Title Page
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Station and Lease site concerns must be reported appropriate trader and the On-shore HSSE group
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PRODUCER / OPERATOR NAME
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DATE & TIME
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STATION / LEASE NAME
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COMPANY TRADER:
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CITY:
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STATE:
Road Conditions
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Your Road
Jay
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1. Roads and pathways are maintained and clear of obstructions?
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2. Facility free of heavy traffic?
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3. Adequate facility entrance turn around radius and exit?
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4. Roadways within facility are of adequate width?
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5. Roadways are prepared with shoulders?
Station / Lease Conditions
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Station
Jay
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6. Grounding Rod Present?
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7. Ground cable in good condition?
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8. Facility beams are in good condition?
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9. Wind Sock on Location?
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10. Signage present for Station Name, Producer Name, Lease Name and Tank #'s?
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11. Facility is free of overgrown vegetation?
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12. Facility has NO evidence of spill or tank overfill.
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13. Facility tank(s) and equipment in good condition and shows no signs of corrosion?
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14. Tank stairs and hand rails in good condition?
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15. Walking surface free of slip and trip hazards?
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16. Is loading or unloading area free of animal hazards (Bees, Wasp, Snakes, etc)?
H2S Safety Controls on site
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17. Posted signs indicating “H2S site”?
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18. Posted sign on stairwell “do not enter”?
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19. Vapor Recovery Unit present?
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20. Vapor Recovery Hose is good condition?
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21. SABA- supplied breathing apparatus available?
Closing
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IF ANY OF THE ABOVE QUESTIONS ARE ANSWERED NO, PLEASE COMMENT:
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POSITIVE FEEDBACK AND ADDITIONAL COMMENTS:
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PREPARED BY:
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COMPANY (CONTRACTORS ONLY)