Project No.

P-OkiPL1
OKI PULP & PAPER MILL PROJECT
Document No. P-OkiPL1-100-15-FRM-0009
[OKIPL1]
Revision 00

Page 1 of 3
Job Safety Analysis (JSA) Form
Issue Date June 12, 2014

Job Safety Analysis (JSA)

Activity Title/ Aktifitas Area/ Tempat Page Number/ Halaman of

PPE, Tools, and Equipment Required/ APD dan Peralatan Yang Diperlukan SOP, WI, Guidance Related/ SOP, WI Terkait Personnel Required to Implement This JSA/
Personil Yang Harus Melaksanakan JSA Ini

Name/ Nama ID No/ NIK Date/ Tanggal Signature/ Tanda Tangan

Prepared By/ Disiapkan

Reviewed By/ Ditinjau Ulang

Approved By/ Disetujui

No Main Steps of Job/ Sequence of Basic Job Steps/ Potential Hazards/ Risk Level/ Recommended Control/ Risk Level/
Tahapan Pokok Urutan Dasar Dari Tahapan Pokok Pekerjaan Potensi Bahaya Tingkat Kontrol Yang Direkomendasikan Tingkat Resiko
Pekerjaan Resiko

This document is confidential, and shall not be reproduced in whole or without the prior written consent of the APP Global Projects Group.
Form GPG-100-01-PRA Dec 20, 2013
Page 1 of 3
 Project No. P-OkiPL1
OKI PULP & PAPER MILL PROJECT
Document No. P-OkiPL1-100-15-FRM-0009
[OKIPL1]
Revision 00

Page 2 of 3
Job Safety Analysis (JSA) Form
Issue Date June 12, 2014

No Main Steps of Job/ Sequence of Basic Job Steps/ Potential Hazards/ Risk Level/ Recommended Control/ Risk Level/
Tahapan Pokok Urutan Dasar Dari Tahapan Pokok Pekerjaan Potensi Bahaya Tingkat Kontrol Yang Direkomendasikan Tingkat Resiko
Pekerjaan Resiko

This document is confidential, and shall not be reproduced in whole or without the prior written consent of the APP Global Projects Group.
Form GPG-100-01-PRA Dec 20, 2013
Page 2 of 3
 Project No. P-OkiPL1
OKI PULP & PAPER MILL PROJECT
Document No. P-OkiPL1-100-15-FRM-0009
[OKIPL1]
Revision 00

Page 3 of 3
Job Safety Analysis (JSA) Form
Issue Date June 12, 2014

No Main Steps of Job/ Sequence of Basic Job Steps/ Potential Hazards/ Risk Level/ Recommended Control/ Risk Level/
Tahapan Pokok Urutan Dasar Dari Tahapan Pokok Pekerjaan Potensi Bahaya Tingkat Kontrol Yang Direkomendasikan Tingkat Resiko
Pekerjaan Resiko

This document is confidential, and shall not be reproduced in whole or without the prior written consent of the APP Global Projects Group.
Form GPG-100-01-PRA Dec 20, 2013
Page 3 of 3