Form BSEE-0133 "Well Activity Report"

What Is Form BSEE-0133?

This is a legal form that was released by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement on March 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2018;
  • The latest available edition released by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BSEE-0133 by clicking the link below or browse more documents and templates provided by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement.

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Download Form BSEE-0133 "Well Activity Report"

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U.S. Department of the Interior
OMB control Number 1014-0018
Bureau of Safety and Environmental
Submit ORIGINAL
OMB Approval Expires 03/31/2021
Enforcement (BSEE)
WELL ACTIVITY REPORT
BEGINNING DATE:
ENDING DATE:
REPORT IS NOT TO EXCEED 7 DAYS (1 WEEK) IN DURATION
CORRECTION
CHECK IF THIS IS THE LAST WELL ACTIVITY REPORT
GENERAL INFORMATION
1. API WELL NO. (10 digits)
2. OPERATOR NAME
6. CONTACT NAME / CONTACT TELEPHONE NUMBER /
3. WELL NAME
4. SIDETRACK NO.
5. BYPASS NO.
CONTACT E-MAIL ADDRESS
7. RIG NAME OR PRIMARY UNIT
8. WATER DEPTH
9. ELEVATION AT KB
(e.g., wireline unit, coil tubing unit, etc.)
(surveyed) (ft)
(Surveyed) (ft)
10. CURRENT WELLBORE INFORMATION
SURFACE
BOTTOM
LEASE NO.
AREA NAME
BLOCK NO.
LEASE NO.
BLOCK NO.
START
KOP
MW
LAST BOP
LAST BOP TEST
END DATE
MD
TVD
WELLBORE
TD DATE
DATE
(MD)
PPG
TEST DATE
PRESSURE
LOW
HIGH
11. WELLBORE HISTORICAL INFORMATION
WELLBORE
BOTTOM LEASE
START DATE
TD DATE
PA DATE
FINAL MD
FINAL TVD
BSEE
Form BSEE-0133
Page 1 of 3
(March/2018 - Supersedes all previous versions of this form which may not be used.)
U.S. Department of the Interior
OMB control Number 1014-0018
Bureau of Safety and Environmental
Submit ORIGINAL
OMB Approval Expires 03/31/2021
Enforcement (BSEE)
WELL ACTIVITY REPORT
BEGINNING DATE:
ENDING DATE:
REPORT IS NOT TO EXCEED 7 DAYS (1 WEEK) IN DURATION
CORRECTION
CHECK IF THIS IS THE LAST WELL ACTIVITY REPORT
GENERAL INFORMATION
1. API WELL NO. (10 digits)
2. OPERATOR NAME
6. CONTACT NAME / CONTACT TELEPHONE NUMBER /
3. WELL NAME
4. SIDETRACK NO.
5. BYPASS NO.
CONTACT E-MAIL ADDRESS
7. RIG NAME OR PRIMARY UNIT
8. WATER DEPTH
9. ELEVATION AT KB
(e.g., wireline unit, coil tubing unit, etc.)
(surveyed) (ft)
(Surveyed) (ft)
10. CURRENT WELLBORE INFORMATION
SURFACE
BOTTOM
LEASE NO.
AREA NAME
BLOCK NO.
LEASE NO.
BLOCK NO.
START
KOP
MW
LAST BOP
LAST BOP TEST
END DATE
MD
TVD
WELLBORE
TD DATE
DATE
(MD)
PPG
TEST DATE
PRESSURE
LOW
HIGH
11. WELLBORE HISTORICAL INFORMATION
WELLBORE
BOTTOM LEASE
START DATE
TD DATE
PA DATE
FINAL MD
FINAL TVD
BSEE
Form BSEE-0133
Page 1 of 3
(March/2018 - Supersedes all previous versions of this form which may not be used.)
WELL ACTIVITY REPORT
12. CASING / LINER / TUBING RECORD
HOLE
TEST
SHOE
SETTING DEPTH (MD)
TUBULAR
SIZE
CEMENT QUANTITY
SIZE
WEIGHT (#/ft)
GRADE
PRESSURE
TEST
TYPE
(IN)
(cubic ft.)
(IN)
(psi)
(EMW)
TOP
BOTTOM
13. WELL ACTIVITY SUMMARY
Provide a daily summary of well activities.
14. Open Hole Log Data
BSEE's Technical Data Management Section requires an Open Hole Well Report (Form BSEE-0133S) to accompany this Well
Activity Report if any of the below conditions have occurred for this wellbore during this period:
None of the following have occurred:
Wireline logs (Report when acquired)
Wireline Directionals (Report when acquired)
Velocity Surveys, VSP's, Conventional Cores, Rotary and Percussion Sidewall Cores (Report when acquired)
Completed MWD/LWD logs and Mudlogs - (Report when they are completed.)
PVT, Paleontological and Geochemical Samples acquired for analysis (Report at completion of Borehole)
Any of the above have occurred; if checked then submit Form BSEE-0133S.
15. Significant Well Events
Please check as many events from the list below:
Kick Occurrence
Well Control Equipment Failure
Shallow Water Flow
H
S Encounter
2
Weather and Oceanographic Conditions
New Technology Failure
General Rig Equipment Failure
Stuck Pipe
Lost Returns
Wellbore Integrity Failure
Station Keeping Failure
Other
BSEE
Form BSEE-0133
Page 2 of 3
(March/2018 - Supersedes all previous versions of this form which may not be used.)
WELL ACTIVITY REPORT
Please provide narrative information with regards to any significant events. Provide attachments, if necessary.
CERTIFICATION: I certify that the information submitted is complete and accurate to the best of my knowledge. I understand that
making a false statement may subject me to criminal penalties under 18 U.S.C. 1001.
Name and Title: ___________________________________________________ Date: __________________________
PAPERWORK REDUCTION ACT OF 1995 (PRA) STATEMENT:
The PRA (44 U.S.C. 3501 et seq. ) requires us to inform you that we
collect this information to obtain knowledge of equipment and procedures to be used in drilling operations. BSEE uses the information to evaluate and
approve or disapprove the adequacy of the equipment and/or procedures to safely perform the proposed drilling operations. Responses are mandatory
(43 U.S.C. 1334). Proprietary data are covered under 30 CFR 250.197. An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for Forms BSEE-0133 and
BSEE-0133S is approximately 1 hour per form per response. This includes the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection
Clearance Officer, Bureau of Safety and Environmental Enforcement, 45600 Woodland Road, Sterling, VA 20166.
BSEE
Form BSEE-0133
Page 3 of 3
(March/2018 - Supersedes all previous versions of this form which may not be used.)
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