DRILLING: Drilling Site Safety Inspection (Site Inspection)

• Site conducted

  Select

• Conducted on

  Date

• Client/ Project Name

• Project Location
  Address

• Project #

• Drill Rig & Support Truck #s

• Prepared by

• Lead Driller

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SAFETY INSPECTION

• 1. Is crew properly wearing all applicable PPE?

• 1.a. Hard Hat

  Yes

  No

• 1.b. Safety Glasses w/ Side Shields

  Yes

  No

• 1.c. Hearing Protection

  Yes

  No

• 1.d. Cut & Impact Resistant Work Gloves (snug at wrist; no open or loose collared gloves)

  Yes

  No

• 1.e. Hi-Vis Class 2 Safety Vest/ Shirt (zipped/ tied; no loose fitting vests or unsecured ties)

  Yes

  No

• 1.f. Steel/ Composite Toe Safety Boots (laced up)

  Yes

  No

• 1.g. Long Pants and Shirt (no holes or rips; no loose fitting/ baggy/ sagging clothing)

  Yes

  No

• 1.h. No jewelry, scarves, or other clothing/ accessories that could become caught in moving parts or machinery)

  Yes

  No

• 1.i. Any other PPE required due to site conditions

• 2. Does the Driller have a copy of the valid utility clearance report/ certification on-site?

  Yes

  No

• 3. Is there 35 feet of clearance with the mast raised from any overhead power lines at all boring locations?

  Yes

  No

  N/A

• 3.a. Has the Branch/ Dept Manager approved any drilling locations that cannot maintain 35 feet of clearance from overhead power lines?

  Yes

  No

• 4. Are traffic controls in place to protect drilling operations in or adjacent to any public roadway?

  Yes

  No

  N/A

• 5. Has the Driller reviewed and documented the Tailgate Safety Meeting with emergency phone numbers and location of emergency/ medical services, as well as Drilling Safety Absolutes and other safety precautions at the start-up of the drilling project?

  Yes

  No

• 6. Are all tools, flammable materials, equipment, and supplies securely and appropriate stored/ stowed when not in use to prevent slip/ trip hazards?

  Yes

  No

• 7. Are emergency supplies stocked, charged, replenished, and secured (e.g. first aid kit, AED, fire extinguisher, spill kit, etc.)?

  Yes

  No

• 8. Are hand tools operable/ in good working conditions (e.g. grease gun, wrenches, etc.)?

  Yes

  No

• 9. Is the Drilling Helper/ Assistant or Other Drill Crew Member establishing and cordoning off the Exclusion Zone boundary around the drill rig at each boring location?

  Yes

  No

• 10. Is the Driller establishing and marking the Immediate Danger Zone at each boring location?

  Select Yes No

  • Yes
  • No

• 11. WAUKESHA ONLY: Is the Driller deploying the barricade around the Immediate Danger Zone and verifying by taking an picture?

  Yes

  No

  N/A

• 12. Does the drill crew have sufficient supplies to properly abandon each boring (e.g. cap, bentonite, etc.)?

  Yes

  No

• 13. Does the drill crew have sufficient supplies to properly remove and dispose of excess spoils from the soil borings (if necessary) and any other trash or debris accumulated during the shift?

  Yes

  No

• 14. Is the drilling rig, equipment, support vehicle and other materials in good working/ running condition?

  Yes

  No

• 15. Are drill rig kill switches/ e-stops in good working order?

  Yes

  No

OTHER OBSERVATIONS & NOTES

• Notes:

• Manager Signature

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• Lead Driller Signature

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• Driller Helper/ Assistant or Other Drill Crew Member Signature

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