Page 183 - claims information pack ebook_e

Example Claim Form
PART 2 Section E Claim Number (for internal use only)
Other Losses
Section E

Part 2 – Costs of reasonable measures to reinstate the contaminated environment

1) Description and extent of the area(s) affected by the spill, degree of pollution and resources impacted by
the oil (please also add separately maps/charts/photos or other evidence)

2) Results of laboratory analysis and/or other evidence linking the oil pollution with the ship(s) involved in
the incident

3) Description of reinstatement measures undertaken

38
4) Date(s) on which such measures were undertaken

5) Personnel used for the reinstatement measures

a. Number and roles of personnel employed

b. Hours worked and rate (specify calculation method, other labour costs, etc)

c. Travel and accommodation expenses for reinstatement personnel

d. Summary of costs of food, personal protective equipment, communications, etc. for response
personnel