Please ensure that a copy of this Form is sent to a minimum of 7-10 days in advance of expected arrival date to site. Visitors must have their visit approved by their PetroChina Canada (PCC) Representative. Failure to follow this process will result in the form being rejected. All Fields to be Completed Date of Arrival: Phone #: Job Name (Last, First): Middle Initial: Employer: Site Supplier: Projects Drilling Completions Logistics Seismic Site Wide Services Camps Operations Division / Department (Indicate): Maintenance Support Staff Others (Specify) Site Access Requested Central Processing Facility Ops Lodge Fuel Station Other (Specify) (Check all that apply): Supervisor: Phone #: Emergency Contact: Phone #: Worker Signature: Orientation Date: PCC Rep. Signature: PCC Rep. Name: For Visitors Only Note: If participating in a group visit or tour, this form is required to be completed per person, not per group. Visits are only for 24 hours only unless approved by a PCC Representative. Areas of Requested Type of Single Visit Group Visit Site Tour Access: Escort Name: Date of Departure: Escort Signature: Date: PCC Approver Name: PCC Approver Signature: Date: To be Completed by PCC HSSE/Corporate Security Central Processing Facility Ops Lodge Fuel Station Other Signed Security Type of (check all Yes No Waiver: that apply): (Specify) Temp Card Issued: Yes No Card #: Card Expiry:
Please ensure that a copy of this Form is sent to a minimum of 7-10 days in advance of expected arrival date to site. Visitors must have their visit approved by their PetroChina Canada (PCC) Representative. Failure to follow this process will result in the form being rejected. All Fields to be Completed Date of Arrival: Phone #: Job Name (Last, First): Middle Initial: Employer: Site Supplier: Division / Department (Indicate): Projects Drilling Completions Logistics Seismic Site Wide Services Camps Operations Maintenance Support Staff Others (Specify) Site Access Requested (Check all that apply): Central Processing Facility Ops Lodge Fuel Station Other (Specify) Supervisor: Phone #: Emergency Contact: Phone #: Worker Signature: Orientation Date: PCC Rep. Name: PCC Rep. Signature: For Visitors Only Note: If participating in a group visit or tour, this form is required to be completed per person, not per group. Visits are only for 24 hours only unless approved by a PCC Representative. Type of Single Visit Group Visit Site Tour Areas of Requested Access: Escort Name: Date of Departure: Escort Signature: Date: PCC Approver Name: PCC Approver Signature: Date: To be Completed by PCC HSSE/Corporate Security Signed Security Waiver: Yes No Type of (check all that apply): Central Processing Facility Ops Lodge Fuel Station Other (Specify) Temp Card Issued: Yes No Card #: Card Expiry:
MRCP-FM-HS-00001%20R10%20MRCP%20Badge%20Authorization%20Form.docx