petroleum incident notification · web viewpart 1 to be completed and submitted to the c ommission...

Petroleum Incident Notification Form

Petroleum Incident NotificationPetroleum Incident Notification.......................................................................................................1

PART 1: INITIAL NOTIFICATION......................................................................................................2

GENERAL........................................................................................................................................... 2

OWNER/OPERATOR DETAILS.........................................................................................................2

EVENT CATEGORISATION...............................................................................................................3

FURTHER REQUIREMENT...............................................................................................................6

PART 2: DETAILED INCIDENT REPORT.........................................................................................7

Class A - Detailed Incident Report................................................................................................7

Class B - Detailed Incident Report..............................................................................................14

Class C - Detailed Incident Report..............................................................................................16

Class D - Detailed Incident Report..............................................................................................19

Class E - Detailed Incident Report..............................................................................................20

Class F - Detailed Incident Report..............................................................................................21

Class G - Detailed Incident Report..............................................................................................22

Class H - Detailed Incident Report..............................................................................................24

Class I - Detailed Incident Report.............................................................................................26

Class J - Detailed Incident Report..............................................................................................27

Class K - Detailed Incident Report..............................................................................................29

Class L - Detailed Incident Report..............................................................................................30

Class M - Detailed Incident Report..............................................................................................31

Class N - Detailed Incident Report..............................................................................................32

Class O - Detailed Incident Report..............................................................................................33

Class P - Detailed Incident Report..............................................................................................34

Class Q - Detailed Incident Report..............................................................................................35

Class R - Detailed Incident Report..............................................................................................36

Class S - Detailed Incident Report..............................................................................................37

CRU use of information.................................................................................................................. 38

Revision: 2 of 39 Reference: CRU18184Revision Date: 30th August 2018


PART 1: INITIAL NOTIFICATION

Part 1 to be completed and submitted to the Commission without delay.

Failure to notify the Commission of a petroleum incident without delay is an offence under Section 13S of the Electricity Regulation Act 1999.

For guidance on what constitutes a petroleum incident, please refer to the Petroleum Safety (Petroleum Incident) Regulations 2016 and the Commission Guidance for Notification of Incidents.

GENERAL

Event Date and Time (hrs:min) Enter event date Enter event time hh:mm

OWNER/OPERATOR DETAILS

Details of the location and the person reporting the event

Operator / owner Enter operator/owner

Name of the installation Enter installation name

Safety Permit Reference Safety Permit Reference

Occupancy Type Choose occupancy type

Function Type Choose function type

Structure Type Choose structure type

Choose an item.Field name / code (if relevant)

Enter name/code

Number of persons on board (POB) or on site at time of event

Enter number of persons on board or on terminal at the time of event

Position of the installation, vessel, pipeline (if relevant)

Quadrant Enter Quadrant Offshore

Latitude Enter Latitude Offshore

Longitude Enter Longitude Offshore

Depth of Water (metres) Enter Water Depth Offshore

Details of the module / area on the installation / vessel where the incident occurred

Enter details

What type of work was being undertaken at the time of the event?

Enter type of work

Name of the reporting person Enter name of reporting person



Role of the reporting person Enter role of reporting person

Name of contact (if different) Name of contact (if different )

Role of the contact (if different)

Role of the contact (if different )

Telephone number Enter phone number

E-mail address Enter email address

Address Line 1 Enter address line 1



Town Enter name of town

County Enter county

Eircode

Description of circumstances, consequences of event & emergency response

Enter description

Please outline which other state agencies have been notified

Please outline which other state agencies have been notified

EVENT CATEGORISATION

What class of event is being reported (more than one option A to S may be applicable)? Please select all relevant classes. A single incident may result in multiple parts to be completed. If any boxes are selected in this form then the detailed report of each selected class needs to be completed.

Class A -

Unintended release of oil, gas or other hazardous substances, whether or not ignited

a. Any unintentional release of ignited gas or petroleum liquid;b. The unintentional release, with the exception of fugitive emissions, of:

i. not ignited natural gas or evaporated associated gas if mass released ≥ 1kg ii. not ignited petroleum liquid if mass released ≥ 60 kg;

c. The unintentional release or escape of any other hazardous substance:i. for which a major accident risk has been identified in the safety case.ii. for which the major accident risk has not been assessed in the safety case and

which would lead to a significant potential to cause fatalities or serious personal injury.

☐

Class B –

Loss of well control requiring actuation of well control equipment, or failure of a well barrier requiring its replacement or repair

☐Revision: 2 of 39 Reference: CRU18184Revision Date: 30th August 2018


1. Any blowout, regardless of the duration 2. The coming into operation of a blowout prevention or diverter system to control flow of

well-fluids; 3. The mechanical failure of any part of a well, whose purpose is to prevent or limit the effect

of the unintentional release of fluids from a well or a reservoir being drawn on by a well, or whose failure would cause or contribute to such a release.

4. Failure to maintain a planned minimum separation distance between two or more wells

Class C -

Failure of a safety (and environmentally) critical element- Any loss or non-availability of a S(E)CE requiring Immediate Remedial Action. ☐

Class D -

Significant loss of structural integrity or loss of station keeping in relation to a mobile installation: - Any detected condition that reduces the designed structural integrity of the installation,

including stability, buoyancy and station keeping, to the extent that it requires Immediate Remedial Action.

☐Class E -

Potential and actual vessel collisions with an offshore installation:- Any collision, or potential collision, between a vessel and an offshore installation which

has, or would have, enough energy to cause sufficient damage to the installation and/or vessel, to jeopardise the overall structural or process integrity

☐Class F -

Helicopter accidents within the safety zone. - Any helicopter accident, or a collision or potential collision, within the safety zone. ☐

Class G -

Any fatality- Death, whether immediate or delayed, within 1 year. - Confirmed missing person ☐

Class H –

Any serious injury Any injury to a person where the person cannot perform all of their normal work activities

for more than 7 consecutive days (not including the day of the petroleum incident, but including subsequent nonworking days); or

Any injury to a person that requires admittance to a hospital for more than 24 hours.

☐

Class I -

Any evacuation of personnel:- Any unplanned emergency evacuation of a number or all personnel ☐



Class J -

Any major environmental incident (offshore):- Any major environmental incident as defined by the Act ☐

Class K -

An uncontrolled fire or explosion ☐Class L-

Instance of a stand-by vessel not being within its defined geographical area except when prevailing weather and climate conditions may endanger the crew, passengers or vessel ☐

Class M -

A person falling into the sea ☐Class N -

Mustering on onshore or offshore petroleum infrastructure, other than for planned drills. ☐Class O -

The detection of hydrogen sulfide in the course of operations at a well or in samples of well-fluids from a well where the presence of hydrogen sulfide in the reservoir being drawn on by the well was not anticipated

☐Class P -

The collapse, overturning, or failure of any load-bearing part of any lift, hoist, crane, or derrick ☐Class Q -

Damage to third party property ☐Class R -

The dropping of an object that could have resulted in a major accident ☐Class S -

A collision by a vehicle, crane, or aircraft with any petroleum infrastructure ☐Does this incident constitute a major accident as defined by the Act of 2015? Yes ☐ No ☐

FURTHER REQUIREMENT

Detailed ReportsA detailed incident report (Part 2 of this form) shall be completed by the owner/operator and submitted



to the Commission within 10 working days.

Fatalities or missing personsIn the case of a petroleum incident which results in a fatality or a missing person, the operator and/or the owner must notify the Commission, by the quickest practicable means, for instance by phone, of: The name of the deceased or missing person(s); Brief particulars of the petroleum incident; and The location of the petroleum incident.

The requirement to notify the Commission using this notification is in addition to the requirements to notify the Commission using this notification Petroleum Incident Notification form as normal, without delay and within 10 days of the incident respectively.

FOR COMMISSION OFFICE USE ONLY

For CRU Office Use Only

Does this constitute a major accident under EU Directive 2013/30/EU?

☐ Yes ☐ No

Give justification Click here to enter text.



PART 2: DETAILED INCIDENT REPORT

Part 2 to be completed and submitted to the CRU within 10 working days of the incident

Class A - Detailed Incident Report

Unintended release of oil, gas or other hazardous substances, whether or not ignited

Was there a release of hydrocarbon substances?

☐ Yes ☐ No

If Yes complete from A1 If No, go to A2

Section A1

i. Hydrocarbon Released

☐ Non Process Please specify

Choose a Hydrocarbon type

Choose an item.☐

Process ☐ Oil ☐ Gas

☐ Condensate ☐ 2-Phase

For gas or 2-Phase, state level of H2S

Enter estimated ppm. If less than 5 ppm enter “insignificant”.

Enter estimated ppm. If less than 5 ppm enter “insignificant”

For gas, estimate approximate molecular weight

Enter molecular weight

For 2-Phase, state GOR (gas/oil ratio)

Specify units.kg/kg, scf/bbl

Enter GOR and specify units)

For liquids, state density (kg/m3) Enter density and specify units

Please state water cut (where relevant) (%age of liquid by mass)

Enter water cut

Was the release limited/stopped due to a local manual intervention / isolation, separate from the ESDV system?

☐ Yes ☐ No



Did liquid spray/mist releases occur?

☐ Yes ☐ No

ii. Estimated quantity released

Estimated quantity released

Specify units e.g. tonnes, kg, Nm3

[Nm3 is normal cubic metre]

Enter quantity released and specify units

What is the basis for this estimate?

Enter description

Total gas HC Inventory in system

Specify units e.g. tonnes, kg Nm3

[Nm3 is normal cubic metre]

Enter gas HC Inventory in system and specify units

Total liquid HC Inventory in system

Specify units e.g. tonnes, kg

Enter liquid HC Inventory and specify units

Extent of dispersion / liquid spread

Enter extent of dispersion

iii. Estimated initial release rate

Estimated initial release rate

Specify units e.g. tonnes/day, kg/s, Nm3/s

[Nm3/s is normal cubic metre per second]

Enter estimated initial release rate and specify units

Equivalent hole diameter

Based on hole area equated to a circular hole (mm)

Enter diameter

Is hole size measured or estimated?

☐ Measured ☐ Estimate

If estimated, on what basis? Please describe

iv. Duration of leak

Duration of leak

(seconds/minutes/hours)

(Estimated time from discovery, e.g. alarm, electronic log, to termination of

Enter duration and specify units



leak)

v. Location of leak

Module / area name (Please state the name in common use on the installation, including subsea if appropriate)

[Please indicate those items which come nearest to pinpointing the location of the leak.]

Enter module/area name

Please provide a description of the system and equipment including details of any valves, flanges, pumps, tubing, pipework, pipelines and other fittings associated with the leak

Describe details of the leak

For valves, flanges, pumps, tubing, pipework, pipelines and other fittings, please specify their size in terms of nominal bore, in inches (i.e. the nominal bore of the piping they connect to)

Enter size

For pig launcher/receivers and pressure vessels give both the length and the diameter in mm or inches, as available

Enter size

For BOP Stacks indicate the design pressure rating, e.g. 5,000 psi. Enter design pressure rating.

vi. Hazardous area classification (i.e. zone at location of incident)

Classification ☐ 1 ☐ 2 ☐ Unclassified

vii. Module ventilation?

☐ Natural ☐ Forced

How many sides enclosed?

(Insert the number of walls, including floor and ceiling)

Enter the number of walls, including floor & ceiling

Module volume (m3) Enter volume in m3

Estimated number of air changes (if known)

If “Natural ventilation” is selected above, type ” n/a”

Specify Hourly rate

Specify hourly rate

viii. Weather conditions

Wind speed

(specify units e.g. mph, m/s, ft/s or knots)

Enter wind speed and specify units

Wind direction

(Specify heading in degrees) from true north

Enter wind direction



Provide a description of other relevant weather conditions

(including sea conditions)

Describe weather conditions

ix. System pressure

Design Pressure

(Specify units, e.g. bar, psi or other)

Enter design pressure and specify units

Actual Pressure

(i.e. at time of release)

Enter actual pressure and specify units

Design Temperature (maximum) Enter maximum design temperature and specify units

Design Temperature (minimum) Minimum design temperature and specify units

Actual Temperature

(i.e. at time of release)

Actual temperature and specify units

x. Means of detection

Detection systems ☐ Gas Choose a Gas detection system

Choose an item. ☐ Fire Choose a Fire detection system

Choose an item. ☐ Smoke

☐ Other Please specify.

Instrumentation of Process System

Choose an item

Choose an item.Planned Manual Inspection

Choose an item

Choose an item.Unplanned Manual Inspection

Choose an item

xi. Choose an item.Cause of leak

Please give a short description and complete the cause checklist below

Describe cause of leak.

☐ Design Failure related to design

☐ Equipment

☐ Internal corrosion ☐ External corrosion

☐ Mechanical failure due to fatigue ☐ Mechanical failure due to wear out

☐ Erosion ☐ Material defect

☐ Degradation of valve sealing ☐ Loss of bolt tensioning

☐ Degradation of flange gasket ☐ Failure of a temporary repair

☐ Degredation of permanent or temporary



repair

☐ Other Please specify

☐ Operation

☐ Incorrectly fitted ☐ Left open

☐ Improper inspection ☐ Improper testing

☐ Improper operation ☐ Improper maintenance

☐ Dropped object ☐ Other impact

☐ Opened when containing HC ☐ Incorrect fitting of flanges or bolts during maintenance

☐ Pressure excursion ☐ Overflow/over filling

☐ Break-down of isolation system during maintenance (technical)

☐ Work on wrong equipment (not known to be pressurised)

☐ Incorrect blinding/isolation ☐ Maloperation of temporary hoses

☐ Maloperation of valve(s) during manual operation

☐ Erroneous choice of installations of sealing device

☐ Impact from bumping / collision ☐ Maloperation of valve(s) during manual operations

☐ Valve(s) in incorrect position after maintenance

☐ Incorrect installation of small bore fittings

☐ Temperature excursion


☐ Procedural

☐ Non-compliance with procedure ☐ Non-compliance with permit-to-work

☐ Deficient procedure


Indicate the operational mode in the area at the time of releaseChoose the relevant parameter(s) from the following categories

☐ Construction

☐ Hot work ☐ Cold work ☐ Draining

☐ Drilling

☐ Oil ☐ Gas

☐ Exploration ☐ Exploration

☐ Appraisal ☐ Appraisal

☐ Development ☐ Development

☐ Maintenance




☐Routine Maintenance


☐ Normal Production

☐ Pipeline operations including Pigging

☐ Well Operations

☐ Oil ☐ Gas

☐ Wireline ☐ Wireline

☐ Well test ☐ Well test

☐ Other ☐ Other

xii. Did ignition occur?

☐ Yes ☐ No

If yes, was it:

☐ Immediate ☐ Delayed

Delay time (sec) Enter time (sec).

Was there: (add sequence of events by numbering appropriate boxes in order of occurrence)

Enter sequence number

A flash fire Enter sequence number

An explosion

Enter sequence number

A jet fire Enter sequence number

A pool fire

xiii. Ignition Source (if known)

Provide a description of the ignition source

Describe ignition source

xiv. What emergency action was taken?

☐ Shutdown ☐ Automatic ESD initiation ☐ Manual

☐ ESD initiation

☐ Local initiation

☐ Blowdown ☐ Automatic ☐ Manual

☐ Deluge ☐ Automatic ☐ Manual

☐ CO2/Halon/inerts ☐ Automatic ☐ Manual


Time between detection and isolation.

Enter time and specify units



(Specify units, e.g. seconds, Minutes)

Time between detection and start of blowdown.

(Specify units, e.g. seconds, Minutes)

Enter time and specify units

☐ Call to muster ☐ At stations ☐ At lifeboats (assembly point)

☐ Partial down man ☐ By helicopter ☐ By lifeboats

Other Please specify

☐ Installation evacuation ☐ By helicopter ☐ By lifeboats

Other Please specify

xv. Any additional comments

Enter additional comments

Section A2

Description of circumstances, consequences of event and emergency response

Enter description

Was there a release of a non-petroleum hazardous substance?

☐ Yes ☐ No

If yes, specify the type and quantity of released substance

Specify type and units

Was there a non-petroleum fire (e.g. electrical) with a significant potential to cause a major accident?

Enter description

Is the incident likely to cause degradation to the surrounding marine environment?

☐ Yes ☐ No

If yes, outline the environmental impacts which may have already been observed or are likely to result from the incident

Enter outline

Section A3

Preliminary direct and underlying causes

Enter causes

Section A4

Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Revision: 2 of 39 Reference: CRU18184Revision Date: 30th August 2018


Enter recommendations and lessons learned



Class B - Detailed Incident Report

Loss of Well Control Requiring Actuation of Well Control Equipment, or Failure of a Well Barrier Requiring its Replacement or Repair.

Section B1

General information

Name/code of well Enter name/code

Name of drilling contractor (if relevant)

Enter name of drilling contractor

Name/type of drilling rig (if relevant) Enter name/type of drilling rig

Start date/time of loss of well control

Enter a start date Enter a start time hh:mm

End date/time of loss of well control Enter an end date Enter an end time hh:mm

Type of fluid (if relevant) ☐ Brine ☐ Oil ☐ Gas


Well head completion ☐ Surface ☐ Subsea

Water depth (m) Enter depth

Reservoir: pressure / temperature / depth

Enter pressure/temperature/depth

Type of activity ☐ Normal production ☐ Drilling

☐ Work over ☐ Well services


Type of well services ☐ Wire line ☐ Coiled tubing ☐ Snubbing


Section B2

Description of circumstances, consequences of event and emergency responseBlowout prevention equipment activated ☒ Yes ☐ NoDiverter system in operation ☐ Yes ☐ NoPressure build-up and/or positive flow check ☐ Yes ☐ NoFailing well barriers (a) Enter text

(b) Enter text

(c) Enter textDescription of circumstances

Enter Description.



Further details(specify units)

☐ Duration of uncontrolled flow of well-fluids

Enter further details and specify units

☐ Flowrate


☐ Liquid volume


☐ Gas volume


Consequences of event and emergency response(e.g. 1. Jet fire / 2. First explosion / 3. Second explosion, etc.)Enter details

Section B3


Enter cause

Section B4

Initial lessons learned and preliminary recommendations to prevent recurrence of similar events

Enter lessons learned and recommendations



Class C - Detailed Incident Report

Failure of a Safety (and Environmentally) Critical Element

Section C1

General information

Name of independent verifier(if applicable)

Enter name of independent verifier

Section C2Description of circumstances, consequences of event and emergency response

Which Safety (and Environmental) Critical systems were reported as lost or unavailable, requiring immediate remedial action, or have failed during an incident?

Incident reported by: ☐Independent Verifier

☐Other

Please state name, organisation and role

Description of S(E)CE and circumstancesWhich Safety (and Environmental) Critical systems were reported as lost or unavailable, requiring immediate remedial action, or have failed during an incident?Enter description

Origin ☐ Report Independent verifier(report no. / date / verifier)

Enter details

☐ Failure during major accident.(date / accident description / …)

Enter details

Safety and Environmental Critical elements concerned

Structural integrity systems ☐ Topside structures ☐ Cranes & lifting equipment

☐ Subsea structures ☐ Mooring systems (anchor line, dynamic positioning)


Process containment systems ☐ Primary well barrier ☐ Secondary well barrier

☐ Wireline equipment ☐ Mud processing

☐ Sand filters ☐ Pipelines & risers

☐ Piping system ☐ Pressure vessels

☐ Well control process equipment - BOP




Ignition control systems ☐ Hazardous area ventilation ☐ Non-hazardous area ventilation

☐ ATEX certified equipment ☐ Electrical tripping equipment

☐ Earthing/bonding equipment ☐ Inert Gas system


Detection systems ☐ Fire & gas detection ☐ Chemical injection monitor

☐ Sand


Process containment relief systems ☐ Well control process equipment - diverter ☐ Relief systems

☐ Gas tight floors


Protection systems ☐ Deluge ☐ Helideck foam system

☐ Fire water pumps ☐ Firewater system

☐ Passive fire protection system ☐ Fire / blast walls

☐ CO2 / Halon fire-fighting system


Shutdown systems ☐ Local shutdown systems (LSD) ☐ Process shutdown system

(PSD)

☐ Subsea isolation valve ☐ Emergency shutdown system (ESD)

☐ Riser ESD valve ☐ Topsides ESD valve

☐ Blowdown


Navigational aids ☐ Aircraft navigation aids ☐ Sea craft navigation. aids


Rotating equipment – power supply ☐ Turbine P.M. for compressor ☐ Turbine P.M. for

generator


Escape, evacuation and rescue equipment

☐ Personal safety equipment ☐ Lifeboats / TEMPSC

☐ Tertiary escape means (life raft) ☐ Temporary refuge /

Muster area

☐ Search & rescue facilities


Communication systems ☐ Radios / telephones ☐ Public address




Other ☐ Please specify

Description of consequences

Is the incident likely to cause degradation to the surrounding marine environment?

☐ Yes ☐ No

If yes, outline the environmental impacts which have already been observed or are likely to result from the incidentEnter outline

Section C3


Enter causes

Section C4


Describe any important lessons learned from the event. List recommendations to prevent the recurrence of similar events. Enter lessons learned and recommendations



Class D - Detailed Incident Report

Significant loss of structural integrity or loss of station keeping in relation to a mobile installation

Section D1

General information

Name of vessel (if applicable) Enter name of vessel

Section D2

Description of circumstances, consequences of event and emergency responseIndicate the system that failed and provide a description of the circumstances of the event / describe what has happened including weather conditions and sea state.Enter description

Section D3

Preliminary direct and underlying causes Enter causes

Section D4

Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations



Class E - Detailed Incident Report

Potential and actual vessel collisions with an offshore installation

Section E1

General information

Name / Flag State of vessel (if applicable)

Enter name / flag state of vessel

Type / tonnage of vessel (if applicable)

Enter type / tonnage of vessel

Contact via AIS? ☐ Yes ☐ No

Section E2

Description of circumstances, consequences of event and emergency responseIndicate the system that failed and provide a description of the circumstances of the event / describe what has happened (minimum distance between vessel and installation, course and speed of vessel, weather condition)Enter description

Section E3


Enter causes

Section E4





Class F - Detailed Incident Report

Helicopter Accidents within the safety zone

Section F1

General information

Name of helicopter contractor Enter name of helicopter contractor

Helicopter type Enter helicopter type

Number of persons on board Enter number of persons on board

Section F2


Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened (weather conditions)

Enter description

Section F3


Enter causes

Section F4



End of Part F Detailed Report



Class G - Detailed Incident Report

Any fatality

Section G1

Prior Incident

Did a previously reported ‘serious injury’ incident result in the fatality?

If yes, enter date of PIN or other identifier

Section G2

Deceased person’s or person’s lost employment status

Was the injured person ☐ One of your employees? ☐ Member of the public?

☐ Employed by someone else?

☐ Self-employed and at work?

Details if the person was employed by someone else

Enter details

Section G3

About the kind of accident

Select the kind of accident that best describes the incident

Choose kind of accident

Choose an item.If a fall from height- how high was the fall (to the nearest meter)

Enter measurement

Work process involved in the incident Choose a work process

Choose an item.Main factor involved in the incident Choose a main factor

Choose an item.Describe what happened(give as much detail as you can, including i) the events that led to the incident ii) the operation or activity in progress. Describe any action taken to prevent similar incidents occurring.)

Enter description

Section G4

About the deceased or person lost

Name Family name

Address Line 1 Enter address line1



Town Enter Town

County Enter county



Post Code Enter postcode Phone No Enter phone number

Gender ☐ Male ☐ Female

Age Enter age

Nationality of deceased or person lost

Enter nationality

Name and address of next-of-kin

Enter name

Enter addressRelationship of next-of-kin Enter relationship



Class H - Detailed Incident Report

Any serious injury

Section H1

Number or persons seriously injured

Please state the number of people injured

☐ One ☐ Between 2 and 4

☐ 5 or greater

Section H2

Injured person’s employment status

Was the injured person ☐ One of your employees? ☐ Member of the public?

☐ Employed by someone else?

☐ Self-employed and at work?

Details if the person was employed by someone else

Enter details

Section H3

About the kind of accident

Select the kind of accident that best describes the incident

Choose kind of accident

Choose an item.If a fall from height- how high was the fall (to the nearest meter)

Enter measurement

Work process involved in the incident Choose a work process

Choose an item.Main factor involved in the incident Choose a main factor

Choose an item.Describe what happened(give as much detail as you can, including i) the events that led to the incident ii) the operation or activity in progress. Describe any action taken to prevent similar incidents occurring.)

Enter description

Section H4

About the Injured person

Name Family name

Address Line 1 Enter address line1





Town Enter Town

County Enter county

Post Code Enter postcode Phone No Enter phone number

Gender ☐ Male ☐ Female

Age Enter age

Section H5

About the severity of the person’s injuries

Describe the injury:Enter details

Did the injury prevent the person from carrying out their routine work for more than 7 days

☐ Yes ☐ No

Did the injury require the person to be admitted to hospital for 24 hours or more

☐ Yes ☐ No

About the person’s injuries

Injuries Choose an injury

Choose an item.Parts of the body Affected

Choose the part of the body affected



Choose an item.Class I - Detailed Incident Report

Any evacuation of personnel.

Section I1

General information

Start date and time of evacuation Enter a date Enter time hh:mm

End date and time of evacuation Click here to enter a date Enter time hh:mm

Section I2


Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened (weather conditions)Was the evacuation precautionary or emergency?

☐ Precautionary ☐ Emergency ☐ Both

Number of persons evacuated Enter number of persons evacuated

Means of evacuation (e.g. helicopter) Enter means of evacuationIndicate the system that failed and provide a description of the circumstances of the event / describe what has happened, unless already reported in a previous section of this report.Enter description

Section I3


Enter causes

Section I4





Class J - Detailed Incident Report

A Major Environmental Incident (offshore)

Section J1

General information

Operator/Owner/Contractor Responsible for Incident:

Enter name of contractor

Tier of Response (1,2 or 3):

(As per Oil Pollution Emergency Plan)

☐ Tier 1 ☐ Tier 2 ☐ Tier 3

Section J2

Description of circumstances, consequences of event and emergency responseIndicate the system that failed and provide a description of the circumstances of the event / describe what has happened.Enter description

Hazardous Substance Release

Max Released (tonnes or kg): Max Released (tonnes or kg)

Min Released (tonnes or kg): Min Released (tonnes)

Type of Hazardous Substance: Type of Hazardous Substance

Hazardous Substance Use Hazardous Substance Use

% oil if OBM or base oil: % oil if OBM or base oil

Hazard label: Hazard label

Appearance: Appearance

Approx. release area on sea surface(m2or km2):

Approx. release area on sea surface

Is Release Ongoing? ☐ Yes ☐ No

If yes the CRU must be updated each 24 hr period

Source of release Source of pollution

Release likely to reach shore ☐ Yes ☐ No

If Yes, time likely to reach shore Time.

Location Location

Weather Conditions

Wind Speed (knots): Wind Speed (knots)

Beaufort Scale Beaufort Scale (1-12)



Wind Direction Wind Direction (0-3600)

Wave Height (metres): Wave Height (metres)

Section J3

Preliminary direct and underlying causes of release

Enter causes

Section J4





Class K - Detailed Incident Report

An uncontrolled fire or explosion

Section K1

General information

Name of contractor (if applicable) Enter name of contractor

Section K2


Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened. What are or are likely to be the significant adverse effects on the environment?Enter description

Section K3


Enter causes

Section K4



End of Part K Detailed Report



Class L - Detailed Incident Report

Instance of a stand-by vessel not being within its defined geographical area, except when prevailing weather and climate conditions may endanger the crew, passengers or vessel.

Section L1

General information

Describe what happened(give as much detail as you can, including i) the events that led to the incident ii) the operation or activity in progress. Describe any action taken to prevent similar incidents occurring.)Enter description

Section L2


Indicate o Name of vessel;o How long the vessel was off station for including dates and time;o The reason it was off station; and o What measures were put in place in its absence?

Enter description



Class M - Detailed Incident Report

A person falling into the sea

Section M1

General information


Section M2


Indicate the system that failed and provide a description of the circumstances of the event / describe what has happenedE.g. Height the person fell from, Location of Impact

Enter description

Section M3


Enter causes

Section M4





Class N - Detailed Incident Report

Mustering on onshore or offshore petroleum infrastructure, other than for planned drills.

Section N1

General information


Section N2


Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened

Enter description

Section N3


Enter causes

Section N4





Class O - Detailed Incident Report

The detection of hydrogen sulfide in the course of operations at a well or in samples of well-fluids from a well where the presence of hydrogen sulfide in the reservoir being drawn on by the well was not anticipated

Section O1

General information


Section O2



Enter description

Section O3


Enter causes

Section O4





Class P - Detailed Incident Report

The collapse, overturning, or failure of any load-bearing part of any lift, hoist, crane, or derrick

Section P1

General information


Section P2



Enter description

Section P3


Enter causes

Section P4





Class Q - Detailed Incident Report

Any incident that results in damage to property the ownership of which is held by a person other than the petroleum undertaking, operator, owner, or a contractor thereof, concerned

Section Q1

General information


Section Q2



Enter description

Section Q3


Enter causes

Section Q4





Class R - Detailed Incident Report

The dropping of an object that could have resulted in a major accident

Section R1

General information


Section R2


Indicate the system that failed and provide a description of the circumstances of the event / describe what has happenedE.g. Size of Dropped Object , Height the object fell from, Location of Impact

Enter description

Section R3


Enter causes

Section R4





Class S - Detailed Incident Report

A collision by a vehicle, crane, or aircraft with any petroleum infrastructure

Section S1

General information


Section S2



Enter description

Section S3


Enter causes

Section S4





CRU use of informationThe information provided in this form may be used by CRU for any of its statutory functions or as required by legislation and for statistical data. CRU is subject to the Freedom of Information Acts 2014 and information obtained by CRU may be released as part of a request make under that Act.


petroleum incident notification · web viewpart 1 to be completed and submitted to the c ommission...

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