Information

  • Pad Site

  • Contract Companies Present

  • Company Men Present

  • Conducted on

  • Prepared by

  • Location
  • Foremen Responsible for Job

1. Drilling Location

  • Authorized Personnel Sign Posted 1910.145(c)(2)(i) RP54 7.1.2-3<br>

  • Hard Hat/Safety Glasses Signs Posted 1910.145(c)(3)

  • No Smoking Area’s Designated & Posted RP54 7.1.2-3 1910.145(c)(2)(i)<br> <br>

  • No Parking within 100 ft of the rig RP54 6.1.15

  • H2S warning signs erected, if applicable 1910.145(c)(2)(i) 1910.1000(e) 1910.1200(f)(5-6) RP54 7.1.2-3<br><br>

  • Emergency escape air packs and life lines available, if applicable 1910.134(d)(2)(i) RP55 3.3 RP55 3.9<br><br>

  • Escape & Guy wires flagged RP4G 7.6.f

  • Outhouse/restroom facility provided or in close proximity to the site. (LT 10 min travel time or 2 miles, whichever is less) (Facility in close proximity only applies if the site is active for less than 1 day) 1910.141(c)(1)(i)<br>

  • Outhouse clean and sanitary, if provided. 1910.142(d)(10)<br>

  • Hard hats & Safety glasses available for visitors 1910.132(a<br>

  • Toolpusher’s trailer grounded RP54 6.1.16<br>

  • Toolpusher’s trailer securely positioned RP54 6.1.16<br>

  • Housekeeping looks good? 1910.22(a)(1) RP54 6.5.1<br><br>

  • Distance from overhead powerlines GT 10 ft RP54 10.1.1

  • Toolpusher at rig location

  • Muster area designated & posted 1910,38(c)(4

  • Visitor tracking system in place I.E. a sign in box. 1910.38(c)(4)

  • All vessels labeled as to their contents 1910.1200(f)(4-5)

  • Supply storage house clean 1910.22(a)(1) RP54 6.5.1<br>

  • Crew change house clean 1910.22(a)(1) RP54 6.5.1<br>

  • Wind Sock available. (H2S may be present) RP55 4.5

  • Evacuation/All-clear alarms system in place? 1910.38(d)

2. TRAINING, PPE & GENERAL SAFETY

  • Someone has First Aid Training RP54 4.3.

  • Certification Card(s) available RP54 4.3.1

  • Pre-Job safety meetings conducted before each shift or if new hazards happen. RP54 6.1.7

  • OSHA poster posted 1903.2(a)(1)

  • Proper clothing worn by crew (No loose clothing). FRC RP54 5.2.5 RP54 5.2.6 1910.132(a)<br>

  • Hard hats used by crew RP54 5.2.1 1910.135(a)(1-2)<br>

  • Safety glasses used by crew RP54 5.2.2 1910.133(a)(1-5<br>

  • Steel toed shoes used by crew RP54 5.2.3 1910.136(a)<br>

  • Hazardous jewelry not worn by crew RP54 5.2.7 1910.132(a)<br>

  • Fall protection used, when required RP54 5.5.

  • No Smoking rules observed only in approved areas RP54 7.1.3

  • First Aid Kit/Bloodborne Pathogen Kit available on site 1910.151(b) RP54 4.3.2<br>

  • Emergency phone numbers posted RP54 4.2.1 RP55 4.6<br>

  • MSDS’s available and accessible RP54 6.1.12 1910.1200(g)(1)<br>

  • Emergency response plan from the rig available 1910.38(b) RP55 4.1-10<br>

  • BOP training up to date RP54 6.4.4

  • Written safety program available from each contractor RP54 6.1.7

  • Hearing protection required in posted areas RP54 5.3.1-2 1910.95(a)<br>

  • Long Hair contained RP54 5.2.8

3A. MUD PUMP AREA

  • Drive belts guarded RP54 6.8.2-3

  • Pony rods guarded RP54 6.8.2-3

  • Shear pin pop-off valve present and covered 1910.169(b)(3)(i-iv)

  • Pressure relief valves present 1910.169(b)(3)(i-iv)

  • General housekeeping of the area RP54 6.5.1 1910.22(a)(1)<br>

  • Discharge lines from relief valves are anchored

3B. MUD MIXING AREA

  • Adequate personal protective equipment available. Rubber gloves, Face shield, Apron, Respirator, etc PER MSDS RP54 6.13.2 1910.132(a)<br>

  • Personal protective equipment properly stored and clean RP54 6.13.2 1910.132(a)<br>

  • Eye wash station available in close proximity and in working order 1910.151(c) <br>

  • Eye wash station in a clean & sanitary condition 1910.141(d)(1)

  • Eye wash station providing clean water supply 1910.141(b)(1)(i)

  • General housekeeping RP54 6.5.1 1910.22(a)(1)<br>

  • Adequate lighting provided

3C. MUD TANKS & PITS

  • Adequate stairs with handrails 1910.24(h) 1910.23(d)(1)<br>

  • Adequate walkways and guardrails 1910.23(c)(1

  • Guardrails installed on all raised platforms, walkways, etc above 48” 1910.23(c)(1) 1910.23(d)(1<br>

  • Walkways free from obstruction and/or damage 1910.23(c)(1

  • Guardrails provided on crossovers 1910.23(c)(1)

  • Shale shaker properly guarded 1910.23(c)(3

  • Explosion proof equipment used in the vicinity of the shale shaker 1910.307(b)(1-3) & subsections 1910.307(c) <br>

  • Agitator shafts & couplings properly guarded 1910.212(a)(1)

  • Mud guns properly secured RP54 9.11.2

  • Jetting hoses properly secured RP54 9.11.2

  • Approved lighting for the location installed 1910.307(b)(1)

  • Stairways and ladders secured RP54 9.3.8

  • General Housekeeping 1910.22(a)(1) RP54 6.5.1<br>

  • All unused floor holes covered 1910.23(a)(8) 1910.23(a)(9<br>

  • Electric wiring in good condition 1910.303(b)(1-2) 1910.303(c)<br>

4. GENERATOR AREA

  • Generators properly located in safe area RP54 9.14.2

  • Moving parts guarded 1910.212(a)(1

  • Generators properly grounded RP54 9.14.11

  • Cover panels on electrical control boxes installed and closed. 1910.305(b)(2)

  • All electrical controls marked as to their function and legible. 1910.303(f

  • HIGH VOLTAGE” warning signs erected 1910.145(c)(2)(i) 1910.305(b)(2)(ii<br>

  • Insulating mats available at electrical panels 1910.335(a)(2)(ii)

  • All electrical tools grounded 1910.304(f)(5)(v)

  • Condition of electrical wiring 1910.303(b)(1-2

  • Electrical wires properly strung 1910.305(a)(2)(iii) RP54 10.2.3<br>

  • Unused electrical outlets covered 1910.305(b)(1-3)

  • Air compressors properly guarded 1910.212(a)(1

  • Air storage tanks equipped with pop-off valve 1910.169(b)(3)(i-iv)

  • Lockout/Tagout devices available RP54 6.9.1 RP54 9.14.9<br>

  • Hearing Protection Required” warning signs erected. 1910.95(b)(1

  • Hearing protection available 1910.95(a)

  • Adequate lighting installed RP54 9.14.7 1910.303(h)(3)(ii)<br>

  • General Housekeeping RP54 6.5.1

  • Equipment properly classified for the location RP54 9.14.6 RP54 10.2.1 RP500 4.1-5 RP500 5.1-2<br>

  • Electrical wiring/fixtures/etc approved for the location (Cl 1 Div 1 or 2 location) RP54 10.2.1 1910.307(b)(1-2)<br>

  • Wires not running along the ground RP54 10.2.3 1910.305(a)(1)(iii)(G)<br>

  • Receptacles and plugs in good condition 1910.303(b)(1)

  • Fire extinguishers rated for electrical fires 1910.157(d)(1)

5. FIRE PROTECTION

  • B/C class fire extinguishers available RP54 7.2.4 RP54 7.2.5<br>

  • Adequate number of fire extinguishers available 1910.157(d)(2-6) RP54 7.2.4 RP54 7.2.5<br>

  • Fire extinguishers properly charged 1910.157(c)(4)

  • Fire extinguishers properly located 1910.157(c)(1) RP54 6.5.5 RP54 7.2.2 RP54 12.1.3<br>

  • Flammables stored in UL listed safety cans 1910.106(d)(2) RP54 8.1.1<br>

  • No Smoking rules enforced RP54 7.1.2-6

  • Spark and heat arrester, or water, on all engine exhausts RP54 9.15.3

  • Welding work performed safely RP54 7.2.6

  • All engines located approx 100 ft from the well or gas source, if possible RP54 9.14.2 RP54 9.15.3<br>

  • Fire extinguishers tagged and/or inspection data logged into database 1910.157(e)(1) RP54 7.2.3 RP54 7.2.7<br>

  • Fire extinguisher location easily identified 1910.157(c)(1) RP54 6.5.5 RP54 7.2.2<br>

6. FUEL STORAGE TANKS

  • Fuel storage tanks properly located RP54 8.3.5 1910.106(b)<br>

  • All storage valve connections identified as to their function 1910.106(b)

  • Discharge nozzles in good condition 1910.106(b)

  • Discharge hoses in good condition 1910.106(b

  • Discharge valves in good condition 1910.106(b)

  • Piping and fuel lines in good condition 1910.106(b)

  • Stationary ladders on storage tanks in good condition 1910.27(f)

  • Approved lighting for the location installed 1910.307(b)(1)

  • Fuel tanks properly labeled RP54 8.4.1d 1910.1200(f)(4-5<br>

  • “Flammable” warning signs erected 1910.145(c)(2)(i) 1910.1200(f)(5-6) RP54 7.1.2-6 RP54 8.4.1d<br>

  • “No Smoking” signs erected 1910.145(c)(2)(i) 1910.1200(f)(5-6) RP54 7.1.2-6 RP54 8.4.1d<br>

  • No Open Flame” signs erected RP54 7.1.2-6 1910.145(c)(2)(i) RP54 8.4.1d<br>

  • Vapor release vents elevated & away from ignition sources 1910.106(b

  • General housekeeping RP54 6.5.1 1910.22(a)(1)<br>

  • Grass & debris kept away from area RP54 6.5.1

  • B/C Class fire extinguisher available RP54 8.4.1e 1910.157(c)(1) 1910.157(d)(1)<br>

  • Protective caps on all fuel cylinders RP54 8.3.3

7. PIPE RACK AREA

  • Ends of pipe racks properly chocked 1910.176(b) RP54 9.12.3<br>

  • Spacers used to separate layers of pipe 1910.176(b)

  • Layers of pipe properly chocked 1910.176(b) RP54 9.12.3<br>

  • Stairs with handrails provided 1910.25(h)

  • Derrick stand and ladder in good condition 1910.27

  • Dead end of drilling line anchored RP9B 3.3.9

  • Approved lighting installed 1910.307(b)(1)

  • General housekeeping 1910.176(c) RP54 6.5.1<br>

8. BLOW-OUT PREVENTERS

  • BOP properly installed RP54 6.4.1

  • BOP properly tested RP54 6.4.1 RP54 6.4.13<br>

  • BOP stack properly stabilized RP54 6.4.10

  • All hydraulic lines connected RP54 6.4.18

  • All unused hydraulic lines capped and secured RP54 6.4.18

  • Accumulator unit properly located

  • Accumulator valves in appropriate position, open or closed and secured

  • Gauges properly located

  • Choke manifold and line secured RP54 6.4.18

  • Approved lighting for the location installed 1910.307(b)(1)

  • Warning signs erected 1910.145(c)(2)(i) RP54 7.1.2-3<br>

  • Proper drainage provided RP54 6.5.2

  • General housekeeping RP54 6.5.1 1910.22(a)(1)<br>

  • Safety valve and handle for tubing installed RP54 6.4.2

  • Hydraulic lines protected

  • BOP Control Lines & Valves identified RP54 6.4.11

  • Daily inspections of the BOP’s conducted RP54 6.4.7

9. DERRICK & SUBSTRUCTURE

  • Derrick/A-Frame assembly pins in place RP54 9.2.8

  • Assembly pins secured with keepers RP54 9.2.8

  • Number of wind guys RP4G 6.1-8RP54 9.2.10<br>

  • Condition of guy lines RP4G 5.1.c

  • Diameter of guy lines RP9B 3.7.4

  • 3 clamp minimum, 4 clamp minimum with sheave RP9B 3.7.4

  • Clamps properly attached RP9B 3.7.4

  • Ground anchors RP4G 7.1-8

  • Anchor pull test performed RP4G 7.1-8

  • Anchors positioned IAW rig manufacturer’s specifications RP4G 7.1-8

  • TUBING BOARD GUYS

  • Strung and crossed for racking

  • 3 clamp minimum RP9B 3.7.4

  • Clamps properly attached RP9B 3.7.4

  • Fall lane of derrick clear

  • Vehicles out of guy pattern

  • Manufacturer’s specification/operation plate attached to derrick RP54 9.2.2

  • Damage and/or corrosion to derrick (waste metal) RP54 9.16.1

  • Damage and/or corrosion to substructure (waste metal) RP54 9.16.1

  • Condition of derrick ladder RP54 9.3.1-2

  • Climb assist device available 1910.27(d)(5)

  • Climb assist device used by derrickman. and in good condition

  • Full body harness with lanyard available 1910.132(c)(1) RP54 5.5.1<br>

  • Fall protection devices in use RP54 5.5.1

  • Derrick/Tubing boards in good condition RP54 9.2.17<br>

  • Guardrails installed on derrick board RP54 9.3.17 RP54 5.5.1<br>

  • Pipe fingers in good condition RP54 9.2.17

  • Derrick board walk around platform in good condition, if available

  • Finger board in good condition RP54 9.2.17 RP54 9.3.16<br>

  • Crown guardrails installed RP54 9.3.17 1910.23(c)(1)<br>

  • Scoping ram stabilizers in good condition RP54 9.2.4

  • Crown sheave guards in place RP54 9.7.5

  • Cracks, metal fatigue or wear evident at hinge points RP54 9.2.4

  • Safety retainers in use on hinge pins RP54 9.2.8

  • Derrick locking pins in place with safety pins RP54 9.2.8

  • Dead line properly anchored RP54 9.6.5 RP9B 3.3.9<br>

  • Approved lighting for the location installed 1910.307(b)(1)

  • Derrick emergency escape line installed RP54 6.10.1

  • Geronimo on-line and ready for immediate access and use. RP54 6.10.1

  • Emergency escape line adequately anchored, per manufacturers specifications, in a clear area away from the rig. RP54 6.10.1

  • Tools secured at elevated levels RP54 9.2.13

  • Mud standpipe/hose secured

  • Data plates installed on derrick that provide information on guying, derrick, etc inst

10. DRILL FLOOR AREA

  • Kelly bushing guard used RP54 9.8.3

  • Controls adequate if guard not used RP54 9.8.3

  • Rotary chain drive guarded 1910.212(a)(1-3)

  • All unused floor holes covered 1910.23(a)(8-9) RP54 9.1.1 RP54 9.3.20 RP54 9.3.21<br>

  • Driller at or near controls RP54 9.4.4

  • Drillers controls properly labeled/identified

  • Pipe slips & Dies in good condition RP54 9.9.2

  • V-door gate provided and in place 1910.23(c)(1)

  • Air hoist line in good condition RP9B 3.2.7

  • Air hoist line properly layed RP9B 3.3.3

  • Cathead line divider/grip in good condition RP54 9.5.1

  • Catline not worn or kinked, if available RP54 9.5.10

  • Headache post in good condition RP54 9.5.8

  • Anti-two blocking device installed and operational RP54 9.2.16 RP54 9.4.8<br>

  • Drilling line in good condition RP9B 3.3.10

  • Drawworks properly guarded RP54 9.4.2 RP54 9.6.4<br>

  • Proper lay of drill line on reel RP9B 3.3.10(b)

  • Appropriate lighting installed 1910.307(b)(1)

  • General housekeeping RP54 6.5.1 1910.22(a)(1)<br>

  • Drill floor level

  • Minimum 2 exits from drill floor doghouse

  • Guardrails installed along open edges of drill floor RP54 9.3.17 1910.23(c)(1)<br>

  • First aid kit available in drill floor doghouse 1910.151(b)

11. POWER AND HAND TOOLS

  • Tong snubbing lines in good condition RP54 9.9.6

  • Tong body & jaws in good condition RP54 9.9.7

  • Tong stiff arm available and operational RP54 9.9.4

  • Condition of tong jerk line(s) RP54 9.9.6

  • Condition of hand tools RP54 6.8.6

  • “Iron Roughneck” used

  • IR body & jaws in good condition RP54 9.9.7

  • IR hydraulic system leaks RP54 9.9.9

  • Electric hand tools double insulated or grounded RP54 6.8.7

  • Guards installed on/over all belts, drive chains, gears and drives RP54 6.8.2

  • “Dead man” switch installed on all Electric and Pneumatic tools RP54 6.8.8

12. HOISTING TOOLS, HOOKS, BAILS, ELEVATORS AND OTHER RELATED EQUIPMENT

  • Traveling blocks in good condition RP54 9.7.1

  • Traveling blocks properly guarded RP54 9.7.4

  • Elevators in good condition RP54 9.7.1 RP54 9.7.8<br>

  • Rod hook in good condition RP54 9.7.1

  • Hoisting hook equipped with safety latch or equiv. RP54 9.7.3

  • Crown block assembly secured RP54 9.7.5

  • Transfer elevators in good condition RP54 9.7.1

  • Crew members not permitted to ride traveling block RP54 6.11.1

  • Circulating hose secured to gooseneck and swivel RP54 9.7.7

  • Power swivel secured RP54 9.7.7

  • Hoisting line inspected daily RP54 9.6.1

13. STAIRS, LADDERS, HANDRAILS & GUARDRAILS

  • Adequate stairs provided off rig RP54 9.3.10 1910.24(b)<br>

  • Minimum of 2 stairways to drill floor RP54 9.3.10 1910.36(b)(1)<br>

  • Stairs secured with a pin/keep or nut/bolt/keeper RP54 9.3.8

  • No obstructions RP54 9.3.11

  • Adequate handrails provided on stairs RP54 9.3.8 1910.24(h)<br>

  • Stair treads of uniform size RP54 9.3.9 1910.24(d)<br>

  • Non-skid type stair treads 1910.24(f)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.