Compliance Audit Form

• Document No.

• Compliance Audit

• Operator / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

RIG LOCATION

• Authorized sign posted 1910.145(c)(2)(I), RP54 7.1.2-3

  Yes

  No

  N/A

• Hard Hat / Safety Glasses Sign Posted 1910.145(c)(3)

  Yes

  No

  N/A

• Smoking area posted 1910.145(c)(2)(I), RP54 7.1.2-3

  Yes

  No

  N/A

• No parking within 100' from the rig 1910.145(c)(2)(I), 1910.1000(e), 1910.1200(f)(5-6), RP54 7.1.2-3

  Safe

  At Risk

  N/A

• Evacuation alarm made available and working properly 1910.38(d)

  Safe

  At Risk

  N/A

• H2s monitoring devices in use, if applicable 1910.1000(e), RP55 3.3

  Safe

  At Risk

  N/A

• Emergency escape air packs and life lines available, if applicable 1910.134(d)(2)(I), RP55 3.3, RP55 3.9

  Yes

  No

  N/A

• Emergency escape air packs fully charged RP55 3.3

  Safe

  At Risk

  N/A

• Outhouse in close proximity and made for all personal on location 1910.141(c)(1)(I)

  Yes

  No

  N/A

• Outhouse cleaned and sanitary 1910.142(d)(10)

  Safe

  At Risk

  N/A

• Hard hats & Safety glasses available for visitors 1910.132(a)

  Yes

  No

  N/A

• Rig managers trailer grounded properly RP54 6.1.16

  Safe

  At Risk

  N/A

• Rig mangers trailer safely positioned on location RP54 6.1.16

  Safe

  At Risk

  N/A

• Rigs location have proper housekeeping 1910.22(a)(1), RP54 6.5.1

  Yes

  No

  N/A

• Distance from overhead power lines GT 10' RP54 10.1.1

  Safe

  At Risk

  N/A

• Muster area designated and posted 1910.38(c)(4)

  Safe

  At Risk

  N/A

• Visitors tracking system

  Yes

  No

  N/A

• Warning signs clean and visible 1910.1200(f)(9)

  Safe

  At Risk

  N/A

• All vessels labeled as to their contents 1910.1200(f)(4-5)

  Safe

  At Risk

  N/A

• Supply connex cleaned 1910.22(a)(1), RP54 6.5.1

  Safe

  At Risk

  N/A

• Change house cleaned 1910.22(a)(1), RP54 6.5.1

  Yes

  No

  N/A

• Wind sock available and in good condition RP55 4.5

  Safe

  At Risk

  N/A

• Hazardous locations identified 1910.1200(f)(5-6)

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

TRAINING, PPE & GENERAL SAFETY

• Certification cards available RP54 4.3.1

  Yes

  No

  N/A

• B.O.P training provided RP54 6.4.4

  Yes

  No

  N/A

• H2s training provided, if applicable RP55 2.5-7

  Yes

  No

  N/A

• First Aid training provided RP54 4.3.1

  Yes

  No

  N/A

• Pre-tour safety meeting properly documented RP54 6.1.7

  Yes

  No

  N/A

• Pre-job safety meetings held and documented RP54 6.1.7

  Yes

  No

  N/A

• Accidents, if any discussed during per-tour safety meetings RP 6.1.7

  Yes

  No

  N/A

• OSHA poster posted at change house 1902.2(a)(1)

  Yes

  No

  N/A

• Safety equipment made available to employees on location 1910.132(a)

  Yes

  No

  N/A

• Hard hat used by employees ( Hardhat, Harness) 1910.135(a)(1-2)

  Safe

  At Risk

  N/A

• Employees wearing steel toed boots with heals 1910.136(a), RP54 5.2.3

  Safe

  At Risk

  N/A

• Employees long hair contained RP54 5.2.8

  Safe

  At Risk

  N/A

• No jewelry to be worn by employees 1910.32(a), RP54 5.2.7

  Safe

  At Risk

  N/A

• Safety glasses worn by employees 1910.133 (a)(1-5)

  Safe

  At Risk

  N/A

• Employees wearing proper FR clothing. Not loose or worn 1910.132(a), RP54 5.2.5-6

  Safe

  At Risk

  N/A

• Hearing protection provided to employees 1910.95(a), RP54 5.3.1-2

  Yes

  No

  N/A

• Fall protection used, when required RP54 5.5.1

  Safe

  At Risk

  N/A

• No smoking rules observed RP54 7.1.3

  Safe

  At Risk

  N/A

• First aid kit / Bloodborne Pathogen Kit available on site

  Yes

  No

  N/A

• Emergency numbers posted RP 4.2.1, RP 4.6

  Yes

  No

  N/A

• Emergency response plan posted 1910.38(b), RP55 4.1-10

  Yes

  No

  N/A

• HazCom program documents on location 1910.1200(e)(1-5)

  Yes

  No

  N/A

• MSDS or DSD available and accessible 1910.1200(g)(1)

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

MUD PUMP AREA

• Drive belts guarded properly RP54 6.8.2-3

  Safe

  At Risk

  N/A

• Pony rods properly guarded RP54 6.8.2-3

  Safe

  At Risk

  N/A

• Shear pin pop off valve covered properly 1910.169(b)(3)(i-iv)

  Safe

  At Risk

  N/A

• Mud pump area clean and organized 1910.22(a)(1), RP54 6.5.1

  Safe

  At Risk

  N/A

• Ends of relief lines secured

  Safe

  At Risk

  N/A

• Ends of mud vibrator hose secured

  Safe

  At Risk

  N/A

• Pressure relief valves in good condition 1910.169(b)(3)(i-iv)

  Safe

  At Risk

  N/A

• Adequate approved lighting provided 1910,307(b)(1)

  Safe

  At Risk

  N/A

• Discharge lines from relief valves anchored properly

  Safe

  At Risk

  N/A

• Fire extinguisher charged and inspected1910.157(c)(4)

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

MUD MIXING AREA

• Bagged material stacked properly 1910.176(b)

  Yes

  No

  N/A

• Adequate personal protective equipment available. Rubber gloves, Face shield, Apron. 1910.132(a), RP54 6.13.2

  Safe

  At Risk

  N/A

• Personal respirators properly covered and stored away 1910.132(a), RP54 6.13.2

  Safe

  At Risk

  N/A

• Eye wash station available in close proximity 1910.151(c)

  Safe

  At Risk

  N/A

• Eye wash station in working order 1910.151(c)

  Safe

  At Risk

  N/A

• Eye wash station in clean and sanitary condition 1910.141(d)(1)

  Safe

  At Risk

  N/A

• Approved and adequate lighting around mixing location 1910.307(b)(1)

  Yes

  No

  N/A

• General housekeeping of mixing area 1910.22(a)(1), RP54 6.5.1

  Safe

  At Risk

  N/A

• Pump room cleaned with no food or drinks 1910.176(b)

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

MUD TANKS & PITS

• Guardrails installed on all raised platforms, walkway, etc above 48" 1910.23(c)(1), 1910.23(d)(1)

  Safe

  At Risk

  N/A

• Walkways free from obstruction and/or damaged 1910.23(c)(1)

  Safe

  At Risk

  N/A

• Adequate stairs with handrails 1910.24(h), 1910.23(d)(1)

  Safe

  At Risk

  N/A

• Adequate walkways and guardrails 1910.23(c)(1)

  Safe

  At Risk

  N/A

• Guardrails provided on crossovers 1910.23(c)(1)

  Safe

  At Risk

  N/A

• "Eye protection required" warning signs erected 1910.145(c)(3)

  Yes

  No

  N/A

• Shale shaker properly guarded 1910.23(c)(3)

  Safe

  At Risk

  N/A

• Explosion proof equipment used in the vicinity of the shale shaker 1910.307(b)(1-3)& subsections 1910.307(c)

  Safe

  At Risk

  N/A

• Agitator shafts & couplings properly guarded 1910.212(a)(1)

  Safe

  At Risk

  N/A

• Approved lighting for the location installed 1910.307(b)(1)

  Safe

  At Risk

  N/A

• Stairways and handrails secured RP54 9.3.8

  Safe

  At Risk

  N/A

• General housekeeping of the area 1910.22(a)(1), RP54 6.5.1

  Safe

  At Risk

  N/A

• All unused floor holes covered on pits 1910.23(a)(8), 1910,23(a)(9)

  Yes

  No

  N/A

• Electric wiring in good condition 1910.303(b)(1-2), 1910.303(c)

  Yes

  No

  N/A

• Fire Extinguishers tagged and charged 1910.157(c)(4)

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

GENERATOR AREA

• Generators properly grounded RP54 9.14.2

  Safe

  At Risk

  N/A

• Moving parts properly guarded 1910.212(a)(1)

  Safe

  At Risk

  N/A

• Electrical panels and control box closed and labeled properly 1910.305(b)(2)

  Safe

  At Risk

  N/A

• Electrical panels and control boxes labeled for their function 1910.303(f)

  Safe

  At Risk

  N/A

• Non-conductive matting at VFD & MCC 1910.335(a)(2)(ii)

  Safe

  At Risk

  N/A

• Condition of electrical wiring 1910.303(b)(1-2)

  Safe

  At Risk

  N/A

• Electrical wiring properly strung 1910.305(a)(2)(iii), RP54 10.2.3

  Safe

  At Risk

  N/A

• Unused electrical outlets covered 1910.305(b)(1-3)

  Safe

  At Risk

  N/A

• Air compressor properly guarded 1910.169(a)(1)

  Safe

  At Risk

  N/A

• Air storage tank equipped with pop-off valve 1910.169(b)(3)(i-iv)

  Safe

  At Risk

  N/A

• LO/TO/TO devices available RP54 6.9.1

  Yes

  No

  N/A

• Hearing protection signs posted 1910.95(b)(1)

  Yes

  No

  N/A

• Hearing protection available for employees 1910.95(a)

  Yes

  No

  N/A

• Approved lighting at generator area 1910.307(b)(1), RP54 9.14.10

  Safe

  At Risk

  N/A

• All light fixtures properly protected 1910.307(b)(1-2)

  Safe

  At Risk

  N/A

• Receptacles and plugs in good condition 1910.303(b)(1)

  Safe

  At Risk

  N/A

• Adequate lighting installed 1910.303(h)(3)(ii), RP54 9.14.7

  Yes

  No

  N/A

• General housekeeping of the area RP54 6.5.1

  Safe

  At Risk

  N/A

• Wires not running along the ground 1910.303(a)(1)(iii)(g)

  Safe

  At Risk

  N/A

• Wires not spliced 1910.305(g)(2)(ii), RP54 10.2.4

  Safe

  At Risk

  N/A

• Fire Extinguishers tagged and charged 1910.157(c)(4)

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

FUEL STORAGE TANKS

• Discharge nozzle in good condition 1910.106(b)

  Safe

  At Risk

  N/A

• Discharge hoses in good condition 1910.106(b)

  Safe

  At Risk

  N/A

• Discharge valve in good condition 1910.106(b)

  Safe

  At Risk

  N/A

• Piping and fueling lines in good condition 1910.106(b)

  Safe

  At Risk

  N/A

• Stationary ladders in good condition 1910.27(f)

  Safe

  At Risk

  N/A

• Adequate and approved lighting provided 1910.307(b)(1)

  Safe

  At Risk

  N/A

• Fuel tanks properly labeled 1910.1200(f)(4-5), RP54 8.4.1d

  Safe

  At Risk

  N/A

• General housekeeping 1910.22(a)(1), RP54 6.5.1

  Safe

  At Risk

  N/A

• Fuel tank grounded properly RP54 9.14.2

  Safe

  At Risk

  N/A

• Fire Extinguisher tagged and charged 1910.157(c)(4)

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

PIPE RACK AREA

• Ends of pipe racks properly chocked 1910.176(b), RP54 9.12.3

  Safe

  At Risk

  N/A

• Spacers used to separate the layers of pipe 1910.176(b)

  Safe

  At Risk

  N/A

• Layers of pipe properly chocked 1910.176(b), RP54 9.12.3

  Safe

  At Risk

  N/A

• Pipe racks on level ground

  Yes

  No

  N/A

• Pipe wrangler grading in good condition

  Safe

  At Risk

  N/A

• Pipe wranglers stairs and handrails in good condition

  Safe

  At Risk

  N/A

• Adequate and approved lighting provided at general area 1910.307(b)(1)

  Safe

  At Risk

  N/A

• General housekeeping 1910.176(c), RP54 6.5.1

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

BLOW-OUT PREVENTERS / SUBSTRUCTURE

• B.O.P. properly installed RP54 6.4.1

  Safe

  At Risk

  N/A

• All unused hydraulic lines capped and secured RP54 6.4.18

  Safe

  At Risk

  N/A

• All hydraulic lines connected properly and with whip checks installed RP54 6.4.18

  Safe

  At Risk

  N/A

• Hydraulic lines off the B.O.P. protected RP54 6.4.2

  Safe

  At Risk

  N/A

• Accumulator valves in appropriate position, open or closed RP54 6.4.18

  Yes

  No

  N/A

• Choke manifold in line and properly secured RP54 6.4.18

  Safe

  At Risk

  N/A

• Adequate and approved light at sub area 1910.307(b)(1)

  Safe

  At Risk

  N/A

• Ditches cleared and running to the sump RP54 6.4.2

  Yes

  No

  N/A

• Sub structure assembly pins properly in place RP54 9.2.8

  Safe

  At Risk

  N/A

• Assembly pin secured with keepers RP54 9.2.8

  Safe

  At Risk

  N/A

• Cracks, metal fatigue or wear evident at hinge points RP54 9.2.4

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

DERRICK / RIG FLOOR

• Fire extinguishers tagged and charged 1910.157(c)(4)

  Safe

  At Risk

  N/A

• Condition of the Derrick ladder RP54 9.3.1-2

  Safe

  At Risk

  N/A

• Climb assist device available 1910.27(b)(5)

  Safe

  At Risk

  N/A

• Climb assist in good condition 1910.27(b)(5)

  Safe

  At Risk

  N/A

• Derrick and tubbing boards in good condition RP54 9.2.17

  Safe

  At Risk

  N/A

• Guardrails installed on derrick board RP54 9.3.17, RP54 5.5.1

  Safe

  At Risk

  N/A

• Pipe fingers in good condition RP54 9.2.17

  Safe

  At Risk

  N/A

• Derrick emergency line installed RP54 6.10.1

  Yes

  No

  N/A

• Data plates installed on derrick that provide information RP54 9.2.2

  Yes

  No

  N/A

• Racking floor in good condition

  Safe

  At Risk

  N/A

• V-Door gate in good condition 1910.23(c)(1)

  Safe

  At Risk

  N/A

• Winch lines in good condition RP9B 3.2.7

  Safe

  At Risk

  N/A

• Winch-lines properly spooled RP9B 3.2.7

  Safe

  At Risk

  N/A

• Headache post in good condition and secured properly RP54 9.5.8

  Safe

  At Risk

  N/A

• Adequate and approved lighting provided 1910.303.(h)(3)(ii)

  Safe

  At Risk

  N/A

• General housekeeping 1910.22(a)(1)

  Safe

  At Risk

  N/A

• First Aid kit available and properly stocked 1910.151(b)

  Safe

  At Risk

  N/A

• Handrails with toe boards secured and installed 1910.23(c)(1), RP54 9.3.17

  Yes

  No

  N/A

• Manuel tongs in good condition RP54 9.9.6

  Safe

  At Risk

  N/A

• Tongs snub lines in good condition RP54 9.9.6

  Safe

  At Risk

  N/A

• Tong snub line clams in good condition RP54 9.9.6

  Safe

  At Risk

  N/A

• Tong body and jaws in good condition RP54 9.9.7

  Safe

  At Risk

  N/A

• Tong safety handle pins secured RP54 9.9.7

  Safe

  At Risk

  N/A

• Tong die pin keeper used RP54 9.9.7

  Safe

  At Risk

  N/A

• Tools properly stored and in good condition RP54 6.8.6

  Safe

  At Risk

  N/A

• Links in good condition RP54 9.7.1

  Safe

  At Risk

  N/A

• Elevators in good condition RP54 9.7.1-8

  Safe

  At Risk

  N/A

• Stairway on rig floor pined and in good condition 1910.36(b)(1)

  Safe

  At Risk

  N/A

• Non-skid type stair treads 1910.24(f)

  Safe

  At Risk

  N/A

• Stair tread not damaged 1910.24(f)

  Safe

  At Risk

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

• Misc.

  Yes

  No

  N/A

RIG MANAGERS / H.S.E. REPRESENTATIVE SIGNATURES

• Rig Manager On Duty :

  Sign

• H.S.E. Field Rep. :

  Sign