Instructions for use This form is for use by owners/operators to submit safety performance indicators to the CER. Owners/operators should complete all parts as a checklist to ensure all items have been addressed/included as part of the submission. Both the scanned hard copy of this form and the electronic version should be included as part of the submission. Part 1(a) Owner/Operator Details – Installation name: of Installation: Postal Address: Owner/Operator Telephone: Owner/Operator Email Address: Part 1(b) Owner Details Point of Contact – – Point of Contact Name: Address Email: Telephone: Part 2 Safety Performance Indicators – Further guidance on the Safety Performance Indicators is provided in the Compliance Assurance System Document Lagging Safety Performance Indicators A1 Number of unintentional releases of ignited gas or petroleum liquid Number of unintentional releases of not ignited natural gas or evaporated associated gas A2 if mass released 1kg ≥ Number of unintentional releases of not ignited liquid of petroleum hydrocarbon if mass A3 released 60 kg ≥ A4 Number of unintentional releases or escapes of any non-petroleum hazardous substance B1 Number of blowouts Number of activations of a blowout prevention or diverter system to control flow of B2 fluids
Instructions for use This form is for use by owners/operators to submit safety performance indicators to the CER. Owners/operators should complete all parts as a checklist to ensure all items have been addressed/included as part of the submission. Both the scanned hard copy of this form and the electronic version should be included as part of the submission. Part 1(a) – Owner/Operator Details Installation name: of Installation: Postal Address: Owner/Operator Telephone: Owner/Operator Email Address: Part 1(b) – Owner Details – Point of Contact Point of Contact Name: Address Email: Telephone: Part 2 – Safety Performance Indicators Further guidance on the Safety Performance Indicators is provided in the Compliance Assurance System Document Lagging Safety Performance Indicators A1 Number of unintentional releases of ignited gas or petroleum liquid A2 Number of unintentional releases of not ignited natural gas or evaporated associated gas if mass released ≥ 1kg A3 Number of unintentional releases of not ignited liquid of petroleum hydrocarbon if mass released ≥ 60 kg A4 Number of unintentional releases or escapes of any non-petroleum hazardous substance B1 Number of blowouts B2 Number of activations of a blowout prevention or diverter system to control flow of fluids
CER16027-Safety-Performance-Reporting-Submission-Form-1.docx