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    Form JSA

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    Della Dwinovalia
    The document is a Job Safety Analysis form for an online training session taking place via Zoom meeting. It lists potential hazards such as electric shock from tripping on cables, ergonomic issues and eye strain from laptop/smartphone use. It also provides ways to eliminate or control these hazards, such as stretching every 30 minutes and taking breaks to rest the eyes. The form notes critical safety questions that must be addressed and required personal protective equipment for online work.

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    Form JSA

    Uploaded by

    Della Dwinovalia
    20 views2 pages
    The document is a Job Safety Analysis form for an online training session taking place via Zoom meeting. It lists potential hazards such as electric shock from tripping on cables, ergonomic issues and eye strain from laptop/smartphone use. It also provides ways to eliminate or control these hazards, such as stretching every 30 minutes and taking breaks to rest the eyes. The form notes critical safety questions that must be addressed and required personal protective equipment for online work.

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    The document is a Job Safety Analysis form for an online training session taking place via Zoom meeting. It lists potential hazards such as electric shock from tripping on cables, ergonomic issues and eye strain from laptop/smartphone use. It also provides ways to eliminate or control these hazards, such as stretching every 30 minutes and taking breaks to rest the eyes. The form notes critical safety questions that must be addressed and required personal protective equipment for online work.

    Copyright:

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

    Form JSA

    Uploaded by

    Della Dwinovalia
    The document is a Job Safety Analysis form for an online training session taking place via Zoom meeting. It lists potential hazards such as electric shock from tripping on cables, ergonomic issues and eye strain from laptop/smartphone use. It also provides ways to eliminate or control these hazards, such as stretching every 30 minutes and taking breaks to rest the eyes. The form notes critical safety questions that must be addressed and required personal protective equipment for online work.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Form No: JAS-HSE-JSA FORM Revision No: 01

    JOB SAFETY ANALYSIS


    PT. JAVARO ABADI SEJAHTERA

    WORK ACTIVITY (JOB) TITLE: Online Training DATE: 31 Oktober 2022


    LOCATION : Zoom Meeting JSA NO:
    WORK TEAM REVIEWED BY: JSA PREPARED BY:
    1. Signature:
    1. R GUSTI 7. 2. Signature:
    2. RENDRA 8. Name : Instruktur 3. Signature:
    3. 9. Signature:__________________ 4. Signature:
    4. 10. 5. Signature:
    5. 11. 6. Signature:
    6. 12.
    CRITICAL QUESTIONS: Everyone Ready/Capable To Work? Potential Spill/Gas Release Addressed? Worst Case Discussed?

    REQUIRED SAFETY EQUIPMENT


    Hard Hats Goggles Safety Harness Hearing Protection Barricades Other (List): To provide Hi – Viz vest when working close
    V Safety Shoes Face Shield V Cotton Gloves Flame Resistant Clothing LEL Monitor to the road________________________________
    V Safety Work Vests V Leather Fire Extinguisher H2S Monitor _____________________________________________
    Glasses Gloves _____________________________________________
    APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS
    V Hot Work Permit Special Pre-Job Safety Discussions Confined Space Entry Permit Pollution Prevention Measures
    Energy Isolation Review Emergency Action Plans Use of Specialized PPE Redundant Protection Measures
    V Written Procedure Site/Job Orientation Overhead/Underground Utility Lines Simultaneous Operations
    POTENTIAL HAZARDS
    Lifting Hazards V Short Service Employees V Elec. Shock/ Flash Dropped/Falling Objects Low Lighting Ionizing
    V Fall Potential Water/Drowning Hazard (includes utility lines) Tripping/Slipping Breathing Hazard Radiation
    Skin Irritants Mech. Equip. Hazards Haz. Chemical Exposure Excavation Hazard Environmental Other Ergonomic,
    Confined Spaces Fire/Explosion Potential (includes H2S) Confined spaces Extremes electrical from
    Elev. Load/Work High Noise Levels Sharp Edges or Hot/Cold Elevated load or work Vehicle Operations electronic device
    surfaces
    Pinch/Crush/Striking
    Hazards
    Potential Release of
    Energy
    Form No: JAS-HSE-JSA FORM Revision No: 01
    BASIC JOB STEPS POTENTIAL INCIDENTS OR WAYS TO ELIMINATE OR CONTROL HAZARDS PIC
    HAZARDS
    Persiapan Tersetrum,Tersandung kabel 5R
    Penggunaan Laptop/smartphone Ergonomi, pengelihatan kabur Peregangan, setiap 30 menit merehatkan pengeliatan
    Telemarketing Tersetrum,Tersandung kabel 5R
    Canvasing Kepanasan, kecelakaan lalu lintas Tidak berkendara dalam keadaan mengantuk,
    menggunakan alat pelindung diri dalam berkendara,
    menggunakan sunblock

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