Policy/Plan/Program: ID-G-BU-00000-00000-00362 Rev.5 Contractor Health, Safety & Environmental Management System (C-HSE MS) ConocoPhillips Indonesia Page 1 of 11 Appendix G.3: HSE Inspection Checklist HSE INSPECTION CHECKLIST Date June 23 2011 Contract Period 15 July 2011 — 14 January 2012 Contract Title ONSHORE SMALL PROJECT Contract No CS-15300041 Risk Level HIGH Work Location ONSHORE SUMATRA Contractor's Name; PROSRU JOINT OPERATION Address JAKARTA, Contractor Representatives: COPI Representatives: 1, WANG ADI PERMANA / SITE MANAGER 1. DEDY WARTADINATA / SS SUPERVISOR 2.SEBASTIAN ISKANDAR / HSE COORDINATOR 2, ANANG USMAN/ HSE INSPECTOR 3. SUMARTONO / HSE COORDINATOR 3, NANTI BUTAR-BUTAR / E-I INSPECTOR 4, NIRWAN SATARI / PIPING INSPECTOR 5, NUNU SURYONO / MATERIAL CONTROLPolicy/Plan/Program: Contractor Health, Safety & Environmental Management System (C-HSE MS) ConocoPhillips Indonesia This checklist does not cover all HSE aspects, if needed it can be adjusted as necessary and use checklist in link: 1D-G-BU-00000-00000-00362 Rev.5 Please check applicability of audit in C-HSE Pian Guideline Page 2 of 11 No ITEM YES | NO | NIA REMARKS Housekeeping Material yang sudah difaabrikasi & yang belum agar dirapikan dan He | eee oe ee v itempatkan dilokasi yang aman dan diberi barricade Fee eee Material milik COPI yang v masih ada didalam 1.2 _ | Rawmaterials stored properly Workshop agara segera dapat dipindahkan - y ‘Area disekitar workshop 1.3. | Walking surfaces neat and clean hrarus bersin dari kain dan scrap Rute Evakuasi harus 1.4 | Escape routes clean and clear v bebas dari material atau peralatan kerja 1.5 _ | "No Smoking” properly posted v 1.6 _| Trash emptied regularly v 1.7 | Materials not in danger of falling v 1.8 _| Nalls removed from wood planks /scrap iz 1.9 _| Lighting adequate v 1.10_| Healthy work place and environment 1.11 _| Aisle ways and walking surfaces is always kept clear of materials and equipment. Personal Protective Equipment (PPE) + Head protection - hard hat, 2.1 | + Bye protection - safety glasses, v + Foot protection - safety shoes/boots, + Protective clothing long-sleeved coveralls, 22 |HeadProtection Hard hats to be used shall meet ANSI 289.1 Class G or E specifications or COP! approved equivalent: * Class G - general service, limited voltage 2.2.1 | protection up to 2,200 volts. v + Class E — utility service, high-voltage protection up to 20,000 volts, use extensively by electrical workers. Metal hard hats are not permitted. s 2.22 | Fifst date of uselservice should be recorded | “2 | in the helmet.Policy/Plan/Program: 'D-G-BU-00000-00000-00362 Rev.5 Contractor Health, Safety & Environmental Management System (C-HSE MS) ConocoPhillips indonesia Pago 3 of 11 No ITEM YES | NO | NIA REMARKS 2.23 | Never carry anything (cigareiles, cards, etc.) inside hat's suspension. 2.3 | Eyeand Face Protection Eye and face protective equipment shall, as 2.3.1 | a minimum, comply with ANSI Z87.1-2003, | V | or COPI approved equivalent standards. Personnel, who wear prescription lasses, in 2.32 | aa requiring eye protection, are required to | ‘wear either prescription safety glasses or ‘other means of safety eye protection. ~ Face shields shall be worn as needed for the protection, 2.3.3 | -Face shields shall be worn over (Le. in v conjunction with) suitable basic eye protection (e.g. safely glasses or goggles). Employees engaged in cutting material wth 2.3.4 | awelding torch shall wear and use goggles | with the appropriate lens shade 2.4 [Hearing Protection Hearing protecion such as ear lugs, ‘earmuffs and communication head sets shall | meet OSHA 29 C.F R. 1926.52 standard. x 924 Hearing protection is required in areas | 2.4.2 | posted with signs "HEARING PROTECTION | | REQUIRED’. 2.5 _| Respiratory Protection — Respirators and their uses are to meet ANSI 788.2 specifications or equivalent. 2.4.1 ‘Masker (Half Mask) yang v sudah digunakan harus _| dibersihkan dan dicuci 254 ‘Ar purlying canisters, carsidges and fters Used with respirators shall be selected bosed | 2.5.2 | on the hazard involved (dust, mist, vapors, | fumes, gases) and manufacturer H recommendation, i 2.5.3 | Personnel must successfully pass fittest. | Personnel required to use Respiratory Protection shall not have facial hair and be 254 | clean shaven ly = No glasses with temple bars including prescription gasses, and contact lenses _shall be worn under respirators. 2.6 |ProtectiveClothes | Personnel who work in night time shall wear 2.6.1 | working suit equipped with reflecting light vi stripe | ‘Any coveralls found to be damaged (Frayed, | 2.6.2 | worn) or badly contaminated shall be v | disposed and replaced, | 2.7 |FootandLeg Protection In areas where chemical splash protection is 2.7.1 | aconcern, chemical resistant, steel toed v Tubber boots shall be worn.