Incident Report Form Training Presentation

1. Incident Report Form Training Presentation HQS-019-17-001 – Rev 0 01 April 2011

2. Learning Objectives Upon completion of this training presentation the trainee will be able to appropriately complete the Songa Offshore Incident Report Form, HQS-013-04-005.

3. References • Incident Report Form, HQS-013-04-005 • Incident Reporting Procedure, HQS-01902-003.

4. Instructions for this Presentation Click here Please Read This Before Proceeding How to use this PowerPoint presentation. On some of the following slides you will see small yellow squares indicating This is where you would “double-click” on the actual Incident Report Form to open a property box or form field. In the PowerPoint, click once to open. After reading and when ready to proceed, clicking on the page and you will be moved to the next slide.

5. Header Area Incidents are numbered in sequence as follows: Rig_Year_Incident No_(FRO)_CAT_Date_Incident Description Examples: SD_09_01_LTI_17 Sept_Crushed Finger SD_09_02_CAT2_24 Sept_Broken Dog Collar SD_09_03_CAT3_19 Oct_HydrualicOil spill on deck

6. Incident Information . Click here • Select Region “European Land & Water” from Drop–Down Form Field Options box • Use arrows on right-hand side to move to area of the Blue above line. • Select “OK”

7. Incident Information Near-Miss definition: “An incident that under slightly different circumstances had the potential to result in injury, damage/loss of equipment and/or an adverse effect on the environment.”

8. Incident Information • For Reporting Only (FRO) definition: • The FRO categorisation may also be used for documenting injuries and illnesses that: • Not caused specifically by work related activities this may include, for example dental conditions, injury caused by pre-existing conditions, etc. • That occurred to a person whose work time on board is not being counted with the rig’s man-hours (guidelines on counting rig man-hours included within IADC Incident Statistics Program Reporting Guidelines). • That did not occur during working hours, for example an injury incurred whilst weight lifting in the gym after work. • That is being investigated as false claims or fraudulent reports.

9. Incident Information FRO Reports are numbered in similar sequence to incidents Rig_Year_Incident No_(FRO)_CAT_Date_Incident Description SD_09_01_FRO_LTI_05 Sept 09_Suspected Appendicitis SD_09_02_FRO_FAC_12 Nov 09_Muscle tenderness SD_09_03_FRO_RWC_19 Dec 09_Lower Back pain (past injury)

10. Incident Information Area indicated with Redhighlight MUST be completed before submitting. Facility operator defines the owner of the vessel, NOT the current client or lease holder.

11. Incident Information Supervisor’s Name here Supervisor’s Position here Click here • Select “Location”from Drop–Down Form Field Options box • Use arrows on right-hand side to move to area of the Blue. • Select “OK”

12. Incident Information Click Here • Select “Incident Type”from Drop–Down Form Field Options box • Use arrows onright-hand side to move to area of the Blue. • Select “OK”

13. Incident Information Click here • Select “Operation / Work Activity” from Drop–Down Form Field Options box • Use arrows on right-hand side to move to area of the Blue. • Select “OK”

14. Incident Information Click here • Select “Equipment / Tools in Use”from Drop–Down Form Field Options box • Use arrows on right hand side to move to area of the Blue. • Select “OK”

15. Incident Information Area indicated with Redhighlight MUST be completed before submitting. In case you cannot find the relevant reference from the drop-down list, indicate by typing as appropriate.

16. Cat 1 - Injury of Illness John Smith Derrickman 01 Jan 1970 Songa Offshore 21 Jones Road, Outback Settlement. Scotland HR2 – W34 +44 123 456 789 IADC Classification for Injuries Scottish 3 years 12 / 21 4 / 12 Male Insert Injured or Sick person’s FULL contact details

17. Cat 1 - Injury of Illness John Smith Derrickman 01 Jan 1970 Songa Offshore 21 Jones Road, Outback Settlement. Scotland HR2 – W34 +44 123 456 789 Check Appropriate Box for Type of Incident Scottish 3 years 12 / 21 4 / 12 Male

18. Cat 1 - Injury of Illness Click here • Double-click the drop-down box. • Select Body Part “Fingers” from Drop–Down Form Field Options box • Use arrows on right-hand side to move to area of the Blue. • Select “OK”

19. Cat 1 - Injury of Illness Click here • Double-click thedrop-down box. • Select “No / Yes” from Drop–Down Form Field Options box • Use arrows on right-hand side to move to area of the Blue. • Select “OK”

20. Cat 1 - Injury of Illness Click here • Double-click the drop-down box. • Select “No / Yes” from Drop–Down Form Field Options box • Use arrows on righthand-sideto move to area of the Blue. • Select “OK”

21. Cat 1 - Injury of Illness Issue of Prescription medication or care beyond FirstAidindicates incident to be classified as MTO

22. Cat 1 - Injury of Illness Area indicated with Redhighlight MUST be completed before submitting. In case you cannot find the relevant reference from the drop-down list, indicate by typing as appropriate. Note: Personal information of Injured Personnel will be used ONLY for internal purposes.

23. Cat 2 – Property or Equipment Damage Handrail on stairs Double-clicking on the “Yes” or the “No”will activate a check box selection field. To select Default Value, indicate the “Checked” circle. Select “OK”

24. Cat 2 - Property or Equipment Damage Click here Double-click on the left-hand side of the cell to activate a Text Form Field option box. In “Default Text:”, indicate period of Down Time if “Yes” was indicated in the previous box. Select “OK”.

25. Cat 2 - Property or Equipment Damage Click here 24 hours • Double -click the drop-down box. • Select “Amount” from Drop–Down Form Field Options box. • Use arrows on right-hand side to move to area of the Blue. • Select “OK”.

26. Cat 2 - Property or Equipment Damage 24 hours

27. Cat 3 - Spill or Discharge Incident Click here Double-click on the left-hand side of the cell to activate a Text Form Field option box. In “Default Text:”, name the type of product that has been spilt – Crane Lube Oil Select “OK”.

28. Cat 3 - Spill or Discharge Incident Crane Lube Oil Click here Double-click on the left-hand side of the cell to activate a Text Form Field option box. In “Default Text:”, enter the amount of Product that has been spilt - 25 Litres Select “OK”.

29. Cat 3 - Spill or Discharge Incident Click here Double-click on the left-hand side of the cell to activate a Text Form Field option box. In “Default Text:”, enter how long the duration of the spill was – 30 Minutes. Select “OK”.

30. Cat 3 - Spill or Discharge Incident Click here • Select “Onboard”fromDrop-down Form Field Options box. • Use arrows on right-hand side to move to area of the Blue. • Select “OK”

31. Cat 3 - Spill or Discharge Incident

32. Witness Contacts Click here Click here • Double-click next to the “Name:” cells to activate a Text Form Field option box. • In “Default Text:” to enter the person’s name – Dave Jones • The same can be done for Tel: - + 44 123 567 912 • Select “OK”

33. Witness Contacts It is advisable that any person listed in the Witness area must have witness statement recorded on the Investigation Witness Statement form, HQS-013-04-007 in case an Investigation is carried out.

34. Description of Incident This area should cover the full description of the incident and include Who was involved within the incident. What occurred before / during / after the incident. When did it occur. How did it occur. Why did it occur (casual factors). The use of pictures to show the scene, peoples’ positions during the incident and/or equipment involved is strongly recommended.

35. Immediate Actions Actions taken to Render the Worksite Safe or Prevent Environmental Damager This may be as simple as “wipe up oil spill”, or as detailed as “isolation of electrical systems” or “undertake well control drilling procedures to make the area safe”.

36. Actions to Prevent Re-occurrence Immediate Actions taken/intended to Prevent Recurrence of Incident Example 1 - Replace damage hydraulic hose . Example 2 - A meeting was called in order to remind crew of the importance of wearing all required PPE. Example 3 - Install additional electrical / mechanical protection devices to equipment.

37. Description of Emergency Response Example 1 - Fire was extinguished using portable fire extinguisher. Example 2 - Rig alarm sounded, crews mustered at life boats, fire teams provided boundary cooling, and entered compartment and extinguished fire. Example 3 - Medic was called to examine the Injured Person. He was taken to the Rig hospital, examined and released after review.

38. Incident Risk Ranking Use above Risk Ranking Matrix for risk ranking of Incidents

39. Corrective Actions Warning sign of height limitations to be placed 12 Jan 2009 0003456 Chief Officer • Corrective Actions arising from an Incident must be tracked in NS5. Define: • NS5 work order number • What is to be done • Who is responsible to undertake the corrective actions • An appropriate time for completion

40. Detailed Report & Release Depending upon the extent of the incident, or directive from a regional regulatory body, an incident investigation report may be required.

41. Detailed Report & Release Michael Johnson +44 123 234 3 Jan 2009 HSE Advisor George Brown +44 123 234 3 Jan 2009 Name and contact details of person preparing and releasing the Incident Report to be inserted for reference.

42. Reporting Timelines