MDL.

Ref: G-840 Hazardous Material Approval

Rev. Date: 20-Dec-18 Request and Risk Assessment
This form is referenced by the following documents:
Hazardous Substances and Dangerous Goods Management Procedure (G-504)

Project Title: Martabe

Project Code: M361

CONTACT INFORMATION

PT Macmahon Mining
Requested By: Theresia Nainggolan Company:
Services
Plant Commercial
Position: Date Requested: 11 July 2022
Superintendent
Phone No.: Email: tnainggolan@macmahon.co.id

REQUESTED MATERIAL DETAILS

Material Product Name: Refrigerant R-134A UN Number: -

Date Product Required: Ongoing Date Requested: 1 January 2016

Manufacturer/Supplier: CV Pauzan Mandiri Supplier Phone No.: 085275558234

Email: cv.pauzan@gmail.com Facsimile No.: -

WorkSafe Classification: Hazchem code(s): 2

Physical Form: Solid Liquid Gas Dust Vapour

SDS Supplied: Yes No Please attach a copy of the SDS (safety data sheet)

SDS Review Date: 1 April 2023 SDS must be reviewed within the last five years

Dangerous Goods Class

4.3 Substances which, in contact with
1 Explosive substances or articles
water, emit flammable gases
2.1 Flammable Gases 5.1 Oxidising Substances

2.2 Non-flammable Non-toxic Gases 5.2 Organic Peroxides

2.3 Toxic Gases 6.1 Toxic Substances

2.4 Oxidizing Gases 6.2 Infectious Substances

3 Flammable Liquids 7 Radio Active Material

4.1 Flammable Solids 8 Corrosive substances

4.2 Substances liable to Spontaneous 9 Miscellaneous Dangerous
Combustion Substances and Articles
Is the substance classified as a Hazardous Material? Yes No (i.e. a Hazardous Substance)

If ‘Yes” Complete the Hazardous Material Risk Assessment section of this form.

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 MDL. Ref: G-840 Hazardous Material Approval
Rev. Date: 20-Dec-18 Request and Risk Assessment
This form is referenced by the following documents:
Hazardous Substances and Dangerous Goods Management Procedure (G-504)
Requested Material Planned Use and Application
Usage: Trial (3 months) One-off Use Ongoing Use
Material Purpose: Refrigerant Gas
Area of Use: Workshop
Details of Use: Air conditioners to absorbing and removing heat from a space
Quantity Used: 6 x 13.6 KG CYL
Concentration Used: 100 % Product
Package Type and Size: 13.6 KG CYL
Method of Application: Automated Additive Disperse
Brush Dilution Dip
Decant Spray Other: Charging

Storage
Location where material is to be stored on-site: Workshop

Does the supplier recycle empty containers? No, the empty cylinder throws to the scrap bin

Maximum quantity likely to be stored: 6 CYL

Is decanting necessary? No
Does the storage area comply with storage
Yes
requirements?

Environmental
What waste will be generated (type and quantity): 2 x Cylinder / Month
Sold to supplier scrap metal due to not classified as
How will be waste be disposed:
hazardous waste

Use
Does a procedure apply to the use of the material: No

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MDL. Ref: G-840 Hazardous Material Approval
Rev. Date: 20-Dec-18 Request and Risk Assessment
This form is referenced by the following documents:
Hazardous Substances and Dangerous Goods Management Procedure (G-504)

ASSESSMENT / APPROVAL

Approved as submitted: Refrigerant R-134A

Approved with the following conditions:

Not Approved for the following reasons:

Hendri Maintenance Superintendent

(print name) (position)

(signature) (date)

Administration Yes No

Gold FFX / Hazardous Substances and Dangerous Goods Register (G-483) updated

SDS Folder(s) updated with a copy of the SDS

Hazardous materials in the Project Risk Register with risks and controls recorded

A copy of the SDS is located at first aid locations where relevant

Copy of SDS attached to the JSEA (or other relevant site document)

Provisions for first aid included in the JSEA (or other relevant site document)

PPE detailed in the JSEA is consistent with requirements contained within the SDS

Page 3 of 6
 MDL. Ref: G-840 Hazardous Material Approval
Rev. Date: 20-Dec-18 Request and Risk Assessment
This form is referenced by the following documents:
Hazardous Substances and Dangerous Goods Management Procedure (G-504)

HAZARDOUS SUBSTANCE RISK ASSESSMENT

Exposure Hazards
Determine the level of exposure to the material. People exposed to the hazards associated with the material must
be consulted and advised of the risk management process. Consider the level of exposure during storage, handling,
use and disposal processes. Refer to the Safety Data Sheet for material specific information.
Are any of the following routes of entry an exposure risk? No, there are no exposure risks

Yes, complete the section below

Inhalation Ingestion Skin contact Eye contact Injection

No, not toxic

Is exposure hazardous to the health of the person/s exposed
e.g. toxic (acute/chronic exposure)?
Yes

If yes, what are the health effects of chemical exposure (toxicity, body contact, reactivity, acute/chronic effects)?

Who will be exposed to the chemical/process (what positions)?

What is the expected duration of the exposure (contact hours per day)?

What is the expected frequency of exposure (number of times per week)?

Have any health problems been reported (elsewhere)?

Is the level of exposure reduced as much as possible?

Handling and Storage Considerations

What are the handling risks (refer to precautionary phrases, handling requirements on the SDS)?
• Protect from sunlight, store in a well-ventilated place
• Always wear recommended personal protective equipment
• Avoid breathing vapours and liquid contact with eyes, skin or clothing
• Do not puncture or drop cylinders, expose them to open flame or excessive heat
• Use authorized cylinders only

Incompatibility requirements - Does the material need to be segregated from other materials?

Yes, not compatible with:

No
• Freshly abraded aluminium surfaces at specific temperatures and pressures may cause a strong
exothermic reaction.
• Chemically reactive metals: potassium, calcium, powdered aluminium, magnesium, and zinc.

Page 4 of 6
 MDL. Ref: G-840 Hazardous Material Approval
Rev. Date: 20-Dec-18 Request and Risk Assessment
This form is referenced by the following documents:
Hazardous Substances and Dangerous Goods Management Procedure (G-504)

Does the material call for any special storage requirements (e.g. a chemicals cabinet, shelving type, bunding)?

No Yes, list details:

Does the volume of the chemical exceed available storage requirements?

No. Store according to SDS instructions.

Safety Control Measures

Is it necessary to wear personal protective equipment as described in the product SDS?
Yes, specify below :
No

Note: while the use of PPE is very important, PPE is considered to be the least effective way of avoiding exposure to chemicals - consider
elimination, substitution, isolation, engineering and administrative controls and changes to your work procedure).

PPE Details

Gloves Rubber Gloves

Hearing protection

Respiratory protection

Protective clothing Uniform

Boots Safety shoes

Eye protection Safety glasses

Face protection

Hygiene control

Barrier cream

Other
Is all required PPE available on site?

Yes No, provide details:

Is ventilation required as described in the product SDS (general, mechanical or cross ventilation) when
undertaking this activity?
Yes, provide details: Provide local ventilation at filling zones and areas where leakage is
No
probable
Is health monitoring required (chemicals that require health monitoring should be avoided where possible)?
Health surveillance is the monitoring (including biological monitoring) of the health of workers to identify any changes caused by exposure to
a hazardous substance. The risk assessment (above) will determine if health surveillance is required. Monitoring can be done by testing body
fluids such as blood and urine, exhaled breath or through biological effect monitoring on a body function.

No Yes, provide details:

Page 5 of 6
 MDL. Ref: G-840 Hazardous Material Approval
Rev. Date: 20-Dec-18 Request and Risk Assessment
This form is referenced by the following documents:
Hazardous Substances and Dangerous Goods Management Procedure (G-504)
Risk Assessment Classification
Taking into consideration all of the risk factors indicated above, and regarding the range of safety controls and
procedures that are already in place in your work location select the risk conclusion.

Conclusion Action Required / Approval Example Notes Selection

Tolerable: Manage using routine procedures.
Comply with all requirements of the label and current SDS.
Comply with the standard operating procedure for the
L1-L4
substance(s).
Manage and document through regular planning
processes.
Person(s) using the chemicals should sign the risk
assessment (JSEA or equivalent).
Select if you are using a concentration less than which
is considered hazardous or no precautions are
required and it is unlikely that the use of the
chemical(s) will adversely affect the health of persons
at the workplace and the risk is not likely to increase in
the future e.g. you are using concentrations that are
too small to constitute a risk, even if controls fail; or the
operation strictly conforms to the information on the
label and in the SDS.

Monitor: Action advisable if cost beneficial.

Comply with all requirements of the label and current
SDS.
Comply with the standard operating procedure for the
substance(s). Select if you are satisfied that adequate controls are in
place. Select where serious health effects could result
Implement the identified controls to minimise the if the control measures fail or deteriorate.
chances of higher exposure occurring.
L5-M12 This usually results from the use of toxic hazardous
Determine and implement additional measures for chemicals or where the potential exposure is high.
regaining control if a high risk event occurs despite the Risks, while presently adequately controlled, could
precautions already taken. increase in the future.
Document all risks and controls in planning documents
and/or complete this Chemical Activity Risk Assessment.
Person(s) using the chemicals should sign the risk
assessment (JSEA or equivalent).

Issue: Action required to manage the risk.

Superintendent and Supervisors must be responsible for
the final approval of the JSEA or equivalent.
Alternatives to undertaking the activity should be Select to indicate that the use of a chemical is likely to
considered where feasible. constitute a significant risk (e.g. there may be the
M13-H17 potential for persistent or widespread complaints of
Comply with all requirements of the current SDS. illness, discomfort, irritation or excessive odour,
Comply with the relevant procedures relating to the hazardous chemicals are splashed etc.)
substance(s).
Implement sufficient controls to ensure the safe use of
the material.

Select if no SDS is available, if labelling is inadequate,

Unacceptable: Immediate action required to manage
if the level of exposure cannot be estimated with
the risk.
H18- confidence or further investigation is necessary.
VH25 The use of the chemical must not be approved.
Obtain additional information from other sources, such
Alternatives to using the hazardous material must be
as suppliers, occupational health and safety
found.
consultants and industry or trade associations.

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