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Cook Inlet Offshore
Nikiski Onshore
Anchorage
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PHASE CONDITION ASSESSMENT
Phase Condition Risk Assessment
HEX Energy Safety Management System
Assessment Information
Name of Assessor(s)
*
Date
*
Location
*
-- Select Location --
Anchorage Office
Allegra Leigh (formerly Julius R)
Spartan 151 jack-up (drilling season)
KLU subsea gathering line
Nikiski Onshore Production Facility
Marine and air transport
Other
Company
*
-- Select Company --
Customer TBD
HEX Energy
Other
Personnel Information
Number of People at Location
*
Number of People on Ice Road
Supervisor in Charge
*
Names of Crew Members Involved
*
Work Scope
Task/Work Scope
*
Weather Conditions
Weather (Temp, Wind Speed, Visibility, Wind Chill)
*
Hazards & Risk Controls
Hazards & Risks (select all that apply)
*
Extreme Cold
High Winds
Low Visibility
Whiteout Conditions
Ice Road Conditions
Blowing Snow
Frostbite Risk
Hypothermia Risk
Equipment Malfunction
Communication Limitations
Limited Evacuation Options
Wildlife
Risk Controls & Mitigation Measures (select all that apply)
*
Warm-up Shelter Available
Buddy System in Place
Cold Weather PPE
Regular Warm-up Breaks
Emergency Communication
Vehicle Staged for Evacuation
Medic On-Site
Weather Monitoring
Work/Rest Rotation
Hot Beverages Available
Reduced Work Scope
Additional Supervision
Emergency Preparedness
Evacuation Vehicle(s) ID & Driver Name(s)
*
On-Site Medic Contact
*
Verify Medic Has Care Capabilities
*
Yes - Verified
No - Not Verified
N/A
Muster Locations
*
Re-Evaluation
Re-Evaluation Frequency
*
Every 30 Minutes
Every Hour
Every 2 Hours
Every 4 Hours
As Conditions Change
Phase Work Plans
Phase 2 Available Work (Describe)
Phase 3 Workplan (Describe)
Status & Approval
Work Suspended?
*
No - Work Continuing
Yes - Work Suspended
Modified Work Only
Phase Management Team Approves Plan?
*
Yes - Approved
No - Not Approved
Pending Review
Photo Documentation
Upload Photo (optional)
📷
Click or tap to upload a photo
Submit Assessment
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