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Natonal Oil Spill Detection and Response Agency Joint Investigation Visit (Jiv) Form

This document is a joint investigation visit form that is to be completed by participating parties after an oil spill or pollution incident in the field. The form collects details about the incident such as the date, location, estimated quantity spilled, cause of spill, impacted areas, extent of impact on communities and the environment, samples taken, and investigation methods used. Signatures are required from representatives of the National Oil Spill Detection and Response Agency, Department of Petroleum Resources, state ministry of environment, local government council, the responsible company, and the impacted community.

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140 views

Natonal Oil Spill Detection and Response Agency Joint Investigation Visit (Jiv) Form

This document is a joint investigation visit form that is to be completed by participating parties after an oil spill or pollution incident in the field. The form collects details about the incident such as the date, location, estimated quantity spilled, cause of spill, impacted areas, extent of impact on communities and the environment, samples taken, and investigation methods used. Signatures are required from representatives of the National Oil Spill Detection and Response Agency, Department of Petroleum Resources, state ministry of environment, local government council, the responsible company, and the impacted community.

Uploaded by

Primelift Safety Resources Limited
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NATONAL OIL SPILL DETECTION AND RESPONSE AGENCY

JOINT INVESTIGATION VISIT (JIV) FORM


Note: This JIV Form is to be completed and signed by all participating parties in the field

1. Company: ………………………………………………………………
2. Type of Complaint/Incident:
□Oil Pollution □ Fire/Explosion □Drilling Mud/Chemical Pollution
□Others (Specify)………………………………………………………
3. Incident Details
i. Date of Incident: ………………… ii. Date first reported:………………….
iii. Date of first investigation:…………………………………..
iv. Date of follow-up investigation:…………………………….
v. Time investigation started:…………………………………..
vi. Estimated quantity spilled:…………………………………...
4. Site Details
i. Site/Location:………………………………………………………………….
ii. Position of Spill/Leak:…………………………………………………………
iii. Spill area
□Land □Swamp □Freshwater □Mangrove □Coastline
□Near shore □Offshore □Others (specify)………………………………
iv. Structural Controls in Place
□Boom □Trenches □Bund wall □Sorbents □Others (specify)……………..
5. Circumstances Around Spill Point
i. Visual observation of Hole Position
□ 12 O’ Clock □ 10 O’ Clock □ 2 O’ Clock □ 3 O’ Clock
□ 4 O’ Clock □ 5 O’ Clock □ 6 O’ Clock
ii. Type of Oil contaminant
□Crude Oil □Condensate □Chemicals □Refined Products
□Others (specify) …………………………………………………….
iii. Facility
□Pipeline □Flow line □Wellhead □Manifold □Flow Station □Rig
□Storage Tank □Compressor Plant □Others (specify)…………………….
iv. Cause Of Spill
□Corrosion □Equipment Failure □Third Party Interference □Accident
□Operational Error □Others (specify)………………………………………..
v. Visible Sign of Third Party Interference
□Hacksaw Marks □Drilled Holes □Blasting □Theft □Acid
□Others (specify)……………………………………………………………..
6. Impact of Incident
i Properties impacted by the incident
□Farmland □Fish Pond □Vegetation □Fishing Net □Surface water
□Venerable Objects □Others (specify)…………………………………..
ii. Nature of impact
□Oil stained vegetation □Oil stained fishing nets □Dead floating fishes
□Dead floating crabs □Withering of vegetation □Others……….…………
iii. Delineation of impacted area
□Within Company’s facility/ROW □Outside Company’s facility/ROW
7. Extent of Impact
a) Community (indicate name) b) Land (indicate area in m2 )
i. ……………………………………… i. ………………………………
ii. ……………………………………… ii. ……………………………..
iii. ……………………………………… iii……………….……………..
iv. ………………………………………. iv. ………………..……………
b) Creeks/Creek lets □Tidal □Non-tidal
NAME DIRECTION OF SLICK LENGTH OF SLICK WIDTH OF SLICK

c) Swamp □Tidal □Non-tidal


NAME DIRECTION OF SLICK LENGTH OF SLICK WIDTH OF SLICK

d) River □Tidal □Non-tidal


NAME DIRECTION OF SLICK LENGTH OF SLICK WIDTH OF SLICK

e) Shoreline/water
NAME DIRECTION OF SLICK LENGTH OF SLICK WIDTH OF SLICK
8. Photograph/Map/Chart Ref.
□Still photographs □Video coverage □Mapping
9. Samples taken…………………………………….. …………………………………….
10. Investigation carried out by
□Foot □Boat □Aircraft
11. Remarks/Recommendation………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
12. Time investigation ended………………………………………………………………..
13. Name and Signature of Participants
 NOSDRA
1.
2.
3.

 DPR
1.
2.
3.

 STATE MINISTRY OF ENVIRONMENT


1.
2.
3.

 LOCAL GOVERNMENT COUNCIL


1.
2.
3.

 COMPANY
1.
2.
3.

 COMMUNITY
1.
2.
3.

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