Corporate Forms Form No.

Element 5: Operations Integrity 5-64

Novel Coronavirus Infection Incident Reporting Form

1. Reporting Unit ASIAN ENDEAVOUR 1

Home Isolation Medical Observation Suspected Case
2. Incident Type
Confirmed Case Suspected Incident
03 March 2022, 4. Name of Reporter / Hand
3. Time Reported M. Azham Mansor (Rig
At 8:30 Local
Phone Number Manager) , +65 6513 5945
time

Name Gender Date of Birth Department / Designation

Adi Rahman Geoservice/Sample

Male 22 July 1980
Sudewo Catcher
5. Particulars of
affected
personnel                   

                       

Personnel onboard on Friday 28-Feb-2022 with 23 other crew by Boat Suberko

from Jetty Somber. On February 28, a rapid antigen was performed and the
results were non-reactive. And today, March 3, 2022, today a mass rapid
antigen test was conducted and for the results were reactive and were
9. Incident repeated rapidly and the results are still the same. Currently, personnel has
Description been self-isolating in his room while waiting for CB. Peacock 2 for pick up to
Jetty (Santan)

He got negative PCR test on 27th February 2022

1. All personnel onboard been antigen tested. (All Non-reactive)

2. Suspect infected person been isolated in his room until the boat arrive for
10. Current
referal to balikpapan for further examination/test.
measures in
place 3. Clinic as the place for antigen test been sanitized and sterilized using
disinfectant and UV light.

1. Personnel in the Rig to continue maintain Physical Distancing

2. Advice personnel to worn mask correctly.
3. Doctor close monitoring the health status of personnel on board
11. Follow up 4. Personnel on board to ensure and immediate report to Rig doctor when any
Actions* health problem, symptomatis of Cough or Flu will takes as the consideration for
further COVID test
5. Campboss to do regular deep cleaning and use UV light, sanitized handrail,
door knobs and public area using disinfectant liquid.
Note:
1. Home isolation medical observation (Leave of Absence), suspected case and confirmed cases shall be
assessed and determined by the National Centre for Infectious Diseases (Singapore) or local Country
Infection department.

CD-CF-OI-5-64 Rev. 0 (11-Feb-20) Page 1 of 2

 Corporate Forms Form No.
Element 5: Operations Integrity 5-64

Novel Coronavirus Infection Incident Reporting Form

Suspected Incident refers to personnel whom may have close contacts with personnel under Home isolation
medical observation, suspected cases and confirmed cases. Individual business unit shall determine next
course of actions as there’s no clear guidelines provided by local authorities for this scenario.
2. This report shall be submitted via email to as follows:
 HSE Manager David Parsons (david.parsons@cosl.com.sg)
 QA Manager Na Hongyu (na.hongyu@cosl.com.sg)
 Operation & QHSE Director (zhang.yan@cosl.com.sg)

CD-CF-OI-5-64 Rev. 0 (11-Feb-20) Page 2 of 2