• Site/crew

  • Manager

  • Supervisor

  • Conducted on

  • HSE Tech/Prepared by

  • Location

Site Arrival

  • JSA filled out properly

  • Is there handwritten input?

  • Are persons trained for their individual tasks

  • Proper warning signs posted at entrance

  • All personnel in proper PPE

  • All personnel trained and certified for their specialized operation

  • Location has designated smoking area

  • Wind sock Available?

  • Additional 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 & a means of bleed off installed.

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

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

  • Additional Comments

Flow Lines

  • No threaded connections leak upstream of choke manifold

  • All flow iron upstream of choke must be tested to 10k and 5k downstream of choke banded/identified every 6 months

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

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

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

  • Lines are not bowed or laid in a bind

  • Additional Comments

Flow Line Restraints

  • Have personnel who install restraints received training, if so by whom?

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

  • Set first Flow Line Restraint 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 Flow Line Restraints.

  • On flow lines, are all angels and unions tied down from the wellhead to open-top tanks

  • Additional 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

  • Additional Comments

Flow Back Tank/ Gas Buster

  • Clean sand prior to transport

  • Set level

  • Tanks grounded

  • Trucks using bonding cables

  • 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

  • Additional 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

  • Additional Comments

  • Add media

Sign Off

  • Signature

  • On site representative

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.