Title Page
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Date
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Lat/Long
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Location
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Inspected by
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Codes:
✔ - Satisfactory
✖ - Unsatisfactory
NA - Not Applicable
ALARMS/SHUTDOWN
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Are alarms and shutdown systems operable & tested quarterly?
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Are level switches and dump valves operating properly?
ELECTRICAL
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Is the wiring in good repair and unexposed?
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Are junction and switch box covers in place?
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Are electrical motors grounded?
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Is the conduit in good condition and all wiring in conduit?
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Is overhead powerline clearance a concern?
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Are all electrical control panels labeled as to function and voltage?
FACILITY SIGNS
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Is a PPE Required sign present (i.e., hard hat, steel toe boots, safety glasses, hearing protection)?
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Is there a 'NO SMOKING" sign at the entrance?
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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)?
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Are all process vessels, storage tanks and drums properly labeled (i.e., NFPA 704, HAZCOM, NORM, Asbestos)?
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Are Lighting instructions posted on fired vessels (i.e., heater treaters, dehydrators, etc.)?
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Is there a "No Trespassing" or "Authorized Employees Only" sign at the entrance?
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Is the tank battery properly identified with a sign?
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Is there a lease sign at the location?
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If required, is there a Regulated Confined Space sign?
FIRE EXTINGUISHERS - FACILITIES
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Are all fire extinguishers inspected within the last 30 days?
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Are fire extinguishers fully charged, sealed and tagged?
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Have dry chemical cartridge operated fire extinguishers been hydrostatically tested according to schedule?
FIRE EXTINGUISHERS - FIELD OFFICE
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Are all fire extinguishers inspected within the last 30 days?
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Are fire extinguishers fully charged, sealed and tagged?
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Have dry chemical cartridge operated fire extinguishers been hydrostatically tested according to schedule?
GAS DETECTION INSTRUMENTS
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Are fixed and portable monitoring instruments calibrated and in good working condition?
GUARDS
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Are all sight glasses guarded and in good condition?
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Do all pumps have the couplings and shafts guarded?
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Are all belts and pulleys totally enclosed?
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Are fans, flywheels and other moving parts properly guarded?
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Is live electrical/transformer equipment guarded?
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Is there a horse head guard on the pumping unit when below 7 ft?
HAZARD COMMUNICATION STANDARD
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Are approved SDSs provided for all appropriate products?
HOUSEKEEPING
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Have stumbling, tripping and falling hazards been eliminated or marked?
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Are all buildings in good repair?
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Have weeds been cut around the production equipment?
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Is the cattleguard properly maintained?
LADDERS
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Are ladder rungs, rails, brackets, etc., in good condition?
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Are all ladders caged when over 20 ft?
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Do side rails of through or side-step ladders extend at least 31/2 ft above landings?
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Is the access opening to ladders provided with a swinging gate or chain closure?
PRODUCTION EQUIPMENT
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Are all pressure gauges in good working order?
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Are all wellhead master and wing valves in good condition?
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Are valves and connections properly bolted, supported, and in good condition?
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Are aluminum, copper tubing and rubber hose not being used for hydrocarbon service?
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Is all process equipment properly anchored for movement from wind and vibration?
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Are burner flame arrestors in good condition?
RELIEF VALVES
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Are relief valve inspections current?
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Are block valves which affect the operation of relief valves, sealed or locked in the open position?
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Are relief valves discharged up and away from personnel and equipment?
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Are relief valves set at or under the maximum allowable working pressure of the protected equipment?
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Are all pressure vessels protected with relief valves? Rupture disk(s) visually examined for leakage?
RESPIRATORY EQUIPMENT (If provided)
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Are all respirators sanitized and properly stored?
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Have all emergency use respirators been inspected and documented within the last 30 days?
ROADWAYS
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Are there any roadway hazards that need to be marked, guarded or eliminated? (anchors, pipelines, risers, etc.)
TANKS, VESSELS
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Are walkways and stairways in good order?
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Are there toeboards on elevated walkways over 4 ft?
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Do the tank thief hatches seal and are they in good repair?
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Are process vessels and storage tanks in sound condition with no sign of corrosion problems?
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Is the insulating or protective coating material in good condition?
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Are vessel/tank foundations in good repair and free of washout or undercutting?
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Does the tank have a vent line attached and is it free of obstruction?
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Are all pressure vessels operating at or below their maximum allowable working pressure?
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Has the insulation been analyzed and labeled if it contains asbestos?
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Are tanks examined visually to check for leaks, tank distortion, corrosion, coating and cathodic protection conditions?
PIPING
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Are all valves and connections in good operating condition?
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Are the facility piping systems in sound condition, with no sign of leaks or potential corrosion problems?
RRC 36 - H2S
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H-9?
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Contingency Plan?
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District Office Notification?
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Warning and Marker Signs?
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Wind Indicators?
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Protective Breathing Equipment?
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Flare Stacks?
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Training?
FIRST AID KITS
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Is a first aid kit easily accessible and maintained in the office area?
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Is there a first aid kit maintained in each truck?
TRAINING AND TRAINING RECORDS
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Are training requirements being maintained?
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Are all training records kept on file?
COMPANY HSE MANUAL
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Is the company HSE manual available and accessible to all employees?
ENVIRONMENTAL REMARKS
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COMPLETION
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Additional Remarks
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Inspector Sign Off
