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Sample JSA

This document provides a job safety analysis for cutting, grinding, and welding activities. It records the work area, required personal protective equipment like helmets and gloves, working time, and potential hazards from the activities. For each basic job step, it identifies potential incidents or hazards and ways to eliminate or control those hazards, such as descriptions of safety measures.

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4nd13s.lf
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40 views1 page

Sample JSA

This document provides a job safety analysis for cutting, grinding, and welding activities. It records the work area, required personal protective equipment like helmets and gloves, working time, and potential hazards from the activities. For each basic job step, it identifies potential incidents or hazards and ways to eliminate or control those hazards, such as descriptions of safety measures.

Uploaded by

4nd13s.lf
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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JOB SAFETY ANALYSIS

Analisa Keselamatan Kerja


WORK ACTIVITY
Aktifitas Pekerjaan Cutting, Grinding & Welding Activity

RECORD OF CHANGES Any Change? / Ada perubahan? □ Yes □ No NAME SIGNATURE


Catatan Perubahan IF ANY ADDITIONAL ACTIVITY OR HAZARDS, PLEASE DESCRIBE AT ROW PROVIDED AT THE END Nama Tanda tangan
Jika terdapat tambahan kegiatan atau potensi bahaya, harap mengisi di baris bagian akhir

WORK AREA TS PIC Acknowlodge:


Area Kerja

WORKING TIME DATE/Tanggal: START TIME/Waktu mulai: END TIME/Waktu selesai: Site supervisor/Foreman:
Durasi waktu bekerja

Required/Recommended PPE : Name of Subcontractor:


Helmet Safety Shoes Safety Glasses Face shield Ear protection (single or double)
Respirator Hand Gloves Body Harness Dust Mask Other / Lainnya:

WAYS TO ELIMINATE OR CONTROL HAZARDS


BASIC JOB STEPS POTENTIAL INCIDENTS OR HAZARDS CARA MENGHILANGKAN ATAU PENGENDALIAN BAHAYA
LANGKAH DASAR PEKERJAAN POTENSIAL KEJADIAN ATAU BAHAYA
Description Y N N/A
1.
  1.1.1.1.

 1.1.1.1.

  1.1.1.2.

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