DRILLING: Project Kickoff Safety Documentation

• OU Name

  Select

• Conducted on

  Date

• Prepared by

Project Information

• PSI Project Number

• PSI Project Manager

• Location
  Address

• Anticipated start up work date (s)

  Date

• Scope of Work

• Site Contact (if applicable)

• Internal or external drilling crews and equipment?

  Internal

  External

• Any non-standard drilling, sampling, or tooling required?

  Yes

  No

In Case of Emergency

• Are Emergency Contacts provided on drilling package?

  Yes

  No

• Is nearest hospital included in drilling package?

  Yes

  No

Personal Protective Equipment

• Hard Hat

  Yes

  No

• Work Boots

  Yes

  No

• Safety Glasses

  Yes

  No

• Impact and Cut Resistant Protective Gloves

  Yes

  No

• Hearing Protection

  Yes

  No

• Safety Vest (required when working in or adjacent to active roadways)

  Yes

  No

  N/A

• Flame Resistance clothing

  Yes

  No

Emergency Equipment

• First Aid Kit

  Yes

  No

• Fire Extinguisher

  Yes

  No

• AED

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Please specify:

  Yes

  No

Utilities

• Is copy of public utility locate request in drilling package?

  Yes

  No

• Is copy of public utility locate responses in drilling package?

  Yes

  No

• Was a private utility locate performed?

  Yes

  No

• Are there any overhead utility lines?

  Yes

  No

• Can 35 feet of clearance be maintained from the overhead utility line at all times?

  Yes

  No

• Are all borings within the marking boundaries specified on the locate ticket?

  Yes

  No

• All utilities accounted for (i.e. either marked or indicated to not be present)?

  Yes

  No

• Is the ticket date is valid (i.e. has not expired)?

  Yes

  No

Site Access and Conditions

• Are boring locations readily accessible and/or marked?

  Yes

  No

• What type(s) of drilling equipment can access? (check all that apply)

  Truck?

  Track?

  ATV?

  Trailer?

  Amphibious/ Barge?

• Are any permits required to access site?

  Yes

  No

• Have permit documents been provided?

  Yes

  No

• Is traffic control required

  Yes

  No

• Has traffic control been coordinated?

  Yes

  No

• Are hazardous chemicals or materials suspected on site?

  Yes

  No

• Has exposure and/or respiratory protection been evaluated by a safety professional?

  Yes

  No

• Is heavy equipment expected on site?

  Yes

  No

• Provide operator certification

  Yes

  No

• Is matting required?

  Yes

  No

• Is access to water available?

  Yes

  No

• Project Manager Sign Off

  Sign