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Management of Change (Hazard Screening)

Area: Gold Creek Location: 100/13-25-68-7w5
Facility: Wellhead Date: June 29, 2016
Hazard Checklist Completed By: Jarett Sopko Phone: (780) 518-5873
New Project Change to: Work Scope Equipment Piping ✔ Process Procedure
Description of Work:
Install 2' threaded backpressure valve on flowline off wellhead to hold pressure on tubing string.

Hazard Checklist
Yes No Comments
1. Will new personnel, procedures, equipment or tools be used to complete this work? ✔

2. Does the work involve any critical facilities, processes, pieces of equipment or procedures? ✔
(Critical is determined by the potential for significant harm, damage or loss if the activity fails.)
3. Does the work require a change in the pressure, temperature or load rating of a piece of ✔
equipment or piping beyond design limits?
4. Have safety devices or systems (e.g., emergency shut-down devices, critical control or ✔
communications systems, equipment protected by a pressure-safety valve) been added,
removed, bypassed or altered?
5. Will the work involve new or unfamiliar technology, processes or equipment? ✔

6. Will inventories of toxic, flammable, or reactive materials increase significantly, or will there ✔
been a change in the manner in which these materials are handled, processed, stored, or
disposed of?
7. Could this activity have an impact on other processes or facilities? ✔

8. Will personnel be required to use substantial personal protective equipment (e.g., supplied-air ✔
breathing apparatus, chemical suits) or decontamination procedures as a result of this work?
9. Could the location (siting) of facilities or buildings create hazards related to equipment ✔
spacing, egress, accessibility or operability?
10. Will the transport of personnel, materials or equipment to and from the worksite require ✔
special precautions?
11. Will subsequent phases of the work (e.g., construction) present new or unique hazards ✔
requiring special controls?
12. Has the work changed for the way it was originally planned? ✔

13. Should safe work practices or procedures be modified or created to perform this work? ✔

14. Is there anyone involved with planning or supervising this work who has not reviewed the ✔
potential hazards of the job?
15. Will this work require a deviation from general specifications, company practices or industry ✔
standards?
16. Should there be additional planning before this work begins to ensure all hazards are ✔
addressed?

IMPORTANT: If any of the above questions is answered “yes”, perform a hazard analysis.

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Management of Change (Hazard Screening)
 Management of Change (Hazard Screening)
Hazards Analysis
Area: Gold Creek Location:
Facility: Wellhead Date: June 29, 2016
Hazard Analysis Completed By: Sara Reinhart Phone: (403) 351-4980

Hazard Identified in Checklist Recommended Mitigation Responsibility of Target Date

Completion Completed
Date
BPV could plug off Confirm presco is in good condition Operations 2016-06-30

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Management of Change (Hazard Screening)