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Job No.: 26071: Tahapanpekerjaan Bahaya Resiko Akibat Tindakanpengendalian

The document is a Job Safety Analysis (JSA) and Risk Assessment Form used to identify potential hazards for a job, assess the level of associated risks, and recommend actions to reduce risks. It contains sections to list the sequence of basic job steps, identify potential hazards and their consequences at each step, assess probability and severity of risks numerically, recommend control actions, and re-assess residual risks after controls. The form is used for an engineering, procurement and construction project for refinery development and provides a framework to methodically plan jobs by anticipating hazards and implementing controls to promote safety.

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Beriandi Hasan
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49 views3 pages

Job No.: 26071: Tahapanpekerjaan Bahaya Resiko Akibat Tindakanpengendalian

The document is a Job Safety Analysis (JSA) and Risk Assessment Form used to identify potential hazards for a job, assess the level of associated risks, and recommend actions to reduce risks. It contains sections to list the sequence of basic job steps, identify potential hazards and their consequences at each step, assess probability and severity of risks numerically, recommend control actions, and re-assess residual risks after controls. The form is used for an engineering, procurement and construction project for refinery development and provides a framework to methodically plan jobs by anticipating hazards and implementing controls to promote safety.

Uploaded by

Beriandi Hasan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071


REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-
V BALIKPAPAN PROJECT JSA Number / NomorJSA : RDMP / JSA / ……………….. / …………………

Company : Prepared By Review by Approved by


Project : SPV Chief/MGR HSE CM
Person in charge name : NAME
Position/ Title job : SIGNATURE
Job activity :
Date : DATE

Sequence of Basic Consequence / Risk Assessment* Result Risk*)


Hazard Risk Recommendation action
NO JobSteps severity
Bahaya Resiko PR SV RR TindakanPengendalian PR’ SV’ RR’
Tahapanpekerjaan Akibat
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071


REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-
V BALIKPAPAN PROJECT JSA Number / NomorJSA : RDMP / JSA / ……………….. / …………………

Sequence of Basic Consequence / Risk Assessment* Result Risk*)


Hazard Risk Recommendation action
NO JobSteps severity
Bahaya Resiko PR SV RR TindakanPengendalian PR’ SV’ RR’
Tahapanpekerjaan Akibat
JOB SAFETY ANALYSIS (JSA) AND RISK ASSESSMENT FORM

ENGINEERING PROCUREMENT CONSTRUCTION FOR HSE Job No. : 26071


REFINERY DEVELOPMENT MASTER PLAN (EPC FOR RDMP) RU-
V BALIKPAPAN PROJECT JSA Number / NomorJSA : RDMP / JSA / ……………….. / …………………

Sequence of Basic Consequence / Risk Assessment* Result Risk*)


Hazard Risk Recommendation action
NO JobSteps severity
Bahaya Resiko PR SV RR TindakanPengendalian PR’ SV’ RR’
Tahapanpekerjaan Akibat

Risk Rangking (RR) Recommendation Action


Severity / consequence Tingkat Risiko TindakanPengendalian
Probability (PR) x =
Keparahan
Score Level Tingkat pengendalian Hierarchy of Control
Frequent =5 Catastrophic = 5 19-25 Extreme high E= 1+2+3+4+5 1= Eleminasi
Probable = 4 Major = 4 13-18 High H= 3+4+5 2= Substitusi
Occasional = 3 Moderate / serious = 3 6-12 Medium M= 4+5 3= REKIND technik
Unlikely = 2 Minor = 2 1-5 Low L=5 4= Administrasi
Improbable = 1 Negligible = 1 5= APD

Note : * : Without Control / Tanpa control


*): With Control / Dengan control

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