Job Safety Analysis (JSA) Worksheet Attachment III PTW No.: - Date Issued
Job Safety Analysis (JSA) Worksheet Attachment III PTW No.: - Date Issued
Job Safety Analysis (JSA) Worksheet Attachment III PTW No.: - Date Issued
Location :
Existing Operation Canteen Building At Bintulu Port
Date :
Page : _______ of _______
New
Rev. No. :
Revised
Primary Hazard :
Cutting and puncturing hazard to body part. Muscular strain/Back pain (Ergonomic issue).
Step
No.
Hazards (Potential
Incident)
Hand & finger cut and
injury. Muscular
strain/Back pain
(Ergonomic issue).
Hand & finger cut and
injury. Muscular
strain/Back pain
(Ergonomic issue).
Supervisor :
LUDAN AK NIRA
Action / Responsible
Party
Workers
Site Supervisor
Workers
Site Supervisor
Workers
Site Supervisor
Workers
Site Supervisor
Workers
Site Supervisor
Analysis by :
SAHARRUDIN BIN
ABDOL WAHET
Reviewed by :
JALIN AK GEORGE
Acknowledged / Approved by :
JALIN AK GEORGE
Attachment III
PTW No. : _______________
Date Issued : _______________
I/C Or Passport
No.
Citizenship
Designation
JALIN AK GEORGE
850621-13-5727
MALAYSIA
CONSTRUCTION MANAGER
ASIR AK PAONG
GIBSON AK SAOH
EDDY AK KUDANG
GEORGE AK SAPIT
ROLAND AK ASIR
NINGKAN AK CHALANA
MORIS LANGI
700101-13-6183
890629-13-5031
800717-13-6059
900816-13-7047
950728-13-6525
750324-13-5415
741127-13-5665
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
SITE SUPERVISOR
BACKHOE OPERATOR
CARPENTER & PLASTERER
GENERAL WORKER
GENERAL WORKER
CARPENTER & BARBENDER
CARPENTER & BARBENDER
SANDAI AK SANDAH
DONNY ROY AK BERINJAN
JULY AK ENTRING
LUDAN AK NIRA
ALAN ANAK MORSIDI MANAI
770101-13-5061
900103-13-7733
740731-13-5587
750712-13-5257
780103-13-5961
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
Signature
Note: Please fill in at the appropriate column below i.e. name of company, your name, signature and stamp, and date.
Name List of Manpower Involved
# All workers involved in this work process have being briefed and shall observe and comply with the requirements of this JSA at all times.
No. Name
14.
15.
16.
17.
18.
19.
20.
I/C Or Passport
No.
Citizenship
731019-13-5685
570502-13-5787
720820-13-6583
611010-13-5551
760213-13-5067
860221-13-5567
851012-13-6809
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
Supervisor :
LUDAN AK NIRA
Designation
Signature
Analysis by :
SAHARRUDIN BIN
ABDOL WAHET
Reviewed by :
JALIN AK GEORGE
Acknowledged / Approved by :
JALIN AK GEORGE
21.
22.
23.
24.
25.
26.
SIMON AK JAWA
ECHAM AK ANDREW ANDIN
RABONG ANAK ASANG
MANGKA AK LENG
RENTAP AK NAWAI
MUHAMAD SHAHRIN ABDULLAH
660726-13-5283
870227-52-6875
571217-13-5395
790510-13-6055
781217-13-5323
720605-13-5799
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
MALAYSIA
Attachment III
PTW No. : _______________
Date Issued : _______________
GENERAL WORKER
GENERAL WORKER
GENERAL WORKER
GENERAL WORKER
RUNNER AND STORE KEEPER
SITE SUPERVISOR
Note: Please fill in at the appropriate column below i.e. name of company, your name, signature and stamp, and date.
No. Name
I/C Or Passport
Citizenship Designation
Signature
No.
27.
28.
29.
JAMIE AK ANGIL
BONNY AK ANGIL
ACHONG AK NIBONG
870618-13-6581
970811-13-6647
650525-13-6299
MALAYSIA
MALAYSIA
MALAYSIA
Note: Please fill in at the appropriate column below i.e. name of company, your name, signature and stamp, and date.
Supervisor :
LUDAN AK NIRA
Analysis by :
SAHARRUDIN BIN
ABDOL WAHET
Reviewed by :
JALIN AK GEORGE
Acknowledged / Approved by :
JALIN AK GEORGE