JOB SAFETY ANALYSIS (JSA)
Project Name: Cirebon 2, 1x1000MW Coal Fired Power Plant Project, Indonesia Company:
Nama Project: Perusahaan: PT. NKE
Work Activity:
Pekerjaan: Working on inside Confined Space JSA No: Rev 0
Work Location: Date Developed:
Lokasi Kerja: MAN HOLE Dibuat Tanggal: 12-11-2019
JSA Participants / Preparation & Review. Peserta pembuat JSA Approval/ Persetujuan
(incl. personnel consulted: e.g. workers, supervisors, foremen, HSE personnel, external parties)
Name Position Company Signature Name Date Signature
HAPPY CAHYA SAFETY OFFICER PT NKE
Remarks / Notes, Keterangan/ Catatan:
Type of Permit Required Additional PPE Requirements Special tools or equipment required:
Jenis Perizinan yg Diperlukan: Tambahan Alat Pelindung Diri yang diperlukan Alat-alat Khusus yang Diperlukan:
Excavation/ Penggalian
Hot work/ Pekerjaan Panas
Confined space/ Ruang terbatas
Other/ Lainnya: General Permit
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JOB SAFETY ANALYSIS (JSA)
Risk Matrix:
CONSEQUENCE
Disciplines will review likelihood and
consequences in line with their specific 1 = Negligible 2 = Slight 3 = Moderate 4 = High 5 = Very High
parameters as noted No injuries requiring any First aid treatment. Medical treatment required, Injuries resulting in; lost time, Single or multiple fatalities.
treatment. Restricted Work Case. permanent disability,
amputation, or surgery.
5 =Very Likely Is expected to occur M-5 H -10 VH-15 VH-20 VH-25
LIKELIHOOD
Will probably occur in most
4=Likely
circumstances
M-4 H-8 H-12 VH-16 VH-20
3=Possible Should occur at some time L-3 M-6 H-9 H-12 VH-15
2=Unlikely Could occur at some time L-2 M-4 M-6 H-8 H-10
May occur only in exceptional
1=Very Unlikely
circumstances
L-1 L-2 L-3 M-4 M-5
Likelihood (L) 1 = Very Unlikely, 2 = Unlikely, 3 = Possible, 4 = Likely, 5 =Very Likely Consequence (C) 1 = Negligible, 2 = Slight, 3 = Moderate, 4 = High, 5 = Very High
Risk Rating (R) LOW [ 1-3 ] Broadly acceptable - MODERATE [ 4-6 ] Tolerable – With identified HIGH [ 8-12 ] Undesirable - Additional VERY HIGH [ 15- 25 ] Intolerable -
Manage by routine procedures controls fully implemented controls required to reduce risk Do not start activity
Residual
Risk
Potential Hazards / Consequences [L x C=R]
Activity
(What can go wrong) Persons Responsible
(Basic job steps) Control Measures/ Tindakan perbaikan
Potensi bahaya/ konsekwensi (Apa yang bisa Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R
Preparation Work The work does not match the
Conduct risk assessment first prior to
permit that already submitted 2 2 4 Supervisor
Create work permit & JSA make JSA and work permit
Unidentified risk
Workers who involve the
Supervisors are required to provide an
work, do not understand the
Toolbox Meeting explanation of potential hazards and how 2 2 4 Supervisor
work plan and its hazards
to prevent them.
every step of work
Page 2 of 9
JOB SAFETY ANALYSIS (JSA)
Residual
Risk
Potential Hazards / Consequences [L x C=R]
Activity
(What can go wrong) Persons Responsible
(Basic job steps) Control Measures/ Tindakan perbaikan
Potensi bahaya/ konsekwensi (Apa yang bisa Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R
Trained Person to be working at
Confined Space.
Have practice working at confined space.
Evacuation map ( attached )
Provide air blower inside for air
circulation
Ensure confined space has been gas
tested ( AGT ) and safe for working.
Identify and do precaution the hazard of
limited entry/exit point before working.
Supervision shall select only
trained/experienced/suitable personnel
for this activity.
Health check shall be confirmed in good
condition to whom will do this activity.
Person caught/slip/fall at
Entry to and exit from Confined Space Supervision to be in place and monitor
limited entry/exit point.
along the work. SPV, HSE,QC, All
Person may not be suitable 2 2 4
Watchman to be stand by and Workers
physically or psychologically
for task. continuously monitor person who
working inside confined space and
situation with effective communication,
with Entry list ( Attached )
Provide full body harness, trolley, ladder,
rope, radio communication if required for
access way and emergency.
Do not bring heavy goods/
Equipments /tools manually.
Provide lighting/torch while working on
confined space. Ligthing must be DC
max. 50 Volt.
No other task is conducted on line during
entry.
Do not bring gas bottle inside confined
space.
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JOB SAFETY ANALYSIS (JSA)
Residual
Risk
Potential Hazards / Consequences [L x C=R]
Activity
(What can go wrong) Persons Responsible
(Basic job steps) Control Measures/ Tindakan perbaikan
Potensi bahaya/ konsekwensi (Apa yang bisa Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R
Ensure confined space had been gas
tested and safe for working.
Provide air blower inside confined space
for air circulation.
Ensure inside confined space is clean
from unnecessary personnel/material.
Ensure lighting is proper for working
inside confined space.
Do not working too long and keep to take
a fresh breath outside.
Rotation of personnel if required to
Working on Confined Space Asphyxiation/ breathing problem
reduce exposure.
Personal injury (poisoned, SPV, HSE,QC, All
Supervision shall select only trained or 2 2 4
death) Workers
experienced personnel for this activity.
Health check shall be confirmed in good
condition to whom will do this activity.
Supervision to be in place and monitor
along the work.
Watchman to be stand by and
continously monitor person who working
inside confined space and
situation with effective communication.
Emergency Rescue Team with
equipment to be stand by for quick action
when needed .
Establish a complete heat illness
prevention program.
Provide training about the hazards
Heat Stress leading to heat stress and how to prevent SPV, HSE,QC, All
Heat Cramp them. 2 2 4
Workers
Provide a lot of cool water to workers
close to the work area. At least one pint
of water per hour is needed.
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JOB SAFETY ANALYSIS (JSA)
Residual
Risk
Potential Hazards / Consequences [L x C=R]
Activity
(What can go wrong) Persons Responsible
(Basic job steps) Control Measures/ Tindakan perbaikan
Potensi bahaya/ konsekwensi (Apa yang bisa Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R
Sharp or protruding objects Provide adequate lighting: area lighting
(metal, nails, bolts, etc.) may
Night Work and/or head and hand lamps
2 2 4
SPV, HSE,QC, All
not be visible to moving
Provide spare batteries, light sources, Workers
operatives, drowsiness of
and bulbs
employees
• Identify and do precaution the hazard of limited
entry/exit point before working.
• Supervision shall select only
trained/experienced/suitable personnel for this
activity.
• Health check shall be confirmed in good
• Person caught/slip/fall at limited condition to whom will do this activity.
entry/exit point.
• Supervision to be in place and monitor along the
work.
• Person may not be suitable
Visual Inspection • Watchman to be stand by and continously
physically or
monitor person who working inside confined space
and 2 2 4 SPV , all workers
psychologically for task.
situation with effective communication.
- Human consequnces • Provide harness, trolley, ladder, rope, radio
communication if required for access way and
Personal injury (hurt) emergency.
• Do not bring heavy goods/equipments/tools
manually.
• Provide lighting/torch while working on confined
space. Ligthing must be DC max. 50 Volt.
• No other task is conducted on line during entry.
• Do not bring gas bottle inside confined space.
Page 5 of 9
JOB SAFETY ANALYSIS (JSA)
Residual
Risk
Potential Hazards / Consequences [L x C=R]
Activity
(What can go wrong) Persons Responsible
(Basic job steps) Control Measures/ Tindakan perbaikan
Potensi bahaya/ konsekwensi (Apa yang bisa Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R
• Perform gas test and provide air blower before
entering confined space.
• Clean hazardous gasess if any from inside
confined space and re-test again.
• Asphyxiation/ breathing problem • Clean inside confined space from unnecessary
personnel/material.
- Human consequnces • No entry inside confined space until gas test
result is confirmed safe. 2 3 6 SPV, AGT, All workers
Personal injury (poisoned, death) • Provide ventilation when detection of hazardous
gas is found.
• Authorized Gas Tester to perform Gas Test.
• Condition must be met for entry without SCBA
(self contained breathing apparatus):
LEL<1%,O2>20%,H2S<1 ppm,CO< 1 ppm.
Page 6 of 9
JOB SAFETY ANALYSIS (JSA)
Residual
Risk
Potential Hazards / Consequences [L x C=R]
Activity
(What can go wrong) Persons Responsible
(Basic job steps) Control Measures/ Tindakan perbaikan
Potensi bahaya/ konsekwensi (Apa yang bisa Penanggung jawab
Aktivitas (Langkah kerja)
salah?)
L C R
• Identify and do precaution the hazard of limited
entry/exit point before working.
• Supervision shall select only
trained/experienced/suitable personnel for this
activity.
• Health check shall be confirmed in good
condition to whom will do this activity.
• Supervision to be in place and monitor along the
• Person caught/slip/fall inside work.
confined space • Watchman to be stand by and continously
Cleaning by manual
monitor person who working inside confined space
- Human consequnces and 2 2 4 SPV, all workers
situation with effective communication.
Personal injury (hurt)
• Provide harness, trolley, ladder, rope, radio
communication if required for access way and
emergency.
• Do not bring heavy goods/equipments/tools
manually.
• Provide lighting/torch while working on confined
space. Ligthing must be DC max. 50 Volt.
• No other task is conducted on line during entry.
• Do not bring gas bottle inside confined space.
• Keep and collect scrap/waste material on
• Dirty working area dedicated place.
Housekeeping • Remove to outsite scrap/waste material
- Environmental consequences regularly. 2 2 4 SPV, all Workers
• Keep working place clean daily.
Scrap/waste material scatterred
• Do not leave any unnecessary
material/tools/equipment after complete the jobs.
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JOB SAFETY ANALYSIS (JSA)
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JOB SAFETY ANALYSIS (JSA)
Sign On: I confirm that the JSA has been explained and its contents are clearly understood. I clearly understand the controls in this JSA must be
applied; otherwise work is to cease immediately.
Saya mengkonfirmasi bahwa JSA telah dijelaskan dan isinya dipahami dengan jelas. Saya memahami dengan jelas kontrol dalam JSA ini harus diterapkan; jika
tidak, pekerjaan akan segera dihentikan
Name Position Signature Date Company
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