ROGI Form 1.1 - Date of Issue 20/07/2015

Petroleum Incident Notification Form

1. Petroleum Incident Notification

of 38 Petroleum Incident Notification Form

2. Section 1: Initial Notification

Section 1 to be completed and submitted to the CER without delay

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

Event Date and Time Enter event date Enter event time hh:mm (hrs:min) Version ☐ Final Version ☐ Interim Version

3. 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 Occupancy Type Choose occupancy type Function Type Choose function type Structure Type Choose structure type Field name / code (if Enter name/code relevant) Number of Persons on board Enter number of persons on board (POB) at time of event Position of the Installation, Quadrant Enter quadrant vessel, pipeline Latitude Enter latitude Longitude Enter longitude Depth of Water (metres) Enter depth Details of the module / area Enter details on the installation / vessel where the incident occurred What type of work was being Enter type of work undertaken at the time of the event? Name of the reporting person Enter name of reporting person Role of the reporting person Enter role of reporting person Telephone Number Enter phone number E-mail address Enter email address Address Line 1 Enter address line 1 Address Line 2 Enter address line 2 Address Line 3 Enter address line 3 Town Enter name of town County Enter county Eircode Enter Eircode

Description of circumstances, Enter description consequences of event & emergency response Please outline which other Other state agencies notified state agencies have been notified

The Competent Authority shall further complete this section. Relates to requirement as detailed in the Implementation Regulation Section (A/B/C/D/E/F)

Is this considered to be a major accident under the Petroleum Safety ☐ Yes ☐ No (Exploration and Extraction) Safety Act 2015? Is it a considered a major accident under EU Directive ☐ Yes ☐ No 2013/30/EU? Give justification Enter justification.

SECTION 1 CONTINUES ON THE NEXT PAGE

4. EVENT CATEGORISATION What type of event is being reported? (More than one option A to S may be applicable) Please select all relevant parts. 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 section needs to be completed.

5. Part A - Unintended Release of Oil, Gas or other Hazardous substance whether or not ignited Unintended release of oil, gas or other hazardous substances, whether or not ignited 1. Any unintentional release of ignited gas or petroleum liquid;

2. The unintentional release, with the exception of fugitive emissions, of:

a. not ignited natural gas or evaporated associated gas if mass released ☐ ≥ 1kg

b. not ignited petroleum liquid if mass released ≥ 60 kg;

3. The unintentional release or escape of any non-petroleum hazardous substance

6. Part B - Loss of well control requiring actuation of well control equipment, or failure of a well barrier requiring its replacement or repair

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

7. Part C - Failure of a Safety (and Environmentally) Critical Element Failure of a safety (and environmentally) critical element - Any loss or non-availability of a S(E)CE requiring Immediate Remedial ☐ Action.

8. Part D - Significant loss of structural integrity or loss of station keeping in relation to a mobile installation

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.

9. Part E - Potential and actual vessel collisions with an offshore installation 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

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

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

12. Part H – Any Serious Injury 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.

13. Part I - Any evacuation of personnel Any evacuation of personnel: ☐ - Any unplanned emergency evacuation of a number or all personnel

14. Part J - A Major Environmental Incident Any major environmental incident (offshore): ☐

- Any major environmental incident as defined by the Act

15. Part K - An uncontrolled fire or explosion

An uncontrolled fire or explosion ☐

16. Part L- Stand-by vessel

Instance of a stand-by vessel not being within its defined geographical area ☐

17. Part M - A person falling into the sea

A person falling into the sea ☐

18. Part N - Mustering Mustering on onshore or offshore petroleum infrastructure, other than for planned ☐ drills.

19. Part O - Hydrogen Sulfide 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

20. Part P - Lifting equipment The collapse, overturning, or failure of any load-bearing part of any lift, hoist, ☐ crane, or derrick

21. Part Q - Damage to Third Party Property 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

22. Part R - Dropped Object

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

23. Part S - Collisions

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

24. Section 2: Detailed Incident Report

Section 2 to be completed and submitted to the CER within 10 working days of the incident

25. Part A Detailed Incident Report Unintended release of oil, gas or other hazardous substances, whether or not ignited

26. Section A1 Was there a release of hydrocarbon substances?

☐ Yes ☐ No If Yes complete from A1 If No, go to A2 1.a.i.a.i.1.a.i. Hydrocarbon Released ☐ Non Process Please specify Choose a Hydrocarbon type ☐ Process ☐ Oil ☐ Gas ☐ Condensate ☐ 2-Phase For gas or 2-Phase, state level of Enter estimated ppm. If less than 5

H2S ppm enter “insignificant” Enter estimated ppm. If less than 5 ppm enter “insignificant”. For gas, estimate approximate Enter molecular weight molecular weight ☐ n/a For 2-Phase, state GOR (gas/oil Enter GOR and specify units) ratio) Specify units.kg/kg, scf/bbl ☐ n/a For liquids, state density (kg/m3) Enter density and specify units Please state water cut (where Enter water cut relevant) (%age of liquid by mass) ☐ n/a Was the release limited/stopped due to a local manual ☐ Yes ☐ No intervention / isolation, separate from the ESDV system? Did liquid spray/mist releases ☐ Yes ☐ No occur? Estimated quantity released

Estimated quantity released Enter quantity released and specify units Specify units e.g. tonnes, kg, Nm3 [Nm3 is normal cubic metre] What is the basis for this Enter description estimate? Total gas HC Inventory in Enter gas HC Inventory in system and specify units system Specify units e.g. tonnes, kg Nm3 [Nm3 is normal cubic metre] Total liquid HC Inventory in Enter liquid HC Inventory and specify units system Specify units e.g. tonnes, kg Extent of dispersion / liquid Enter extent of dispersion spread Estimated initial release rate Estimated initial release rate Enter estimated initial release rate and specify units Specify units e.g. tonnes/day, kg/s, Nm3/s [Nm3/s is normal cubic metre per second] Equivalent hole diameter Enter diameter Based on hole area equated to a circular hole (mm) Is hole size measured or ☐ Measured ☐ Estimate estimated? If estimated, on what basis? Please describe Duration of leak Duration of leak Enter duration and specify units (seconds/minutes/hours) (Estimated time from discovery, e.g. alarm, electronic log, to termination of leak) Location of leak

Module / area name Enter 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.]

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 Enter size other fittings, please specify their size in terms of nominal bore, in inches (i.e. the nominal bore of the piping they connect to) For pig launcher/receivers and pressure vessels give both the Enter size length and the diameter in mm or inches, as available For BOP Stacks indicate the design pressure rating, e.g. 5,000 Enter design pressure rating. psi. Hazardous area classification (i.e. zone at location of incident) Classification ☐ 1 ☐ 2 ☐ Unclassified Module ventilation? ☐ Natural ☐ Forced How many sides enclosed? Enter the number of walls, including floor & ceiling (Insert the number of walls, including floor and ceiling) Module volume (m3) Enter volume in m3 Estimated number of air Specify hourly rate changes (if known) If “Natural ventilation” is selected above, type ” n/a” Specify Hourly rate Weather conditions Wind speed Enter wind speed and specify units (specify units e.g. mph, m/s, ft/s or knots) Wind direction Enter wind direction (Specify heading in degrees) from true north Provide a description of other Describe weather conditions relevant weather conditions (including sea conditions) System pressure Design Pressure Enter design pressure and specify units (Specify units, e.g. bar, psi or other) Actual Pressure Enter actual pressure and specify units (i.e. at time of release) Design Temperature Enter maximum design temperature and specify units

(maximum) Design Temperature Minimum design temperature and specify units (minimum) Actual Temperature Actual temperature and specify units (i.e. at time of release) Means of detection Detection systems ☐ Gas Choose a Gas detection system ☐ Fire Choose a Fire detection system ☐ Smoke ☐ Other Please specify. Instrumentation of Process Choose an item System Planned Manual Inspection Choose an item Unplanned Manual Inspection 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 ☐ Work on wrong equipment (not during maintenance (technical) known to be pressurised) ☐ Incorrect blinding/isolation ☐ Maloperation of temporary hoses ☐ Maloperation of valve(s) during ☐ Erroneous choice of installations of manual operation sealing device ☐ Impact from bumping / collision ☐ Maloperation of valve(s) during manual operations ☐ Valve(s) in incorrect position after ☐ Incorrect installation of small bore maintenance fittings ☐ Temperature excursion ☐ Other Please specify ☐ Procedural ☐ Non-compliance with procedure ☐ Non-compliance with permit-to-work ☐ Deficient procedure ☐ Other Please specify Indicate the operational mode in the area at the time of release Choose the relevant parameter(s) from the following categories ☐ Construction ☐ Hot work ☐ Cold work ☐ Draining ☐ Drilling ☐ Oil ☐ Gas ☐ Exploration ☐ Exploration ☐ Appraisal ☐ Appraisal ☐ Development ☐ Development Maintenance ☐ ☐ Hot work ☐ Cold work ☐ Draining Routine Maintenance ☐ ☐ Hot work ☐ Cold work ☐ Draining ☐ Normal Production ☐ Pipeline operations including Pigging ☐ Well Operations ☐ Oil ☐ Gas ☐ Wireline ☐ Wireline ☐ Well test ☐ Well test ☐ Other ☐ Other

Did ignition occur? ☐ Yes ☐ No If yes, was it: ☒ Immediate ☐ Delayed Delay time (sec) Enter time (sec). Was there: (add sequence of Enter sequence A flash fire Enter sequence An explosion events by numbering number number appropriate boxes in order of occurrence) Enter sequence A jet fire Enter sequence A pool fire number number Ignition Source (if known) Provide a description of the Describe ignition source ignition source What emergency action was taken? ☐ Shutdown ☐ Automatic ESD ☐ Manual initiation ☐ ESD initiation ☐ Local initiation ☐ Blowdown ☐ Automatic ☐ Manual ☐ Deluge ☐ Automatic ☐ Manual

☐ CO2/Halon/inerts ☐ Automatic ☐ Manual ☐ Other Please specify Time between detection and Enter time and specify units isolation. (Specify units, e.g. seconds, Minutes) Time between detection and Enter time and specify units start of blowdown. (Specify units, e.g. seconds, Minutes) ☐ Call to muster ☐ At stations ☐ At lifeboats (assembly point) ☐ Partial down man ☐ By helicopter ☐ By lifeboats Other Please specify ☐ Installation ☐ By helicopter ☐ By lifeboats evacuation Other Please specify

Any additional comments Enter additional comments

27. Section A2 Description of circumstances, consequences of event and emergency response Enter description Was there a release of a non- ☐ Yes ☐ No hydrocarbon hazardous If yes, specify the type and Specify type and units substance? quantity of released substance

Was there a non-hydrocarbon Enter description fire (e.g. electrical) with a significant potential to cause a major accident? Is the incident likely to cause ☐ Yes ☐ No degradation to the surrounding marine environment? If yes, outline the Enter outline environmental impacts which may have already been observed or are likely to result from the incident

28. Section A3 Preliminary direct and underlying causes Enter causes

29. Section A4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter recommendations and lessons learned

30. Part 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.

31. Section B1 General information Name/code of well Enter name/code Name of drilling contractor (if Enter name of drilling contractor relevant) Name/type of drilling rig (if Enter name/type of drilling rig relevant) Start date/time of loss of well Enter a start date Enter a start time hh:mm control End date/time of loss of well Enter an end date Enter an end time hh:mm control Type of fluid (if relevant) ☐ Brine ☐ Oil ☐ Gas ☐ Other Please specify Well head completion ☐ Surface ☐ Subsea Water depth (m) Enter depth Reservoir: pressure / Enter pressure/temperature/depth temperature / depth Type of activity ☐ Normal production ☐ Drilling ☐ Work over ☐ Well services ☐ Other Please specify Type of well services ☐ Wire line ☐ Coiled tubing ☐ Snubbing ☐ Other Please specify

32. Section B2 Description of circumstances, consequences of event and emergency response Blowout prevention equipment ☐ Yes ☐ No activated Diverter system in operation ☐ Yes ☐ No Pressure build-up and/or positive ☐ Yes ☐ No flow check Failing well barriers (a) Enter text (b) Enter text

(c) Enter text Description of circumstances Enter Description. Further ☐ Duration of uncontrolled flow of well-fluids details (specify units) Enter further details and specify units ☐ Flowrate Enter further details and specify units ☐ Liquid volume Enter further details and specify units ☐ Gas volume Enter further details and specify units Consequences of event and emergency response (e.g. 1. Jet fire / 2. First explosion / 3. Second explosion, etc.) Enter details

33. Section B3 Preliminary direct and underlying causes Enter cause

34. Section B4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

35. Part C - Detailed Incident Report Failure of a Safety (and Environmentally) Critical Element

36. Section C1 General information Name of independent verifier Enter name of independent verifier (if applicable)

37. Section C2 Description 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 circumstances Which Safety (and Environmental) Critical systems were reported as lost or unavailable, requiring immediate remedial action, or have failed during an incident? Enter description Report Independent verifier Origin ☐ (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) ☐ Other Please specify

Process containment ☐ Primary well barrier ☐ Secondary well systems barrier ☐ Wireline equipment ☐ Mud processing ☐ Sand filters ☐ Pipelines & risers ☐ Piping system ☐ Pressure vessels ☐ Well control process equipment - BOP ☐ Other Please specify Ignition control systems ☐ Hazardous area ☐ Non-hazardous area ventilation ventilation ☐ ATEX certified ☐ Electrical tripping equipment equipment ☐ Earthing/bonding ☐ Inert Gas system equipment ☐ Other Please specify Detection systems ☐ Fire & gas detection ☐ Chemical injection monitor ☐ Sand ☐ Other Please specify Process containment relief ☐ Well control process ☐ Relief systems systems equipment - diverter ☐ Gas tight floors ☐ Other Please specify Protection systems ☐ Deluge ☐ Helideck foam system ☐ Fire water pumps ☐ Firewater system ☐ Passive fire protection ☐ Fire / blast walls system ☐ CO2 / Halon fire- fighting system ☐ Other Please specify Shutdown systems ☐ Local shutdown ☐ Process shutdown systems (LSD) system (PSD) ☐ Subsea isolation valve ☐ Emergency shutdown system (ESD) ☐ Riser ESD valve ☐ Topsides ESD valve ☐ Blowdown ☐ Other Please specify

Navigational aids ☐ Aircraft navigation ☐ Sea craft navigation. aids aids ☐ Other Please specify Rotating equipment – power ☐ Turbine P.M. for ☐ Turbine P.M. for supply compressor generator ☐ Other Please specify Escape, evacuation and rescue ☐ Personal safety ☐ Lifeboats / TEMPSC equipment equipment ☐ Tertiary escape ☐ Temporary refuge / means (life raft) Muster area ☐ Search & rescue facilities ☐ Other Please specify Communication systems ☐ Radios / telephones ☐ Public address ☐ Other Please specify Other ☐ Please specify Description of consequences Is the incident likely to cause ☐ Yes ☐ No degradation to the surrounding If yes, outline the environmental impacts which have already marine environment? been observed or are likely to result from the incident Enter outline

38. Section C3 Preliminary direct and underlying causes Enter causes

39. Section C4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Describe any important lessons learned from the event. List recommendations to prevent the recurrence of similar events. Enter lessons learned and recommendations

40. Part D - Detailed Incident Report Significant loss of structural integrity or loss of station keeping in relation to a mobile installation

41. Section D1 General information Name of vessel (if applicable) Enter name of vessel

42. Section D2 Description of circumstances, consequences of event and emergency response Indicate 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

43. Section D3 Preliminary direct and underlying causes Enter causes

44. Section D4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

45. Part E - Detailed Incident Report Potential and actual vessel collisions with an offshore installation

46. Section E1

General information Name / Flag State of vessel (if Enter name / flag state of vessel applicable) Type / tonnage of vessel (if Enter type / tonnage of vessel applicable) Contact via AIS? ☐ Yes ☐ No

47. Section E2 Description of circumstances, consequences of event and emergency response Indicate 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

48. Section E3 Preliminary direct and underlying causes Enter causes

49. Section E4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

50. Part F - Detailed Incident Report Helicopter Accidents within the safety zone

51. 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

52. Section F2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened (weather conditions) Enter description

53. Section F3 Preliminary direct and underlying causes Enter causes

54. Section F4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations End of Part F Detailed Report

55. Part G - Detailed Incident Report Any fatality

56. Section G1 Prior Incident Did a previously reported ‘serious injury’ incident If yes, enter date of PIN or other identifier result in the fatality?

57. 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 ☐ Self-employed and at else? work? Details if the person was employed by someone else Enter details

58. Section G3 About the kind of accident Select the kind of accident that best describes the Choose kind of accident incident If a fall from height- how high was the fall (to the Enter measurement nearest meter) Work process involved in the incident Choose a work process Main factor involved in the incident Choose a main factor 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

59. Section G4 About the deceased or person lost Name Family name Address Line 1 Enter address line1 Address Line 2 Enter address line 2

Address Line 3 Enter address line 3 Town Enter Town County Enter county Post Code Enter postcode Phone No Enter phone number Gender ☐ Male ☐ Female Age Enter age Nationality of deceased Enter nationality or person lost Name and address of Enter name next-of-kin Enter address Relationship of next-of- Enter relationship kin

60. Part H - Detailed Incident Report Any serious injury

61. Section H1 Number or persons seriously injured Please state the number of ☐ One ☐ Between 2 and 4 people injured ☐ 5 or greater

62. Section H2 Injured person’s employment status Was the injured person ☐ One of your employees? ☐ Member of the public? ☐ Employed by someone ☐ Self-employed and at else? work? Details if the person was employed by someone else Enter details

63. Section H3 About the kind of accident Select the kind of accident that best describes the Choose kind of accident incident If a fall from height- how high was the fall (to the Enter measurement nearest meter) Work process involved in the incident Choose a work process Main factor involved in the incident Choose a main factor 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

64. Section H4 About the Injured person Name Family name Address Line 1 Enter address line1

Address Line 2 Enter address line 2 Address Line 3 Enter address line 3 Town Enter Town County Enter county Post Code Enter postcode Phone No Enter phone number Gender ☐ Male ☐ Female Age Enter age

65. 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 ☐ Yes ☐ No work for more than 7 days Did the injury require the person to be admitted to hospital for 24 ☐ Yes ☐ No hours or more About the person’s injuries Injuries Choose an injury Parts of the body Affected Choose the part of the body affected

66. Part I - Detailed Incident Report Any evacuation of personnel.

67. 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

68. Section I2 Description of circumstances, consequences of event and emergency response 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 ☐ Emergency ☐ Both precautionary or emergency? Number of persons evacuated Enter number of persons evacuated Means of evacuation (e.g. Enter means of evacuation helicopter) Indicate 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

69. Section I3 Preliminary direct and underlying causes Enter causes

70. Section I4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

71. Part J - Detailed Incident Report A Major Environmental Incident (offshore)

72. Section J1 General information Operator/Owner/Contractor Enter name of contractor Responsible for Incident: Tier of Response (1,2 or 3): (As per Oil Pollution Emergency ☐ Tier 1 ☐ Tier 2 ☐ Tier 3 Plan)

73. Section J2 Description of circumstances, consequences of event and emergency response Indicate 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 Approx. release area on sea surface surface (m2or km2): Is Release Ongoing? ☐ Yes ☐ No If yes the CER 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)

74. Section J3 Preliminary direct and underlying causes of release Enter causes

75. Section J4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

76. Part K - Detailed Incident Report An uncontrolled fire or explosion

77. Section K1 General information Name of contractor (if applicable) Enter name of contractor

78. Section K2 Description of circumstances, consequences of event and emergency response 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

79. Section K3 Preliminary direct and underlying causes Enter causes

80. Section K4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations End of Part K Detailed Report

81. Part L - Detailed Incident Report Instance of a stand-by vessel not being within its defined geographical area

82. 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

83. Section L2 Description of circumstances, consequences of event and emergency response 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

84. Part M - Detailed Incident Report A person falling into the sea

85. Section M1 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

86. Section M2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened E.g. Height the person fell from, Location of Impact Enter description

87. Section M3 Preliminary direct and underlying causes Enter causes

88. Section M4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

90. Part N - Detailed Incident Report Mustering on onshore or offshore petroleum infrastructure, other than for planned drills.

91. Section N1 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

92. Section N2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened Enter description

93. Section N3 Preliminary direct and underlying causes Enter causes

94. Section N4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

96. Part 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

97. Section O1 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

98. Section O2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened

Enter description

99. Section O3 Preliminary direct and underlying causes Enter causes

100. Section O4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

101. Part P - Detailed Incident Report The collapse, overturning, or failure of any load-bearing part of any lift, hoist, crane, or derrick

102. Section P1 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

103. Section P2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened Enter description

104. Section P3 Preliminary direct and underlying causes Enter causes

105. Section P4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

106. Part 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

107. Section Q1 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

108. Section Q2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened Enter description

109. Section Q3 Preliminary direct and underlying causes Enter causes

110. Section Q4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

111. Part R - Detailed Incident Report The dropping of an object that could have resulted in a major accident

112. Section R1 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

113. Section R2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened E.g. Size of Dropped Object , Height the object fell from, Location of Impact Enter description

114. Section R3 Preliminary direct and underlying causes Enter causes

115. Section R4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations

116. Part S - Detailed Incident Report A collision by a vehicle, crane, or aircraft with any petroleum infrastructure

117. Section S1 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

118. Section S2 Description of circumstances, consequences of event and emergency response Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened Enter description

119. Section S3 Preliminary direct and underlying causes Enter causes

120. Section S4 Initial lessons learned and preliminary recommendations to prevent recurrence of similar events Enter lessons learned and recommendations