Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Employee #1 Information

  • Enter employees name and position

  • Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)

  • Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)

  • Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)

Employee #2 Information

  • Enter employees name and position

  • Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)

  • Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)

  • Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)

Employee #3 Information

  • Enter employees name and position

  • Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)

  • Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)

  • Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)

Employee #4 Information

  • Enter employees name and position

  • Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)

  • Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)

  • Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)

Employee #5 Information

  • Enter employees name and position

  • Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)

  • Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)

  • Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)

Employee #6 Information

  • Enter employees name and position

  • Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)

  • Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)

  • Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)

Record of Driving Evaluation

  • Enter Drivers Name

  • Did the driver complete a pre trip inspection in accordance with DOT regulations?

  • Did the driver properly hook onto the trailer?

  • Did the driver utilize chocks on both truck and trailer whenever stopped?

  • Did the driver keep smooth control of vehicle at all times?

  • Did the driver utilize a spotter when backing trailer?

  • Was the driver consistently alert and attentive?

  • Did the driver maintain proper speed?

  • Did the driver look back and utilize mirrors?

Truck Checklist - Please Note: Item must be serviceable in order to receive a 'Pass' score.

  • Tool Box

  • Wrench Set (3/8" to 1 1/4")

  • 1/2" Socket Set

  • Allen Wrench Set

  • Screw Driver Set

  • Vise Grip Set

  • Plier Set

  • 2 - 12" Crescent Wrenches

  • Hack Saw

  • 3lb Small Sledge

  • Grease Gun

  • Thread Tape

  • Grease

  • Cat Line (Rope)

  • Sash Cord

  • Shackle Assortment

  • Wire Brush

  • Paint Brushes

  • File Set

  • Punch Set

  • Electrical Tape

  • 2 - 18" Pipe Wrenches

  • Spare Tong Fittings x2

  • 2 - 15' Chains

  • Ratcheting Boomers

  • Tong Line

  • Snub Line

  • Pickup Sling

  • Stabbing Harness

  • Lanyard

  • Stabbing Belly Pad

  • 6' Weight Box Chain

  • Seat Covers

  • Floor Mats

  • JSA Book

  • Registration

  • Insurance

  • Fire Extinguisher

  • MSDS Book

  • Spare Tong Hoses

  • First Aid Kit

  • Crash Kit

  • Power Unit Hoses

  • Tire Chains

  • Diesel 911

  • Break Clean

  • PB Blaster

  • Antifreeze

  • Starting Fluid

  • Spare Tong Dies

  • Stabbing Board

  • Triangles

  • Sala Block

  • AVIR

  • Jumper Cables

  • Spare Fuses

  • Cotter Pin Assortment

  • R-Pin Assortment

  • Flash Light

  • Door Stickers

  • Unit Number

  • DOT Number

Pre-Job

  • Did all personnel sign in when they arrived on location?

  • Was a JSA completed prior to rig up of equipment?

  • Was a JSA completed prior to beginning job?

  • Are all JSA signature sheets accounted for?

  • Have changes/additions been made to the JSA's to accommodate for job specific conditions?

Personnel

  • Are all personnel utilizing required PPE?

  • Is all PPE in good repair? (clean, minimal tears/rips, etc)

  • Please select the number of SSE Employees on the Casing Crew.

Crew Pusher

  • Did the crew pusher hold a pre-job safety meeting and ensure that all lines of communication are properly established?

  • Crew Pusher inspected the rig and equipment for unsafe conditions?

  • Crew Pusher ensured that all equipment is rigged up properly?

  • Crew Pusher ensured that all Noble Casing, Inc personnel and rig personnel used proper procedures?

  • Crew Pusher ensured that the crew worked safely?

Tong Operator

  • The Tong Operator rigged up the tongs correctly?

  • The Tong Operator inspected and function tested the tongs prior to starting job?

  • The Tong Operator ensured that the snub line is properly sized, properly angled and secured correctly?

  • Does the Tong Operator watch the Stabber during make up of joints?

  • Does the Tong Operator correctly make up the shoe and float?

  • Does the Tong Operator ensure the centralizes are run correctly?

  • Does the Tong Operator manage the crew effectively on the floor?

Stabber (if utilized)

  • Did the Stabber inspect all fall protection equipment?

  • Did the Stabber correctly rig up fall protection?

  • Is the Stabber properly utilizing the SRL (safety restraint lanyard)?

  • Is the Stabber practicing 100% tie off?

  • Did the Stabber inspect the stabbing board?

  • Did the Stabber discuss proper hand signals with the driller?

  • Is the Stabber practicing good hand placement?

  • Does the Stabber practice good communication with the driller?

Floor Hand/Backup Hand

  • Does the Floor Hand ensure the correct amount of pipe dope is used at each connection?

  • Does the Floor Hand inspect the pin and box for damage?

  • Does the Floor Hand ensure proper placement of hands when working back-up tongs?

  • Does the Floor Hand ensure proper hand placement while boxing or setting casing?

  • Does the Floor Hand wait until the Stabber is ready to box the casing?

  • Does the Floor Hand watch the Stabber to ensure the elevator is latched before disengaging the slips?

V-Door Operator

  • Is the pick up line correctly wrapped on each joint?

  • Does the V-Door Operator ensure body extremities are kept away from the PU/LD machine sheave, hat, pole, trough, etc.?

  • Does the V-Door Operator ensure proper body placement by not turning back to the V-Door?

  • Does the V-Door Operator ensure proper body placement by not placing body in path of incoming casing?

  • Has the V-Door rope been properly inspected, installed and used?

  • Is the V-Door Operator aware of tongs and snub line?

  • Is the V-Door Operator wearing a reflective vest and is it clean and does it fit well?

Vehicles/Power Units

  • Are all vehicles parked in such a position as to follow Noble Casing, Inc's first move forward policy?

  • Is the parking break set on all vehicles?

  • Are wheel chocks being utilized on all vehicles?

  • Are all areas around vehicle(s) clear of litter/garbage?

  • If observed, were any of the vehicles speeding?

  • If observed, were all vehicle occupants wearing seat belts?

  • 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)

  • Are vehicles and power units free from leaks?

  • Is there a spill kit available for all vehicles and power units?

Power Tongs

  • Are there any leaks on the tongs or connections?

  • Are the tong dies in good condition?

  • Are replacement tong dies available?

  • Are hydraulic hoses properly tied off?

  • Are hoses adequately run/placed to minimize tripping hazard for V-door operator and other personnel?

  • Is the door valve functioning properly?

  • Is the appropriate torque gauge installed and functioning properly?

Electric Stabbing Board

  • Was the electric stabbing board function tested prior to being placed in the derrick?

  • Are the cords properly secured?

  • Do the lines on the stabbing board present any hazards during board movement?

  • Are all safety devices installed and functioning properly?

Air Slips

  • Are the hoses hooked up properly?

  • Have the hoses been run to minimize tripping hazards?

  • Is the safety lever/latch being used?

  • Is the regulator/water separator working/drained?

  • Are dies/cavins in good condition?

Large Body Tools/Fill Tool/SJE

  • After latching/in latching large body tools (350 ton tools) 1" tool bar is removed?

  • Have air lines been properly inspected?

  • Have air lines been run in such a way as to mitigate tripping hazards to the floor hand and Stabber?

  • Are the mud lines run properly?

  • Have the mud tools been properly inspected?

  • Are all safety cables in place?

Behavior Based Safety

  • Are employees free of any indication of Rushing, Frustration, Fatigue or Complacency?

  • Are employees free of any indication of Mind Not On Task, Eyes Not On Task, Line Of Fire or Loss Of Balance, Traction or Grip?

Post Job

  • Was a JSA completed prior to rigging down equipment?

  • I certify that I completed this field evaluation and that all items are true and correct to the best of my knowledge.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.