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1. FORM JSA
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1. FORM JSA
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Author:
Ilham Dwi Anshori
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PT PLN (PERSERO) TRANSMISI JAWA BAGIAN TENGAH
FORMULIR JOB SAFETY ANALYSIS
No. Dokumen Edisi / Revisi Berlaku Efektif Halaman
FK3/008 01 / 00 03 Februari 2016 1 dari 2
JOB SAFETY ANALYSIS : APP
: ......................................................................
LOKASI
: .....................................................................
TANGGAL
: ....................................................................
KONDISI PERALATAN : BEBAS TEGANGAN / BERTEGANGAN NAMA PEKERJAAN
NO
: ....................................................................
TAHAPAN PEKERJAAN
POTENSI BAHAYA 1
1 2 1 2 2 1 3 2 1 4 2 1 5 2
Dianalisa oleh
: SPV JARGDI
Diperiksa oleh
: Pengawas K3
Disetujui
: ASMAN HASET
( ……............. …….............……..……………. ……..……………. )
( …………............. ………….............……………… ……………… )
( …………............. ………….............……………….) ……………….)
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