Derrick Inspection Report Template

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K2 Specialist Services

DRILLING DERRICK INSPECTION

API 4G CATEGORY III

VISUAL INSPECTION FORM

Client:

Installation/Rig:

K2 Specialist Services Project No:

Report No:

Inspected by:

Inspection Date:

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FOREWORD

The reporting format utilised by K2 Specialist Services ensures that a comprehensive examination of the main derrick structure and appurtenances is systematically carried out and recorded. The derrick inspection also highlights any visible or potential defects and adverse conditions giving concern to the safetyof the operating personnel and/or the integrity of the structure.

The derrick inspection reporting format has been developed by K2 Specialist Services to compliment the standard API RP 4G Inspection format for drilling structures and coversthe inspection of components that may not otherwise be referenced in API reporting formats.

The scope of the K2 Specialist Services derrick inspection is designed to satisfy the requirements of API RP 4G Category III for the periodic survey of mobile units and fixedinstallations.

With the exception of the derrick crown block, the inspection of associated travelling equipment will be reported under separate contract and cover to the main report.

In accordance with controlling industry regulations and the recommendations of derrick manufacturers, the derrick operator may be required to carryout inspections additional to those specified above if the derrick structure is affected by one or more of the following conditions:

a) Where the derrick is used regularly in the upper range of its load limitsb) When the structure has been subjected to critical conditions which could affect safety performancec) When obvious deterioration has occurred, i.e. loose bolts and fixings, damaged structural members, damaged equipment etc.

If the derrick has been subject to one of the aforementioned conditions, K2 Specialist Services recommends that the structure be inspected immediately, or alternatively,further advice is obtained from the original derrick manufacturer or suitably qualified person as defined in API RP 4G (4.2.1).

Inspection Guidelines

At the time of inspection, damaged sections or equipment will be clearly and visibly marked by the K2 Specialist Services Inspector so that needed repairs may be made - a bright contrasting paint marker is suggested for this. When repairs are made, the visible markings should be removed by painting over them. It is recommendedthat inspection be made with assistance of manufacturers assembly drawings and operating instructions. For items not accessible or that do not apply,write N/A against the item pertaining to the component on the report sheet.

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CONTENTS

Section 0.1 Installation Details Section 4.0 Pedestals, Base Plates

Section 1.0 A-Frame/Gin Pole Section 5.0 Working Platforms1.1 Padeyes 5.1 Racking Board

5.1.1 Derrickman's Escape SystemSection 2.0 Crown Assembly 5.1.2 Details of Additional Racking Board Equipment

2.1 Sheave Cluster 5.2 Casing Stabbing Board2.1.1 Pillar Blocks (Support Assemblies)2.1.2 Cap Plates2.1.3 Lubrication2.1.4 Sheave Guards/Line Guards Section 6.0 Ladders

2.2 Crown Platform2.3 Crown Support Beams Section 7.0 Tong Counterweight2.4 Fast Line Assembly

2.4.1 Pillar Blocks (Support Assemblies) Section 8.0 Miscellaneous Sheave Assemblies2.4.2 Cap Plates2.4.3 Lubrication Section 9.0 Ancillary Equipment2.4.4 Sheave Guards/Line Guards 9.1 Mud Line Clamps

2.5 Dead Line Assembly 9.2 Gas Vent Line Clamps2.5.1 Pillar Blocks (Support Assemblies) 9.3 Cement Line Clamps2.5.2 Cap Plates 9.4 Windwalls, Heat Shields, Frames & Attachments2.5.3 Lubrication 9.5 Top Drive Mounting System2.5.4 Sheave Guards/Line Guards 9.6 V-Door Rollers/Guides

2.6 Padeyes Under Crown Platform 9.7 Climber Assist System2.7 Hang Off Padeye 9.8 Fall Arrest System2.8 Fall Arrest/Climbing Assist Device Mounting2.9 Crown Saver Block(s) Section 10.0 Paint/Coating2.10 Top Beams/Water Table

Section 11.0 Bolt InspectionSection 3.0 Derrick

3.1 Upper Section3.2 Lower Section

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SECTION 0.1 - INSTALLATION DETAILSSub-Section Item Findings Comments

0.1 General Client:

Installation Name:

Installation Type: - Platform - Jack-up - Semi-submersible - Submersible - Drill Ship - Floating Production - Other (specify)

Survey Location:

Survey Date:

Nameplate on structure: Yes No

Derrick type: Bolted Welded

Derrick Manufacturer:

Manufacturer's Serial No:

Date of Manufacture:

Stem Height:

Maximum Static Hook Load (lbs):(Number of lines to Travel Block)

Maximum Rated Wind Velocity (knots):

Manufacturer's drawings available Yes No for use in inspection?

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SECTION 1.0 - A-FRAME / GIN POLESub-Section Item Findings Comments

1.0 A-Frame/Gin Pole Gin Pole type: A-Frame Square Frame Other Not applicableGin pole height:Rated capacity:

a) Gin pole condition: OK Damaged See Comment a)b) Frame legs: OK Damaged See Comment b)c) Girts: OK Damaged See Comment c)d) Braces: OK Damaged See Comment d)e) Access ladders: OK Damaged See Comment e)f) Access platforms: OK Damaged See Comment f)g) Bolted connections: OK Damaged See Comment g)h) Welds: OK Damaged See Comment h)i) Bolts and nuts: OK Corroded Lock Nuts i)j) Additional assemblies/components: j)

Recommendations:(please quote item no.)

1.1 Padeyes a) No. of padeyes: a)b) Load rating: b)c) SWL marked: c)d) Colour code valid: d)e) Welds: e)f) Pin holes: f)g) Last inspection: Date: Certificate Ref: g)


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SECTION 2.0 - CROWN ASSEMBLYSub-Section Item Findings Comments

2.1 Sheave Cluster Manufacturer's model/serial no:Total no. of sheaves:

Sheave ident no's:Sheave dia sizes:Wireline groove size:

Condition: a) Are sheaves free running: Yes No See Comment a)b) Are grooves in gauge: Yes No See Comment b)c) Are grooves free of visual defects: Yes No See Comment c)d) Signs of wear on fleet angle: Yes No See Comment d)e) Are rims free of damage: Yes No See Comment e)f) Are sheaves warped: Yes No See Comment f)g) Any sign of corrosion: Yes No See Comment g)


2.1.1 Pillar Blocks a) Secured to structural support: Yes No See Comment a) (Support Assemblies) b) Bolts installed correctly: Yes No See Comment b)

c) Lock nuts fitted to bolts: Yes No See Comment c)d) Signs of corrosion: Yes No See Comment d)e) Welded areas: UT MPI Visual e)

OK Defect See CommentRecommendations:(please quote item no.)

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2.1.2 Cap Plates a) Signs of distortion: Yes No See Commentb) Bolts installed correctly: Yes No See Commentc) Lock wire to cap plate bolts: Yes No See Comment


2.1.3 Lubrication a) System type: Manual Central a)b) Lubrication system free of damage: Yes No See Comment b)c) All ports free of obstruction: Yes No See Comment c)


2.1.4 Sheave Guards a) Guards in place: Yes No See Comment a) Line Guards b) Guards secured with lock nuts installeYes No See Comment b)

c) Any signs of wear/impact damage: Yes No See Comment c)Recommendations:(please quote item no.)

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2.2 Crown Platform a) Decking: OK Damaged See Comment a)b) Holes covered: OK Damaged See Comment b)c) Safety gate: OK Damaged See Comment c)d) Ladder access: OK Damaged See Comment d)e) Handrails: OK Damaged See Comment e)f) Frame straight: OK Damaged See Comment f)g) Welds: OK Damaged See Comment g)h) Bolts and nuts: OK Corroded Lock nuts h)


2.3 Crown Support Beams a) Beam Straight: OK Damaged See Comment a)b) Pins: OK Damaged See Comment b)c) Safety pins/keepers: OK Damaged See Comment c)d) Welds: OK Damaged See Comment d)e) Bolts and nuts: OK Damaged See Comment e)


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2.4 Fast Line Assembly Manufacturer's model/serial no:Total no. of sheaves:Sheave ident no's:Sheave dia sizes:Wireline groove size:

Condition: a) Are sheaves free running: Yes No See Comment a)b) Are grooves in gauge: Yes No See Comment b)c) Are grooves free of visual defects: Yes No See Comment c)d) Signs of wear on fleet angle: Yes No See Comment d)e) Are rims free of damage: Yes No See Comment e)f) Are sheaves warped: Yes No See Comment f)g) Any sign of corrosion: Yes No See Comment g)





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2.4.2 Cap Plates a) Signs of distortion: Yes No See Comment a)b) Bolts installed correctly: Yes No See Comment b)c) Lock wire to cap plate bolts: Yes No See Comment c)






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2.5 Dead Line Assembly Manufacturer's model/serial no:Total no. of sheaves:Sheave ident no's:Sheave dia sizes:Wireline groove size:

Condition: a) Are grooves in gauge: Yes No See Comment a)b) Are grooves free of visual defects: Yes No See Comment b)c) Signs of wear on fleet angle: Yes No See Comment c)d) Are rims free of damage: Yes No See Comment d)e) Are sheaves warped: Yes No See Comment e)f) Any sign of corrosion: Yes No See Comment f)





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2.5.2 Cap Plates a) Signs of distortion: Yes No See Comment a)b) Bolts installed correctly: Yes No See Comment b)c) Lock wire to cap plate bolts: Yes No See Comment c)






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2.6 Padeyes under the a) No. off: a) Crown Platform b) Load rating: b)

c) SWL marked: Yes No See Comment c)d) Colour code valid: Yes No See Comment d)e) Welds: OK Damaged See Comment e)f) Pin holes: OK Damaged See Comment f)g) Last inspection: Date:15 March 2013Certificate Ref: g)


2.7 Hang Off Padeye a) Load rating: a)b) SWL marked: Yes No See Comment b)c) Colour code valid: Yes No See Comment c)d) Welds: OK Damaged See Comment d)e) Pin holes: OK Damaged See Comment e)f) Last inspection: Date: Certificate Ref: f)


2.8 Fall Arrest/Climbing a) Support pole: OK Damaged See Comment a)b) Base: OK Damaged See Comment b)c) Sheave attachment: OK Damaged See Comment c)d) Weight bucket attachment: OK Damaged See Comment d)e) Welds: OK Damaged See Comment e)



2.9 Crown Saver Block(s) a) Safety mesh: OK Damaged See Comment a)

Assist Device Mounting

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b) Safety cable: OK Damaged See Comment b)c) Attachment strapping: OK Damaged See Comment c)d) Strapping welds: OK Damaged See Comment d)


2.10 Top Beams/Water Table a) Water table beams: OK Damaged See Comment a)b) Header beams: OK Damaged See Comment b)c) Secondary support beams: OK Damaged See Comment c)d) Welds: OK Damaged See Comment d)e) Bolt connections: OK Damaged See Comment e)f) Details of additional items: f)


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SECTION 3.0 - DERRICKSub-Section Item Findings Comments

3.1 Upper SectionDrillers Side a) Legs: OK Damaged Loose Bolts Other a)

b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


Off Drillers Side a) Legs: OK Damaged Loose Bolts Other a)b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


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Drawworks side a) Legs: OK Damaged Loose Bolts Other a)b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


Off Drawworks side a) Legs: OK Damaged Loose Bolts Other a)b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


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3.2 Lower SectionDrillers Side a) Legs: OK Damaged Loose Bolts Other a)

b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


Off Drillers Side a) Legs: OK Damaged Loose Bolts Other a)b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


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SECTION 3.0 - DERRICK Sub-Section Item Findings Comments

Drawworks side a) Legs: OK Damaged Loose Bolts Other a)b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


Off Drawworks side a) Legs: OK Damaged Loose Bolts Other a)b) Girts: OK Damaged Loose Bolts Other b)c) Braces: OK Damaged Loose Bolts Other c)d) Splice connections/plates: OK Damaged Loose Bolts Other d)e) Bolts and nuts: OK Corroded Lock Nuts Other e)f) Access ladders: OK Damaged See Comment f)g) Platforms: OK Damaged See Comment g)h) Safety gates: OK Damaged See Comment h)i) Welds: OK Damaged See Comment i)j) Details of additional items: j)


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SECTION 4.0 - PEDESTALS, BASE PLATESSub-Section Item Findings Comments

4.1 Pedestals, Base Plates a) Condition: OK Damaged See Comment a)b) Anchor bolts: OK Damaged See Comment b)c) Welds: OK Damaged See Comment c)


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SECTION 5.0 - WORKING PLATFORMSSub-Section Item Findings Comments

5.1 Racking Board a) Support frames: OK Damaged See Comment a)b) Frame welds: OK Damaged See Comment b)c) Ladder access: OK Damaged See Comment c)d) Handrails: OK Damaged See Comment d)e) Working platform: OK Damaged See CommentX e)f) Landing platform: OK Damaged See Comment f)g) Pin holes: OK Damaged See Comment g)h) Pins: OK Damaged See Comment h)i) Fingers straight: OK Damaged See Comment i)j) Finger welds: OK Damaged See Comment j)k) Finger safety lines: OK Damaged See Comment k)l) Latches: OK Damaged See Comment l)m)Finger access platforms: OK Damaged See Comment m)n) Foundations of monkey board: OK Damaged See Comment n)o) Foundations of finger assemblies: OK Damaged See Comment o)p) Hoist mounting: OK Damaged See Comment p)


5.1.1 Derrickman's Escape a) System type: a) System b) Condition: OK Damaged See Comment b)(See Users Manual for c) Derrick attachment: OK Damaged See Comment c)specific inspection d) Cable: OK Damaged See Comment d)requirements) e) Device condition: OK Damaged See Comment e)

f) Anchor attachment: OK Damaged See Comment f)g) Last inspection: Date: Certificate Ref: g)


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SECTION 5.0 - WORKING PLATFORMSSub-Section Item Findings Comments

5.1.2 Details of Additional a) Automatic racking system: OK Damaged See Comment a) Racking Board b) Support frames: OK Damaged See Comment b) Equipment c) Windwalls: OK Damaged See Comment c)

d) Mule stands: OK Damaged See Comment d)e) Details of any other additional items: e)


5.2 Casing Stabbing Board Manufacturers serial no:Hoisting assembly: Type: Model:

(See Users Manual for a) Hoisting mounting: OK Damaged See Comment a)specific inspection b) Condition of wire: OK Damaged See Comment b)requirements) c) Support braces: OK Damaged See Comment c)

d) Access platform: OK Damaged See Comment d)e) Access ladder: OK Damaged See Comment e)f) Carriage assembly: OK Damaged See Comment f)g) Handrails: OK Damaged See Comment g)h) Track: OK Damaged See Comment h)i) Connection plate: OK Damaged See Comment i)j) Wheel assemblies: OK Damaged See Comment j)k) Lower travel stops: OK Damaged See Comment k)l) Pin or bolt holes: OK Damaged See Comment l)m)Pins or bolts: OK Damaged See Comment m)n) Safety pins/keepers: OK Damaged See Comment n)o) Welds: OK Damaged See Comment o)p) Last inspection: Date: Certificate Ref: p)


Sub-Section Item Findings Comments6.1 Ladders a) Vertical rails straight: OK Damaged See Comment a)

b) Rails in alignment: Yes No See Comment b)c) Ladders stand offs: OK Damaged See Comment c)d) Stand off connections: OK Damaged See Comment d)e) Rail welds: OK Damaged See Comment e)f) Rungs: OK Damaged See Comment f)g) Rung welds: OK Damaged See Comment g)

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h) Rung spacing: OK Damaged See Comment h)i) Access at rig floor: OK Damaged See Comment i)j) Cage: OK Damaged See Comment j)k) Toe clearance: OK Damaged See Comment k)


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SECTION 7.0 - TONG COUNTERWEIGHTSub-Section Item Findings Comments

7.1 Tong Counterweight a) Guides: OK Damaged See Comment a)b) Weight device: OK Damaged See Comment b)c) Sheaves: OK Damaged See Comment c)d) Wire lines: OK Damaged See Comment d)e) Cable clamps: OK Damaged See Comment e)f) Welds: OK Damaged See Comment f)


SECTION 8.0 - MISCELLANEOUS SHEAVE ASSEMBLIESSub-Section Item Findings Comments

8.1 Miscellaneous Sheave a) Clevis/shackle: OK Damaged See Comment a) Assemblies b) Derrick/padeye: OK Damaged See Comment b)

c) Sheaves: OK Damaged See Comment c)d) Bearings: OK Damaged See Comment d)e) Shafts: OK Damaged See Comment e)f) Sheave bolt: OK Damaged See Comment f)g) Side plate bolts: OK Damaged See Comment g)h) Bolt safety pins: OK Damaged See Comment h)i) Grease fittings: OK Damaged See Comment i)j) Safety line: OK Damaged See Comment j)


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SECTION 9.0 - ANCILLARY EQUIPMENTSub-Section Item Findings Comments

9.0 Ancillary Equipment

9.1 Mud Line Clamps a) Pipe clamps: OK Damaged See Comment a)b) Leg clamps: OK Damaged See Comment b)c) Welds: OK Damaged See Comment c)d) Bolts/nuts: OK Corroded Lock Nuts d)


9.2 Gas Vent Line Clamps a) Pipe clamps: OK Damaged See Comment a)b) Leg clamps: OK Damaged See Comment b)c) Welds: OK Damaged See Comment c)d) Bolts/nuts: OK Corroded Lock Nuts d)


9.3 Cement Line Clamps a) Pipe clamps: OK Damaged See Comment a)b) Leg clamps: OK Damaged See Comment b)c) Welds: OK Damaged See Comment c)d) Bolts/nuts: OK Corroded Lock Nuts d)


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9.4 Windwalls, Heat Shields, a) Frame condition: OK Damaged See Comment a) Frames & Attachments b) Frame welds: OK Damaged See Comment b)

c) Frame bolts/pins: OK Damaged See Comment c)d) Metal wall sections: OK Damaged See Comment d)


9.5 Top Drive Mounting a) Rail(s): OK Damaged See Comment a) System b) Padeyes: OK Damaged See Comment b)

c) Mounting brackets: OK Damaged See Comment c)d) Pins/bolts: OK Damaged See Comment d)e) Safety pins/keepers: OK Damaged See Comment e)f) Roller assemblies: OK Damaged See Comment f)g) Block dollies: OK Damaged See Comment g)h) Welds: OK Damaged See Comment h)


9.6 V-Door Rollers/Guides a) Rollers: OK Damaged See Comment a)b) Grease fittings: OK Damaged See Comment b)c) Welds: OK Damaged See Comment c)d) Bolts and nuts: OK Damaged See Comment d)e) Brackets: OK Damaged See Comment e)


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9.7 Climber Assist System Type/make:(See Users Manual for a) Cable: OK Damaged See Comment a)specific inspection b) Cable attachments: OK Damaged See Comment b)requirements) c) Counterweight: OK Damaged See Comment c)

d) Sheave/control descent device: OK Damaged See Comment d)Recommendations:(please quote item no.)

9.8 Fall Arrest System Type/make:(See Users Manual for a) Cable: OK Damaged See Comment a)specific inspection b) Cable attachments: OK Damaged See Comment b)requirements) c) Counterweight: OK Damaged See Comment c)

d) Sheave/control descent device: OK Damaged See Comment d)Recommendations:(please quote item no.)

SECTION 10.0 - PAINT/COATINGSub-Section Item Findings Comments

10.1 Paint/Coating a) Condition: OK Damaged See Comment a)b) Area/section in derrick (specify):


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SECTION 11.0 - BOLT INSPECTIONSub-Section Item Findings Comments

11.0 Bolt Inspection Guidance Note:

a) Stem bolt type: a)b) Accessory bolt type: b)c) Original torque procedure: c)d) % of bolts checked: d)e) % of loose bolts: e)f) Colour of applied identification marks: f)


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SUPPLEMENT SHEETNote: Supplement sheets may be used for recording any additional informationand be cross referenced to the relevant section/sub-section of the main report.

Section/Sub-Section No. Item No./Description Comments Recommendations

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