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

/ Petroleum Incident Notification Form

Petroleum Incident Notification

PETROLEUM INCIDENT NOTIFICATION 1

SECTION 1: INITIAL NOTIFICATION 3

Owner/Operator Details 3

EVENT CATEGORISATION 5

Part A - Unintended Release of Oil, Gas or other Hazardous substance whether or not ignited 5

Part B - Loss of well control requiring actuation of well control equipment, or failure of a well barrier requiring its replacement or repair 5

Part C - Failure of a Safety (and Environmentally) Critical Element 5

Part D - Significant loss of structural integrity or loss of station keeping in relation to a mobile installation 5

Part E - Potential and actual vessel collisions with an offshore installation 6

Part F - Helicopter accidents within the safety zone 6

Part G - Any fatality 6

Part H – Any Serious Injury 6

Part I - Any evacuation of personnel 6

Part J - A Major Environmental Incident 6

Part K - An uncontrolled fire or explosion 6

Part L- Stand-by vessel 6

Part M - A person falling into the sea 7

Part N - Mustering 7

Part O - Hydrogen Sulfide 7

Part P - Lifting equipment 7

Part Q - Damage to Third Party Property 7

Part R - Dropped Object 7

Part S - Collisions 7

SECTION 2: DETAILED INCIDENT REPORT 8

Part A Detailed Incident Report 8

Part B - Detailed Incident Report 15

Part C - Detailed Incident Report 17

Part D - Detailed Incident Report 20

Part E - Detailed Incident Report 21

Part F - Detailed Incident Report 22

Part G - Detailed Incident Report 23

Part H - Detailed Incident Report 25

Part I - Detailed Incident Report 27

Part J - Detailed Incident Report 28

Part K - Detailed Incident Report 30

Part L - Detailed Incident Report 31

Part M - Detailed Incident Report 32

Part N - Detailed Incident Report 33

Part O - Detailed Incident Report 34

Part P - Detailed Incident Report 35

Part Q - Detailed Incident Report 36

Part R - Detailed Incident Report 37

Part S - Detailed Incident Report 38

Page 2 of 38
/ Petroleum Incident Notification Form

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 (hrs:min) / Enter event date / Enter event time hh:mm
Version / ☐ / Final Version / ☐ / Interim Version

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 relevant) / Enter name/code
Number of Persons on board (POB) at time of event / Enter number of persons on board
Position of the Installation, vessel, pipeline / Quadrant / Enter quadrant
Latitude / Enter latitude
Longitude / Enter longitude
Depth of Water (metres) / Enter depth
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
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, consequences of event & emergency response / Enter description
Please outline which other state agencies have been notified / Other state agencies 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 (Exploration and Extraction) Safety Act 2015? / ☐ / Yes / ☐ / No
Is it a considered a major accident under EU Directive 2013/30/EU? / ☐ / Yes / ☐ / No
Give justification / Enter justification.

SECTION 1 CONTINUES ON THE NEXT PAGE

Page 2 of 38
/ Petroleum Incident Notification Form

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.

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 / ☐

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 / ☐

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. / ☐

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. / ☐

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 / ☐

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. / ☐

Part G - Any fatality

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

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. / ☐

Part I - Any evacuation of personnel

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

Part J - A Major Environmental Incident

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

Part K - An uncontrolled fire or explosion

An uncontrolled fire or explosion / ☐

Part L- Stand-by vessel

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

Part M - A person falling into the sea

A person falling into the sea / ☐

Part N - Mustering

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

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 / ☐

Part P - Lifting equipment

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

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 / ☐

Part R - Dropped Object

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

Part S - Collisions

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

Section 2: Detailed Incident Report

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

Part A Detailed Incident Report

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

Section A1

Was there a release of hydrocarbon substances?
☐ / Yes / ☐ / No
If Yes complete from A1 / If No, go to A2
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 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
☐ / n/a
For 2-Phase, state GOR (gas/oil ratio)
Specify units.kg/kg, scf/bbl / Enter GOR and specify units)
☐ / n/a
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
☐ / n/a
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 leak) / Enter duration and specify units
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
☐ / Fire / Choose a Fire detection system