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Petroleum Incident NotificationPetroleum Incident Notification.......................................................................................................1
PART 1: INITIAL NOTIFICATION......................................................................................................2
GENERAL........................................................................................................................................... 2
OWNER/OPERATOR DETAILS.........................................................................................................2
EVENT CATEGORISATION...............................................................................................................3
FURTHER REQUIREMENT...............................................................................................................5
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
CER use of information.................................................................................................................. 38
Revision: 1 Page 1 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Revision: 1 Page 2 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Address Line 2 Enter address line 2
Address Line 3 Enter address line 3
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
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;
☐
Revision: 1 Page 3 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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 ☐
Revision: 1 Page 4 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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 ☐
Revision: 1 Page 5 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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 CER Office Use Only
Does this constitute a major accident under EU Directive 2013/30/EU?
☐ Yes ☐ No
Give justification Click here to enter text.
Revision: 1 Page 6 of 38 Reference: CER/16/022Revision Date: 29th February 2016
PART 2: DETAILED INCIDENT REPORT
Part 2 to be completed and submitted to the CER 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
Revision: 1 Page 7 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Revision: 1 Page 8 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Describe weather conditions
Revision: 1 Page 9 of 38 Reference: CER/16/022Revision Date: 29th February 2016
(including sea 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
☐ OperationRevision: 1 Page 10 of 38 Reference: CER/16/022Revision Date: 29th February 2016
☐ 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
☐ 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 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
☐ Hot work ☐ Cold work ☐ Draining
☐Routine Maintenance
☐ Hot work ☐ Cold work ☐ Draining
☐ Normal ProductionRevision: 1 Page 11 of 38 Reference: CER/16/022Revision Date: 29th February 2016
☐ 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
☐ Other Please specify
Time between detection and isolation.
(Specify units, e.g. seconds, Minutes)
Enter time and specify units
Time between detection and start of blowdown.
(Specify units, e.g. seconds,
Enter time and specify units
Revision: 1 Page 12 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Minutes)
☐ 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
Enter recommendations and lessons learned
Revision: 1 Page 13 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
☐ Other Please specify
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
☐ Other Please specify
Type of well services ☐ Wire line ☐ Coiled tubing ☐ Snubbing
☐ Other Please specify
Section B2
Description of circumstances, consequences of event and emergency response
Blowout prevention equipment activated
☒ Yes ☐ No
Diverter system in operation ☐ Yes ☐ No
Pressure build-up and/or positive flow check
☐ Yes ☐ No
Failing well barriers (a) Enter text
(b) Enter text
(c) Enter textDescription of circumstances
Enter Description.
Revision: 1 Page 14 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Further details(specify units)
☐ Duration of uncontrolled flow of well-fluids
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
Section B3
Preliminary direct and underlying causes
Enter cause
Section B4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 15 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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)
☐ Other Please specify
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
☐ Other Please specify
Revision: 1 Page 16 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Ignition control systems ☐ Hazardous area ventilation ☐ Non-hazardous area ventilation
☐ ATEX certified equipment ☐ Electrical tripping equipment
☐ Earthing/bonding equipment ☐ Inert Gas system
☐ Other Please specify
Detection systems ☐ Fire & gas detection ☐ Chemical injection monitor
☐ Sand
☐ Other Please specify
Process containment relief systems ☐ Well control process equipment - diverter ☐ Relief systems
☐ Gas tight floors
☐ Other Please specify
Protection systems ☐ Deluge ☐ Helideck foam system
☐ Fire water pumps ☐ Firewater system
☐ Passive fire protection system ☐ Fire / blast walls
☐ CO2 / Halon fire-fighting system
☐ Other Please specify
Shutdown systems ☐ Local shutdown systems (LSD) ☐ Process shutdown system
(PSD)
☐ Subsea isolation valve ☐ Emergency shutdown system (ESD)
☐ Riser ESD valve ☐ Topsides ESD valve
☐ Blowdown
☐ Other Please specify
Navigational aids ☐ Aircraft navigation aids ☐ Sea craft navigation. aids
☐ Other Please specify
Rotating equipment – power supply ☐ Turbine P.M. for compressor ☐ Turbine P.M. for
generator
☐ Other Please specify
Escape, evacuation and rescue equipment
☐ Personal safety equipment ☐ Lifeboats / TEMPSC
☐ Tertiary escape means (life raft) ☐ Temporary refuge /
Muster area
☐ Search & rescue facilities
☐ Other Please specify
Communication systems ☐ Radios / telephones ☐ Public address
☐ Other Please specify
Other ☐ Please specify
Revision: 1 Page 17 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Preliminary direct and underlying causes
Enter causes
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
Revision: 1 Page 18 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Revision: 1 Page 19 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Preliminary direct and underlying causes
Enter causes
Section E4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 20 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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
Section F3
Preliminary direct and underlying causes
Enter causes
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
Revision: 1 Page 21 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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
Revision: 1 Page 22 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Revision: 1 Page 23 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Address Line 2 Enter address line 2
Address Line 3 Enter address line 3
Town Enter Town
Revision: 1 Page 24 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
Revision: 1 Page 25 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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 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
Preliminary direct and underlying causes
Enter causes
Section I4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 26 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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 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)
Revision: 1 Page 27 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Wave Height (metres): Wave Height (metres)
Section J3
Preliminary direct and underlying causes of release
Enter causes
Section J4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 28 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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
Section K3
Preliminary direct and underlying causes
Enter causes
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
Revision: 1 Page 29 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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
Revision: 1 Page 30 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Class M - Detailed Incident Report
A person falling into the sea
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
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 happenedE.g. Height the person fell from, Location of Impact
Enter description
Section M3
Preliminary direct and underlying causes
Enter causes
Section M4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 31 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Class N - Detailed Incident Report
Mustering on onshore or offshore petroleum infrastructure, other than for planned drills.
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
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
Section N3
Preliminary direct and underlying causes
Enter causes
Section N4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 32 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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 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
Section O3
Preliminary direct and underlying causes
Enter causes
Section O4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 33 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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 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
Section P3
Preliminary direct and underlying causes
Enter causes
Section P4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 34 of 38 Reference: CER/16/022Revision Date: 29th February 2016
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
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 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
Section Q3
Preliminary direct and underlying causes
Enter causes
Section Q4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 35 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Class R - Detailed Incident Report
The dropping of an object that could have resulted in a major accident
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
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 happenedE.g. Size of Dropped Object , Height the object fell from, Location of Impact
Enter description
Section R3
Preliminary direct and underlying causes
Enter causes
Section R4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 36 of 38 Reference: CER/16/022Revision Date: 29th February 2016
Class S - Detailed Incident Report
A collision by a vehicle, crane, or aircraft with any petroleum infrastructure
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
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
Section S3
Preliminary direct and underlying causes
Enter causes
Section S4
Initial lessons learned and preliminary recommendations to prevent recurrence of similar events
Enter lessons learned and recommendations
Revision: 1 Page 37 of 38 Reference: CER/16/022Revision Date: 29th February 2016
CER use of informationThe information provided in this form may be used by CER for any of its statutory functions or as required by legislation and for statistical data. CER is subject to the Freedom of Information Acts 2014 and information obtained by CER may be released as part of a request make under that Act.
Revision: 1 Page 38 of 38 Reference: CER/16/022Revision Date: 29th February 2016