Clean and Drift Field Evaluation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Evaluation Items

• Are all vehicles parked with consideration of first move forward policy?

  Yes

  No

  N/A

• Is the parking break set on all vehicles?

  Yes

  No

  N/A

• Are there any leaks from vehicles or equipment?

  Yes

  No

  N/A

• Is there a spill kit available?<br>

  Yes

  No

  N/A

• Are wheel chocks being used?

  Yes

  No

  N/A

• Where safety belts used?

  Yes

  No

  N/A

• Where any of the vehicles speeding?

  Yes

  No

  N/A

• Is plastic laid properly to collect all liquids?

  Yes

  No

  N/A

• Is pipe being cleaned in accordance with customer requirements?

  Yes

  No

  N/A

• Is pipe being inspected in accordance with customer requirements?

  Yes

  No

  N/A

• Are thread protectors being piled neatly in an area designated by the customer?

  Yes

  No

  N/A

• Is the drift snake being controlled in such a manner to reduce unnecessary movement?

  Yes

  No

  N/A

• Are pipe chalks being used appropriately to prevent pipe from rolling?

  Yes

  No

  N/A

• Is pipe being rolled controllably from the end?

  Yes

  No

  N/A

• Are any Noble Casing, Inc employees on the racks?

  Yes

  No

  N/A

• Is the 30' buffer zone around the loader being enforced?

  Yes

  No

  N/A

JSA

• Was a JSA safety meeting held prior to Rig Up?

  Yes

  No

  N/A

• Was a JSA safety meeting held prior to running?

  Yes

  No

  N/A

• Was a JSA safety meeting held prior to rigging down?

  Yes

  No

  N/A

• Are all signature sheets accounted for?

  Yes

  No

  N/A

• Are changes made and documented for job specific conditions?

  Yes

  No

  N/A

• Any adverse challenges (weather, mud, extreme temperature, etc.) identified and communicated in the JSA process?

  Yes

  No

  N/A

PPE

• Are minimum PPE (hard hat, safety glasses, steel toed boots and FRC's) being properly utilized?

  Yes

  No

  N/A

• Is all PPE in a serviceable condition?

  Yes

  No

  N/A

Behavioral Based Safety

• Are there any signs of the following: Rushing, Frustration, Fatigue, Complacency

  Yes

  No

  N/A

• Are there any signs of the following: Mind Not On Task, Eyes Not On Task, Balance/Traction/Grip Issues, Line Of Fire

  Yes

  No

  N/A

• What is the crews overall attitude?

  Yes

  No

  N/A

Crew Pusher/Supervisor

• Crew Pusher/Supervisor inspected the rig and 3rd party equipment for unsafe conditions?

  Yes

  No

  N/A

• Crew Pusher/Supervisor ensured that all equipment is rigged up correctly?

  Yes

  No

  N/A

• Crew Pusher/Supervisor ensured that all personnel are aware of all proper procedures and are utilizing them?

  Yes

  No

  N/A

• Crew Pusher/Supervisor ensured that all personnel worked safely?

  Yes

  No

  N/A

Loader

• Loader has been inspected and any defects were brought to the attention to the company man?

  Yes

  No

  N/A

• Loader was function tested prior to moving tubulars?

  Yes

  No

  N/A

• Is the loader operator wearing a seat belt while operating the loader?

  Yes

  No

  N/A

• Are all personnel aware of proper hand signals?

  Yes

  No

  N/A

• Has the loader operator participated in loader safety training?

  Yes

  No

  N/A

Hot Work

• Will hot work be performed? (Torch)

  Yes

  No

  N/A

• Was a hot work permit obtained from the customer representative?

  Yes

  No

  N/A

• Has a designated fire watch been assigned for both sides of the casing?

  Yes

  No

  N/A

Noble Casing, Inc

• Are there any SSE/SPE employees present? If 'yes' please place number in comments.

  Yes

  No

  N/A

• Are any Noble Casing, Inc employees smoking outside of the designated smoking area?

  Yes

  No

  N/A

• Are any Noble Casing, Inc employees operating 3rd party equipment? If 'yes' please identify in comments.

  Yes

  No

  N/A

• Are any Noble Casing, Inc employees utilizing a cell phone while working?

  Yes

  No

  N/A

• By signing this I hereby certify that I conducted this Casing Field Evaluation and that all information is true and correct

  Sign