NMDPRA FORM A OIL SPILLAGE

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 FORM 002A: Spillage /Release Notification Report 
(to be submitted within 24 hours of Spill Incident) 
 
The Authority Chief Executive, 
                
Nigeria Midstream and Downstream  
Regulatory Authority 
Plot 1012 Cadastral Zone A00,  
Central Business District, Abuja. 
 
 
 
 
Spill/Release Serial No. ….…/20……………………. 
Company Name: ……………………………………...  
Address………………………………………………….. 
Ref: …………………………………………. …………… 
Date of Report: ……………………………………….. 
 
Please be informed that an oil spillage/leakage has occurred. 
 
1. Facility name and Location (UTM/GPS)……………………………………………………………………………. 
 
2. Date of spill: ……………………………………………………………………………………………………………... 
 
3. Time Observed (in 24hr format e.g. 13:00Hrs) ………………………………………………………………………….. 
 
4. Known extent of pollution………………………………………………………………………………………. 
            .................................................................................................................................................................... 
 
5. Precautionary measures taken since the spillage/leakage occurred to prevent hazards that 
may arise: 
....................................................................................................................................................................
.....………….....................................................................................................................................………. 
 
6. Probable Cause:  
(a)  [ ] equipment failure 
 
(b)  [ ] sabotage 
 
(c)  [ ] human error 
 
(d)  [ ] other (please specify)…………………………………………………………………………………… 
 
7. Estimated Quantity Spilled (in barrel) …………………………………………………………………………. 
Additional details about the spillage/leakage must be reported within 14 days of the spill on the spillage/release 
(FORM 002B). The Oil Spillage response/clean-up report must be submitted within four (4) weeks 
Reporting Officer:…………………………………………………      Signature: ………………………………….. 
Designation ……………………………………………………………………………………………………………...