FORM (FRM)

NEW DRILL SITE IN MINE AREA CHECKLIST

No. Document: Effective Date: Revision No:
BKP-EXP-FRM-xxx 01-May-23 0
Location/Lokasi : Specific Drill Area/Area spesifik pengeboran:
Coordinate/Koordinat :
Rig Type/Tipe Rig :
Drill Program/Program
Resource Exploration Metallurgical Geotechnical Others
pengeboran:
Drawing attached/Gambar
Lokasi kerja terlampir :
Proposed Date/Tanggal :
Communication/Alat
komunikasi: Radio Channel No … Mobile Coverage Others:
Dimension/ Ukuran area
kerja :
Emergency Tool/Peralatan Interlock/Emergency 1 Lightning Detector/ Gas Detector
Emergensi: Button/Tombol Emergensi Pendeteksi petir (optional)/Pendeteksi
Work area/Area Kerja : Blasting Area Pit Area Waste Dump Hauling Road Excavation/Loading Area
Work Shift/ Shift Kerja : 1 Shift (Only D/S or N/S) 2 Shifts (D/S and N/S)

Potential Safety
Impact/Potensi Dampak
Keselamatan:

Yes/ No/
Comment/ Komentar
Ya Tidak
Is barricade installed/Apakah barikade terpasang?
Is bundwall build as required/Apakah bundwall sudah tersedia?
Is safety signs installed/Apakah rambu/papan keselamatan
terpasang?
Exploration drill area/Area Flammable Material/
1 8
pengeboran eksplorasi Bahan mudah terbakar
Mandatory PPE in drill area /
Traffic signs/Rambu
2 APD Wajib di area 9
lalu lintas
pengeboran
Restricted drill area /Area
3
Kerja terbatas
Rock Fall Sign/papan
4 keselamatan untuk jatuhan
batu
Barricades-Yellow
5 Chain/Barikade dengan
rantai kuning
Muster Point/Area
6
berkumpul darurat
7 Parking Area/Area Parkir
Is emergency equipment completed such as 1 First Aid box, 2 Fire
Extinguishers, 2 Eye washes, 1 lightning detector, 1 handtalk radio/
Apakah peralatan emergency lengkap seperti 1 box P3K, 2 APAR,
2 stasiun pencuci mata, 1 pendeteksi petir, 1 radio HT?

Is working area within safe distance to cliff/ Apakah area bekerja

dalam jarak aman dari tebing?
Is rig within safe blasting distance (>500m from the blasting area)/
Apakah rig berada di dalam jarak aman peledakan? (>500m dari
area peledakan? )
Is there any potential mud sump leak to pit wall/ Apakah ada
potensi kebocoran lubang mud ke dinding pit?
Is impermeable layer such as liners/ terpauline installed in mud
Hazard
sumps / Apakah lapisan impermeable/terpal terpasang pada
Prevention/Pencegahan
lubang mud?
Dampak bahaya:
Is mud sump in stable ground/ Apakah lubang mud dibuat pada
tanah yang stabil?
Is drainage provided/ Apakah saluran air disediakan?
Is there any potential hanging or falling rock or objects, include
from interface work /Apakah ada potensi batu menggantung
atau objek jatuh, termasuk adanya kegiatan interface?
Is there any potential fall or dead tree/ Apakah ada potensi pohon
jatuh atau pohon mati?
Is the car park area adequate and safe/ Apakah area parkir mobil
memadai dan aman?
Is the access to rig site safe / Apakah akses ke lokasi rig aman?
 Is the drill pad located in the stable ground / Apakah drill pad
dibuat di lokasi yang stabil?
Is drill pad adequate to station all equipment/ Apakah lokasi drill
pad memadai untuk meletakkan semua alat pengeboran?
Is any public/mining facility around the drill area/ Apakah ada
fasilitas umum atau mining di sekitar area drill pad?
Is muster Point provided/Apakah area berkumpul darurat
tersedia?
Is lightning Shelter provided/Apakah tempat berlindung dari petir
tersedia?
Is water source identified/provided/ Apakah sumber air tersedia?
Is mud sump adequate for drilling activity (L x W)/Apakah ukuran
mudsump sudah mencukupi untuk keperluan pengeboran (tinggi
x lebar)?
Is there interface work around the drill site/ Adakah pekerjaan
interface di sekitar area pengeboran?
Is other parties aware for drilling activity/Apakah seluruh pihak
sudah mengetahui kegiatan pengeboran pada lokasi ini?
Others/Lainnya:

Notes/Catatan:

Exploration Representative
Inspected By/Diinpeksi Drilling Contractor Representative
oleh: Mining Representative
Other Dept Representative
Date Inspection/Tanggal
Exploration Representative Drilling Contractor Representative Mining Representative Other Dept Representative

Final
Approvement/Persetuju
an Akhir: