Drilling Site Safety Evaluation

• Job Site

• Conducted on

  Date

• Safety Personnel Conducting Audit

• Supervisor

• Engineer/ Prime Contractor

• Location
  Address

1.0 Fire Prevention

• Adequate number of chemical extinguishers onsite

  Yes

  No

  N/A

• Workers Trained in Extinguisher Use

  Yes

  No

  N/A

• Fire Extinguishers Accessible to Workers

  Yes

  No

  N/A

• Extinguishers secured from movement.

  Safe

  At Risk

  N/A

• Extinguishers fully charged

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

2.0 First Aid and Emergency Response

• First Aid Trained Persons Onsite

  Yes

  No

  N/A

• First Aid Kit accessible and fully stocked

  Yes

  No

  N/A

• Emergency Response Complete (Muster Point, Nearest hospital etc.)

  Yes

  No

  N/A

• Workers aware of emergency response plan

  Yes

  No

  N/A

• Secondary vehicle onsite for site emergencies.

  Yes

  No

  N/A

• Emergency Phone Numbers Onsite

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

3.0 Site Access

• Tripping Hazards

  Yes

  No

  N/A

• Clean Level Ground

  Yes

  No

  N/A

• Adequate Site Access and Egress

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

4.0 Housekeeping

• Garbage and Debris Cleaned Up

  Yes

  No

  N/A

• Clear Work Areas

  Yes

  No

  N/A

• Clear Walkways

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

5.0 Personal Protective Equipment

• Head Protection

  Yes

  No

  N/A

• Foot Protection

  Yes

  No

  N/A

• Eye and Face Protection

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• High Visibility Outerwear

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

6.0 - Tools and Equipment

• General Condition

  Safe

  At Risk

  N/A

• Lock-out/Tag-out procedures in place with defective tools

  Yes

  No

  N/A

• Vehicle and Rig inspections complete

  Yes

  No

  N/A

• Safety Clevis in place

  Yes

  No

  N/A

• Vehicle/Rig stabilized when in use, outriggers are in place

  Yes

  No

  N/A

• Adequate safety guards in place

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

7.0 - Electrical/ Utility Safety

• Drill Rig Mast is 3meters (10ft) from high voltage power lines.

  Yes

  No

  N/A

• Underground Utilities Marked.

  Yes

  No

  N/A

• Current Utility Locates onsite.

  Yes

  No

  N/A

• Drilling location adequate distance from underground locates.

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

8.0 Safety Requirements

• Safety Manual Onsite

  Yes

  No

  N/A

• Hazard Assessment Completed

  Yes

  No

  N/A

• Toolbox Talk completed and discussed with Workers.

  Yes

  No

  N/A

• Workplace H&S Legislation Book onsite

  Yes

  No

  N/A

• MSDS Sheets Onsite

  Yes

  No

  N/A

• Yes

  No

  N/A

9.0 Public/Worker Way Protection

• Proper Delineation- Public/Other Trades

  Yes

  No

  N/A

• Proper protection around Equipment/Materials

  Yes

  No

  N/A

• Proper lighting where Required

  Yes

  No

  N/A

• Ground Setup Isolated (Fencing)

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

10. Training Requirements

• Orientated on Maple Leaf Drilling Policies and Procedures

  Yes

  No

  N/A

• Supervisory Training

  Yes

  No

  N/A

• Safety Representative Training

  Yes

  No

  N/A

• WHMIS Trained

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Safety Infractions and Corrective Action

• Number of Safety Infractions Onsite

• Corrective Action for Site Audit Deficiencies

Sign Off

• Site Supervisor

  Sign

• Health and Safety

  Sign

• Manager Signature

  Sign