Thanks to visit codestin.com
Credit goes to www.scribd.com

Scribd
Upload
43 views2 pages

Form JSA

The document is a Job Safety Analysis form for an online training session taking place via Zoom meeting. It lists potential hazards such as electric shock from tripping on cables, ergonomic issues and eye strain from laptop/smartphone use. It also provides ways to eliminate or control these hazards, such as stretching every 30 minutes and taking breaks to rest the eyes. The form notes critical safety questions that must be addressed and required personal protective equipment for online work.

Uploaded by

Della Dwinovalia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
43 views2 pages

Form JSA

The document is a Job Safety Analysis form for an online training session taking place via Zoom meeting. It lists potential hazards such as electric shock from tripping on cables, ergonomic issues and eye strain from laptop/smartphone use. It also provides ways to eliminate or control these hazards, such as stretching every 30 minutes and taking breaks to rest the eyes. The form notes critical safety questions that must be addressed and required personal protective equipment for online work.

Uploaded by

Della Dwinovalia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 2

Form No: JAS-HSE-JSA FORM Revision No: 01

JOB SAFETY ANALYSIS


PT. JAVARO ABADI SEJAHTERA

WORK ACTIVITY (JOB) TITLE: Online Training DATE: 31 Oktober 2022


LOCATION : Zoom Meeting JSA NO:
WORK TEAM REVIEWED BY: JSA PREPARED BY:
1. Signature:
1. R GUSTI 7. 2. Signature:
2. RENDRA 8. Name : Instruktur 3. Signature:
3. 9. Signature:__________________ 4. Signature:
4. 10. 5. Signature:
5. 11. 6. Signature:
6. 12.
CRITICAL QUESTIONS: Everyone Ready/Capable To Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

REQUIRED SAFETY EQUIPMENT


Hard Hats Goggles Safety Harness Hearing Protection Barricades Other (List): To provide Hi – Viz vest when working close
V Safety Shoes Face Shield V Cotton Gloves Flame Resistant Clothing LEL Monitor to the road________________________________
V Safety Work Vests V Leather Fire Extinguisher H2S Monitor _____________________________________________
Glasses Gloves _____________________________________________
APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
V Hot Work Permit Special Pre-Job Safety Discussions Confined Space Entry Permit Pollution Prevention Measures
Energy Isolation Review Emergency Action Plans Use of Specialized PPE Redundant Protection Measures
V Written Procedure Site/Job Orientation Overhead/Underground Utility Lines Simultaneous Operations
POTENTIAL HAZARDS
Lifting Hazards V Short Service Employees V Elec. Shock/ Flash Dropped/Falling Objects Low Lighting Ionizing
V Fall Potential Water/Drowning Hazard (includes utility lines) Tripping/Slipping Breathing Hazard Radiation
Skin Irritants Mech. Equip. Hazards Haz. Chemical Exposure Excavation Hazard Environmental Other Ergonomic,
Confined Spaces Fire/Explosion Potential (includes H2S) Confined spaces Extremes electrical from
Elev. Load/Work High Noise Levels Sharp Edges or Hot/Cold Elevated load or work Vehicle Operations electronic device
surfaces
Pinch/Crush/Striking
Hazards
Potential Release of
Energy
Form No: JAS-HSE-JSA FORM Revision No: 01
BASIC JOB STEPS POTENTIAL INCIDENTS OR WAYS TO ELIMINATE OR CONTROL HAZARDS PIC
HAZARDS
Persiapan Tersetrum,Tersandung kabel 5R
Penggunaan Laptop/smartphone Ergonomi, pengelihatan kabur Peregangan, setiap 30 menit merehatkan pengeliatan
Telemarketing Tersetrum,Tersandung kabel 5R
Canvasing Kepanasan, kecelakaan lalu lintas Tidak berkendara dalam keadaan mengantuk,
menggunakan alat pelindung diri dalam berkendara,
menggunakan sunblock

You might also like