Part 1

JSA No. : 01/PKG/2022 JOB SAFETY ANALYSIS/HIRADC

Company Name : Company Address : Work Activity : Project : Seaport Expansion Project
PT. PASIFIK KONSTRUKSI GROUP KO Jl. Suvarna Utama Kav.26 C No.87 CUT & FILL, INSTALL RCP Link Road Concrete from Mills to Seaport
Wanakerta Sindang Jaya -Tangerang Warehouse – MUARA SUGIHAN,
PALEMBANG

JSA Prepared by : EKO SAPUTRO Reviewed by : M. AZHAR Approved by : YU HAIBO

Signature : Signature : Signature :

Task Description : CUT & FILL,RCP

Date : 20 – 05 – 2022
High Risk Tasks : LOW RISK
Special precautions must be taken when undertaking non-routine work. Ensure entire team have Start Date : End Date :
Routine task? □ Non-routine task? 🗹 developed a comprehensive JSA and check requirements for lifting plans; special permits; isolations; 04 – 6 - 2022
services; unexpected hazards; emergency planning and team competencies
Permit / Plan Required : Isolation Required : PPE Required Above Site Standard : Equipment Required :
General / Cold Work ✓ Electricals Helmet / Hard Hat ✓ Safety Gloves ✓ Warning / Hazard Signs ✓
Hot Work Mechanicals Safety Eye Glasses ✓ Electrical Gloves Soft Barricades / Hard Barricades ✓

✓ Oxy Cutting ✓
Excavation / Penetration Erection Zone Full Body Harness Safety Life Lines
Googles

Working at Height Lifting Zone Chemical Googles Safety Shoes / Boots ✓ First Aid Kit ✓
Confined Space Live Existing Zone Ear Plug / Ear Muff Rompi ✓ Stretcher / Palanquin (tandu)

Dust Mask / ✓
Electrical / LOTO Commissioning Zone Arc Flash Lifting Gears / Equipments
Respirator

Lifting Plan / Review Energizing Zone Face Shield Disposable Overalls Fire Extinghuiser / Spill Kit ✓
Manual Handling
Potential Environmental Hazards Hazardous Materials / Substances Will Hazardous manual Handling be possible during the job? E.G. Lifting,
This item requires continual review to include the specific area (List any chemicals and hazardous materials to be used or pushing, pulling, Twisting or bending? If so tick the box that most likely
or activities requirements. Please Tick Box present in the work Area. Attach an MSDS for each) describes the manual handling risk and include the code on each SWMS Job
step
Weather ✓ Oil / Flammable Material None There will be no Hazardous Manual handling in this job.

Physical ✓ Gas / Compressed Material MH1 The task may involve high forces. ✓
Ergonomic / Erosion ✓ Corrosive Material MH2 The task will require repetitive forceful movements ✓
The task is likely to cause fatigue or soreness due to it’s long
Working at Height / Confined Space Asbestos Material MH3 duration ✓
Environmental factors are likely to increase the chance of
Noise / Dust ✓ Electricity Material MH4 injury. ✓
Joggle / Parallel ✓ Moving Particles ✓ MH5 Awkward posture or movements. ✓
 JSA No. : 01/PKG/2022 JOB SAFETY ANALYSIS/HIRADC
Company Name : Company Address : Work Activity : Project : Seaport Expansion Project
PT. PASIFIK KONSTRUKSI GROUP KO Jl. Suvarna Utama Kav.26 C No.87 CUT & FILL, INSTALL RCP Link Road Concrete from Mills to Seaport
Wanakerta Sindang Jaya -Tangerang Warehouse – MUARA SUGIHAN,
PALEMBANG
Lift Review
Lift review MUST be done on all field and service jobs.
For more complex lifts – use a full detailed lift plan.
_____
Maximum lift (static) load KG
kg
Sling _____
CHN SYN RND OTHR
Type kg General
_____
Lift capacity of sling
kg
Crane condition checked & operation tested
(yes/no)
Protective barrier required for sling, chains
(yes/no)
Lifting Gear Checked Own Equipment
(Yes, No) Tested &
Tagged , good Condition Customer equip.

Rigging Required (yes/no)

Full Lift Plan Required (yes/no)

Lifting Operation Zone ✓ ✓ ✓ ✓ ✓

Probability Consequences Hierarchy of Control

A – Repeating occurrence-happens People Environment 1 – Eliminate
on most occasions. 1 – Fatality or Permanent 1 – off site release with major detrimental effect 2 – Substitute
MATRIX A – common or repeating Disability 2 – off site release with minor detrimental effect 3 – Engineering
A B C D E occurrence 2 – Lost Time Injury or Illness 3 – on site release contained with outside 4 – Administration
B – Common occurrence-happens 3 – Medical Treatment assistance 5 – PPE
1 H H H M M approx 1 in 10 4 – First Aid Treatment 4 – on site release immediately contained
2 H H M M M C – Could occur-infrequent 5 – Incident Report only 5 – no environmental impact Apply in order of preference
occurrence-happens approx 1 in from 1 to 5 – note control
3 H M M M L 100 used
4 M M M L L D – Not likely to occur-unusual
5 M M L L L occurrence-approx 1in 500
E – Practically impossible-occurs
less than 1 in 5000

Hierarchy of Control
When choosing the controls to be used for each of the hazards that exist, it is important to consider the hierarchy of controls in determining the best practicable control.
Consider each hazard and whether there exist a way in which the hazard can be eliminated. If such a control is practicable - nominate the control in the “control” column,
and circle the number 1 in the hierarchy of control column. If elimination is not practicable - consider substitution to reduce the risk of the hazard. If such a control is
practicable put the control in the “control” column then cross out 1 and circle 2 in the hierarchy of control column. Repeat until the best practicable control is determined.
Then repeat for each hazard.

Part 2
Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d

CUT & FILL - Identifikasi potensi bahaya di

123 Logotic atau operator
Terjatuh dari peralatan C 4 M area. E 5 L
456 alat berat
- Menggunakan APD
- Jangan tergesa-gesa dan 123 Logotic atau operator
1 Persiapan peralatan Kaki terjepit peralatan C 4 M tahap demi tahap. E 5 L
456 alat berat
- Cek peralatan sesuai dengan
permintaan.
- Persiapkan alat sesuai dengan
pekerjaan.

Area tanah yang - Identifikasi potensi bahaya 123

2 Terkena swing alat berat C 2 H E 5 L Site supervisor
lebih tinggi di lansir diarea kerja. 456
 Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d
- Menggunakan APD 123
Terperosok C 4 M - Jangan tergesa-gesa saat E 5 L Site supervisor
456
melakukan pekerjaan.
- Kordinasikan sebelum 123
ke area tanah yang Tertimpa tanah longsor C 2 H E 5 L Site supervisor
melakukan pekerjaan. 456
lebih rendah
- Operator dan alat angkat
angkuta harus mempunyai 123
Alat berat terbalik C 2 M E 5 L Site supervisor
SIO SILO 456

123
Terpeleset C 4 L - Identifikasi potensi bahaya E 5 L Site supervisor
456
diarea kerja.
- Memastikan keadaan alat 123
Terkena swing alat berat C 2 H tidak ada kendala saat E 5 L Site supervisor
456
pekerjaan di mulai
Excavation/ 123
3 Tertimpa tanah longsor C 2 H - Jangan tergesa-gesa saat E 5 L Site supervisor
Penggalian 456
melakukan pekerjaan.
- Menggunakan APD 123
Kena gas sisa bahan bakar C 4 M E 5 L Site supervisor
- Kordinasikan sebelum 456
melakukan pekerjaan
123
Alat berat terbalik C 2 M E 5 L Site supervisor
456
 Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d

123
Terkena debu C 3 M - Identifikasi potensi bahaya 4 5 6 E 5 L Site supervisor
diarea kerja.
- Pemeriksaan material kerja 1 2 3
C 4 L E 5 L Site supervisor
sebelum melakukan 4 5 6
pekerjaan.
4 Finishing Cut & Fill. Terpeleset - Menggunakan APD
- Jangan tergesa-gesa saat
melakukan pekerjaan.
- Kordinasikan sebelum
melakukan pekerjaan.
- Menyiapkan ijin kerja.

5 RCP - Terpeleset/Terperosok C 4 L - Identifikasi potensi bahaya 123 E 5 L Site supervisor

diarea kerja. 456
- Memastikan keadaan alat
- Terkena swing alat berat C 2 H tidak ada kendala saat 123
pekerjaan di mulai 456 E 5 L Site supervisor
- Jangan tergesa-gesa saat
Excavation/ 123
- Tertimpa tanah longsor C 2 H melakukan pekerjaan. E 5 L Site supervisor
Penggalian saluran 456
- Menggunakan APD
drainase
 Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d

123
- Kena gas sisa bahan bakar C 4 M 456
- Kordinasikan sebelum
E 5 L Site supervisor
melakukan pekerjaan
123
- Alat berat terbalik C 2 M 456 E 5 L
Site supervisor
6 Perapihan sisi - Anggota tubuh tergores C 4 - Identifikasi potensi bahaya
- 123 E 5 L Site supervisor
saluran drainase terkena cangkul L diarea kerja. 456
- Memastikan keadaan alat
menggunakan
tidak ada kendala saat
cangkul 123
C 3 pekerjaan di mulai (Layak E 5 L Site supervisor
- Tertimbun tanah lonsor M Pakai) 456
- Jangan tergesa-gesa saat
melakukan pekerjaan.
C 4 - Menggunakan APD E 5 L Site supervisor
- dehidrasi 123
L - Kordinasikan sebelum 456
melakukan pekerjaan
C 4 123 E 5 L
Site supervisor
- Ergonomis ( Low back M 456
Pain)
 Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d

7 Pemadatan tanah - Saat memindahkan C 4 - Identifikasi potensi bahaya 123 E 5 L Site supervisor
menggunakan stemper jatuh (tumbang) L diarea kerja. 456
- Memastikan keadaan alat
stemper
C 4 tidak ada kendala saat
- Stemper jatuh waktu tarik L pekerjaan di mulai (Layak 123 E 5 L
tali starter mengenai 456 Site supervisor
Pakai)
anggota tubuh - Jangan tergesa-gesa saat
melakukan pekerjaan.
- Tapak stemper menjepit C 3 - Menggunakan APD
123
kaki / anggota tubuh lainnya M - Kordinasikan sebelum 456 E 5 L Site supervisor
melakukan pekerjaan
- Mengoperasikan stemper
minimal 2 orang
 Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d

- Gunakan tali untuk menarik

stemper
- Gas jangan terlalu tinggi
- Bekerja dengan hati-hati
dan penuh konsentrasi dan
selalu focus
- Komunikasi 2 arah sesame
team
- dilarang prilaku tidak aman
saat bekerja

8 Proses - Pengikatan yang salah C 2 - Identifikasi potensi bahaya 123 E 5 L Site supervisor
pengangkatan pipa sehingga material jatuh H diarea kerja. 456
- Memastikan keadaan alat
RCP ke saluran
tidak ada kendala saat E 5 L Site supervisor
drainase - koordnasi yang buruk 123
C 3 pekerjaan di mulai (Layak
menggunakan alat selama pengangkatan M Pakai) 456
bantu excavator - Jangan tergesa-gesa saat
- Area kerja tidak steril dari C 4 melakukan pekerjaan.
Mterial lain M - Menggunakan APD E 5 L
 Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d
Kordinasikan sebelum 123 Site supervisor
C 2 melakukan pekerjaan 456
- pekerja terkena swing alat
H - operator dan riger harus
berat
E 5 L
diakukan oleh orang yang 123
kompeten yang sudah memili 456
Site supervisor
SIO
- komuniksi 2 arah selama
pengangkatan
- sebelum memulai
pengangkatan sterilkan terleih
dahulu area kerja
- beri safey ling area
pengangkatan
- yang tidak berkepentingan
dilarang masuk lokasi
pengangkatan
- memberi tanda aktivitas
pengangkatan sedang
 Hie
Initial Risk rar
Assessment ch
without REQUIRED HAZARD y
CONTROL of
Controls Co
For each hazard identified list the Risk Assessed
ntr
control measures required to ols
with Controls
eliminate or minimize the risk of co
injury nsi
JOB STEP POTENTIAL HAZARD der
RESPONSIBLE
ed
PERSON
Cro
NO. List the steps Against each step list the ss P Nominate the person
required to perform potential / risk hazards that P R out r R
r who will be required to
the task in the could cause injury / damage a con o a
o n trol b n action the control
sequence they are when the task step is b k s a k measures
carried out performed a Con ( not b
Con (
bi seq L pra seq L
il
lit uen , (use hierarchy of controls – at end of ctic it
uen ,
y ce M this form) abl ce M
y
( (1-5) e. (1-5)
(
A o Cir o
A
- r cle r
-
E H con H
E
) ) trol )
)
use
d
berlangsung
Terpeleset/Terperosok C 4 L 123 E 5 L Site supervisor
456
- Identifikasi potensi bahaya
diarea kerja. 123
- Terkena swing alat berat C 2 H - Memastikan keadaan alat 456 Site supervisor
tidak ada kendala saat E 5 L
Pengurukan tanah
pekerjaan di mulai 123
9 kembali ke saluran - Tertimpa tanah longsor C 2 H E 5 L Site supervisor
- Jangan tergesa-gesa saat 456
drainase melakukan pekerjaan.
- Menggunakan APD 123
- Kena gas sisa bahan bakar C 4 M Kordinasikan sebelum 456 Site supervisor
E 5 L
melakukan pekerjaan
123
- Alat berat terbalik C 2 M 456 E 5 L Site supervisor