Weekly HSE Lateral Learning 05/01/05

1. Weekly HSE Lateral Learning 05/01/05 29/12/04 MB Pet N.M. 0P C3P Rig-88,When attempting to test the completion tubing to 69000kPa the 3.5” New Vam to 3.5” IF cross over from the completion tubing to the pumping sub was leaking. It was changed out for the MB slick line unit's crossover (3 ½” Vam - 5 ¾” Otis) and then crossed back to fit the pumping sub connection. The tubing was re-tested, but the crossover leaked at 60,000kPa. On investigation the crossover was only rated to 35000kPa and not 69,000kPa. This crossover should have been rated to 69000kPa because it was part of the 69000kPa lubricator equipment that was going to be used for the next stage of the operation. LEARNING The root cause of failure was mobilizing to site without performing the 10k load-out checklist to check that crossovers matched callout requirements with regard to thread pattern & pressure rating. Also upon arrival and use at the rigsite the supervisors did not go through their equipment and recognise that one of the X-Overs was not suitable. Many opportunities were missed to pick up this rogue X-Over Pin hole Picture 2 Pressure testing to 10 k.lbs with a sub in the assembly rated to 5 k.lbs • ACTIONS: • The 10k load out form is to accompany all load-outs where multiple x-overs are sent on a unit. No job is to start without this form. • DSV’s are to assure themselves, through questions and evidence, that all equipment supplied is rated to the correct value for the job • DSV’s to hold pre-job meetings and use this opportunity to ask questions relate to the equipment • TBT prior to job should have talked through equipment. • How was this X-Over to be torqued up? Given the position of the band-it strap