NMDPRA FORM C OIL SPILLAGE

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 FORM 002C: Spill Response/ Clean-up Report 
(to be submitted within 4 weeks 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: ……………………………………….. 
 
 
1. 
Date and Time of Spill/ Release (in 24hrs format e.g. 13:00hrs): ………………………………………….. 
 
2. 
Date and Time of Observation (in 24hrs format e.g. 13:00hrs): …………………………………...……… 
 
3. 
Location of Spill: ……………………………………………………………………………………………. 
 
4. 
Steps taken to clean-up the spilled oil: ………………………………………………………………… 
 
5. 
Clean-up party: …………………………………………………………………………………………….. 
 
6. 
Equipment utilized and/or containment method used for cleanup: 
(a) Bundwalls                                                  7. Chemical Dispersant: 
(b) Booms 
(a) Type: ......................………………………… 
(c) Sorbents 
(b) Quantity: ...................……………………… 
(d) Others (specify) 
(c)   Not applicable: ....................................... 
 
8. 
Progress of clean-up (tick) 
Not started 30% [   ]  40% [     ] 60% [     ]    80%  
[     ]    Completed [     ] 
 
 
9. 
Clean-up duration: ………………………………………………………………………………………… 
 
10. 
Man-hours used: .…………………………………………………………………………………………... 
 
11. 
Amount of crude oil or contaminant recovered: .…………………………………………………... 
 
12. 
Damage to the environment: .………………………………………………………………………….. 
(a) 
[ ] Land/Spill media: .....................................................................................……………….. 
(b) 
[ ] Water Bodies: ...........................................................................................……………….. 
(c)     [    ]Air Media: ......................................................................................................................... 
13. 
Rehabilitation for impacted area: …............................................................................................... 
...................................………………………….…………………………………………………………….