Title Page
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Conducted on
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Prepared by
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Office Name
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Location
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Drilling Crew Members Interviewed
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Drill Rigs Inspected (Truck # and DOT #)
ROLES & RESPONSIBILITIES
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1. Does the branch have an appropriate level of resources to adequately meet all requirements of HSE-004 Drilling Safety Program?
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2. Has the Branch/ Site reported any work related injuries/ illnesses, vehicle accidents, near misses, hazard observations, or other incidents?
- Work related injuries/ illnesses?
- Vehicle accidents/ property damage
- Near misses
- Hazard observations
- Other incidents
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2.a. Did manager/ supervisor conduct and document an investigation to identify root causes, and assign/ complete actions to prevent recurrence of injuries/ illnesses or vehicle accidents/ property damage?
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2.b. Did manager/ supervisor follow up on any identified actions from near misses or hazardous observations to prevent injury/ illness from reported workplace hazards?
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3. Has the Branch/ Site designated a Drilling Trainer/ Instructor responsible for training and verifying competency of Lead Drillers and drilling crew members authorized to perform maintenance/ repair on any of the drill rigs?
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4. Has the Branch/ Site designated a Branch Site Safety Representative (SSR) responsible for communicating updates to HSE-004 and procuring/ maintaining adequate supplies of PPE and other safety equipment?
TRAINING & COMPETENCY
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5. Have all drilling crew members completed First Aid/ CPR/ AED certification training through an accredited provider within the first 30 days of any field assignment?
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6. Have all drilling crew members completed Safe Drilling Operations Training prior to working in the field on any drilling project assignment?
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7. Have all Lead Drillers successfully demonstrated competency to an authorized Drilling Trainer/ Instructor before performing drilling operations as an Authorized Operator and Lead Driller?
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8. Have all persons authorized to perform maintenance/ repairs to drill rigs successfully demonstrated competency to an authorized Drilling Trainer/ Instructor before performing this work on any drill rigs?
SAFETY EQUIPMENT & SUPPLIES
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9. Does the Branch/ Site have adequate supplies and appropriate inventory the following safety supplies OR has the Branch/ Site made arrangements with a third party vendor to visit the site at least monthly to restock, replenish, and/or repair safety supplies and equipment:
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9.a. Required PPE?
- Yes, inventory is adequate
- Yes, third party vendor replenishes supplies
- No, no inventory to replenish/ no third party arrangement
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9.b. Name of third party vendor:
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9.c. First Aid Kits?
- Yes, inventory is adequate
- Yes, third party vendor replenishes supplies
- No, no inventory to replenish/ no third party arrangement
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9.d. Name of third party vendor:
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9.e. Oil Spill Kits?
- Yes, inventory is adequate
- Yes, third party vendor replenishes supplies
- No, no inventory to replenish/ no third party arrangement
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9.f. Name of third party vendor:
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9.g. Fire Extinguisher?
- Yes, inventory is adequate
- Yes, third party vendor replenishes supplies
- No, no inventory to replenish/ no third party arrangement
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9.h. Name of third party vendor:
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9.i. AED?
- Yes, inventory is adequate
- Yes, third party vendor replenishes supplies
- No, no inventory to replenish/ no third party arrangement
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9.j. Name of third party vendor:
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9.k. Other Safety Supplies?
SAFETY INSPECTIONS & MEETINGS
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10. Are the following Preventive Maintenance inspections being completed for all drill rigs?
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10.a. Daily?
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10.b. How is inspection documented?
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10.c. Describe the other electronic method:
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10.d. Weekly?
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10.e. How is inspection documented?
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10.f. Describe the other electronic method:
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10.g. Bi-Monthly?
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10.h. How is inspection documented?
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10.i. Describe the other electronic method:
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10.j. Semi-Annual?
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10.k. How is inspection documented?
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10.l. Describe the other electronic method:
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11. Is the Branch/ Department Manager completing field inspections of active drilling project site?
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12. Is the Branch/ Department Manager holding monthly safety meetings with the drilling crew members?
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13. Is the Lead Driller holding Tailgate Safety Meetings at the start of all drilling projects with the Drill Crew Members?
DOCUMENTS & RECORDS
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14. Is the Branch/ Site maintaining the following records in accordance with HSE-004 Table 2 - Retention of Drilling Safety Program Records:
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14.a. First Aid/ CPR/ AED certification cards for all drilling crew members (for 3 years)?
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14.b. Safe Drilling Operations Training for all drilling drew members (for 1 year)?
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14.c. Drill Rig Preventive Maintenance & Repair Competency Training for all drilling crew members authorized to perform maintenance and/or repairs on drill rigs (for the duration of each employee's service with the company)?
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14.d. Drilling Operator Competency Training records for all Lead Drillers (for the duration of each employee's service with the company)?
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14.e. Completed requests to Bypass Required Clearance from Overhead Power Lines (for 1 year)?
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14.f Completed Drilling Site Safety Inspections (for 2 years)?
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14.g. Completed Annual Drilling Safety Program Compliance Audits (for 2 years)?
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14.h. Completed Daily Preventive Maintenance Inspections (for 3 months)?
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14.i. Completed Weekly Preventive Maintenance Inspections (for 6 months)?
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14.k. Completed Bi-Monthly Preventive Maintenance Inspections (for 1 year)?
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14.l. Completed Semi-Annual Preventive Maintenance Inspections (for 2 years)?
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14.m. Completed Tailgate Safety Meeting records (for 1 year)?
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14.n. Completed Monthly Drilling Team Safety Meeting records (for 1 year)?
DRILLING CREW INTERVIEWS
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15. Were any drill crews or individual drillers or helpers interviewed during this annual audit?
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15.a. Provide a summary of the issues raised by the drilling personnel related to training, safety, rig and vehicle maintenance, or general concerns, comments and complaints.
DRILL RIG INSPECTIONS
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16. How many drill rigs were inspected during this audit?
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17. How many drill rigs are in operation at this Branch/ Site?
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18. Is the general appearance of rigs/ vehicles is acceptable?
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19. Do the rigs/ vehicles show evidence of sound maintenance program?
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20. Do the rigs & vehicles have required decals (e.g. company logo, vehicle ID#, US DOT#, Office City & State, “How Am I Driving” bumper sticker, etc.)?
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21. Are the deck areas clear of any unsecured items (e.g. rods, traffic cones, shelby tubes, etc.)?
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22. Does each vehicle have the following safety supplies and equipment, fully stocked, charged, and replenished:
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22.a. First Aid Kit?
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22.b. Oil Spill Kit?
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22.c. Fire Extinguisher?
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22.d. AED?
APPROVALS
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Regional Vice President Signature
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Branch/ Department Manager Signature