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Hazard Identifications Risk Assessment

Job Safety and Environment Analysis (JSEA)

Facility/ Lokasi : Assessed by (dipersiapakan Oleh) :


Job/ Pekerjaan/ Aktifitas : Tanggal/Bulan :
Job Dilakukan oleh (jabatan) : Revisi No :
Group Leader untuk Preventive action : :
JSA Number : Disetujui oleh Ka Departemen / Section : SHE Coordinator :

Urutan Potensi Akibat yang Tindakan


Lokasi/ K3 Tingkat Resiko Rekomendasi
kegiatan pada Bahaya ditimbulkanya. Pengendalian Kemungkinan Akibat Peraturan
No. Kegiatan/ L A / Dampak pengendalian
pekerjaan (Hazard/ ( Consequence yang telah (K) (A) terkait
Bahan S H (K)x(A) tambahan
(Proses) Aspek) /Dampak) dilakukan

Likelihood/ Kemungkinan terjadi Severity/ Kemungkinan besarnya dampak B. Dampak bagi Aset/ Perlengkapan/Lingkungan Tabel Nilai Resiko
1. Rare = practically impossible A. Dampak bagi Personal 1. Insignificant = loss < 5,000,000.
2. Unlikely = may occur at some time 1. Insignificant = no treatment required, level 2. Minor = 5,000,001 < loss < 50,000,000. Likeli- Severity of Risk
3. Possible = could occur or “I have heard of it short time injury 3. Moderate = 50,000,001< loss < 500,000,000 hood 1 2 3 4 5
happening” 2. Minor = first aid 4. Major = 500,000,0001 < loss <
4. Likely = known to occur or “it has happened” 3. Moderate = MTI or LTI by doctor 1,000,000,000. 1 L L L M H
5. Almost Certain = occur in most circumstances certificate 5. Catastrophic = loss > Rp 2 L L M H H
or repeating occurrence 4. Major = permanent disability or single
fatality 1,000,000,000. 3 L M H H E
5. Catastrophic = multiple fatalities 4 M H H E E
5 H H E E E
Prosedur-QSHE-001/S1 Rev 0
Eliminasi, subtitusi, engineering desain, dengan cara administrasi atau memberlakukan prosedur operasional (Work Instruction) serta fasilitas Alat pelindung diri

Likelihood/ Kemungkinan terjadi Severity/ Kemungkinan besarnya dampak B. Dampak bagi Aset/ Perlengkapan/Lingkungan Tabel Nilai Resiko
6. Rare = practically impossible A. Dampak bagi Personal 6. Insignificant = loss < 5,000,000.
7. Unlikely = may occur at some time 6. Insignificant = no treatment required, level 7. Minor = 5,000,001 < loss < 50,000,000. Likeli- Severity of Risk
8. Possible = could occur or “I have heard of it short time injury 8. Moderate = 50,000,001< loss < 500,000,000 hood 1 2 3 4 5
happening” 7. Minor = first aid 9. Major = 500,000,0001 < loss <
9. Likely = known to occur or “it has happened” 8. Moderate = MTI or LTI by doctor 1,000,000,000. 1 L L L M H
10. Almost Certain = occur in most certificate 10. Catastrophic = loss > Rp 2 L L M H H
circumstances or repeating occurrence 9. Major = permanent disability or single
fatality 1,000,000,000. 3 L M H H E
10. Catastrophic = multiple fatalities 4 M H H E E
5 H H E E E
Prosedur-QSHE-001/S1 Rev 0