Daily HSE Report

• Conducted on

  Date

• HSE Supervisor

• Well Site Location(s)

• GPS Location
  Address

• Incidents

  Yes

  No

  N/A

• What type of incident?

  First Aid

  Medical

  Environmental

  Near Miss

• Was this incident reported and documented?

  Yes

  No

  N/A

• Was this incident reported and documented?

  Yes

  No

  N/A

• Was this incident reported and documented?

  Yes

  No

  N/A

• Was the incident Reported and Documented?

  Yes

  No

  N/A

• Any use of SWA?

  Yes

  No

  N/A

Daily Summary

• Please provide a brief summary of today's activities and encounters