Title Page
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Facility/ Line Segment
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Conducted on
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Prepared by
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Location
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Companies Line
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District/Area
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Work order Required
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Yes
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If "yes" please explain
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No
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AFE #
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Date Found
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Found by
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Reported To
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Date Reported
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Potentially Hazardous Condition?
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Yes
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Situation must be immediately reported, investigated, and appropriate action implemented.
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No
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Has the condition been repaired?
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Comments:
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LAT/LONG of Location
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Description
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Condition Found
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Immediate Action Taken
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Brief Description/Scope of Work
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Picture(s)
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Signature
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Date
