Field Hazard ID
Use for All Workers
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Time
*
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
Division
*
Abandonment
Completions
Construction
Drilling
HSE
Operations
Well Servicing
Operations Area
*
Avon Hill
Coleville
Core North
Core South
Dodsland
Carrot Creek
Edgerton
Hoosier
Maintenance
Midstream
Plato
Completions Area
*
AB - Completions
SK - Completions
Abandonment Area
*
AB - Abandonment
SK - Abandonment
Core South Runs
*
Core South Chauvin Run #10
Core South Chauvin Run #11
Core South Chauvin Run #12
Core South Chauvin Run #13
Core North Runs
*
Core North Chauvin Run #00
Core North Chauvin Run #01
Core North Chauvin Run #02
Edgerton Runs
*
Edgerton Operations
Czar Operations
Midstream Area
*
Chauvin - Midstream
Well Servicing Area
*
AB - Well Servicing
SK - Well Servicing
Construction Area
*
AB - Construction
SK - Construction
Drilling Area
*
AB - Drilling
SK - Drilling
Carrot Creek Area
*
AB - Operations
HSE Area
*
AB - HSE
SK - HSE
Maintenance Area
*
Chauvin - Maintenance
SK - Operations - Maintenance - James Elliott
Avon Hill Runs
*
Avon Hill - 2-15
Avon Hill - 2-18
Avon Hill - 5-26
Avon Hill - 7-5
Avon Hill - 8-13/14-27
Avon Hill - 8-14
Avon Hill - Kerrobert
Avon Hill - NWSU
Avon Hill - Plenty 2-34
Avon Hill - Stranraer
Avon Hill - Whiteside
Coleville Runs
*
Coleville - 3-14
Coleville - Run #1
Coleville - Run #2
Coleville - Run #3
Coleville - Run #4 10-30
Coleville - Run #5
Coleville - Run #6
Dodsland Runs
*
Dodsland - Run #1
Dodsland - Run #2
Dodsland - Run #3
Dodsland - Run #4
Dodsland - Run #5
Dodsland - Run #6
Dodsland - Run #7
Dodsland - Run #8
Hoosier Runs
*
Hoosier - Run #20
Hoosier - Run #22
Hoosier - Run #23
Hoosier - Run #24
Hoosier - Run #25
Hoosier - Run #26
Hoosier - Run #27
Hoosier - Run #28
Hoosier - Run #29
Hoosier - Run #31
Hoosier - Run #7
Hoosier - Run #8
Plato Runs
*
Plato - 11-7
Plato - 13-12 Bty
Plato - 13-12 West
Plato - 14-19
Plato - Run #1 4-7
Plato - Run #2
Plato - Run #3
Plato - Run #4
Plato - Run #5 11-12
Plato - Run #6 SUT
Plato - Run #7 13-18
Plato - Run #8 Elrose
Surface Location
*
Downhole Location (if applicable)
Life Saving Rules
Which Life Saving Rules apply to the hazard? (Check all that apply)
*
Information
Classification
*
PCP Drivehead
Pumpjack
Wellhead
Flowline
Separation
Tank
Injection System
Roads, Leases or Buildings
Weather
Electrical
Pumps
Regulatory Compliance
Other
PCP Drivehead Hazard
*
Packing
Seals
Belts
Brake System
Guards
Electrical
PCP Drivehead Electrical Hazard
*
VFD
Wiring
Conduit
Fuses
Pumpjack Hazard
*
Belts
Guards
Bridle
Bearings
Seals
Loose or Missing Bolts
Electrical
Pumpjack Electrical Hazard
*
VFD
Wiring
Conduit
Fuses
Wellhead Hazard
*
Valves
Packing
Rod Rotators and Cable
Pressure Switches and Shutdowns
Heat Trace
Corrosion
Well Monitoring Equipment
Well Monitoring Equipment Hazard
*
Scada
Watchdog
DV8
Flowline Hazard
*
Valves
Fittings
Corrosion
Separation Hazard
*
Inlet Separation
FWKO
Treater
Flare System
Valves
Instrumentation
Electrical
Separation Instrumentation Hazard
*
Controllers
Regulators
Back Pressure Valves
Shutdowns
Separation Electrical Hazard
*
VFD
Wiring
Conduit
Fuses
Tank Hazard
*
Corrosion
Door
Containment and Liner
Burner
Shutdowns
Valves
Thief Hatch
Instrumentation
Electrical
Tank Instrumentation Hazard
*
Controllers
Regulators
Back Pressure Valves
Shutdowns
Tank Electrical Hazard
*
VFD
Wiring
Conduit
Fuses
Injection System Hazard
*
Corrosion
Leaks
Pump
Packing
Pulsation Dampener
Instrumentation
Electrical
Injection System Instrumentation Hazard
*
Controllers
Regulators
Back Pressure Valves
Shutdowns
Injection System Electrical Hazard
*
VFD
Wiring
Conduit
Fuses
Roads, Leases or Buildings Hazard
*
Signage
Sinking
Erosion
Other
What is the hazard?
*
Weather Hazard
*
Heat
Cold
Wind Damage
Rain Damage
Pump Hazard
*
Guards/rotating equipment
Piping/flanges
Fittings
Valves
Photo of Hazard
*
Take Photo / Upload file
Cancel
of
Additional Hazard Comments
*
0/0
Risk Ranking
*
Low
High
Actions Taken / Actions Required
Was immediate action taken to eliminate hazard? (enter in photos of any actions taken)
*
Yes
No
Actions Taken
*
Photo of Action taken
Take Photo / Upload file
Cancel
of
Actions Required
*
Was work request created to rectify deficiency?
*
Yes
No
Was a potential spill or release prevented?
*
Yes
No
Prevention / Suggestions
Optional Vendor Hazard ID Picture
Browse Files
Cancel
of
Who is the area lead?
*
First Name
Last Name
Submit
Should be Empty: