Flow Testing SHE Assessment
Date
-
Month
-
Day
Year
Date
Assessor
First Name
Last Name
Email
example@example.com
Well Name/s
Type of Assessment
Scheduled Safety Assessment
Walk Through
Progress
Draft Assessment
Closed Assessment
Assessment Overview
Section 1 Lease Road & Entrance
1. Road surface damage excessive or could cause damage to vehicles
2. Litter present along lease road or entrance to location
3. Signage not adequate at entrance to location
4. Emergency Action Plan in place as per 29 CFR 1910.38
5. Site-specific induction not completed for all personne
6. Muster points not clearly communicated marked or unobstructed
Section 1. Number of Deficiencies Noted
Section 1. Notes/Deficiencies
Section 1. Photo
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Section 2. General SHE
1. Poor housekeeping around the perimeter of the location
2. Poor housekeeping around wellhead
3. Presence of or condition of rental/ third-party equipment on location
4. Spills present on location
5. Fencing not adequate or in poor condition
6. Cattle guard in poor condition
7. Gate in poor condition if applicable
8. Open pit(s) on location
9. Pit(s) not adequately backfilled and/or reclaimed
10. Barrier not present around open pit
11. Cellar not filled in or barricaded
12. Mousehole not covered
13. Wind indicator in disrepair or not present
14. Leaks on location.
15. Liquid/chemicals not labeled
16. Wildlife hazard present on location
17. Grounding not adequate
18. Well identification sign not present
19. Facility Piping not adequate
20. Electrical components not adequate
21. Containment not adequate
22. Fire fighting equipment not adequate
23. Hazard/Caution signs not present or in poor condition
24. Safety equipment not adequate
25. Vegetation overgrowth
26. Other
Section 2. Number of Deficiencies Noted
Section 2. Notes/Deficiencies
Section 2. Photo
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Section 3. FlowTesting Equipment & Setup
3.1 Choke manifold not correctly installed and pressure rated
3.2 Separation equipment not grounded and bonded
3.3 Flowlines and connections are not free from leaks and or properly supported
3.4 other
3.4 Gas vent lines are not routed away from ignition sources
3.5 Flare stack is not properly positioned or functional
3.6 ESD (Emergency Shut Down) systems not tested or functional
Section 3. Number of Deficiencies Noted
Section 3. Notes/Deficiencies
Section 3. Photo
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Section 4. PersonalProtective Equipment (PPE)
4.1 Proper protective clothing not worn by all personnel
4.2 Hard hats, safety glasses, gloves, and steel-toe boots not in use where required
4.3 Hearing protection not available or used where required
4.4 Gas monitors not used or functional (bump tested) where required
4.5 Other
Section 4. Number of Deficiencies Noted
Section 4. Notes/Deficiencies
Section 4. Photo
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Section 5. Health& Industrial Hygiene
5.1 Hazard zones not marked, identified or restricted
5.2 Gas detection systems not active or calibrated
5.3 First aid kits not available, stocked or accessible
5.4 Potable water not availible provided
5.5 Other
Section 5. Number of Deficiencies Noted
Section 5. Notes/Deficiencies
Section 5. Photo
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Section 6. EnvironmentalControls
6.1 Spill containment not under tanks and separators
6.2 Drip pans not under potential leak sources
6.3 Waste is not properly labeled, stored, or segregated
6.4 Secondary containment for fuel storage is not present or intact
6.5 Flare emissions not monitored or documented
6.6 Other
Section 6. Number of Deficiencies Noted
Section 6. Notes/Deficiencies
Section 6. Photo
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Section 7. Fireand Explosion Prevention
7.1 Fire extinguishers not inspected or accessible
7.2 No smoking zones are not enforced
7.3 Grounding and bonding fuel containers is not completed
7.4 Hot work permits are not reviewed or active where applicable
7.5 Ignition sources are not controlled as appropriate
7.6 Other
Section 7. Number of Deficiencies Noted
Section 7. Notes/Deficiencies
Section 7. Photo
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Section 8. Documentationand Compliance
8.1 Job Safety Analysis (JSA) not completed as appropriate
8.2 Permits to work are not current or complete
8.3 Safety Data Sheets (SDS) are not avalible or accessible for all chemicals
8.4 Daily toolbox talks pre pre-job safety meetings are not conducted or documented
8.5 Incident reporting procedures are not clearly communicated
8.6 Other
Section 8. Number of Deficiencies Noted
Section 8. Notes/Deficiencies
Section 8. Photo
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