• Service Rig Company and Rig #

  • Conducted on

  • Prepared by

  • Location
  • Chaparral Energy Personnel on Location

  • Rig Operator


  • Is the rig adequate distance from overhead power lines?

  • Are flammable liquid stored in the proper containers?

  • Is the service rig hazard sign displayed?

  • Is a first aid kit available on the rig location?

  • Are the service rig guy wires flagged?

  • Is the fall lane of the derrick clear?

  • Is the overall housekeeping on the service rig satisfactory?

  • Are pipe racks and catwalks satisfactory?

  • Are fire hazards controlled?

  • Is the latitude and longitude board displayed on the service rig? Is it updated with current well location coordinates?

  • Pictures:


  • Are the condition of the guy lines acceptable?

  • Is the diameter of the guy line correct per manufacturers recommendations?

  • Is there a minimum of three wire rope clamps on all guy wires including the tubing guy wires?

  • Are the ground anchors in good condition and pull tested to 18,600 lbs. Is there a tag attached to the ground anchors?

  • Are the tubing board guys strung and crossed for racking?

  • Are the internal guys adjusted for tension?

  • Pictures:

Mast & Derrick

  • Is the manufacturers specifications plate on the Mast/Derrick?

  • Is the mast/derrick free of excess corrosion and damage?

  • Ladder condition?

  • Racking platform condition?

  • Rod basket condition?

  • Crows nest condition?

  • Manual latch dog extension and retraction mechanism condition?

  • Latch dog condition?

  • Scoping ram stabilizer condition?

  • Crown sheave guards condition?

  • Are the hinge points free of signs of metal failure such as cracks?

  • Is the finger board safety cable operational?

  • Are the derrick locking pins in place?

  • Are hinge point dowel pins provided with a safety retainer?

  • Is the hydraulic system free of leaks?

  • Lighting system condition?

  • Pictures:


  • Are handrails in place on elevated walkways and steps?

  • Are the wheels chocked?

  • Are the fuel tanks labeled?

  • Is the carrier free of leaking fuel?

  • Are the hydraulic leveling jacks secured by mechanical lock nuts?

  • Pictures:


  • Machine guarding.

  • Tubing line and sandline condition? Look for any kinking or crushing on the wire rope.

  • Is there sufficient wraps left on the drum with the blocks in the down position,

  • Dead line anchor condition?

  • Road gear lockout condition?

  • Handling winch condition?

  • Pictures:

Operator Station/Work Platform/Floor

  • Are all operator controls labeled?

  • Is the work floor free of hazards? i.e slip, trip and fall etc.

  • Pictures:

Tools and Equipment

  • Tong safety gate condition?

  • Backup tongs condition?

  • Stiff arm and snub line condition?

  • Head guard condition?

  • Are the hoses and fittings securely connected and free of defects?

  • Traveling blocks in good condition?

  • Sheave guard condition?

  • Are the bales/links free of defects?

  • Elevator condition?

  • Rod hook condition?

  • Transfer elevator condition?

  • Weights/Wire Rope/Winch Line/Attachments

  • Pipe rack condition?

  • Are the walkways free of tripping hazards?

  • Are the BOP's installed, tested and functional?

  • Is the standpipe secure on the mud circulating system?

  • Safety pressure relief valve condition?

  • Is there high pressure fittings in the high pressure system?

  • Is the discharge line from the relief valves anchored?

  • Mud mixing area condition?

  • Is the rotary hose secured to the gooseneck and swivel with safety hobbles?

  • Pictures:

Safety Equipment

  • Is there a safety harness and restraint lanyard provided at the tubing board, rod basket and stabbing board?

  • Derrick ladder climbing device condition?

  • Is there an emergency derrick escape equipment on the service rig or nearby? Is it operational and easily accessible?

  • Date rig crew conducted rig rescue training.

  • If the crew has not conducted training within the last 12 months, what is their plan to meet this requirement?

  • Is there 2 - 20 lb Class A, B, C Extinguishers on the service rig? Are they charged and free of defects?

  • Is appropriate PPE being worn by all personnel?

  • Pictures:

SRL Information

  • SRL condition?

  • Harness Information; model #, lot # etc.

  • Pictures:

  • Comments and/or anything not covered needs to go here.

  • Pictures:

  • Date:

  • Signature

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.