Form

ORG-ARW-HSM-FOR-00141

Site Notification Form

This completed form is to be provided directly to your supervisor for approval. Once approved, completed form must also be sent to Central Permit Coordinator (CPC) at the respective site 48 hours prior to your arrival. Ensure you have filled out all fields as incomplete or failure to send the form 48 hours prior to the trip may result in denied site access. This form does not negate other mandatory Health, Safety & Environment documentation.

.

CPC – South / / Arrow provided Bus? / No
CPC – North / / Public Bus? (Deviation not required) / No
Important: Attach deviation for travel using other vehicles:
·  Brisbane Staff- email authority of VP minus 1
·  Surat Basin based Staff – email authority of Manager Southern Operations or MOA. / Other Vehicle? (Deviation required) / No
Deviation obtained from VP minus1 / No
Name of VP minus 1:
Purpose of your visit
Site/s you are visiting/accessing
Site contact’s name and phone no.
Date and time of expected arrival / Date and time of expected departure
Name of Personnel coming to site / Mobile contact number / Worker category / Company name
1
2
3
4

NB: Individuals are required to bring copies of inductions and competencies completed to site.

Insert date
(DD/MM/YY) of attainment by each person onto line for each induction/competency / Person 1 / Person 2 / Person 3 / Person 4
What Inductions have you completed? / ISI or equivalent:
·  Previous Arrow HSE Induction (Baseline)
·  Previous DCGI
HSE Online Module (only if completing ISI or previous DCGI)
Arrow Facilities/Field Site Specific Induction
Land Access Induction
Vale IMP (Bowen only)
Direct Induction (where applicable only)
Visitor Induction North
Visitor Induction South
Offline Visitor Induction(paper based)
Will you be driving? If yes, will it be on unsealed roads? / Yes
What driving competency have you completed? / Sealed Road - RIIVEH201B
Unsealed Roads:
·  RIIVEH305E
·  PMASUP236B
Other ______

WORKER – Arrow Energy Employees or Employees of Contractor completing Physical Work including supervision of personnel completing physical work. They must complete (1)- Face to face Industry Safety Induction (ISI) + HSE Online Module (2)- Arrow Facility/Field site specific induction). If you have to access a location which you haven’t previously completed a site induction for, then you will be required to complete Module 2. Further information refers to Sec 2.2, 2.2.3 of ORG-ARW-HSM-PRO-00024 HSE Competence and Induction Procedure.

VISITOR- anyone accessing Arrow controlled facilities/fields including offices that will not be performing Physical Work. Refer to Sec. 2.1 of ORG-ARW-HSM-PRO-00024 HSE Competence and Induction Procedure for detailed definition of visitors and Sec. 3.5 for induction requirements.

ORG-ARW-HSM-FOR-00141 (Legacy Doc No.: 99-H-FM-0097)

Released November 2017 Version 9

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