PT.

Leighton Contractors Indonesia

RISK ASSESSMENT REPORT

Risk Assessment Team

Business Unit / Project : BU3/ID205/Wahana Coal Mine Project
Names Dept - Position Sign Off
Date :

Team Leader : Richard Douglas HSEQ General Supt Team Members :

Reference Number :
Facilitator : :

Process/Activity : Team Members :

Approved By :

(PM/Delegated)
Note: Attach meeting attandance if more.

Hirarchy Control

Hirarchy Control
Risk Identified
People /
Process / Activity / Task Environment at Hazard / Cause of Incident / Adverse L1 C1 RFN ** Current Mitigating Controls L2 C2 RRN * Additional Controls Required
Risk Adverse Effect / Effect / Environmental
Environmental Aspect Impact

Uncontrolled Document When Printed 1 of 10 LCI-HSE-FM-001A(02)

Feb 2010
PT. Leighton Contractors Indonesia

RISK ASSESSMENT REPORT

Risk Assessment Team

Business Unit / Project : BU3/ID205/Wahana Coal Mine Project
Names Dept - Position Sign Off
Date :

Team Leader : Richard Douglas HSEQ General Supt Team Members :

Reference Number :
Facilitator : :

Process/Activity : Team Members :

Approved By :

(PM/Delegated)
Note: Attach meeting attandance if more.

Hirarchy Control

Hirarchy Control
Risk Identified
People /
Process / Activity / Task Environment at Hazard / Cause of Incident / Adverse L1 C1 RFN ** Current Mitigating Controls L2 C2 RRN * Additional Controls Required
Risk Adverse Effect / Effect / Environmental
Environmental Aspect Impact

Uncontrolled Document When Printed 2 of 10 LCI-HSE-FM-001A(02)

Feb 2010
PT. Leighton Contractors Indonesia

RISK ASSESSMENT REPORT

Risk Assessment Team

Business Unit / Project : BU3/ID205/Wahana Coal Mine Project
Names Dept - Position Sign Off
Date :

Team Leader : Richard Douglas HSEQ General Supt Team Members :

Reference Number :
Facilitator : :

Process/Activity : Team Members :

Approved By :

(PM/Delegated)
Note: Attach meeting attandance if more.

Hirarchy Control

Hirarchy Control
Risk Identified
People /
Process / Activity / Task Environment at Hazard / Cause of Incident / Adverse L1 C1 RFN ** Current Mitigating Controls L2 C2 RRN * Additional Controls Required
Risk Adverse Effect / Effect / Environmental
Environmental Aspect Impact

Uncontrolled Document When Printed 3 of 10 LCI-HSE-FM-001A(02)

Feb 2010
PT. Leighton Contractors Indonesia

RISK ASSESSMENT REPORT

Risk Assessment Team

Business Unit / Project : BU3/ID205/Wahana Coal Mine Project
Names Dept - Position Sign Off
Date :

Team Leader : Richard Douglas HSEQ General Supt Team Members :

Reference Number :
Facilitator : :

Process/Activity : Team Members :

Approved By :

(PM/Delegated)
Note: Attach meeting attandance if more.

Hirarchy Control

Hirarchy Control
Risk Identified
People /
Process / Activity / Task Environment at Hazard / Cause of Incident / Adverse L1 C1 RFN ** Current Mitigating Controls L2 C2 RRN * Additional Controls Required
Risk Adverse Effect / Effect / Environmental
Environmental Aspect Impact

Uncontrolled Document When Printed 4 of 10 LCI-HSE-FM-001A(02)

Feb 2010
PT. Leighton Contractors Indonesia

RISK ASSESSMENT REPORT

Risk Assessment Team

Business Unit / Project : BU3/ID205/Wahana Coal Mine Project
Names Dept - Position Sign Off
Date :

Team Leader : Richard Douglas HSEQ General Supt Team Members :

Reference Number :
Facilitator : :

Process/Activity : Team Members :

Approved By :

(PM/Delegated)
Note: Attach meeting attandance if more.

Hirarchy Control

Hirarchy Control
Risk Identified
People /
Process / Activity / Task Environment at Hazard / Cause of Incident / Adverse L1 C1 RFN ** Current Mitigating Controls L2 C2 RRN * Additional Controls Required
Risk Adverse Effect / Effect / Environmental
Environmental Aspect Impact

Uncontrolled Document When Printed 5 of 10 LCI-HSE-FM-001A(02)

Feb 2010
Team

Names Dept. - Position Sign Off

ols Required By whom By When Status Legal and Other Requirements Reference

Uncontrolled Document When Printed 6 of 10 LCI-HSE-FM-001A(02)

Feb 2010
Team

Names Dept. - Position Sign Off

ols Required By whom By When Status Legal and Other Requirements Reference

Uncontrolled Document When Printed 7 of 10 LCI-HSE-FM-001A(02)

Feb 2010
Team

Names Dept. - Position Sign Off

ols Required By whom By When Status Legal and Other Requirements Reference

Uncontrolled Document When Printed 8 of 10 LCI-HSE-FM-001A(02)

Feb 2010
Team

Names Dept. - Position Sign Off

ols Required By whom By When Status Legal and Other Requirements Reference

Uncontrolled Document When Printed 9 of 10 LCI-HSE-FM-001A(02)

Feb 2010
Team

Names Dept. - Position Sign Off

ols Required By whom By When Status Legal and Other Requirements Reference

Uncontrolled Document When Printed 10 of 10 LCI-HSE-FM-001A(02)

Feb 2010