JOB SAFETY ANALYSIS (JSA)

ANALIS KERJA AMAN

Date/Time Project Company

MIM
Tanggal/Waktu Proyek Perusahaan
Work Location Supervisor HSE Officer
Lokasi Kerja Pengawas Petugas HSE
Task / Pekerjaan:

Put a cross sign (X) in the following column □/ Berilah tanda silang (X) pada kolom □ berikut ini:

Area of work involved /Daerah kerja yang terlibat: Tools and equipment involved/ Alat kerja yang terlibat :

At closing room/ Di ruang tertutup atau sempit At close water/ Di dekat air 1. 6.
At open yard/ Di ruang terbuka On the vessel/ Di atas kapal 2. 7.
At Workshop/ Di ruang kerja At height / Di ketinggian 3. 8.
Other/Lain-lain: ……………………… …………………………………. 4. 9.
5. 10.

Work Personnel Members/ Anggota Kelompok Kerja

Name Designation Sign Name Designation Sign
No No
Nama Jabatan Paraf Nama Jabatan Paraf
1 7

2 8

3 9

4 10

5 11

6 12

Pages(s): 1
Date: 05 Desember 2018
F.06 – Job Safety Analysis Rev.03
 JOB SAFETY ANALYSIS (JSA)
ANALIS KERJA AMAN

No Job Steps Potential Hazards Control Measures Remarks

No Tahapan Pekerjaan Potensi Bahaya Tindakan Pengendalian Keterangan

Pages(s): 2
Date: 05 Desember 2018
F.06 – Job Safety Analysis Rev.03
JOB SAFETY ANALYSIS (JSA)
ANALIS KERJA AMAN

Pages(s): 3
Date: 05 Desember 2018
F.06 – Job Safety Analysis Rev.03