Chaparral Energy Contractor Field Audit_2017

• Contractor

• Lease/Location

• Field Office

• Date

  Date
• LAT/LONG
  Address

• Contractor Job Supervisor

• Chaparral employees on location

• What type of work is being done?

Emergency Response

• Are fire extinguishers operational and have proper tags? Are the tags dated and initialed?

  Yes

  No

  N/A

• Are the 1st Aid kits available and supplied correctly?

  Yes

  No

  N/A

H2S

• Are H2S monitors being worn?

  Yes

  No

  N/A

LOTO

• Is LOTO being utilized correctly? If N/A is selected, skip to the next category.

  Yes

  No

  N/A

• What type of energization does the LOTO address?

  Select Electrical Gravity Hydraulic Pneumatic Positional Springs Stored Energy Other N/A

  • Electrical
  • Gravity
  • Hydraulic
  • Pneumatic
  • Positional
  • Springs
  • Stored Energy
  • Other
  • N/A

• Are lock out devices suitable for use on what is being locked out?

  Yes

  No

  N/A

• Does tag/'s meet minimum requirements?

  Yes

  No

  N/A

Housekeeping

• Is the work area clean?

  Yes

  No

  N/A

• Are slip, trip, and fall issues addressed?

  Yes

  No

  N/A

• Are the environmental issues addressed?

  Yes

  No

  N/A

Electricity

• Are GFCI being utilized? i.e. pigtails, GFCI plug etc.

  Yes

  No

  N/A

• Extension Cords

  are good

  are frayed

  create another hazard

  are missing a GFCI

  are not being used

Fall Protection

• Are workers working at a height of 4ft or more? If not, select N/A and skip to the next category.

  Yes

  N/A

• If so, is the preferred method being utilized for the application?

  Yes

  No

  N/A

• Are workers working in a self-elevated work platform?

  Yes

  No

  N/A

• If so, are they properly restrained?

  Yes

  No

  N/A

Power Tools

• Are guards in place?

  Yes

  No

  N/A

• Are the cords free of damage?

  Yes

  No

  N/A

Hand tools

• Is the right tool for the job being used?

  Yes

  No

  N/A

• Overall are the tools in good condition?

  Yes

  No

  N/A

Hoses over 100psi

• Are they hobbled/restraint?

  Yes

  No

  N/A

Ladders

• Are they being used properly?

  Yes

  No

  N/A

• Is the worker maintaining 3 points of contact?

  Yes

  No

  N/A

• What is the condition of the ladders?

  Safe

  At Risk

  N/A

Mobile equipment

• Is the operator certified to operate the equipment?

  Yes

  No

  N/A

• Is the seat belt being used?

  Yes

  No

  N/A

• Is the equipment being operated in a safe manner?

  Yes

  No

  N/A

Excavations

• Are there excavation operations going on? If not, select N/A and skip to the next category.

  Yes

  N/A

• What method of protection is being utilized

  Shored

  Benched

  Shielded

  Sloped

  N/A

• Is there a competent person on site supervising?

  Yes

  No

  N/A

• Is the excavation properly marked and protected when not in use?

  Yes

  No

  N/A

• Are all encumbrances located as to not create another hazard?

  Yes

  No

  N/A

• Is there a one call ticket available? Hard copy is preferred but email or text will work also.

  Yes

  No

  N/A

• Is there a means of egress provided?

  Yes

  No

  N/A

Hot work

• Are there hot work operations going on? If not, select N/A and skip to the next category.

  Yes

  N/A

• Is there a fire watch present?

  Yes

  No

  N/A

• Is there a fire extinguisher set aside for that job only?

  Yes

  No

  N/A

• Is there a permit on site?

  Yes

  No

  N/A

Confined space

• Are there confined space operations going on? If not, select N/A and skip to the next category.

  Yes

  N/A

• Are the workers performing the job trained and qualified in confined space operations?

  Yes

  No

  N/A

• Is there a competent person on site supervising?

  Yes

  No

  N/A

• Is the appropriate equipment being utilized?

  Yes

  No

  N/A

• Is the permit posted at the entrance?

  Yes

  No

  N/A

• Is the permit filled out correctly with all pertinent information?

  Yes

  No

  N/A

PPE

• Is all appropriate PPE being worn? Hard hat, safety glasses, FRC when applicable, and steel/composite boots at a minimum.

  Yes

  No

  N/A

• Are all other PPE needs met?

  Yes

  No

  N/A

• Comments

• Date

  Date

• Name

  Sign