Doc No: GC-SHE-F-04

SHE DEPARTMENT Page: Page 1 of 5

Version: 0.0
Approval Date:
ANALISIS KESELAMATAN PEKERJAAN (AKP) Author: Mgr SHE
JOB SAFETY ANALYSIS (JSA)

Nama Pekerjaan SLIP FORM Disusun GAO LIANG AKP No. SINOMA-2
/Task Title oleh /Developed. by /JSA No.
Departemen/Seksi CIVIL Persetujuan WANG XIAOJUN Dibuat Tanggal 2014-2-8
/Dept/Section /Approval /Issued on
Divisi /Unit Usaha Revisi Tanggal
/Division/BU /Revision date
Perusahaan SINOMA No AKP Terkait SINOMA-2
/Company /Relevant JSA No..
Alat Pelindung Diri (APD) yang harus Dipakai /Required Personal Protective Equipment (PPE)

HELMET SAFETY HARNESS

URUTAN PEKERJAAN BAHAYA YANG BISA TIMBUL TINDAKAN PENCEGAHAN ATAU PROSEDUR YANG DIREKOMENDASIKAN
SEQUENCE OF TASK POTENTIAL HAZARDS RECCOMMENDED PREVENTION ACTION OR PROCEDURE
1 Construction preparation

1.1 Personnel preparation High falling and Physical fitness test for all personnel should be done at clinic; persons with
mechanical injury caused acrophobia or hypertension are rejected.
by person who has
Train and clarify to the physically qualified personnel for work at height and
acrophobia or
tower crane erection.
hypertension, or the
person who does not
have work at height
experience or hoist
tower training.

THIS DOCUMENT IS UNCONTROLLED IN HARDCOPY FORMAT

 Doc No: GC-SHE-F-04
SHE DEPARTMENT Page: Page 2 of 5
Version: 0.0
Approval Date:
ANALISIS KESELAMATAN PEKERJAAN (AKP) Author: Mgr SHE
JOB SAFETY ANALYSIS (JSA)

URUTAN PEKERJAAN BAHAYA YANG BISA TIMBUL
SEQUENCE OF TASK POTENTIAL HAZARDS
1.2 PPE High falling and
mechanical injury caused
by not wearing safety belt
or safety shoes.
TINDAKAN PENCEGAHAN ATAU PROSEDUR YANG DIREKOMENDASIKAN
RECCOMMENDED PREVENTION ACTION OR PROCEDURE
After training, distribute PPE according to their work allocation, ensuring every
worker knows how to use PPE correctly and works safely.

1.3 tool, equipment and material safety risk in unqualified Check the soundness of all used tool, equipment and material, ensuring safety
product of workers and equipment.

2 slip form platform assembly
Electric shock Inspect welding machine before operation, ensuring no cable damage or
electrical leakage; rain proof measures is necessary.
Mechanical injury
Before hydraulic system commissioning, inspect jack, oil pump and pipeline,
Object attack
ensuring correct connection and smooth circulation.
When slip form platform needs temporary fixation, it has to be fastened to
avoid collapsed-caused injury.

3 Slip form operation

3.1 Safety passageway Meet usage requirement, Size of safety passageway should meet the maximal requirement during rush
avoid crowd-caused hours of shift change-over.
accident; supply enough
It should be firm, safe, and be inspected occasionally.
lighting fixtures.
Set up enough lighting fixtures for passage at night.
It should be erected higher or heightened according to construction progress,
so as to meet application requirement.

3.2 Material transportation Bumpy and steep road Choose suitable crane, instructed by riggers.

THIS DOCUMENT IS UNCONTROLLED IN HARDCOPY FORMAT


SHE DEPARTMENT
ANALISIS KESELAMATAN PEKERJAAN (AKP)
JOB SAFETY ANALYSIS (JSA)
URUTAN PEKERJAAN BAHAYA YANG BISA TIMBUL
SEQUENCE OF TASK POTENTIAL HAZARDS
would result in mechanical
injury, goods falling and
objects attack.
3.3 Pump truck operation Inappropriate instruction
results in crash
3.4 Work at height, and high falling Workers are injured by
high falling.
3.5 Falling objects Workers and equipments
under platform are injured
by objects by deliberate
throw or accidental falling
3.6 Lifting Inappropriate instruction
results in equipment
crash, objects falling, and
THIS DOCUMENT IS UNCONTROLLED IN HARDCOPY FORMAT
Doc No: GC-SHE-F-04
Page: Page 3 of 5
Version: 0.0
Approval Date:
Author: Mgr SHE
TINDAKAN PENCEGAHAN ATAU PROSEDUR YANG DIREKOMENDASIKAN
RECCOMMENDED PREVENTION ACTION OR PROCEDURE
The relatively longer and heavier materials should be fixed on vehicles by chain
block, preventing it dropping to hurt workers during transportation.
Pump trucks are instructed by professionals lest inappropriate instruction
results in equipment crashing against buildings or tower crane, which make
equipment damaged.
Put up lighting fixtures around pump truck to prevent crash at night.
Workers shall be work at height clarification and physical fitness test before
climbing up.
Guardrail and safety net are put on around construction platform, to prevent
against accidental falling.
The worker working under slip form platform should wear safety belt fastened.
Forbid throwing goods downward from platform; collect garbage together, and
send it down by tower crane.
Set up skirt board along the edge of slip form platform to prevent falling
objects hurting workers and equipments.
Set operation region, do not allow irrelevant personnel entering it, to prevent
personnel and equipment against damage by falling objects.
Material and equipment lifting are instructed by professionals; avoid
equipment crash resulting in equipment and personnel injury.
 Doc No: GC-SHE-F-04
SHE DEPARTMENT Page: Page 4 of 5
Version: 0.0
Approval Date:
ANALISIS KESELAMATAN PEKERJAAN (AKP) Author: Mgr SHE
JOB SAFETY ANALYSIS (JSA)

URUTAN PEKERJAAN BAHAYA YANG BISA TIMBUL TINDAKAN PENCEGAHAN ATAU PROSEDUR YANG DIREKOMENDASIKAN
SEQUENCE OF TASK POTENTIAL HAZARDS RECCOMMENDED PREVENTION ACTION OR PROCEDURE
subsequent personnel and Hanged objects must be fastened, lest objects drop or fall down accidentally.
equipment damage.

3.7 Lighting Accident caused by Set up enough lighting fixtures to meet the requirement of night work,
insufficient lighting avoiding personnel and equipment crash.

4 Slip form platform dismantlement

4.1 High falling Workers shall have work at height clarification and physical fitness inspection
before climbing up, and must wear safety belt correctly during working at
height.
Set up work zone, do not allow irrelevant personnel entering it, to prevent
personnel or equipment against damage by accidental falling.
Construction is not allowed during night in bad weather condition.

4.2 High falling Do not allow throw dismantled objects downward directly, which should be
passed by tower crane.

4.3 Electric shock Inspect electric welder or electric tools, ensuring no cable damage or
electricity leakage; rainproof measures should also be done.

4.4 Mechanical injury Inspect tools and equipments before using, and use it in correct way.

4.5 Object strike/attack Arrange reasonable dismantling sequence for platform dismantlement,
avoiding accidents by unreasonable dismantlement.

THIS DOCUMENT IS UNCONTROLLED IN HARDCOPY FORMAT

 Doc No: GC-SHE-F-04
SHE DEPARTMENT Page: Page 5 of 5
Version: 0.0
Approval Date:
ANALISIS KESELAMATAN PEKERJAAN (AKP) Author: Mgr SHE
JOB SAFETY ANALYSIS (JSA)

Petunjuk Umum /General Guidelines:

1. Sebutkan secara berurutan hanya langkah-langkah pokok tugas yang harus dikerjakan. Gunakan kalimat aktif secara jelas dan singkat /Describe in sequence only
the main steps of the task to be performed. Use active sentences.
2. Gunakan frasa singkat untuk mendeskripsikan Bahaya-bahaya Potensial, seperti: Terjepit di antara daun pintu dan kerangka mesin, dll. / Use simple phrases
to describe identified potential hazards, such as: Pinched between the door and the machine, etc.
1. Terpukul oleh ... / Struck by ... 6. Terperangkap dalam … / Caught in 11. Terpapar oleh … / Exposure to
2. Membentur ... / Struct … …
against ... 7. Terjepit di antara … / Caught  Menghirup … / Inhaling …
3. Terkena oleh ... / Contacted between  Kulit tubuh terkena …
by ... 8. Terpeleset … / Slip … /Absorbing
4. Kontak dengan ... (listrik, 9. Jatuh … / Fall …  Menelan … / Swallowing …
kimia) ... / Contact with ... 10. Terlalu memforsir tenaga /
(Electrical, chemical) Overexertion
5. Terkait pada … / Caught on …

3. Sebutkan Tindakan atau Prosedur yang Direkomendasikan secara jelas dan singkat, dengan menggunakan kalimat aktif /Describe the recommended action or
procedure in brief, using active sentence

THIS DOCUMENT IS UNCONTROLLED IN HARDCOPY FORMAT