Cement Bond Log Safety Audit

• Audit Title

• Pad

• CHK Rep

• Location
  Address

• Conducted on

  Date

• Prepared by

• Contractors Onsite

EHS POLICY 101: HAZCOM

• SDS'S available and accessible at all times

  Safe

  At Risk

  N/A

• All containers in work area properly labeled with NFPA or HMIS labels

  Safe

  At Risk

  N/A

EHS POLICY 102: PPE

• FRC clothing worn properly by crew, buttoned, zipped and sleeves down

  Safe

  At Risk

  N/A

• Hard hats used by crew

  Safe

  At Risk

  N/A

• Safety glasses with side shields used by crew

  Safe

  At Risk

  N/A

• Hard toed shoes used by crew

  Safe

  At Risk

  N/A

• Hazardous jewelry not worn by crew

  Safe

  At Risk

  N/A

• Hand protection used when necessary

  Yes

  No

  N/A

• Personal gas monitor worn by at least one member of each crew

  Safe

  At Risk

  N/A

• Long hair contained

  Safe

  At Risk

  N/A

• Proper PPE worn while handling chemicals, based on SDS/HMIS

  Safe

  At Risk

  N/A

EHS POLICY 104: HEARING PROTECTION

• High noise areas present and marked

  Safe

  At Risk

  N/A

• Proper hearing protection available

  Safe

  At Risk

  N/A

EHS POLICY 105: LOTO

• LOTO being used

  Safe

  At Risk

  N/A

• Locks and tags available to crew

  Safe

  At Risk

  N/A

EHS POLICY 106: HOT WORK MANAGEMENT

• Smoking or open flames not permitted within 35' where compressed gasses are used or stored

  Safe

  At Risk

  N/A

• Hot work Qualified Individual onsite

  Yes

  No

  N/A

• Hot Work Permit available and completed prior to commencing hot work

  Safe

  At Risk

  N/A

• No smoking rules observed

  Safe

  At Risk

  N/A

EHS POLICY 109: FIRST AID AND CARDIOPULMONARY RESUSCITATION

• First aid training provided

  Safe

  At Risk

  N/A

• First aid supplies available onsite

  Safe

  At Risk

  N/A

• Adequate 2-way radio or cell phone communication available

  Safe

  At Risk

  N/A

• Emergency phone numbers posted

  Safe

  At Risk

  N/A

• Provisions made for known workers with allergies

  Safe

  At Risk

  N/A

• Provisions made for prompt medical attention

  Safe

  At Risk

  N/A

EHS POLICY 110: H2S

• H2S Training provided

  Safe

  At Risk

  N/A

• Certification cards available

  Safe

  At Risk

  N/A

• Onsite H2S safety review conducted

  Safe

  At Risk

  N/A

• H2S training drills conducted

  Safe

  At Risk

  N/A

• Hazard specific safety meeting conducted when H2S or SO2 present

  Safe

  At Risk

  N/A

EHS POLICY 111: CHEMICAL, FLAMMABLE AND COMBUSTIBLE LIQUIDS/MATERIALS

• Flammable liquids not stored within 50' of the wellbore

  Safe

  At Risk

  N/A

• When not in use, flammable sand combustibles are stored in designed area or cabinets

  Safe

  At Risk

  N/A

• All containers are grounded and bonded, conforming to manufacturers specification when dispensing flammable or combustable liquids

  Yes

  No

  N/A

EHS POLICY 112: HEAT AND COLD STRESS

• All workers taking procautions for heat or cold

  Safe

  At Risk

  N/A

• Heat stress and cold stress training provided

  Safe

  At Risk

  N/A

EHS POLICY 113: FIRE PROTECTION

• Fire extinguisher available in company trailer, vehicles and work areas

  Safe

  At Risk

  N/A

• Annual Inspection tags present

  Yes

  No

  N/A

• Monthly inspection tags on each extinguisher

  Safe

  At Risk

  N/A

EHS POLICY 114: ELECTRICAL SAFETY

• Electrical equipment 600V or greater labeled and HIGH VOLTAGE

  Safe

  At Risk

  N/A

• Work clearance of 36" maintained in front of electrical equipment

  Safe

  At Risk

  N/A

• Fixed equipment and portable equipment connected by cord grounded

  Yes

  No

  N/A

• Only 3 wire cords in good condition used onsite

  Safe

  At Risk

  N/A

• No cords running through doorways or windows

  Safe

  At Risk

  N/A

EHS POLICY 115: POWERED INDUSTRIAL TRUCKS (Forklifts and Telehandlers)

• Forklift operators certified and certificate available

  Safe

  At Risk

  N/A

• Seatbelt provided (per manufacturer)

  Safe

  At Risk

  N/A

• Backup alarm working

  Safe

  At Risk

  N/A

• Auxiliary lighting working

  Safe

  At Risk

  N/A

• Horn working

  Safe

  At Risk

  N/A

• Rated lifting capacity posted

  Safe

  At Risk

  N/A

• Pre-use inspection checklist completed

  Safe

  At Risk

  N/A

• Tires in good condition

  Safe

  At Risk

  N/A

• Refueling and hydraulic lines checked with engine off

  Yes

  No

  N/A

• No damage to windows or mirrors

  Safe

  At Risk

  N/A

• Loads moved low to the ground

  Safe

  At Risk

  N/A

• Parked with brake on, key removed and forks grounded

  Safe

  At Risk

  N/A

EHS POLICY 116: HOISTING AND LIFTING EQUIPMENT

• Workers operating hoisting and lifting equipment properly trained

  Safe

  At Risk

  N/A

• Monthly hoisting machinery inspection record available

  Safe

  At Risk

  N/A

• Pre use inspection checklist completed

  Safe

  At Risk

  N/A

• Straps and slings have been inspected and are in proper working condition

  Safe

  At Risk

  N/A

EHS POLICY 118: LIFTING AND CARRYING SAFETY

• Proper lifting and carrying techniques being used

  Safe

  At Risk

  N/A

EHS POLICY 119: WALKING AND WORKING SURFACES

• Well cellar is protected by floor gate

  Safe

  At Risk

  N/A

• Access walkway must have guard rails at least 42" above the platform and have intermediate mid-rail and toe-board

  Safe

  At Risk

  N/A

• Fall arrest system must be utilized when working above 4' on an unguarded surface

  Safe

  At Risk

  N/A

• Anchorage used for fall arrest system must be capable of supporting at least 5000lbs

  Safe

  At Risk

  N/A

• All walking and working surfaces are be clear of debris and trip hazards have been identified

  Safe

  At Risk

  N/A

EHS POLICY 120: LADDER SAFETY

• No wooden ladders allowed onsite

  Safe

  At Risk

  N/A

• Metal ladders must have warning label for electrical caution

  Safe

  At Risk

  N/A

• Ends or feet of ladder must be fitted with insulated non-slip material

  Safe

  At Risk

  N/A

• Extension ladders must extend 3' past the landing if used to access another working surface and be secured

  Safe

  At Risk

  N/A

• 3 points of contact utilized by workers while on ladder

  Safe

  At Risk

  N/A

• Fixed ladders and cellar ladders are inspected and in good condition, inspections are noted on an annual inspections checklist

  Safe

  At Risk

  N/A

• Portable ladders inspected monthly and noted on monthly ladder inspection checklist

  Safe

  At Risk

  N/A

EHS POLICY 121: BLOOD BORNE PATHOGENS EXPOSURE CONTROL

• Blood borne pathogen kit available on site

  Safe

  At Risk

  N/A

• Blood borne pathogen exposure training complete

  Safe

  At Risk

  N/A

EHS POLICY 122: PRE JOB SAFETY ASSESSMENT

• Pre PJSA safety tour of site conducted

  Safe

  At Risk

  N/A

• Daily safety meeting being conducted

  Safe

  At Risk

  N/A

• Accidents, if any, are discussed during safety meetings

  Safe

  At Risk

  N/A

• Safety meeting is properly documented

  Yes

  No

  N/A

• PJSA filled out properly and completely

  Safe

  At Risk

  N/A

• Individual contractors conducting JSA to identify task-specific hazards

  Safe

  At Risk

  N/A

GENERAL

• Proper incident reporting procedure known and utilized when neccessary

  Safe

  At Risk

  N/A

• Stop Work Authority in use

  Safe

  At Risk

  N/A

• Adequate communication between contractors onsite

  Safe

  At Risk

  N/A

• Emergency response plan understood

  Safe

  At Risk

  N/A

• Smoke point identified outside of gate

  Yes

  No

  N/A

CEMENT BOND LOG

• Tubing hanger and bottom master valve installed per BMP

  Safe

  At Risk

  N/A

• Production tree valves installed per BMP

  Safe

  At Risk

  N/A

• Frac valve installed per BMP

  Safe

  At Risk

  N/A

• CBL run under static pressure

  Safe

  At Risk

  N/A

• Secondary run under pressure as authorized by the Completions Consultant

  Safe

  At Risk

  N/A

CASING PRESSURE TEST

• Pressure test the secondary casing head seal

  Safe

  At Risk

  N/A

• Production casing, tubing hanger, and bottom master valve tested to 9500 PSI for a minimum of 15 minutes

  Safe

  At Risk

  N/A

• Test witnessed by CHK Rep

  Safe

  At Risk

  N/A

• Test to be charted with a Barton Test Chart, signed and dated by the wellhead test pump operator and CHK Rep

  Safe

  At Risk

  N/A

WIRELINE SERVICES

• Wireline units, vehicles, portable houses placed outside the guy-wires of well service unit

  Safe

  At Risk

  N/A

• Mobile, portable or skid-mounted wireline service units chocked or secured to prevent movement

  Safe

  At Risk

  N/A

• Lower wireline sheave secured

  Safe

  At Risk

  N/A

• Splices not used in the entire length of wire

  Safe

  At Risk

  N/A

ADDITIONAL COMMENTS

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