Part 1

JSA No. : 05/TWK/2018 JOB SAFETY ANALYSIS

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

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

Signature : Signature : Signature :

Task Description : PEMBUATAN DIREKSI KIT Date : 21 – 12 – 2018

High Risk Tasks : Working At Hight
Special precautions must be taken when undertaking non-routine work. Ensure entire team have Start Date : End Date :
Routine task?  Non-routine task?  developed a comprehensive JSA and check requirements for lifting plans; special permits; isolations; 03 – 01 - 2018
services; 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) 

Electrical / LOTO Commissioning Zone

Dust Mask /  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
activities requirements. Please Tick Box present in the work Area. Attach an MSDS for each)
manual 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

Environmental factors are likely to increase the chance of
Noise / Dust  Electricity Material  MH4 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.
 _____
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- People Environment 1 – Eliminate
MATRIX happens on most occasions. 1 – Fatality or Permanent 1 – off site release with major detrimental effect 2 – Substitute
A B C D E common or repeating occurrence Disability 2 – off site release with minor detrimental effect 3 – Isolation
B – Common occurrence-happens 2 – Lost Time Injury or Illness 3 – on site release contained with outside 4 – Engineering
1 H H H M M approx 1 in 10 3 – Medical Treatment assistance 5 – Administration
2 H H M M M C – Could occur-infrequent 4 – First Aid Treatment 4 – on site release immediately contained 6 – PPE
occurrence-happens approx 1 in 5 – Incident Report only 5 – no environmental impact
3 H M M M L 100 Apply in order of
4 M M M L L D – Not likely to occur-unusual preference from 1 to 6 –
5 M M L L L occurrence-approx 1in 500 note control used
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
 Initial Risk REQUIRED HAZARD
Assessment CONTROL

Hierarchy of

considered
without For each hazard identified list the Risk Assessed

Controls
JOB STEP POTENTIAL HAZARD Controls control measures required to with Controls RESPONSIBLE
eliminate or minimize the risk of PERSON
NO. List the steps Against each step list the injury
Nominate the person
required to perform potential / risk hazards that

Consequence (1-5)

Consequence (1-5)
practicable. Circle
who will be required to

Probability (A-E)

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

Rank (L,M or H)
the task in the could cause injury / damage
action the control
sequence they are when the task step is

control used
controls not
(use hierarchy of controls – at end of measures
carried out performed

Cross out
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 E 5 L
- Cek peralatan sesuai dengan 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 tertimpa peralatan C 4 M E 5 L
digunakan yang sudah di 456 gudang
lakukan pemeriksaan
(register).
Tertimpa material - Identifikasi potensi bahaya
123
D 4 H diarea kerja. E 5 L Site supervisor
scaffolding 456
- Memeriksa kembali
kelengkapan dan kekuatan 123
Terjepit material scaffolding C 4 M E 5 L Site supervisor
scaffolding. 456
Pemasangan - Kordinasikan sebelum
scaffolding 123
Terjatuh dari ketinggian D 4 H melakukan pekerjaan, dengan E 5 L Site supervisor
456
2 COP, PPE-01. COP, scaffolder dan pengawas
WH-05. COP WH-04. pekerjaan.
COP, WE-07. COP, - Menyiapkan ijin kerja.
WE-06. - Hanya scaffolding yang
Scaffolding roboh 123
D 4 H bersertifikat yang dapat E 5 L Site supervisor
memasang scaffolding (COP 456
Scaffolding/WAH).
- Menggunakan FBH.
 Initial Risk REQUIRED HAZARD
Assessment CONTROL

Hierarchy of

considered
without For each hazard identified list the Risk Assessed

Controls
JOB STEP POTENTIAL HAZARD Controls control measures required to with Controls RESPONSIBLE
eliminate or minimize the risk of PERSON
NO. List the steps Against each step list the injury
Nominate the person
required to perform potential / risk hazards that

Consequence (1-5)

Consequence (1-5)
practicable. Circle
who will be required to

Probability (A-E)

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

Rank (L,M or H)
the task in the could cause injury / damage
action the control
sequence they are when the task step is

control used
controls not
(use hierarchy of controls – at end of measures
carried out performed

Cross out
this form)

- Menggunakan scaffolding yg 123

terjatuh D 4 H aman E 5 L Site supervisor
456
- Memakai fullbody harness
- Pastikan perancah sudah di 123
Tertimpa material C 4 M E 5 L Site supervisor
inspeksi oleh yg berkompeten 456
- Melakukan komunikasi yg 123
Tersayat material C 4 M benar ketika melakukan E 5 L Site supervisor
456
pengangkatan manual
- Tempatkan material diposisi 123
Tergores material D 4 M E 5 L Site supervisor
yang aman 456
- Jangan meletakkan material
Pemasangan di akses
material direksi kit - Menghindari daerah tajam
3 material
COP WE-07,WH.05, - Menggunakan sarung tangan
WP. 02 - Pastikan peralatan listrik
telah di inspeksi
- Periksa peralatan sebelum
digunakan
- Jangan pernah melakukan
perbaikan peralatan listrik
jika tidak berkompeten
- Berhentikan pekerjaan jika
cuaca hujan
 Initial Risk REQUIRED HAZARD
Assessment CONTROL

Hierarchy of

considered
without For each hazard identified list the Risk Assessed

Controls
JOB STEP POTENTIAL HAZARD Controls control measures required to with Controls RESPONSIBLE
eliminate or minimize the risk of PERSON
NO. List the steps Against each step list the injury
Nominate the person
required to perform potential / risk hazards that

Consequence (1-5)

Consequence (1-5)
practicable. Circle
who will be required to

Probability (A-E)

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

Rank (L,M or H)
the task in the could cause injury / damage
action the control
sequence they are when the task step is

control used
controls not
(use hierarchy of controls – at end of measures
carried out performed

Cross out
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
Electricity - Jangan tergesa-gesa saat 123
Tersandung/terpeleset D 4 M melakukan pekerjaan. E 5 L Site supervisor
COP, ES-01. COP, ES- 456
4 02, ES-03, ES-04, ES- - Melakukan pekerjaan di
05. Tersengat Listrik D 4 M ketinggian sesuai dengan
aturan ( WAH ).
- Menggunakan APD
- Kordinasikan sebelum
melakukan pekerjaan.

- 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
5 456
COP, WE-07. COP, - Melakukan pekerjaan di
HH-01. ketinggian sesuai dengan
aturan ( WAH ).
- Menggunakan APD
- Kordinasikan sebelum
melakukan pekerjaan.
 Employee Acknowledgement
NOTE: EVERY MEMBER OF THE WORK CREW/TEAM MUST SIGN OFF ON THE SWMS TO ACKNOWLEDGE AWARENESS & PARTICIPATION
We the undersigned, confirm that we have been consulted in the development of this SWMS. If a failure is identified within the SWMS work will stop, the SWMS amended and changes
communicated to the workforce. We also clearly understand that the controls must be applied as documented, otherwise work is to cease immediately. We also confirm that we are
qualified to carry out the works identified above; a copy of our required qualifications has been provided and where applicable all insurances and work cover policies to undertake this
activity are current.
Team Member to print name Team Member to Sign Date Team Member to print name Team Member to Sign Date