Well Lockout Tagout Checklist
**To be used when shutting in wells for any reason**
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
Surface Location
*
Downhole Location (if applicable)
Foreman Area
*
Avon Hill
Coleville
Dodsland
Hoosier
Plato
Chauvin
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 8-34
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
Well Information
Wellhead sign (must include picture of wellhead sign)
*
Browse Files
Cancel
of
***IF YOU HAVE ANSWER NO FOR ANY OF THE QUESTIONS BELOW YOU MUST ENTER A COMMENT IN THE SECTION BELOW***
Reason for well being shut in
*
How long is well expected to be shut in?
*
1 day
1 Week
2 Weeks
3 Weeks
1 Month
Indefinately
Has Power been isolated and locked and tagged? (If No, please enter comments below)
*
Yes
No
Power Comments
*
Has ratigans or master valve been closed? (include picture) (If No, please enter comments below)
*
Yes
No
Ratigans Comments
*
Are all fittings tight? (plugs / swedges / nipples) with no open ended pipe? (If No, please enter comments below)
*
Yes
No
Fittings Comments
*
Are all valves on wellhead closed and locked out? (If No, please enter comments below)
*
Yes
No
Valve Comments
*
Has flowline been pigged? (If No, please enter comments below)
*
Yes
No
Flowline Comments
*
Are all valves downstream of wellhead and tank closed and locked out? (If No, please enter comments below)
*
Yes
No
Valves Downstream Comments
*
Have all valves on riser been closed and locked out? (If No, please enter comments below)
*
Yes
No
Valves on Riser Comments
*
Pictures of wellhead
*
Take Picture / Upload Photo
Cancel
of
Are there any concerns with this location?
Submit
Should be Empty: