Wellsite EHS Assessment
Validus Energy
Date
-
Month
-
Day
Year
Date
Conducted by
Please Select
BOTG 1 CJ&BL
BOTG 2 BR&HM
BOTG 3 JN&JW
BOTG 4 WH&JT&JC
Bobby Ryan
Jason Nieuwenhuis
Email
example@example.com
Lease Name
Type of Assessment
Scheduled
Unannounced
Section 1 - General Lease Condition
Lease road has potholes or could damage vehicles
Cattle guard in poor condition
Gate in poor condition
Signage not adequate (lease signs/well signs/safety signs/labeling)
Poor housekeeping
Fencing not adequate or in poor condition
Old/unused parts/filters
Other
Section 1 Photos
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Section 2 - Environmental Conditions
Spills present on location
Pits on location that are not protected or need to be reclaimed
Gas leaks on location
Wildlife hazard present on location
Piping damaged or corroded
Damaged or leaking containment
Vegetation overgrowth
Erosion/holes on pad
Combustor not lit
Thief hatches not latched
Other
Section 2 Photos
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Section 3 - Equipment Conditions
Compressor Issues/Leaks/Damage
Combustor/Flare Damage/Leaks
Damaged, defective or not needed rental/ third-party equipment on location
Cellar not filled in or covered
Cellar full of fluid
Guarding issues on Production equipment (rotating shafts…etc.)
Mousehole not covered
Wind indicator in disrepair or not present
Chemical containers not labeled
Tank/equipment grounding not adequate
Improper Isolation
Electrical components not adequate
Fire fighting equipment damaged/out of date
Damaged/Defective Stairs or ladders
Other
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Items Corrected On-site
Additional Notes or Comments
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