PetroChina Halfaya / Initial HSE Notification Form

PCHALL
WorkHSE-Events including Observations, Life-Saving Rules, Unsafe Act/ Condition, Near-Miss, All Incidents - V3.3 (Mar-2021)
Related

A- REPORTING DETAILS SN.:

(Yes / No) Yes 2 Accountable Party: PCH-Contractor PCH 2 PCH Accountable Department
P
Account.
A Reported by (PCH / Contractor) PCH 2
Contractor Anton-O&M
8 Well Ser/ WO-Rig 8
R
T Time of Incident
Reporting Person (Full Name) Position / Job Title Date of Incident (dd-mmm-yyyy) Primary Incident Location
(hh:mm) 24H
A
Mohammed Yahia FSC 07:15 10-Dec-2022 Warehouse 32
Event Category / Type
Notification Tittle / Location Antonoil Chemical WH BC Site (Confirmed by HSE-Dept. 24
Unsafe Act/ Condition
(Plant / Wellpad No., Area)
Manager)
B- NOTIFICATION - INITIAL CLASSIFICATION (Final Classification to be confirmed by PCH HSE MANAGER).
Line Strike
High Potential Loss of Primary (OHTL,
Fatality 1 1 1 1 Near Miss 1
Incident Containment Underground
Process Safety Facility) Unsafe Act
P LTI 1 Aviation 1 Event
1 Asset Damage 1
Category
1
A
R Restricted Work Severe Vehicle Well Control or Unsafe Condition
T Case 1 Accident
1
Well Integrity
1 Fire / Explosion 1
Category Defective8 tools, equipment
HFY 10 LSR
B Medical Minor Vehicle
1 Leak Period 1 Env. Incident 1 (Life-Saving 1
Treatment Case 1 Accident
Rules)
Occupational Vol. Env.SPILL
First Aid Case 1 1 Spill material 1 COVID-19 1
Illness (Bbls)
Notes: For Injuries communicate immediately with PCH (email, phone); For LOPC & Spills indicate leaking period & estimated spill volume.
C- INCIDENT DESCRIPTION - PCH-SCC (Security Control Center) Phone: 078 3495 8257 / 078 2200 8022 - Desk: 50911, 60911.
C1 Brief Fire Detection System
Summary (02
Lines Max.)
C2- DETAILED DESCRIPTION
P During our Ad-Hoc fire safety survey within base camp contractors facilities Antonoil warehouse we observed:
A
R Non-operational fire detection system "smoke detector" within the maintenance rooms.
T
C

D- PRELIMINARY CAUSE(S)
Lack of attention,lack of inspection by Antonoil team, lack of maintenance.
S
E
C
T Lack of situational awareness.
I
O
N

E- IMMEDIATE ACTION TAKEN

Antonoil team will be informed that according to NFPA standards 72 “All workshop area (when in use) should be
fitted with fully operational smoke detectors”. These should be tested monthly and the outcomes recorded Of
particular priority is the lack of maintenance and operability of the Smoke Detectors (The later will require either
P new batteries or New Smoke Detectors).
A
R
T
E

STOP Work Authority used for observed unsafe condition / behaviour

1 Priority: L / M / H and TH (Team-H) H 4
(Select):
F- PICTURES (Note: Please use compressed/small size photos before attaching) / Email to: HSEincident@petrochina-hfy.com

P
A
R
T
F