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Report Forms

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Please note that some of these forms can be electronically submitted. In a future website update, each form will have a denotation indicating whether it can be electronically submitted or not.

If you need to fill out a PDF, click here for instructions.

Form Number

Form Type

  - Form 1   Application for Permit to Conduct Seismic Exploration
  - Form 2   Seismic Exploration Completion Report
  - Form 3   Application for Permit to Drill (APD)
  - Form   APD Checklist
  - Form   Request to Transfer Application or Permit to Drill (APD)
  Well Bonds (Individual and/or Blanket)
 - Form 4A   Surety Bond
 - Form 4B.1   Certificate of Deposit
 - Form 4B.2   Utah State Treasurer's Cash Account
 - Form 4B.3   Irrevocable Letter of Credit
 - Form 4B.4   Request for Bond Release
  Facility Bonds
 - Form 4C   Surety Bond
 - Form 4D.1   Certificate of Deposit
 - Form 4D.2   Utah State Treasurer's Cash Account
 - Form 4D.3   Irrevocable Letter of Credit
  Request for Bond Release
 - Bond Release Form   Request for Bond Release
  Surface Owner Protection Act Bonds
 - Form 4S.1   Certificate of Deposit
 - Form 4S.2   Utah State Treasurer's Cash Account
 - Form 5   Designation of Agent or Operator
 - Form 6   Entity Action Form
 - Form 7   Report of Water Encountered During Drilling
 - Form 8   Well Completion or Recompletion Report and Log
 - Form 9   Sundry Notices and Reports on Wells
 - Form 10   Monthly Oil and Gas Production Report
 - Form 11   Monthly Oil and Gas Disposition Report
 - Form 12   Report of Transferred Oil
 - Form 13A   Summary of Gas Processing Plant Operations
 - Form 13B   Gas Processing Plant Product Allocations
 - Form 14   Monthly Report of Waste Crude Oil Treatment Facility Operations
 - Form 15   Designation of Workover or Recompletion
 - Form 15 Procedures   Designation of Workover or Recompletion -- Procedures For Submitting Application
  UIC Forms
 - UIC Form 1   Application for Injection Well
 - UIC Form 2 (part 1)   Monthly Report of Enhanced Recovery Project
 - UIC Form 2 (part 2)   Monthly Report of Enhanced Recovery Project
 - UIC Form 3   Monthly Injection Report
 - UIC Form 4   Annual Fluid Injection Report
 - UIC Form 5   Transfer of Authority to Inject
 - UIC Form 6   Injection Well - Pressure Test
 - Incident Report eForm   Incident Report Electronic Web Form        (Click here for reporting Guidelines)
 - ePermit Registration   ePermit Registration Form (for electronic permit & report submittal) This registration form may now be submitted by email to rachelmedina@utah.gov. Please follow up with notarized paper form.
 - Waste Facilty Report   E & P Waste Facility Quarterly Report