Field Level Hazard Assessment

Type First & Last Name

Fill out with Site Supervisor EMail Address

If the Muster Point is not listed above, please describe the location here

All Required PPE Inspected & Appropriate for Operation

Personal 4 Head Gas Monitor Bump Test Results (Select all that apply)

Select SOP/SWP required for Scope Of Work

Job Safety Analysis Section for Coiled Tubing Operations

Job Safety Analysis Section for Wireline Operations

Job Safety Analysis Selection for Pumping Operation

Site Specific Environmental Hazards

Site Specific Hazardous Conditions

Site Specific Physical Hazardous

Site Specific & Job Scope Relevant LSRs

Please identify any hazardous conditions not listed here

Select all that Apply

Select all that Apply

Select all that Apply

Please List any Control Implemented But Not Listed Here

Select the topics of your safety meeting here

Document details of your safety meeting discussion here

Select the crew members on site in attendance

Select or enter the Email Address 0f the crew Members in attendance for their acknowledgement of the FLHA

Add the names of Non-Titanium meeting attendees

FLHA Sections have been discussed by all attendees listed for the acknowledgment and approval to commence operations

Site Supervisor or Direct Supervisor Approval

Attach any relevant supporting photos or documents. (Signatures)

Enter your email address