CHECKLIST SITE : WS1 / WS2 / WS3 / WS4 / AS1 / AS2 / AS3 / TBM1 / TBM2 / TBM3 Date:

Project: STEP DTS T01 Form Number: HSE CL008B Page 1 of 1 DAILY SITE SAFETY CHECKLST 17 July 2013

Item

Time

Location

Description

Person/s involved of unsafe act

Site Incharge

Date & Time of Compliance

Remarks

01

0910H

WS2 shaft

Loose & improper setting of break away wire Khalid Mr. Peter Lloyd 17-07-13 0915H Possible contact to rail bolt & potential to damaged company property

Loose & improper setting

02 1245H WS2 TUNNEL @ring 1200 Khalid Mr. Peter Lloyd Pending

Saggy & bended Ventilation

03 1720H WS2 TUNNEL @ring 49

PHOTO

Khalid

Mr. Peter Lloyd

Closed

Exposed to water & sodium

Prepared by: Name and Signature: Joshua Palisoc Designation: Safety Officer Approved by: Name and Signature Manager in-charge

CHECKLIST SITE : WS1 / WS2 / WS3 / WS4 / AS1 / AS2 / AS3 / TBM1 / TBM2 / TBM3 Date:

Project: STEP DTS T01 Form Number: HSE CL008B Page 1 of 1 DAILY SITE SAFETY CHECKLST 17 July 2013

Prepared by: Name and Signature: Joshua Palisoc Designation: Safety Officer

Approved by: Name and Signature Manager in-charge