ChecklistWell Integrity Test

Field

Well Number

Rig

Workover Number

Task to be performed

Well Type

Single or dual completion

Gaslift tree or side outlet

Well Services Handover ReportNo. Component Designed Pressure & Duration Actual Pressure & Duration Conclusion

1 Plug set test Pressure & Duration Pressure & Duration Pass / Fail / N/A

2 Downhole safety device test(SSSV, storm choke, etc.) Pressure & Duration Pressure & Duration Pass / Fail / N/A

3 Sliding side door test Pressure & Duration Pressure & Duration Pass / Fail / N/A

4 Sidepocket mandrels test Pressure & Duration Pressure & Duration Pass / Fail / N/A

5 Water shut off device test Pressure & Duration Pressure & Duration Pass / Fail / N/A

6 Tubing test Pressure & Duration Pressure & Duration Pass / Fail / N/A

7 Tubing hanger test Pressure & Duration Pressure & Duration Pass / Fail / N/A

8 Xmas tree interface test Pressure & Duration Pressure & Duration Pass / Fail / N/A

9 Production casing tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

10 Liner lap tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

11 B annulus tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

12 C annulus tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

13 A annular outlet valves tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

14 B annular outlet valves tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

15 C annular outlet valves tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

16 LMGV Pressure & Duration Pressure & Duration Pass / Fail / N/A

17 UMGV Pressure & Duration Pressure & Duration Pass / Fail / N/A

18 FWV Pressure & Duration Pressure & Duration Pass / Fail / N/A

19 KWV Pressure & Duration Pressure & Duration Pass / Fail / N/A

20 SWAB Pressure & Duration Pressure & Duration Pass / Fail / N/A

21 Tubing material loss verified(calliper) %age wall thickness lost %age wall thickness lost Pass / Fail / N/A

22 Casing material loss verified(calliper) %age wall thickness lost %age wall thickness lost Pass / Fail / N/A

23 Annular safety device tested Pressure & Duration Pressure & Duration Pass / Fail / N/A

Well Services ConclusionNo. Investigation Conclusion

1 Is original integrity issue(s) still evident? Yes / No

2 Have any other integrity issues been identified? Yes / No

Comments

Sign offWork Completed by

Date Completed

Supervisor Name

ApprovalConclusions reviewed and approved by

Date

Approved