BU3 Form - Health, Safety & Environmental

LAND CLEARING INSPECTION

Division/ Project : Inspection No

Work area : Date

Conformance
No Description
Yes No N/A
Is there a land clearing plan with map describing land clearing
1
area?
2 Has the Land clearing permit been obtained?
Are land clearing & conservation boundaries clearly marked with
3
peg and flagging tape with max 25 m spacing?
Arrangement for commercial timber location have been identify
4
and available?
5 No evidence of clearing outside the approved area?
6 Are there protected flora & fauna sighted ?
7 Is sediment control sufficient & available?
8 Is clearing done using recommended equipment?
9 Dust build up is within acceptable limits?
10 Land clearing completed with no tree standing left

Preventative & Corrective action

Preventative & Corrective Action Recommended corrective & preventive action to be input into
required for entry into register LCI-QAM-FM-005B NCR Register

Yes / No

Name Signature
Inspector

Area responsibility

Project ENV/HSE Reps

Project manager

PT. Leighton Contractors Indonesia Page 1 of 2

BU3-ENV-FRM-017A Rev 01
02 April 2013
ND CLEARING INSPECTION

:
:

Remark

Date

PT. Leighton Contractors Indonesia Page 2 of 2

BU3-ENV-FRM-017A Rev 01
02 April 2013