Chaparral Energy

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Previous Inspections

• Has the last quarterly audit been reviewed?

  Yes

  No

  N/A

• Is there outstanding action items?

  Yes

  No

  N/A

Bulletin Board Postings

• Is a copy of the emergency action plan posted?

  Yes

  No

  N/A

• Is a copy of authorized medical facilities posted?

  Yes

  No

  N/A

• Is a copy of the OSHA 300A posted from February 1st through April 30th?

  Yes

  No

  N/A

• Is a Safety Alert book available for reviewing?

  Yes

  No

  N/A

Personal Protective Equipment

• Are employees complying with Chaparral Energy PPE program for head, face, eye, hand and foot protection?

  Yes

  No

  N/A

• Is PPE readily available and in appropriate condition? 29 CFR 1910.132(a)

  Yes

  No

  N/A

• Have employees received appropriate training in the use, care and maintenance of PPE? 29 CFR 1910.132 (e) (1)

  Yes

  No

  N/A

• Does employees safety eyewear meet ANSI Z-87.1? 29 CFR 1910.133 (b)

  Yes

  No

  N/A

• Are all safety glasses with side shields used in conjunction with a full face shield during grinding, chipping or cutting operations? 29 CFR 1910.133 (b) (1)

  Yes

  No

  N/A

• Does employee safety footwear meet ANSI Z-41.1 steel toe requirements? 29 CFR 1910.136

  Yes

  No

  N/A

• Is hearing protection available for work areas that exceed 85 decibels? 29 CFR 1910.95

  Yes

  No

  N/A

• Are other PPE considerations such as protective gloves or shields provided to employees for protection against cuts, corrosive liquids and chemicals? 29 CFR 1910.132 ; 29 CFR 1910.138

  Yes

  No

  N/A

Lockout Tagout

• Are employees trained on energy control procedures? 29 CFR 1910.147 (c) (7) (I)(iii)

  Yes

  No

  N/A

• Are LOTO locks uniquely identifiable for the exclusive purposes of Lockout/Tagout? 29 CFR 1910.147 (c) (5) (ii)

  Yes

  No

  N/A

• Are LOTO devices used solely for the purpose of isolating energy sources during maintenance or servicing activities? 29 CFR 1910.147 (a) (1) (i)

  Yes

  No

  N/A

• Are energy isolation procedures developed for each machine? 29 CFR 1910.147 (d)

  Yes

  No

  N/A

Fire Prevention & Protection

• Are portable fire extinguishers provided, mounted and located within 50 feet of travel and identified so as to be easily accessible? 29 CFR 1910.157 (c) (1) (4) (d)

  Yes

  No

  N/A

• Are fire extinguishers and other suppression systems visually inspected monthly and documented? 29 CFR 1910. 157 (e) (2)

  Yes

  No

  N/A

• Are all fire extinguishers subjected to an annual maintenance inspection? 29 CFR 1910.157 (e) (3)

  Yes

  No

  N/A

• Are all employees aware of the Chaparral Energy "No Smoking" policy inside company facilities? Company Policy

  Yes

  No

  N/A

Life Safety Code

• Have all emergency exits for evacuation from the building been identified and properly posted with illuminated signage? NFPA 101.(7.5)

  Yes

  No

  N/A

• Are all designated emergency exits accessible and free from obstructions to allow all employees, including those with physical mobility impairments, to safely exit the building? NFPA 101 (7.5)

  Yes

  No

  N/A

• Do all designated emergency exit doors open in the direction of egress from the building? NFPA 101 (7.2.1)

  Yes

  No

  N/A

Flammable & Combustible Liquids

• Are flammables stored in approved containers such as flammable cabinets?

  Yes

  No

  N/A

• Are approved containers and tanks used for the storage and handling of flammable and combustible liquids? 29 CFR 1919.106 (d) (2)

  Yes

  No

  N/A

• Are all flammable and combustible liquids kept in closed containers when not in use? 29 CFR 1910.106 (a) (9)

  Yes

  No

  N/A

• Are bulk drums of flammable liquids grounded and bonded to containers during dispensing? 29 CFR 1910.106 (e) (6) (ii)

  Yes

  No

  N/A

• Are all spills of flammable and combustible liquids cleaned up promptly? Good Operating Practice

  Yes

  No

  N/A

Compressed Oxygen/Fuel Gas and Cylinders

• Are all cylinders legibly marked to clearly identify the contents of the cylinder? 29 CFR 1910.253 (b) (2) (ii)

  Yes

  No

  N/A

• Are fuel-gas cylinders separated by a distance of 20 feet from other highly combustible materials, or by fire resistant barriers or other means while in storage? 29 CFR 1910.253 (b) (2) (ii)

  Yes

  No

  N/A

• Are valve protector caps always placed on cylinders when the cylinders are not in use? 29 CFR 1910.253 (b) (2) (iv)

  Yes

  No

  N/A

• Are cylinders stored and secured in an upright position, and in a manner that prevents them from tipping, falling or rolling? 29 CFR 1910.253 (b) (2) (ii)

  Yes

  No

  N/A

• Are cylinders stored away from heat or other possible igintion sources? 29 CFR 1910.253 (b) (2) (i)

  Yes

  No

  N/A

• Are valve regulators closed before cylinders are moved or transported? 29 CFR 1910.253 (b) (5) (ii) (F)

  Yes

  No

  N/A

Machinery & Equipment Guarding

• Is all machinery and equipment clean and properly maintained? Good Operating Practice

  Yes

  No

  N/A

• Is there a shutoff switch within the reach of the operators position at each machine? 29 CFR 1910.212 (a) (1)

  Yes

  No

  N/A

• Are belts, pulleys, gears, shafts, rotational and moving parts adequately guarded? 29 CFR 1910.212 (a) (1)

  Yes

  No

  N/A

• Is all electrically powered machinery and equipment properly grounded? 29 CFR 1910.304 (f)

  Yes

  No

  N/A

• Are machines designed for a fixed location securely anchored to prevent walking or moving? 29 CFR 1910.212 (b)

  Yes

  No

  N/A

• Is sufficient clearance provided around and between machines to allow for safe operation, setup, servicing, material handling and waste removal? 29 CFR 1910.212 (a)

  Yes

  No

  N/A

• If the machine is equipped with manufacturer safeguards, are they functional and in proper working order? 29 CFR 1910.212 (a) (2)

  Yes

  No

  N/A

Bench & Portable Grinders

• Are bench and pedestal grinders permanently mounted? 29 CFR 1910.212 (b)

  Yes

  No

  N/A

• Are tool rests on bench/pedestal grinders adjusted to a maximum 1/8" from the grinding wheel? 29 CFR 1910.215 (a) (4)

  Yes

  No

  N/A

• Are tongue guards on bench/pedestal grinders adjusted not to exceed 1/4" from the grinding wheel? 29 CFR 1910.215 (b) (9)

  Yes

  No

  N/A

• Are safety glasses with side shields, or goggles, used in combination with a full face shield during grinding operations. 29 CFR 1910.133 (a)

  Yes

  No

  N/A

• Are portable angle grinders with wheels larger than 2" in diameter equipped with proper guards? 29 CFR 1910.243 (c)

  Yes

  No

  N/A

• Is the maximum RPM rating of each abrasive wheel compatible with the RPM rating of the grinder motor? 29 CFR 1910.215 (d) (1)

  Yes

  No

  N/A

Hoists & Cranes

• Have all operators received training on the specific type of crane and hoist equipment being used? Company Policy

  Yes

  No

  N/A

• Are all overhead and gantry cranes, hoists and jacks load rated? 29 CFR 1910.179 (b) (5) (k) (2)

  Yes

  No

  N/A

• Are the load ratings posted and clearly visible? 29 CFR 1910.179 (b) (5) (k) (2)

  Yes

  No

  N/A

• Are all overhead gantry cranes equipped with the following: stops, bumpers, brakes and guards? 29 CFR 1910.179 (e) & 29 CFR 1910.179 (f)

  Yes

  No

  N/A

Air Tanks & Recievers

• Is the air receiver equipped with a water drain valve? Is it located at the lowest point of the air receiver for removal of accumulated water? 29 CFR 1910.169 (b) (2)

  Yes

  No

  N/A

• Is the air receiver equipped with and indicating gauge and located as to be readily visible? 29 CFR 1910.169 (b) (3) (ii)

  Yes

  No

  N/A

Storage

• Are shelves and racks designed to support the weight of the materials being stored, and are they safeguarded to prevent objects from falling onto personnel?

  Yes

  No

  N/A

• Is appropriate housekeeping being maintained in all storage areas? 29 CFR 1910.175 (c)

  Yes

  No

  N/A

Work Areas, Walking and Working Surfaces

• Are handrails, covers and/or guardrails provided to protect personnel from hazards of open stairways, open sided floors, pits, tanks and vats? 29 CFR 1910.22 (c)

  Yes

  No

  N/A

• Are open sided floors, walkways or platforms more than 4 feet high provided with standard railings and toe boards? 29 CFR 1910.23 (c)

  Yes

  No

  N/A

• Is each flight of stairs with 4 or more risers equipped with standard stair handrails? 29 CFR 1910.23 (d) (1)

  Yes

  No

  N/A

• Are all walking surfaces and aisles kept dry and free from slip, trip and fall hazards? 29 CFR 1910.22

  Yes

  No

  N/A

• Are covered metal waste cans used for oily rag collection? 29 CFR 1910.106 (a) (9)

  Yes

  No

  N/A

Portable Ladders

• Are ladders maintained in good condition? 29 CFR 1910.25 (d) (1) & 29 CFR 1910.(c) (2)

  Yes

  No

  N/A

• Are ladders equipped with safety feet or auxiliary equipment to prevent the ladder from slipping? 29 CFR 1910.25 (d) (iv) (xix)

  Yes

  No

  N/A

Hand and Portable Power Tools and Equipment

• Are all power cords to electric tools equipped with the proper ground plug, or double insulated from protection of electric shock? 29 CFR 1910.243 (a) (5)

  Yes

  No

  N/A

Electrical

• Is an unobstructed minimum distance of 36 inches maintained in front of electrical panels, switches, circuit breakers, motor controllers and relays? 29 CFR 1910.303 (g) (1) (i)

  Yes

  No

  N/A

• Are all electrical switches/breakers/emergency disconnecting boxes labeled and legible to identify equipment they serve? 29 CFR 1910.303 (b)

  Yes

  No

  N/A

• Are all electrical disconnect/breaker boxes over 50 volts labeled for "High Voltage"? 29 CFR 1910.303

  Yes

  No

  N/A

• Are all electrical cords free of fraying and deteriorated insulation? 29 CFR 1910.305 (a) (2) (x)

  Yes

  No

  N/A

• Are electrical insulating rubber gloves inspected and tested every 6 months? 29 CFR 1910.137 (a) (1) (ii) (b) (2) (vii)

  Yes

  No

  N/A

Signage

• Are all posted signs legible and in good repair? 29 CFR 1910.145 (e) (2)

  Yes

  No

  N/A

• Are the appropriate signs posted for the identified hazards ( i.e. noise, high pressure, high voltage, etc)? 29 CFR 1910.145 (a)

  Yes

  No

  N/A

• Are signs posted in locations where they are highly visible and free from obstruction? 29 CFR 1910.145 (e)

  Yes

  No

  N/A

Medical Services

• Are first aid kits stocked in accordance with approved inventory? 29 CFR 1910.151 (b)

  Yes

  No

  N/A

• Are emergency eye wash stations clearly marked, in good repair, inspected monthly? 29 CFR 1910.151 (c)

  Yes

  No

  N/A

Hazard Communication

• Are all hazardous chemicals containers labeled (I.e. drums, portable containers)? Is 29 CFR 1910.1200 (f) (5)

  Yes

  No

  N/A

• Does each chemical have an MSDS sheet on file? Company Policy

  Yes

  No

  N/A

Welding Operations

• Is the welding area a safe distance away from potential flammables and combustibles? 29 CFR 1910.252 (a) (2)

  Yes

  No

  N/A

• Are protective barriers such as panels or curtains being used to protect employee exposure? 29 CFR 1910.252 (c)

  Yes

  No

  N/A

• Is appropriate PPE being used such as fire retardant clothing, welding gloves, welding hood?

  Yes

  No

  N/A

• Are spare and/ or empty oxygen and acetylene separated by a minimum of 25 feet, and are cylinders securely stored in an upright position to prevent them from falling? ANSI Z49.1 8

  Yes

  No

  N/A

• Notes

• Note Pictures

  Media

• Shop Representative

  Sign

• Safety Specialist

  Sign