DATE : 06.11.

02

REVISION : 00

TITLE : Job Safety Analysis Worksheet

Job Safety Analysis Worksheet Lembar Analisa Keselamatan Kerja

Reference No.: No. Referensi: Division, Department / Contractor Company: Divisi, Departemen / Perusahaan Kontraktor: Title of Person who does Job: Jabatan orang yang Mengerjakan Pekerjaan: Job: Pekerjaan: Work Location: Lokasi Kerja: Contract No.: No. Kontrak:

COM-TS-TK-TKS
Managers, coordinators, and supervisors

Production Line / Project: Lini Produksi / Proyek: New / Activites Revision: Baru / Revisi Aktivitas :

Telkomsel- TINEM Project New

Logistic, SITAC, CME, and Implementation Activity Site RAGUKLAMPITAN (JPA024)

Date: Tanggal:

2-Aug-07
Signature / Tanda Tangan

Name, position and signature of the JSA team members. Nama, jabatan dan tanda tangan dari anggota tim JSA Hadi Suprayitno : CME Coordinator (

Name, position and signature of the person reviewed and approved: Nama, jabatan dan tanda tangan dari orang yang telah meninjau dan menyetujui:

Signature / Tanda Tangan

Distribution: Line Manager, Corporate Safety Distribusi: Manager Lini, Corporate Safety Scoring Table of Effect "E", Probability "P" and Frequency "F" Tabel Penilaian Akibat "E", Kemungkinan "P" dan Frekwensi "F" Scoring Penilaian Effect "E" Akibat "E" Harm Luka Sickness Sakit Serious invalidity Cacat berat Fatal Fatal Catastrophe Bencana Probability "P" Kemungkinan "P" Unlikely Kecil kemungkinan Not normal Tidak biasa Possible Mungkin Expected can happen Diperkirakan bisa terjadi Expected will happen Diperkirakan akan terjadi Potential Hazards Bahaya Potensial

Arief Wibisono yohanes ( Area manager Mid Java & DIY ) Risk Assessment Score "R" Angka Penilaian Risiko "R" Frequency "F" Frekwensi "F" Seldom (yearly) Jarang (setahun sekali) Sometimes (monthly) Kadang-kadang (sebulan sekali) Weekly Seminggu sekali Regularly (daily) Teratur (setiap hari) Always Selalu Continuously Terus menerus

R=E+P+F

1 2 3 6 7 10 40

Low risk Risiko rendah Medium risk Risiko sedang High risk Risiko tinggi

R < 10 10 R < 19 19 R

Basic Job Steps Langkah Dasar Pekerjaan

Solutions / Risk Control Plans Solusi / Rencana Pengendalian Risiko

SITAC Activity
a. Site Acquisition b. Technical site survey - Community problem - neighbour problems that close with site

7 7

10 6

2 1

19 14

Use the right permit procedure, held on appropriate community sociallization, make sure that all problem which related with all CME work are clear before CME activity started.That problems including land and access clearing from tree

LOGISTIC Activity
a. Material unloading - Hit by fallen heavy material - twisted muscle a. Material unwraping checking c. Material lifting - injured due too using tools - scratched by wraping wood - hit by fallen materials and scratched

7 3 3 3 7

6 6 6 6 3

1 1 1 1 1

14 10 10 10 11

Use the right procedure and methods, use the relevant PPE Use the following Dop : - Ergonomic : ( Dop 06-16 ) - Loading and unloading : ( Dop 06-33 ) - Safety sign : ( Dop 06-46 ) Use The relevant PPE - Manual Handling : ( Dop 09-01 ) Use The relevant PPE

Author : BE Printed Date : 11/12/2013

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DATE : 06.11.02

REVISION : 00

TITLE : Job Safety Analysis Worksheet

Job Safety Analysis Worksheet (continued) Lembaran Analisa Keselamatan Kerja (lanjutan) Basic Job Steps Langkah Dasar Pekerjaan Potential Hazards Bahaya Potensial Reference No.: No. Referensi:

Solutions / Risk Control Plans Solusi / Rencana Pengendalian Risiko

CME Activity
Pre Reconstruction Requirments a. Site Survey b. soil test ( sondir and boring) Civil, Mechanical, Electrical works a. Tower Foundation construction - Exavation - fall into exavation area - Hesped up by landslide - Exavation waste soil - Steel bar reinforcement preparation - Formwork / Bekisting - Injury due to using tools - Injury due to using tools - Fall from height - Concrete Pouring - Forms stripping and soil bacfilling b. Tower Construction - Tower erection - Fall from height - hit by fallen materials - Ascesorris Installation - Fall from height - hit by fallen materials - Tower painting - Fall from height - hit by fallen materials - ahocked by lightning - Dehidration - Scratched c. Base frame construction - base frame foundation construct d.Base Frame Installation - Base frame member installation - Injury due to using tools - Fall from height - Electric Shock when using bore tool e. Grounding Installation - Tower, base frame and fence grounding - Injury due to using tools - Shocked by Lightning - Scratched f. Fence, paving and Yard - Backfilling and soil compaction - Fence construction - Paving block Installation - Injury due to using tools - Injury due to using tools - Injury due to using tools - Injury due to using tools - Injury due to using tools - Injury due to using tools - Neighbour problem (near site) - Injury due to using tools

7 7

1 3

1 1

9 11

Use the right permit procedure and appropriate community sociallization Use the manual, use PPE, use the right methods

7 10 3 1 3 7 3 3

3 3 6 6 6 3 1 3

2 1 2 2 2 1 1 1

12 14 11 9 11 11 5 7

use the right methods with appropriate supervision, provide a safety area signs Prepare a proper area for that soil exavation

work carefully and use glove and safety shoes

work carefully and use glove and safety shoes, need appropriate supervision

Use the right methos, use glove, safety shoes, need appropriate supervision too Use the right methos, use glove, safety shoes, need appropriate supervision too

10 10 10 10 10 10 10 3 3

10 10 10 10 10 10 6 6 3

1 1 1 1 1 1 1 3 1

21 21 21 21 21 21 17 12 7

Recommended to be done by quilified personals. Use the right methods and PPE need appropriate supervision work carefully, use helmet, make sure that erection area are clear Recommended to be done by quilified personals. Use the right methods and PPE need appropriate supervision work carefully, use helmet, make sure that erection area are clear Recommended to be done by quilified personals. Use the right methods and PPE need appropriate supervision work carefully, use helmet, make sure that erection area are clear Avoid rainy when installation prepare dringkin water, Work carefully and use glove

work carefully, use the right methods and relevant PPE

3 7 10

1 3 1

1 1 1

5 11 12

work carefully, use the right methods Recommended to be done by quilified personals. Use the right methods and relevant PPE

1 7 3

3 3 3

1 1 1

5 11 7

Check the equipment always, use the right methods Avoid working when rainy day Work carefully and use safety glove

3 1 1

3 3 3

1 1 1

7 5 5

Recommended check every single equipments, use the right methods, use safety shoes, gloves, prepare good skafolding

Author : BE Printed Date : 11/12/2013

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DATE : 06.11.02

REVISION : 00

TITLE : Job Safety Analysis Worksheet

Job Safety Analysis Worksheet (continued) Lembaran Analisa Keselamatan Kerja (lanjutan) Basic Job Steps Langkah Dasar Pekerjaan Potential Hazards Bahaya Potensial

Reference No.: No. Referensi:

E 1 10 10

P 3 10 3

F 1 1 1

R 5 21 14

Solutions / Risk Control Plans Solusi / Rencana Pengendalian Risiko work carefully, and check every equipments that used Work carefully, recommended to not working at rainy day Use relevant PPE, prepare good stair

f. KWH meter installation, and PLN

- Injury due to using tools - Shocked by Electricity

Connection - Fall from height

Author : BE Printed Date : 11/12/2013

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SITE ID : 0 SITE NAME : 0

HEALTH & SAFETY CHECKLIST

Item Nr. Description I. GENERAL Emergency call numbers displayed on site (police, hospital, fire brigade) Fire estinguisher is available on site (if required) First aid kit & First Aider is available on site Health & Safety related issues (e.g. accident/incident) has been reported to project management Health & Safety responsible person on site Risk assessment and job safety analysis (JSA) are conducted with appropriate control and submitted to NSN representatives and EPM system. Safety sign is available on site (signboards) Personnel on site has a copy or understand the objectives of Nokia Siemens Networks Health & Safety Policy Barriers to access the site have been erected. Team understands the Nokia Siemens Networks Safe working practices & procedures. Electromagnetic Radiation Hazards are known by personnel on site. Daily prestart briefing must be conducted prior to commencement of work activities. E M H H H H M M Risk Rating Finding

Score

Observation

1001 1002 1003 1004 1005 1006 1007 1008

U U U U U U U U

8 2 4 4 4 4 2 2

1009 1010 1011 1012

H H H H

U U N/A U

4 4

4 38

Total Score General II. 1101 1102 1103 1104 1105 1106
SITE ACCESS Access by unauthorized persons to site is prevented. Access to site is in safe condition for every circumstances Designated walkpath routes free of tripping and sliping hazards Emergency exits are clearly visible and free of obstacles Access by unauthorized persons to site is prevented. Access lighting to BTS is working and sufficient H M M M H H

U U U U U U

4 2 2 2 4 4 18

Total Score Site Access

November 2007

Print date: 11/12/2013

NSN-PSI-002 Health and Safety Inspection

SITE ID : 0 SITE NAME : 0

III. 1201 1202 1203 1204 1205 1206

PERSONNEL All personnel have undergone health assessment prior to work on site. Personnel on site must be fit to work Personnel must be competent to perform work safely (Safety trained) Individuals are supervised according to their capabilities and the degree of risk of the task No underage workers employed General public individuals shall not be allowed on site without safety Induction or PPE. Personnel from other companies and contractors, not under the responsibility of the assessed subcontractor, shall be advised about the Safety requirements of working on site. H H H H E H

U U U U U U

4 4 4 4 8 4

1207

2 30

Total Score Personel

IV. WORKING TOOLS & EQUIPMENTS Hand tools are in good and safe condition Hand tools are used properly Machinery tools & rigging equipment are in good and safe condition Power tools are in good and safe condition Lifting equipment must be safe & checked prior to use. H M H M H

1301 1302 1303 1304 1305

U U U U U

4 2 4 2 4 12

Total Score Working Tools & Equipments

V. PERSONAL PROTECTIVE EQUIPMENT Personal Protective Equipment is standardize, functioning and maintained All personnel on site are using Hard Hat (helmet). All personnel on site are using Safety Shoes All personnel working at height are using the full body harness per NSN specifictions. All personnel are using additional specific required PPE according to the work hazard H H H E H

1401 1402 1403 1405 1406

U U U U U

4 4 4 8 4 12

Total Score Personal Protective Equipment

VI. ANTENNA/FEEDER ACCESS Safe access to antenna & feeder and other are enabled Pole ladder reaching working height on antenna level Positions of safety systems (ladders, anchor points, platforms, and etc) is practical and safe for use Radiation meter on site. EMF Hazards are clearly marked on site. H H M H

1501 1502 1503 1504 1505

U U U N/A N/A

4 4 2

Total Score ANTENNA/FEEDER ACCESS

November 2007

Print date: 11/12/2013

NSN-PSI-002 Health and Safety Inspection

SITE ID : 0 SITE NAME : 0 VII. MATERIAL HANDLING Appropriate storage system is in place Loading area is clearly defined, marked and free from obstacles. Site is clear from hazardous substances (or under controlled storage) in line with MSDS M M M

1601 1602 1603

U U U

2 2 2 6

Total Score Material Handling

SUMMARY OF INSPECTION SCORING

122

Item / Area
I. II. III. IV. V. VI. VII. GENERAL SITE ACCESS PERSONNEL WORKING TOOLS & EQUIPMENTS PERSONAL PROTECTIVE EQUIPMENT ANTENNA/FEEDER ACCESS MATERIAL HANDLING

Maximum Score

Score
38 18 30 12 12 6 6

42 18 30 12 12 12 6

OVERALL RATING

Total

132
A

122
B

92%
B/A*100

Project Baseline Health & Safety Performance Indicator: Maximum of 30% of total score is acceptable

November 2007

Print date: 11/12/2013

NSN-PSI-002 Health and Safety Inspection

Observation

November 2007

Print date: 11/12/2013

NSN-PSI-002 Health and Safety Inspection

November 2007

Print date: 11/12/2013

NSN-PSI-002 Health and Safety Inspection

122

r: Maximum of 30% of total score is acceptable

November 2007

Print date: 11/12/2013

NSN-PSI-002 Health and Safety Inspection

DATE : 14.07.03

REVISION : 00

P.T. SIEMENS INDONESIA

TITLE : Hazards Identification Sheet / Lembar Identifikasi Bahaya

Hazards Identification Sheet Lembar Identifikasi Bahaya

Reference No. : No. Referensi :

GL - COM - TKS - 0001 - 00 COM - TKS

Managers, Coordinators, and Supervisors

Contract No. No. Kontrak

: :

Division, Department / Contractor Company : Divisi, Departemen / Perusahaan Kontraktor : Title of Person who does Job : Jabatan orang yang Mengerjakan Pekerjaan : Job Pekerjaan : :

Production Line / Project : Lini Produksi / Proyek : New / Revision Baru / Revisi : :

Telkomsel - National Region

Revision - 01

Logistic, SITAC, CME, and Implementation Activity On site

Date Tanggal : :

Work Location : Lokasi Kerja :

February 15, 2006

Signature / Tanda tangan

Name, position and signature of the Hazards Identification team members. Nama, jabatan dan tanda tangan dari anggota tim Identifikasi Bahaya.

Moerhadi

QHSE Manager for Telkomsel

Didiet Priatmadji

Tinem OSP QHSE Officer

Atri Bolivar

Tinem BMN PM

Ishak Halim

Tinem OSP PM

Name, position and signature of the person reviewed and approved : Nama, jabatan dan tanda tangan dari orang yang telah meninjau dan menyetujui :

Distribution: Line Manager, Corporate Safety Distribusi : Manager Lini, Corporate Safety

( Herman Santoso ) COM Safety Representative

( Karsten Isenbeck GPM Tinem OSP

( K. H. Koesters GPM Tinem BMN

Scoring Table of Effect "E", Probability "P" and Frequency "F" Tabel Penilaian Akibat "E", Kemungkinan "P" dan Frekwensi "F" Scoring Penilaian Effect "E" Akibat "E" Harm Luka Probability "P" Kemungkinan "P" Unlikely Kecil kemungkinan

Risk Assessment Score "R" Angka Penilaian Risiko "R" Frequency "F" Frekwensi "F" Seldom (yearly) Jarang (setahun sekali) Sometimes (monthly) Kadang-kadang (sebulan sekali) Weekly Seminggu sekali Regularly (daily) Teratur (setiap hari)

R=E+P+F

1 2 3 6 7 10 40

Low risk Risiko rendah

R < 10

Sickness Sakit

Not normal Tidak biasa Possible Mungkin

Medium risk Risiko sedang

10 R < 19

Serious invalidity Cacat berat Fatal Fatal Catastrophe Bencana Potential Hazards Bahaya Potensial

Expected can happen Diperkirakan bisa terjadi Expected will happen Diperkirakan akan terjadi

Always Selalu Continuously Terus menerus

High risk Risiko tinggi

19 R

Solutions / Risk Control Plans Solusi / Rencana Pengendalian Risiko

Machinery Permesinan

Soil Test - Sondir & boring Excavation work : - Excavator back hoe 7 1 1 9
Define the right and safe place, make sure the excavation area is clear.

11

Define the right and safe place.

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Concrete work : - Ready mix truck - Ready mix pump - Molen / Concrete mixing - Vibrator Other: - Compactor - Genset
Equipment Perlengkapan

3 3 3 1

1 1 1 1

1 1 1 1

5 5 5 3

Supervise, define the right and safe place.

Maintenance, define the right and safe place.

1 1

1 3

1 1

3 5

Maintenance, define the right and safe place.

- Mattock/Hoe (cangkul) - Electric Drill (bor listrik) - Tackle (katrol) - Electric Saw (gergaji listrik)
Workplace Tempat Kerja

1 3 7 7

6 3 3 3

1 1 1 1

8 7 11 11

Check Equipment, routine maintenance.

- Underbrush & rural area, far from town - Hill, gulch area (bukit, jurang) - Work at hight / tower - Inside Shelter
Workers Pekerja

1 7 10 3

3 3 10 1

1 1 1 1

5 11 21 5

Appropriate communication equipment and transportation, local information briefing, provide JSA (if necessary). Work carefully, prepare first aid kit, safety sign, relevant PPE and provide JSA (if necessary). Work Carefully, use safety harness and other relevant PPE, safety sign and provide JSA. Use relevant PPE, safety sign and provide JSA.

- Machine operator (operator mesin) - Tower erector - Shelter constructor - M&E installer - BTS installer - BTS inspector/troubleshooter - BTS commisioner - Microwave installer - Microwave inspector/troubleshooter - Microwave commisioner
Work Pekerjaan

7 10 1 10 1 7 1 10 10 10

3 10 3 3 3 6 1 6 6 3

1 1 1 1 1 1 1 1 1 1

11 21 5 14 5 14 3 17 17 14

License permit (SIM, if required), proper training and PPE. Proper training, provide right PPE.

Work Carefully, use relevant PPE.

Work Carefully, use safety harness, safety shoes, gloves.

- Survery (SITAC / CME)

10

Health check, personal medication, provide appropriate communication equipment, transportation and first aids.

- Sondir & Boring - Tower foundation excavation - Tower erection - Shelter installation - M&E installation - Fencing & Paving block installation

7 10 10 1 10 1

3 6 10 3 3 3

1 1 1 1 1 1

11 17 21 5 14 5

Work Carefully, check Equipment, right technique. Check equipment, right technique, work carefully, safety signs and provide relevant PPE. Done by qualified personnel, provide safety signs, safety harness and other relevant PPE. Work Carefully, Check Equipment, right technique, safety signs.

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- BTS installation - BTS inspection/troubleshooting - BTS commisioning - Microwave installation - Microwave inspection/troubleshooting - Microwave commisioning
Housekeeping Housekeeping

1 7 1 10 10 10

3 6 1 6 6 3

1 1 1 1 1 1

5 14 3 17 17 14
Work Carefully, Check Equipment, right technique.

- Material Storage - Handling of waste

1 1

6 6

1 1

8 8

Provide segregate area for storage, safety signs. Provide waste disposal box and label it, keep the area always clean.

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