Was any loss of Hydrocarbon containment of any fluid Please specify_________________________ Type of fluid (liquid or gas) (liquid or gas)? Non-hydrocarbon If hydrocarbon release please Please specify_________________________ complete item no.15 as well Estimated quantity Liquid (L), Gas (kg) Calculation Measurement Estimation details Please specify______________________________ Composition Percentage and description Toxicity to people toxicity to people and/or environment Toxicity to environment How was the leak/spill F&G detection Visual detected? CCTV Other No Immediate Yes Delayed Hotwork If yes, what was Spark electrical source Did ignition occur? the likely ignition Spark metallic contact source Hot surface Other Yes or no Duration of the release Has the release been 10. hh:mm:ss stopped and/or contained? Estimated rate of release Litres or kg per hour What or where is the location of the release? What equipment was 11. Location of release involved in the release? Is this functional location listed as safety-critical equipment? Ambient temperature C° Weather conditions 12. Please complete as appropriate Relative humidity %
Was any loss of containment of any fluid (liquid or gas)? Type of fluid (liquid or gas) If hydrocarbon release please complete item no.15 as well Hydrocarbon Please specify_________________________ Non-hydrocarbon Please specify_________________________ Estimated quantity Liquid (L), Gas (kg) Estimation details Calculation Measurement Please specify______________________________ Composition Percentage and description toxicity to people and/or environment Toxicity to people Toxicity to environment How was the leak/spill detected? F&G detection CCTV Visual Other Did ignition occur? No Yes Immediate Delayed If yes, what was the likely ignition source Hotwork Spark electrical source Spark metallic contact Hot surface Other 10. Has the release been stopped and/or contained? Yes or no Duration of the release hh:mm:ss Estimated rate of release Litres or kg per hour 11. Location of release What or where is the location of the release? What equipment was involved in the release? Is this functional location listed as safety-critical equipment? 12. Weather conditions Please complete as appropriate Ambient temperature C° Relative humidity %
N-03000-FM0831-Report-of-an-Accident-Dangerous-Occurrence-or-Environmental-Incident-Rev-8-Jan-2015-MS-Word-2010.docx