Information
Daily Field HSSE Report
TES-MS-1030
Daily Field HSSE Report
Document Number: TES-MS-1030
Revision Level: 1.0
Release Date: 03/08/2013
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Customer Location
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Date (mm/dd/yyyy)
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Arrival Time (24 hours)
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Departure Time (24 Hours)
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Name
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Field Supervisor
INSPECTION ITEM
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Control cabin interior
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Fire truck fueled / clean
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Site Access unobstructed
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Data cable runs protected
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Trip hazards clearly marked
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Appropriate signage installed
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Dual handrails firmly installed
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Whip-checks and restraints
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Noise, vehicles, dust and facial hair issues are compliant
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Spot checked chemical(s) MSDS available and up to date
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All containers labeled
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Equipment physical appearance (rust, paint etc.)
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Safecard Counts
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All JSEA's signed
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Frac Pumps stands extendable
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Exclusion Zone
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Shower trailer function test (daily)
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Potable water chlorine test (monthly)
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PPE condition and storage
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Correct PPE observe
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All wheels chocked
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All liners in place / sides upright
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Respiratory protection / facial hair
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Lock Out / Tag Out Box
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Fall Protection inspected
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Controlled work instructions on site
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Chemical Transport manifest on site and signed by driver
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Delivery notes on site and signed by the driver and the receiver
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Incident recorded and reported
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NPT has been recorded and reported
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Calibration Devices (PRV's, torque)
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Extinguishers placed
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Hose color coding correct
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PPE stock level
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Lifting equipment inspected and register up to date
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Hot fueling vent hoses in place and directed to temporary containment
INCIDENTS:
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Did an incident occur?
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If yes, Has PIN been submitted? <br>Note: DO NOT SUBMIT PIN FOR UNSHADED AREAS BELOW
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Category* (check all that apply)
- FA
- MT
- LTA
- NM
- PROP / VEH
- HIPO
- SCE
- SPILL >1gal
- SPILL <1 gal [No PIN]
- NPT >60 min [No PIN]
- EQUIP [No PIN]
- HR [No PIN]
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Provide details of NPT > 30 minutes
STATISTICS
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Item
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Safe Cards:
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Incidents:
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Spills / Leaks:
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Recordable Injuries:
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First Aid incidents:
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JSEA's:
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Vehicle Incidents:
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Comments
Weather delay (what)
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Weather delay (what)
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Start Time
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End Time
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Total
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Comment
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SAFECARD Action Issue [Review safecards, note any action for Base to communicate / take action. At least one action per week (or as arises) should be noted or best SOC
SAFECARD Action Issue
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SAFECARD Action Issue
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Comments:
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Weekly SOP Audit
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Date
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Procedure #
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Result (S=Satisfactory, NI = Needs Improvement)
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Audit Result Comment:
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Other Issues / Suggestions / NCR's:
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*Codes: FA=First Aid MT=Medical Treatment LTA=Lost Time Accident NM=Near Miss Prop/Veh = Property or Vehicle Damage HIPO = Hi Potential SCE = Safety Critical Equipment NPT = Non-productive Time EQUIP = Equipment failure PIN = Preliminary Incident Notification HR = Compliance Issue / labour Relations (use HSSE Violation Form)