Daily EHS Advisor Notes

• Note Title

• Conducted

  Date

• Client / Site

• Conducted

  Date

• Prepared by

• Personnel

• Location
  Address

• Date

  Date

RIG #1

• Incident?

  Safe

  At Risk

  N/A

• 1st STOP job

  Yes

  No

  N/A

• 2nd STOP Job

  Safe

  At Risk

  N/A

• Rig Activities

  Safe

  At Risk

  N/A

• EHS Activities

  Safe

  At Risk

  N/A

• Additional Notes

  Safe

  At Risk

  N/A

• Sketch Pad

  Drawing

Rig #2

• Incident Rig

  Safe

  At Risk

  N/A

• 1st STOP Job

  Safe

  At Risk

  N/A

• 2nd STOP Job

  Safe

  At Risk

  N/A

• Rig Activities

  Yes

  No

  N/A

• EHS Activities

  Safe

  At Risk

  N/A

• Additional Notes

  Safe

  At Risk

  N/A

• Sketch Pad

  Drawing

Rig #3

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Rig #4

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Rig #5

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Rig #6

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Rig #7

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Rig #8

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Rig #9

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Rig #10

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Conductor Rig #1

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Conductor Rig #2

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Conductor Rig #3

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

Notes

• Rig, Location, AFE

  Safe

  At Risk

  N/A

• Weather

  Safe

  At Risk

  N/A

• Road Conditions

  Safe

  At Risk

  N/A

• Location Condition i.e. muddy, uneven, dusty

  Safe

  At Risk

  N/A

• Operations Report

  Media

Corrective Actions

• Enter any corrective actions that will be undertaken

Sign Off

• On site representative

  Sign

• EHS Advisor signature

  Sign

• Add drawing

  Drawing