Mobilization Request Form

Please call the General Manager before submitting this form.

Section 1 - Contact Details

Member Company/Spiller * Name of Person Notifying CNA * Job Title (Designation) Direct Phone Number Mobile Phone Number * Email Address * Command Centre Number (if any) Date of Activation * Time of Activation *

Section 2 - Spill Details

Date of Spill * Time of Spill Source of Spill Cause of Spill Name of Location/Facility Nearby Town/Community

Status of Spill *

Secured Uncontrolled Unknown

Type of Production

Pipeline Flow Line Flow Station

Facility/Installation

Wellhead Manifold Gas Plant FPSO Tank Farm Others

Section 3 - Location

Type of Environment *

Offshore Subsea Shoreline Estuary Swamp Port Harbour Inland River Seasonal Swamp

Section 4 - Resources at Risk

Environmental or socio-economic sensitivities

Section 5 - Equipment & Personnel

Number of Personnel & Equipment to be mobilized by CNA *

Section 6 - Health, Safety & Security

Protection Protocol * Crew Change Requirements * Known Safety/Security Risks Security Arrangements for CNA Staff

Section 7 - Further Information

Additional Information

Commitments

COVID-19 PPE Decent Accommodation Safety of Location Security (Armed Escort) Transportation Communication Access to Site On-site Medical Services Welfare Safety Devices

Welfare Provisions

Please state applicable welfare provisions

Submit Request