NOTIFICATION FORM

 SIMOPS  JHA
1A. Information SimOps /JHA-CA-C021
Date of Application: 05-Jan-2023 Main Trade: Commissioning
Application by: Myat Moe Supporting Trade: Shipwright
Expected Activity Start: 10-Jan-2023 Sub-Contractors: TBC
Expected End Date: 06-Feb-2023 Specialist: NA
Location: Bunker Ship to Onboard Golar GIMI
5DB Port MGO Service Tank
1B. Type Of Activity (Refer to Activities requiring SimOps/ JHA)
[ ] Lifting Safety [ ] Fire Safety [ ] Confined Space Safety [ ] Heavy Vehicle Safety
[ ] Height Safety [ ] Electrical Safety [] Incompatible Work
Activity: Bunkering LSDO from Bunker Barge to No 5 (P) Double Bottom Tank (1,000 Ton)

1C. Brief Description Of Work Activity

Bunker Ship will be moored stbd alongside of the GIMI at Frame 79.
Keplift to be parked in between the bunker ship & GIMI.
The 4” hose will be lifted with Keplift and laid over from Bunker ship to onboard GIMI and connected to the
Bunker Line.
Bunkering 1,000 Ton LSDO into 5DB Service Tank onboard via bunker line.
Ensure to stop all hot works at the surrounding area and closely monitor( patrolling and sounding) the oil
leak & spillage.Activity will be stopped after completion of Total 1,000 Ton LSDO bunkered onboard.

1D. Required Documents / Information

Process Person Environment Equipment/ Materials/
□ Legislation □ Certificates □ Tidal Data Tools

 Method Statement Competency □ Weather Forecast  Certificates

(Rev No: __/ Date: ___) (Rain/ Lightning)  Validity
 Permits □ Wind Forecast  LOTO
 Checklists
 Communications
1E. Composition Of Team
Designation Name Designation Name
Project Manager (C) Mahendran / Ragesh Subject Matter Expert Myat Moe
Section Manager (DC) Hla Moe / Zeyar Subject Matter Expert Sai Min Htwe
HSE Hadikul / Akram

*C=Chairperson, DC=Deputy Chairperson

Verified by Acknowledged by Approved by

SimOps+JHA Notification Form Rev 5, Dated: 03 April 2017

(Section Manager) (HSE Officer) (Project Manager)
2A. Closure/ Completion – Review of Work Done (Lessons Learnt)

Work Activity is completed/ stopped on _______________________

Good initiatives:

Areas to Improve:

SimOps+JHA Notification Form Rev 5, Dated: 03 April 2017

2B. Comment(s) by Team

Comment(s):

Verified by Acknowledged by Closed by

(Section Manager) (HSE Officer) (Project Manager)

SimOps+JHA Notification Form Rev 5, Dated: 03 April 2017