A1 Rocket Supervisor Evaluation

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name of Supervisor/Operator of the crew:

• Supervision leads crews in Tailgate meeting.

  Yes

  No

  N/A

• Covers all applicable safety risks that are not covered in SOP in JSA. e.g Covid, Working under air, heat, etc.

  Yes

  No

  N/A

• Supervision ensures all equipment in good repair and certifications in place.

  Yes

  No

  N/A

• Validates key items are in place with any 3rd party crews that may affect A1 crews (e.g. air trailer, others)

  Yes

  No

  N/A

• Remains engaged with crew to ensure communication is consistent

  Yes

  No

  N/A

• Ensures signage and rescue equipment is staged and ready for deployment.

  Yes

  No

  N/A

• Details on Confined Space Permit are accurate and have all applicable details as required by program.

  Yes

  No

  N/A

Equipment and Paperwork

• SDS sheets on site

  Yes

  No

  N/A

• Workers have appropriate training and credentials been verified on site and/or at the office

  Yes

  No

  N/A

• JSA's been completed and signed

  Yes

  No

  N/A

• Confined Space Permits been signed by all workers

  Yes

  No

  N/A

• If appropriate, reclassification paperwork been completed

  Yes

  No

  N/A

• Signage posted on site

  Yes

  No

  N/A

• Operator's 4 Gas Monitor has been bump tested

  Yes

  No

  N/A

• Operator's 4 Gas Monitor has been calibrated and on what date

  Yes

  No

  N/A

• Are we working under supplied air

  Yes

  No

  N/A

• Will we be utilizing LOTO

  Yes

  No

  N/A

Procedure

• Upon arrival on location Operator filled out all paperwork. JSA / Confined Space Permits

  Yes

  No

  N/A

• Perform Tailgate Meeting

  Yes

  No

  N/A

• Checked if tanks were isolated or in production

  Yes

  No

  N/A

• Removed all manifolds and opened back hatches

  Yes

  No

  N/A

• Safely examine inside all tanks and took pictures of any tanks that have abnormal amounts of water, sludge, oil, or sand

  Media

• Used 4-way gas monitor to check each tank and filled out a confined space permit for each tank

  Yes

  No

  N/A

• One entry one hole watch and one confined space supervisor

  Yes

  No

  N/A

• Entrant wearing harness and tagline & supplied air

  Yes

  No

  N/A

• Squeegeed all solids out first from front shelf to back hatch

  Yes

  No

  N/A

• Inserted hydrovac hose in manway hatch to begin removing solids

  Yes

  No

  N/A

• Power washed bottoms, manifold lines, jet lines, and front shelf

  Yes

  No

  N/A

• Removed all water from tank with squeegee

  Yes

  No

  N/A

• Cleaned up all trash on jobsite after shift was complete

  Yes

  No

  N/A

• Reported any spills or incidents to dispatch immediately

• ** Displayed safe driving on and off leases**

  Yes

  No

  N/A