Job Safety Assessment Form

Job Safety Assessment Form Template for Indonesia

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Key Requirements PROMPT example:

"I need a Job Safety Assessment Form for a large-scale chemical plant maintenance project in Jakarta starting March 2025, involving multiple contractors and requiring specific hazardous material handling procedures, with emphasis on confined space entry and hot work permits."

Document background

The Job Safety Assessment Form is a crucial document required under Indonesian workplace safety regulations, specifically aligned with Law No. 1 of 1970 on Occupational Safety and Government Regulation No. 50 of 2012 on Safety Management Systems. This form must be completed before undertaking any work that involves potential hazards or risks to worker safety. It serves as both a planning tool and a legal document, demonstrating due diligence in identifying, assessing, and controlling workplace risks. The assessment includes detailed evaluation of work procedures, necessary safety equipment, emergency responses, and required authorizations, ensuring comprehensive safety coverage for all workplace activities in compliance with Indonesian safety standards.

Suggested Sections

1. Job Details: Basic information about the job including location, date, time, and work description

2. Work Team: Details of all personnel involved in the task, including supervisors and workers

3. Required Permits and Licenses: List of necessary work permits and licenses required for the task

4. Equipment and PPE Requirements: Detailed list of required personal protective equipment and tools

5. Hazard Identification: Systematic identification of all potential hazards associated with the task

6. Risk Assessment Matrix: Assessment of likelihood and consequence for each identified hazard

7. Control Measures: Specific actions and measures to eliminate or minimize identified risks

8. Emergency Procedures: Emergency response plans and evacuation procedures specific to the task

9. Sign-off and Authorization: Approval signatures from relevant supervisors and workers

Optional Sections

1. Environmental Impact Assessment: Required when work may affect the environment - includes assessment of environmental risks and mitigation measures

2. Working at Heights Assessment: Additional assessment required for any work conducted above 1.8 meters as per Indonesian regulations

3. Confined Space Entry: Specific assessment required for work in confined spaces

4. Hot Work Requirements: Additional controls and permits required for welding, cutting, or other hot work

5. Chemical Handling Assessment: Required when handling hazardous substances or chemicals

6. Noise Assessment: Required when work involves high noise levels or use of loud equipment

Suggested Schedules

1. Risk Assessment Matrix Reference: Standard risk assessment matrix used for scoring hazards

2. PPE Requirements Chart: Visual guide showing required PPE for different types of work

3. Emergency Contact List: List of emergency numbers and key contacts

4. Incident Report Form: Template for reporting any incidents or near-misses

5. Daily Equipment Inspection Checklist: Checklist for verifying equipment safety before use

6. Relevant Safety Data Sheets: Collection of SDS for any hazardous materials being used

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Construction

Manufacturing

Mining

Oil and Gas

Chemical Processing

Utilities

Transportation

Warehousing

Agriculture

Forestry

Marine Operations

Infrastructure Development

Industrial Maintenance

Waste Management

Energy Production

Relevant Teams

Health and Safety

Operations

Maintenance

Production

Quality Assurance

Project Management

Risk Management

Compliance

Training

Engineering

Field Operations

Emergency Response

Environmental Protection

Facilities Management

Relevant Roles

Safety Manager

Project Supervisor

Site Engineer

Construction Manager

Operations Supervisor

Maintenance Technician

Production Manager

Quality Control Inspector

Field Supervisor

Risk Assessment Specialist

HSE Coordinator

Plant Manager

Compliance Officer

Safety Trainer

Work Permit Issuer

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Authors

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