JOB RISK ASSESSMENT - FRONT SHEET

DATE : 28-Jul-2008 ONSHORE BEKAPAI SURFACE FACILITIES NO. OF SHEETS: SYSTEM NO.
MODIFICATION 5
INSTALLATION / SITE : JOB REFERENCE:
SENIPAH AREA SNP-40-003-B
ASSESSED OVERALL
ROAD CROSSING II INSTALLATION
AT PPA REASSESSMENT REQUIRED ?
A N
RISK (Y/N)

NOTES :
¨ This Risk assessment is acceptable for Road Crossing No. 02 Activity ( Road To LP Flare )
¨ Tasks assesed are as follows :
- Asphalt Cutting
- Excavation
- Install culvert
- Install and Tie-in the 18" New Pipe
- Re-instate the main road with Soil and Asphalt
- House keeping
¨ Pre job meeting to be attended by all key personnels for
finalizing Risk Assessment shall be conducted.
¨ Toolbox talk / Pre job briefing to be held with all personnel
who will take part in work activities.
¨ Barrier and warning sign must settled until completion of the activity

NOTICE :
1. This document to be reviewed and commented by personnel in charge
2. This document will be finallized and signed prior to work execution
3. The signed document will be attached in work permit

ASSESSMENT REVIEWED AND ACCEPTED BY (COMPANY) :

POSITION PRINT NAME SIGNATURE DATE

ENG/CST/PJC/CSR LISPER PURBA / SRI WIDADI

ENG/CST/OPB/SUPT PONCO. K / GULAM P.

FO/AMB/BSP/S&E AGUS W./ DADANG H.

FO/AMB/BSP/PRD EDY WIDJAYA / BAMBANG H.

FO/AMB/BSP/PMM P. NOWACK / M. BOUJEME

FO/AMB/BSP F. JACOB / NOVYAL ERWIN

ASSESSMENT PERFORMED BY (CONTRACTOR) :

POSITION PRINT NAME SIGNATURE DATE

CONSTRUCTION MANAGER ZUL HADRIANSYAH

HSE COORDINATOR BAYU MAHENDRA GAUTAMA

QA / QC MUARIFIN
 JOB RISK ASSESSMENT
Installation : Piping System :- Page : 1 of 5
Reff No : SNP-40-003-B Date : 17-Dec-08
Leader : Attendess : Site Visit : YES
Site Construction Manager Company (TOTAL) / Contractor (PGM) Date :- Duration : -

JOB DESCRIPTION:

ROAD CROSSING 02
INITIAL RISK RESIDUAL RISK
N0 TASK HAZARD RISK CONTROL MEASURIES ACTION PARTY TARGET DATE COMPLETION DATE FOLLOW UP
S P R S P R
1 Asphalt cutting Layer of asphalt too hard
- Human consequences Se Po U - Breifing before comemcement activity Mi Un A SPV/HSE
Personnel injury (hurt) - Personnel must be full concentrate to the job ALL
- Material consequences - All person in charge (PIC) must wear PPE Mi Un A ALL
Drill machine broken (Safety glasses, shoes, helmet and gloves)
Road obstruction - Inspection drill mechine before use HSE
- Follow road crossing install procedure
- Install barricade
2 Excavation Excavator loss balance
by Excavator - Human consequence Hi Po U - Briefing before comencement activity Mi Un A SPV/HSE
Personnel injury (hurt) - Ensure that certify and experienced operator ope- ALL
rate excavator ALL
- Use proper PPE
- Valid certificate of Excavator & oparator HSE
- Material consequences Hi Po U - Make sure excavated wall slove Mi Un A
Damage to existing facilities - Do not exced backhoe/excavator capacity
- Crawler drum regular check will be done
Surrounding person facilities hit by
Excavator - Ensure only mandatory personnel near excavator SPV/HSE
- Human consequence Se Po U - Provide barrier Mi Un A ALL
Personnel injury (hurt) - Use board for way backhoe to protect facilities
Hydraulic hose broken hit personnel
- Human consequence Se Po U - Briefing before comencement activity Mi Un A HSE
Personnel injury (hurt) - Ensure that mandatory personnel near excavator
- Material consequences Hi Po U - Use proper PPE Mi Un A
Hydraulic hose broken - Regular maintenance to be carried out on crawler SPV/HSE
and hydraulic ALL
- Daily prestart check to be carried out ALL
Equipment hit the barried pipe/cables HSE
- Human consequence Se Po U - Acivities should be done at the clear weather Mi Un A
Personnel injury (hurt) - Good communication between personnel near
exacavator
- Excavation permit to be issued
- Material consequences Se Po U - Use update drawing and complementary excav- Mi Un A SPV/HSE
Facility damage (pipe leacking) tion permit ALL
Short circuit - Use metal detector ALL
Process shutdown - Do not excavator when the burried pipe/cable HSE
less that 1m depth
The soil burried up
- Human consequence Se Po U - Efective communication both the worker on Mi Uv A SPV/HSE
Personnel injury (hurt) above and ground ALL
- Use proper PPE ALL
- Soil partly to throw out site are Total with dump
- Material consequences Se Po U truck and partly use for back fill again Mi Uv A
Facility damage (pipe leacking) - Ensure in the trech is clear from person or HSE
equipment
- Extra supervise by site supervisor
Road obstruction - Ensure acess for fire truck and other truck is SPV/HSE
strong enough (follow road crossing procedure) ALL
- Assign signal man to manage traffic
 JOB RISK ASSESSMENT
Installation : Piping System :- Page : 2 of 5
Reff No : SNP-40-003-B Date : 17-Dec-08
Leader : Attendess : Site Visit : YES
Site Construction Manager Company (TOTAL) / Contractor (PGM) Date :- Duration : -

JOB DESCRIPTION:

ROAD CROSSING 02
INITIAL RISK RESIDUAL RISK
N0 TASK HAZARD RISK CONTROL MEASURIES ACTION PARTY TARGET DATE COMPLETION DATE FOLLOW UP
S P R S P R
Soil collapse
- Human consequence Se Po U - After digging we shall use wood for detertion from Mi Un A SPV/HSE
Personnel injury (hurt) soil collapse or we shall digging unstraight to ALL
prohibit soil from collapse ALL
Heavy truck / car pass on half HSE
on the road - Ensure in the trench is clear from persn or
- Equipment consequences Se Po U equipment Mi Un A SPV/HSE
Facility damage (pipe leacking) - Extra supervise by site supervisor ALL
- Use temporary acess to road heavy truck and car ALL
pass on half on the road HSE
- We use a temporary bridge above a half road
crossing for heavy truck and heavy vehicle pass
away
Main access road broken
- Human consequences Se Po U - Provide temporary access road Mo Un A SPV / HSE
Personnel injury (hurt) - Provide sign barrier ALL
Tranffic jump - Use proper PPE ALL
- Provide temporary acess road HSE
Temporary access road failure
- Human consequences Se Po U - Provide sign barrier Mi Uv A SPV / HSE
Personnel injury (hurt) - Use proper PPE ALL
- Material consequences Mo Po U - Complimentery calculation analysis load for Mi Uv A ALL
Facility damage/traffic jump temporary access road HSE
- Use apropiate plate/materials
Work at Height Dark
- Human consequences Hi Po U - Extra supervisor at night Mi Uv A SPV / HSE
Personnel injury (hurt) - Provide sufficient lighting ALL
- Standard PPE is a must ALL

Manual digging Trench side collapsing

- Human consequences Se Po U - Wearing PPE (Personal Protective Equipment) Mi Uv A SPV / HSE
Personnel injury (hurt) especially safety glasses and gloves
- Material consequences Mo Po U - Uninvolved personnel to keep away from working Mi Uv A SPV / HSE
Underground cable/pipe damage area ALL
- Provide First Aid Kit at the working area ALL
- Provide signalman at the unvisible traffic intersec-
tion
- Barricade area that potential to settlement
- Proper Protection to be installed HSE
Hit be hoelike tools
- Human consequences Se Po U - Wearing PPE (Personnel Protectve Equipment) Mi Un A SPV / HSE
Personnel injury (hurt) especially safety glasses and gloves
- Equipment consequences Mo Po T - Provide First Aid Kit at the working area Mi Un A SPV / HSE
Hoelike tools broken - Qualified / Skill Person

3 Install Culvert Dropped object

by crane - Human consequences Hi Vu T - Use approved procedure for lifting Mi Vu A RIG/SPV
Personnel injury (hurt,death) - Recognize the weight of load ( to be in safe limit ENG/HSE
- Equipment consequences of SWL )
Damage object lifting - Control & make sure that sling(s) and shackle(s) RIG/HSE
Personnel injury (hurt) installed under safe working load certification/
check color code
 JOB RISK ASSESSMENT
Installation : Piping System :- Page : 3 of 5
Reff No : SNP-40-003-B Date : 17-Dec-08
Leader : Attendess : Site Visit : YES
Site Construction Manager Company (TOTAL) / Contractor (PGM) Date :- Duration : -

JOB DESCRIPTION:

ROAD CROSSING 02
INITIAL RISK RESIDUAL RISK
N0 TASK HAZARD RISK CONTROL MEASURIES ACTION PARTY TARGET DATE COMPLETION DATE FOLLOW UP
S P R S P R
- Ensure crane capacity is capable to lift material
- Ensure that no body passing/working under the
lifted object
- Tag lines shall tied to any lifting object for control RIG / SPV
- Control movement of object during lifting SPV
- Crane is safe for use and certified RIG / HSE
- Operator crane certificate and experience RIG / HSE
- Lifting gear use must be certificate and proper RIG / HSE
color code.
- Issued Lifting plan attached to the PT. PGM and
follow strictcy
- Block the road during crane operation
4 Install and Tie-in the 18" New Pipe Oxygen & gas bottle,Explosion,fire SPV / HSE
Cutting, Grinding - Human consequences Se Un T - Proper oxygen&gas bottle handling (do not drop, Mi Un A SPV / HSE
Personnel injury (hurt or death) - Put in bottle rack) c/w nozzle protection/bottle cap SPV / HSE
- Furnish cutting torch with cover/fire blanket SPV / HSE
- Material consequences Se Un T - Proper hose and clamp + flash back aresster Mi Un A SPV / HSE
- Tidy hose (good house keeping) / no flammable
material in the area SPV / HSE
- Leak test prior to use at all connection SPV / HSE
- Make sure that fire hydrant unit in existing area
in good condition SPV / HSE
- Make sure that fire monitor unit in existing area
in good condition
- Ensure that intervention team ziegler truck can
pass to blcked area in case emergency
- Emergency that temporary acces road can be
used safely by others
- Stand by fire extinguisher
Electrical shock / short circuit SPV / HSE
- Human consequences Se Un T - Electrical tools has to be inspected before use Mi Un A SPV / HSE
Personnel injury (hurt or death) - Good cabling and grounding SPV / HSE
- Material consequences Mo Po T - Proper connection Mi Un A SPV / HSE
Material damage - Tidy power cable (good house keeping) SPV / HSE
Personnel injury (hurt or death) - ELCB to be provided on electric pannel SPV / HSE
- Electrical safety kit is available SPV / HSE
- Material consequences Mi Pr T - Furnish cutting torch with cover/fire blanket Mi Un A SPV / HSE
- Proper hose and clamp + flash back aresster SPV / HSE
- Tidy hose (good house keeping) / no flammable
material in the area SPV / HSE
- Leak test prior to use at all connection SPV / HSE
- Make sure that fire hydrant unit in existing area
in good condition SPV / HSE
- Make sure that fire monitor unit in existing area
in good condition
Flying small particles, Eye damage, SPV / HSE
eye irritation - PPE : Eye goggle is a must / face shield WRK
- Human consequences Mo Po T - Good house keeping Mi Un A SPV / HSE
Personnel injury (hurt or death) - Make sure that eye wash unit in existing area
- Material consequences Mo Po T in good condition Mi Un A SPV / HSE
Material damage - First Aid kit is available
 JOB RISK ASSESSMENT
Installation : Piping System :- Page : 4 of 5
Reff No : SNP-40-003-B Date : 17-Dec-08
Leader : Attendess : Site Visit : YES
Site Construction Manager Company (TOTAL) / Contractor (PGM) Date :- Duration : -

JOB DESCRIPTION:

ROAD CROSSING 02
INITIAL RISK RESIDUAL RISK
N0 TASK HAZARD RISK CONTROL MEASURIES ACTION PARTY TARGET DATE COMPLETION DATE FOLLOW UP
S P R S P R
Grinding disk broken, Serious injury SPV / HSE
- Human consequences Se Un T - Use proper machine and disc / manual check Mi Un A
Personnel injury (hurt or death) to be perform SPV / HSE
- Material consequences Mo Po T - Grinding machine must be c/w disc guard Mi Un A SPV / HSE
Material damage - Understand using cutting/grinding machine SPV / HSE
- Follow manufacture procedure manual SPV / HSE
- First Aid kit is available
Welding Bad electrical cable, Electrical shock SPV / HSE
/ short circuit, Personnel injury - Good cable grounding SPV / HSE
- Human consequences Mo Po T - Good cable insulation Mi Un A SPV / HSE
Personnel injury (hurt or death) - Good cable connection SPV / HSE
- Material consequences Mo Po T - Good laying welding cable (house keeping) Mi Un A SPV / HSE
Material damage - Welding PPE to be used SPV / HSE
- Make sure that fire hydrant unit in existing area
in good condition SPV / HSE
- Make sure that fire monitor unit in existing area
in good condition SPV / HSE
- Electrical safety kit is available
Compressor fail, hose broken / Mechanics
Personnel injury - Good maintenance. Check compressor daily Mechanics
- Human consequences Mo Po T - Use proper air receiver (c/w safety valve) Mi Un A Mechanics
Personnel injury (hurt or death) - Proper hose connection (c/w safety chain) / anti whip WRK
- Material consequences Mo Po T - Good house keeping Mi Un A
Material damage
Confined Space Activity Bad ventilation, bad illuminated
- Human consequences Se Un T - Provide / Install exhaus vent
Personnel injury (hurt or death) - Provide ood lighting
- Material consequences Se Un T - Ensure that ventilation reaches all parts of the
Material damage confined space
- Provide First Aid Kit at the working area
- Stand by person
- Make sure that the monitor unit in existing area
in good communcation
certified space permit
05 Re-instate the main road with Soil Hit by hoelike tools WRK
and Asphalt - Human consequences Se Po U - Personnel be carefull on work Mi Un A WRK
Personnel injury (hurt) - Wearing PPE (Personal Protective Equipment),
- Material consequences Mo Po T especially safety glasses and gloves Mi Un A SPV, WRK
Hoelike tools broken - Provide First Aid Kit at the working area
Hit by Compactor ALL
- Human consequences Mo Po T - Personnel be carefull on work Mi Un A WRK, SPV
Personnel injury (hurt) - Wearing PPE (Personal Protective Equipment),
especially safety glasses and gloves
Vibro roller are slipped OPR, SPV,HSE
- Human consequences Se Po U - Ensure the operator has certificate and familiar Mi Un A
Personnel injury (hurt) with the equipment operation WRK,SPV,HSE
- Material consequences Mo Po T - Wearing PPE (Personal Protective Equipment), Mi Un A
The vibro roller damage especially safety belt HSE,WRK,SPV
 JOB RISK ASSESSMENT
Installation : Piping System :- Page : 5 of 5
Reff No : SNP-40-003-B Date : 17-Dec-08
Leader : Attendess : Site Visit : YES
Site Construction Manager Company (TOTAL) / Contractor (PGM) Date :- Duration : -

JOB DESCRIPTION:

ROAD CROSSING 02
INITIAL RISK RESIDUAL RISK
N0 TASK HAZARD RISK CONTROL MEASURIES ACTION PARTY TARGET DATE COMPLETION DATE FOLLOW UP
S P R S P R
- Provide the traffic / safety sign at the working area
and must be obeyed OPR,MNT
- Ensure the vibro roller in good condition SPV,HSE
- Provide First Aid Kit at the working area
Hit by vibro roller OPR, SPV,HSE
- Human consequences Se Po U - Ensure the operator has certificate and familiar Mi Un A
Personnel injury (hurt,death) with the equipment operation WRK,SPV,HSE
- Material consequences Se Po U - Wearing PPE (Personal Protective Equipment), Mi Un A
Collision between vibro roller (damage) especially safety belt WRK,SPV,HSE
Hit the close existing structure (damage) - Uninvolved personnel to keep away from working
area HSE,WRK,SPV
- Provide the traffic / safety sign at the working area
and must be obeyed OPR,MNT
- Ensure the excavator / bulldozer / dump truck are
in good condition SPV,HSE
- Provide First Aid Kit at the working area SPV
- Provide signalman at traffic intersection HSE
- Barricade or protect the existing structure which
close to the working area
6 House Keeping Poor housekeeping
- Human consequences Mo Po T - Good housekeeping Mi Vu A WRK
Personal injury (slip, trip, or fall)

Approval of JRA Conclusion (1) by : Signature : Date :

(1) If one answer "tolerable" then filled by Entity Management but if one answer "unacceptable" then a new JRA must be organized regarding a new proposal for the execution of the job
Note : The "OK" to start work will be given after completion of the last follow up column and use of the Work Permit
SPV = Supervisor, WRK =Worker, ALL = All participant, HSE = Safety, RIG = Rigger, SCF = Scaffolder