CLOV Project Ref.

: AO-045-PG-CLM-000174

CLOV MARINE RESTRICTED AREA - FICHE de LIAISON Rev.: 00

Request for Authorization to position at specific location within the CMRA
Vessel Characteristics
Name and reference of facility
(Well, Manifold, Pipeline, Umbilical number)
Proposed Work Activity/Operation
Reference #: FDL_SH_068
Contractor/Operator: Marine Vessel or RIG Name:
TEPA – DT – SUB – IOS Stanford Hawk
 CLOV FPSO HULL (Protection frames, boat landing, I tubes and
hoses) Starboard Side,
 Single Hybrid Riser tower – GE
 P10 Dynamical Umbilicals
All job Inside 500 m zone Starboard side
CLOV INSPECTION CAMPAIGN 2019

Interface Information & Attached - FDL Signed

Documents Reference (if any)
- Task Plan provided
(HSE information, Specific Precautionary
Measures before job start, bridging document, - JRA Provided
planning, risk assessment, etc…) - Vessel contact CLOV CCR before start at location
Dates of operation Expected Arrival on Location: Estimated End Date:
(dd/mm/yyyy) Date: 17/05/2019 Date: 22/05/2019
GMT Time
Time: 18:00 Time: 24:00

Location coordinates East North

Start point coordinates

Finish point coordinates (if applicable)

Other location information

(reference of attached map if applicable)

Requester Name: Date & Time: Signature:

eurico.
Signé numériquement par :

Vessel RSES Eurico Kupessa eurico.kupessa@total.com

kupessa@total kupessa@total.com
Nom DN : CN = eurico.
17/05/2019
.com
Date : 2019.05.17 05:56:29 +
01'00'

Additional Interface Requests

Working Area Layout
APPROVAL (Authorisation to

Comments, HSE restrictions, Safety Zone

limits, etc…
Contact RSES & MOS on CLOV before each shift to review the
CMRA RSES scope
Name: of work and check coactivity. Immediately
Date & Time: contact CCR by
Signature:
Position)

Christopher Signature numérique de Christopher ROESCH J0270589

VHF88 in case of emergency.

DN : c=FR, o=TOTAL, ou=TOTAL AUTHENTIFICATION
INTERNE, 2.5.4.45=J0270589, cn=Christopher ROESCH

ROESCH J0270589 J0270589

Date : 2019.05.17 12:01:48 +01'00'

PMRA RSES Authorisation is hereby given for the above named marine vessel/RIG to position at the specified location and associated Safety
Zone (the SITE) ready for the Proposed Work Activity/Operation. The Proposed Work Activity/Operation shall only commence when authorised by
the Vessel Delegate RSES/RIG RSES.

Additional Approval (if Required) Name: Date & Time: Signature:

(e.g. other Vessel Delegate RSES or RIG RSES
in case of move in Safety Zone)

Work Activity / Operation relative to this Fiche de Liaison is:

 Completed and the location is Suitable and Safe
 Suspended and not completed for the following reasons: ___________________________________________
CLOSE OUT

Expected Date and Time of Departure: _____/ _____ / ________ __________

Interface Information & Attached
Documents Reference (if any)
(Feedback, Facility status of HSE equipments,
downgraded situations, integrity concerns,
compensatory measures, etc…)

Vessel RSES or RIG RSES Name: Date & Time: Signature:

 CLOV Project Ref.: AO-045-PG-CLM-000174

CLOV MARINE RESTRICTED AREA - FICHE de LIAISON Rev.: 00

Working Area Layout

 CLOV Project Ref.: AO-045-PG-CLM-000174

CLOV MARINE RESTRICTED AREA - FICHE de LIAISON Rev.: 00