EXCO PRE SPUD AUDIT

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

• PRE-DRILL RIG INSPECTION

  Yes

  No

  N/A

• CHECKLIST FOR LAND

  Yes

  No

  N/A

• DRILLING OPERATIONS

  Yes

  No

  N/A

• Drilling Company:

• Rig #

  Yes

  No

  N/A

• Date:

  Date

• Drilling Company:

• Rig #

  Yes

  No

  N/A

• Time:

  Date

• Rig Manager(s) on Duty:

• Spud Date:

  Date

• Depth of Well:

• No.# of days on location:

• No. # Days Since Last Recordable:

• No. # Days Since Last LTA:

• Operator:

• Operator Representative(s) on Duty:

• Well Name and #

• Location (City, State)

• Inspection Conducted By:

• Employer:

• Contact Information for Inspector:

• Office No.#

  Yes

  No

  N/A

• Cell No.#

  Yes

  No

  N/A

• Ton Miles Logged:

• BOP Test Date:

  Date

• This modified checklist is a product of the Occupational Safety & Health Administration, Baton Rouge Area Office, in conjunction with the OSHA Region 6 Regional Emphasis Program (REP or LEP) for the Oil & Gas Industry

  Yes

  No

  N/A

• The checklist combines the applicable requirements of 29 CFR 1910, American Petroleum Institute Recommended Practice 54 (API RP54), other more specific American Petroleum Institute Recommended Practices, and the current and previous checklists for drilling and well servicing rigs generated by the International Association of Drilling Contractors (IADC) and the Association of Energy Service Companies (AESC)

  Yes

  No

  N/A

• This checklist is not all inclusive but is intended to provide a clear and consistent inspection approach for inspecting land drilling rigs during REP/LEP inspections conducted by an Operator, Contractor or OSHA Representative, but may also be used for Complaint & Fatality Investigations. The overall goal of the checklist is to assure that all employees working at Oil & Gas sites are provided a safe and healthy work environment in an extremely dangerous industry

• This checklist shall be updated, as required, to keep up with advances in technology, changes in the industry and general updates to the contents of the checklist. Therefore, OSHA requests that all interested parties submit suggestions and recommendations to improve this checklist at any time to the Baton Rouge Area Office of OSHA, 9100 Bluebonnet Centre, Suite 201, Baton Rouge LA 70809

• Distribution of this checklist: Unlimited, OSHA & Industry

• References:

• 29 CFR 1910, Code of Federal Regulations, Safety & Health Regulations for General Industry

  Yes

  No

  N/A

• 29 CFR 1926, Subpart P, Code of Federal Regulations, Safety & Health Regulations for Construction, Excavations and Trenching

  Yes

  No

  N/A

• API Spec 4F, Specification for Drilling & Well Servicing Structures, 2nd Edition - 2001

  Yes

  No

  N/A

• Edition 2004

  Yes

  No

  N/A

• API RP 4G, Recommended Practice for Maintenance & Use of Drilling and Well Servicing Structures, 3rd

  Yes

  No

  N/A

• API RP 9B, Recommended Practice on Application, Care and Use of Wire Rope for Oilfield Service, 11th Edition - 2002

  Yes

  No

  N/A

• API RP 53, Recommended Practice for Blowout Prevention Equipment Systems for Drilling Wells, 3rd Edition - 1997

  Yes

  No

  N/A

• API RP 54, Recommended Practice for Safety & Health for Oil & Gas Well Drilling and Servicing Operations, 3rd Edition – 1999

  Yes

  No

  N/A

• API RP 55, Recommended Practice for Conducting Oil & Gas Production Operations involving Hydrogen Sulfide, 2nd Edition - 1995

  Yes

  No

  N/A

• API RP 500, Recommended Practice for Classification of Locations for Electrical Installations at Petroleum Facilities, 2nd Edition – 1997

  Yes

  No

  N/A

• API RP 2003, Protection against Ignitions Arising out of Static, Lightning, and Stray Currents, 6th Edition – 1998

  Yes

  No

  N/A

• ANSI B30.*, American National Standards Institute, Various crane (*type) standards

  Yes

  No

  N/A

• ANSI B56.1, American National Standards Institute, Safety Standard for Low Lift and High Lift Trucks, 1993 edition

  Yes

  No

  N/A

• ANSI B56.6, American National Standards Institute, Safety Standard for Rough Terrain Forklift Trucks, 2002 Edition

  Yes

  No

  N/A

• ANSI Z358.1, American National Standards Institute, Emergency Eyewash & Shower Equipment, 2004 Edition

  Yes

  No

  N/A

• Legend:

• SAT – Satisfactory Condition or “Yes” Response

  Yes

  No

  N/A

• UNS – Unsatisfactory Condition or “No” Response

  Yes

  No

  N/A

• NA – Not Applicable

  Yes

  No

  N/A

• CDI – An unsatisfactory condition that was corrected During Inspection

  Yes

  No

  N/A

• Standard – Applicable OSHA, API, ANSI or other government or industry recognized standard

  Yes

  No

  N/A

• ARRIVAL TO DRILL / SITE LOCATION

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Does this operation involve H2S? If yes, then move to section (3) “H2S” and complete section (1) second

  Yes

  No

  N/A

• “Authorized Personnel” sign posted at entrance to site

• Sign posted directing visitors to report to Tool pusher upon entry & is the Rig Manager’s Trailer identified with signage

  Sign

• (Hard Hat/Safety Glasses/Steel Toe Shoes Required) Sign / Signs Posted at entrance to site and other prominent locations on site

• Smoking Area’s Designated

  Yes

  No

  N/A

• No Smoking Area’s Posted

  Yes

  No

  N/A

• No Parking within 100 ft of the rig

  Yes

  No

  N/A

• What vehicles and company are parked within 100’ of rig?

• Are those vehicles a required tool for the CURRENT operation?

  Yes

  No

  N/A

• If not, then for which reason are they parked within 100’ of the rig?

  Yes

  No

  N/A

• Distance from overhead power lines Adequate as per

  Yes

  No

  N/A

• Geronimo escape wire flagged with visible material

  Yes

  No

  N/A

• Are living quarters and trailers securely positioned

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

Muster area designated – Entrances to Location

• Muster area posted

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• DRILL SITE LOCATION

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Toolpusher housed at rig location

• Best Practice

  Yes

  No

  N/A

• Hardhats available for visitors & are FRC’s available for visitors

  Yes

  No

  N/A

• Safety glasses available for visitors

  Yes

  No

  N/A

• Visitor tracking system utilized

  Yes

  No

  N/A

• Evacuation/All-clear alarms being utilized

  Yes

  No

  N/A

• Have buried pipelines been identified

  Yes

  No

  N/A

• Supply storage house clean

  Yes

  No

  N/A

• Crew change house clean

  Yes

  No

  N/A

• Are all living quarters and buildings grounded

  Yes

  No

  N/A

• Are living quarters equipped with fire extinguishers

  Yes

  No

  N/A

• Are living quarters equipped with smoke detectors and/or fire alarms

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Warning signs legible, in English, and prominently displayed on the containers, or readily available in the work area

• All vessels labeled as to their contents

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

Electrical grounding

• Are all ladders in manufactured working condition

  Yes

  No

  N/A

• Any spills or leaks

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized in the above listed areas

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Outhouse/restroom facility provided? If the job is active for less than one day on the specific location, then restroom facility must be located less then two (2) miles or ten minutes from location

• Outhouse clean and sanitary

  Yes

  No

  N/A

• Condition of general location housekeeping

  Yes

  No

  N/A

• Is the rig water tank labeled with a “NON-POTABLE WATER” sign

  Sign

• Bridle lines in good condition

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Derrick stand and ladder in good condition

  Yes

  No

  N/A

• “Fall Protection Required” warning signs erected at the base of all stairs that extend above 6 feet of un unguarded platform

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

All site personnel notified of the presence of H2S, SO2, or other hazardous gases

H2S warning signs erected, if applicable, at entrance to site and at other prominent locations on site

H2S monitoring devices in use

• Yes

  No

  N/A

H2S monitoring device calibrated and tested

Windsock available

Emergency escape air packs fully charged

Emergency escape air packs and life-lines available, if applicable

Are all personnel H2S trained and able to present current training certificate

Any unsafe condition not listed above

• Section NA:

• MUD PUMP AREA

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Drive belts and shafts guarded

  Yes

  No

  N/A

• 1910.219(c)(2)(i)(ii)

  Yes

  No

  N/A

• Pony rods guarded

  Yes

  No

  N/A

• Rotating parts guarded

  Yes

  No

  N/A

• Head and valve covers fully bolted

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Shear pin pop-off valves present and covered

  Yes

  No

  N/A

• Pop-off relief lines routed to discharge in suction pit

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Ends of pop-off relief lines secured

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Mud vibrator hose snubbed at hammer unions

  Yes

  No

  N/A

• Pressure relief valves accessible

  Yes

  No

  N/A

• High pressure fitting used in high pressure system

  Yes

  No

  N/A

• Discharge lines from relief valves anchored

  Yes

  No

  N/A

• Are all high-pressure lines secured with whip checks or safety cables

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

• All electrical Equipment grounded as required

  Yes

  No

  N/A

• Approved lighting for the location available

  Yes

  No

  N/A

• Adequate lighting provided

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• General housekeeping of the area

• Any leaks or washing from high pressure connections

  Yes

  No

  N/A

• Any leaks or washing from the pump pod caps

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• MUD TANKS & PITS Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Adequate stairs with handrail

  Yes

  No

  N/A

• Stairways and ladders secured

  Yes

  No

  N/A

• Adequate walkways and guardrails

  Yes

  No

  N/A

• Guardrails, Midrails, & Toeboards installed along all open side edges of mud tanks and pits, 4ft above ground level

  Yes

  No

  N/A

• Walkways free from obstruction and/or damage

  Yes

  No

  N/A

• Guardrails provided on crossovers

  Yes

  No

  N/A

• All unused floor holes covered

  Yes

  No

  N/A

• 1910.23(a)(8)(8i)(8ii)

  Yes

  No

  N/A

• Shale shaker properly guarded

  Yes

  No

  N/A

• Agitator shafts & couplings properly guarded

  Yes

  No

  N/A

• Drive belts and shafts guarded

  Yes

  No

  N/A

• Are all high-pressure lines secured with whip checks or safety cables

  Yes

  No

  N/A

• Mud guns properly secured

  Yes

  No

  N/A

• Jetting hoses properly secured

  Yes

  No

  N/A

• Explosion proof equipment, fixtures and wiring used in the vicinity of the shale shaker. Class 1 Div 1/2 Location

• (1-3) & subsections

  Yes

  No

  N/A

• De-silter Unit in good condition

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Explosion proof equipment, fixtures and wiring used in the vicinity of the De-silter

  Yes

  No

  N/A

• Class 1 Div 2 Location

• (1-3) & subsections

  Yes

  No

  N/A

• De-sander Unit in good condition

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Explosion proof equipment, fixtures and wiring used in the vicinity of the De-Sander

  Yes

  No

  N/A

• Class 1 Div 2 Location

• (1-3) & subsections

  Yes

  No

  N/A

• Degasser Unit in good condition

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Chemical hazard warning signs erected

  Yes

  No

  N/A

• “PPE Required” warning signs erected

  Yes

  No

  N/A

• (grouped or individual signs)

  Yes

  No

  N/A

• Assessment for respirator use conducted, documented and available

  Yes

  No

  N/A

• Adequate personal protective equipment available:

• Rubber Gloves □ Apron Face Shield

  Yes

  No

  N/A

• □ Goggles

  Yes

  No

  N/A

• Respirator: □½ mask □ Full Face

  Yes

  No

  N/A

• □ Other: _

  Yes

  No

  N/A

• Personal protective equipment properly stored

  Yes

  No

  N/A

• Personal protective equipment properly maintained

  Yes

  No

  N/A

• Personal protective equipment in a clean & sanitary condition

  Yes

  No

  N/A

• Employees using all required PPE

  Yes

  No

  N/A

• Eye wash location identified with visible sign –

  Sign

• Eye wash access free from obstructions

  Yes

  No

  N/A

• Eye wash station in close proximity (10 seconds walking distance from hazard)

  Yes

  No

  N/A

• Eye wash station in a clean & sanitary condition

  Yes

  No

  N/A

• Eye wash station in working order

  Yes

  No

  N/A

• Eye wash station providing a clean water supply

  Yes

  No

  N/A

• Eye wash provides a minimum continuous flow of 0.4 gallons of water/solution per minute for 15 minutes

  Yes

  No

  N/A

• Data plates on equipment legible

  Yes

  No

  N/A

• Approved lighting for the location installed

  Yes

  No

  N/A

• Adequate lighting provided

  Yes

  No

  N/A

• All electrical equipment grounded as required

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Condition of general housekeeping

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• MUD MIXING AREA Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Bagged material properly stacked

  Yes

  No

  N/A

• Adequate personal protective equipment available:

• □ Rubber Gloves □ Apron □ Face Shield □ Chemical Goggles □

  Yes

  No

  N/A

• □ Respirator: □ mask □ Full Face

  Yes

  No

  N/A

Located on pits and personal lockers

□ Other:

• Personal protective equipment properly stored

  Yes

  No

  N/A

• Personal protective equipment properly maintained

  Yes

  No

  N/A

• “PPE Required” warning signs posted

  Yes

  No

  N/A

• (Grouped or individual signs)

  Yes

  No

  N/A

• Chemical hazard warning signs erected

  Yes

  No

  N/A

• Assessment for respirator use conducted, documented and available

  Yes

  No

  N/A

• Employees using all required PPE

  Yes

  No

  N/A

At time of inspection

• Adequate ventilation in the area

• Eye wash location identified with visible sign

  Sign

Eye wash located on top of pits

• Eye wash station available in close proximity to general hazards (10 seconds walking distance from hazard)

  Yes

  No

  N/A

• Eye wash station available immediately adjacent to caustic barrel and hopper (Anywhere a strong acid or corrosive is handled)

  Yes

  No

  N/A

• Eye wash at the hopper and caustic barrel provides a minimum continuous flow of 0.4 gallons of water/solution per minute for 15 minutes

  Yes

  No

  N/A

• Eye wash access free from obstructions

  Yes

  No

  N/A

• Eye wash station in a clean & sanitary condition

  Yes

  No

  N/A

• Eye wash station in working order –

  Yes

  No

  N/A

• Eye wash station providing clean water supply

  Yes

  No

  N/A

• All electrical equipment grounded as required

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

• Approved lighting for the location available

  Yes

  No

  N/A

• RP500 5.3

  Yes

  No

  N/A

• Adequate lighting provided

  Yes

  No

  N/A

• Elevated loading door opening protected

  Yes

  No

  N/A

• Any spills

  Yes

  No

  N/A

• General housekeeping –

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• MATERIAL HANDLING EQUIPMENT Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Material Handling Equipment (forklift) operators trained and certified

  Yes

  No

  N/A

• Training & Certification documents available on site

• Are the operators using the forklift during the inspection trained

  Yes

  No

  N/A

• Are the operators using the forklift during the inspection able to provide training certificate

  Yes

  No

  N/A

• Correct type of Forklift, etc in use for the location (all terrain)

  Yes

  No

  N/A

• Manlift basket securely attached at pivot point

  Yes

  No

  N/A

• Personnel wearing proper fall protection while in basket

  Yes

  No

  N/A

• Forklift Backup Alarm operational

  Yes

  No

  N/A

• Forklift equipped with seat belts

  Yes

  No

  N/A

• Seat belts in use by forklift operators

  Yes

  No

  N/A

• Forklift inspected prior to use (daily)

  Yes

  No

  N/A

Electronically

• Forklift hydraulic system free of leaks

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• GENERATOR AREA Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Generators located 100 ft from wellhead

  Yes

  No

  N/A

• If closer then 100 ft, are equivalent measures taken to ensure a (Class 1 Div 1 or 2 location) based on worst condition scenario

  Yes

  No

  N/A

• Generators properly grounded

  Yes

  No

  N/A

• “HIGH VOLTAGE” warning signs erected

  Yes

  No

  N/A

• Insulating mats available at electrical panels

  Yes

  No

  N/A

• Water hose used for washing area kept away from generator skid

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Cover panels on electrical control boxes installed

  Yes

  No

  N/A

• Cover panels on electrical control boxes closed

  Yes

  No

  N/A

• Is the electrical panel accessible

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• All electrical controls marked as to their function and legible

  Yes

  No

  N/A

• Equipment design sufficient to accommodate LO/TO devices

  Yes

  No

  N/A

• Lockout/Tagout devices available

  Yes

  No

  N/A

• Wires spliced as per regulation

  Yes

  No

  N/A

• Electrical wires properly strung

  Yes

  No

  N/A

• All electrical tools grounded

  Yes

  No

  N/A

• Condition of electrical Receptacles, outlets and plugs

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

• Adequate lighting installed

  Yes

  No

  N/A

• Approved lighting for the location provided

  Yes

  No

  N/A

• Moving and/or rotating parts guarded

  Yes

  No

  N/A

• Air compressors properly guarded

  Yes

  No

  N/A

• Air storage tanks equipped with pop-off valve

  Yes

  No

  N/A

• Are all high-pressure lines secured with whip checks or safety cables

  Yes

  No

  N/A

• Are whip checks and safety cables properly rated for the amount of pressure inside the line it is attached to

  Yes

  No

  N/A

• “Hearing Protection Required” warning signs erected

  Yes

  No

  N/A

• Hearing protection available

  Yes

  No

  N/A

• Fire extinguishers rated for electrical fires

  Yes

  No

  N/A

• Fire extinguishers properly located

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Condition of general housekeeping in the generator and SCR house

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• FIRE PROTECTION Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

Class B/C fire extinguishers available

Adequate number of fire extinguishers available

Fire extinguishers properly located

Fire extinguishers equipped with gauges

Fire extinguishers properly charged

Fire extinguishers tagged and inspection data logged

Fire extinguisher location easily identified

Overall condition of fire extinguishers

Site-specific fire extinguisher location diagram developed and posted

• Best Practice

  Yes

  No

  N/A

Open pit burning not permitted

Flare area, if present, is clear of combustibles

Welding work performed safely

Are flammable products such as paint and paint thinners properly stored

• 1910.106 (e) (2) (ii) (b)

  Yes

  No

  N/A

Condition of the flammable product storage cabinet

• 1910.106 (e) (2) (ii) (b)

  Yes

  No

  N/A

Flammables stored in UL listed safety cans

Does the methanol air dump system have double valves

Is the methanol air dump system located away from ignition sources

Is the methanol air dump opening angled in a direction or located at a height sufficient to prevent workers from being sprayed should pressure and liquid be trapped between the two valves

All engines located approx 100 ft from the well or gas source, if possible

Spark arrester, or water, on all engine exhausts

Heat arresters on all engine turbo snails and exhaust piping where contact with personnel could cause burn or injury

Condition of boiler

• Best Practice

  Yes

  No

  N/A

Boiler Safety Controls operating properly

No Smoking rules enforced

Flammable product leakage accumulating in ditches or other areas`

Any unsafe condition not listed above

Monthly inspection needs to be done on all fire extinguishers

• FUEL & OTHER FLAMMABLE LIQUID STORAGE AREAS

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Flammable liquid storage tanks properly located

  Yes

  No

  N/A

• All flammable liquid storage valves identified as to their function

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Discharge valves in good condition

  Yes

  No

  N/A

• Discharge nozzles in good condition

  Yes

  No

  N/A

• Discharge hoses in good condition

  Yes

  No

  N/A

• Piping and fuel lines in good condition

  Yes

  No

  N/A

• Vapor release vents elevated & away from ignition sources

  Yes

  No

  N/A

• Fuel & Storage tanks ESD protected

  Yes

  No

  N/A

• □X Splash Filling Prohibited

  Yes

  No

  N/A

• □ X Fill Line & Discharge Velocity Limited

  Yes

  No

  N/A

• Are flammable liquids stored or handled within an area having a basement or pit into which flammable vapors may travel therefore causing an accumulation of flammable vapors therein (such as fuel pump cabinets & cellars)

  Yes

  No

  N/A

• LPG storage tanks and compressed gas cylinders in good condition

  Yes

  No

  N/A

• Protective caps on all fuel cylinders

  Yes

  No

  N/A

• Is cleanup and absorbent material available in case of spills

  Yes

  No

  N/A

• Best Practices

  Yes

  No

  N/A

• Grass & debris kept away from area

• Fuel tanks properly labeled

  Yes

  No

  N/A

• “No Smoking” signs erected

  Yes

  No

  N/A

• “No Open Flame” signs erected

  Yes

  No

  N/A

• Stationary ladders on storage tanks in good condition

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

• All electrical equipment grounded as required

  Yes

  No

  N/A

• Electrical wiring/fixtures/etc used in flammable product storage area approved for (Class 1 Div 1 or 2 location) Based on worst condition scenario

  Yes

  No

  N/A

• Adequate lighting provided

  Yes

  No

  N/A

• Approved lighting for the location installed

  Yes

  No

  N/A

• B/C Class fire extinguisher available and identified

  Yes

  No

  N/A

• Are all high-pressure lines secured with whip checks or safety cables

  Yes

  No

  N/A

• Condition of general housekeeping

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• PIPE RACK AREA Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Ends of pipe racks properly pinned

  Yes

  No

  N/A

• Spacers used to separate layers of pipe

  Yes

  No

  N/A

• Layers of pipe properly chocked

  Yes

  No

  N/A

• Pipe racks level and stable

  Yes

  No

  N/A

• Catwalk in good condition

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Pipe rack and catwalk at same height

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Stairs with handrails to catwalk provided if necessary

  Yes

  No

  N/A

• V-door slide in good condition

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Employees not permitted on top of pipe

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Adequate lighting provided

  Yes

  No

  N/A

• Approved lighting installed

  Yes

  No

  N/A

• All electrical equipment grounded as required

  Yes

  No

  N/A

• Condition of high-pressure hydraulic equipment

  Yes

  No

  N/A

• Are hydraulic lines free of leaks

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Is the ground surface free of potholes and/or ankle breakers

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Is the terrain around the pipe racks adequate for maintaining control of wide loads on forklift

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• General housekeeping

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• BLOWOUT PREVENTERS

  Yes

  No

  N/A

• Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• BOP properly installed

  Yes

  No

  N/A

• BOP tested and documented

  Yes

  No

  N/A

• (Input date and results on cover page)

  Yes

  No

  N/A

• All lines, valves, check valves, flow fittings, etc have a working pressure equal to or greater than the rated working pressure of the rams in use

  Yes

  No

  N/A

• Wheels and stems in place, if automatic device is not available

  Yes

  No

  N/A

• BOP stack properly stabilized

  Yes

  No

  N/A

• All hydraulic lines connected

  Yes

  No

  N/A

• All unused hydraulic lines capped and secured

  Yes

  No

  N/A

• Accumulator bottles labeled with contents

  Yes

  No

  N/A

• Accumulator operational warning signs erected

  Yes

  No

  N/A

• Accumulator valves in appropriate position (open position except when accumulators are isolated for servicing, testing or transporting)

  Yes

  No

  N/A

• Accumulator valves identified as to purpose and position

  Yes

  No

  N/A

• Does the accumulator reservoir have fluid in it

  Yes

  No

  N/A

• Accumulator hydraulic oil level adequate

  Yes

  No

  N/A

• Best practice

  Yes

  No

  N/A

• Gauges properly installed & located

  Yes

  No

  N/A

• Gauges in working order

  Yes

  No

  N/A

• Choke manifold and line secured

  Yes

  No

  N/A

• Choke manifold accessible

  Yes

  No

  N/A

• Flair line secured / anchored

  Yes

  No

  N/A

• Pilot light used

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Adequate lighting provided

  Yes

  No

  N/A

• Approved lighting for the location installed

  Yes

  No

  N/A

• Warning signs erected at the flare pit

  Yes

  No

  N/A

• □ Flammable □ H2S □ Hard Hat

  Yes

  No

  N/A

• □ Eye Protection □ Confined Space

  Yes

  No

  N/A

• □ Auth. Personnel □ Ear Protection

  Yes

  No

  N/A

• Proper drainage provided

  Yes

  No

  N/A

• Safety (stabbing) valve and handle for tubing available

  Yes

  No

  N/A

• Hydraulic controls accessible

  Yes

  No

  N/A

• Hydraulic lines protected

  Yes

  No

  N/A

• BOP Control Lines & Valves identified

  Yes

  No

  N/A

• BOP Scaffolding / work boards secure

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Daily visual inspections of the BOP’s conducted

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Are all high-pressure lines secured with whip checks or safety cables

  Yes

  No

  N/A

• Crew members knowledge of and understanding of his/her responsibilities during well shut-in procedures

  Yes

  No

  N/A

• RP54 6.1.3

  Yes

  No

  N/A

• General housekeeping

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• Section NA:

• DERRICK

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Derrick/A-Frame assembly pins in place

  Yes

  No

  N/A

• Assembly pins secured with keepers

  Yes

  No

  N/A

• Derrick emergency escape line properly attached to board or derrick

  Yes

  No

  N/A

• Condition of derrick emergency escape line

  Yes

  No

  N/A

• Geronimo chair on-line and ready for immediate access and use

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Clamps properly attached

  Yes

  No

  N/A

• 3 clamp minimum

  Yes

  No

  N/A

• Geronimo line path clear of obstruction

  Yes

  No

  N/A

• Type of anchor:

• CEMENT SLED_X_ Rod

  Yes

  No

  N/A

• Anchor pull test performed to 3000 pounds

  Yes

  No

  N/A

• Yes

  No

  N/A

• Fall lane of derrick clear “dead man side”

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Condition of derrick ladder

  Yes

  No

  N/A

• Climb assist device available

  Yes

  No

  N/A

• Climb assist device used by derrickman

  Yes

  No

  N/A

• Condition of climb assist device

  Yes

  No

  N/A

• Full body harness with lanyard available

  Yes

  No

  N/A

• Condition of full body harness

  Yes

  No

  N/A

• Condition of lanyard

  Yes

  No

  N/A

• Fall protection equipment in use

  Yes

  No

  N/A

• “Fall Protection Required” warning sign erected at the base of the derrick ladder

  Yes

  No

  N/A

• Condition of the derrick tubing board

  Yes

  No

  N/A

• Guardrails installed on derrick board

  Yes

  No

  N/A

• Condition of pipe fingers

  Yes

  No

  N/A

• Condition of derrick board walk around platform

  Yes

  No

  N/A

• Rods, Tubulars, Drill Pipe, etc racked or hung in derrick secured to prevent them from falling

  Yes

  No

  N/A

• Mud standpipe secured

  Yes

  No

  N/A

• Mud vibrator hose snubbed at all connections and at both ends

  Yes

  No

  N/A

• Drilling line installed properly on anchor and keyed

  Yes

  No

  N/A

• Dead end of drilling line anchored

  Yes

  No

  N/A

• Data plates installed on derrick

  Yes

  No

  N/A

• Condition of booms and boom lines

  Yes

  No

  N/A

• Tools secured at elevated levels

  Yes

  No

  N/A

• Are all high-pressure lines secured with the proper whip checks or safety cables

  Yes

  No

  N/A

• Condition of electrical in the derrick

  Yes

  No

  N/A

• Condition of lighting in the derrick

  Yes

  No

  N/A

• Overhead falling object hazards

  Yes

  No

  N/A

• Any unsafe condition not listed above –

  Yes

  No

  N/A

• DRILL FLOOR AREA Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Minimum 2 exits from drill floor doghouse

  Yes

  No

  N/A

• Drill floor doghouse doors open and close easily

  Yes

  No

  N/A

First aid kit available in drill floor doghouse – Needs updated/some items expired

• Minimum 2 exits from drill floor

  Yes

  No

  N/A

• Driller at or near controls

  Yes

  No

  N/A

• Condition of rotary floor

  Yes

  No

  N/A

• Racking floor area in good condition

  Yes

  No

  N/A

• V-door gate or chain provided and in place

  Yes

  No

  N/A

• Condition of headache post

  Yes

  No

  N/A

• Is a Kelly bushing guard used

  Yes

  No

  N/A

• Are controls adequate if guard is not used

  Yes

  No

  N/A

• Are workers allowed to work on floor with harness and /or lanyard on while rotary is turning

  Yes

  No

  N/A

• Nonskid material used around rotary

  Yes

  No

  N/A

• Rotary chain drive guarded

  Yes

  No

  N/A

• Drillers controls properly labeled/identified

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Kelly cock wrench and safety valve accessible

  Yes

  No

  N/A

• Crown-O-Matic device installed and operational

  Yes

  No

  N/A

• Drawworks properly guarded

  Yes

  No

  N/A

• Proper lay of drill line on reel

  Yes

  No

  N/A

• Condition of drilling line

  Yes

  No

  N/A

• Condition of X hydraulic □Hydromatic brakes

  Yes

  No

  N/A

• Condition of Drawworks brake linkage

  Yes

  No

  N/A

• Overrunning clutch in good condition

  Yes

  No

  N/A

• Cathead friction surface in good condition

  Yes

  No

  N/A

• Cathead line divider/grip in good condition

  Yes

  No

  N/A

• Catline not worn or kinked

  Yes

  No

  N/A

• Spinning chain in good condition

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Condition of air hoist lines

  Yes

  No

  N/A

• X near driller X opposite driller

  Yes

  No

  N/A

• Condition of air hoist line guide

  Yes

  No

  N/A

• X□ near driller X□ opposite driller

  Yes

  No

  N/A

• 1910.212(a)(3)(ii)

  Yes

  No

  N/A

• Air hoist line properly laid/wound on drum

  Yes

  No

  N/A

• X□ near driller X□ opposite driller

  Yes

  No

  N/A

• 1910.212(a)(3)(ii)

  Yes

  No

  N/A

• Air hoist line properly guarded

  Yes

  No

  N/A

• X□ near driller X□ opposite driller

  Yes

  No

  N/A

• 1910.212(a)(3)(ii)

  Yes

  No

  N/A

• Tong snubbing lines in good condition

  Yes

  No

  N/A

• Tong snubbing line clamps in good condition

  Yes

  No

  N/A

• Tong counterweights installed

  Yes

  No

  N/A

• Tong counterweights operational

  Yes

  No

  N/A

• Tong body & jaws in good condition

  Yes

  No

  N/A

• Tong safety handle pins secured

  Yes

  No

  N/A

• Tong dies sharp

  Yes

  No

  N/A

• Tong die keeper in place

  Yes

  No

  N/A

• Tong stiff arm available and operational

  Yes

  No

  N/A

• Condition of tong jerk line(s)

  Yes

  No

  N/A

• Overall condition of tongs

  Yes

  No

  N/A

• Iron-roughneck dies sharp

  Yes

  No

  N/A

• Iron-roughneck die keeper used

  Yes

  No

  N/A

• Iron-roughneck body & jaws in good condition

  Yes

  No

  N/A

• Iron-roughneck hydraulic system leaks

  Yes

  No

  N/A

• Overall condition of iron roughneck

  Yes

  No

  N/A

• Condition of slips and dies

  Yes

  No

  N/A

• Condition of collar clamps and dies

  Yes

  No

  N/A

• Condition of elevators

  Yes

  No

  N/A

• Condition of automatic spinner

  Yes

  No

  N/A

• Condition of lift subs

  Yes

  No

  N/A

• Guardrails and mid-rails installed along all open side edges of drill floor, 4ft above ground level

  Yes

  No

  N/A

• Toe-boards installed along all open side edges of drill floor, 4ft above ground level

  Yes

  No

  N/A

• Condition of guardrails and mid-rails

  Yes

  No

  N/A

• Condition of toe-boards

  Yes

  No

  N/A

• Condition of Toeboards

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Condition of hand tools

  Yes

  No

  N/A

• All electrical equipment grounded as required

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

• Condition of electrical equipment

  Yes

  No

  N/A

• Does electrical meet requirements for a class 1 div 1 & 2 area

• Adequate lighting provided

  Yes

  No

  N/A

• Appropriate lighting for (Class 1 Div 1& 2) area

• RP500 10.1-16

  Yes

  No

  N/A

• Are all high-pressure lines secured with whip checks or safety cables

  Yes

  No

  N/A

• Condition of motors

  Yes

  No

  N/A

• Do motors have heat and spark arresters

  Yes

  No

  N/A

• Condition of all other wire rope

  Yes

  No

  N/A

• Are there trip hazards present on the drill floor

  Yes

  No

  N/A

• Condition of overall general housekeeping

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• HOISTING TOOLS, HOOKS, BAILS, ELEVATORS AND OTHER RELATED EQUIPMENT

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Traveling blocks in good condition

  Yes

  No

  N/A

• Traveling blocks properly guarded

  Yes

  No

  N/A

• Sheave guards in good condition

  Yes

  No

  N/A

• Bales and/or links in good condition

  Yes

  No

  N/A

• Rod hook in good condition

  Yes

  No

  N/A

• Hoisting hook equipped with safety latch or equiv

  Yes

  No

  N/A

• Crown block assembly secured

  Yes

  No

  N/A

• Crew members not permitted to ride traveling block

  Yes

  No

  N/A

• Circulating hose secured to gooseneck and swivel

  Yes

  No

  N/A

• Power swivel secured

  Yes

  No

  N/A

• Hoisting line inspected daily

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• SUBSTRUCTURE

  Yes

  No

  N/A

• Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Substructure assembly pins in place

  Yes

  No

  N/A

• Substructure assembly pins secured with keepers

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Lighting around the outside of sub-structure

  Yes

  No

  N/A

• Lighting in the sub-structure

  Yes

  No

  N/A

• Lower and upper substructures properly bolted together

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Rotating equipment under the floor and in the sub-structure guarded i.e., Rotary chain, Drawworks, Pump shafts, etc…

  Yes

  No

  N/A

• Rotary beams and all braces are in good condition

  Yes

  No

  N/A

• Are all high-pressure lines secured with the proper whip checks or safety cables

  Yes

  No

  N/A

• Vibrator hose properly snubbed

  Yes

  No

  N/A

• Open holes guarded or covered

  Yes

  No

  N/A

• “Confined space” signs present, if applicable

  Yes

  No

  N/A

• Condition of electrical in the sub-structure

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• POWER AND HAND TOOLS Section NA:

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Bench grinder in good condition

  Yes

  No

  N/A

• Bench grinder wheels properly guarded

  Yes

  No

  N/A

• Bench grinder rest spacing – 1/8” from wheel

  Yes

  No

  N/A

• Face shield available when using bench grinder

  Yes

  No

  N/A

• Power Tongs used?

  Yes

  No

  N/A

• Power Tongs body & jaws in good condition

  Yes

  No

  N/A

• Power Tongs hydraulic system leaks

  Yes

  No

  N/A

• Electric hand tools double insulated or grounded

  Yes

  No

  N/A

• Electrical extension cords properly insulated

  Yes

  No

  N/A

• Plugs of electrical extension cords in good condition

  Yes

  No

  N/A

• Are plugs and sockets GFIC

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Machinery not operated without guards installed

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• All electrical equipment grounded as required

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• STAIRS, LADDERS, HANDRAILS & GUARDRAILS

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• Adequate stairs provided off rig

  Yes

  No

  N/A

• Stairs level

  Yes

  No

  N/A

• Minimum of 2 stairways to drill floor

  Yes

  No

  N/A

• Stairs secure

  Yes

  No

  N/A

• No obstructions –

  Yes

  No

  N/A

• Adequate handrails provided on stairs with 4 or more risers

  Yes

  No

  N/A

• Stair treads of uniform size

  Yes

  No

  N/A

• Non-skid type stair treads

  Yes

  No

  N/A

• Stair treads not damaged

  Yes

  No

  N/A

• Guardrails, Midrails, & Toeboards installed along all open side edges of floors, platforms, etc, 4ft above ground level

  Yes

  No

  N/A

• Handrails extend 3.5 ft above platform

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• 19. HOTWORK, WELDING & FLAME CUTTING OPERATIONS

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

Written safety work permit system covering welding and flame cutting operations observed

• 1910.252(a)(2)(iv)

  Yes

  No

  N/A

Verification of certified welders used

Welding and flame cutting not permitted near flammables, accumulation of oil, escaping gas or near sources of ignition

• RP54 20.1.3

  Yes

  No

  N/A

• 1910.252(a)(2)(vi)

  Yes

  No

  N/A

Helmets with face shields used during operations

Goggles with proper shade selection used

Helpers/attendants supplied with and using proper eye protection

Appropriate protective attire worn for welding and cutting ops

Moveable fire hazards in vicinity of welding operations moved

• 1910.252(a)(2)(vii)

  Yes

  No

  N/A

Guards used to confine flash, heat, sparks & slag

• 1910.252(a)(1)(ii)

  Yes

  No

  N/A

Fire extinguishing equipment available

• 1910.252(a)(2)(ii)

  Yes

  No

  N/A

Fire watch required

• 1910.252(a)(2)(iii)(A)

  Yes

  No

  N/A

Fire watch remains in area of welding or cutting for at least 30 minutes after hot work is performed

Area inspected by individual responsible for authorizing cutting or welding

• 1910.252(a)(2)(iv)

  Yes

  No

  N/A

Is the gas detector calibrated and tested and documented as per manufacture recommendations

Is the gas detector alarm tested daily – tested prior to use

Welding equipment in good condition

Approved Oxygen & Acetylene bottle used

Oxygen & Acetylene bottles labeled – color coded

Oxygen & Acetylene torches equipped with flash back arrestors

Cylinders stored in assigned places and secured in place

• 1910.253(b)(2)(ii)

  Yes

  No

  N/A

Are the proper tools for the job available and being utilized

• Best Practice

  Yes

  No

  N/A

Any unsafe condition not listed above

• CONFINED SPACES, EXCAVATIONS & HAZARDOUS ENVIRONMENTS

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• All site personnel notified of the presence of H2S, SO2, or other hazardous gases

  Yes

  No

  N/A

• Site evaluated to determine the presence of confined spaces/permit required confined spaces

• Confined Space location warning signs erected

  Yes

  No

  N/A

• Atmospheric testing of confined space prior to entry

  Yes

  No

  N/A

• Confined Space Permit Entry System & Procedures understood and followed

  Yes

  No

  N/A

• Excavations, including trenches, deeper than 4 ft or containing hazardous gases tested prior to entry

  Yes

  No

  N/A

• Emergency Rescue equipment readily available

  Yes

  No

  N/A

• 1926.651(g)(2)(i-ii)

  Yes

  No

  N/A

• Employees protected from cave-ins while in excavations

  Yes

  No

  N/A

• Water in excavation

  Yes

  No

  N/A

• A means of egress from excavation provided

  Yes

  No

  N/A

• □ Stairway □X Ladder □ Ramp □ Other

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• TRAINING, PPE & GENERAL SAFETY

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• SAT

  Yes

  No

  N/A

• UNS

  Yes

  No

  N/A

• Standard

  Yes

  No

  N/A

• First Aid Training provided to at least one member of the crew

  Yes

  No

  N/A

• Certification Card(s) available

  Yes

  No

  N/A

• Pre-tour safety meetings conducted

  Yes

  No

  N/A

• Are weekly or impromptu safety meetings conducted

  Yes

  No

  N/A

• Safety meetings properly documented

  Yes

  No

  N/A

• Are accidents if any, discussed during safety meetings

  Yes

  No

  N/A

• OSHA poster posted

  Yes

  No

  N/A

• Pre-Job safety meeting held

  Yes

  No

  N/A

• Safety equipment available “Hard hats, Safety glasses, Hearing protection, Gloves, Respiratory protection, Chemical protection, etc…”

  Yes

  No

  N/A

• Proper clothing worn by crew (No loose clothing)

  Yes

  No

  N/A

• Hard hats used by crew

  Yes

  No

  N/A

• ANSI Z87.1

  Yes

  No

  N/A

• Safety glasses used by crew

  Yes

  No

  N/A

• Hard toed shoes used by crew

  Yes

  No

  N/A

• Hazardous jewelry not worn by crew

  Yes

  No

  N/A

• Fall protection used, when required

  Yes

  No

  N/A

• No Smoking rules observed

  Yes

  No

  N/A

• OSHA Log able to be provided within 4 business hours of accidents during current year

  Yes

  No

  N/A

• Injuries reported and documented immediately

  Yes

  No

  N/A

• First Aid Kit/Bloodborne Pathogen Kit available on site

• Adequate 2-way communication on site

• Emergency phone numbers posted

  Yes

  No

  N/A

• Provisions made for prompt medical attention for serious injuries

  Yes

  No

  N/A

• Copy of HAZCOM program available onsite

  Yes

  No

  N/A

• MSDS’s available and accessible at all times

  Yes

  No

  N/A

• B.B.S.M. program, or equivalent, in use

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Adequate communication w/other contractors on site

• Emergency response plan available onsite

  Yes

  No

  N/A

• BOP / Well Control training documentation current

  Yes

  No

  N/A

• BOP Drills conducted and documented

  Yes

  No

  N/A

• Written safety program available onsite

  Yes

  No

  N/A

• Respiratory Protection Program available onsite

  Yes

  No

  N/A

• Hearing protection required in high noise areas

  Yes

  No

  N/A

• Job Safety Analysis (JSA) conducted for each task

  Yes

  No

  N/A

• Short Service Employee Program

  Yes

  No

  N/A

• Time:

  Date

• Type:

• Best Practice

  Yes

  No

  N/A

• All incidents resulting in injuries to employees investigated and documented to prevent recurrence

  Yes

  No

  N/A

• Long Hair contained

  Yes

  No

  N/A

• Smoking or open flames not permitted within 50 ft of compressed gases used or stored

  Yes

  No

  N/A

• Flammable liquids not stored within 50 ft of wellbore

  Yes

  No

  N/A

• Critical Equipment such as BOPs periodically inspected & tested

  Yes

  No

  N/A

• Is all electrical equipment grounded as required?

  Yes

  No

  N/A

• Condition of electrical wiring

  Yes

  No

  N/A

• Where is the methanol injection valve located

• Is equipment properly classified for the location of the methanol injection valve

  Yes

  No

  N/A

• Are the proper tools for the job available and being utilized

  Yes

  No

  N/A

• Best Practice

  Yes

  No

  N/A

• Are workers being subjected to high potential risks that could otherwise be managed

  Yes

  No

  N/A

• Any unsafe condition not listed above

  Yes

  No

  N/A

• DOCUMENTATION NEEDED FOR REVIEW DURING AUDIT

  Yes

  No

  N/A

• Visitor tracking sign in sheet

  Yes

  No

  N/A

• Third party / visitor orientation

  Yes

  No

  N/A

• Written safety program

  Yes

  No

  N/A

• Pre-tour safety meeting documentation

  Yes

  No

  N/A

• Completed JSA’s

  Yes

  No

  N/A

• weekly safety meeting documentation

  Yes

  No

  N/A

• Emergency phone numbers and directions for prompt medical attention

  Yes

  No

  N/A

• Emergency response plan

  Yes

  No

  N/A

• Copy of HAZCOM

  Yes

  No

  N/A

• First aid certification cards

  Yes

  No

  N/A

• OSHA Log

  Yes

  No

  N/A

• OSHA poster

  Yes

  No

  N/A

• Copy of MSDS

  Yes

  No

  N/A

• Completed B.B.S.M. cards

  Yes

  No

  N/A

• BOP / Well Control training documentation

  Yes

  No

  N/A

• BOP drill documentation

  Yes

  No

  N/A

• Respiratory Protection Program

  Yes

  No

  N/A

• BOP test documentation

  Yes

  No

  N/A

• TON mile log

  Yes

  No

  N/A

• H2S training certificates “if applicable”

  Yes

  No

  N/A

• Injury reports and/or documentation

  Yes

  No

  N/A

• Near miss reports and/or documentation

  Yes

  No

  N/A

• Date of last LTA

  Date

• Date of last Recordable

  Date

• PHOTOS

  Media

• ACTION ITEMS

  Yes

  No

  N/A

• INSPECTOR

  Yes

  No

  N/A

• ACTION

  Yes

  No

  N/A

• LEASE NAME / RIG NAME

• ACTION PARTY

• TARGET CLOSE OUT DATE

  Date

• ACTUAL CLOSE OUT DATE

  Date

• STATUS

  Yes

  No

  N/A