INITIAL NOTIFICATION INCIDENT (INI) OPERATIONAL AND ENVIRONMENTAL INCIDENTS

Notification To: Notification Date: To be submitted to the Regulation & Supervision Bureau (as per the Incident Reporting Regulations)

1. Reporting Entity Information: Incident No. (for official use by RSB) Name of Licensee: Address of Licensee: Authorized Contact Person: Email Address: Telephone Number: Mobile Number:

2. Reporting on behalf of Contractor Yes No Name of Principle Contractor: Type of Business: Address: Name of Sub-Contractor: Type of Business: Address:

3. Incident Information Time (24 hr): Date of Incident (dd/mm/year): _ _ / _ _ / ______:__ ☐ Electricity ☐ Water Type of Incident: ☐ Operational ☐ Wastewater ☐ Other:

Incident Summary: (full incident description to be completed in Section 9)

Environmental (In case of any ☐ ☐ Air ☐ Water ☐ Land ☐ Sea environmental impact) Incident Location on Site: N GPS Coordinates: E: : Incident Workplace Address:

Applicable Reports: ☐ Emergency Services Department ☐ Other (Specify): Attached: ☐ Yes ☐ No ☐ Yes ☐ No

4. More information

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Electricity (event or chain of unplanned events that results in one or more of the following) Generation ☐ 1. The loss of generation output of more ☐ 2. Simultaneous tripping/forced outage of any than 200 MW two machines even if the second machine trip/forced outage is a consequence to the first ☐ 3. Any generation tripping that causes ☐ 4. More than two forced outages for a specific under frequency load-shedding machine/unit within 48 hours ☐ 5. Repeat failure of a particular type of ☐ 6. Fire, explosion or implosion equipment or component thereof ☐ 7. Evidence of trespass on operational land ☐ 8. Any environmental discharge which exceeds or premises the permissible levels as shown under Appendix N of the Power and Water Agreements Transmission ☐ 1. Simultaneous tripping/loss of multiple ☐ 2. Frequency deviation outside of the limits transmission circuits 49.8 Hz to 50.2 Hz ☐ 3. Loss of generation outside of the limit of ☐ 4. Voltage deviation outside of the limits required the Normal Infeed Loss Risk as per the by the Electricity Transmission Security System Electricity Transmission System Security Standard or Electricity Transmission Code Standards ☐ 5. Any transmission system Incident causing ☐ 6. Any transmission system Incident or unplanned interruption to any User (where the term circumstance where load is at risk to a single User is as defined in the Electricity credible contingency (sites with an agreed Transmission Code) derogation from the Bureau will be excluded from reporting) ☐ 7. Any fault on the transmission system ☐ 8. Loss of output at 220kV, 132kV, 22kV and 11kV that causes an outage of any generation from any transformer in any grid station unit or results in a restriction of output from any production Licensee ☐ 9. An inability to comply fully with the ☐ 10. An overhead line conductor being at less than Electricity Transmission System Security its design height Standard, Electricity Transmission Code, Emirates National Grid Code and GCCIA Interconnector Transmission Code Distribution ☐ 1. An interruption of demand of above 10 MW ☐ 2. An interruption of demand of above 5 MW for a for a period of 3 minutes or longer period of 1 hour of longer ☐ 3. Loss of output at 33kV, 22kV, 11kV or 6.6kV ☐ 4. An outage on any 33kV, 22kV, 11kV busbar section from any transformer at any grid station or at any grid station or primary substation primary substation ☐ 5. Any incident where there is evidence of loss ☐ 6. An interruption where the supply to any user (where of demand of above 10 MW resulting from the term User is as defined in the Electricity voltage disturbance Distribution Code) is not restored within 12 hours ☐ 7. Manual load curtailment for a load of 1MW ☐ 8. An overhead line conductor being at less than its or more for more than six hours during any design height 24 hours

Water (event or chain of unplanned events that results in one or more of the following)

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Desalination ☐ 1. The simultaneous outage of any two ☐ 2. The loss of plant with a production capacity of distillers or reverse osmosis units more than 15 MGD (68,100 m3/day) ☐ 3. More than two unplanned outages for a ☐ 4. A significant and unexpected deterioration in specific distiller within 48 hours the quality of a raw water source, which effects, or may affect the water production from quantity or quality perspective Transmission ☐ 1. A total tripping to any transmission ☐ 2. Damage to a trunk main that causes total pumping station component that results pipeline shutdown for more than 24 hours or if in failing to deliver 50% or more of the it results in failing to deliver 50% or more of the agreed Water targets according to the agreed water targets according to the daily daily dispatch schedule dispatch schedule ☐ 3. A failure in the transmission system that ☐ 4. A significant and unexpected or unusual causes a shutdown to either 50% of the deterioration in the quality of the water Desalination capacity or production loss entering the supply which by reason of its of more than 25 MGD (113,500 m3/day) effect or likely effect gives rise or is likely to give rise to a significant risk to the health of consumers Distribution ☐ 1. The interruption of supply to one or ☐ 2. The interruption of supply to one or more more customers of 2.5 MGD (11,350 customers of 1MGD (4,540 m3/day) or more m3/day) or more for a period of six hours for a period of 12 hours or longer or longer ☐ 3. the interruption of supply to 100 ☐ 4. The interruption of supply to 1 or more customers or more for a period of 12 customers for a period of 24 hours or longer hours or longer ☐ 5. The interruption of supply to 1000 or ☐ 6. A significant and unexpected or unusual more customers for a period of 24 hours deterioration in the quality of the water at any or longer point within the distribution system which by reason of its effect or likely effect gives rise or is likely to give rise to a significant risk to the health of consumers.

Wastewater (event or chain of unplanned events that results in one or more of the following)

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Collection ☐ 1. The release into the collection system of ☐ 2. The release into the collection system of a a trade effluent without a consent or in prohibited waste breach of a condition of a Consent ☐ 3. The issuance of an improvement notice ☐ 4. Detection of any cross connection, backflow or or termination notice to a trade effluent other fault with potential to contaminate any consent holder under Regulations 6.4 or other third party water network (potable, 6.5 of the Trade Effluent Control recycled or stormwater etc.) Regulations 2010 ☐ 5. Pump station power or mechanical ☐ 6. Power loss in multiple Pump Stations failure which cannot be resolved within 8 hours ☐ 7. Partial or complete failure to one or more of the main pumping station pumps or discharge lines Treatment ☐ 1. The occurrence of a trend of breaches of any ☐ 2. Detection of any cross connection, backflow or other recycled water or biosolids quality standard fault with potential to contaminate any other third for a parameter in Schedule A or B of the party water network (potable, recycled, stormwater Recycled Water & Biosolids Regulations. etc.) Disposal ☐ 1. A discharge of Recycled Water to the ☐ 2. Any discharge of Biosolids to landfill under the site environment under the site contingency plan contingency plan as defined by Regulation 5.3.1 (e) as defined by Regulation 5.3.1 (e) of the of the Recycled Water & Biosolids Regulations. RW&B Regulations 2010 ☐ 3. A failure of a disposal system that prevents ☐ 4. Detection of any cross connection, backflow or other the delivery of recycled water or biosolids fault with potential to contaminate any other third supply to a customer for more than 24hrs or party water network (potable, stormwater etc.) by more than 50% of the agreed volume or mass. ☐ 5. Pump station power or mechanical failure ☐ 6. Partial or complete permanent failure to one which cannot be resolved within 8 hours or/more of the main pumping station pumps or Power loss in multiple Pump Stations discharge lines.

5. Incident Description:

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1. Sequence of Events: (Clearly describe the sequence of events that lead to the Incident and describe the tasks being performed at the time of the Incident.)

2. Consequences: (Clearly describe the consequences of the Incident and describe impact on operations, people, equipment and the environment.)

3. Most Likely Causes: (If possible identify the immediate causes of the Incident, nature of defect, failures, etc.)

4. Remedial Action: (Clearly describe the actions taken to prevent further recurrence of the Incident and actions taken to rectify the situation.)

5. Other information: (Provide any other information that may be of relevance, i.e. police presence, media interest, public involvement.)

6. Bureau Contact Details: Telephone Office Reception (02) 6543 666 HSE Manager (02) 6543 527 Email: [email protected]

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