Daily Field HSSE Report

• Daily Field HSSE Report

• TES-MS-1030

• Customer Location

• Date (mm/dd/yy)

  Date

• Arrival Time (24 hours)

  Date

• Departure Time (24 Hours)

  Date

• Name

• Field Supervisor

INSPECTION ITEM

• Control cabin interior

  Safe

  At Risk

  N/A

• Fire truck fueled / clean

  Safe

  At Risk

  N/A

• Site Access unobstructed

  Safe

  At Risk

  N/A

• Data cable runs protected

  Safe

  At Risk

  N/A

• Trip hazards clearly marked

  Safe

  At Risk

  N/A

• Appropriate signage installed

  Safe

  At Risk

  N/A

• Dual handrails firmly installed

  Safe

  At Risk

  N/A

• Whip-checks and restraints

  Safe

  At Risk

  N/A

• Noise, vehicles, dust and facial hair issues are compliant

  Safe

  At Risk

  N/A

• Spot checked chemical(s) MSDS available and up to date

  Safe

  At Risk

  N/A

• All containers labeled

  Safe

  At Risk

  N/A

• Equipment physical appearance (rust, paint etc.)

  Safe

  At Risk

  N/A

• Safecard Counts

  Safe

  At Risk

  N/A

• All JSEA's signed

  Safe

  At Risk

  N/A

• Frac Pumps stands extendable

  Safe

  At Risk

  N/A

• Exclusion Zone

  Safe

  At Risk

  N/A

• Shower trailer function test (daily)

  Safe

  At Risk

  N/A

• Potable water chlorine test (monthly)

  Safe

  At Risk

  N/A

• PPE condition and storage

  Safe

  At Risk

  N/A

• Correct PPE observe

  Safe

  At Risk

  N/A

• All wheels chocked

  Safe

  At Risk

  N/A

• All liners in place / sides upright

  Safe

  At Risk

  N/A

• Respiratory protection / facial hair

  Safe

  At Risk

  N/A

• Lock Out / Tag Out Box

  Safe

  At Risk

  N/A

• Fall Protection inspected

  Safe

  At Risk

  N/A

• Controlled work instructions on site

  Safe

  At Risk

  N/A

• Chemical Transport manifest on site and signed by driver

  Safe

  At Risk

  N/A

• Delivery notes on site and signed by the driver and the receiver

  Safe

  At Risk

  N/A

• Incident recorded and reported

  Safe

  At Risk

  N/A

• NPT has been recorded and reported

  Safe

  At Risk

  N/A

• Calibration Devices (PRV's, torque)

  Safe

  At Risk

  N/A

• Extinguishers placed

  Safe

  At Risk

  N/A

• Hose color coding correct

  Safe

  At Risk

  N/A

• PPE stock level

  Safe

  At Risk

  N/A

• Lifting equipment inspected and register up to date

  Safe

  At Risk

  N/A

• Hot fueling vent hoses in place and directed to temporary containment

  Safe

  At Risk

  N/A

INCIDENTS:

• Did an incident occur?

  YES

  NO

• If yes, Has PIN been submitted? <br>Note: DO NOT SUBMIT PIN FOR UNSHADED AREAS BELOW

  YES

  NO

• Category* (check all that apply)

  Select 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]

  • 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]

• Provide details of NPT > 30 minutes

STATISTICS

• Item

• Safe Cards:

• Incidents:

• Spills / Leaks:

• Recordable Injuries:

• First Aid incidents:

• JSEA's:

• Vehicle Incidents:

• Comments

Weather delay (what)

• Weather delay (what)

  Lightning

  Wind

  Tornado

  Snow/Ice

  Rain

• Start Time

  Date

• End Time

  Date

• Total

• Comment

• 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

• SAFECARD Action Issue

• Comments:

• Weekly SOP Audit

• Date

  Date

• Procedure #

• Result (S=Satisfactory, NI = Needs Improvement)

  Satisfactory

  Needs Improvement

• Audit Result Comment:

• Other Issues / Suggestions / NCR's:

• *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)