Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Employee #1 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Employee #2 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Employee #3 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Employee #4 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Employee #5 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Record of Driving Evaluation
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Enter Drivers Name
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Did the driver complete a pre trip inspection in accordance with DOT regulations?
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Did the driver properly hook onto the trailer?
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Did the driver utilize chocks on both truck and trailer whenever stopped?
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Did the driver keep smooth control of vehicle at all times?
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Did the driver utilize a spotter when backing trailer?
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Was the driver consistently alert and attentive?
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Did the driver maintain proper speed?
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Did the driver look back and utilize mirrors?
Truck Checklist - Please Note: Item must be serviceable in order to receive a 'Pass' score.
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Tool Box
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Wrench Set (3/8" to 1 1/4")
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1/2" Socket Set
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Allen Wrench Set
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Screw Driver Set
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Vise GripSet
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Plier Set
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2 - 12" Crescent Wrenches
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Hack Saw
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3lb Small Sledge
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Grease Gun
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Grease
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Thread Tape
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Cat Line (Rope)
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Sash Cord
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Shackle Assortment
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Wire Brush
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Paint Brushes
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File Set
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Punch Set
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Electrical Tape
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2 - 18" Pipe Wrenches
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2 - Spare Tong Fittings
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Ratcheting Boomers
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Tong Line
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Snub Line
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Pickup Sling
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Stabbing Harness
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Lanyard
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Stabbing Belly Pad
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6' Weight Box Chain
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Seat Covers
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Floor Mats
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JSA Book
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Registration
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Insurance
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Fire Extinguisher
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MSDS Book
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Spare Tong Hoses
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First Aid Kit
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Crash Kit
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Power Unit Hoses
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Tire Chains
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Diesel 911
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Break Clean
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PB Blaster
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Antifreeze
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Starting Fluid
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Spare Tong Dies
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Stabbing Board
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Triangles
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Sala Block
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AVIR
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Jumper Cables
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Spare Fuses
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Cotter Pin Assortment
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R - Pin Assortment
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Flash Light
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Door Stickers
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Unit Number
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DOT Number
Pre-Job
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Did all personnel sign in when they arrived on location?
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Was a JSA completed prior to rig up of equipment?
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Was a JSA completed prior to beginning job?
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Are all JSA signature sheets accounted for?
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Have changes/additions been made to the JSA's to accommodate for job specific conditions?
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Are there any unusual challenges present? (weather, mud, extreme temperatures, down hole problems, etc)
Personnel
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Are all personnel utilizing required PPE?
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Is all PPE in good repair? (clean, minimal tears/rips, etc)
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Please select the number of SSE Employees on the Casing Crew.
Crew Pusher
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Did the crew pusher hold a pre-job safety meeting and ensure that all lines of communication are properly established?
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Crew Pusher inspected the rig and equipment for unsafe conditions?
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Crew Pusher ensured that all equipment is rigged up properly?
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Crew Pusher ensured that all Noble Casing, Inc personnel and rig personnel used proper procedures?
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Crew Pusher ensured that the crew worked safely?
Tong Operator
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The Tong Operator rigged up the tongs correctly?
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The Tong Operator inspected and function tested the tongs prior to starting job?
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The Tong Operator ensured that the snub line is properly sized, properly angled and secured correctly?
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Does the Tong Operator watch the Stabber during make up of joints?
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Does the Tong Operator correctly make up the shoe and float?
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Does the Tong Operator ensure the centralizes are run correctly?
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Does the Tong Operator manage the crew effectively on the floor?
Stabber (if utilized)
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Did the Stabber inspect all fall protection equipment?
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Did the Stabber correctly rig up fall protection?
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Is the Stabber properly utilizing the SRL (safety restraint lanyard)?
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Is the Stabber practicing 100% tie off?
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Did the Stabber inspect the stabbing board?
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Does the Stabber practice good communication with the driller?
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Did the Stabber discuss proper hand signals with the driller?
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Is the Stabber practicing good hand placement?
Floor Hand/Backup Hand
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Does the Floor Hand ensure the correct amount of pipe dope is used at each connection?
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Does the Floor Hand inspect the pin and box for damage?
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Does the Floor Hand ensure proper placement of hands when working back-up tongs?
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Does the Floor Hand ensure proper hand placement while boxing or setting n casing?
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Does the Floor Hand box the pipe before the Stabber is ready?
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Does the Floor Hand watch the Stabber to ensure the elevator is latched before disengaging the slips?
V-Door Operator
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Is the pick up line correctly wrapped on each joint?
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Does the V-Door Operator ensure body extremities are kept away from the PU/LD machine sheave, hat, pole, trough, etc.?
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Does the V-Door Operator ensure proper body placement by not turning back to the V-Door?
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Does the V-Door Operator ensure proper body placement by not placing body in path of incoming casing?
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Has the V-Door rope been properly inspected, installed and used?
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Is the V-Door Operator aware of tongs and snub line?
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Is the V-Door Operator wearing a reflective vest and is it clean and does it fit well?
Vehicles/Power Units
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Are all vehicles parked in such a position as to follow Noble Casing, Inc's first move forward policy?
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Is the parking break set on all vehicles?
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Are wheel chocks being utilized on all vehicles?
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Are all areas around vehicle(s) clear of litter/garbage?
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If observed, were any of the vehicles speeding?
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If observed, were all vehicle occupants wearing seat belts?
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Are there any obvious defects with vehicles? (flat tires, dents, scrapes, etc. If yes, please document type of defect, note vehicle or asset number, and photograph damage)
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Are there any leaks from any vehicle or power unit?
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Is there a spill kit available for all vehicles and power units?
Power Tongs
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Is there a safety cable on the tong spring?
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Are there any leaks on the tongs or connections?
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Are the tong dies in good condition?
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Are replacement tong dies available?
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Are hydraulic hoses properly tied off?
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Are hoses adequately run/placed to minimize tripping hazard for V-door operator and other personnel?
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Is the door valve functioning properly?
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Is the appropriate torque gauge installed and functioning properly?
Electric Stabbing Board
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Was the electric stabbing board function tested prior to being placed in the derrick?
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Are the cords properly secured?
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Do the lines on the stabbing board present any hazards during board movement?
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Are all safety devices installed and functioning properly?
Air Slips
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Are the hoses hooked up properly?
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Have the hoses been run to minimize tripping hazards?
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Is the safety lever/latch being used?
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Is the regulator/water separator working/drained?
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Are dies/cavins in good condition?
Large Body Tools/Fill Tool/SJE
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After latching/in latching large body tools (350 ton tools) 1" tool bar is removed?
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Have air lines been properly inspected?
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Have air lines been run in such a way as to mitigate tripping hazards to the floor hand and Stabber?
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Are the mud lines run properly?
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Have the mud tools been properly inspected?
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Are all safety cables in place?
Behavior Based Safety
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Is there any indication of Rushing, Frustration, Fatigue or Complacency?
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Is there any indication of Mind Not On Task, Eyes Not On Task, Line Of Fire or Loss Of Balance, Traction or Grip?
Post Job
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Was a JSA completed prior to rigging down equipment?
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I certify that I completed this field evaluation and that all items are true and correct to the best of my knowledge.
