JSA WORKSHEET

HOW TO USE THIS FORM Installation/Facility INC1 AREA

Location KUALITI ALAM

1. Crew performing task reviews ALL generic JSA considerations. Associated Work Permit Type
2. Review previous JSA updates for useful information which will help this task.
3. Create new JSA update with generic form and ALL considerations for this task. Associate Work Permit Number
4. Carry out tasks as per plan. If any conditions change - STOP AND RE-ASSESS
5. File JSA update for future reference.

Work Description RECONSRTUCTION OF BUND WALL JHA Reference Number IRV/JHA/001

JOB HAZARDS ANALYSIS

Job Description of Potential Control Recovery
Potential Hazards L S R L S R Result
Step Job Steps Impact Measures Measures
-Driver is driving only in the
minimum speed limit.
- Put speed limit sign at
Mobilization and - person will slip, 1 2 2
1 -Physical injury site area 1 1 1 ACCEPTABLE
demobilization trip and fall. -ensure that a driver is
having knowledge to the
hazard.
-failure of lifting
-All lifting operation shall be
Unloading of - people will 1 2 2 planned in prior to the
-physical injury - Apply STOP work
materials at the suffer limb operation
2 policy 1 1 1 ACCEPTABLE
site using heavy fractures. .
-Property damage.
equipment. 1 2 2 -Use appropriate PPE.
- Hit by falling items
1 3 3
- PPE plus face shield,
- Personal injury - Apply STOP work 1 1 1
- firewatcher c/w fire
Use of hand and - Eye injury; (face) 1 2 2 policy
extinguisher.
3 power tools – Lacerations and hand - Burn 1 1 1 ACCEPTABLE
- Wear appropriate hand
General injuries - Finger get 2 1 2 - Apply first aid
protection
caught in pinch measure 1 1 1
area 1 2 2

- Absence of worker, - All pouring operation shall - Apply STOP work

Concrete - personal injury,
4 major damage 2 2 2 be planned in prior to the policy 1 1 1 ACCEPTABLE
Pouring Property injury
equipment/ property operation

- Apply STOP work

- pinch point, hand - Use appropriate PPE 1 1 1
Form, install and - personal injury, policy
5 injury, cut from sharp 1 2 2 - Always keep fingers away ACCEPTABLE
fixing finger cut - Apply first aid
surface between wood and concrete 1 1 1
measure
 JSA WORKSHEET

HOW TO USE THIS FORM Installation/Facility INC1 AREA

Location KUALITI ALAM

1. Crew performing task reviews ALL generic JSA considerations. Associated Work Permit Type
2. Review previous JSA updates for useful information which will help this task.
3. Create new JSA update with generic form and ALL considerations for this task. Associate Work Permit Number
4. Carry out tasks as per plan. If any conditions change - STOP AND RE-ASSESS
5. File JSA update for future reference.

Work Description RECONSRTUCTION OF BUND WALL JHA Reference Number IRV/JHA/001

Job Description of Potential Potential Control Recovery

L S R L S R Result
Step Job Steps Hazards Impact Measures Measures
Apply STOP work
Handling - Accident 1 2 2 Check for dent, faulty 1 1 1
6 Faulty equipment policy ACCEPTABLE
machineries -machine broken 1 2 2 Check for safety devices 1 1 1
Apply first aid measure
- Asphyxiation
2
- Dust 1 2 -Regular PPE including dust 1 1
1
- Slip, trip and mask Apply STOP work
2
- Obstruction fall 1 2 - Buddy system policy 1 1
Housekeeping 1
- Barricade work area
7 2 ACCEPTABLE
- Manual handling - Back ache 1 2 Apply first aid measure 1 1
1
2
- Sharp edge - Minor injury 1 2 1 1
1
(hand)
 JSA WORKSHEET

HOW TO USE THIS FORM Installation/Facility INC1 AREA

Location KUALITI ALAM

1. Crew performing task reviews ALL generic JSA considerations. Associated Work Permit Type
2. Review previous JSA updates for useful information which will help this task.
3. Create new JSA update with generic form and ALL considerations for this task. Associate Work Permit Number
4. Carry out tasks as per plan. If any conditions change - STOP AND RE-ASSESS
5. File JSA update for future reference.

Work Description RECONSRTUCTION OF BUND WALL JHA Reference Number IRV/JHA/001

L - LIKELIHOOD S - SEVERITY R - RATING RESULT

S
CATEGORY DEFINITION CATEGORY DEFINITIONS E H 3 6 9 6-9 UNACCEPTABLE
No V
LOW 1 Remote LOW 1 No Injury No Damage E M 2 4 6 3-4 TOLERABLE
Pollution
MEDI Minor R
2 Possible MEDIUM 2 First Aid Minor Damage I L 1 2 3 1-2 ACCEPTABLE
UM Pollution
Major T
HIGH 3 Probable HIGH 3 Lost Time Injury Major Damage Y L M H
Pollution
IS THERE A SAFER WAY TO COMPLETE THE JOB? ARE THERE ALTERNATIVES WITH LESS RISK? LIKELIHOOD

JHA Number Date This JHA Created: 05/08/2022

TASK SAFETY MANAGEMENT OUTLINE
001 Date JHA Last Revised: 01/11/2022

WORK ACTIVITY EQUIPMENT

Type of Equipment Manufacturer Tag No Precise Work Site

N/A N/A N/A INC1 AREA

WORK ACTIVITY PARTICIPANTS THIS JHA CREATED BY

Name Discipline Position Performed Job Before? Name Discipline Position

RONSIFASLA CIVIL SUPERVISOR YES NMK CIVIL ENGINEER

REDZUAN CIVIL WORKER YES

SHAFIQ CIVIL WORKER YES

YASIR CIVIL WORKER YES

ABDUL CIVIL WORKER YES

WORK ACTIVITY RESPONSIBILITY JHA SUBMITTED BY JHA ACCEPTED BY

Name ARIEFF Name NABILAH

Signature Signature

Date 01/11/2022 Date 01/11/2022

Time 06:11PM Time 06:11PM