Leighton International Limited
JOB SAFETY AND ENVIRONMENTAL ANALYSIS WORKSHEET
Country Office / Project:
Job Location & Details:
JSA Participants:
Responsible Supervisor:
JOB STEP
(Eg. Set Up Crane)
1. Park Machine and isolate
1.3.1 Ensure have spotter
spotter pemandu ketika
2. Remove & Install Stick
Cylinder Bucket/
Melepaskan dan memasang
Stick Cylinder bucket
Mar 2008
Indonesia/ ID 204 MHU Coal Mine Project Tools and or Equipment required: JSA No: ID 204-JSA-WS-003
- Helmet, Safety Boot, Reflective
MHU, Remove & Install Stick Cylinder Bucket Exc. 5110B Date Prepared: 15 Feb 10
Vest, Hand Glove, Ear plug
Suhar, Subekan - Safety Glasses, Etc
M. Thoha, Mujiko S, Jefri Mengi - Ladder/ Tangga Approved by PM:
Mujiko, Jefri Mengi - All Tools/ Semua Peralatan
- Crane Truck/ Manitou
- Lifting Chain/ Webbing sling
- Rope, Safety Harness
- Toolbox set
      - Isolation tags Date: Sahala Aritonang
HAZARDS IDENTIFIED CONTROLS REQUIRED (Eg. Remove overhead cable or ACTION BY/RECORD
(Eg. Electrocution from 11Kv Cables) isolate/sheath overhead or monitor with spotter) Training PPE Needs (Eg. Supervisor)
1.1 Worker slip/ Fall down/ 1.1.1 Ensure the woker wearing PPE and becareful while working/ 1.1.1.1 Supervisor, Mechanics
Crushed/ Injury/ Pekerja Pastikan pekerja memakai alat pelindung diri dan berhati-hati
disaat bekerja
1.2 Area not level condition 1.2.1 Ensure the area must be level and clean/ Pastikan area 1.2.1.1 Supervisor, Mechanics
harus di ratakan dan bersih
1.3 Equipment
fault/unit
to direct when adanya
moving. The operator must look at spotter not in his mirrors. / Pastikan ada 1.3.1.1 Operators
kerusakan
unit / berpindah. Operator harus melihat kea rah spotter bukan ke kaca spion
unit bergerak
1.4 Unit no Isolation/ Unit tidak di 1.4.1 Ensure fit”Out of Service tag” and Personal danger tag” / 1.4.1.1 Mechanics, supervisor
isolasi Pastikan pasang Out of service tag” and Personal Danger tag”
1.5 Tools set/ support equipment 1.5.1 Ensure check tools set/ support equipment in good condition/ 1.5.1.1 Supervisor, Mechanics
fault/ Alat-alat atau peralatan Pastikan pemeriksaan alat-alat/ peralatan pembantu dalam kondisi
pembantu rusak baik
2.1 Worker injury/ Pekerja terluka 2.1.1 Ensure wearing PPE as standard (Hand gloves)/ Pastikan 2.1.1.1 Supervisor and Mechanics
pakai alat pelindung diri
2.1.2 Ensure hands correct position when hold pin, arm hoist 2.1.2.1 Mechanics
cylinder/ Pastikan posisikan tangan dengan tepat ketika
Page 1 of 3 LIL-HSE-FM001B(01)
Leighton International Limited
JOB SAFETY AND ENVIRONMENTAL ANALYSIS WORKSHEET
2.2 Falling / Impacted/ Terjatuh/
Terjepit
2.3 Tools set/ Support equipment
broken/ Alat-alat /peralatan
pembantu rusak
2.4 Manual handling/ Mengangkat
secara manual
2.5 Missed communication/ salah
pengertian saat berkomunikasi
3. Job Finish/ Pekerjaan 3.1 No remove isolation tags/
selesai Tidak melepaskan tanda isolasi
unit
3.2 Poor housekeeping at the
area/ area kurang bersih
Mar 2008
memegang pin, arm hoist cylinder
2.2.1 The worker must be careful and concentration while working/ 2.2.1.1 Mechanics
Pekerja harus berhati-hati dan konsentrasi ketika bekerja
2.2.2 Ensure working at high more 1,8m use safety harness belt as 2.2.2.1 Supervisor and Mechanics
standard./ Pastikan bekerja di ketinggian lebih dari 1,8m harus
pakai safety harness belt
2.2.3 Ensure use ladder agreeable/ Pastikan menggunakan tangga 2.2.3.1 Mechanics
yang sesuai
2.2.4 Ensure release hydraulic pressure/ Pastikan melepaskan 2.2.4.1 Mechanics
tekanan hidrolik
2.2.5 Ensure the workers not under load / radius lifting activity/
Pastikan pekerja tidak berada di bawah beban / radius
pengangkatan beban
2.3.1 Ensure use correct proper tools and lifting gear set(chain/belt) 2.3.1.1 Mechanics and Crane/
/ Pastikan menggunakan alat-alat dan peralatan bantu angkat- Manitou Operators
mengangkat (rantai/ sabuk) yang benar.
2.4.1 Ensure correct manual handling procedure/ Pastikan 2.4.1.1 Mechanics
melakukan mengangkat manual dengan benar / sesuai prosedur
2.4.2 Ensure use lifting equipment to move stick cylinder/ Pastikan 2.4.2.1 Supervisor, Mechanics,
menggunakan alat angkat untuk memindahkan stick cylinder operator Crane/Manitou
2.4.3 Ensure use webbing sling to tie arm/stick cylinder/ Pastikan 2.4.3.1 Mechanics, Operator Crane/
menggunakan webbing sling untuk mengikat stik cylinder Manitou
2.4.4 Ensure use agreeable lifting chain/ webbing belt with weigh 2.4.4.1 Operator Crane/ Mechanics
stick cylinder/ Pastikan menggunakan rantai/ webbing belt sesuai
dengan berat stick cylinder
2.5.1 Ensure have rigger when lifting activities/ Pastikan ada rigger 2.5.1.1 Supervisor, Operator Crane/
pemandu untuk kegiatan pengangkatan Manitou
2.5.2 Ensure the operator crane/ Manitou must concentration, only 2.5.2.1 Operator Crane/ Manitou
following signal from rigger ./ Pastikan operator crane/Manitou
memperhatikan, mengikuti signal, aba-aba rigger
3.1 Ensure remove isolation tags from machine/ Pastikan 3.1.1 Mechanics
melepaskan tanda isolasi dari unit
3.2.1 Cleaning and tidy up work area/ bersihkan dan rapihkan area 3.2.1.1 Supervisor, Mechanics
kerja
Page 2 of 3 LIL-HSE-FM001B(01)
 Leighton International Limited

JOB SAFETY AND ENVIRONMENTAL ANALYSIS WORKSHEET

I fully understand this Job Safety Analysis and will work according to it Job Description ,
Saya Sangat mengerti Analisa bekerja aman dan akan melakukan sebaik-baiknya. __________________________
__________________________
Date issued , _______________
JOB PARTICIPANT LIST

NO. Name Position Signature

01

02

03

04

05

06

07

08
09
10

Mar 2008 Page 3 of 3 LIL-HSE-FM001B(01)