Dialog Wireline Services, L.L.C. - 3

• Document No.

• Client / Site

• Personnel

• Prepared by

• Conducted on

  Date
• Location
  Address

Location

• Location is free of observable hazards?

  Safe

  At Risk

  N/A

• Explosive signage is in place?

  Yes

  No

  N/A

• Wireline area is free from tripping hazards?

  Safe

  At Risk

  N/A

• Caution tape is in place?

  Yes

  No

  N/A

• Wireline equipment has a clear exit path in case of an emergency?

  Safe

  At Risk

  N/A

• Pre-work meeting was conducted and JSA completed prior to starting work?

  Yes

  No

  N/A

• Crane JSA completed?

  Yes

  No

  N/A

• FOCUS cards utilized for any unsafe conditions?

  Yes

  No

  N/A

• Stop Work Authority discussed in meeting?

  Yes

  No

  N/A

Crew

• Everyone is donning proper PPE before arrival to location?

  Yes

  No

  N/A

• FRC's are in acceptable condition?

  Safe

  At Risk

  N/A

• Safety glasses are available?

  Yes

  No

  N/A

• Dialog employees wearing Steel toe boots?

  Yes

  No

  N/A

• Proper gloves are available and being used?

  Yes

  No

  N/A

• Everyone is aware of muster point location?

  Safe

  At Risk

  N/A

• Stop work authority has been reviewed?

  Yes

  No

  N/A

Wireline/Pickup Trucks

• Wheel chocks are in place?

  Yes

  No

  N/A

• Fire Extinguishers available?

  Yes

  No

  N/A

• Hand rails in place?

  Yes

  No

  N/A

• Ground cables connected?

  Yes

  No

  N/A

• Only authorized personnel in the wireline area?

  Safe

  At Risk

  N/A

• Truck cab free of excess trash/debri?

  Safe

  At Risk

  N/A

• Explosives stored properly when not in use?

  Safe

  At Risk

  N/A

• Oil levels good?

  Safe

  At Risk

  N/A

• Line oil working and line is in good shape?

  Safe

  At Risk

  N/A

• Chains and Slings have current certification?

  Safe

  At Risk

  N/A

• Sheaves have current certification?

  Safe

  At Risk

  N/A

• Pre-trip completed Wireline truck/Crane?

  Safe

  At Risk

  N/A

• Daily Crane inspection complete

  Safe

  At Risk

  N/A

Tools & Equipment

• First Aid kits available?

  Safe

  At Risk

  N/A

• SDS Sheets available?

  Yes

  No

  N/A

• Daily crane inspection completed?

  Yes

  No

  N/A

• Aerial Lift inspection completed?

  Yes

  No

  N/A

• Chains and Sheaves inspected?

  Yes

  No

  N/A

• Straps and Harnesses in good working order?

  Yes

  No

  N/A

• Adequate lighting in wireline truck?

  Yes

  No

  N/A

• Adequate lighting on ground level?

  Yes

  No

  N/A

• Tools in good working order?

  Yes

  No

  N/A

• Trucks equipped with day mags?

  Safe

  At Risk

  N/A