• Title:

  • Client / Site

  • Manager

  • Supervisor

  • Conducted on

  • Prepared by/HSE Tech

  • Location

Flow Back

Site Arrival

  • JSA filled out properly

  • Proper warning signs posted at entrance

  • All personnel in proper PPE

  • All personnel trained and certified in specialized operation

  • Wind sock

  • Location has designated smoking area

  • Comments:


  • Flanges have all bolts and are the correct size and properly torqued and tested

  • All valve handles are correctly installed for proper use

  • Valves capable of venting to atmosphere are capped and a means of bleed off installed.

  • Tree pressure tested at shop to maximum anticipated pressure/ API standard

  • Verify that the number of turns to (FULLY) open/close each valve and choke are written on the wellhead and are correct

  • Comments:

Flow Lines

  • All flow iron upstream of choke must be tested to 10k and 5k downstream of choke banded/identified every 12 months

  • Break apart ALL threaded connections and visually inspect before EVERY flow line installation

  • Lines are not bowed or laid in a bind

  • Unions are positioned correctly for direction of flow & checked for compatibility

  • Tested to maximum anticipated pressure + an acceptable safety margin or working pressure

  • Comments:

Flow Line Anchors

  • Set as not to cause excessive dips, arches, or bows in flow lines

  • Set first anchor as close to wellhead as feasible placing one every joint- upstream of manifold every other joint- downstream of manifold with hammer union positioned between the anchors

  • When encountering bend or turn in flow line repeat process placing first one as close as feasible after turn with one every other joint thereafter

  • Verify that anchors have been driven flush to the top of line clamp (NO USE OF SUCKER RODS)

  • Verify that the clamps used with the anchors are correct size for the outside diameter of flow line

  • Verify that clamps/anchors are sufficiently bound together and annotate be broken apart

  • Ensure that anchor clamps are 1/2" thick by 3" wide by 12" length with rod holes no greater than 1" or equivalent

  • Comments:

Manual Chokes

  • When completely closed- reading is 0/64

  • Pressure test body to same pressure as flow line

  • Housing and seat checked prior to flowing of well

  • Comments:

Flow Back Separator

  • Valves checked prior to flow back and function tested at appropriate time.

  • Adequate fall protection of tie-offs (Built in or portable platforms if properly secured will suffice)

  • Set in level position

  • Comments:

Flow Back Tank/ Gas Buster

  • Clean sand prior to transport

  • Set level

  • Adequate fall protection or tie-offs(built in or portable platforms if properly secured will suffice)

  • Easy access for tank gauging, walkways and stairs should not be damaged or missing pins

  • External valves not in use have barrier device installed in case of accidental opening

  • Set to provide easy truck access for hauling out produced fluids

  • Working wind sock installed near tank

  • Comments:


  • Comments:

  • H2S plan provided for well that may exceed 10 PPM

  • H2S site specific procedures developed for location (if required)

  • H2S contingency plan on location (if required)

  • H2S plan is coordinated by safety department and implemented by foreman



  • All personnel on pad wearing proper PPE IAW current PPE Hazard Assessment and/or SDS.

  • SSE's identified and assigned a mentor. Ref. RP54 6.1.7

  • Personnel H2S awareness trained. Ref. API RP 49 5.1

  • Each company on pad has JSA for their job. Ref. RP54 6.1.7

  • SIMOPS is being coordinated through Co/Man. Ref. RP54 6.1.7

  • Personnel using spotters when backing.

  • Personnel using tag lines. Ref. 1910.180(h)3()(vi), RP54 6.2.12

  • Crews communicating well.

  • All personnel sign in and out when entering/exiting pad. Ref. 1910.38(c)(4)

  • Personnel use designated smoking area. Rf. RP54 7.1.2-3

  • All personnel operating equipment are trained and certified on that equipment. Ref. manufacturer recommendation

  • General housekeeping good. Ref. RP54 6.5.1, 1910.22(a)(1)

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  • Comments:

Data Van

  • Proper PPE inventory

  • Fire extinguisher

  • First aid kit

  • Emergency shut off switch functional

  • Houskeeping

  • SDS's

  • Add media

  • Comments:

Outside of equipment (trailers)

  • Is equipment clean?

  • Fuel tanks/caps/mounts in place and not damaged. Ref. API RP 54 8.3.3

  • Fuel, hydraulic and other tanks properly labeled. Ref. 1910. 1200 (f) (5)

  • All drive belts and rotating lines have guards in place. Ref. API RP 54 6.8.3 API RP 54 6.8.2-3

  • All hoses on equipment in good condition. Ref. General duty clause

  • One unit on each axel chocked. Ref. API RP 54 11.1.2

  • Trailer plug and hitch secured and not damaged.

  • Breaking away cable on light duty trailers connected and working. Ref. FMCA 393.43 (d)

  • Tool/junk boxes uncluttered and lids able to close and latch. Ref. FMCA 393. 100(b)

  • Cooling Trailer operable

  • No leaks on equipment. Ref. Industry standard.

  • Comments:

  • Add media

Fuel Trucks

  • Discharge valves, hose, and nozzles in good condition. Nozzle equipped with auto shut off. Ref. 1910.106(b)

  • Piping and fuel lines in good condition. Ref. 1910.106(b)

  • Fuel tanks properly labeled on all sides. Ref. RP54 8.4.1d, 1910.1200(f)(4-5)

  • Fuel lines not ran under equipment when not in use.

  • "No Smoking" signs erected on all sides. Ref. RP54 7.1.2-6

  • Vapor release vents elevated& away from ignition source. Ref. 1919.106(b)(2)(iv)(c)

  • General housekeeping. Ref. 1910.22(a)(1)

  • B/C class fire extinguisher available and identified. Ref. 1910.157(c)(1)

  • Splash filling prohibited.

  • Fill line & discharge velocity limited.

  • Grounded.

  • Contents on NON-FLAMMABLE storage tanks identified on all sides of tank(s). Ref. 1910.145(c)(2)(i)

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  • Comments:

Sand Kings

  • Stairs and walkway free of clutter and undamaged. All open holes on walkways covered. All hand rails are up and pinned. Ref. RP54 9.3.8, 1910.24(h)

  • Rotating equipment and belts have all guards. Ref. 1910.219(c)(2)(i)

  • Spotter located at front of sand kings to assist haulers in backing.

  • F.E.'s charged, inspected, and ready for service. Ref. 1910.252(a)(2)(ii)

  • Grounded

  • proper signage

  • Appropriate PPE worn, P-100 respirators or better. Ref. 1910.132

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  • Comments:

Frac Tanks

  • Quick connect pipe from fresh water source free of leaks or damage?

  • Water manifold to tanks free of leaks, all valves to operate present and in containment if re-use water is used?

  • All lines from manifold into tank secured to tank?

  • tanks sit level?

  • Stairs, handrails, and walkways pinned, connected and not damaged with no open holes? Ref. RP54 9.3.8, 1910.24(h)

  • Frac tanks grounded? Ref. RP2003 4.5.2

  • Valves double blocked when not in use?

  • Comments:

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Hydration Unit

  • Hydration unit grounded

  • Stairs and walkways free of clutter and undamaged. Hand rails up and pinned. Ref. RP54 9.3.8, 1910.24(h)

  • SDS of all chemicals on site. Ref. 1910.1200

  • Chemicals are properly labeled. Ref. 1910.1200

  • All personnel wearing proper PPE per SDS. Ref. 1910.1200, LEG Policy, 1910.132

  • F.E.'s charged, inspected and ready for service. Ref. RP 54 20.3.4, 1910.252(a)(2)(ii)

  • Hydration unit free of leaks.

  • Hoses from hydration to blender free from abrasions, gouges, and cuts. Hose rated to 100 psi with factory ends. Whip checks installed properly. RP54 16.1.7/ OEM

  • Add media

  • Comments:


  • Acid transport and all other tote tanks in containment.

  • All chemicals clearly labeled with SDS. Ref. 1910.1200(b)(1)

  • All personnel wearing proper PPE Per SDS. Ref 1910. 1200 (b)(1)

  • All transfer lines are fit for purpose. Ref. manufacturer recommendation.

  • Acid transport grounded. Ref. RR 2003

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  • Comments:

Eye Wash Trailer

  • Personnel know where eyewash trailer is located. Ref. 1910.151, Z358., RP54 4.4.1

  • Trailer clearly marked. Ref. Z358.1 5.4.3, 1910.145(c)(2)(i)

  • Tanks are full and have been tested daily. Ref. Z358.1 4.1.4

  • Generator starts on first crank. Ref. manufacturer recommendation

  • Water flows freely from eye wash and shower. Ref. Z358.1 5.1.6 & 4.1.4

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  • Hydraulic hoses in vicinity of turbo sheathed. Ref. RP54 16.1.7

  • Blender free of leaks.

  • Fire suppression system inspected and ready for use

  • Radiation source (densitometer) labeled, closed, and locked. Ref. 1910.1096(j)

  • All personnel wearing proper PPE per SDS. Ref. 1910.1200

  • Valves double blocked when not in use on suction and discharge side.

  • Hoses on discharge side of blender to missile free from abrasions, gouges, and cuts. Hose rated to 250 psi with factory ends. Whip checks installed properly. Ref. RP54 16.1.7, RP54 9.13.3

  • F.E.'s charged, inspected and ready for service. Ref. 1910.252(a)(2)(ii)

  • Stairs and walkway free of clutter and undamaged. Hand rails are up and pinned. Ref. RP54 9.3.8, 1910.24(h)

  • Blender, hydration unit, and sand king caution taped off. Ref. API 5416.1.10

  • Rotating equipment at sand screw appropriately guarded ref. 1910.219(c)(2)(i)

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  • Comments:


  • High pressure area only 1 Line Boss in area to look for leaks while testing or pumping. Ref. API 5416.1.10

  • Hoses on missile free from abrasions, gouges, and cuts. Hose rated to 250 psi with factory ends. Whip checks installed properly. Ref. RP 54 16.1.7, RP 54 9.13.3

  • All valves have handles. Ref. industry standard

  • All brackets on missile have bolts and tightened. Ref. industry standard

  • All iron on missile certified and banded within last 6 months.

  • Hammer unions clean and dressed free of mushrooms. Ref. RP54 12.5.1

  • All valves not in use capped.

  • F.E.'s charged, inspected, and ready for service. Ref. RP 54 20.3.4, 1910.252(a)(2)(ii)

  • All iron between missile and pumps certified, tested, and banded (last 12 months). (Min4 chick sans) blocked under chicks. Ref. API 54 12.4.2

  • Bars available for isolation valves.

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  • Comments:

Pump Trucks

  • Fire Suppression system inspected and ready for use

  • Wheel chocks in place. Ref. industry standard

  • F.E.'s charged, inspected and ready for service. Ref. RP 54 16.1.10

  • High pressure area only 1 SDS in area to look for leaks while testing or pumping. Caution tape up or no go zone designated. Ref. 1910.219(c)(2)(i)

  • Guards in place over transmission and drive shaft. Ref RP54 16.1.7

  • Hydraulic hoses in vicinity of turbo sheathed.

  • All iron brackets in place and bolted down tightly.

  • All iron on pumps certified, tested, and banded in last 12 months. Ref. RP54 12.5.1

  • Hammer unions clean and dressed free of mushrooms. Ref. RP54 12.5.1

  • Bars for isolation valves readily available.

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  • Comments:

Well Head

  • Area around hydraulic lines for BOP or hydraulic valves free of leaks. Ref. Manufacturer Recommendation

  • All valves have handles installed.

  • Frac stack has platform installed or man lift on location. Ref. RP54 5.5.1

  • All flanges have all bolts and not short bolted. Ref. RP54 6.4.10

  • Cellar has been cleaned out filled in to CSG valve less than 4 ft. And properly guarded. Ref. API 54 7.1.9, API RP 54 6.7.2

  • Flow back tie in(see FB Checklist)

  • Hydraulic valves have 1 male and 1 female fitting.

  • BOP hoses have crush proof sheaths. Ref. RP53 12.5.2

  • Frac head, hydraulic valve, BOP, and B section should be accompanied with test chart. Ref. RP 53 17.3.7

  • Comments:

  • Add media

Treating Iron to Well Head

  • High pressure are only 1 Line Boss in area to look for leaks while testing or pumping. Caution tape up or no go zone designated. Ref. RP 54 16.1.10

  • All iron certified, tested, and banded in last 12 months.

  • All hammer unions dressed and ready for service. RP 54 12.5.1

  • All treating lines to well head have flapper style check valve, isolation valve, manifold or tree, and pressure recording device. Ref. RP54 16.1.4 BMP

  • All iron and chiksans and blocked to prevent digging into ground. Ref. RP54 12.4.2

  • Isolation valves have bar readily available. Ref. Industry Standard

  • 3" wheel valves have handles.

  • Where treating iron crosses is the iron rubbing together.

  • Down joints are anchored together with 10k strap.

  • Add media

  • Comments:


  • Spotters used when backing equipment

  • 20 lb. fire extinguisher located at left front bumper of each piece of equipment Ref. API RP 54 7.2.4-5

  • Fall arrest system used while in aerial lift? Ref. 1926.453(b)(2)(v)

  • Person using forklift and arial lift must have current certification cards. Ref 1910.178(I), 1926.453(b)(2) (ii)

  • Forklift inspected before use? Ref. 1926. 453(b)(2)(v)

  • Seatbelt used while operating forklift. Ref. B56. 1 5. 3. 19

  • Ropes used on hammer wrenches

  • Iron certification current. Ref. API RP5412.5.1

  • Hammer up unions in good shape and not mushroomed. Ref. API RP54

  • Restraints on iron and rated for that pressure. Ref. Industry standard

  • Lubricator marked with permanent serial number. Ref. API RP 54 13.6.5c

  • Lubricator certification current. Ref. API RP 54 13.6.2

  • BOP tested. Ref. API RP 54 6.4.1

  • All bolts in place in all flanges. Ref API RP 54 6.4.1

  • All personnel not involved with pressure testing should be outside of the taped area. Ref API RP 54 16.1.10

  • Caution tape around high pressure and crane working area. Ref API RP 54 16.1.10

  • Comments:

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  • Are wireline personnel giving Cr/Op clear signals

  • Unit chocked, positioned 50ft. from well head, and grounded. Ref RP54 13.8.6, RP67 2.9.1, 3.7, RP54 13.2.1

  • F.E.'s charged, inspected, and ready for service. Ref. RP54 16.1.10

  • Lower wire line sheave secured to well head. Ref. RP54 13.4.5

  • Wireline BOP tested in open and closed position. Ref. RP54 13.6.2 & 13.6.3

  • Wireline unit caution taped off. Ref. RP54 12.1.7

  • Wireline personnel maintain 75 ft. Rule from wellhead when testing or pumping. Ref. RP54 16.1.10, BMP frac standard

  • Are personnel respecting radio silence. Ref RP67

  • Is warning given prior to guns being armed ballistically. Ref. 1910.109(e)(5)

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  • Comments:


  • Lubricator marked with permanent serial number. Ref. RP54 13.6.5c

  • Lubricator tested, banded, and inspected on annual basis. Ref. RP54 13.6.2

  • Weight of lubricator marked on lubricator. Ref. Manufacturer Recommendation

  • Lubricator has 2 bleed valves. Ref. RP54 12.5.2

  • Personnel check for pressure prior to removing lubricator. Ref. RP 54 12.5.4

  • Lubricator bleed valves cycled after pressure bled off. Ref. RP54 12.5.11

  • Are personnel using tag lines and staying out from under suspended loads. Ref. RP54 6.2.12

  • Add media

  • Comments:


  • Cr/Op certified and knowledgable. Ref. 1910.180(b)(3)

  • Outriggers out and pads under them. Ref. 1910.180(h)(3)(i)(a)

  • Is boom angle not too great for load. Ref. 1910.180(h)(1)(i)

  • Cones out to identify swing path. Ref. 1910.180(h)(3)(iii)(b)

  • Crane is free of leaks. Ref. manufacturer recommendation

  • Cr/Op has performed daily inspection. Ref. 1910.180(d)(2)(i)

  • Annual inspection on crane is up to date. Ref. 1910.180(d)(2)(ii)

  • Cr/Op remains at controls while lubricator is unsecured. Ref. 1910.180(h)(4)(i)

  • Rigging meets Crosby standards. Ref. Industry standard

  • F.E.'s charged, inspected, and ready for service. Ref. RP54 16.1.10

  • Cr/Op clear of area when testing or pumping. Ref. Rap54 16.1.10

  • Lift slings inspected and label readable? Ref.1910.184 , 1915. 112(b)

  • Chains inspected and tagged grade 8 or better? Ref. 1910. 184, 1915. 112(c)

  • Tag lines inspected and used while lifting loads? Ref 1910.180(h)(3)(vi), API RP54 6.2.12

  • Only one person signaling crane operator? Ref. industry standard

  • Outriggers floats secures with pad pin? Ref. 1910.180(h) (3)(IV)

  • Boom exhibits no damage to structure, wear pads, boom stops, or cylinder. Ref. 1910. 180 (h) (3) (ix)

  • Wire rope free of dirt, excess lube, kinks and spooled correctly. Ref. 1910. 180(g)

  • Block not damaged? Ref. per manufacturer

  • No damage to the hook and it swivels freely. Ref. 1910.180(d)(3)(v)

  • All Guards in place. Ref. 1910.212(a)(1)

  • Handrails in place , secured, and not damaged? Ref. 1910.21 (f)(10)

  • Cab glass not cracked and wipers are functional. Ref. per manufacturer

  • Anti-two block in place and functioning. Ref. 1910.180(b)(3)(iii)

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  • Comments:

Light Plants/Generators

  • Lighting and fixtures shall be of appropriate electrical classification for the area in which they are located. Ref. RP54 9.14.6, RP 500

  • Light fixtures should be placed and maintained to provide illumination for work areas. Ref. RP54 9.14.7

  • Light plants/generators shall be placed 100ft. From well. Ref. RP54 9.14.2

  • All electrical extension cords shall be properly insulated and plugs shall be in good condition. Ref. RP54 9.14.5

  • Light plants are grounded. Ref. RP 2003

  • Repairs shall not be made on light plants unless LOTO is performed and person is qualified. Ref. RP54 9.14.9

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  • Comments:

Job execution

  • Supervisor /PIC identified and in control

  • Equipment working without failures

  • Regular checks or equipment are done? Ref. API RP 54 9.16.1-3

  • Tools in good working order? Ref API PR54 6.8.6

  • Leaks on equipment contained?

  • Spill kit easily accessible

  • Spill containment in place?

  • Safety procedure followed?

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  • Comments:

Post job

  • Area policed, garbage picked up.

  • Spills cleaned up before leaving location.

  • Location left clean.

  • Cellars empty.

  • Reserve pit empty.

  • Cellar covers in good condition

  • Does wellhead have cages or gaurds?

  • Comments:

  • Add media

Sign off

  • Any additional comments:

  • Inspected By/HSE Tech

  • On site representative

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