PRELIMINARY INCIDENT INFORMATION

Entity PT. McDermott Indonesia - Batam Facility

Incident No. APF-12-019-R2190D-ED-BTM Incident Name Fire of Paint Can
Type of Incident Fire
Date 25-Feb-12 Time 08.05am
Location Batam Fabrication
Department/ Project R-2190D Vetco Gray
Specific Activity 04-Structural Work Actual Activity Gas Cutting
Narrative (Description of Incident)
Around 08.05am a structure fitter was cutting plates at Coping Shop. During the process sparks flied and landed
onto paint Can (primer paint) placed nearby causing fire to the paint Can cover. The distance between paint Can
and the cutting activity is around 3.5 meters. A welder immediately put off the fire by using a fire extinguisher. The
incident is under investigation.

Immediate Actions Taken

1. Stopped the activity;
2. Reported the using of fire extinguisher to Yard FE Coordinator and requested for its replacement;
3. Barricaded incident area and took pictures;
4. Conducted incident investigation;

Remarks

Photos (if available)

The distance between the cutting activity

and paint Can is around 3.5m.

Note that this is issued for the purpose of early sharing of information. It is not a formal report.

Rev 19, December 2011 MDR-GLOBAL-L2-MGT-003 Page 1 of 2

Incident No./Name Near Miss
PT. McDermott Indonesia - Batam Facility Equipment Damage /
APF-12-019-R2190D-ED-BTM
Production Loss

Fire of Paint Can INCIDENT NOTIFICATION REPORT Employee injury/illness

Security

(assigned by HSES Department) (To be completed by person making initial report) Environmental Spill

LOGISTICS OF INCIDENT
Incident Date 25-Feb-12 Location Batam Fabrication Weather Conditions Meet/Assist notified? N/A
Incident Time 08.05am Project/Contract R-2190D Vetco Gray Wind 6. N/A to Claim How Injured transported? N/A
Shift Day Specific Activity 04-Structural Work Seas 6. N/A to Claim Location/time to meet? N/A
Destination? N/A

RELEVANT PERSONNEL
Superintendent Robert Damanik Captain N/A Chief Eng N/A
Foreman Tumpal Purba Chief Mate N/A Chief Elect N/A
Leaderman Ruseno # 13390 Steward N/A 1st Assistant N/A
Medic N/A Watch Sup./Other N/A Witness Yosnedi (welder0
Muhammad Taufiq (welder)

List below all persons involved in incident: TO BE COMPLETED BY SAFETY REPRESENTATIVE ONLY FOR INJURED PERSONNEL
Name Company Title/Position Employee Consecutive Days Length Type of Accident Body Part Side of Primary Diagnosis Injury/Illness
ID/SSN Worked service Body (company doctor) Severity

Ramses Purba PTMI Structural Fitter 1640D 13 6. 2 – 4 Yrs

DESCRIPTION OF INCIDENT (continue on another sheet if necessary)

Around 08.05am a structure fitter was cutting plates at Coping Shop. During the process sparks flied and landed onto paint Can (primer paint) placed nearby causing fire to the paint Can cover. The distance between paint Can and the cutting activity is
around 3.5 meters. A welder immediately put off the fire by using a fire extinguisher. The incident is under investigation.

INITIAL ACTIONS TAKEN TO MITIGATE RISKS, PREVENT ESCALATION OR REOCCURRENCE

1. Stopped the activity;
2. Reported the using of fire extinguisher to Yard FE Coordinator and requested for its replacement;
3. Barricaded incident area and took pictures;
4. Conducted incident investigation;

NOTIFICATION MADE (customers, agencies, management Mcdermott Group HSES Dept., etc.) PERSON COMPLETING INITIAL REPORT
ENTITY NAME PERSON TIME DATE REPORTING METHOD Print Name
Project HSES Manager Hervan Ralas 08.25am 25-Feb-12 Phone Radion Iskandar 25-Feb-12
Construction Manager Pujiono Wandiyo 08.30am 25-Feb-12 Phone Signature (only on original for file)
Client Rep. Jimi Azmi 08.35am 25-Feb-12 Phone

Status Change/Corrections Date of Change

Rev 19, December 2011 MDR-GLOBAL-L2-MGT-003 Page 2 of 2