RISK BASED ASSESSMENT OF OIL SPILL INCIDENCE (FORM B)

FORM B
RISK BASED ASSESSMENT OF OIL SPILL INCIDENCE

Note: This report must be submitted within 2 weeks of Spill Incidence
Company Name *
Date of Assessment *

Month Day Year
Date Hour Minutes AM/PM Option
Date of Incidence *

Month Day Year
Date Hour Minutes AM/PM Option
Date spill was stopped *

Month Day Year
Date Hour Minutes AM/PM Option
Method Used *

Clamping Well Shut‐in Valve Shut‐in F/Station Shut down
Estimated quantity spilled *
Estimated quantity recovered *
Cause of Spill *

Corrosion Equipment Failure Third Party Interference Accident Operational Error
Site Details
Site Name *
OML *
GPS FIELD POINTS *

Total Length in meters Length Surveyed in meters
Differential GPS *
Spill Start Point GPS *

Total Length in meters Length Surveyed in meters
Spill End Point GPS *

Total Length in meters Length Surveyed in meters
Site area *

Land Swamp Freshwater Mangrove Coastline Near Shore Offshore
Facility *

Pipeline Flow line Wellhead Manifold Flow Station Rig Storage Tank Compressor Plant
Site Characterization (Sea Conditions) *

Calm Rough Not Applicable Low Tide High Tide
Current direction *
Swell Height *
Current Strength *
Site Characterization (Weather Conditions) *

Bright Sunny Party Cloudy Slight rain
Temperature *
Wind Direction *
Wind Speed *
Relative Humidity *
Visual Observation of Impacted area
Any oil sheen on water *

Receptor Assessment

Pathway to
Impacted
Area(m2)

Distance to
Impacted
Area(m2)

Estimated
Area of Impact
Area(m2)

Receptor Impacted
(Yes/No)

Remarks

Farmland

Fish Pond

Vegetation

Surface Water

Ground Water

Venerable Object

Human Habitation

Livestock

Plantation

Swamp

Any Casualties
If Yes, give details below.
Give details for casualties
Method of clean‐up *
Time frame for clean‐up *
General Remarks
Reporting officer *
Officer's name is accepted as Signature.
Designation *
Date *

Day Month Year
Date Hour Minutes AM/PM Option
Clean‐up program report must be submitted within 2 weeks of spill incidence.
Should be Empty: