Major environmental Incident arising from a Safety Incident. (Note: PON1 reporting is still a requirement. The ROGI form is additional in the event of a Major environmental incident)
Implementing Regulation Section J: A Major Environmental Incident
Name of contractor (if applicable)
Enter name of contractor
Description of circumstances, consequences of event and emergency response
Indicate the system that failed and provide a description of the circumstances of the event / describe what has happened. What are or are likely to be the significant adverse effects on the environment?
Death or Loss of a Person Pursuant to MAR Regulation 21B (Note: although provided within the ROGI Form this must be printed and sent to the Registrar General of Shipping and Seamen)
Form to be Completed in respect of the death or loss of a person pursuant to Regulation 21B – Offshore Installations and Pipelines Works (Management and Administration) Regulations 1995
Section L only is to be printed out and the form is to be sent to the :
Registrar General of Shipping and Seamen
Name or other designation of offshore installation
I certify that the particulars entered above are true to the best of my knowledge and belief:
Signature of duty holder furnishing information or person acting on behalf of duty holder
Name of duty holder/pm whose behalf information is furnished
Enter duty holder name
Status of signatory
Date of signing
NOTES (a) To be given by geographical co-ordinates.
(b) Forename(s) in full, followed by surname, all in block capitals.
(c) To be accompanied by the certificate of a registered medical practitioner who holds a licence to practise as to the cause of death or a statement of the reason why such a certificate is not available.