WELL HEAD INSPECTION CHECKLIST

WELL NAME: __________________________ FIELD/LOCATION: ______________________________

OPERATOR: ___________________________ CONTACT NAME: _______________________________

DATE OF INSPECTION: ___________________ INSPECTION TEAM: _____________________________

INSPECTION DETAILS

 Inspection Purpose: Scheduled Inspection Others: _______________________________

 Downhole Completion Equipment:

Surface-Controlled Subsurface Safety Valve (WR-SCSSV/TR-SCSSV): ______

Others (e.g., Bridge Plug. etc): _____________________________________

Status (Open/Close):

 Inhibitor Program in Place (Cathodic Protection): Yes/No?

Site Checklist

Location Sign Present? Yes/No: ___ Good Access to Well Site? Yes/No: ____

Vegetation/Environment Control? Yes/No: ___

WELLHEAD CHECKLIST

Christmas Tree Details:

TYPE SIZE PRESSURE RATING WELL STATUS (open/close)

Wellhead
Condition
(e.g., corrosion, valve condition):
X-MAS TREE VALVES CONDITION
Swab Valve
Wing Valve
Master Valve
Other:

 Wellhead Pressure Readings: CITHP/CHP(Psi/MPa): ______________________________________

 Surface Casing Check (Good/Bad): __________ Valves Secured (i.e., Chain/lock): _____________
 Wellhead Area Fencing, Yes/No: ____________
 All Outlets equipped with blind flanges/bull plugs where necessary? Yes/No: ___________
Observation Comments

NOTE: All other files to be attached (e.g., Pictures) where necessary.

DECLARATION:

I, __________________________________________________, the undersigned ASSET HOLDER

REPRESENTATIVE hereby attests that based on personal knowledge of operations undertaken at the above
named well, the information herein is true, accurate and complete.

Signature: ________________________ Date: ___________________________