PetroChina Halfaya / Initial HSE Notification Form

PCHALL
WorkHSE-Events including Observations, Life-Saving Rules, Unsafe Act/ Condition, Near-Miss, All Incidents - V3.2 (Dec-2020)
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
3
A
R Restricted Work Severe Vehicle Well Control or Unsafe Condition
T Case 1 Accident
1
Well Integrity
1 Fire / Explosion 1
Category Fire and explosion
9 hazards
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 Overgrowing vegetation
Summary (02
Lines Max.)
C2- DETAILED DESCRIPTION
P During our Ad-Hoc fire safety survey within base camp contractors facilities Antonoil chemical WH we observed:
A
R
T 1. Overgrowing vegetation in the mentioned area, most of the wild weeds are dry and it’s a matter of highly likely
C fire hazardous and need to be removed immediately.

D- PRELIMINARY CAUSE(S)
Lack of routine inspection and attention,
S Lack of situational awareness &
E
C consequences.
T
I
O
N

E- IMMEDIATE ACTION TAKEN

Antonoil HSE team will be informed to ensure that dry weeds need to be removed immediately.

P
A
R
T
E

STOP Work Authority used for observed unsafe condition / behaviour

1 Priority: L / M / H and TH (Team-H) M 3
(Select):
F- PICTURES (Note: Please use compressed/small size photos before attaching) / Email to: HSE-Notification@petrochina-hfy.com

P
A
R
T
F