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    Jobs Safety Analysis (JSA) : Date

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    Syandi Perdana
    This document is a job safety analysis for PT. PELAYARAN SYANDI ARUNG SAMUDERA. It lists potential hazards and controls for basic job steps but does not specify the actual job or steps. Workers and supervisors must sign to acknowledge understanding of the hazards and agree to follow the controls. The area manager also signs to authorize the work in the specified locations.

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    Jobs Safety Analysis (JSA) : Date

    Uploaded by

    Syandi Perdana
    50 views2 pages
    This document is a job safety analysis for PT. PELAYARAN SYANDI ARUNG SAMUDERA. It lists potential hazards and controls for basic job steps but does not specify the actual job or steps. Workers and supervisors must sign to acknowledge understanding of the hazards and agree to follow the controls. The area manager also signs to authorize the work in the specified locations.

    Original Description:

    CONTOH JSA

    Original Title

    Job Safety Analysis

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    This document is a job safety analysis for PT. PELAYARAN SYANDI ARUNG SAMUDERA. It lists potential hazards and controls for basic job steps but does not specify the actual job or steps. Workers and supervisors must sign to acknowledge understanding of the hazards and agree to follow the controls. The area manager also signs to authorize the work in the specified locations.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    50 views2 pages

    Jobs Safety Analysis (JSA) : Date

    Uploaded by

    Syandi Perdana
    This document is a job safety analysis for PT. PELAYARAN SYANDI ARUNG SAMUDERA. It lists potential hazards and controls for basic job steps but does not specify the actual job or steps. Workers and supervisors must sign to acknowledge understanding of the hazards and agree to follow the controls. The area manager also signs to authorize the work in the specified locations.

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    Jobs Safety Analysis Date :           

    PT. PELAYARAN SYANDI ARUNG SAMUDERA (JSA)


    JOB/ACTIVITY NAME: JSA #:

    DEPARTMENT/GROUP NAME AREA LOCATION(s): OTHER INFORMATION:

    REQUIRED PERSONAL PROTECTIVE EQUIPMENT FOR ENTIRE JOB


    safety glasses safety shoes chemical resistant gloves other __________________      other____________________
    chemical goggles hard hat welding gloves
    face shield harness lanyard leather gloves other ___________________ other____________________
    welding goggles hearing protection

    Basic Steps Potential Hazards Controls


    (Langkah Dasar Pekerjaan) (Potensi Dapat Terjadi Kecelakaan) (Prosedur Kerja Secara Aman)

    412557923.doc Page 1 of 2
    I understand & will adhere to the steps, hazards & controls as described in this JSA. I understand that
    performing steps out of sequence may pose hazards that have not been evaluated, nor authorized. I
    will contact my supervisor prior to continuing work, if the scope of work changes or new hazards
    are introduced. I understand I have the authority
    and responsibility to stop work I believe to be unsafe.

    Worker Name Signature Date


    ____

    ____

    ____

    ____

    I have reviewed the steps, hazards & controls described in this JSA with all workers listed above and
    authorize them to perform the work. Workers are qualified (i.e. licensed or certified, as appropriate, & in
    full compliance with SLAC training requirements) to perform this activity.
    ____

    Supervisor Signature Date

    I have communicated area hazards with the supervisor or listed worker(s) for this activity and have
    coordinated the described activity with affected occupants. The above listed workers are released to
    perform described scope of work in the following area(s):

          ____

    Area Manager Signature Date


    Page 2 of 2

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