)

- Identifikasi potensi bahaya 123

Terjatuh dari ketinggian D 4 H diarea kerja. E 5 L Site supervisor
456
- Memastikan lokasi kerja dan
scaffolding dalam kondisi 123
Tangan terluka D 4 M E 5 L Site supervisor
yang layak. 456
- Jangan tergesa-gesa saat 123
Finishing Tersandung/terpeleset D 4 M melakukan pekerjaan. E 5 L Site supervisor
456
5 COP, WE-07. COP, - Melakukan pekerjaan di
HH-01. ketinggian sesuai dengan
aturan ( WAH ).
- Menggunakan APD
- Kordinasikan sebelum
melakukan pekerjaan.