Title Page

  • Conducted on

  • Prepared by

  • Office Name

  • Location
  • Drilling Crew Members Interviewed

  • Drill Rigs Inspected (Truck # and DOT #)

ROLES & RESPONSIBILITIES

  • 1. Does the branch have an appropriate level of resources to adequately meet all requirements of HSE-004 Drilling Safety Program?

  • 2. Has the Branch/ Site reported any work related injuries/ illnesses, vehicle accidents, near misses, hazard observations, or other incidents?

  • 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?

  • 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?

  • 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?

  • 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

  • 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?

  • 6. Have all drilling crew members completed Safe Drilling Operations Training prior to working in the field on any drilling project assignment?

  • 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?

  • 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

  • 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:

  • 9.a. Required PPE?

  • 9.b. Name of third party vendor:

  • 9.c. First Aid Kits?

  • 9.d. Name of third party vendor:

  • 9.e. Oil Spill Kits?

  • 9.f. Name of third party vendor:

  • 9.g. Fire Extinguisher?

  • 9.h. Name of third party vendor:

  • 9.i. AED?

  • 9.j. Name of third party vendor:

  • 9.k. Other Safety Supplies?

SAFETY INSPECTIONS & MEETINGS

  • 10. Are the following Preventive Maintenance inspections being completed for all drill rigs?

  • 10.a. Daily?

  • 10.b. How is inspection documented?

  • 10.c. Describe the other electronic method:

  • 10.d. Weekly?

  • 10.e. How is inspection documented?

  • 10.f. Describe the other electronic method:

  • 10.g. Bi-Monthly?

  • 10.h. How is inspection documented?

  • 10.i. Describe the other electronic method:

  • 10.j. Semi-Annual?

  • 10.k. How is inspection documented?

  • 10.l. Describe the other electronic method:

  • 11. Is the Branch/ Department Manager completing field inspections of active drilling project site?

  • 12. Is the Branch/ Department Manager holding monthly safety meetings with the drilling crew members?

  • 13. Is the Lead Driller holding Tailgate Safety Meetings at the start of all drilling projects with the Drill Crew Members?

DOCUMENTS & RECORDS

  • 14. Is the Branch/ Site maintaining the following records in accordance with HSE-004 Table 2 - Retention of Drilling Safety Program Records:

  • 14.a. First Aid/ CPR/ AED certification cards for all drilling crew members (for 3 years)?

  • 14.b. Safe Drilling Operations Training for all drilling drew members (for 1 year)?

  • 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)?

  • 14.d. Drilling Operator Competency Training records for all Lead Drillers (for the duration of each employee's service with the company)?

  • 14.e. Completed requests to Bypass Required Clearance from Overhead Power Lines (for 1 year)?

  • 14.f Completed Drilling Site Safety Inspections (for 2 years)?

  • 14.g. Completed Annual Drilling Safety Program Compliance Audits (for 2 years)?

  • 14.h. Completed Daily Preventive Maintenance Inspections (for 3 months)?

  • 14.i. Completed Weekly Preventive Maintenance Inspections (for 6 months)?

  • 14.k. Completed Bi-Monthly Preventive Maintenance Inspections (for 1 year)?

  • 14.l. Completed Semi-Annual Preventive Maintenance Inspections (for 2 years)?

  • 14.m. Completed Tailgate Safety Meeting records (for 1 year)?

  • 14.n. Completed Monthly Drilling Team Safety Meeting records (for 1 year)?

DRILLING CREW INTERVIEWS

  • 15. Were any drill crews or individual drillers or helpers interviewed during this annual audit?

  • 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

  • 16. How many drill rigs were inspected during this audit?

  • 17. How many drill rigs are in operation at this Branch/ Site?

  • 18. Is the general appearance of rigs/ vehicles is acceptable?

  • 19. Do the rigs/ vehicles show evidence of sound maintenance program?

  • 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.)?

  • 21. Are the deck areas clear of any unsecured items (e.g. rods, traffic cones, shelby tubes, etc.)?

  • 22. Does each vehicle have the following safety supplies and equipment, fully stocked, charged, and replenished:

  • 22.a. First Aid Kit?

  • 22.b. Oil Spill Kit?

  • 22.c. Fire Extinguisher?

  • 22.d. AED?

APPROVALS

  • Regional Vice President Signature

  • Branch/ Department Manager Signature

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