Title Page

  • Conducted on

  • Client/ Project Name

  • Project Location
  • Project #

  • Drill Rig & Support Truck #s

  • Prepared by

  • Lead Driller

Field Inspection

SAFETY INSPECTION

  • 1. Is crew properly wearing all applicable PPE?

  • 1.a. Hard Hat

  • 1.b. Safety Glasses w/ Side Shields

  • 1.c. Hearing Protection

  • 1.d. Cut & Impact Resistant Work Gloves (snug at wrist; no open or loose collared gloves)

  • 1.e. Hi-Vis Class 2 Safety Vest/ Shirt (zipped/ tied; no loose fitting vests or unsecured ties)

  • 1.f. Steel/ Composite Toe Safety Boots (laced up)

  • 1.g. Long Pants and Long Sleeves (no holes or rips; no loose fitting/ baggy/ sagging clothing)

  • 1.h. No jewelry, scarves, or other clothing/ accessories that could become caught in moving parts or machinery)

  • 1.i. Any other PPE required due to site conditions

  • 2. Does the Lead Driller have a copy of the utility clearance report/ certification on-site?

  • 3. Is there 35 feet of clearance with the mast raised from any overhead power lines at all boring locations?

  • 3.a. Has the RVP approved any drilling locations that cannot maintain 35 feet of clearance from overhead power lines?

  • 4. Are traffic controls in place to protect drilling operations in or adjacent to any public roadway?

  • 5. Has the Lead Driller reviewed and documented the Tailgate Safety Meeting with emergency phone numbers and location of emergency/ medical services, as well as Drilling Safety Absolutes and other safety precautions at the start-up of the drilling project?

  • 6. Are all tools, flammable materials, equipment, and supplies securely and appropriate stored/ stowed when not in use to prevent slip/ trip hazards?

  • 7. Are emergency supplies stocked, charged, replenished, and secured (e.g. first aid kit, AED, fire extinguisher, spill kit, etc.)?

  • 8. Are hand tools operable/ in good working conditions (e.g. grease gun, wrenches, etc.)?

  • 9. Is the Drilling Helper/ Assistant or Other Drill Crew Member establishing and cordoning off the Exclusion Zone boundary around the drill rig at each boring location?

  • 10. Is the Lead Driller establishing and marking the Immediate Danger Zone at each boring location?

  • 11. Does the drill crew have sufficient supplies to properly abandon each boring (e.g. cap, bentonite, etc.)?

  • 12. Does the drill crew have sufficient supplies to properly remove and dispose of excess spoils from the soil borings (if necessary) and any other trash or debris accumulated during the shift?

  • 13. Is the drilling rig, equipment, support vehicle and other materials in good working/ running condition?

  • 14. Are drill rig kill switches/ e-stops in good working order?

OTHER OBSERVATIONS & NOTES

  • Notes:

Approvals

  • Manager Signature

  • Lead Driller Signature

  • Driller Helper/ Assistant or Other Drill Crew Member Signature

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