Event Management System (EMS)

• Asset

  Compass 1

  MV Lil Weasel

  MV Elie Cheramie

  MV Amanda A

• Occurred

  Date

• Reported

  Date

• Prepared by

• Location
  Address

• What is being reported (use key from above for best selection):

  Select UAC (UAC) Unsafe Act or Condition: hazardous condition or behavior which COULD directly permit the occurrence of an incident. NM - (NM) Near Miss: A potential hazard or incident in which no property was damaged, and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred. LOPC - (LOPC) Loss of Primary Containment: Unplanned/ uncontrolled release of material whether into the environment or secondary containment. Mechanical Failure - Any instances where equipment onboard fails and causes a disruption to operations. MTC - (MTC) Medical Treatment Case: Any work-related incident where the involved parties received medical treatment other than first aid Fatality - Employee death resulting from a work- related incident or exposure. Vessel Incident – unintended event that disturbs normal operations (allision, collision, grounding, loss of propulsion, black ship, etc.) Commercial Delay - Any event that creates a delay in commercial operations Nonconformity USCG 835 USCG Army Corp

  • UAC (UAC) Unsafe Act or Condition: hazardous condition or behavior which COULD directly permit the occurrence of an incident.
  • NM - (NM) Near Miss: A potential hazard or incident in which no property was damaged, and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred.
  • LOPC - (LOPC) Loss of Primary Containment: Unplanned/ uncontrolled release of material whether into the environment or secondary containment.
  • Mechanical Failure - Any instances where equipment onboard fails and causes a disruption to operations.
  • MTC - (MTC) Medical Treatment Case: Any work-related incident where the involved parties received medical treatment other than first aid
  • Fatality - Employee death resulting from a work- related incident or exposure.
  • Vessel Incident – unintended event that disturbs normal operations (allision, collision, grounding, loss of propulsion, black ship, etc.)
  • Commercial Delay - Any event that creates a delay in commercial operations
  • Nonconformity
  • USCG 835
  • USCG
  • Army Corp

• You must follow up with the SSHO Manager to ensure all OSHA requirements are met.

• Is the event work- related?

  Yes

  No

  N/A

• Please provide as much detail as possible (individuals involved/ present, activity being performed, any contributing factors, product involved, amount of product, etc.- notifications made- hint: SSHO managers should be alerted as soon as reasonably possible)

• Do you have supporting photos? (if so please send to DPA@nglcompanies.com or attach to report if using portable device

  Select Yes No N/A

  • Yes
  • No
  • N/A

Rank of Event (see attachment above for Risk Assessment Matrix for guidance)

• Please select one:

  Select A: Never Heard of before in the industry B: Heard of in the industry C: Has happened in the company or more than once a year in the industry D: Has happened at the location or more than once per year in the company E: Has happened more than once per year at the location

  • A: Never Heard of before in the industry
  • B: Heard of in the industry
  • C: Has happened in the company or more than once a year in the industry
  • D: Has happened at the location or more than once per year in the company
  • E: Has happened more than once per year at the location

• Please select one:

  Select 0: Nor injury or health effect/ No damage to asset/ no impact to the environment 1: Slight injury or health effect/slight damage to asset/ slight effect to the environment/ slight impact to reputation 2: Minor injury or health effect/minor damage to asset/ minor effect to the environment/ minor impact to reputation 3: Major injury or health effect/major damage to asset/ major effect to the environment/ major impact to reputation 4: Permanant disability or up to three fatalities/major damage to asset/ major effect on the environment/major impact on reputation 5: More than 3 fatalities/ massive damage to asset/ massive effect on the environment/ massive impact to reputation

  • 0: Nor injury or health effect/ No damage to asset/ no impact to the environment
  • 1: Slight injury or health effect/slight damage to asset/ slight effect to the environment/ slight impact to reputation
  • 2: Minor injury or health effect/minor damage to asset/ minor effect to the environment/ minor impact to reputation
  • 3: Major injury or health effect/major damage to asset/ major effect to the environment/ major impact to reputation
  • 4: Permanant disability or up to three fatalities/major damage to asset/ major effect on the environment/major impact on reputation
  • 5: More than 3 fatalities/ massive damage to asset/ massive effect on the environment/ massive impact to reputation

• What corrective action was taken?

• Is there any damage to the equipment that needs repairs

  Yes

  No

  N/A

• Do you require follow-up or assistance to correct the situation going forward?

  Yes

  No

  N/A

Shoreside Approval

• Is USCG 2692 Required?

  Yes

  No

  N/A

• Is Customer Notification Required

  Yes

  No

  N/A

• Root Cause

• Corrective Action

• Prevenative Action