METHOD STATEMENT (MS) & JOB SAFETY ANALYSIS (JSA)

JPT/FABS/MS/GVD/002/R0 O Pekerjaan
Nomor MS & JSA O Ruang Terbatas O Penggalian O Isolasi
Umum
Jenis Pekerjaan
JPT WP-03 &WP-09 O Pekerjaan O Lainnya Tulis
Nama Project O Pekerjaan Ketinggian O Kelistrikan
Panas disebelah
Lokasi Pekerjaan Constructio yard

Waktu Pekerjaan s/d Otorisasi Disiapkan oleh Diperiksa oleh Disetujui oleh Disetujui oleh Remarks

Nama Perusahaan PT.FABS INDONESIA Nama Riko Yogi Pranata

Nama Pimpinan Achmad Syaifudin Tanggal 18 /12 / 2023 18 /12 / 2023

Nama Supervisor Riko Valentino Tanda Tangan

Level Risiko Level Risiko

No Langkah-langkah Pekerjaan Potensi Bahaya & Risiko Kontrol yang dilakukan Kontrol Tambahan
(L/M/H) Sisa (L/M/H)
L : Low ; M : Medium : Masukan kontrol yang dibutuhkan untuk mengurangi risiko & potensi L : Low ; M : Medium : Masukan kontrol tambahan yang dibutuhkan untuk mengurangi
Deskripsikan pekerjaan ataupun aktifitas yang akan dilakukan Masukan potensi bahaya dan risiko yang mungkin terjadi selama berkerja
H : High bahaya H : High risiko & potensi bahaya
1

1.TBM sebelum melakukan pekerjaan 2. Pengecekan lokasi kerja 3.

1 Persiapan Pekerjaan Tersandung Luka Ringan L : Low Pastikan pekerja di posisi yang aman 4 .Pastikan pekerja L : Low Gunakan APD sesuai dengan pekerjaan
menggunakan APD lengkap

1. Pastikan scaffolding di install oleh scaffolder yang

Terjatuh dari ketinggian, material
2 Pemasangan Scaffolding
jatuh
bersertifikat , 2. Gunakan Full body harness pada saat
Luka Berat H : High bekerja di ketinggian ,3 .selalu mengaitkan hook body L : Low Gunakan APD sesuai dengan pekerjaan
harnes pada saat assembling scaffolding 4. Gunakan tali
pada saat transfer material scaffolding

1.Cek rpm mata gerinda pada pastikan lebih besar daripada

Luka
Mata gerinda pecah,Percikan api
Berat,Kebakaran,Gang
penggerindaan,Kebisingan
guan pendengaran
rpm mesin . 2.Gunakan Face shield pada saat melakukan
H : High pemotongan rangka baja . 3. Eliminasi material yang mudah L : Low Gunakan APD sesuai dengan pekerjaan
terbakar dari area hot work. 4.Stabye APAR di area 5.
Gunakan Ear plug pada saat melakukan pekerjaan

1.Gunakan sarung tangan pada saat melakukan pekerjaan

Terkena benda sisi tajam Terluka M : Medium 2. Proteksi material 3.Kordinasi yang baik pada saat transfer L : Low Gunakan APD sesuai dengan pekerjaan
material

3 Proses Pemasangan Rangka dan Atap

1.Pastikan scaffolding sudah di inspection dan diberi tag
Terjatuh dati ketinggian Luka Berat,Patah hijau 2.Gunakan Full body harness. 3.Selalu mengaitkan Inspection lifting gear sebelum digunakan
H : High L : Low
tulang hook harnes pada ralling scaffolding

1.Pastikan scaffolding di install oleh scaffolder yang

Luka Berat,Patah bersertifikat 2. Scaffolding sudah di inpscetion dan sudah di
Scaffolding Roboh H : High L : Low Pasang safety sign dan tagging
tulang beri tagging hijau 3. Jangan memberi beban berlebihan
pada scaffolding

1.TBM sebelum melakukan pekerjaan 2. Pengecekan lokasi

Tersandung Luka Ringan L : Low kerja 3. Pastikan pekerja di posisi yang aman 4 .Pastikan L : Low Gunakan APD sesuai dengan pekerjaan
pekerja menggunakan APD lengkap

1.Pastikan scaffolding sudah di inspection dan diberi tag

Terjatuh dati ketinggian Luka Berat,Patah hijau 2.Gunakan Full body harness. 3.Selalu mengaitkan Inspection lifting gear sebelum digunakan
H : High L : Low
tulang hook harnes pada ralling scaffolding

1.Gunakan sarung tangan pada saat melakukan pekerjaan

Terkena benda sisi tajam Terluka M : Medium 2. Proteksi material 3.Kordinasi yang baik pada saat transfer L : Low Gunakan APD sesuai dengan pekerjaan
4 Penarikan cable dan Terminasi material

1. Matikan Aliran listrik pada panel sebelum melakukan

Tersengat Listrik Fatality H : High pekerjaan. 2.Loto MCB pada sumber yang akan di connec L : Low Gunakan APD sesuai dengan pekerjaan
kabel.

1. Matikan Aliran listrik pada panel sebelum melakukan

Fatality H : High pekerjaan. 2.Loto MCB pada sumber yang akan di connec L : Low Gunakan APD sesuai dengan pekerjaan
kabel.

List Peralatan List Bahan Kimia Alat Pelindung Diri (APD) & Safety Kits Training / Sertifikat
Masukan bahan kimia yang akan digunakan selama berkerja dan lampirkan Material Safety Data Sheet
1. Tangga 2.Tang Kombinasi 3.Cutter 4.Scaffolding (MSDS)
1. Sepatu Safety 2.Rompi safety 3.Helm safety 4.Sarung tangan 1 .Scaffolder
5. Full body harness 6. Face Shield

Catatan : Semua informasi pada tabel di atas ini wajib diisi. Untuk melengkapi metode kerja harap untuk melampirkan kedalam ini drawing / gambar, P&ID (piping and intrument diagram) ataupun as built drawing jika diperlukan, Untuk kasus-kasus khusus seperti pekerjaan ruang terbatas mohon untuk menyediakan rescue plan dan kit dan untuk
aktivitas lifting mohon untuk memberikan lifting plan. Untuk pekerjaan dalam proyek khusus untuk menjadi konsiderasi dalam pembuatan MS&JSA ini yaitu EHS Plan dari kontraktor yang telah di submit sebelum proyek dimulai.

Form 04-041 MS & JSA

Issue Date : 08 February 2023
Rev : 02
 METHODE STATEMENT RECORD
PROJECT : Givaudan JPT
Revision – 0
REVISION STATUS :
INSTALLATION OF: Construction yard
(Location)
METHOD FABS-JPT-MS-02
STATEMENT & Lembar 1 of 11
RISK ASSESSMENT
No.
RISK LEVEL
ν
HIGH MEDIUM LOW
Complete all parts, use N / A on the part that is not appropriate
( If a more complete plan is needed, attach a separate sheet )

1.0 Decreption Of Work Scope :

Contraktor: PT. FABS Indonesia

Supervisor: Riko Valentino

Plan date to start: 18 December 2023

Plan date completed: 24 December 2023

Planning and preparation site office :

2. Required Work Yes No DETAILS/NOTES

Permit

General Work Permit: ν

Hot Work: ν

Working at high ν

Critical Lift ν
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Excavation ν

Energy Isolation ν

3.0 ENDORSMENT DATE NAME SIGNATURE

Preparation by: - /18/2023 Riko Valentino
Checked by: -/18/2023 Yogi Pranata

Approved by:

4.0 ACCESS YES NO DETAILS/NOTES

Closed Main Road ν

Pedestrian ν
Scaffolding ν

Roofing ν

Next Stair ν

Details

5.0 EXCAVATION YES NO DETAILS/NOTES

If there is excavation work, make

Underground Cable ν sure there is no underground
facility
Buried cables that can
be electrically
insulated
ν
( If not, equipment with high
risk, including hand tools
with edges / sharp edges,
must be avoided as far as 1
meter from the location of
suspected buried cables)

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Attach required details

(image, physical / wide
marking or detection using a
detection cable, etc.)
6.0 Vehicle and Lifting YES NO DETAILS/NOTES
Vehicle:

Lifting Operating: ν

Attach detail as needed: ν

7.0 SAFETY Yes No DETAILS/NOTES

Fire Fighter/Emergency:
ν
Lock Out Tag Out:
ν
Pengawas Safety: ν
Fire Watcher ν
Peralatan Tambahan & ν
APD:

8.0 LINKAGES YES NO DETAILS/NOTES

Drainase/Water ν
Disposal:

Production Proccess: ν
Utility: ν
Other: ν

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9.0 Use of Chemicals Yes No DETAILS/NOTES

Solvent yang digunakan: ν

Dangerous Material has ν

be disposal:

Use of hazardous
chemicals
ν

If YES to any of the

above, provide a
separate explanation

10.0 Special Equipment/ Equipment (Register)

Equipment
1. Ladder
2. Power tools
3. Scaffolding

HSE Item
Item 1 : Barricade Line
Item 2 : PPE mandatory (helm, Safety Glass, Safety Vest, Hand Glove, Safety Shoes, and Full Body
Harness)
Item 4 : Safety Sign
Item 5 : Ear Plug
Item 6 : Face shield

11.0 RESTRAINTS (Daftar yang diantisipasi)

Item 1 : Pinched
Item 2 : Falling from height
Item 3 : Electric shock
Item 4 : Fall of material

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12.0. Roles and Responsibilities

List of names and contact :

Site Manager : Achmad Syaifudin 0812 – 6463 - 3723

Civil Engineer : Riko Valentino 0812 – 3646 - 1329

Supervisor Electrical : TBA

0852 – 1601 – 0516
Safety Officer : Yogi Pranata

First Aider : Yogi Pranata 0852 – 1601 – 0516

13.0 Description Of Work Methods

Deskripsi Kerja:

1. Fabrication and install structure (truss galvanum)

a. Check all work tools before to used.
b. Check all electrical lines before used.
c. Fabrication thrush based on the required size.
d. Using hand gloves to prevent cuts on the hands.
e. The used grinders must match the type of disc
f. Perform a series of structures in accordance with the drawing.
g. Using full body harness with double lanyards when working at
height.
h. Prepared access and working platforms to work at heights
(Scaffolding, and ladder)
i. Scaffolding must be inspection before to used for work.
j. Give a tagging and safety signs about working regulation.

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k. Don’t using scaffolding above the maximum allowable load.

l. Adjust the tilt of the stairs (1:4).
m. Make sure 3cpoints contact when working with stairs.
n. Carrying items is prohibited going up and down the stairs.
o. Raise the material with the help of a rope.
p. Tie a series of structures in a safe/strong position.
q. Ensure that individual load capacities don’t exceed safe threshold,
max 25 kg per person.

r. Stand the rafter in the position according to the drawing.

s. Install temporary support to prevent rafter from collapsing.
t. Lift and stand the next rafter.
u. Installing diagonal bracing between are the rafter that are already
standing

2. Roofing working
a. Check all work tools before use.
a. Check all electrical lines before using.
b. Fabrication roofing based on the size needed.
c. Make sure the shoes are not in slippery conditions.
d. Use Full Body harness with double lanyards and Absorber when
working at height.
e. Prepare access and working platforms to work at heights
(scaffolding).
f. Scaffolding must be installed by a competent person and has a
license.
g. Scaffolding inspection before use for work.
h. Install tagging and safety signs about working regulations at
height.
i. Do not use scaffolding above the maximum allowable load.

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j. Carrying items is prohibited when going up and down the stairs.

k. Raise the material with the help of a rope.
l. Only the roof that will be installed directly can be raised.
m. Position the roof according to the design and immediately install
the screw.

3. Puling cable, Install lighting , and termination

a. Check all work tools before use.
b. Use cutting tools that have sharp edge protection (cutting pliers
and crimping pliers).
c. Use Full Body harness with double lanyards when working at
height.
d. Scaffolding must be installed by a competent person and has a
license.
e. Scaffolding inspection before use for work.
f. Install tagging and safety signs about working regulations at
height.
g. Don’t Using scaffolding above the maximum allowable load.
h. Adjust the tilt of the stairs (1:4).
i. When the stairs are made access to the platform, leave 1 meter/ 3
steps.
j. Make sure 3 point contact when going up and down the stairs.
k. Measure the cable length as needed.
l. Using to cutting pliers to cut the cable.
m. Attach marking at each end of the cable to simplify cable
identification.

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n. Make sure the cable pull path is protecting form sharp objects that
can damage the quality of the cable and to able risk black out.
o. Make sure the cable position and cable conduit are neat.
p. Tie tight to prevent falls.
q. Do clear up area before rest and finishing of work.

Finish

Notes: