ARCHIRODON GROUP NV Integrated Management System

Health, Safety & Environment (HSE) Rev. Issued For General Use Reference No. HSE-PRO-02-F01 Serial No. Page 1 of 1

FORM Drill Report

0.0

Drill Scenario Location Sea State Target Time Drill Preparation: ft Wind Minutes Vessel / Barge knots Achieved Time Time Minutes

Drill Sequence: Actual Time Stop Watch Event / Action Comment

Conclusion:

Actions to be Taken: (Record Actions within Form Ref No. HSE-PRO-05-F02 Action Tracking and Recording)

Was the drill successful?

(tick applicable)

YES

NO*

*The drill will be re-run on the ......../..../... after attending to all action items identified above

Completed by Job Position Diving Supervisor Name Surname Signature Date

Approved by Job Position Diving Superintendent Name Surname Signature Date

Distribution List Job Position Name Surname Project Manager HSE Manager Reg. Diving Manager