Conducted on
Date
Prepared by
Location
Address
Area
Inspection Type
Oil, Gas, Injection
Active or Inactive
1. Signs - Location
Satisfactory
Unsatisfactory
N/A
2. Signs- Safety
Satisfactory
Unsatisfactory
N/A
Emergency Procedures
Satisfactory
Unsatisfactory
N/A
WHMIS-Labeling
Satisfactory
Unsatisfactory
N/A
WHMIS-SDS
Satisfactory
Unsatisfactory
N/A
Vegetation-Lease
Satisfactory
Unsatisfactory
N/A
Vegetation-Access road
Satisfactory
Unsatisfactory
N/A
Fence/Gate/Security
Satisfactory
Unsatisfactory
N/A
Wind Indicator
Satisfactory
Unsatisfactory
N/A
Dike/Berm- Around lease
Satisfactory
Unsatisfactory
N/A
General Housekeeping
Satisfactory
Unsatisfactory
N/A
Garbage/Debris/Clutter
Satisfactory
Unsatisfactory
N/A
Staining
Satisfactory
Unsatisfactory
N/A
Buildings
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters
Satisfactory
Unsatisfactory
N/A
Valve/Lines- plugged
Satisfactory
Unsatisfactory
N/A
Tanks-Above ground
Satisfactory
Unsatisfactory
N/A
Berm/Containment
Satisfactory
Unsatisfactory
N/A
Load/Unload areas
Satisfactory
Unsatisfactory
N/A
Tanks-Underground
Satisfactory
Unsatisfactory
N/A
Berm/Containment
Satisfactory
Unsatisfactory
N/A
Load/Unload areas
Satisfactory
Unsatisfactory
N/A
Vent/Flare stacks
Satisfactory
Unsatisfactory
N/A
Zero vegetation(20 meters)
Satisfactory
Unsatisfactory
N/A
Knockout/Accumulator
Satisfactory
Unsatisfactory
N/A
Cathodic Protection
Satisfactory
Unsatisfactory
N/A
Stairs/Ladders
Satisfactory
Unsatisfactory
N/A
Guards Installed
Satisfactory
Unsatisfactory
N/A
Instrumentation vents
Satisfactory
Unsatisfactory
N/A
PSV's (Tagged, Bolts tight)
Satisfactory
Unsatisfactory
N/A
Meters (Calibrated)
Satisfactory
Unsatisfactory
N/A
Short bolting
Satisfactory
Unsatisfactory
N/A
Shutdowns/ESD Alarms
Satisfactory
Unsatisfactory
N/A
Lockout/Tagout
Satisfactory
Unsatisfactory
N/A
Electrical grounding/bonding
Satisfactory
Unsatisfactory
N/A
Surface Casing Vent Open
Satisfactory
Unsatisfactory
N/A
Fugitive Emission Leaks
Satisfactory
Unsatisfactory
N/A
Barrel Storage
Satisfactory
Unsatisfactory
N/A
Barrel Containment
Satisfactory
Unsatisfactory
N/A
Waste Storage/Disposal
Satisfactory
Unsatisfactory
N/A
Fire Detection
Satisfactory
Unsatisfactory
N/A
Gas Detection
Satisfactory
Unsatisfactory
N/A
H2S Detection
Satisfactory
Unsatisfactory
N/A
Fire Extinguishers
Satisfactory
Unsatisfactory
N/A
Eye Wash Stations
Satisfactory
Unsatisfactory
N/A
First Aid Equipment (AED)
Satisfactory
Unsatisfactory
N/A
Burn Kit
Satisfactory
Unsatisfactory
N/A
Air Stations/Bottles/SCBA/SABA
Satisfactory
Unsatisfactory
N/A
PPE (Fall Arrest, Respirators, Etc.
Satisfactory
Unsatisfactory
N/A
Nitrogen stations
Satisfactory
Unsatisfactory
N/A
Regulator Paperwork Posted
Satisfactory
Unsatisfactory
N/A
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Anonymous
Facility and/or Wellsite Inspection Form
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