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Notification of order after incident on Gullfaks C, 17 December 2004

During a crane lift on Gullfaks C (photo) on 17 December 2004, a signalman got a guide rope tangled around his leg. The person was unable to free himself, hung on tight and was lifted seven meters into the air. The Petroleum Safety Authority Norway (PSA) regards Statoil's own investigation of the incident as being deficient. We have therefore issued a notification of order asking the company to reinvestigate this incident.


The signalman was not physically injured in the incident, but both the PSA and Statoil believe that, if conditions were only slightly altered, this could have led to a serious accident.

Statoil has conducted its own investigation of the incident. The PSA believes that this investigation is inadequate, and that it does not fulfill regulatory requirements. Examples of deficiencies include:

  • Gross collective violations of procedures have been identified, but the investigation does not reveal the causes. Measures appear to be proposed on a deficient basis.
  • Breaches of barriers that have not been identified. For example, that the signalman does not position himself so that he can give a manual stop signal, and that the slinger is positioned under a hanging load.

Pursuant to Section 19 of the Management Regulations, cf. Section 58 of the Framework Regulations, the PSA is considering ordering Statoil to:

  1. Reinvestigate the incident, identify and implement measures that can prevent recurrence.
  2. Review a representative selection of undesirable incidents on the Gullfaks field to confirm whether violations of procedures in general, and collective violations of procedures in particular, are a problem in the organization. If this review reveals that violation of procedures is a problem, necessary measures must be identified and implemented.

We have asked Statoil to provide comments in writing regarding this notification of order by 28 April 2005.

Link: What is a notification of order?

Contact in the PSA Norway:
Inger Anda,
E-mail:
inger.anda@ptil.no
Phone: +47 970 54 064