Drill Site Inspection Checklist

• Conducted on

  Date

• Prepared by

• Map
  Address

• LSD

Contractor/Rig #:

• Rig Name & #

  Yes

  No

  N/A

• Drilling Supervisor:

• Client/Project:

A. General Safety

• 1. Direction signs are properly signed into location

  Yes

  No

  N/A

• 2. Lease entrance sign is displayed (H2S/tight hole sign posted or removed as required)

  Yes

  No

  N/A

• 3. Means of communication

  Yes

  No

  N/A

• 4. Medic available on site or lease is within 40 minutes of a hospital facility

  Yes

  No

  N/A

• 5. Designated muster/smoking area identified

  Yes

  No

  N/A

B. Postings Required

• 1. Baytex Corporate HSE Policy

  Yes

  No

  N/A

• 2. Well license posted

  Yes

  No

  N/A

• 3. Turnover from construction to drilling

  Yes

  No

  N/A

• 4. Term work authorization permit (if required)

  Yes

  No

  N/A

• 5. Temporary diversion water license (TDL) posted at point of diversion

  Yes

  No

  N/A

• 6. AER/ECON Regulatory weekly rig inspection

  Yes

  No

  N/A

• 7. Prime Designate (Notice of Supervisor) completed and posted

  Yes

  No

  N/A

• 8. Workers Compensation Board (WCB) 1,2,3 Poster

  Yes

  No

  N/A

• 9. Canadian Association of Oilwell Drilling Contractors (CAODC) Well Control Poster

  Yes

  No

  N/A

• 10. Canadian Association of Oilwell Drilling Contractors (CAODC) Oilfield Waste Poster

  Yes

  No

  N/A

• 11. Lockout and Tag out Procedures

  Yes

  No

  N/A

• 12. Emergency Evacuation procedures

  Yes

  No

  N/A

• 13. Boiler license is posted and current

  Yes

  No

  N/A

• Expiry Date

  Date

• 14. Maximum allowable casing pressure (MACP) posted

  Yes

  No

  N/A

• 15. ERP contacts updated and posted in doghouse and all well site trailers

  Yes

  No

  N/A

• 16. Directions to location from nearest hospital

  Yes

  No

  N/A

• 17. Flow check/Spacing waiver posted

  Yes

  No

  N/A

C. Required Documentation (Electronic or Paper Copy)

• 1. AB/SK OHS Act, Regulations and Code

  Yes

  No

  N/A

• 2. Canadian Association of Oilwell Drilling Contractors (CAODC) Recommended Practices

  Yes

  No

  N/A

• 3. AER Directives

  Yes

  No

  N/A

• 4. Contractor HSE Manual

  Yes

  No

  N/A

• 5. Contractor Job Safety Analysis and standard operating procedures (JSA's and SOP's)

  Yes

  No

  N/A

• 6. Contractor SDS Manual

  Yes

  No

  N/A

D. Hazard/Risk Assessment and Daily HSE Meeting

• 1. Completed Daily

  Yes

  No

  N/A

• 2. JSA/SOP reviewed prior to completing tasks

  Yes

  No

  N/A

• 3. Contractor hazard reporting process in place

  Yes

  No

  N/A

• 4. Critical Task Assessment completed for simultaneous operations

  Yes

  No

  N/A

• 5. Production equipment, producing/suspended wells sufficiently barricaded

  Yes

  No

  N/A

• 6. Contractor hazard reporting process in place

  Yes

  No

  N/A

E. Work Permits

• 1. Hot Work Permits being issued/completed

  Yes

  No

  N/A

• 2. Confined Space Entry Permits being issued and Rescue Plans completed

  Yes

  No

  N/A

F. Drilling Equipment Inspections

• 1. Canadian Association of Oilwell Drilling Contractors (CAODC) Rig Site Inspections

  Yes

  No

  N/A

• 2. Canadian Association of Oilwell Drilling Contractors (CAODC) Pre-Spud Inspections/checklist

  Yes

  No

  N/A

• 3. Canadian Association of Oilwell Drilling Contractors (CAODC) BOP

  Yes

  No

  N/A

• 4. Canadian Association of Oilwell Drilling Contractors (DAODC)Pre-Raise Derrick Inspection

  Yes

  No

  N/A

• 5. Daily Loader Inspections

  Yes

  No

  N/A

G. Safety Equipment Inspections

• 1. SCBA’s on location.

  Yes

  No

  N/A

• Number of packs availible

• Number of spare bottles availible

• Packs are checked monthly

  Yes

  No

  N/A

• 2. Fire Extinguishers in good repair: monthly Inspections and yearly recertification’s complete

  Yes

  No

  N/A

• 3. First Aid Kits stocked and clean: monthly inspections complete

  Yes

  No

  N/A

• 4. Eye Wash stations in good repair: monthly inspections and 6 month fluid changes complete

  Yes

  No

  N/A

• 5. Fall Protection in in good repair: Pre-use inspections and yearly inspections complete

  Yes

  No

  N/A

• 6. 4 Head Gas Monitors: Pre Use Bump Test records available; Calibration completed every 90 days

  Yes

  No

  N/A

• 7. Stand-alone H2S/LEL Monitors: Pre Use Bump Test records available; Calibration completed every 90 days. Positioned in appropriate location

  Yes

  No

  N/A

• 8. Lockout tag out board present and only one key available for each lock

  Yes

  No

  N/A

H. Housekeeping

• 1. Rig floor

  Good

  Fair

  Poor

  N/A

• 2. Dog House

  Good

  Fair

  Poor

  N/A

• Mixing Shack and Mud Tanks

  Good

  Fair

  Poor

  N/A

• Pump House

  Good

  Fair

  Poor

  N/A

• Substructure

  Good

  Fair

  Poor

  N/A

• Manifold Shack

  Good

  Fair

  Poor

  N/A

• Other Combo Buildings

  Good

  Fair

  Poor

  N/A

• Sewage System

  Good

  Fair

  Poor

  N/A

• Waste bins in good condition and organized, Hazardous/Non Hazardous

  Good

  Fair

  Poor

  N/A

• Cement rings/pits/bins, intact, not leaks, appropriate freeboard

  Good

  Fair

  Poor

  N/A

• Spread field inspected for appropriate access, no rutting, pooling, etc.

  Good

  Fair

  Poor

  N/A

• Overall Lease conditions

  Good

  Fair

  Poor

  N/A

J. Environment/Spill Management

• 1. No noticeable spills/leaks

  Yes

  No

  N/A

• 2. Spill response absorbents available

  Yes

  No

  N/A

• 3. Spill reporting form available

  Yes

  No

  N/A

K. Employee Training Certifications

• 1. All workers have completed Baytex Contractor Service Provider HSE Orientation

  Yes

  No

  N/A

• 2. Driller(s) has first line certification on their person

  Yes

  No

  N/A

• 3. Rig Manager(s) and Drilling Supervisor(s) have 2nd line certification on their person

  Yes

  No

  N/A

• 4. All workers on location have current training certification per Baytex training matrix

  Yes

  No

  N/A

• 5. Green hand program in place and all green hands identifiable

  Yes

  No

  N/A

Signoff

• Safety Advisor (print name)

• Signature

  Sign

• Rig Consultant (print name)

• Signature

  Sign

• Rig Push/Manager (Print name)

• Signature

  Sign