Title Page

  • Date

  • Lat/Long

  • Location

  • Inspected by

  • Codes:
    ✔ - Satisfactory
    ✖ - Unsatisfactory
    NA - Not Applicable


  • Are alarms and shutdown systems operable & tested quarterly?

  • Are level switches and dump valves operating properly?


  • Is the wiring in good repair and unexposed?

  • Are junction and switch box covers in place?

  • Are electrical motors grounded?

  • Is the conduit in good condition and all wiring in conduit?

  • Is overhead powerline clearance a concern?

  • Are all electrical control panels labeled as to function and voltage?


  • Is a PPE Required sign present (i.e., hard hat, steel toe boots, safety glasses, hearing protection)?

  • Is there a 'NO SMOKING" sign at the entrance?

  • If required, are there "Danger Poison Gas, H2S May Be Present" signs (> 10 ppm)? "Respiratory Protection Required" signs (> 100 ppm) and " Standby Required Beyond This Point" signs (> 300 ppm)?

  • Are all process vessels, storage tanks and drums properly labeled (i.e., NFPA 704, HAZCOM, NORM, Asbestos)?

  • Are Lighting instructions posted on fired vessels (i.e., heater treaters, dehydrators, etc.)?

  • Is there a "No Trespassing" or "Authorized Employees Only" sign at the entrance?

  • Is the tank battery properly identified with a sign?

  • Is there a lease sign at the location?

  • If required, is there a Regulated Confined Space sign?


  • Are all fire extinguishers inspected within the last 30 days?

  • Are fire extinguishers fully charged, sealed and tagged?

  • Have dry chemical cartridge operated fire extinguishers been hydrostatically tested according to schedule?


  • Are all fire extinguishers inspected within the last 30 days?

  • Are fire extinguishers fully charged, sealed and tagged?

  • Have dry chemical cartridge operated fire extinguishers been hydrostatically tested according to schedule?


  • Are fixed and portable monitoring instruments calibrated and in good working condition?


  • Are all sight glasses guarded and in good condition?

  • Do all pumps have the couplings and shafts guarded?

  • Are all belts and pulleys totally enclosed?

  • Are fans, flywheels and other moving parts properly guarded?

  • Is live electrical/transformer equipment guarded?

  • Is there a horse head guard on the pumping unit when below 7 ft?


  • Are approved SDSs provided for all appropriate products?


  • Have stumbling, tripping and falling hazards been eliminated or marked?

  • Are all buildings in good repair?

  • Have weeds been cut around the production equipment?

  • Is the cattleguard properly maintained?


  • Are ladder rungs, rails, brackets, etc., in good condition?

  • Are all ladders caged when over 20 ft?

  • Do side rails of through or side-step ladders extend at least 31/2 ft above landings?

  • Is the access opening to ladders provided with a swinging gate or chain closure?


  • Are all pressure gauges in good working order?

  • Are all wellhead master and wing valves in good condition?

  • Are valves and connections properly bolted, supported, and in good condition?

  • Are aluminum, copper tubing and rubber hose not being used for hydrocarbon service?

  • Is all process equipment properly anchored for movement from wind and vibration?

  • Are burner flame arrestors in good condition?


  • Are relief valve inspections current?

  • Are block valves which affect the operation of relief valves, sealed or locked in the open position?

  • Are relief valves discharged up and away from personnel and equipment?

  • Are relief valves set at or under the maximum allowable working pressure of the protected equipment?

  • Are all pressure vessels protected with relief valves? Rupture disk(s) visually examined for leakage?


  • Are all respirators sanitized and properly stored?

  • Have all emergency use respirators been inspected and documented within the last 30 days?


  • Are there any roadway hazards that need to be marked, guarded or eliminated? (anchors, pipelines, risers, etc.)


  • Are walkways and stairways in good order?

  • Are there toeboards on elevated walkways over 4 ft?

  • Do the tank thief hatches seal and are they in good repair?

  • Are process vessels and storage tanks in sound condition with no sign of corrosion problems?

  • Is the insulating or protective coating material in good condition?

  • Are vessel/tank foundations in good repair and free of washout or undercutting?

  • Does the tank have a vent line attached and is it free of obstruction?

  • Are all pressure vessels operating at or below their maximum allowable working pressure?

  • Has the insulation been analyzed and labeled if it contains asbestos?

  • Are tanks examined visually to check for leaks, tank distortion, corrosion, coating and cathodic protection conditions?


  • Are all valves and connections in good operating condition?

  • Are the facility piping systems in sound condition, with no sign of leaks or potential corrosion problems?

RRC 36 - H2S

  • H-9?

  • Contingency Plan?

  • District Office Notification?

  • Warning and Marker Signs?

  • Wind Indicators?

  • Protective Breathing Equipment?

  • Flare Stacks?

  • Training?


  • Is a first aid kit easily accessible and maintained in the office area?

  • Is there a first aid kit maintained in each truck?


  • Are training requirements being maintained?

  • Are all training records kept on file?


  • Is the company HSE manual available and accessible to all employees?


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  • Additional Remarks

  • Inspector Sign Off

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