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Identifikasi Bahaya dan Pengendalian Resiko



Rev. 03 28 Jan 2016



Facility/ Lokasi Job/ Pekerjaan/ Aktifitas Job Dilakukan oleh (jabatan) Assessed by (dipersiapakan Oleh)



No.



Lokasi/ Kegiatan/ Bahan



Urutan kegiatan pada pekerjaan (Proses)



: : : :



Potensi Bahaya (Hazard/ Aspek)



Likelihood/ Kemungkinan terjadi 1. Rare = practically impossible 2. Unlikely = may occur at some time 3. Possible = could occur or “I have heard of it happening” 4. Likely = known to occur or “it has happened” 5. Almost Certain = occur in most circumstances or repeating occurrence



Tanggal/Bulan Revisi No Disetujui oleh Ka Departemen / Section



Akibat yang ditimbulkanya. ( Consequence /Dampak)



Jenis Resiko / Dampak



Severity/ Kemungkinan besarnya dampak A. Dampak bagi Personal 1. Insignificant = no treatment required, level short time injury 2. Minor = first aid 3. Moderate = MTI or LTI by doctor certificate 4. Major = permanent disability or single fatality 5. Catastrophic = multiple fatalities



Tindakan Pengendalian yang telah dilakukan



Kemungkinan (K)



Akibat (A)



B. Dampak bagi Aset/ Perlengkapan/Lingkungan 1. Insignificant = loss < US$ 100 2. Minor = US$ 100 < & < US$ 1.000 3. Moderate = US$ 1.000 < & < US$ 5.000 4. Major = US$ 5.000 < & < US$ 10.000 5. Catastrophic = > US$ 10.000



: : SHE Coordinator



Tingkat Resiko / Dampak (K)x(A)



Rekomendasi pengendalian tambahan



Peraturan terkait



Tabel Nilai Resiko Severity of Risk



Likelihood



1



2



3



4



5



1



L



L



L



M



H



2



L



L



M



H



H



3



L



M



H



H



E



4



M



H



H



E



E



5



H



H



E



E



E