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.
