MD Site Office At DSME - HSE REPORT

• MAERSK DRILLING XLE-4 PROJECT AT DSME

• SPECIFIC TO: definitions)
  
  PROJECT
  All reports related to the Jack up project, this includes structures, areas used for construction including subcontractors and Vendors facilities.
  
  YARD:
  All reports not directly related to the project such as traffic, yard facilities and observations on other projects.
  
  MD:
  Reports where corrective action is to be taken internally by MD Site such as office facilities not related to Emergencies, Access etc.
  
  

• SPECIFIC TO:<br>

  1. PROJECT

  2. YARD

  3. MD

• AREA

  XLE4 JACK-UP

  DSME YARD

  SUB CONTRACTOR

• LOCATION

• Conducted on

  Date

• Prepared by

• Definitions:
  
  POSITIVE REPORT:
  Condition or act above expected standard evident of a strong positive safety culture
  
  OBSERVATION:
  No incident occurred, can be immediately remedied with no further follow up required.
  
  UNSAFE ACT / CONDITION:
  No Incident occurred, can not be immediately remedied, further follow up required.
  
  NEAR MISS:
  Incident occurred, but has not led to personal injury

Report type

• Report Type

  POSITIVE REPORT

  OBSERVATION

  UNSAFE ACT / CONDITION

  NEAR MISS

• Category

  Select POSITIVE REPORT HOUSEKEEPING FIRE & EXPLOSIONS HAZARD MECHANICAL / MACHINERY HAZARDOUS SUBSTANCES ELECTRICAL ENVIRONMENTAL SLIPS, TRIPS & FALLS PPE SCAFFOLDING BARRIERS & SIGNS AMBIENT CONDITIONS (ventilation, light, temperature) WORKING AT HEIGHTS DROPPED OBJECTS LIFTING & LIFTING EQUIPMENT PRESSURE TESTING / FLUSHING PERMIT TO WORK / PROCEDURES CONFINED SPACE ENTRY NOISE VIBRATION RADIATION ACCESS & SAFE WALKWAYS TRAFFIC MANUAL HANDLING OTHER HAZARDS

  • POSITIVE REPORT
  • HOUSEKEEPING
  • FIRE & EXPLOSIONS HAZARD
  • MECHANICAL / MACHINERY
  • HAZARDOUS SUBSTANCES
  • ELECTRICAL
  • ENVIRONMENTAL
  • SLIPS, TRIPS & FALLS
  • PPE
  • SCAFFOLDING
  • BARRIERS & SIGNS
  • AMBIENT CONDITIONS (ventilation, light, temperature)
  • WORKING AT HEIGHTS
  • DROPPED OBJECTS
  • LIFTING & LIFTING EQUIPMENT
  • PRESSURE TESTING / FLUSHING
  • PERMIT TO WORK / PROCEDURES
  • CONFINED SPACE ENTRY
  • NOISE
  • VIBRATION
  • RADIATION
  • ACCESS & SAFE WALKWAYS
  • TRAFFIC
  • MANUAL HANDLING
  • OTHER HAZARDS

Description of Hazard

• Description of Hazard and how it poses a risk ( or positive observation)

• Photos of Hazard / Observation

  Media

Assessment of Risk (Not applicable for positive observation)

• Reasonable foreseeable outcome be if an incident occurred

• Consequence

  Select 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Catastrophic

  • 1 Insignificant
  • 2 Minor
  • 3 Moderate
  • 4 Major
  • 5 Catastrophic

• Likelihood

  1 Rare

  2 Unlikely

  3 Possible

  4 Likely

  5 Almost Certain

• Risk Rating

  Low

  Moderate

  Significant

  High

Control the hazard

• Corrective Action

  Select Corrected immediately by reporter Corrected immediately by Yard / contractor Worker / Supervisor informed DSME safety rep. informed Reported to DSME As described Below

  • Corrected immediately by reporter
  • Corrected immediately by Yard / contractor
  • Worker / Supervisor informed
  • DSME safety rep. informed
  • Reported to DSME
  • As described Below

• Describe actions ( If applicable)

• Photos of corrective action

  Media

Long term recommendations

• Describe recommendations

Name and signature of issuer

• Name

  Sign